Good Morning~ Welcome!

1. Good Morning~ Welcome! • Today’s presentation is sponsored by the Florida Department of Transportation • Our host agency is the Central Florida Regional Planning Council • Presenter is: Diana Byrnes Substance Abuse Management Specialist; C-SAPA Center for Urban Transportation Research University of South Florida, Tampa Campus

2. Video • Clean Sober and Safe, • Produced by the Center for Urban Transportation Research • This portion of the video explains the background of DOT required drug testing • Available for download from http://www.cutr.usf.edu/byrnessamsite

3. DOT Required Drug and Alcohol Testing Program Management

4. Regulations • US DOT Regulations: 49 CFR Part 40 • FTA: 49 CFR Part 655 (OR) • FMCSA: 49 CFR Part 382 • Employer Policy

5. DOT Modes Department of Transportation FTA PHMSA FAA FMCSA FRA All DOT Modes are subject to 49 CFR Part 40

6. 49 CFR Part 40 • US DOT Regulations • All DOT modes must comply with Part 40 • This regulation tells us how to conduct drug and alcohol testing • Explains procedures for collection of specimens; testing for alcohol; analysis of specimen; MRO verification process; reporting of results; and the return to duty (SAP) process • Part 40 also includes provision for drug and alcohol background checks (40.25)

7. Parties Subject to Part 40 DOT Employer SAP Collector MRO Laboratory

8. Employer Responsibilities

9. Substance Abuse Policy • Each mode has specific policy provisions, but in all cases your policy must identify which components are conducted under agency authority and which are conducted under DOT authority • Okay to reference the regulations, as long as employees are provided access to the regulations referenced • Policy must be adopted by a governing board or agency official (in order for it to be legally defensible) • Policy must be disseminated to all covered employees prior to the performance of safety sensitive duties and each time there are major revisions made to the policy • Enforcement of policy must be consistent

10. Employee and Supervisor Training • FTA requires that all covered employees receive a min. of 60 minutes of drug awareness training (Clean, Sober and Safe will satisfy only 23 minutes) • If alcohol awareness training is provided, must be in addition to the 60 min. minimum • FMCSA requires that employers distribute information material to all covered drivers • Policy should be reviewed as one of the pieces of informational material

11. Testing Program

12. Test Types • Pre-employment • Random • Post Accident • Reasonable Suspicion • Return to Duty • Follow Up

13. Pre-employment Testing • Negative result required before performance of safety sensitive functions (FMCSA allows for transfer from one employer to another without pre-employment test, as long as employee has been in testing program for one year without violation) • Urine drug test is required; alcohol test is permitted for this test type • Extended absence and removal from the random testing pool requires a pre-employment test upon return to work (30 days for FMCSA and 90 for FTA)

14. Pre-employment D& A Background Checks • 40.25 • FTA requirement is DOT employers two years back • FMCSA extends to DOT employers three years back • Must get employee consent; if employee fails to give consent– they may not perform safety sensitive duties • If you do not receive reply, employee can remain working– but you must be able to show that you have made attempts to obtain the information • If you receive notice that employee has violated the program; you need to ensure that SAP and RTD process has been successfully completed. You are also responsible for continuing any follow up testing requirements.

15. Random Testing • Each DOT mode sets the testing rates for this test type (FTA: 25/10; FMCSA: 50/10) • Random testing must be spread reasonably throughout all days of the week and all hours that safety sensitive functions are performed* FTA requirement • Random testing schedules should never reveal a predictable pattern of testing i.e.: NO group testing • Employee must report immediately to collection facility– no advance notice should be given

16. Post Accident • Each DOT mode defines the criteria for an accident or incident to be subject to post accident testing • When criteria is met; both drug and alcohol testing must be conducted- use of decision and documentation form is highly recommended • Testing windows are the same for both FMCSA and FTA: alcohol up to 8 hours, drug up to 32 hours begin documenting delays after first two hours

17. Reasonable Suspicion • Most underutilized test type despite training requirements • Supervisors must be trained in signs and symptoms of probable drug use and probable alcohol misuse • FMCSA: Documentation is required within 24 hours of observed behavior or before drug test results report • FTA: No documentation is required; but it is highly suggested. If audited, it will be expected • Best Practice: Keep supervisor training documentation on file indefinitely

18. Return to Duty and Follow Up Test Types • Only applicable when an employee has violated the DOT rule • Violation means: Employee tested positive or refused to test when required • A negative RTD is required before returning to safety sensitive functions after a rule violation (After extended absences use pre-employment test type not return to duty!) • Follow up testing plan is determined by SAP with a min. of 6 tests in 12 months • Employees are still subject to all other test types during follow up testing plan • Employer option to conduct these tests under direct observation (highly recommended)

19. Urine Collections

20. Urine Specimen Collections • Collector must meet Part 40 qualifications • Collection site must meet Part 40 qualifications • A Federal custody and control form must be used for all DOT required tests • A split specimen method must be used for all DOT required tests • Collector must send specimen to a DHHS certified lab for analysis (cannot use instant test method or any other method of analysis)

21. Basic Collection Procedures • Collector checks identification and explains process to donor. Collector begins filling in the CCF • Collector instructs donor to empty pockets, remove outer garments, etc. • Collector instructs donor to wash hands • Collector secures stall (checking for any possible contaminates or water sources) • Collector instructs donor to fill collection cup to at least 45 mL

22. Basic Collection Procedures Cont. • Collector checks specimen for temperature and looks for signs of adulteration or substitution (odor, color, odd appearance) • Collector splits sample into A and B bottle • Collector asks donor to sign Step 5 and initial seals after seals are affixed to bottles.*** • Collector completes paperwork and packages the lab copy of CCF with the specimen bottles in bag (in the donor’s view) • Donor is given the employee copy of CCF and is then permitted to leave testing site • Collector then disseminates the MRO and Employer copies of the CCF

23. Collection Irregularities • Shy bladder • If donor is unable to supply a 45 ml of urine on the first attempt: • The void is discarded (unless out of temp. range or otherwise appears to have been tampered with) • Donor is urged to consume up to 40 ounces of fluid and is given up to 3 hours to provide 45 ml of urine in one single void. • Attempts and fluid consumed are recorded on CCF by collector • After 3 hours; donor is released to employer but must be examined by a physician within 5 days to determine if legitimate medical excuse • No medical explanation; deemed as refusal. Failure to comply with requirement; deemed as refusal

24. Collection Irregularities Cont. • Specimen Temperature out of range • Specimen falls outside of the 90-100 degree range • Not humanly possible, donor is attempting to substitute or adulterate the specimen • Collector must initiate an immediate recollection under direct observation • First specimen is NOT discarded, it is sent to the lab, with comments in remarks section indicating that it is 1 of 2 specimens for the same donor (specimen ID numbers should be referenced) • Common error: Collector fails to initiate the DO collection and follows shy bladder instructions instead

25. Collection Irregularities Cont. • Donor fails to cooperate with any part of the testing process, for example: • Does not report immediately to testing site in time allotted by employer • Refuses to empty pockets • Refuses to wash hands • Leaves the site before process is complete • Is caught with items intended to tamper with or substitute their specimen

26. How are Directly Observed Collections Conducted? • Recently enhanced; effective August 25, 2008. • ALL Directly Observed Collections must occur in this manner: • Collector/Observer must be same gender as donor • If collector is not same gender, DER or other company official may be asked to serve as “observer” • Donor must raise clothing above the waist and lower clothing (including under garments) to mid thigh • Donor must turn completely around to reveal to the observer that no prosthetic device is being used • Observer must watch the donor’s urine leave the body and enter the collection cup (this part has not changed)

27. Directly Observed Collection Enhancements- Why? • Directly observed collections are only conducted when there is reason to believe that an employee or applicant is attempting to thwart the drug testing process • The enhancements to the directly observed collection procedures are intended to deter employees from attempting to use prosthetic devices

28. Who can order a Directly Observed Collection? • As an employer, you can order a directly observed collection when your policy specifies that return to duty and follow up testing will be conducted in this manner and when a test was cancelled due to a fatal flaw and a negative result is required • A collector can initiate direct observation collection procedures when a donor exhibits behavior that could be considered an attempt to conceal an adulterant, a substituted sample or a prosthetic device • An MRO can initiate recollection under direct observation when there are irregularities with the specimen- MRO will instruct employer when this is required

29. Employer Best Practices For Collection Procedures • Use a “Testing Notification Form” • Determine a reasonable time for employees to report to site– then let collectors know that delays must be reported to you • Ensure that all collectors are aware of how to reach you (the DAPM/DER) in the event of an irregularity in the collection process • Ensure that collection sites are willing and able to conduct directly observed collections in accordance with Part 40 (same gender available?)

30. Alcohol Testing • Alcohol use is prohibited within 4 hours of performing safety sensitive duties (both FTA and FMCSA) • Saliva screening may be used • Confirmation test must always be made with EBT • Alcohol testing must take place following any accident that meets the criteria to test • An employee with an alcohol level of 0.02-0.039 is not considered positive– but does require removal from duty for a period of at least 8 hours for FTA and 24 hours for FMCSA • Positive result is 0.04 and above

31. Alcohol Testing Continued • Following an accident that meets the criteria to conduct testing; all employees subject to testing are prohibited from consuming alcohol for a period of eight hours following the accident or until post accident tests are completed • Failure to locate a breath alcohol technician or saliva test technician are not legitimate excuses for failure to conduct testing following an accident that meets the criteria to test

32. Laboratory Process

33. Prohibited Drugs • Marijuana • Cocaine • Amphetamines • Opiates • PCP • These are the only drugs permitted to be tested for under DOT authority

34. Lab Analysis • All labs used for the purpose of DOT urine drug analysis must be certified by the Dept. of Health and Human Services • A list of currently certified labs is published the first week of each month in the federal register • Labs are heavily monitored by DOT and DHHS • Effective August 25, 2008; labs are required to conduct specimen validity testing

35. Specimen Validity Testing • SVT is in addition to immunoassay and GC/MS • Purpose: to screen for adulterants and substitutions used to interfere with specimen analysis • Huge market for products that are designed to “beat drug tests” • Even prosthetic devices are being sold!

36. Video • News story explores the use of products designed to “beat” a drug test • WZZM ABC local affiliate in Grand Rapids Michigan • 3:38 in length • This and other videos on this topic can be viewed on You-Tube

37. Thwarting the System  Results 1 - 10 of about 1,130,000 for beat a drugtest. (0.16 seconds)

38. Let’s take a short break

39. Medical Review Officer MRO

40. MRO Process • Medical Review Officer is the gatekeeper of the DOT drug testing program • MRO is the only individual that can produce a drug test result for the employer • MRO protects employee’s rights by offering an opportunity for employee to present legitimate explanations for lab results that are non-negative

41. MRO Safety Concerns • Medical Miranda • Interview process is confidential except when employee reveals information to MRO that could jeopardize public safety • MRO has a responsibility to report to employer • Employer receives a Negative result, with an attached medication safety concern • Employee is told that within five days, prescribing physician must contact MRO to determine alternate medication- employer must have policy in place in order to “stand down” an employee in this circumstance

42. 8 MRO Results Employers Can Receive • Negative • Negative- Dilute • Negative- Dilute with creatinine in the 2-5 range • Invalid • Cancelled • Positive • Positive- Dilute • Refusal to Test- Adulterated or Substituted

43. Employer Actions following Each Result • Negative- applicant/employee may begin, resume or continue safety sensitive functions • Negative Dilute- employer policy must indicate if negative dilute results will require retesting. (Note: employer must be consistent in enforcement and not use direct observation procedures) § 40.197Second result is final result • Negative Dilute with creatinine in 2-5 range- employee or applicant must undergo a second collection under direct observation** MRO will report quantitative data in this instance and instructions to recollect under direct observation § 40.197 • Cancelled or Invalid- actions will differ depending on circumstances; follow MRO instructions

44. Employer Actions Cont. • Positive- applicant/employee must be prohibited from performing safety sensitive duties upon receipt of positive result, referral to SAP required • Positive-Dilute- same as above • Refusal to Test (either adulterated or substituted)- same as above • Applicants and current employees who test positive or refuse a DOT required test MUST receive a referral to a qualified Substance Abuse Professional (SAP) regardless of second chance or zero tolerance policy.

45. Substance Abuse Professional SAP

46. Substance Abuse Professional (SAP) • Regardless of whether employer policy is Zero Tolerance or Second Chance– all violating applicants and employees must be referred to a SAP that meets the qualifications per Part 40 • Return to duty process includes two face-to-face evaluations with SAP and employee • SAP must provide initial evaluation letter to employer

47. SAP continued • SAP determines form of treatment needed • SAP provides return to duty release letter upon employee’s completion of program • SAP prescribes the number and frequency of follow up testing. Minimum is 6 tests within 12 months. • Employer determines testing dates in accordance with SAP (employer must never decrease or increase the follow up testing schedule per SAP) • Employee is subject to all other DOT testing during follow up program

48. Rx and OTC Medications

49. Prescription and OTC Meds • Some commonly prescribed (and often abused) medications such as Vicodin, Xanax Valium and sleep aids are not detected as part of the DOT urine drug test • Employers are strongly encouraged to develop policies and procedures that will obligate employees to report the use of prescribed medication and OTC medication that carries a warning label

50. Rx and OTC Awareness • Employers should develop training materials and training sessions on the topic of Rx and OTC Safety Concerns • Effects of medication on motor functions • Possible adverse interaction of medicines • Importance of communicating job functions to doctors and pharmacists • Importance of reporting to supervisor when illness or medication causes impairment • Employers must develop protocol for employees who report impairment