Posted for public inspection in today’s Federal Register for publication Friday, May 4, 2012, is a Department of Transportation Interim Final Rule:
Procedures for Transportation Workplace Drug and Alcohol Testing Programs
6-Acetylmorphine (6-AM) Testing

The following is a summary of the Interim Final Rule (IFR):

1) The Department is amending certain provisions of its drug testing procedures for 6-acetylmorphine (6-AM), a unique metabolite for heroin.

2) The IFR is intended to streamline the laboratory process for analyzing and reporting 6-AM positive test results and is designed to facilitate Medical Review Officer (MRO) verification of 6-AM positive results.

3) Effective July 3, 2012:

a) For Laboratories:
• Laboratories will not be required to consult with MROs when 6-AM is confirmed and there is no morphine detected at 2000 ng/mL;
• In such cases, laboratories will not be required to test for morphine at Limit of Detection (LOD); and
• Laboratories will not be required to report these 6-AM results to ODAPC.

b) For MROs:
• MROs will no longer be required to consult with laboratories when 6-AM is confirmed and there is no morphine detected at 2000 ng/mL; and
• MROs will not be required to report these 6-AM results to and consult with ODAPC.

4) MROs will continue to adhere to 40.151(g) by not accepting an employee’s assertion that there is a legitimate medical explanation for the presence of 6-AM in a specimen.

5) Public comments regarding the IFR will be accepted until June 3, 2012.
The document can be viewed at the Federal Register’s Public Inspection website: https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-10665.pdf (This link is only good for today, May 3, 2012).
We expect to have the actual Federal Register IFR on our website Friday, May 4, 2012: http://www.dot.gov/odapc/frpubs.html.
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From the Australian Eye: A new study by Lab Testing Solution finds drug testing saves employers US$705 per year in workers compensation savings, lost productivity making drug screening a key risk mitigation strategy.

“Employee screening – that is, drug testing – is not only a risk mitigation strategy, employee screening is proven to improve employees’ productivity by 25% thereby helping them reach their full potential as an employee – contributing to their on-going job success. And, as it is said, a happy employee is a loyal employee – a benefit for both employer and employee in these turbulent economic times,” said a spokesperson for Lab Testing Solution.

The company says the study found an average of 10% of employees in workforces that are not in an employee screening program abuse drugs or alcohol; employees operate at about 75% of their full potential when they abuse drugs; and about 20% of health insurance benefits are paid to cover substance abuse-related claims. The company says the study reviewed employees that did not have any benefits paid for the year, and notes that an increase in actual savings per employee results when benefits claims are paid – a drug free workplace can help improve overall profit, added the spokesperson.

From MEDTOX Scientific: For many years now, addiction professionals have proclaimed of a noticeable syndrome developing with users who suddenly stop smoking marijuana. A hallmark phenomenon that occurs with the use of powerful stimulant and depressant drugs, withdrawal syndrome is an uncomfortable and often painful experience that results from extended, chronic administration of a drug. Typically a withdrawal syndrome presents with symptoms that appear to be the exact opposite of an abused drug’s direct effects. Until recently, DSM-IV failed to include marijuana withdrawal as a syndrome worthy of diagnosis and treatment. But the National Epidemiologic Survey on Alcohol and Related Conditions examined a group of over 1100 regular marijuana users who did not binge drink or regularly use other drugs or narcotics. The respondents in the survey pointed to a marked set of symptoms that were experienced when they suddenly stopped the consumption of marijuana, the symptoms immediately resolved when marijuana use was restarted [1]. Withdrawal and abstinence syndrome symptoms are attributed to the action that THC and other cannabinoids have on sensitive receptors in the mid-brain. Cannabinoid receptors and relevant transmitters are not entirely understood but are known to influence serotonin, dopamine, acetylcholine and GABA in the brain.

Respondents to the marijuana withdrawal syndromes survey represented 44% of all those who admitted to regular use of marijuana. Those who responded to the survey reported three or more symptoms of cannabis withdrawal syndrome. Two types of withdrawal symptoms emerged in the survey: somatic and psychological. Somatic-related symptoms of withdrawal included weakness, psychomotor retardation and sleep disturbances. Psychological symptoms included depression, hyper anxiety and panic disorder. Respondents who experienced personality disorders concurrent to the use of cannabis found that the underlying personality problem was exacerbated and more pronounced upon withdrawal from marijuana.

This study points to the difficulties that a substantial number of marijuana users have in trying to stop using the drug and/or in maintaining periods of sobriety or non-use. Not all marijuana users experience this syndrome when they try to quit, but this survey reveals that a very substantial minority does have to weather the symptoms and discomfort. Motivated addicts may find it very difficult to stop marijuana use and may need pharmacologic assistance in completing the task. Additionally, the research indicates that people seeking to stop marijuana abuse may switch to other drugs of abuse to ease the discomfort and pain of withdrawal. Authors and experts associated with this study argue for cannabis withdrawal syndrome inclusion in DSM-V.

For community corrections and rehabilitation professionals, marijuana abuse is no laughing matter. Ignoring use and abuse of marijuana as nothing more than a harmless vice is unwise, especially in light of still increasing purity in THC concentration of commercial grade marijuana sold on the street. Prior essays in the MEDTOX Journal have cast light on the profound effects that cannabis use has on the anatomy of the brain and the functioning of the limbic system. Marijuana abuse should be taken seriously by all professionals who work with those who smoke it. Efforts should be made to guide marijuana users to programs and experts who specialize in the treatment of that type of addiction and dependency.

[1] Hasin DS et al. Cannabis withdrawal in the United States: Results from NESARC. J Clin Psychiatry 2008 Sep; 69:1354.

From the DOT:

We want to reiterate that it is very important for collectors to send Copy 2 of the CCF to Medical Review Officers (MROs) in an expedient, legible manner. According to 49 CFR Part 40 [see 40.127 & 40.129], an MRO cannot report negative and non-negative verified drug test results to employers without first having Copy 2 of the CCF, a legible copy of it, or any other CCF copy containing the employee’s signature. And, if collectors fax CCFs to MROs, those faxes must be legible.
Also, collectors must provide legible copies of CCFs to MROs and DERs within 24 hours of the collection or during the next business day; and collectors must keep Copy 3 of the CCF for at least 30 days [see 40.73].
Thanks collectors! We appreciate your spotlight on this important matter.

Jim L. Swart
Director
Office of Drug and Alcohol
Policy and Compliance
U.S. Department of Transportation
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TAMPA, Fla., Oct 13, 2011 (BUSINESS WIRE) — Small businesses may be at increased risk when it comes to hiring employees who abuse alcohol and drugs, according to USA Mobile Drug Testing ( http://www.usamdt.com ). Although the government encourages alcohol and drug-free workplaces, a large number of small businesses do not have the necessary policies or testing procedures in place to protect them against substance-abusing employees.

“The numbers are alarming. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nine of 10 small and medium-sized businesses employ heavy drinkers or drug users,” says Jeffrey Sardisco, COO of USA Mobile Drug Testing. “The SAMHSA study also found that 75 percent of illicit drug users were employed, primarily by small businesses.”

Sardisco says small and medium-sized businesses can avoid this by instituting drug testing programs and putting a drug-free workplace program in place. “Although business owners may think that starting a drug testing program is not possible because they fear the costs or lack the staff to manage it, in reality any business can put together an effective program,” he says.