Webinar Notes: Best Drug Testing Practices

Webinar Notes Best Drug Testing Practices

 

Webinar Focus (0:20)

  • Perspectives linking current supervision case management principles and drug testing industry basics.
  • Rational approaches to improve testing outcomes and reducing risk levels.

 

Resource Speakers (00:36)

  • Mark Hendershot

    • Currently the Chief Information Officer at Treat Assessment Screening Center (TASC)

      • Community-based non-profit providing certified laboratory testing
      • 40 years of experience
    • Facilitates and collaborates amongst justice, treatment, and community stakeholders through data and systems
    • Provides smart and timely data to drive agency policies and decision making
    • With 31 years of experience at the Maricopa County Adult Probation Department

      • Started as an officer where he did lots of sample collections
      • As an administrator, he was in charge for certain drug testing processes

 

The Justice Clearinghouse (01:13)

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Statistics (04:46)

  • Chart illustrating numbers of drug overdoses and deaths
  • 2010: Overdoses surpass auto deaths
  • Overdoses run across all age groups

    • Highest for age 45-54
    • 35-44
    • 25-34
    • 55-64
    • 15-24
    • Lowest for age 65 and over
  • There is about 300% increase in the 25 and above age range recently
  • Overdose incidents higher for males than females
  • Opioid painkiller deaths higher than heroin overdose deaths
  • 2014 ended with around 28,000 deaths, then it increased to about 40,000 by 2015

 

Origins of Drug Testing (06:22)

  • Dawn of the Industrial Age

    • Henry Ford created a Social Department which surveilled his own employees
    • Used the Social Department to check employee alcohol consumption and gambling
    • Denied benefits to those seen to do gambling and alcohol
  • Nixon Administration

    • Focus began in the last 1960s
    • 1968: Bureau of Narcotics and Dangerous Drug established

      • During Vietnam, Nixon was disturbed with positive results of drug tests with servicemen
      • Drug abuse was named public enemy #1
    • 1971: Ordered Military UA testing

      • “Operation Golden Flow”
      • 4.5% of the military had positive test results for heroin
    • 1973: DEA was formed
    • 1974: National Institute on Drug Abuse was created

      • Look at drug abuse from a legal and punitive approach to a scientific perspective
  • Ford Administration: White Papers on Drug Abuse
  • Carter Administration: Proposed decriminalization of marijuana
  • Reagan Administration:

    • Accident on USS Nimitz that killed 14 people and injured 48. 6 of the people who were killed tested positive for marijuana.
    • 1982: Department of Defense defined forensic drug testing requirements

      • The navy, army, and air force established panels of active duty scientists for the development and implementation of forensically sound drug testing procedure.

        • The beginning of drug testing as we know it today
    • 1988: Executive Order from the president that all federal workers and government contractors undergo drug testing.

      • Clinical Laboratory Improvement Amendments (CLIA) was created to certify drug testing laboratories.
  • First Bush Administration

    • Testing was ordered for the Department of Transportation
  • Pushback

    • Case Law

      • 4th Amendment: Reasonable expectation to privacy
      • From 1989 to 2002 challenges encountered
      • Special exclusions upheld to drug testing

        • If a job is important and great harm could result if it was not performed properly, drug testing could proceed

          • Law enforcement
          • Medical
          • Firefighters
          • People dealing with classified and sensitive information
          • Prison employees
          • Post-accident testing

 

Modern Drug Testing (11:55)

  • Rationales for Drug Testing

    • Screen Job Applicants
    • Workplace Safety Protection Productivity
    • Contain Healthcare Costs
    • Deter drug use and relapse/ prevention
    • Determine Accident Liability
    • Encourage Healthy Living and Families
    • Enforce Court Orders / Surveillance
  • Workplace Testing Trends

    • 5/16/17 Report 

      • Overall positive rate of 4.2% for 2016
      • Marijuana has increased each of the past three years

        • Highest rate of steady increase
        • CO and WA are twice the national average (where marijuana is legal)
  • Workplace Testing

    • Types

      • Pre-employment
      • Randomized verification testing
      • Testing for probable cause
      • Testing following accident or injury
    • Reasons

      • To improve employee productivity
      • Reduce on the job accidents and workplace crime as theft and violence
      • Reduce employee turnover
      • Decrease absenteeism
      • Lower worker’s compensation insurance and health care costs and premiums
      • Compliance to State and Federal regulations
    • Side note: New York State’s Code Rule 59

      • Incentivizes drug testing and requires insurance premium reductions for businesses that participate in drug testing programs.
    • Implementation Hurdles

      • Workplace resistance

        • Dealing with hurdles

          • Identify the purpose of the drug testing
          • Know how your workforce feel about mandatory testing
          • Identify who will be tested and the frequency of testing
          • Who’s the trusted agency to lead the change
      • Downsides

        • Reasons not to drug test

          • Avoid morale problems
          • Avoid union grievances
          • Avoid costs of drug testing
          • Legal challenges
          • Hits the hiring pool and shrinks the workforce
      • Workforce adoption/trust

        • Ensure they’ll be treated equally and fairly

          • New hires and those already in the workforce
          • Random testing is tricky and may be seen as unfair
        • Practice transparency

          • What will happen if a test is confirmed positive?
          • Create prescribed definitions of sanctions before the first test is taken
          • How will workforce records be used and accessed?
        • Open communication with workforce through a forum

          • Raise concerns
          • Ask questions
  • Workplace Summary

    • Purpose

      • Articulate agency purpose for drug test
    • Research

      • Research State and Local laws that protect both employees and employers

        • Medical marijuana
        • Transgender population
    • Policies

      • Develop policies that clearly describe the program rules

        • Legal
        • Best practices
        • Address confidentiality
        • Use an independent, third-party medical review officer

          • To review the tests
          • To coordinate with people tested positive
        • State consequences and sanctions
        • Cover data storage and security – who has access to those records
    • Educate

      • Train staff to establish clear understandings and expectations
    • Fidelity

      • Implement with fidelity to ensure uniform treatment across all staff
      • Strive for total transparency

 

Justice Populations (22:25)

  • Important

    • There are lots of justice populations
    • Ensure that your agency's testing philosophy is aligned with your mission, vision, and values
    • Questions for agencies to ask themselves

      • What are the goals you’re trying to achieve with testing?
      • How are you going to measure the achievement of these goals?
  • Justice Population

    • Diversion
    • Pre-trial
    • Family Courts
    • CPS
    • Jails
    • Probation
    • Prisons
    • Parole
    • Juveniles
    • Adults
    • Transferred Youth
    • Therapeutic Courts
    • Target populations

      • Drug
      • Alcohol
      • Co‐occurring disorders
  • Ineffective Drug Policies

    • WAR on DRUGS

      • What’s being done in the last 30 years in criminal justice are catch-phrase based policies

        • Get tough on crime
        • 3 strikes you’re out
        • Truth in sentencing
        • Mandatory minimums
        • Bootcamp probation
    • The results of these programs

      • Not building prisons fast enough
      • Inability to maintain jail and prison bed day costs
      • Offenders getting worse in corrections
      • Return to the street in a riskier state
      • Repeat, shorter prison time
      • Incarceration of the wrong people
      • Mass Incarceration
      • Family Devastation
      • Crippled budgets with system too expensive to maintain
    • Increased Racial Inequality

      • Black Americans are no more likely than whites to use or sell drugs
      • Black Americans are more 3 to 4 times more likely to be arrested for drug crimes
      • Black Americans are 9 times more likely to be admitted to State prisons for drug offense
    • Jails and Prisons used to treat mental illness
  • What has been learned?

    • Lessons learned

      • Therapeutic approaches are proven to work when implemented according to design.

        • Treating clients with dignity and respect
        • Using validated instruments and assessment tools
        • Identify areas of risk
      • Case management is informed by assessments and should be tailored to personal needs. (RNR)

        • Case plans specific to the needs of the client
        • Consider protective factors
      • Drug testing encourages drug abstinence.
      • Regular drug testing coupled with treatment improves outcomes and lessens risk.
      • Don’t mix low and low‐medium risk offenders with higher risk offenders.
  • Agencies that are the resources for these learning

    • Office of Justice Programs
    • Bureau of Justice Assistance
    • NIJ
    • NIC
    • BOP
    • Canadian system

      • Medical approach to addiction
      • Done 30 years ago
    • Academe

      • University of Cincinnati
      • Albany, NY
      • University of Missouri
      • St. Louis
      • Texas Christian University
  • What was done with the knowledge?

    • Evidence-based knowledge for testing offender populations through publications

      • National Association of Drug Court Professionals

        • Adult Drug Court Best Practice Standards Vol II 2015
        • 10 Principles of a Good Testing Program
      • Michigan Association of Treatment Court Professionals

        • Standards, Best Practices, Promising Practices
        • March 2017
  • National Association of Drug Court Professionals Recommendations

    • Frequent Testing

      • 2x a week
    • Random Testing

      • Unpredictable
    • Duration of Testing
    • Breadth of Testing

      • Baseline testing
    • Witnessed Collection

      • Strictly observed
    • Valid Specimens

      • Untampered
      • Unadulterated
      • Certified laboratories
    • Accurate and Reliable Methodology
    • Rapid Results and Consequences
    • Participant Contract

      • Understand responsibilities and consequences
      • Missing a test is worse than testing positive, admitting and dealing with it.
  • Michigan Association of Treatment Court Professional Recommendations

    • Detailed manual for court, officer, and donor
    • Client contract expectations & responsibilities
    • Scientific, Valid testing Methodology
    • Collection witnessed, random & unannounced
    • Confirmed testing unless admits to use
    • Validity testing/ diluted, adulterated, tampered
    • Rigid interpretation guidelines
    • Eliminate interpretation of urine levels
    • Behavior change intervention strategies
    • Caveat – drug detection is one dimension
  • Drug Court Selection Process (35:21)

    • Factors considered

      • High needs for drug treatment
      • Seriously addicted individuals
      • Pre-admission screening and evaluation assessment
      • Multi‐discipline team case management

        • County attorney
        • Defense attorney
        • Probation officer
        • Judge
      • Approved by the prosecutor
      • Voice is given to the victim
    • What about the other populations

      • Agencies and officers need guidance

        • What to do with those that are not high-risk offenders?
        • Drug testing training guides for officers

          • When to start frequency testing?
          • When to do baseline testing?
          • When to increase/decrease frequency?
          • What’s the frequency of tests?
        • GAP – Lower risk offenders
        • Most offenders come into the system with a history of drug and/or alcohol use and are Court ordered to test
        • What kind of tolerance for recovering / relapse case?
        • How to apply EBP to case management?
        • Use drug testing as support and encouragement, not as a punishment or sanction
        • Understand an addict’s motivation and mindset

          • Incentivize
          • Gamify
  • Justice Clients Summary

    • Purpose

      • Therapeutic drug testing to aid recovery
      • Encourage healthy sober living
      • Supplement treatment
      • Help individual succeed (i.e., reduce risk for safer community)
    • Research

      • Stay on top of research, evidence, publications, etc.
    • Policies

      • Uniformly apply policies

        • Best practices – proven with research
        • Promising practices – common sense
    • Educate

      • Train staff to establish fair and effective case management practices
    • Fidelity

      • Strive for transparency

 

Collection Standards (41:10)

  • Direct Visual Verification

    • Collectors are trained to catch accepted behaviors.
    • Visually verify the source (body) and the destination (bottle)
    • Visual Monitoring Collection

      • One-way mirror to view collection
      • Bluing agent in toilets
      • No hot water
      • No chemicals in area
      • Remove excessive clothing
      • No items allowed in restroom
    • Evasion

      • Diluted

        • Two conditions that must be present that determines dilution

          • Lowered specific gravity
          • Reduced creatinine – element in urine that specifies that it came from a human being
      • Adulterant

        • Foreign substance added to the sample
      • Substitution

        • Squeeze bottles
        • Vaginal inserts
      • Devices

        • Whizzinator
  • Chain of Custody/Control

    • Document procedures to ensure results are attributed to the true sample provider.

      • Document of Order
      • Collection details
      • Transportation manifest
      • Laboratory check-in
      • Verification of sample and Chain
      • Barcoded to order and testing device
      • Results Certification
  • Certified Laboratories

    • Regularly reviewed by CLIA, CAP, SAMSA
    • Calibrate machines
    • Validity testing
    • Industry level cut-offs
  • Confirmation Testing

    • GCMS and LCMS testing
  • Expert Testimony

    • For clarifications
  • Detection Times

    • Use the same media type across testing in your agency so it’s consistent

      • Urine – 24 to 72 hours

        • Standard best practice
      • Oral fluid – 12 to 36 hours / 6 to 8 hours THC

        • Shorter detection times
        • Doesn’t test for as many drugs
        • No drug details
      • Hair

        • Head hair – 14 to 90 days prior
        • Body hair – 30 to 365 days prior
        • Broad but vague test
        • Not timely
      • Blood – 8 to 36 hours

        • Invasive
      • Sweat – 1 to 4 weeks (period patch is worn)

        • Proprietary service
        • Expensive
        • Not timely
  • Urine Drug Detection Times

    • Stimulants – 24 to 72 hours

      • Amphetamines
      • Cocaine
      • Ecstasy
      • Bath salts
    • Narcotics / narcotic analgesics – 24 to 72 hours

      • Methadone
      • Opiates
      • Propoxyphene
    • Sedative Hypnotics – 24 to 72 hours / 2 to 6 weeks*

      • Barbiturates, Benzodiazepines
    • Hallucinogens

      • Marijuana – 24 to 72 hours / 2 to 6 weeks*
      • PCP, LSD – 2 to 5 days 
    • Depressants:

      • Alcohol – 1 to 12 hours
      • Ethyl Glucuronide (EtG)- 8 to 72 hours
    • Fentanyl – 2 to 3 days

 

General Information (49:32)

  • Marijuana – THC is fat-soluble

    • Casual user will test clean between 2 and 5 days
    • Chronic users will test clean in about 3 weeks, 6 weeks maximum
    • Chronic users should be clean in 21 days, levels drop by 50% every 3 to 10 days
    • Poppy seeds, hemp oil, ibuprofen will not test positive for THC
  • Amphetamines

    • Ritalin
    • Albuterol
    • Proair
    • Adderall
  • Opiates

    • Vicodin
    • Codeine
    • Hydrocodone
    • Morphine
    • Heroin
  • EtG

    • Alcohol
    • Stays on the system for 8 to 80 hours
  • Trending Drugs

    • Fentanyl

      • 10x stronger than heroin
      • From Mexico
      • Highly suggested to test, killing people in the streets
    • DXM (Dextromethorphan)

      • 2 to 3 days detection times
    • Bath Salts

      • Designer drug
      • Mimics marijuana
    • SPICE

      • Designer drug
    • Kratom

      • New in the US
      • Tropical evergreen from the coffee family
      • From Southwest Asia and Indochina
      • Tea in Thailand
      • Not enough research
      • Lots of cases admitted to hospital due to use

 

Types of Exposure (55:55)

  • Untrue

    • Sexual intercourse with a drug user
    • Touching a contaminated surface
    • Inhaling second‐hand smoke
    • Consuming products cooked with alcohol
    • Hand Sanitizer
    • Mouthwashes
  • Incidental Exposures

    • Hand sanitizer applied every 15 minutes for 8 hours – Negative
    • Gargling mouthwash 3 times a day for 5 days – Negative
    • Gargling mouthwash 4 times a day for 78 hours – Negative
    • Eating beer brats – Negative
    • Communion wine – Negative

 

For questions and clarifications, contact:

MARK HENDERSHOT

Chief Information Officer

mhendershot@tascsolutions.org

 

 

Q&A:

Can you speak to creatinine ratios as a way to monitor THC level reduction, and whether it is a valid protocol? (57:37)

I can't, but I'd be happy to connect them with the people in our laboratory who could speak very wisely on that topic.

 

I've recently had a few juvenile clients tested positive for buprenorphine, but they honestly do not know what suboxone is, have you ever had that happen?  (58:19)

Bup is a prescription drug used as mood stabilizers. Suboxone and Bup come in the same classification. I'm happy to have those questions addressed by the people here as well.

 

Do you have any best practices you can suggest for sharing drug testing result information between the courts and the drug testing labs in a secure way? (59:54)

Sharing drug testing results across agencies, for our laboratory, we're restricted to provide drug testing results only to the agency that ordered those tests. But that doesn't prohibit for example child protective service caseworkers from sharing results with a probation officer. That's something that their agency agrees to share across each other. If you're going to try and do it in a secure way, I would recommend using secure email which most law enforcement and law organizations have.

 

Have you ever heard of Benadryl and Tylenol PM results in false positive for heroin? (1:01:52)  

I've never heard of that. Send that to me in writing and we'll let our laboratory experts comment on that.

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