The opioid epidemic presents serious challenges for employers. And most employers don’t test for many commonly abused opioids.

In 2018, the federal government added what is called “expanded opiates” to the DOT drug test panel. The expanded panel now includes many commonly prescribed pain killers and the result has been an increase in safety concern letters (see below) from MROs.

DOT’s Final Rule on Opiate Testing and Safety Concerns

The U.S. Department of Transportation’s (DOT) final rule which requires federally regulated drug testing panels to include testing for expanded opiates, added oxycodone, oxymorphone, hydrocodone, and hydromorphone. Common names for drugs in this category include drugs like Oxycontin, Vicodin, Norco, Percocet and Dilaudid.

All employers must be mindful of prescription drug use. Legally prescribed or not, these drugs present both health and safety concerns.

Positive Drug Tests for Opioids

Often a positive drug test for opioids is caused by a valid prescription. If there is no valid scrip, the case is clear. But if a safety sensitive employee tests positive for a prescribed pain medication, then what?

All federally regulated drug test results are reviewed by a Medical Review Officer (MRO). Well designed non-DOT programs also include MRO review. In case a positive test result occurs, the donor gets the opportunity to present the MRO with an explanation, such as a valid prescription.

If the MRO cannot verify a prescription, s/he reports the result as positive.

In the event there is a valid prescription, the employer receives a negative result from the MRO.

But a valid prescription does not mean the employee okay to perform safety-sensitive work, so in addition to reporting the negative test result, the MRO will often include a safety concern note.

Negative Lab Results and Safety Concerns

A lab result labeled “negative with a safety concern” indicates that the MRO reviewed a positive test result and determined there is a valid medical explanation. The safety concern notifies the employer of the employee’s prescription, which may impair the employee’s ability to operate in a safety-sensitive job.

The MRO will typically ask the employee to talk to the prescribing physician to find out if there is an alternative medication that will cause less impairment. If the employee does not ask the prescribing physician, or there is no acceptable alternative medication, the MRO notifies the employer.

Safety Concern Sample Language:

SAFETY WARNING: To comply with federal guidelines the employer is hereby advised that this person’s test result is negative by reason of a prescription that was filled more than one year ago. Although use of out-dated medication is not a violation of law or federal regulations, the FDA recommends annual prescription renewals and physician supervision of all prescription drugs.


Safety concern: The employee has disclosed the use of medication(s) that may pose a significant safety risk or may make the individual medically unqualified for a safety-sensitive position. The MRO recommends a fitness for duty evaluation by an occupational medicine physician or obtaining a statement from the individual’s prescribing health care provider attesting that use of the medication(s) does not adversely affect the employee’s safe performance of his/her duties.

Employer’s Responsibility and Safety Concerns

Regarding motor carriers, the Federal Motor Carrier Safety Administration notes that drugs like opiates are medically disqualifying. That is, during a driver’s biennial medical exam, the medical examiner asks whether the driver uses any prescribed opiates. A “yes” answer is immediately disqualifying. When a safety concern appears on a drug test result, employers are advised to find out whether the prescription is new, or if the driver lied to the medical examiner.

During the medical exam, the examiner may ask that the driver  get documentation from a doctor with knowledge of the employee’s valid prescription to testify that the driver is safe to perform safety-sensitive duties.

In the end, the carrier company, as the employer, is responsible for deciding whether it is appropriate for the driver to continue performing safety-sensitive functions while on medication. In the case of an incident, the motor carrier is responsible for permitting its employees to operate in safety-sensitive roles. Mismanaged safety concerns may land the company in a lawsuit.

Driver’s Responsibility

Drivers must know that safety-sensitive employees get random tests (Employee Education is a DOT requirement).  The employee is responsible for notifying their prescribing doctor of the job’s safety-sensitive nature. And the regulated employee is responsible for telling a medical examiner the truth about prescribed medications.

Choosing a Drug Testing Partner

If you are looking for a drug testing partner, InOut Labs is a compliance expert with clients nationwide. We work with HHS certified labs and independent MROs. We ensure that the drug testing procedure is fair and accurate to protect your business.