What is a Signs of Illicit Drug Use Evaluation?


A Signs of Illicit Drug Use Evaluation is a physical examination performed by a doctor, assessing the presence of any signs of current or recent drug use.  There are many such possible signs and to list them here would be impractical.

When is a Signs of Illicit Drug Use Evaluation needed?


If such an evaluation is needed, the MRO will contact the employer to notify them of the necessary steps.  In DOT testing, there are three specific situations in which a Signs of Illicit Drug Use Evaluation is required.

  1. Under Rule 49 CFR Part 40.139, when in the course of reviewing a drug test result, the MRO determines it is necessary for a physician to perform an evaluation specifically checking for signs of illicit use of any opium, opiate or opium derivative (morphine, heroin or codeine).
  2. Under Rule 49 CFR Part 40.160, when in the course of reviewing an invalid drug test result, the MRO determines the donor is not able to produce a valid specimen and a negative result is necessary for the employer to move forward (Pre-Employment, Return-to-Duty or Follow-Up tests), it is necessary for a physician to perform an evaluation specifically checking for signs of use of any illicit substance.
  3. Under Rule 49 CFR Part 40.195, when a donor is unable to produce a urine specimen of sufficient volume due to a medical condition and this has been establish by a Shy Bladder Evaluation, and a negative result is necessary for the employer to move forward (Pre-Employment, Return-to-Duty, or Follow-Up tests), it is necessary for a physician to perform an evaluation specifically checking for signs of use of any illicit substance.

Who can perform a Signs of Illicit Drug Use Evaluation?


This evaluation must be performed by a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.). To prevent a conflict of interest, this evaluation should NOT be performed by the patient's Primary Care Physician (PCP). We recommend checking with the occupational clinics and the physicians who regularly conduct Fitness for Duty evaluations. The DOT does not permit Doctors of Chiropractic Medicine (D.C.), Nurse Practitioners (N.P. or A.P.R.N.), or Physician Assistants (P.A.) to perform this evaluation.

What if the employee/applicant refuses to be evaluated?


This is considered a refusal to test.  You should ensure the donor is aware of the consequences of refusing to be evaluated. The donor would be disallowed from performing safety-sensitive tasks for any employer, not just the one for whom this test was conducted.  A refusal requires an evaluation by a substance abuse professional and completion of a return-to-duty test and must be entered into a follow-up testing program.  When a donor declines evaluation, document the communication and inform the MRO in writing.

Who pays for this evaluation?


The federal regulations are deliberately silent on this, leaving it as a matter to be decided by the employer/employee relationship.

What if the evaluating doctor finds signs of illicit drug use?


The evaluating doctor will send a written report to the MRO.  If that report indicates the doctor found evidence of drug use, the MRO would label the drug test as cancelled.

What if the evaluating doctor finds no signs of illicit drug use?


If the evaluating doctor reports that no signs of illicit drug use were found, the MRO would label the drug test as negative, and the result can be used in the same way as any other negative result.