Substance abuse drug testing

Ciraulo DA, Jaffe JH Tricyclic antidepressants in the treatment of depression associated with alcoholism. Clin Psychopharmacol 1 146—150, 1981 Ciraulo DA, Nace E Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict 9 276—284, 2000 Ciraulo DA, Barnhill JG, Jaffe JH, et al Intravenous pharmacokinetics of 2-hydroxy-imipramine in alcoholics and normal controls. J StudAlcohol 51 366-372, 1990 Ciraulo DA, Knapp CM, LoCastro J, et al A benzodiazepine mood effect scale reliability and validity determined for alcohol-dependent subjects and adults with a parental history of alcoholism. Am J Drug Alcohol Abuse 27 339—347, 2001 Collins MA Tetrahydropapaveroline in Parkinson s disease and alcoholism a look back in honor of Merton Sandler. Neurotoxicology 25 117-120, 2004 COMBINE Study Research Group Testing combined pharmacotherapies and behavioral interventions in alcohol dependence rationale and methods. Alcohol Clin Exp Res 27 1107-1122, 2003a... 

Treatment considerations for antiretroviral-experienced patients are much more complex than for patients who are naive to therapy. Prior to changing therapy, the reasons for treatment failure should be identified. A comprehensive review of the patient s severity of disease, antiretroviral treatment history, adherence to therapy, intolerance or toxicity, concomitant drug therapies, co-morbidities, and results of current and past HIV resistance testing should be performed. If patients fail therapy due to poor adherence, the underlying reasons must be determined and addressed prior to initiation of new therapy. Reasons for poor adherence include problems with medication access, active substance abuse, depression and/or denial of the disease, and a lack of education on the importance of 100%... 

Another study by the same group assessed the use of fluoxetine (Prozac) (20 mg) in a 7-week open trial in 10 adolescents with the commonly occurring triad of SUD, CD, and major depression (Riggs et ah, 1997). Seven of the eight subjects had significant improvement in mood p < 0.001), and the majority reported that the fluoxetine (Prozac) assisted in their substance rehabilitation. The medication was well tolerated and no interactions between fluoxetine (Prozac) and any substances of abuse were reported. There were no positive drug tests for the duration for the study. 

Goldstein A Brown BW (2003). Urine testing in methadone maintenance treatment applications and limitations. Journal of Substance Abuse Treatment, 25, 61-3 Gonzalez JP Brogden RN (1988). Naltrexone a review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the management of opioid dependence. Drugs, 35, 192-213... 

Federal government guidelines (by NIDA-The National Institute on Drug Abuse and SAMHSA-The Substance Abuse and Mental Health Services Administration) require that companies which use commercial class drivers licenses for employees must have a testing system in place. 

United States Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Division of Workplace Programs. Drug Testing—Urine Drug Testing. Available online. 

The principal weakness of drug discrimination procedures for assessing abuse liability is that they provide only indirect evidence regarding abuse. If a test substance is discriminated as being similar to a known drug of abuse, this is taken to indicate that the test substance is likely to be abused in a similar manner. On the other hand, if a test substance does not share discriminative stimulus effects with any known drug of abuse, drug discrimination procedures alone provide no indication of whether the test substance is likely to be abused. 

After a driver, who tested positive for drugs, failed an alcohol test, or refused to take a drug or alcohol test, successfully completes an education and/or treatment program (including a negative return-to-duty drug and/or alcohol test) prescribed by a substance abuse professional (SAP) he/she is subject to follow-up testing. 

He/she must be knowledgeable about and have clinical experience in controlled substances abuse disorders, including detailed knowledge of alternative medical explanations for laboratory confirmed drug test results ... 

A substance abuse professional (SAP) is defined as a person who evaluates employees who have violated Department of Transportation (DOT) drug and alcohol regulation and makes recommendations concerning education, treatment, follow-up testing and aftercare. ... 

Because drug testing for controlled substances bears heavily on a person s reputation, the method to detect controlled substance must be accurate and must follow international guidelines, which advocate a method that must include chromatographic separation to isolate the analyte from other matrix components and mass spectrometric detection with either SIM of three compound-specific ions on a single mass analyzer or with selected-reaction monitoring (SRM) of two specified precursor-product reactions. GC/MS and LC/MS methods that follow these guidelines are used routinely to detect and quantify cannabinoids, narcotics, cocaine, amphetamines, and other substances of abuse [57]. 

A service agent means any person or entity, other than an employee of the employer, who provides services specified imder this part to employers and/or employees in connection with DOT drug and alcohol testing requirements. This includes, but is not limited to, collectors, BATs and STTs, laboratories, MROs, substance abuse professionals, and C/TPAs. To act as service agents, persons and organizations must meet the qualifications set forth in applicable sections of this part. Service agents are not employers for purposes of this part. 

MROs need no written authorizations from employees to verify drug test results, to discuss alternative medical explanations with prescribing physicians and issuing pharmacists, to report results to employers, to confer with Substance Abuse Professionals (SAPs) and evaluating physicians, or to report other medical information (see 40.327). 

Positive dilute. If the test is a positive dilute, it is treated as a positive test result — end of story. The driver is removed from a safety-sensitive function, is given a list of Substance Abuse Professionals (SAPs), and must rmdergo the DOT Return-to-Duty Process in order to operate a commercial motor vehicle (CMV) again. The violation is reported to futm e DOT-regulated employers under the Safety Performance History inquiry in 391.23 or the DOT drug and alcohol investigation... 

Section 382.117 Public interest exclusion says you cannot use the services of a service agent who doesn t follow the rules. A service agent is anyone who performs services for you in relation to the drug/alcohol testing requirements, and includes collectors, labs, substance abuse professionals, doctors, etc. 

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