Welcome to, I don't know, MRO Controversies. Sounds like a good session. The way we're gonna, let's see how we have this, because I didn't know if you had an intro slide or not. Doug and I kind of tag teamed to put this together so I had to figure out who did what. To start off, I'm Dr. Natalie Hartenbaum, I'm a member of the MRO section, and I'm gonna be speaking a little bit about what's new going on in the MRO world. After we, Catherine Russo from Jackson-Lewis will be coming, visiting us remotely. Hi, Catherine, I think you can hear me, but I was told I couldn't talk to you otherwise. Dr. Martin, we'll have to advance your slides because that's the way this is set up right now. And then we'll finish up with the ever-popular MRO Jeopardy. I think you might wanna start thinking about who's going to be volunteering, because if you do not volunteer, you will be volunteered, and Dr. Martin has given me the authority to do so. So I will be scouting out, and if you don't have enough volunteers, you probably already know who you are that I may pick on, as I look at many of you. So anyway, gonna start off with what's new in MRO. I do serve as a chief medical officer at Norfolk Southern, this presentation I am speaking on behalf of IQ Medics and Dr. Natalie Hartenbaum. What I am saying is not the opinion, nor is it supported by Norfolk Southern, so I did my disclosure. What are we gonna talk about? Not a lot of really, really new stuff, really controversial stuff, but a little bit about some of the new rulemakings. And it's always interesting when rulemakings kind of come out seemingly out of order, which I'll point out why I'm saying that as we go through it. Look at the revised CCF. Yes, you should be using it by now. Yes, the oral fluid piece is there. I know you shouldn't be using it, but just as importantly, you don't have to be using the new CCF. But if you use it between date A and date B, you've gotta do a corrective memo. It's really stupid. I'll explain when we get to that. ODABSI had requested oral fluid, put out an NPRM for oral fluid. ACOM did, thanks to Dr. Martin, finally submit the oral fluid comment from ACOM. That was submitted on Friday, on the 30th. And yes, we are supportive of oral fluid testing, but there were a few other little funny things in there that we did comment on. The other thing that gets a little bit more fun is after the oral fluid guidance from DOT came out, the oral fluid and urine guidance from HHS, Health and Human Services, and I'll explain how the two interface, kind of in the opposite order of how they came out, and some of the recommendations in there which are a little bit different. And we will want some input. If you're a member of the MRO section, you already heard me cajole, threaten, that I'm really looking for input. I will continue to do that here. It's two very, very large documents. There's a lot of things that will be changing about how we do things, and I really would welcome input from as many people who are willing to do so. I'm happy to put it together, but I really would love if you all would do the best you can reading through even a small portion of it and provide some comments. Mention a little bit about the Drug Testing Clearinghouse from FMCSA, and finally just present some of the data from the Quest Drug Testing Index from this year. So by now you already probably know where the drug testing form can be. You can find the link and the explanations and the instructions from that link. You probably already have it from your lab, probably already using it, probably already wishing, why can't I do the oral fluid box? Not yet. Again, I circled this. The oral fluid is there because the intent was that oral fluid would be available. It includes little boxes for oral fluid, split specimen, concurrent, subdivided. What's the expiration date? The expiration date piece on the oral fluid is important because that will become a problem as different clinics are trying to stock both urine collection devices and oral fluid devices to be used as an alternative specimen if the person can't provide the urine specimen. But you've gotta make sure that the oral fluid devices, which have not very long expiration dates, are current. And you have to make sure that gets marked down. The labs are a little concerned of who's gonna be responsible for monitoring that. So we have the new forms. They came out a while ago. Prior to that, we were using forms in 2017. But what happened? Well, the forms weren't exactly ready because due to COVID, there was a paucity of the appropriate paperwork to do the kind of one copy, write hard, and it goes through to the other ones. So what they've said, that we can now continue to use the old forms through, what was the exact date? I don't think they gave us an exact date. You can continue to using it until the, there was no exact date, I'm remembering that now. November 21st, 2020, there are two dates given. When you're supposed to start using it was August 30th, 2021. But you could start using it again, or use the, sorry, let me start over one more time. Because this is, these were really confusing ones. I'll be really honest, I must have read these like five or six times to understand what they were saying. Did you find the same thing with the set of, thank God. I thought it was just me. But they really were confusing. So we were supposed to be using the new form by August 30th, 2021, okay? Some people were still using the form after August 30th, 2021, which they weren't supposed to. We were then told in November that we could start using the old form all over again. So as of now, we can use the old form, okay? But if you use the old form between August and November, you have to do a correction memo for that because you were using it when you weren't authorized to do so. Don't ask, I don't write these rules. They're written by the NCAA. They're written by the NCAA, he said. Not gonna get, yeah. Anyway, so the oral fluid, what was, again, ADAPC proposed amending the transportation drug testing programs to include the oral fluid. We have a lot of benefits in oral fluid. One of the biggest ones is finally getting rid of that shy bladder situation. Theoretically, oral fluid testing is cheaper. It is easier. It is harder to adulterate. It is harder to substitute. However, there's always an industry and there's always people who are smarter than the regulators. So there are adulterants. There are lozenges that you can take to cleanse your mouth to potentially adulterate it. You can also come in with something in your mouth. So even though it's observed, you can still be giving a non-your-own oral fluid. It is not necessarily cheaper, and one of the reasons it may not be cheaper because, as I mentioned earlier, you have to change out the oral fluid devices to keep them current because they'd expire in a much shorter timeframe. So you may have more costs associated with replenishing and monitoring the expiration dates. And whether or not the cost of the MRO and the labs are gonna really be significantly different is hard to tell. However, it is a lot better when we're looking at impairment. We recognize that the drug test positive does not mean that the person is impaired. We do not always know when they use the substance. The oral fluid window detection is much shorter. So there is a higher likelihood, but not positivity, that the person may still have that in their system at the time they pop positive for oral fluid. Comments were extended to, as I said, April 29th, 2022. I think what happened was the original closing date, nobody commented. So that's already been done. We're waiting for the final recommendations or the final rule. So what did they propose? Remit oral fluid as an alternative drug testing method for DOT-regulated workplaces. What would need to be done is that the employer would need to work with the collectors to set up a protocol of, if the person can't provide a specimen, you can go on and do they. Otherwise, the collector has to go back to the employer to say, should I do this if they can't provide a urine specimen? Or the employer can decide, I want to do only oral fluids. Or the employer can decide theoretically that they want to do oral fluids in one category of employees and urine in a different category. So it gives an option, depending on what you're really looking for. For those industries that want that longer window, they may continue to use urine and they may decide to use oral fluid as a secondary. They don't have to. It's just an option that an employer can think about using as a second possible specimen. They want to interestingly harmonize the wording when needed with the new mandatory guidelines for federal workplace drug testing programs developed by HHS. Now what's interesting is that this came out in February. And it came out in January. The first notice was for February. It came out in January. And in April 7th, we have the newer HHS guidelines, which are now contradicting the current DOT guidelines. They're still out for comment. They're not final rules yet. One of the other things that will allow direct observation on a urine specimen by any licensed healthcare professional who can perform examinations when you need an observed specimen, observed collection right now. Observed collections can only be done by someone from the same gender. This will be very helpful, especially in some remote areas like where Dr. Martin lives. There's not that many people available. And in order to find a collector that's the same gender, it's a little harder. So if this goes through, that will be permitted to have someone who is a licensed healthcare professional to be an observer for that type of collection. The next is to allow an MRO assistant, MRO staff to contact the pharmacy to verify the drug test. I don't know about many of you, but I've had a really hard time with a lot of pharmacists even wanting to talk to me as Dr. So-and-so, Dr. Medical Review Officer for such-and-such railroad. I want to verify that this prescription, which I have written in my hand for such-and-such person on such-and-such date with RX number such-and-such, can you confirm that this is accurate? It's a HIPAA violation. I can't tell you anything. I think that if they're talking to an MRO staff member who doesn't have that doctor or something in front of their name and can't better describe who they are and why they need to know, then we see even more pushback with trying to get that type of information. When it comes comment was that really what we need here is more education for the pharmacy. This is not a HIPAA-protected piece of information. It's just simply verifying for a federal drug test that the information we have is accurate or not. So we'll see what happens with that one. It will allow a MRO to uncancel a test that has already been canceled, that already exists in certain situations where the individual was unavailable to respond and provide information for a positive, a laboratory positive test. This just allows the individual to provide information for a test that may have been canceled for whatever reason, whether it was temperature, whether it was a possible substance present in the urine or not. So it'll allow the MRO to uncancel the test. Allows different identification numbers to be used rather than just a social security number for FMCSA, clearly we're already primarily using driver's license. This will allow that with the regulations. It requires laboratories to provide to DOT biannual reports, categorized by test reasons and sub-specimen type. Now, they're requiring the laboratory to require biannual reports, or this is annual reports, but the HHS proposal actually is gonna require MROs to provide biannual reports, or twice a year reports, depending on how you say it. And then laboratories have to provide the DOT with final data for the reporting period if they withdraw. If they stop submitting specimens or stop collecting, stop testing specimens, they have to provide a report to the National Library Certification Program and to DOT. They're shortening the period of time that laboratories have to maintain negative drug tests to only 90 days. They require the phone number provided on the collection is the collector's direct number. Right now collectors are putting down their employer's phone number, if they have any questions. Collectors do not want to put down their personal phone number. A lot of collectors kind of use their home office, they kind of work for a collection site, or in many situations, many different collection organizations. So they really don't want to put down their own personal phone number. But this is felt to be fairer to the individual who's providing the specimen, that if they have a problem with how they think the collection was done, they can reach out to that collector and complain. Again, a lot of comments on that, I've been seeing both ways. They removed some of those redundant, non-necessary provisions, and they are eliminating all the cross-referencing. Right now in the regulation, there's a lot of a see-also. The assumption is, whether it's accurate or not, that a lot of these individuals will be accessing the regulations through the internet, through their website, not on paper. So they put in the term they're looking for, split specimen, verification, invalid, adulterated, and they'll be able to easily find each of the different sections that relate to that particular term. I like the cross-referencing. It is a little bit more redundant, it has a lot more material in there, but they're trying to streamline the document itself. Adding some clarifying language, and then this is a continuation really of COVID to allow the SAP to continue to do evaluations remotely, as they've been doing now during COVID. A couple of the requirements to make this adequate is there has to actually be adequate technology where the SAP and the individual can see each other, speak to each other simultaneously, not a video-less interview, and it has to be reliable enough to be consistent. So those were a lot of the major 14 points they were seeking comments on. We commented, we, ACOM, Dr. Martin, commented on several of them, but some of them we really felt were outside of our wheelhouse and were not commented on. Can I ask if you want to add anything to it? No, we've covered it. Okay, thank you. Some of the other key proposals where they weren't really seeking any types of comments, they were questioning on whether or not, or they were adding oral fluid training requirements, and that will be a new requirement that if you are an MRO, you will need to learn about oral fluids. The question was, if you're a current MRO and you're not due for recertification for retraining, should you have to take retraining right now? Probably so. It is gonna be very different. There are gonna be some changes in how we assess it, how we evaluate the adulterated, the unadulterated. I do think it's probably not unreasonable, even if it's a short course, to make sure that all the MROs are aware about how oral fluid testing should be interpreted. They emphasize that the drug or alcohol test that is done as a part of an examination for a federal Department of Transportation agency can certainly be done. If an individual comes in, long, curved fingernail, they have a perforated septum, they're reeking of alcohol, they tell you they're using THC for their back pain, but it's not real THC, whatever they wanna tell you, and you wanna go ahead and do a drug or alcohol test, you absolutely can do that as part of the examination. You cannot say it's a DOT. It is not a regulated test. It's a non-regulated test, done on a non-regulated form. You do not need to report to the clearinghouse. You do not need to do any other reporting. It is a non-federal test, non-DOT. It does not fall under the, now they've gotta go to a SAP, and now they've gotta go through follow-up testing and return to work and all that kind of stuff. The one thing which is also nice that they did clarify, that at the time of a pre-placement, pre-employment, physical examination, the employer may request to have that pre-employment, and yes, that's the term they use, pre-employment drug test done at the same time as the examination. In general, you would not be doing a drug test at the time of an examination, unless it is a non-federal test. One more. Right now, as actually Doug mentioned just in the last room we were in, they're talking about doing split specimens for oral flows. If you've done an oral fluid collection, you can't do a split specimen trying to pour that little teeny tiny bit into a second bottle. There's absolutely no technology out there that would allow that. So they say allow split specimen. Obviously, that's not going to work. Fortunately, at the HHS proposal, they will allow serial testing, which is specimen A, specimen B, label them A and B and send them off that way. Emphasize that DOT drug tests can only be conducted on safety-sensitive employees as designated. A company cannot decide, oh, we're going to test everybody in this workplace, even though 50% of them are regulated and the 50% are not. That's why we have our numbers. We're going to put them all in the pool. No, you can only consider someone who is covered under DOT in a safety-sensitive position as part of that pool and reaching your regular numbers. Talk a little bit about it. Alternative specimens, if you have an employee that you don't like, and you know they're using something because someone told you they're using something, you send them for a drug test and they come back negative on urine or oral fluid, you can't go turn around and send them for another test. You get one shot at it. So those were some of the proposals that were in the ODAPSI's Department of Transportation's Oral Fluid Rulemaking. Now, the rules, the HHS, to give you the idea, just a refresher, really, of how this gets done. Department of Health and Human Services oversees all the federal drug testing programs. They put out their mandatory guidelines. The federal agencies then write their implementing regulations that says this is how we're going to do it. It usually follows very closely against HHS, but not always. There are several components in the HHS procedures that are different than from Department of Transportation. So they've put out on April 7th their procedures to update both urine and oral fluid. These are your websites if you want to read through. I have them in my bag. They're about this thick, two-sided each. But please do look at them and give me some comments of what you think. Couple of the major changes. One of the biggest one is probably having to do with the analytes and cut-offs and biomarkers, that what they would like to do, because over the years there's been a lot of thoughts about how do we change what we test? How do we change the cut-offs? I should look at my time, okay. How do we change the cut-offs? How do we add things such as fentanyl? How do we change the amphetamines? Right now it has to go through a formal rule-making process where they publish it in the Federal Register, they seek public comment, they evaluate the public comment, and then they put out a final rule. They want to be able to annually put out a, this is what we're going to test for, this is the cut-offs we're going to use, do it. They will allow each agency to go back and say, okay, we want to go ahead and continue to test for this, we want to change this a little bit, and they can petition for it. But the bottom line is HHS will put out their guidance on an annual basis with no comments needed. The other big thing I think is really changing the morphine coding situation. Right now we evaluate, we clinically, theoretically evaluate for clinical evidence of abuse if the morphine level is less than 15,000. They are increasing the confirmatory level or proposing to increase the confirmatory level of morphine to 4,000. If it's above 4,000, it's a positive test. No more clinical assessment. In their studies, the only way they were finding people who had significantly elevated morphine levels after high levels of raw poppy seeds, they probably were making you sick anyway. And they would be clarifying that any substance that's ingested is not going to be a valid explanation for a positive test. That includes any of the morphine, it also refers to any of the cannabinoids. So if they end up testing positive for THC, they can't go ahead and say, okay, it's the CBD, it's the delta something else. No, if you've ingested it, you shouldn't have, it's a positive, it's a positive, end of story. It's eliminating that clinical evaluation. For oral fluids, they're gonna also change that where we don't have that evaluation needed to be done for morphine once again. Right now they've removed the requirement for MROs to evaluate and report specimens with morphine or codeine between cutoff and 15,000 as positive. If there's clinical evidence, right now they just report it as negative. So it's a little bit opposite of what was put in for morphine for the urine's testing. Also proposed changing the report from invalid to substituted when a biomarker's outside the normal human range. This is the proposed modifications to the urine cutoffs. The only really important one is that 4,000 confirmatory cutoff for morphine. A few clarifications for the MRO. If you are doing a collection and the individual cannot provide, whether it's the oral fluid or the urine, there's no need to do a medical evaluation to say, is there a reason this person could not have provided this specimen? You just go to the other specimen. So there's no medical evaluation needed. The tricky piece here is going to be making certain that the collector and the employers have in place before collections start, what happens if the individual cannot provide the specimen that the employer chose as their primary specimen? Do they automatically go to the other one? Or do they say, no, we want the evaluation done. We only want to do urine. We want that longer window of detection. Or we only want oral fluid because we only want, so again, there's a lot of nuances that I suspect most employers will not understand. Again, these are proposals. They are not final rules. These are from HHS, not DOT. So at some point, they will trickle down to DOT. Right now, we need to comment that the agencies understand what the potential problems are. Reminding right now, if a specimen is invalid, you only report that invalid if the other specimen has been reported as negative or if the specimen was tested and reported as a failure. So you don't report multiple specimens. You only report one of the results. Another big change is that the donor says, I've used fill in the blank. I've used my spouse's hydrocodone or yeah, I was at a party and I accidentally drank this. If the individual says, I did this, I shouldn't have, you've got to report it as a positive. No more, you know, squirrely of maybe you did, maybe you didn't. I know I've always been hesitant to do it for the simple reason they can easily turn around and say, that's not what I told you. This proposes you document it, you report it as a positive, you tell it as an agency. Passive exposure of ingestion of any food product, any drug is not a valid explanation. So for example, if you're drinking an entire bottle of Starbucks vanilla syrup, there's alcohol in there. You may not realize that if you're doing any kind of testing, ETH, ETG, ETS testing, you're going to find that if you drink enough Starbucks vanilla syrup, there's alcohol in it, it will test positive. So if you drink a whole bottle of it, it may hit you positive on an alcohol test. It may still be in the mouth after 15 minutes, probably not, but possibly doesn't really matter. Ingestion, inhalation, any way of any other substance is not going to be a valid explanation for a positive test. Nor is a physician's authorization, recommendation, or anything else. So we all know that just because the doctor said you can use THC, doesn't matter. Federal drug testing, it's a positive test. Talked already about removing that 15,000 nanogram decision point, requires the MRO to report semi-annual reports to the designated HHS representative for each federal agency. So what that means is if the lab reports something as a positive and you downgrade it to a negative, you've got a report twice a year of what the lab for the report was and why you downgraded it. So they can have some control over the program. They also expect that the federal agency is responsible for designating the MROs, credential them more appropriately, verify that they are able to actually be an MRO, and then make certain that all the drug tests are reported consistent with the guidelines. So that was the HHS proposal. We really would appreciate any kind of comments or inputs that anyone might have. We can pull together to submit as they come. The Clearinghouse is still in effect. You still have to report your results to the Clearinghouse. They are finding a lot of positives. Not surprisingly, it's marijuana. Clearinghouse did recently put out a reminder. I urge you to please share this with your companies, share this with your drivers, share it with anybody you want to, but I'm seeing way too many problems with CBD still being considered as a possible explanation for a positive THC test. The other thing I just want to remind everyone that CBD is not a prohibited substance under the Federal Department of Federal Motor Carrier Safety Administration's medical examination. It is CBD in its appropriate form, as appropriately used, is still a legal substance. If it has adulterants in it, that's your problem, so you need to be warned, and if you want to accept that risk, that's your risk to accept, but it's not a valid explanation. Before I ease into the next speaker, just a reminder once again, lots of announcements, reminders on medical marijuana, Department of Transportation, no way, no how, forget it, let's not even talk about it anymore. Still getting employees that walk in and say, yeah, I use medical marijuana on their Department of Transportation medical examination form. You know, sometimes I just wonder. And finally, the Quest Diagnostic Drug Testing Index for 2022, rate of positivity highest since 2001. Overall positivity was up at 4.6 percent compared to 4.4 in 2020. Most of it was positive in the federally mandated safety sensitive workforce, but that kind of stayed kind of even over the last couple of years, and not surprisingly, in the general workforce, marijuana was the highest positive driver. So that's the end of mine, and I will ask Dr. Martin if there's any questions for me, hopefully not. I'll read what's on the chat here, kind of a difficult syntax. No need to give report before. I'll repeat it. No need to give report before. Is that one more piece of data that will sit somewhere where the undermanned government department will never look? Why is that a question for me? Okay, so this report that we have to give twice a year, will it be something that will just kind of sit and nobody will look at it, and it will be kind of useless? I think it's a really good comment to make of what will be done with those results. Will MROs be held accountable? Will they be challenged if they are downgrading? You know, I think it's an appropriate question of what are you going to do with it? If we have to do a report, we want to know what the outcome is. That's it. Okay, I am now going to turn the podium over to Catherine Russo. She's an attorney with Jackson Lewis, who is just an amazing, I guess her blog is great. I follow it all the time. If you don't, Catherine, I'm sure will give you how to track it down. She does a lot of regular emails on drug testing programs, policies, marijuana testing throughout the country, and she's going to really talk about state and local marijuana laws impact on employers. So hopefully this will work well. Do you want to go ahead and do those? Okay, hello everyone. I don't see the PowerPoint now. Here we are. Okay, so I'm Catherine Russo. I'm delighted to be here with you again this year. I'm an employment attorney, so I'm going to be talking to you about marijuana laws, state and local marijuana laws, and I'm really going to be talking about their impact on employers. I'm a defense attorney. I represent employers, and given the, you know, vast number of laws on marijuana now, this is an issue that employers are really struggling with. So can we go to the next slide, please? Thank you. So I'm going to give you just a little bit of background on the federal, where we are with federal law. Then I'm going to talk about state and local laws, and in particular, I'm going to talk about laws that were enacted in the last 12 months, right? Because I gave you an update last year, and it seems like every year we have, you know, a whole bunch of new laws that came out, and you know, as an employer, it makes their heads spin around a little bit trying to keep up with all of these. The next thing I will talk about is that there are some laws that do address safety-sensitive positions, and I think this is something for employers to think about and make sure that in the states that have those laws, that they're complying with that, because it may give them a way to get around some of these marijuana laws. And then at the end, I'm going to talk a little bit about what to do about CBD, which is a whole other headache. All right, so just by way of background, let me take a few minutes to talk about where we are with federal law. So next slide, please. So technically, as you know, we're still at the stage where marijuana is still illegal at the federal level. It's still on Schedule 1. You know, Congress and the U.S. Department of Justice has taken a hands-off approach with regard to marijuana for many years now. You may have heard, of course, that the Moore Act was recently passed by the U.S. House of Representatives. I don't think the Senate's going to do anything with it, and reportedly there are a group of senators that are working on their own legislation to legalize marijuana. So we're waiting to see how that shakes out. In addition to that, you know, we've got, you know, the Farm Bill that was passed in 2018. You know, there's been one drug that the FDA has accepted, CBD, for certain types of epilepsy. But, you know, the big problem that employers are facing is that, you know, the FDA really isn't at the point yet where it's regulating CBD and hemp products, and these products are just everywhere. You know, and most people, what employers are struggling with is that employees, who are not lawyers, think that, you know, they can buy these things because they're being sold in the supermarket, on the internet, and everybody thinks they're legal and they're safe. And then they test positive on a drug test, and it creates all kinds of problems. So, thank you. So just by way of background, before I kind of go into all of the crazy state and local laws, just as a threshold, I'm not talking about DOT-regulated employees, right? So if you have DOT-regulated employees, they can never use marijuana. The employer is required to test them for marijuana. And if they test positive, they cannot perform safety-sensitive job duties. So that is still a given. The real problem for employers, though, is, well, what about everybody else? What do we do with all of our non-DOT-regulated people? And, you know, do we have to really comply with all of these laws? You know, and it's just a little background, too. Even if the employer is a federal contractor, and I've been getting this question a lot recently, even if you're a federal contractor, that's not really going to be a defense to say, I don't have to comply with state and local marijuana laws, because the courts are now saying, look, the federal government is not enforcing the law that makes marijuana illegal, so the courts are going to enforce state and local marijuana laws. So, you know, the advice I'm giving is that employers need to know the marijuana laws in the states where they operate. Okay. So here's the number. This slide changes constantly, right? So here's where we are today. We've got 37 states plus D.C. that have medical marijuana laws, 18 states plus D.C. have recreational marijuana laws, and then 18 states have separate CBD laws that, you know, allow CBD use for medical purposes, and that's separate from the medical marijuana laws. There's two cities that prohibit pre-employment marijuana testing, and then, you know, one state that limits adverse actions for positive pre-employment marijuana tests, but in addition, there are a few other states where I don't recommend pre-employment marijuana testing, among others, because now we're starting to see recreational marijuana laws that protect off-duty use, and that is creating a huge problem for employers. Okay. So I'm going to start with the recreational marijuana laws, and what's interesting about this is that, you know, a few years ago, it was the medical marijuana laws that were creating kind of the big problems for employers, and I always said to employers, don't worry about the recreational because, you know, you're not required to allow people to use recreational marijuana. Don't worry about that. It's really the medical that you have to worry about because the person has a medical condition, and you need to think about accommodations. Now that's really changing a little bit, so let's go to our next slide. So now, so here are the states that have recreational marijuana laws, and you can see I put a little asterisk next to states that are starting to have, you know, protection, legal protections for people who use marijuana off-duty, and the reason that's significant, as you know, you all know, is that, you know, for most employers who use urine drug testing, you know, a urine drug test is not going to tell the employer when the person used marijuana. So in a state where, you know, recreational off-duty marijuana use is protected, you know, it's very difficult to take a drug test and then for the employer to impose an adverse employment action. So now, you know, New Jersey and New York, I think, are the worst right now, which I'll talk about in a second, but this is now starting to grow, and we're starting to see more and more states that are going to protect off-duty recreational use. So I'm just going to take you through the newer recreational marijuana laws, again, in the last 12 months. So Connecticut made marijuana use legal, you know, recreationally last July. The good thing about Connecticut, I think Connecticut has a little more sense than New York and New Jersey do, because there are some provisions that will take effect on July 1st of this year that are going to allow employers to take adverse actions if you have a written drug testing policy, and there are also a whole host of exceptions for certain types of industries and certain types of safety-sensitive jobs. So, you know, the bottom line is if you have a safety-sensitive employee in Connecticut and you have a written policy, you're probably going to be fine to continue testing for marijuana. Montana now has a new recreational marijuana law as of January 1st. Again, all off-duty use is protected, but the good thing about this law is that there are some exceptions for safety-sensitive jobs and where the testing is conducted, again, pursuant to an established policy or collective bargaining agreement. New Jersey, okay, New Jersey and New York, the worst. So New Jersey, I find, gives people the biggest headache. So New Jersey legalized marijuana last year. You know, off-duty use is protected and the law is very poorly written and it will, when these regulations come out, which have not come out yet, we're waiting for the New Jersey Cannabis Regulatory Commission to come out with regulations that will require employers to have a trained workplace impairment recognition expert who will evaluate the employee before sending them out for a drug test. And we're all kind of waiting to see what exactly does that mean. We don't know. These regulations are expected to come out possibly later this year. But right now, I'm telling employers in New Jersey, you cannot test for marijuana on a pre-employment test or random test. I think you can still continue with your reasonable suspicion testing as long as you've documented the reasons why you're doing the test. And post-accident, I'm a little bit on the fence about because you know, again, the person is going to argue, well, you know, I used marijuana last week and I wasn't high when I got into the accident. So just be aware, post-accident testing may be a little bit tough. And if you're in New Jersey, just be on the lookout for those regulations to come out later this year. Okay, New Mexico has a new law that was effective last year. Retail sales started there very recently. The good news about this law, it doesn't have explicit employment protections for applicants or employees. New York, which is where I am, is my least favorite marijuana law. So New York legalized recreational marijuana last year. And the Department of Labor then issued some guidance in October that I think is just horrible. And basically the bottom line is employers can't test for marijuana in New York for any reason at all. All off-duty use is protected. And even though there's some language in the law that says you can test when there are articulable symptoms of impairment, meaning reasonable suspicion, the Department of Labor then went on to say, well, even if you have articulable symptoms of impairment, you really can't take an adverse employment action because there are no drug tests that can detect very recent or current use. So guess what, employers, you can't do any drug testing for marijuana. And this is just absolutely mystifying. I can't even tell you how many employers in New York I've spoken to recently who are just outraged. There are no exceptions for safety-sensitive jobs. There are no exceptions for safety-sensitive industries. It is absolutely shocking. But this is the law in New York state right now. Now, you may recall New York City in 2020 came out with their own law that banned pre-employment marijuana testing, but there were some good exceptions for safety-sensitive jobs. So a lot of employers are saying, oh, well, I can still go with the New York City law, right, and I can test if it's safety-sensitive. And my view is you can't, because you've got the New York State law that really kind of preempts the New York City law. And New York State protects all off-duty use. So in effect, there's no pre-employment marijuana testing allowed anywhere in the state, even in New York City. Okay. Philadelphia has a brand new law as of January 1st this year, does not allow any pre-employment marijuana testing. Theoretically, there were some regulations that were supposed to be published to give us some exceptions for certain types of safety-sensitive jobs. We're still waiting for those regulations. They haven't come out yet. Virginia has a recreational marijuana law that took effect in July of last year, and there are no employment protections for applicants or employees. So I think in Virginia, employers can still take adverse actions when someone tests positive for recreational use. So that's the summary of the new recreational laws. The trend I will tell you that I'm seeing, and this is pretty much in all states where recreational use is now allowed. I've spoken to many, many employers who were just saying to me, we can't recruit. Everybody thinks marijuana is legal now. It's legal in many, many states. And so applicants are just kind of shocked to find out that when they apply for a job, they have to take a drug test. And if they test positive for marijuana, they're not going to get the job. And given that it's such a tight labor market now, employers are just saying, you know what? We're not going to test for marijuana. Even in states where you're allowed to test, many employers are saying, we're not testing for marijuana anymore because it's just making our recruiting efforts just too, too difficult. Okay. So now let me go through the newer state medical marijuana laws. And this is also a gigantic headache for employers because they're all so different. So Alabama has a new one that came out last May. I like Alabama because there really are no express employment protections for medical marijuana users. And the law also does not allow employees to sue their employers. So that's a good one. Mississippi came out with a new medical marijuana law this year, no express employment protections for medical marijuana users. Employers can enforce their drug testing policy. Employers and their workers' comp carriers don't have to reimburse, which is great because there are some states where you do have to reimburse for medical marijuana related expenses. And again, there's no private right of action for employees to sue their employers. Okay. Virginia has a medical cannabis oil law. This one is a little, a little bit of a hybrid law, right? Because usually, most of the laws fall into medical marijuana or CBD. This one only protects medical cannabis oil use. Again, though, when you get a positive drug test result, the employer's not going to know whether the person was smoking it or using medical cannabis oil. But I do warn employers that the law prohibits discrimination against users of medical cannabis oil. So I think if an applicant or an employee claims to be using this, I think the employer has to proceed a little bit cautiously before they refuse to hire or they fire the person. So these next couple of slides just show you how I categorize all the different states. I see them in several different categories. These are the high risk states, either because there have been court cases with rulings against employers and or because there is explicit language in the statute that says employers may not discriminate against medical marijuana users. And you can see it's a pretty big list now. So employers in many, many states cannot discriminate against people who use medical marijuana. Now, that's not to say you can't take an adverse action. You might be able to, and I'm going to get into this in a moment, in certain states for safety sensitive positions. Next slide. This second category, these are the states where I think the legal risk for employers is just a little bit uncertain, right? You know, that the law doesn't explicitly protect employees or applicants. I haven't seen court cases, so I'm not a hundred percent sure what would happen in these cases, so in these states. So in general, what I'm telling employers is just be careful. You know, if you've got somebody in Louisiana who tests positive and they tell you they're a medical user, you know, maybe we have a discussion before we make a decision. And then this final category, these are my favorite states. So these are the states where either there have been court rulings that are favorable to employers or the law actually says, like I was just talking about Alabama and Mississippi, there are some state laws that say, you know, employers can still take adverse actions and employees can't sue their employers in these states. So these are my favorites. Now, having said all that, just realize when you're dealing with medical marijuana, it means the person has a medical condition, right? So I always warn employers, look, even if you're in a good state like Alabama or Ohio, if the person comes in, like you have an applicant who comes in and tells you a whole big story about how I have this medical condition and that medical condition and my doctor wants me to use medical marijuana and they kind of spill their whole life story to you, you just should always be thinking about what's the possibility of just a general or generic disability discrimination claim, which is legal in every state, right? So even if you're in a state like Florida that says employees can't sue their employers for a medical marijuana issue, the person could hire a lawyer that just says, well, this was just general disability discrimination, so I'm still bringing my lawsuit. So that's a little side note for employers to just keep that in mind when you're making decisions about these issues. So in general, as far as general work rules, it's totally acceptable in all 50 states to prohibit use and possession of marijuana at work as well as being impaired at work. So that's still fine. It's really the whole drug testing issue that is so complicated. You know, for employers and, you know, when communicating with their MROs, you know, I always tell employers, just make sure you're on the same page with your MRO. Make sure that if somebody claims, if they tell the MRO, I'm using medical marijuana, or even now if I'm using medical CBD or CBD for a medical reason, you know, that's fine. I think the MRO should still verify the result is positive, but just tell the employer, this is what the person is claiming. They're claiming to use medical marijuana or CBD for a medical reason. And then it's up to the employer. The employer then needs to assess, you know, what's the level of risk in that state. You know, they may have to verify whether the person has a medical marijuana card or they're authorized by their doctor to use this. You know, think about whether the job is safety sensitive, you know, gather any other information from the person's physician, and then they have to do their whole direct threat analysis, which is to kind of decide, you know, if we allow this person to do this safety sensitive job, knowing that they use medical marijuana, what's the risk? What do we think the risk will be? And so this is, you know, for medical marijuana, I've been telling employers, you know, we need to start thinking about it like other prescription medications, especially if you're in a state where the legal risk is very high, meaning that discrimination is prohibited. So rather than just saying, oh, I can't have a medical marijuana user in this dangerous job, we need to assess it on an individualized basis. And again, you know, these are, you know, that one of the things I have to stress to employers is avoid blanket rules about medical marijuana. Many employees will say to me, well, you know, we have a very, very dangerous workplace here. We have a lot of people operating machinery and driving forklifts. So can't we just create a list that says, you know, these are the jobs that are too dangerous for a marijuana, a medical marijuana user? And the answer is no, because under the Americans with Disabilities Act and related state laws, you can't make blanket rules about the use of any medication. So this always has to be done on an individualized basis. So even if you've already analyzed the issue with regard to four other forklift drivers and now the fifth one comes in and says, I need to use medical marijuana, we still have to assess it on an individualized basis. And that basically means you've got to have your dialogue with the person, gather information from their doctor and make sure your human resources professionals are trained and your managers are trained to have that kind of dialogue. And you've got to do this direct threat analysis, which is, is there a significant risk of substantial harm to the health or safety of that employee or others that cannot be eliminated by a reasonable accommodation? Now, reasonable accommodations are lots of different things, right? It could be, you know, a waiver of a positive test result, especially for pre-employment or random. You may just have to throw out the positive and say, okay, given all the information we have, we're gonna hire this person and, you know, just hope that they don't use marijuana, you know, at work or immediately before work and that it all works out. It could also be modifying their work schedule. It could be a leave of absence, an exception to certain policies, and, you know, lastly, possible reassignment if we can't work out any other type of accommodation. Now, I wanted to spend a couple of minutes this year talking about these laws. I've been getting a lot of requests from employers to highlight the marijuana laws that allow employers to, you know, make an adverse action because the position is safety sensitive. And there are a few states that allow this. So, you know, the one that jumps to my mind is Arkansas. So if you have, if any of you operate in Arkansas, you know, one thing that the employer really needs to know is that if you designate a job as safety sensitive, you know, in the job description or the job posting, you know, that is really going to help you tremendously because if you have, for example, you have an applicant who comes in for a safety sensitive job and then test positive on the pre-employment test and says, oh, guess what? I have a medical marijuana law. And Arkansas says, you can't discriminate against me. If you've designated that job in writing as safety sensitive, you don't have to hire that person. So, but it's really, really important that you do that in writing. I'm just, I'm aware that a client of ours was just hit with a class action in Arkansas a couple of weeks ago because the plaintiff's attorney is arguing, well, you didn't designate your jobs as safety sensitive in writing. And then you refuse to hire all of these people who use medical marijuana. That violates the law. So this is really, really important in Arkansas. Nevada, as you may know, does not allow employers to refuse to hire an applicant unless the job is safety sensitive. The good thing is that it's in the opinion of the employer. You don't have to designate it in writing, although I would recommend that you do it. But if you think, you employer, think the job is safety sensitive and they test positive for marijuana, you don't have to hire them. Oklahoma also has a similar law. Again, the employer can take an adverse action against somebody who tests positive for marijuana and claims to be using medical marijuana if the job is safety sensitive. And then they give a whole long list of what they consider to be safety sensitive. You know, most of these are pretty, I think obvious operating vehicles, machinery, repairing equipment. These are all the types of jobs that would be considered safety sensitive in Oklahoma. Now, the last two, Pennsylvania and West Virginia have some language about safety sensitive jobs, but it's troubling to me because the way the law is worded, it says that an employer can prohibit an employee from performing these types of job duties while under the influence of marijuana. And they don't define, what does that mean? What's under the influence? Does it mean a positive test result? Does it mean you have to have signs and symptoms of impairment? They don't say, so I'm not 100% sure, but at least the employer should be aware that there is some language in Pennsylvania about safety sensitive jobs. And same for West Virginia. They have also a list of safety sensitive jobs, but again, it's the language is, you know, under the influence. So an employer does not have to allow somebody to do these safety sensitive job duties while they're under the influence, but it's not really clear what that means. Okay, and then the last thing I just wanted to touch on are other cannabis products and state CBD laws. You know, we're seeing, this is becoming a huge, huge problem for employers now. So next slide, please. So, you know, as I said earlier, these CBD products are everywhere, every supermarket, every drug store, internet, Amazon, they're everywhere. So the presence of it being everywhere makes people think these products are legal, everybody's using them, and then they seem to be a little bit surprised when they test positive on a drug test. So one thing I've been telling employers is to just keep in the back of their minds is that there are 18 states that have CBD laws that allow, you know, the use of CBD for medical reasons. And this is separate and apart from the medical marijuana laws. They're all different. They cover different medical conditions. They all, you know, allow different amounts of THC in the CBD, so it's crazy. So, you know, I mentioned the Virginia law earlier about protecting the users of medical cannabis oil. Most of these other laws don't have explicit employment protections, but again, I worry about a generic disability discrimination claim, and we're seeing a huge uptick in litigation involving CBD. My firm is starting to see a lot of lawsuits where the person applies for a job, you know, test positive for marijuana, the employer says, we're not hiring you, and then they say, oh, but wait a second, I'm using CBD, and CBD is legal under federal law, and or my doctor said I should use CBD for my medical condition. So this is really starting to become, you know, a big thing. We're seeing a lot of these suits. This is a recent lawsuit. I just mentioned it because it was favorable for the employer. You know, it's probably a little bit unusual in that, you know, the court dismissed the claims against the employer. It was basically because the employer had no idea that the employee was disabled, and there were no facts showing that the employer regarded the person as a drug user, which would also violate the ADA. But I think that's usually unusual. You know, what I said earlier is that, you know, 90% of the time the applicant or the employee comes in and just tells the employer all about their medical conditions and illnesses, and my doctor says I have to use this. This case was a little bit unusual because the employer didn't disclose her medical condition or that she was using CBD for medical reasons until after she tested positive. And so that's why there was a favorable result for the employer. But I think if she had disclosed it beforehand, you know, it might've been a very different result. So this is our blog, as Natalie mentioned to you earlier. I am the editor of my firm's Drug Test Law Advisor blog. We post anything that happens, whether it's a new state or city law or DOT issue. Anytime there's a new update, we post it on there. So please feel free to follow the blog just to keep updated on all of these issues. And I'm happy to take any questions now if there are any. We have two questions and just a general comment on the folks that are virtual. The first question is, is what are the marijuana laws in Texas? I'm reminded that Texas was their own country once. Yeah. Yeah, Texas does not have a medical marijuana law or a recreational marijuana law. They have a low THC law that took effect, I believe, last year. So yeah, that is something, you know, again, that's the kind of scenario where if an employee or applicant comes in and says, hey, I tested positive because my doctor wants me to use this low THC product for medical reasons, you know, the employer may wanna have a conversation before taking an adverse action against the person. Very good. The second is just a comment from Dr. Vrablich. I see urine THC and blood THC levels in medical marijuana users much higher than those who simply smoke marijuana. So do I. Second question. I may have missed this in the lecture. I assume that when working in a Department of Defense position, even as a subcontractor on a DOD site, marijuana use in employers is still forbidden. That is true. Yeah, it's federal. When we're dealing with a federal agency, yeah, there's no marijuana use is allowed. Please come to the microphones that I don't see in the stand. If you shout really loud, I'll try to repeat the question. She said that I agree that you should treat medical marijuana similar to prescription medicine. The problem with that is if somebody has a prescription for an opiate or anything, I can go to the pharmacy and verify that they have it. So I have a case, I'm in Virginia, where they have a medical cannabinoid law. She has a certified medical cannabinoid prescriber verification. She showed that to me. She said the prescriber that I talked to said, well, yeah, I sent it to the only legal dispensary nearby. And so I called the dispensary. The dispensary said, oh, yeah, we have the prescription. She just never came here to fill it, never had it. So she's getting it on the street, but. Yeah, so for those folks that didn't hear that, the issue is verification of medical marijuana in scenarios where it's not akin to having a prescription. There is no such thing as a prescription for marijuana. And what happens is, is oftentimes when the MRO tries to verify that with the marijuana dispensary that's authorized in the state, what happens if the dispensary has the authorization but no record of ever giving it to the person, right? So that becomes a problem. Right, Virginia's ridiculous because it's legal to test it, it's the only refurbishment we're selling. Okay, yeah, well, yeah, come to South Dakota. Dr. Burris. Yeah, just a quick question. A shipyard, a rigger, they do DOD, they refurbish the ships. I know they're gonna say, well, what should we do? Can we continue to test these federal, you know? Are they doing safety-sensitive work under a federal agency? They're not an agency, it's a private company doing DOT work, DOD work. I think that's what I'm saying, just because they have a federal contract doesn't mean they're covered under federal drug testing. Federal drug-free workplace program does not require drug testing. Okay, right. Does not require drug testing at all. Right, there's lots of contracting work out there. Let's go with this microphone. Yes, sir. Yeah, hi, I'm Michael Cosnett from Denver. Catherine, thank you for another very detailed and illuminating talk about all these laws. I was intrigued by what you said, that employers need to start treating medical marijuana like they treat other prescription drugs. Now, it is the case, for example, that employers, and I'm talking about non-federal workplaces, non-federally regulated workplaces, they can refuse a person employment or create a policy if a person uses a prescription opioid or, for example, is on methadone maintenance, right? They can say, you can't have this job. Michael, can you kind of summarize? First of all, we're running out of time, so we haven't had time. I'm just wondering, if our people, can workplaces allow people to use methadone, like on methadone maintenance, or to use opioids for pain relief and participate in safety-sensitive jobs and then say at the same time, no, you can use opioids, but you can't use marijuana? Depends on the state. Depends on the state, but your scenario currently exists in many states. Okay. Okay, yes, sir. He's last, right? Yeah, let's, quickly, if we could. Thank you, I'm Nicholas Pytel from Pennsylvania. My question is about being under the influence of work. So my question is, has anybody been successful in establishing that if your underlying condition is a perpetual condition, such as general anxiety disorder or seizure disorder, then the ongoing therapeutic treatment for that would necessitate a therapeutic dose while at work, and therefore you are under the influence during the workplace, or while you're in the workplace? I'm gonna take that as a, are they qualified or are they not qualified to do your job? Can you explain the problem? Okay. I would take that position being, is this person able to do the job because of the underlying medical condition? Or does the underlying medical condition make them unsafe? Does the treatment, potentially, make them unsafe? So I think you gotta do a lot of assessment in that individual, and whether or not they can use the THC as a treatment really depends on the state. All right, thank you. And the job that they're doing. Tom McClure, Montana. Does the fact that a hospital receives CMS federal dollars have any bearing on anything when we are required to have a drug-free workplace? No. Hi, Lori Orlando, Tennessee. Is there any recourse for an employee who works in a state where marijuana is not legal, medical or otherwise, tests positive on a random drug test, but says, I used it while I was on vacation in Colorado? For example. Good luck. Yeah, thought so, but just wanted to confirm. However, anybody can sue anybody. All you have to have is $25 away to file it at the courthouse, so. Okay, folks, it's time for MRO Jeopardy. If you're not familiar with how this works, this is just like the Jeopardy game show that you see on television. We do need to have three voluntolds, or volunteers. You decide. I've deputized Natalie to go in the audience and pick people, so don't be shy. There are presents at the end. We have awards, gifts. What prizes? I won last year. Yeah. The brass. The brass and football tickets? Yeah. Put those, so you can give those away. Recently, you could give those away. So don't be shy. I'm just gonna volunteer. Wonderful. Sir, are you volunteering? No. No? I was voluntold by her, so. Please pick one of the stations over here. There's another voluntold. Natalie, how's come I didn't do this a long time ago? You do such a good job with this. Everybody looks at their cell phone. I love it. No eye contact. Everybody's hiding. Oh, we got to write it down. Yay. Congratulations. Way to go, Natalie. Thank you. Okay, so a few ground rules, okay? So this is very much like the game show on television, as I told you. In front of you are wireless buzzers. Don't kill them. That's not necessary. There's a few sort of like housekeeping things here. We only have one round, okay? There is one daily double, okay? And you know how that works. And if you don't know how that works, we'll explain it to you when we get there. And we also have a final Jeopardy round, which is the reason why you have two pieces of paper in front of you and a writing instrument. When the time comes, just like on television, I'll have you write down what you want to wager. And then once the final question comes up, or final answer, then you get to write the question on the piece of paper, okay? Now, a few things about things. Please look at the screen, okay? And what I want you to do is make sure you pay attention to the upper right-hand corner. I have control over when the buzzers can be activated, and I will not hit that button until I'm done reading the question, which is just like it is on the game show on TV, where you see people doing this on TV, and you know, it's like they're not buzzing in. Well, that's the reason. So there is somewhat of a delay there, okay? So everybody understand? Okay, make sure that whatever you say is in the form of a question. Don't forget that, okay? So we're ready to play Emerald Jeopardy of 2022. The categories are by the numbers, collectors beware, ethics and delegation, acronyms, and in the acronym category, I will display the acronym, and then you have to tell us what it stands for, okay? And the last category is Salt Lake City. Now, how do we have this designated? The contestant that's closest to the audience is MRO-A, the middle person is MRO-B, the far contestant is MRO-C. Could you please introduce yourselves to the audience before we begin? MRO-A. Michelle Alexander. John Clark. Carla Olson. Wonderful. Michelle, back in the hallway, I flipped a coin and you get to choose the first category and the amount. Okay. Let's see. I'll go for collectors beware for 100. Collectors beware for 100. The answer is, general term used for the type of testing done where the collector is both the collector, administrator, and interpreter of a drug test done at the same time. Yes. What is a refusal to test? I'm sorry, that's incorrect. Yes, John. An MRO? Could you please put that in the form of a question? Oh, what is an MRO? I'm sorry, that's incorrect. She's not biting. Audience, do you know the answer? Pointer collection testing. Michelle, you still have control of the board. Please choose another category. So I'm going to try this again. What is collectors beware 200? Collectors beware for 200. The answer is, the number of error-free mock collections that a collector needs to complete after qualification training in order to be initially qualified. Yes, MROC. What is 1%? I'm sorry, that's incorrect. Yes, Michelle. What is 5? That is correct. Yes. You still have control of the board, Michelle. Collectors beware for 300. Collectors beware for 300 is the Daily Double. Now, I'm afraid you only have a hundred that you can wager, but you can wager any amount up to 100. I'll bust, so I'll go for all of it. All right. The answer is, the number of days a collector has in order to complete error correction training after being notified. What is 30 days? That is correct. Please choose a category. We'll go for collectors beware for 400. Collectors beware for 400, the urine volume necessary to be provided by the donor for an acceptable split specimen test. MROC got in first on that one. What is 60 cc's? I'm sorry, that's incorrect. Yes. What is 45 cc's? That is correct. Please choose a category. Collectors beware for 500. Collectors beware for 500. Copy 4 of the chain of custody form goes to this person. Yes, C. What is the employee? No, I'm sorry. That's incorrect. What is the employer? That is correct. All right. Okay. Let's go by the numbers for 100. By the numbers for 100, the answer is the federal confirmatory urine testing cutoff level for PCP and nanograms per milliliter. Yes. What is 25? That is correct. Michelle, you're on somewhat of a roll. Okay. Continue. By the numbers for 200. The answer is the FMCSA 2022 random drug testing rate. Yes. What is 25%? I'm sorry. That's incorrect. There you go. What is 10%? I'm sorry. That's incorrect. John, you want to take a nap at it? 5% Sorry. That's incorrect. Correct answer is 50%. Michelle, you still have control. Please pick up by the numbers for 300 by the numbers for 300 proposed federal hair testing initial cutoff level for marijuana metabolites in picograms per milligram. They're not taking the bait on that one. Audience. Correct answer is one. One. Okay, Michelle. Okay, we'll go by the numbers for 400 by the numbers for 400 proposed federal oral fluid confirmatory cutoff level for 6 a.m. Yeah. Those four and 500 point ones are really hard, aren't they? Yeah. Audience. Correct answer is four. Okay, by the numbers for 500. They really want to get rid of that category. The answer is the 2022 random alcohol testing rate for the Yes, but it's 10%. That is correct. Okay, so we'll go for an acronym sport 100 acronyms for 100. The answer is Sam. So They're not biting audience. Substance abuse. Okay, acronyms for 200 acronyms for 200. Yes. Officer drug and alcohol program compliance. Yeah, we're going to give it to you. Okay, that's right. Yeah. Okay, acronyms for 300 acronyms for 300. The answer is Not Apple, not blueberry. Not cherry. I know it's exclusion. Although cherry pie was a good song by warrant. Oh now, you know how old I am. No takers audience. Public interest public interest exclusion. I knew it was I knew it was exclusion. I couldn't remember. Okay. Okay, 400 acronyms. Well, they're still going with acronyms. The answer is THC me. I don't know if I'm going to pronounce it. Right. All right, tetrahydroxy cannabinoid verabrine. There that's close enough. So we're going to go for Salt Lake City for 100. Yeah. Yeah, good choice. Salt Lake City for 100. The answer is the National Basketball Association's Utah Jazz originally came from this city. See New Orleans. Please put that in the form of a question. Oh, what is New Orleans? What is New Orleans? That is correct. You have now have control of the board Salt Lake City for 500 Salt Lake City for 500. Yes, go big or go home, right? Okay, here we go. Salt Lake City is the largest and only manufacturer of this product frequently used in comedy sketches. It is also a disparaging term used to describe food served at large political or corporate events. Yes, what is Jell-O? I'm sorry. That's incorrect. Audience. Please choose another category. Salt Lake City for 400. Salt Lake City for 400. The answer is this oil company is headquartered here famous for its dinosaur logo. What is Sinclair oil? That is correct. Salt Lake City for 300. Salt Lake City for 300. The answer is the Winter Olympics of 2002, however, was known for a scandal between French and Russian pairs in this sport. Yes, what is figure skating? That is correct. Salt Lake City for 200. Despite the appearance of its founder having Southern charm and a killer recipe, this chain restaurant opened its first location here in 1952. Yes, John. Oh, no. What is Kentucky fried chicken? Yes. I'm sorry. She got it before you. My bad. That is correct. I think it's interesting that they left ethics for the last. Let's go for Ethics for 100. Ethics for 100. The answer is this is an example of a fatal flaw. Yes, no signature. Sorry, that's not quite correct. Oh, what is no signature? Any fatal flaw. What is the absence of a collector signature? With that that has been not corrected. Uncorrected. Okay, I'm going to give that one to you. Yes. Okay. Go ahead. Ethics and delegation for 200. Ethics for 200. The answer is laboratories typically verify oral fluid specimens actually are human by testing this. Yes. What is this factant? I'm sorry. That's incorrect. Audience. IgG. Yeah, it's yeah. Okay, so ethics and delegation for 400 ethics for 400. Yes. The answer is the MRO should consider elapsed time and increased temperature effects when an invalid test is recorded with the pH between these two values. Yes, 8.5 and 9.2. Yes, 8.5 and 9.2. Sorry, that's incorrect. What is 5 and 9.2? No, okay. Audience 99.5. Oh, okay. Three to go. Okay. What is let's go for ethics and delegation for 300. The answer is an invalid urine result occurs when the specific gravity is greater than 1.0010, but less than 1.020 and the creatinine is less than this in milligrams per deciliter. Yes. What is 2? That is correct. Ethics and delegation for 500 ethics and delegation for 500. The answer is an invalid urine test result is recorded when both initial and second tests on 2.011 or greater than 50 for this adulterant, which is the primary active ingredient in the product urine. I'm going to try night. What is nitrite? Sorry, that's incorrect. Audience. And we'll take the last one for 500 and it is so appropriate that you leave this question for the last. Goat referring to the 1995 University of Nebraska football team. Oh, John, what is greatest of all time? Yes, sir. All right, everybody gets to play Final Jeopardy. Okay. Okay, sweet. So this round is complete. The scores is there as you see them 1300 200 minus 900. Yeah, you can bet up to 200 since that's what John has. Okay. Okay. All right. Okay. So is everybody sort of quasi ready? You found the two pieces of paper in front of you. I hope and a writing instrument. Okay, we're going to move into Final Jeopardy and the Final Jeopardy category is drug testing in treatment monitoring. So if you could please write down what you are willing to wager on one piece of paper and if you could put that piece of paper at the top of your podium so that I know that you completed that that would be great. All right. The Final Jeopardy answer is urine testing can be used in methadone treatment monitoring. Typically either the metabolite edpp is tested at a cutoff of 100 milligrams per milliliter or the parent compound at this cutoff level. Also a 2006 Gerard Butler film. Okay. Please put your pens down like to go to contestants. See, could you please reveal your Final Jeopardy question? What is 10? What is 10? I'm sorry. That's incorrect. I'll come back to what you wagered in a bit. John is I don't know what is I don't know. I'm pretty sure that's never been a movie, but that's okay. And contested a so I said one what is 150 but I didn't what is 150 that's incorrect. So, you know who Gerard Butler is? No, yes, no. Have no idea. The answer is 300. Oh, okay. All right. So now I need to know who who wagered what 200 200 John $10 $10 way to go on the confidence 500 500. Okay, so I think I can do this, right? 10 yeah, right. Okay. Congratulations, Michelle. Nicely done. Wonderful. Thank you. And thank you for playing. Thank you. Emerald Jeopardy. Emerald Jeopardy 22. Well done. Yeah, I just wanted to reveal that, you know, Michelle was my boss for many years. So that's why I underperformed. Now, I really know why they left ethics at the end and Michelle and I are new best friends. So I had to let her win. So I want to thank everybody for your attendance today at Emerald controversies. Have a good rest of the conference and rest of the day. Thank you.

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