the changing face of drug screening - trends & best practices for 2017

The Changing Face of Drug Screening –

Trends & Best Practices for 2017

Todd Simo, M.D. – Chief Medical Officer

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Agenda

Positive Rates

» Self reported illicit drug use

» Lab positive trends year over year

– Lab positive rates by specimen

» Juxtaposition of MRO verified positive rate by specimen

Marijuana Trends

» Medical marijuana

» State decriminalized marijuana

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Self Reported Illicit Drug Use in the Past Month

NIDA data for age group 26 years old and older

5

7.3%

8.3%8.2%

2013 2014 2015

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Self Reported Illicit Drug Use in the Past Month

NIDA data for age group 26 years old and older

By drug class

6

5.6%

6.6% 6.5%

0.5% 0.5% 0.6%0.3% 0.3% 0.5%

2.1% 2.1% 2.0%

2013 2014 2015

Cannabinoids Cocaine

Methamphetamines Prescription medications



Lab Positive vs. Self Reported Drug Use Rates

Quest Diagnostics data vs. NIDA data

7

7.3%

8.3% 8.2%

3.7% 3.9%

2013 2014 2015

NIDA Urine


?

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8

7.3%

8.3% 8.2%

3.7% 3.9%

6.7%

7.7%

2013 2014 2015

NIDA Urine Oral fluid


? ?

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9

7.3%

8.3% 8.2%

3.7% 3.9%

7.7%

9.6%

2013 2014 2015

NIDA Urine Hair


? ?

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Lab Positive Rate by Specimen

Quest Diagnostics data

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3.5% 3.7% 3.9%

5.5%

6.7%7.7%

5.6%

7.4%

9.6%

2012 2013 2014

Urine Oral fluid Hair

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HireRight MRO Verified Positive Rate

2.2%

4.0%

5.0%

1.9%

6.0% 5.8%

Urine Oral fluid Hair

FY15 FY16

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NIDA Data & Lab Positive Rate by Specimen

Conclusions

» Escalation in self reported illicit drug use is being driven by increased marijuana usage

» Urine lab positive rate is not keeping up with the self reported illicit drug use rate

» Lab positive rates for alternate specimens is tracking with the self reported illicit drug use rate

» MRO verified positive rates for alternate specimens is significantly higher than the urine positive rate

» Based upon previously cited data, a one point increase in MRO verified positive rate confers a cost avoidance of $14K per one hundred tests




Medical Marijuana

States that have Medical Marijuana statutes in place

» Legacy: 24 States - AK, AZ, CA, CO, CT, DE, HI, IL, ME, MD, MA, MI, MN, MT, NV, NH, NJ, NM, NY, PA, OR, RI, VT, WA, and Washington DC

» New: 4 States – AR, FL, ND, and OH

Green = statute addresses need to accommodate when possible

Red = Regulation/case law explicitly states that employers DO NOT NEED to accommodate medical marijuana use

Black = Regulation silent in regard to need to accommodate

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Medical Marijuana

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Decriminalized Recreational Marijuana

Red = States with decriminalized recreational use prior to Nov. 2016 election

Pink = States that passed statutes for decriminalization of recreation use in the Nov. 2016 election

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Why Is Medical Marijuana Used Today?

Original intention

» To help people with extremely serious (often terminal) diseases to live more comfortably

– Generally terminal patients

• End stage AIDS

• Cancer

• Severe debilitating neurologic diseases

Today

» Most medical marijuana users list “chronic pain” as the reason they use marijuana

– Several state studies identify over 90% of medical marijuana users identify chronic pain as reason for their use

– Average age is under 50 years old



President Trump

Donald Trump has made supportive statements for marijuana legalization in the past

» His statements in regard to recreational use have not been favorable

The potential inclusion of politicians who are traditionally conservative on drug policy in his future administration — such as his nominee for Attorney General, Sen. Jeff Sessions — has caused some legalization support to mellow

» "I'm mostly concerned by the people around Donald Trump," said Executive Director of the Drug Policy Alliance Ethan Nadelmann —the man considered the major powerhouse behind marijuana legalization in the country



Best Practices - Recommendations

Drug Free Workplace Programs (DFWP)

» Consider alternate specimens

– Both hair and oral fluid have substantially higher “hit” rates

» Specimen selection is dependent upon DFWP configuration

– Pre-employment only

• Hair

– Long detection window

– Robust incumbent testing program with static facilities

• Oral fluid

– Unable to easily subvert & no lost time from work

– Other programs

• Variable – consider using a consultant who can help configure your program



Best Practices - Recommendations

Decriminalized Marijuana

» Know the states you employee people in

– Some states require you to consider accommodation

» Know your risk tolerance / employee profiles

– Safety sensitive vs. non-safety sensitive

– Risk adverse vs. not risk adverse

» Know the regulatory rules which apply to your company

– Is your company subject to following federal drug screening rules?

» Consider oral fluid testing

– Short detection window mimics period in which marijuana is impairing




QUESTIONS

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the changing face of drug screening - trends & best practices for 2017

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