Workplace Drug Testing
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1 Interpretation of Workplace Tests for Cannabinoids Ken Kulig MD, FACMT, FAACT Toxicology Associates, Prof LLC Workplace Drug Testing 1. How did it get where it is today? 2. Where is it today? 3. Where might it be going? Like to know more? Become an MRO (MROCC or AAMRO) (must be a physician by law) Medical Review Officer s Manual (Swotinsky, 5 th edition, OEM Press) ACOEM MRO Update (newsletter) 49 CFR Part 40 (online) References cited here 1
2 The Origin of Workplace Drug Testing in the US US Military in 70 s began testing Vets Executive Order (1986) prohibited federal employees from using illegal drugs, part of Just Say No campaign Drug Free Workplace act, 1988 (establishing the NIDA 5 panel) DOT 49 CFR Part 40 in 1989 Omnibus Transportation Employee Testing Act of 1991 (DOT) Some Issues in Regulated Testing - Temperature (32-38ºC) - Direct Observation (When) - Dilution (Cr and sp gr) - Adulterants (ie Oxidizers) - Refusal to Test (Consequence) - Chain of Custody (Access) - Split Specimens (diff lab) - Shy bladder (Rules/procedures) Federal testing v Private Private employers who do not have contracts with the federal government can establish their own policies regarding drug testing, discipline, firing. ie Hair testing, oral fluid, blood, sweat, expanded drug panels, counseling. However, private companies very often use same DOT policies and procedures. 2
3 Purpose of the MRO To determine if there is a legitimate medical explanation for the employee to have a positive urine drug test. To insure Protocol followed MRO calls employee. If they have a prescription or medical record, they then need to provide documentation. How recent? Purpose? Family member? Party? Diet? Malintent? Positive test may become Negative Safety sensitive positions Federal Agency Model Workplace URINE Testing Since 1988 (NIDA 5): C ocaine (metabolite BE) O piates (morphine, codeine) M arijuana (metabolite THC-COOH) P hencyclidine (PCP) A mphetamines (meth, amphet) N Y Changes in 2010 (urine) 6-MAM, MDA, MDMA, MDEA included Regulated Testing in 2015 still does not include oxycodone, hydrocodone, hydromorphone, fentanyl (and analogues), benzos, barbs, Z drugs, etc, etc. 3
4 Remainder of Talk: Cannabis 4
5 Street Synthetic Cannabinoids not included in regulated workplace testing. Private employers can make it their policy if they choose. Two part procedures Urine, oral fluid and hair testing are all two part procedures in workplace testing. The original screen (usually by IA), if positive, must be confirmed by alternate technology (ie GC/MS or LC/MS/MS) False positives often misused phrase (Initial v Confirm, technology, when) Call the lab prn to discuss 5
6 THCA Cutoffs in Urine For Initial Test 50 ng/ml For Confirmatory Test 15 ng/ml Why would an initial test between 15 and 50 ng/ml be positive initially? Positive Test does not demonstrate impairment, as it measures only the inactive metabolite. Marinol (dronabinol) - Synthetic THC (positive UDS) - Originally FDA approved Currently Schedule III 6
7 Cesamet (nabilone) -re-approved by FDA in Schedule II -Synthetic THC-like (Neg UDS) Sativex (1:1) Epidiolex (CBD) Workplace urine test results with ID removed - - what the MRO sees 7
8 8
9 The short term future of federally regulated Cannabis testing (maybe) Important concepts Blood THC concentration is 0.5 to 0.7 that of serum or plasma (with a wide range) Per se THC impairment (in CO & WA) is Blood THC > 5 ng/ml Urine target analyte is THCA, an inactive metabolite Passive exposure not what it used to be Oral fluid (OF) tests for THC (4 and 2 ng/ml) and becomes negative relatively quickly; THCA may be absent even in presence of OF THC Hair target analyte THC and THCA (1 / 0.05 pg/ml) 9
10 ORAL FLUID (split:spit or swab?) May 15, 2015 Federal Register; SAMHSA recommends oral fluid testing be included (4 and 2 ng/ml; ACOEM rec 2 and 1 ng/ml) and that oxycodone, oxymorphone, hydrocodone, and hydromorphone be Included in testing. (Initial recs for hair, oral fluid, and sweat in 2004 were never implemented) Hair Testing May 29, 2015 Federal Register SAMHSA requests comments on addition of hair testing in federally regulated testing. Aug 7, 2015 Drug Testing Advisory Board unanimously votes to recommend hair be included in federal testing cutoffs not yet finalized (1 and 0.05 pg/mg THCA common in private companies and also in 2004 rec s) JOEM 2015;57(4): Proposed serum level of THC plus THC- OH of 5 ng/ml to determine impairment 10
11 JOEM 2015 ; 57(5): (ACOEM Pharma and MRO Committees; rec workplace neuropsych testing for impairment) O Dell MS et al: Residual cannabis levels in blood, urine and oral fluid following heavy cannabis use. For Sci Intern 2015 : 248: Colorado Cannabis Cup Chem D.O.G. by Next Harvest 32.13% THC 11
12 June 15, 2015 decision Colorado Supreme Court Coats Case Random test on oral fluid positive THC Employee fired for violating company s drug policy (first strike you re out) Colorado has a lawful activities statute SC ruled that lawful must mean under both state and federal law MMJ and RMJ currently legal in CO 2010 Firing upheld 12
13 If Dish loses the case, the company wrote in a brief to the court, Dish (and every other Colorado employer) can no longer maintain a drug-free policy and companies across the state could risk losing federal contracts because they no longer complied with federal drug-free workplace laws. Thank you for your time and consideration 13
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