1. Workshop - Drug Testing: Best Practices Greg Skipper, MD Michael Kaufmann, MD

2. At the end of today’s workshop: We will have a shared understanding of the concept of a “Best Practices” in PHP drug testing document; We will have blueprint suggestions for the categorical content of the document; We will have suggestions for specific content for the document; We will have good ideas regarding the format and stewardship of such a document; We will have direction for next steps in the production of this document.

3. Consider: Elements of a “best practices” document must include: –Elements that ought to be included –Elements that don’t need to be included –Where further information or research is required before a decision regarding inclusion can be made –Content not discussed today that you think ought to be included

4. Drug Test Panels Components – Fixed vs Variable Panels? –Based on DOC? –How and when to vary? Naltrexone – Other therapeutic meds, (Psych etc.) Alternative substrates –Hair, nails – for security? How often? Saliva? Dipsticks? Use in the “field” or office? Cutoffs – arbitrary, as low as possible?

5. Collection Supervised? Witnessed? Observed? To what degree? DOT protocol? (empty pockets, remove jacket and outer clothing, have no access to water in bathroom, etc..) Enforced and if so how? QA?

6. Frequency & Duration of Testing What type of random testing? Define When to suspend? Vacation? Evidence? Should the pattern change after relapse and if so how? Duration of testing? Who should decide frequency, duration, change after relapse? PHP, Evaluator, Tx Provider?

7. TPAs Is having the TPA provide the PHP management software a good idea? Is it a conflict of interest for programs to mark-up the price for a drug test and take profits? Registry for TPAs FSPHP authorized? Accredited?

8. Ethanol Monitoring  EtG,EtS, pEth – (i.e. cutoffs, EtG immunoassay, normalization to creatinine 100, warning regarding products to avoid, confirmation of drinking with PEth,  Protocol for use with EtG that “proves drinking?” SCRAM/TAD – transcutaneous monitors Home/work photo/voice recognition breathalyser

9. Interpretation Issues Dilute urine Missed check-in Missed tests False positives and negatives Second hand exposure Out of range: temp, pH Invalid test Consequences for each?

10. Best Practices “Document” What should this document be called? –Best Practices, guidelines, other? What will be the format for this “document”? –Published paper –Pamphlet –Digital –Web-based –Some form of Wiki document –other How will this document be produced? How will this document be maintained? How will this document be distributed? Who will oversee validity?

11. Participants on Prescribed Drugs How to designate test (positive, negative, other) when on legitimate prescription How to certify legitimacy 1.Valid prescription from any licensed MD 2.Require evaluation by PHP authorized MD 3.Never allow 4.Other