Transcript Slide 1

Substance Abuse Management
Regulatory Updates
Tuesday March 31, 2009
Distance Learning Session
Welcome
• Diana Byrnes, Substance Abuse
Management Specialist
• Center for Urban Transportation Research
(CUTR)
• Project Manager for the FDOT Substance
Abuse Management Oversight and
Technical Assistance Program
• Transportation Safety Institute Associate Staff
Instructor
• Certified Substance Abuse Program
Administrator (C-SAPA)
Distance Learning - Things to Remember
• We can hear you too
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Course Goal
• To inform you of the drug and alcohol
testing regulation amendments that
went into effect on August 25, 2008
• To educate you in key areas of
potential non-compliance within your
testing program
Poll 1
Participant Level of Experience
Basics of Drug and Alcohol Testing
• Regulations:
49 CFR Part 655 Federal Transit
Administration: Prevention of Alcohol
Misuse and Prohibited Drug Use in Transit
Operations
49 CFR Part 40 US DOT Procedures for
Transportation Workplace Drug and
Alcohol Testing Programs
What does Part 655 tell us?
• Defines Covered Employers
• Defines Covered Employees
• Defines the circumstances in which testing
must occur (such as random rate, post accident
criteria)
• Establishes regulations concerning policy
and training requirements
• Defines the consequences for positive results
and refusals to test (removal from s-s duty)
• Conditions financial assistance to
compliance (per OTETA)
What does Part 40 tell us?
• The required procedures for the collection,
analysis, MRO review, and reporting of drug
and alcohol specimens
• Safeguards the integrity of the program by
establishing specific procedures for each
step of the process
• Must be consistent with US Department of
Health and Human Services guidelines for
federal workplace drug testing
Basics of Drug and Alcohol Testing
• Test Types
– Pre-employment (urine drug required, breath
alcohol allowed)
– Random (minimum rate is 25% urine drug 10%
breath alcohol)
– Post Accident (must always do both drug and
alcohol!)
– Reasonable Suspicion (urine drug or breath
alcohol-depends on nature of suspicion)
– Return to Duty (follow SAP instructions for test
types)
– Follow Up (follow SAP instructions for test type
and frequency)
Basics of Drug Testing
• DOT urine drug testing panel includes
these five prohibited substances:
• Amphetamines
• Cocaine
• Marijuana
• Opiates
• PCP
DOT panel can only include these five
Hair and blood are not acceptable DOT
specimens
Basics of Urine Collection
• Collectors must meet training qualifications
in accordance with 40.33
• A Federal CCF must be used for all DOT
collections
• DOT urine collections must be “split”
• Privacy enclosure must be free of potential
contaminating agents, water sources and
“hiding spots”
• Bluing agent must be present in toilet water
• Collection site must be secure (restricted
access)
Basics of Laboratory
• Labs must be certified by DHHS
(Department of Health and Human
Services)
• A list is of certified labs is updated
every month and published in the
Federal Register during the first week of
each month.
What happens at the Lab ?
• Accessioning of specimen
– Inspect condition of specimen
– Review CCF for fatal or correctable flaws
• Initial screening by immunoassay,
includes specimen validity testing
• Negative results report out
• Non-negative results move on for
further testing
Lab results reported to MRO
• Negative Dilute with creatinine level
between 5 and 20 ng/ml
• Negative Dilute with creatinine level
between 2 and 5 ng/ml
• Positive or Positive Dilute
• Adulterated
• Substituted
• Invalid
The Role of the MRO
• MRO is the gatekeeper
– Impartial, independent; protects the integrity of
the testing process
– Inspects MRO and Lab copies of CCF for errors
– Obtains lab report inclusive of quantitative data
– Interviews donor via telephone or in person
– Recites Medical Miranda to donor
– Verifies possible medical explanations
– Has the authority to order additional testing,
cancel a test, or deem a test to be invalid
– Has the final word! Drug test results cannot be
changed by anyone other than the MRO
Results from MRO
Negative- no further action required, employee may
begin or resume s-s duty
Negative Dilute- follow policy regarding retesting,
follow MRO instruction to recollect under direct
observation (when creatinine in the 2-5 range)
Positive with drug listed- remove employee
immediately from s-s duty, follow policy
Positive Dilute- POSITIVE, see above
Cancelled- must be considered neither positive nor
negative (follow MRO instruction, recollect under direct
observation, second collection or no further action)
Refusal to Test because of Adulterated or Substitutedremove employee from s-s duty, follow policy
Regulatory Updates
Effective August 25, 2008
Video
SpikeTV: Manswers
Available Products
GOOGLE Results 1 - 10 of about 1,040,000 for beat a drug
test. (0.18 seconds)
Prosthetic Devices
Amendments- Background
• Overall purpose:
– To make DOT required drug testing harder to
“beat”.
– To require specimen validity testing at all DHHS
certified laboratories
– To enhance the direct observation procedures
• The manufacturing of adulterants, urine
substitutes and prosthetic devices have
made this necessary
Breakdown of Amendments to Part 40
Specimen Validity Testing Required-40.89
What it means: Laboratories must test
specimens for adulterants and
substitutions using DHHS guidelines
Who does it effect: Labs
What you need to do: Update your
policy to reflect this change (FL DOT
Model Policy includes this is Section 16)
Breakdown of Amendments to Part 40
Direct Observation Procedures Change
What it means: Whenever there is a
specific reason to believe a donor is
attempting to tamper with or evade a
test, a recollection under direct
observation must take place
Who does it effect: Donors and
Collectors
What you need to do: Make policy
changes (FL DOT Model Policy includes this in
Section 15)
Breakdown of Amendments to Part 40
Three new behaviors that constitute a
Refusal to Test
 What does this mean: additional measures
taken to secure the process from those
attempting to evade or tamper with tests
Who does this effect: Donors, collectors,
employers
 What you need to do: You MUST include all
of the behaviors in your policy (FL DOT
Model Policy lists them in Section 14)
Breakdown of Amendments to Part 40
MRO can use a medical evaluation to
determine prohibited drug use following an
invalid result
What it means: When a (-) result is required
and only an invalid result can be produced
via urine, this provides a means to obtaining a
negative result
Who it effects: Donors who produce invalid
results, MROs, Employers
What do you need to do: Add this language
to your policy (FL DOT Model addresses this in
Section 20)
Breakdown of Amendments to Part 40
Negative Dilute Retesting
What it means: When a negative dilute
result with a creatinine level between 5ng/ml
and 20 ng/ml is reported; you are authorized
to conduct a second collection. The second
collection may not be directly observed and
is the final result.
Who it effects: Donors, Employers
What do you need to do: Add this
language to your policy, implement
consistently (reference FL DOT Model Section 17)
Additional Information Regarding Negative Dilute Results
Negative Dilute Results with a creatinine
level between 2 and 5 ng/ml require retest
under direct observation
 What it means: Specimen that the human
body can rarely produce
 Who does it effect: Donors, collectors,
Employers
 What do you need to do: Check results
carefully, when levels are not indicated,
contact MRO. Always follow MRO
instructions on how to proceed
Breakdown of Amendments to Part 40
No Split Testing of Invalid results
What it means: Donors will not be able to
request that their B bottle (split specimen)
be tested at another lab when the A bottle
produced an invalid result
Who it effects: Donors with invalid results
What you need to do: add statement to
policy (reference FL DOT Model Policy Section 21)
Breakdown of Amendments to Part 40
Stop Publication of Lab Methods
What it means: laboratory testing and
analysis methods will no longer be
published
Who it effects: The multi-million dollar
industry that manufactures products
designed to “beat” DOT drug tests!
What you need to do: Nothing
Breakdown
Lab Reports to DOT
What does it mean: drug testing
laboratories must report to DOT semiannual statistical summaries on all of
their DOT testing
Who does it effect: Labs and DOT
What do you need to do: Nothing
Poll 2
Zero Tolerance vs 2nd Chance
Return to Duty and Follow Up Tests
At this time there is an Administrative Stay on
making these test types mandatory direct
observation collections
 What does this mean: Employer Option still remains
to conduct these tests under direct observation
 Who does this effect: Second Chance Employers
 What do you need to do: Determine if your agency
would like to exercise the option; add it to your
policy; apply it consistently (FDOT Model Policy for
Second Chance Agencies exercises this option)
This concludes the Amendments
Anticipated Problem
No D.O.C.’s @ P.S.C.’s
 What it means: LabCorp and Quest Patient
Service Centers will no longer conduct
directly observed collections
 Who it effects: Employers of both Zero
Tolerance and Second Chance programs
 What you need to do: Establish alternate
collection site resources; and/or identify
both a male and female representative
from your agency that is willing to be an
observer
Poll 3
Laboratory Patient Service Center
Poll 4
Directly Observed Collection
Action Items for Employers
Action Items for Employers
• Policy Items that MUST be addressed:
– Specimen Validity Testing Required
– Addition of three new behaviors that
constitute a refusal to test
– Circumstances that lead to a directly
observed collection
– Directly observed collection procedures
“will be in accordance with 49CFR Part 40,
as amended”
– If second chance: RTD and Follow Up
direct observation option
Action Items for Employers
• Contact collection sites; ask if they are
aware of the changes to Part 40 and
how they would handle a directly
observed collection
• Identify an Agency Representative
who is willing to be an observer when
a routine collection at a PSC turns into
a DOC (you’ll need one male & one
female)
Five of the Most Common Areas
of Non-Compliance
And how to avoid them!
#1Most Common Area of Non-Compliance
• Collection Sites: the weakest link
– Collection Site compliance= your compliance
– Provide collectors with DOT collection guidelines
and awareness resources (such as the new DOT video:
10 Steps to Collection Site Security and Integrity available on the
ODAPC website)
– Inspect sites for security measures
– Audit the site informally when you are called for
testing (reference: FDOT’s Collection Site
Monitoring Toolkit)
– Conduct unannounced visits that include an
interview with a site staff member
#2 Most Common Area of Non-Compliance
• Random Testing
– Must cover all hours of operation and all days of
operation (weekends and holidays)
– Must be spread throughout entire testing period
– Never “group test”
– Never give advanced notice to employees
– Use alternate selections properly
– Cancelled tests do not count toward minimums
– Update employee testing pool prior to each
draw
# 3 Most Common Area of Non-Compliance
• Post Accident Testing Decisions
– Use decision and documentation form every
time- whether or not you test
– Use only the FTA criteria to decide to test/or not
– Always conduct BOTH drug and alcohol tests
– Train your supervisors
– Make arrangements in advance for after hours
testing resources
– Conduct NON DOT testing if your agency feels
testing is always necessary following an accident
#4 Most Common Area of Non-Compliance
• Policy Issues:
– Substance Abuse Policy does not include
all of the FTA required elements
– Policy items included under an agency’s
own authority contradict DOT/FTA
regulations (e.g.; FTA post accident criteria not used–
testing conducted in all cases)
– Failure to document employee receipt of
policy revisions/updates
# 5 Most Common Area of Non-Compliance
• Pre-employment Background Checks-40.25
– Get consent form signed by employee (see
handout)
– Check with DOT covered employers going back
2 years
– Positive drug tests, Positive alcohol tests or any
refusals to test
– Make at least three attempts, document
attempts
– If employee’s past reveals a previous violation,
employee must complete SAP evaluation,
treatment and RTD before performing s-s duty
Resources for Further Information
Resources
• ODAPC website:
http://www.dot.gov/ost/dapc/video.html
What to get here:
New video and posters on collection site
security and integrity
Collection instructions for direct observation
DOT Employer and DOT Employee Handbooks
about the drug and alcohol testing program
Updated Part 40 and FAQs
List of certified labs
Resources Continued
• FDOT/CUTR Substance Abuse
Management Resource Site
http://www.cutr.usf.edu/byrnessamsite
 What to get here:
 FDOT Model Policies for Zero Tolerance and Second
Chance agencies
 Collection Site Monitoring Toolkit
 Collector Questionnaire for Employer-Collector
Interview
 Training Presentations
 Notices of Upcoming Training Opportunities
 Clean, Sober and Safe training video
This concludes our session~
Thank you for joining us!
Please feel free to contact me:
Diana Byrnes
[email protected]
813-426-6980