Well, in the interest of time, we're going to go ahead and get started. Just for AV purposes, I cannot advance the slides from my computer, so if you could come up here and help, that would be great. I want to welcome everybody to Emerald Controversies for AOHC 2023. My name is Doug Martin, and I'm the current president of AECOM. And without further ado, I'd like to introduce our first speaker this morning, Katherine Russo, is a principal attorney with Jackson Lewis PC in Long Island. Katherine has been involved in the legal aspects of drug and alcohol testing for 25 years, and we're pleased to have her come back this year and speak to us again. Interesting. Well, it's switching up there, but it's not here. Yeah, so it is switching. But it's not switching on there. No, I don't know why. But it's switching there. Let me try something real quick. They are using it for the interview. I don't know why it's doing that, but it is switching. And now it's not. Hmm. Okay. Can we close it and reopen it? Sure. That's what it's doing. It's doing that. Okay. All right. Thank you. Okay. Good morning, everybody. I'm very happy to be back here speaking to you about marijuana laws. So I'm an employment attorney, management side. I represent employers only. And most of my practice is devoted to drug testing and substance abuse issues. So I get questions. I'm pretty much on the phone all day long giving employers advice on how to handle positive marijuana test results. What do we do if somebody's using medical marijuana? What if they're using CBD? And how do we handle that? And a lot of it, as you may imagine and you probably know already, a lot of it depends on what law is applicable. And that's always my first question, the first thing I think about when I'm handling these issues. So let me talk a little bit about just federal law because I still get asked all the time by employers, but is it marijuana illegal at the federal level? So why are we even having a discussion about it? And I always say, well, yeah, technically, yes. It's technically still on Schedule I of the Controlled Substances Act. But Congress and the Department of Justice have been taking a hands-off approach about marijuana since, you know, early in the Obama administration. So there is no enforcement. The Department of Justice doesn't prosecute people. They don't interfere in state regulation of marijuana. And Congress, you know, issues in their budget every year, Congress prohibits the Department of Justice from using funds to interfere in state laws. So what that means is that the courts now are starting to say, hey, you know what? Congress is telling the Department of Justice to keep your hands off. In effect, that's like an implicit blessing, if you will, of state marijuana laws. And that's a hard thing for people to wrap their heads around because many people still say to me, well, it's illegal. It's on Schedule I of the Controlled Substances Act. We don't have to allow it. I think there's legal risk to any employer who takes that position because that's not how the courts are viewing it. The courts are saying that, you know, Congress and the Department of Justice are saying, hands off, let the states regulate it, which means we need to follow state law. Okay. And then to complicate things, as you know, there was the 2018 farm bill that legalized industrial hemp. Now these CBD products are being sold everywhere, right? You see them in the grocery store, in the drug store. And people are using them. And then they're surprised when they test positive for THC, that's also creating a lot of headaches for employers. Okay. So before I go on, I'm sure you all know any of the DOT, the Department of Transportation agencies, they do not allow marijuana. So if you have clients who are regulated by FAA, FMCSA, FRA, Pipeline, they cannot use marijuana. Those are the easy cases. I love it when I get the easy cases. But everybody else, you've got to follow state law. Now this one I want to point out because this is a common question I get all the time. The employer says to me, oh, but we're a federal contractor, we have to follow federal law, right? And the answer is no, not really. I hate to tell you that. The Federal Drug-Free Workplace Act only says you can't allow illegal drug use at work. It doesn't address drug testing. And again, several court cases have said that the law doesn't mandate any drug testing. It doesn't allow employers to regulate off-duty conduct. So guess what, employer? This is not a good defense. And I'm going to tell you as we go along, the trend in the court cases that I'm seeing is not good for employers. Most of the rulings go against the employer. So I have become very conservative in the legal advice I give to employers because I'm not seeing a lot of employers winning these cases anymore. Okay, so again, as I just said, the bottom line is that stating that marijuana is illegal at the federal level, not a good defense anymore, and relying on the Federal Drug-Free Workplace Act, not a good defense anymore. However, here's what I will say. If your client has a federal contract with a federal agency that explicitly says you must drug test your employees for marijuana, then I think that's an out, but most of them don't say that. I always ask employers that question. Please review your contracts and see what they say about drug testing. If testing for marijuana is mandated, then I think you have a good defense. If it's not mandated, you don't have a good defense, and then you're going to have to comply with state laws. Okay, so we've got state and local laws. There's tons and tons of them. You know, for my clients who are multi-state employers, it's a nightmare, okay? That's all I can say to you. It's a nightmare. We've got 38 states plus D.C. with medical marijuana laws, 22 states. I'm still calling it recreational marijuana. I understand it's really adult use. I have to change my lingo here. We also have states that have CBD laws for medical use that are separate from the medical marijuana laws. So there's a ton. There's just a ton of laws, and it's very hard for a multi-state employer to say, hey, we want one policy to cover all of our locations. And I think, honestly, that the fact that there are so many of these laws and regulations, it's kind of contributing to a trend that I'm seeing, which is that many employers are just giving up and saying, you know what, we're not going to test for marijuana anymore, especially on pre-employment tests. The trend that I'm seeing is employers are dropping it from pre-employment because so many people test positive. It's still a tight labor market in most places, and it's just so difficult for recruiting purposes. Okay, there's a lot of these off-duty use laws now, and I'm not going to go through every one of them. But another legal trend that I'm seeing is a trend in protecting all off-duty use. So back a few years ago, I used to be much more concerned about the medical marijuana laws, because there was more protection for medical users, not so much protection for people who just used it for whatever reason. Now that trend is changing, and not only are there laws still protecting medical users, but now we've got laws protecting all off-duty use. And as you might imagine, that creates a huge problem, because a drug test can't tell an employer, did the person use it on duty, off duty, when did they use it, what product did they use? We don't know. So it's very, very difficult. So I'm just going to quickly take you through a few of the, I'm not going to go through every state. You have a copy of my PowerPoint, and I put too many slides, quite honestly. But I wanted you to have the information. There's a few I want to point out to you. So California's law is going to take effect in January, and a lot of people are freaked out about this. But it's going to protect all off-duty use. You cannot discriminate against individuals who use marijuana. And you can't take any adverse employment actions based on a positive test result, if the test is for non-psychoactive cannabis metabolites. Now, the law had some language in it, making it seem that, you know, employers can choose to either test for non-psychoactive or psychoactive components of marijuana. I honestly don't know what they're talking about. Maybe somebody in the audience knows what they're talking about. I don't. So to me, it seems that as of January 1st, employers are not going to be able to test for marijuana at all. There is, interestingly, an exception for people in the building and construction trades. Why just those two industries? I can't tell you. Connecticut, I like Connecticut's law, one of the few recreational use laws that I like, because there are many, many, many exceptions in it, which kind of makes sense to me, you know. For employers in safety-sensitive industries and with people in safety-sensitive jobs, there are many, many exceptions, meaning that it's still okay to test for marijuana. So I like Connecticut. Illinois concerns me because I think the law is contradictory. There's part of the law that says marijuana is a lawful product. You can't discriminate against people who use lawful products. But then it goes on to say it's okay, employers, if you want to test for it and take adverse actions. I think those two provisions contradict each other. I think we're going to see litigation. Maine is another state where I think the law is a little bit ambiguous. And again, some of these states talk about it's okay to prohibit being under the influence of marijuana without really defining that. So what is under the influence? Is it a positive test result? Is it acting like you're impaired at work? It's not always clear in some of these states. Montana is another newish law. It does have some good exceptions for safety-sensitive jobs, so I do like that law. New Jersey is another state with a lot going on. We're waiting for these new regulations to have a workplace intoxication recognition expert, which will be a person trained to recognize impairment in the workplace. And that person will have to evaluate the employee before sending them out for testing. Those regulations haven't come out yet. In the meantime, New Jersey has said it's still okay to do reasonable suspicion testing, as long as you have two trained supervisors observe the employee and document the reason for the testing. New York, which is my home state, crazy law. In my opinion, because all off-duty use is protected, there are no exceptions. And this is so hard for employers, and I spend so much time on the phone with New York employers who say, but what about, you know, my employees are doctors, my employees are construction workers, my employees are, you know, climbing up heights and doing really dangerous work. Sorry, there's no exception. So you can't do any drug testing for marijuana in New York State. If you have, you know, if you work with clients who are in New York, people still have the misperception that testing in New York is okay, particularly if there's reasonable suspicion. But the Department of Labor issued some guidance saying, even if you have reasonable suspicion, you can't take adverse action based on a positive test result because you don't know when they used it. Maybe they used it off-duty, and that's protected. So no testing in New York. Rhode Island has another all off-duty use is protected. I don't recommend any marijuana testing in Rhode Island except maybe for reasonable suspicion. And even then, I recommend that you base your adverse employment action on your observations of the impairment and not so much on the drug test. Because remember, in all of these states where it's protected, the employee is going to say, oh, yeah, I used it when I was off-duty, so I'm protected. You can't fire me. So you've got to really think about what's going to be the basis of the discipline. Philadelphia, where we are today. City of Philadelphia has a law that says no marijuana testing on pre-employment tests. And we're still waiting for some regulations to be published that supposedly are going to have some exceptions. So again, just to wrap up this theme here, as I said earlier, what I'm seeing is a nationwide trend where employers are dropping marijuana from their pre-employment tests because they're just like going out of their minds. Either you're in a state where you can't test for it at all, or the applicant is going to say, hey, I used it off-duty. I don't even work for you yet. Of course I used it off-duty. I wasn't under the influence at work because you didn't hire me. So I think it's very hard to take adverse actions in states where off-duty adult use is protected. Okay, a little bit about medical marijuana. I kind of divide the states into three groups. The first one is really higher legal risk. And by that I mean there are either court cases or statutes that say you can't discriminate. So these are some of those states. Then I have the second group of states is where I'm really not sure because the law doesn't mention employment. I don't know. I haven't seen a court case. I'm not 100% sure what's going to happen in those states. And then this group is the states with lower legal risk either because there's been case law that's favorable for employers or the statute actually says you can't sue your employer. So there's only a few of those states. I have California up here, but just remember 2024 is coming. California is going to change completely in 2024. Now, this slide I always include because, you know, even if you're in a state like Florida is a good state, there's some good language protecting employers, but I always say to the employer, just realize they can do like a little backdoor legal claim and just assert generic disability discrimination. They don't have to use the medical marijuana statute to sue you. There's lots of other statutes they can use, including just generic disability discrimination. So my advice is look at the whole situation. Did the person disclose a disability? Did they say, my doctor says I have to use the medical marijuana? And think about all of that before you say, nope, I'm not going to hire you. So, again, in many of these states I'm telling clients, you know, start thinking about medical marijuana the same way you would other prescription medications. One of the things or one of the errors that I see some employers doing is making like a list of jobs they think are too dangerous. And you really can't do that. I mean, under the Americans with Disabilities Act, with any medication at all, you can't just say, oh, that medication is too dangerous for this particular job. There always has to be an individualized assessment under the Americans with Disabilities Act and comparable state laws. So just be careful about any type of blanket rule. Now, I'm just going to zip quickly through. How am I doing with time here? Okay. So I just want you to be aware there are some statutes that have helpful language, I think, regarding safety sensitive positions. I wanted to mention Arkansas because we've actually seen, weirdly, why Arkansas of all states, but we've been seeing an uptick in class action litigation in Arkansas over medical marijuana. So the important thing to know about this statute is that the employer must designate in writing that the job is safety sensitive. I usually tell employers, put it in your job description. If you do that, then you're going to be in a better position if you say, I don't want to hire this person. And because we said in our job description, this is safety sensitive, all right? The statute allows you to do that. If you don't do that, you may get sued. And there are many class actions going on in Arkansas. So just be aware of that. You may be aware, this has been around for a while, the Nevada law, that you can test for marijuana preemployment, but you can't take adverse action unless the job is safety sensitive. So that's pretty good. Oklahoma also has some ability to take adverse actions if the job is safety sensitive. I've listed that for you there. Pennsylvania also, although Pennsylvania's law troubles me because it just says, it prohibits employees from doing any of the following dangerous work while under the influence. Again, I don't know exactly what under the influence is, but that's there. West Virginia also has a very similar law to Pennsylvania. Okay, I mentioned earlier there are also medical CBD laws. And this is creating a lot of problems for employers. I'm sure you're all seeing it. We're seeing another uptick in litigation where the applicant or employee is saying, I didn't use marijuana. I went to the grocery store and I bought this CBD product, this lotion that I put on my skin, and I didn't know it was going to make me test positive for THC. So we're seeing a lot of lawsuits now. And I don't have really good advice for employers, because the truth is, you don't know if the person's lying to you. Maybe they are using marijuana and they're lying, or maybe they did go to the grocery store and buy this product. It's very, very hard. It's very hard. I usually tell the employer, if they're claiming they're using this CBD product for medical reasons, ask them if they have a note or a letter from their doctor saying they must use it for medical reasons. Most of these CBD laws don't have employment protections in them. But again, we're seeing this uptick in lawsuits. The other thing we're starting to see that is concerning me are these low THC laws, which is similar. Minnesotas came out last summer, and basically, they legalized all low THC products. Now, if you have an employee that tests positive, how do you know? Are they using a low THC product? Are they using a high THC product? I don't know. So honestly, I've been telling employers in Minnesota to be really careful. And you may want to think about certainly not testing on a pre-employment basis, maybe just limiting to reasonable suspicion, but I think that's a huge problem. So just to kind of quickly wrap up, it's still okay for employers to prohibit use and possession at work. Make sure the employer has a really good, clear policy. What I'm seeing in New York is people think they can go outside in the parking lot at lunchtime and smoke marijuana. So I'm telling the employer, make sure your policy tells them they cannot use it during work time, cannot use it on our premises. Don't go in your car at lunchtime and use it. I also recommend that employers and their MROs just get on the same page. This is better. I think a few years ago, there was a lot of disconnect between some employers and MROs about reporting things as positive. I don't see that problem so much anymore. I think most of the MROs are just telling the employer, this person claims to have a medical marijuana card, so now you, employer, figure out what you want to do, because it's going to depend, really, on state law and how much legal risk the employer wants to take. So this is kind of just to wrap up, this is my decision tree. I look at what kind of test was it. If it's reasonable suspicion, that means the person was impaired. I'm probably more inclined to be okay with adverse action. I look at the state law. I look at whether the job is safety sensitive. Did the person tell us up front that they were using medical marijuana or CBD? And then I just talk to the client and assess how much legal risk are they willing to take. And we also, here on this slide, we have a drug testing blog. So anytime a new law or regulation comes out, I post it up there on the blog. But thank you very much for having me. Thank you, Catherine. We're monitoring questions online, which I think we'll do at the end, maybe? Yeah, let's do that. So next, I'd like to introduce a person who does not need an introduction. And that's Dr. Natalie Hartenbaum, who is the President and Chief Medical Officer of Ocumetics, past President of ACOM, and face on the Mount Rushmore of transportation safety in the United States. Dr. Hartenbaum. Thank you, Dr. Martin. And first of all, I did not teach Catherine how to talk real quickly. So, got the right thing. I also serve as Chief Medical Officer of Norfolk Southern. I am not speaking on behalf of NS, but as Ocumetics. So, my disclaimers. Not a lot's been happening this year, which is kind of a relief. So what I'm gonna go through is what is on the horizon, what things should you be watching for, and hopefully giving you the resources so you can watch for what's coming through. A couple of the important things that we're looking at is finally, hopefully, we'll be able to do all electronic forms. What that would mean is that in his MRO, you can electronically sign that CCF, even if it was a lab non-negative. That's still pending. Watch for that coming out soon. Link to the announcement is at the bottom of this handout page. The next thing is a reminder from FMCSA. The clearinghouse is really fully implemented by this point in time, which means that there are three years worth of data in the clearinghouse. What has been happening is the collectors and others are not doing the collections properly. They need to make certain, A, that the appropriate agency is marked. The appropriate agency is marked in its FMCSA. They need to double check whether or not the individual has a CDL, has a CDL permit, or has some other reason why they need to be tested under CDL FMCSA requirements. Has to have their CDL driver's license on this drug testing CCF. If it doesn't, they shouldn't be having an FMCSA drug test. So there's a nice little flow chart, people who like flow charts, that's in that announcement, the bulletin you can find again at that link, at the bottom of that web page. Make sure that if you are a collector, supervising collectors, or if you're an employer who has drivers in FMCSA drug testing, that they are aware of how this test are supposed to be done. It's not as difficult to upgrade, essentially, if you have a test done on a non-federal form. And it should have been a federal form. That's not horrible. On the other hand, if it's done on a federal form and you're trying to downgrade it because it should have been a non-federal test to start with, agency doesn't like you doing that. And you have to get approval from them to go forward. And this was about that same slide twice. Okay, that makes life easier for me. Some of the things from COVID, really productive, and then we could do a lot more things remote than we used to be able to do. One of those was that SAP, Substance Abuse Professional Evaluation. In the past, had to be in-person only. What is now being permitted is they're extending that discretionary enforcement. So if the SAP interviews the individual remotely with the appropriate video conferencing ability, they can continue to do so until the decision is made that they must stop. So that enforcement discretion continues. It doesn't mean you still are supposed to do it or you can do it, but they're just not going to enforce it, kind of like what's happening with marijuana at the federal level. For several years, there have been a number of organizations in the trucking industry that have been trying very, very, very, very, very, keep on going hard to allow hair testing. There's many reasons why hair testing has benefit. Yes, longer window of detection. Disadvantages, longer window of detection. Is the person impaired? Are they using it now? Is it recent use? Is it past use? And things along those lines. This was kind of a run around to try to get the FMCSA to permit hair testing and consider it as actual knowledge. So the ask here was permit the actual knowledge because of a hair test can't be considered a positive drug test and employers can act appropriately. FMCSA came back and said, nope, we don't have discretion to do that. Therefore, we are denying that request. Hair testing is still pending as a potential alternate matrix for FMCSA as well as for other transportation modes. FMCSA remembering that we now have three years of data within the Clearinghouse, so we now expect that all employers can check into the Clearinghouse to get that background information. Where are we looking at at the Clearinghouse? Not surprising. Marijuana numbers are continuing to climb from 23 to 2022. Yes, these are numbers of tests, but you would kind of assume that the same number of tests are increasing for all types of tests. So if they're seeing more marijuana, they should proportionally see more cocaine, more methamphetamine, more amphetamine. They are seeing more marijuana, more cocaine. The others are staying about relatively the same. And if you're interested again in the data, the link is there. I like to provide resources, not just only answers. What else is going on with the Clearinghouse? The Clearinghouse used to only tell employers if there had been a change in the individual's status, if there's been a change three months after they did the annual or the initial query. They are now extending that to 12 months. So employers can go back. They don't have to go back and keep on checking and checking and checking. FMCSA will notify those who have done a query into the Clearinghouse if there's been a change in status. Oral fluid mandatory guidelines, modifications to the urine mandatory guidelines. By the biggest thing that I see in the urine especially, is lowering the cutoffs for morphine codeine to 4,000. It would really do away with a lot of that window, because quite honestly, how many of us really do that actual assessment to see if there's signs and symptoms? And they've done studies over and over again looking at how much poppy seeds do you need to take to actually have a positive morphine or codeine test? That's one of the proposals. It's still pending. This is SAMHSA, so this is through the Department of Health and Human Services. Once these mandatory guidelines go through, then we go back and DOT will put together their implementing specific guidelines for that agency. All pending, please watch for it. All the links are here. This is not DOT, Substance Abuse Mental Health Services Administration, Health and Human Services, have slightly different MRO requirements than Department of Transportation. So if you're a certified MRO and you're certified under the DOT Part 40 testing, that's the guidance you look at, that's the instructions you look at. If you're doing drug testing under federal drug free workplace, then you want to look at these guidance. And there's relatively new case studies that were posted back in 2022. Interesting to look at them and see how they differ from DOT, keeping in mind it is different. Moving on to Department of Transportation, we're still looking at the implementation for oral fluid. Yes, the CCFs have a little spot for oral fluids. We shouldn't be doing it as part of a federally approved drug test yet. Commons closed over a year ago, still waiting for next steps. Little bit of information I think is interesting. We see a lot of suboxone. What do we do with suboxone? Can we certify? Can we not certify? Well, at least it's limited to who can prescribe. Not anymore. They have removed that X waiver requirement that said you need to have certain training, need to be licensed and registered in a certain way to prescribe suboxone buprenorphine for opioid use disorder. Now if you have a DEA, you meet requirements, and I'm going to talk about a training program that's required, you can go ahead and prescribe it. I suspect my fear is we will see a lot more off-label use than we have seen before. Goes back to the, are they safe, are they not safe? Goes back to the same question of, are they impaired, are they not impaired? Are they taking the medication while on duty or subject to duty? If they don't take the medication, do they become impaired because they're not properly treated? So a lot of things that need to be considered, but I suspect we'll be seeing a lot more buprenorphine use than suboxone use when this goes into effect. NTSB did a really nice study on alcohol drug and multiple drug use among drivers. What I liked about it, I wanted to share this one specific chart, we talk a lot about what are potentially impairing medications. NTSB has given us a list of potentially impairing medications. So when you're looking at safety, when you're looking at it as an MRO, the safety concerns. What would be considered a potentially impairing medication? This is the resource, so when the attorneys come back and say, well, what makes you think that's a potentially impairing medication? National Transportation Safety Board says so. This came up on one of the discussion boards, and I just thought it was kind of worth repeating. Can an MRO accept a photograph of a label? Back in the olden days, and I'm not going to say how old, but in the past, we would get a label, we'd look at the label, we'd say, yeah, it looks pretty good, I'm going to accept this. In 2017, very clearly said, Department of Transportation, no, you cannot, you must do primary source verification of that label. We have gotten, people have gotten really, really good, Photoshopping, Word documents, and all those things. You must get primary verification from pharmacists or a health care provider. The DTAP meeting, March of 2023, unfortunately, the presentation summaries were not posted until earlier this week. I did not have a chance to update, but the presentations were very interesting, useful, and you can find them on that website there. What was kind of interesting, there was some discussion on, yes, rulemaking is almost ready for the oral fluid and, next slide, I think I have that, yes. Oral fluid and urine mandatory guidelines from SAMHSA are very close. We should be seeing rulemaking, final rulemaking on that in the near future. Hair, mandatory guidelines, getting closer, but not yet ready for prime time. And the Federal Custody and Control Form, which expires at the end of April, sorry, end of August, is now in for approval. There's no changes on that, so we don't have to worry about changing all of our CCFs over at this point in time. Catherine asked me to address Delta 8. Delta 8 is going to be a significant problem. It is not a metabolite that's tested. It is a psychoactive metabolite. The metabolite we test for in our federal drug testing is not psychoactive, which is part of the problem. There are a number of different cannabinoids in marijuana that are psychoactive and those that are not. Delta 8 is. I know of a lot of companies who are selling hemp, they're selling CBD, and what are they doing? They're adding Delta 8 to their product, so it gives that high. In this study, they looked at about 1,200 specimens that were positive for Delta 8 and or Delta 9 and found that about 11% of them were positive for Delta 8 alone. So what that pretty much means is they would have totally passed the drug test, but they're probably impaired. This is just the last slide I have, is that as DEA, if you have DEA licensure, you need to take an eight-hour course on opioid use disorders, a new one-time eight-hour training program. So let's get our training work ready and we have more to learn. So that is the questions. I am looking at the questions. First of all, focus keeps going out. So AV, if you can please help for the live stream attendees if they're not seeing things very clearly. And I see no other questions. So at this point, I will turn it over to Dr. Martin for MRO Jeopardy. Thank you. Thank you, Natalie. Well, folks, it's time to do MRO Jeopardy. You've come to expect MRO Jeopardy from me. Let's see if I can get this to work. Maybe not. Yes, we typically ask for volunteers. However, I've instructed Dr. Hartendon to be voluntold individuals as well. All right. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. 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The correct answer is point of collection testing. MROA you still have control of the board. All right let's go to those crazy collectors 200. Those crazy collectors 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. MROB what is 5? That is correct. What is 5? Carl you have control of the board. Philadelphia for 100. Philadelphia for 100. The answer is this man first brought American Bandstand to West Philadelphia in 1957. MROB. Who is Dick Clark? Dick Clark is correct. Philadelphia for 200. Philadelphia for 200. They seem to be avoiding the MRO question. The answer is the University of Pennsylvania was founded by this person. MROC. Could you put that in the form of a question please? Who is Benjamin Franklin? That is correct. MROC you have control. Philadelphia for 300. Philadelphia for 300. The only sports team to have a courtroom at the stadium to deal with its rowdy fans. MROC. Who is the Philadelphia Eagles? That is correct. We hear horror stories about that in Philly where they get beat up when the tunnel's going to the stadium man. You still have control MROC. Philadelphia for 400. Philadelphia for 400 is the obligatory Nebraska football question. The number of Nebraska Cornhuskers on the Eagles active roster for this past Super Bowl? I'm surprised the Minnesotan doesn't even want to try to guess. We are in the same conference you know now. What is three? Who said that? Me. What is three? What is three is correct. I didn't know for sure man. I'm a Steeler fan. Those would be Indomitian Sioux, Jack Stoll who's a tight end, and Kevin Jurgens who's the backup center. MROC you have control. Philadelphia for 500. The answer is portions of this scientist's brain are on display at the Mudder Museum along with 100 other skulls. He shares the same birthday as the current AECOM president. MROC. Who is Albert Einstein? That is correct. That would be March 14th for those of you who are interested. MROC. Legitimate explanations for 100. Legit explanations for 100. The answer is an MRO interview determines that a donor is taking Adderall which may cause this to be positive on the urine drug test. MROB. What are amphetamines? That is correct. Amphetamines. Legit explanations for 200. Legit for 200. The answer is a non-federal rapid screen may show positive for this drug if the donor is taking sertraline. I'll try it. All right. What is, I think it's PCP. Sorry that's incorrect. Okay. Probably no takers. Anybody from the audience know? Benzodiazepines is correct. Very good audience. MROB. You have control. Acronyms for 100. It's a non-federal. Read the question Dr. Hardenbach. Acronyms for 100 please. Acronyms for 100. The answer is SAMHSA. MROB. What is the Substance Abuse and Mental Health Services Administration? That is correct. Acronyms for 200. Acronyms for 200. The answer is ODAPSI. No takers. Audience. Office of Drug and Alcohol Policy Compliance. MROB. You still have control. Acronyms for 300. Acronyms for 300. The answer is PIE. Audience. Public Interest Exclusion. Right. Carl you still have control. Okay. Acronyms for 400. Acronyms for 400. The answer is THCV. No takers. Audience. Okay Carl. Okay. Acronyms for 500. Acronyms for 500. The answer is DACIA. Okay. Audience. I'm gonna try. He's gonna try it. Okay. What's the Drug and Alcohol and Tobacco Information Administration? I'm sorry that's incorrect. Okay. Audience. Industry Association. Okay Carl. Wow. Legit Explanations for 300. Legit Explanations for 300. The answer is an invalid urine result occurs when the specific gravity is greater than 1.0010 but less than 1.0200 and the creatinine is less than this in milligrams per deciliter. MROA. What is 20? I'm sorry that's incorrect. What's 5? I'm sorry that's incorrect. Might as well go for it. What is 4? I'm sorry that's incorrect. Oh sorry. Audience. The answer is 2. Correct. Carl. Legit Explanations for 4. Legit Explanations for 400. The MRO should consider elapsed time and increased temperature effects when an invalid test is reported with the pH between these two values. MROA. What is between 11 and 9? I'm sorry that's incorrect. Audience. 9 and 9.5. Carl. Legit Explanations for 5. Legit for 500. The answer is an older non-federal point-of-collection test might show this drug to show positive if the donor is taking verapamil. Anyone in the audience want to try? Correct answer is opioids. Carl. You still have control. Crazy Collectors for 3. Crazy Collectors for 300. This is the bonus question. Now Carl you're in a deficit situation but you do get to wager up to 600 to get yourself out of the hole if you'd like. Oh let's go for it. Okay. So the answer is the number of days a collector has in order to complete air correction training after being notified. What is five days? I'm sorry that's incorrect. The answer is 30. The good news is you still have control of the board. Okay. Crazy Collectors for 400. Crazy Collectors for 400. The answer is the urine volume necessary to be provided by the donor for an acceptable split specimen federal test. Carl. What is 60 milliliters? I'm sorry that's incorrect. Buzzer's on. MROC. What is 45? That is correct. And MROC you have control. I can do Pittsburgh too if you want. I'm sorry. Cut-offs for 100. Cut-offs for 100. The answer is the federal confirmatory urine testing cut-off level for PCP and anagrams per milliliter. What is 25? That is correct. MROA you have control. Cut-offs for 200. Cut-offs for 200. The answer is the federal screening cut-off level for THC-A. MROA. What is 15? I'm sorry did you say 50? What is 50 rather. Yeah. MROA. 300 cut-offs. Cut-offs for 300. Proposed federal hair testing initial cut-off level for marijuana metabolites in picograms per milligram. This will be a Hail Mary pass here. That's a tough one. Audience anybody want to try? It's one. MROA you have control. Cut-off for 400. Cut-offs for 400. The answer is federal confirmatory cut-off value for amphetamine methamphetamine. MROA. What is 200? Okay I'll give that to you. Yeah let's give it to him. Two options remain. Okay. Cut-offs for 500. Cut-offs for 500. The answer is the federal initial test cut-off level for marijuana metabolites in picograms per milliliter. MROA. Two options remain. Okay cut-off 500. Which one I'm sorry? Cut-offs for 500. Cut-offs for 500. The answer is the federal initial test cut-off level for benzodiazepines. How long did it take you to work on these questions? He has a full year. If you're looking at the host like I should have some answer of some sort. Anybody want to try? It might be a trick question. There is none. Well somebody needs to buzz in. Oh you are buzzed in. That's correct. The answer is there is no such thing. Okay. The last item in the round is crazy collectors and it's copy four of the chain of custody form goes to this person. MROB. Who is who's the employer? That's close enough. Designated employer representative. That is correct. All right. So we're going to move into final jeopardy. You'll see that there are hopefully a pen and two pieces of paper that are in front of you. Carl you do get to play. So you can wager up to the smallest value of the other player. So you get to wager 400. Can I donate something to him? It still makes a negative. I don't know. So if you could write down your wager on the piece of paper for me and then just turn that over when you're done. Is everybody ready for the final jeopardy answer? I probably should have told you the category. The final category is certified laboratories and numerology. If you want to change your wager because of that you certainly can. Are you ready? Please write this down on the form of the question. I'll reiterate that. Please write your answer down in the form of a question. The final jeopardy question answer is the number of SAMHSA certified laboratories in the United States. It is also the eighth prime number, the atomic number for potassium, and can be written in Roman numerals as a palindrome. I don't know what a palindrome is though. Okay if you could please put your pens down. We'll go to MROB first. Dr. Wentz, could you please tell us the final jeopardy answer that you wrote down? What is 23? What is 23? I'm sorry is incorrect. The correct answer is 19. So sorry you don't even get to register on my program. My bad. I'm even more negative. We'll go to MROA. MROA, could you please tell us your answer? What is 19? What is 19? Is correct. And how much did you wager? 400. 400. You went for the whole thing. Very good. And MROC, could you please tell us your final answer? 17. 17 he said. That's incorrect. Could you please tell us how much you bid? A thousand. A thousand. I did that on purpose. Oh my. That means we have a tie. Well that's cool. He wins. He gets it. That's cool. Okay so I have some some gifts for you. Just take them all here. So in third place, Dr. Wentz, I have a Birch Peak battered white chocolate bar for you. Congratulations. Excellent. Thank you. And there's a tie here. Give him first place. What's that? I think it's first. Okay. So I have a shot glass. When you get really tired of doing your MROA work, and we're participating in being the so-called winner, I have a Philadelphia t-shirt for you, sir. Wonderful. Thank you. Thank you all for playing. Is gritty on the t-shirt? If it doesn't have gritty on it, it's not real Philadelphia. Question. We've had a recent increase in samples. And my question is, I'll repeat it. I'll repeat it. All right. We've had a recent increase in substituted samples. And my question is, I want to be sure we're doing it well, under what circumstance can a substituted sample be eligible for recollection? And if recollected, if it is substituted a second time, positive or negative, how do you interpret this? Yeah, under the federal system, if it's substituted, it's reported as substituted, and you're done. So the answer to your first question is never. Understood. What if the client sends the donor back in for recollection? That's up to the client has to take the responsibility of making sure that whatever requirements are done. If that person's completed their SAP clearance and they want to bring them back? Understood. How should we interpret the second test result? If it is, how do you, what's the MRO designation? If it comes back substituted a second time, if it comes back positive as easy, or if it comes back negative? The same way as you report if it was the first specimen. You're not responsible for the stupidity of the employer? Correct. I don't think I didn't say that, did I? Yes, you didn't. It's all recorded. All right. And it's been recorded. Okay. So, yes, sir. Thank you for the talk and the game. It was fun. I have a question about primary sourcing the prescription. I just looked up on MyChart and I saw my prescriptions on MyChart. Is that one example of primary sourcing? If they take a picture of MyChart and send it to you? You're supposed to contact the pharmacist or the healthcare provider, because it's really, really easy to falsify those things and take their name from one part of the chart and somebody else's med list from another part of the chart, and it looks pretty damn good. Yeah. I will tell you that I have firsthand knowledge of people who have done what you suggested, obtained their electronic health record, and have doctored it. So you have to be careful about that. Okay. No more questions. Thank you. All right. Thank you very much all for your attendance. Have a good rest of the conference.

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