So, You Tested Positive… Now What?
You get the call, or the message, or you see it on a portal: positive. And your first reaction is not calm. It is something
Mia LoPreiato
September 2, 2026
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Mia Loprieato is a board-certified nurse practitioner and certified medical examiner through the National Registry of Certified Medical Examiners (NRCME). With a background in functional and integrative medicine, she helps patients improve energy, cognition, hormone balance, and metabolic health through a personalized, data-driven approach. Known online as the “Biohacker Nurse Practitioner,” Mia shares actionable insights on wellness, nutrition, and longevity with a growing audience.
In addition to her clinical practice, Mia is a contributing author at Express Physicals, where she provides trusted content on DOT medical exam standards, driver health, and regulatory compliance. Her experience as a certified medical examiner informs her writing and patient education, making her a go-to resource for both drivers and fellow examiners seeking clarity on FMCSA protocols and wellness optimization.
You get the call, or the message, or you see it on a portal: positive. And your first reaction is not calm. It is something
Define the term correctly first, because most of the confusion around this question starts with a loose understanding of one word: refusal. What Refusal Actually
Here is the single most useful fact before anything else: as of today, every DOT-regulated drug test in the trucking industry is a urine test,
Every certified medical examiner performing DOT physical exams is already operating under a federal electronic submission mandate, whether their office workflow reflects that or not.
Two drivers walk into the same clinic with prescriptions in hand. One walks out certified. One walks out with a denial and no truck to
You have a DOT drug test coming up. Maybe it’s pre-employment, maybe it’s a random selection, maybe it follows an accident. Whatever the reason, one
You already know drug testing is part of working in a safety-sensitive transportation role. You’ve probably heard it’s strict. But do you know exactly how
You scheduled the appointment. You showed up. And then the examiner told you that you did not pass. For commercial drivers, a failed DOT physical
You’ve built your career mile by mile. Every pre-trip inspection, every logbook entry, every on-time delivery is a brick in the professional reputation you’ve earned.