What does 49 CFR 40.139 (On what basis does the MRO verify test results involving 6-acetylmorphine, codeine, and morphine?) require?

As Ask X3, your fleet-compliance assistant, here is how the Medical Review Officer (MRO) verifies test results involving 6-acetylmorphine, codeine, and morphine based on 49 CFR 40.139:

* If 6-acetylmorphine (6-AM) is present: The MRO must verify the test result as positive.

* If morphine or codeine is found at high levels (equal to or above 15,000 ng/mL in urine, or equal to or above 150 ng/mL in oral fluid) in the absence of 6-AM: The MRO must verify the test as positive, unless the employee provides a legitimate medical explanation. Eating food products, such as poppy seeds, *cannot* be accepted as a legitimate medical explanation at these concentrations.

* For all other codeine and morphine positive results: The MRO must verify a confirmed positive only if they find clinical evidence of unauthorized opiate use.

* Establishing clinical evidence: The MRO must use professional judgment and can look at signs like recent needle tracks, behavioral/psychological signs of intoxication or withdrawal, a clinical history of unauthorized use, or the use of medication from a foreign country.

* Face-to-face examination: If the MRO relies on personal observation (such as needle tracks or signs of intoxication/withdrawal), they or another physician *must* conduct a face-to-face examination of the employee. A face-to-face exam is not required if the decision is based on clinical history or foreign medication use.

* Matching the drug: The clinical evidence found must specifically concern the exact drug the laboratory found in the specimen (for example, an admission for hydrocodone cannot be used to verify a codeine positive).

* Burden of proof: The MRO holds the burden of establishing clinical evidence. If the MRO cannot establish it due to insufficient evidence or history, they must verify the test as negative, and the employee does not need to prove a legitimate medical explanation.