So welcome, everyone, on April 12th, this is our fourth monthly faculty call for those people participating in the online MRO course. It's also the night before your faculty are traveling to Philadelphia for the American Occupational Health Conference, where we will be teaching a two-day full or comprehensive course, so we'll be seeing each other for the next few days. But for those of you who are here tonight, we welcome all of you. We've had very rich and sometimes very well-attended faculty meetings every month, and we're glad that you're here tonight. We'll do quick introductions, and then we'll go to two questions that were submitted by people during the last few days, and then we will open the floor to an open discussion with all of you who are here. So I'll just ask, as we do go from the faculty introductions to you all, that you also, with this small number, introduce yourselves to us and tell us your name, where you're located, and how far along you are in the MRO online course, and how it's been going for you so far, because we always welcome feedback. So with that, I'll introduce myself. I'm Kent Peterson. I've been hoarse for two months, and I'm going to have a vocal cord biopsy two weeks from now to find out what's going on. I'm a recovering internist. I started my career in internal medicine, got into preventive medicine through service in the military, and then found myself serving with the Corps of Engineers while I was serving with the military, and got very interested in occupational and environmental medicine. So I am boarded in preventive medicine as well as occupational medicine. So I'm the MRO member of our teaching faculty. I do some MRO work, and I constantly have to keep up to date with ever-changing and evolving technology, and constantly changing regulations. So let me introduce Donna, our second member of our three-person team. Good evening, my name is Donna Smith, and as Kent said, I'm one of the three faculty members now for, I'm afraid it's been over a couple of decades, to be honest with you, along with Mike, Pete, and Kent. My background is in psychology, is my training, did a lot of work early on on the clinical side of addiction prevention and treatment, and then began work with the US government. And I guess perhaps my claim to fame or shame, depending on your viewpoint, is that I was more instrumental in writing and in developing the drug testing regulations and policies for the US Department of Army than the US Department of Transportation. Since my retirement from federal service in 1995, I've worked for a couple of large medical review officer, third-party administration companies, and have more recently in the past decade done a little bit of work in the professional health monitoring programs, again, with quality assurance work in the testing that is done by state boards and state bureau assistance programs. And then lastly, dabbled a little bit, which you'll hear a lot more about from my other colleague, Michael Peet, did a little bit of work in the sports anti-doping arena for a few years. So that's my resume in a nutshell. Hi, I'm Michael Peet, and I've known Donna and Kent for as long as we probably all can remember at this point, and enjoyed that experience, obviously. I'm a toxicologist by training. I've been involved in forensic toxicology since the 19-somethings, and still involved in that. I'm the editor of the Journal of Forensic Sciences. When I'm not talking to Donna about drug testing results, she has issues with, and I'm here to answer your questions in the toxicology arena. Great. Thank you, Michael. So Chris, why don't you unmute yourself and introduce yourself as a key player? Hi, I'm Chris Paciak. I'm the executive director of the Medical Review Officer Certification Council, and I'm here to help you with any questions you may have on the exam and the certification process. Once you complete the course, Heather will send me your information, and I will contact you with information on how to register for the exam. Terrific. And Heather, you're our backbone and our main supporter, so tell us about yourself. And I just real quickly want to introduce Danielle Feinberg is on the call today. She's actually the one who sends the list, but Danielle is one of the staff people in the education department. So I'll let her introduce herself after I'm done, but I'm Heather Hodge, currently the director of education at ACOM, and always enjoy these calls. If you have questions about the course, you can reach out to us, and we work real closely with Chris, making sure that we all are in sync with who's completed the course and things like that. So we certainly can refer you. If you reach out to us with a question that should go to Chris, we'll refer each other back and forth. So you guys are all in good shape with MRO, all things MRO. Hi, my name is Danielle Feinberg. I'm the manager for e-learning currently at ACOM, and I think this is my second call I've sat on, and I really enjoy just learning from a layperson's view about the MRO course and the interesting questions that come up. So great, thank you for being with us. I know last time we didn't know how to record the call, but other than that, it was a pleasure having you with us. So our numbers have grown, and I think rather than having everybody introduce themselves in turn, I'll ask you to introduce yourself just as you begin to speak, and particularly if you have a question. But I do have two questions that were submitted, and we're going to take those first before we open it up to the rest of you. I'm going to share my screen, and they're very short questions. The first came from Jennifer Souders, who's a regular participant in these calls. She called it a weird question, but I don't think any question is weird, and there's no reason why anyone should ever be hesitant to ask a question. But she said, what would the approach be to drug testing in the presumably very rare situation where someone has a safety-sensitive job and has renal failure? So that's a legitimate question. I can talk about it, but do you want to talk about it as well, Donna? No, go ahead, Kent. I can chime in. All right, so there's a section of the course on dealing with the failure to be able to provide an adequate specimen, and it's important to know what the specifications are. So if someone is not able to provide 45 milliliters of fluid within a three-hour period after being allowed to drink fluids, then they have a shy bladder. It's not a medical term, but it's a very practical and useful term. And at that point, the person will be reported as a canceled test. Basically, no report will be given, and the individual will be given an opportunity to go to a treating physician, someone who will evaluate them for their inability to produce a specimen. So if somebody does have renal failure and are unable to generate an adequate urine specimen, they will have a physician. They'll be under the care of that physician. The physician should be able to write a letter to the MRO and explain what the condition is. What's important to do is for the MRO to find out who that physician is and communicate with the physician in advance and let them know what the requirements are so that they're not just shooting blindly to say that this person has renal disease. So when I'm in this situation, I will send a communication to the examining physician and ask them to write me an explanation back. And the question will be, is there a bona fide medical explanation for them not being able to provide the specimen? Because if not, it is going to be reported by me as a refusal to test, and the consequences will not be very positive for the donor. So it is a rare situation, but it does occur. Now we've had a couple of discussions about at what level of creatinine clearance a person should be able to produce an adequate specimen. And you actually can have fairly severe renal disease and still be able to produce enough specimen in three hours to provide a urine. So a person has to be truly in renal failure, like on dialysis, in order for that to occur. So Donna, do you want to add anything to that? Or Mike? Well, the only addition that I'd like to say is that once that has been established that by either the treating physician or an examining physician, that this person is in stage four or late stage renal failure and is on dialysis, then that really is termed as a permanent or long-term medical condition. That would mean that the individual is not going to be able to produce a specimen the next time. Let's say that this was a pre-employment test, or this was a random test. Well, the person will still be in the random pool, and there may be other circumstances where they will be called upon to give a urine specimen for testing. So in that instance, once this is determined to be a long-term or more or less permanent medical condition that precludes them from providing an adequate urine specimen, then either the person who has done that evaluation or another physician is to do a further exam, and this would be a clinical exam for any indication of drug use, of prohibited drug use. For that clinical exam, they can, in fact, use another specimen matrix. So they could administer a blood test. They could administer an oral fluid test or something else, or they don't have to do a test. They simply, through a clinical exam, would make a statement that there is no indication or there's no evidence that this person is a drug user, and then in that case, then, that test becomes reported as a negative. So all of that information comes to the medical review officer and then makes that determination. Now where things get a little tricky is, okay, that has been done. The person had a negative, and they have an established long-term or permanent condition. Now the next time that they are called for a test, again, let's say their number comes up in the random selection. Is it required, especially under DOT regulations, that they would go to the clinic again and go through that whole process of consuming fluids and waiting three hours and then revalidating, if you will, that they still are in end-stage renal disease, et cetera? And I have to say that the guidance from the Department of Transportation is not real specific on this. What has been done is, yes, the person does have to go to the, appear for the drug test, if you will, however, taking, again, the documentation that they already have to that clinic, it is in fact possible for the clinic then, you know, filling out the custody of control form, stating that there is a permanent and existing condition. And so then that is sent to the medical review officer. The medical review officer, well, all that needs to be done then is that the physician who originally said this is a long-term permanent condition has to say that still exists. In other words, the person hasn't had a kidney transplant or something that now, you know, enables him or her to produce the specimen. And that's the, it's a cumbersome process. We are very hopeful that within several months, the Department of Transportation is going to allow that in those situations that the person can have a oral fluid drug test as essentially a substitute for the urine test. That hasn't happened yet, but I think it will happen again within several months. And so that will make the management of the long-term permanent medical condition that precludes an individual from producing a urine specimen much easier for everyone to manage. So let me summarize what I've heard. The Department of Transportation, not unlike certain pharmaceutical companies, has been creating new medical diagnoses. So in this case, DOT invented the term shy bladder. They also invented the term shy lung. And you also now need to be aware of a permanent shy bladder. Fortunately, there is not a permanent shy lung. So that's part of what has happened from the intersection of policymaking and medical medicine. Mike, any other comments on the subject? I think you guys have covered it very well. Thank you. All right. The next question is going to come straight to you, Mike, because you lecture on the subject of negative and positive and failure to be able to test and also invalid and substituted specimen. So one of our students this afternoon said, sharing this for the benefit of group discussion, I have no questions about it. I realize it might be too late to include for this meeting. But here you have an actual result. And you'll see at the bottom that the laboratory called this a specimen substituted. And Mike, you can walk through the two requirements for a substituted specimen. And maybe you have some thoughts about this particular specimen. Well, let me start with the testing of federal employees, because that is by far the simplest when we look at the regulated employee workforce. If a creatinine is less than 1.0001, 1.001, and the specific graph, and sorry, let me start again. Creatinine is less than two milligrams per decaliter. And specific gravity is less than 1.0010. Then the specimen under the federal workforce is considered to be substituted. And the labs have procedures to check all the quality control measures around that. In the DoT world, there's two cut offs there's that cut off of two and 1.0010. And there's also a cut off between two and five creatinine. And and again, the Pacific gravity remains 0010. If the creatinine is between two and five, then it is considered under DoT to be an exceptional circumstance. And that specimen would then be all the donor would then be required to do a directly observed collection. And the lab reports to the MRO, the creatinine and Pacific gravity reasons, and readings that make that decision straightforward. So again, there's two cut offs federal and DoT, the federal one, you very rarely have that situation. DoT may encounter a few a year or a few a decade between two and five, that requires a directly observed collection recollection. This report wouldn't be given out in a DoT arena, those numbers would come for you the readings, the creatinine and Pacific gravity that the lab has detected on this patient, which is less than one of creatinine and Pacific gravity of zero would come to you as numbers and then you would be required to take action on it. You will not also on a DoT specimen, or federal employee see an acceptable range, they don't include those on those reports. You would just see the creatinine and Pacific gravity reading. So it's really this one, Mike, let me just point out, I believe that the lab would still say specimen substituted, would it not? Yes, it would. Sorry, I missed that, Donna, you're correct. It would be, it would report it as specimen substituted. Yes. So given these extreme values, Mike, what do you think was submitted? Well, this is obviously probably water. Pacific gravity of 1.000 is, I think, more likely to be water than anything else. Yeah, creatinine being less than one, less than one is probably the detection limit of that instrument in that lab. So they may well report it as one and not negative. Good. So this is, again, a real life example in a non federally regulated specimen of the very things that Michael teaches, and Donna teach and I teach in the course. If I could just go one step further, although I don't know that the questioner asked this, but under any federally regulated regulations, whether that's the Nuclear Regulatory Commission, the Federal Employee Program, as Mike mentioned, or the DOT, a specimen substituted report from the laboratory is reported by the MRO as a refusal to test. So that's the second thing, when you report that to the employer, you report that as a refusal to test. Now, there's a little caveat here, just from an MRO perspective standpoint, is that the Department of Transportation, and the federal program, and the nuclear program also do require you to do an interview with this donor, even though, just like they would for a positive drug, a confirmed positive drug test. So you do have to contact the donor, and you tell them, your specimen was reported by the laboratory as not human urine as substituted specimen, not your urine, and ask them if they have an explanation for that. If they do try to tell you that they have a rare urological condition, a rare kidney condition, a rare whatever rare mental condition that would that would give these values. And if if you feel that there is some merit to what they are telling you that you it could be the one case that's going to be written up in the Journal of Forensic Science, right, that is physiologically explained, then you can go down that route with the donor to provide the documentation from, again, from medical specialists that yes, this person does in fact produce urine that has creatinine less than one, and specific gravity at 1.000. Again, there is no obligation on your part, however, that if the, you know, the the explanation that the person is providing to you doesn't have doesn't fall within the realm of probability or possibility from a medical standpoint, then you would report this as a refusal to test. Good, thank thank you for the other end of that, Donna. So given that there were only two written questions, the floor is now open. And as I said earlier, if you have a question, we'd like you to introduce yourself where you're from, how far you are in the course, and how it's going for you. So Bobby, are you the first? So Bobby, are you the first? Yeah, how are you? Sorry, just got off a call. But one of my questions I've asked, you know, I took your, you know, course, you know, I think a year and a half, two years. Great. So I'm doing some emerald stuff. Now. One question. I had two questions. Actually, the first question is, if a donor asked for a split to be retested, and do we tell the DER what the results are? Or do we wait until the split comes back? Oh, no, you always report your, your determination on the primary specimen. Okay. And then the second question, you know, getting a lot of this, sorry, go ahead. There are very, very, very, very few specimens that don't reconfirm. All right. I know. I told him I told him I never seen one. It's not going to happen. You want to waste your money. That's that's your prerogative. I don't say it that way, obviously. But yeah. And the second question regarding marijuana, you know, we get a lot of questions about, you know, like delta eight, you know, is that what we're testing for? And then another client asked, is there a way to measure acute intoxication for marijuana by doing some creatinine to marijuana ratio over time? And are any lab doing that now? And I just say, it's hard to measure acute toxicity. It's not being done routinely now. If I'm mistaken, there's a better way to answer those questions. Yeah, well, the acute toxicity is almost impossible, if not impossible to measure with any body fluid, including blood. So even though they spent lots of money over the years trying to answer that question, even blood levels of THC don't correlate with toxicity or intoxication, or impaired driving, none of the above. And then but they are used the measurement of the THC metabolite in urine per milligram of creatinine is used in the rehab programs to monitor the decay of THC acid in heavy users who are going through rehab. Okay, it has proven somewhat useful there. There are algorithms that have been published to show the decurve curve measured in nanogram per milligram. And there's proof useful over the years for that purpose. Okay, helpful. And then the last question, you know, there I know there are some articles recently on poppy seed use from the US Army, or I think one of the departments saying that use of poppy seed muffins can sometimes show up as a positive coding. And I'm just trying to see, you know, how we respond to that, if we're getting asked the questions, like how many poppy seed muffins can I eat before it turns up positive on a coding test, actually, so I'm not too sure if that's been widely read, but I someone did form a like forming article that one of the departments of the Air Force, Navy or someone are telling their members to beware of poppy seed muffins, and coding, testing positive. Well, there's two things that are a little different with the military program, it has a lower cutoff for opioids, opiates than does a the federal government. And I know it's part of the federal government, their cutoff for morphine coding is 300 DOT is 2000. So right there, you have a differentiation. The second thing is that although I've read those reports with interest, all the available scientific literature, say that coding is if present in poppy seeds is that look very, very low concentrations compared to the morphine. So I, you know, they can you can think in the opioid opiate world today, you can think of all sorts of explanations, maybe for coding. But the published data on poppy seeds show that coding concentrations in the poppy seeds are very low compared to the morphine. Yeah, that's what I'm saying. Yeah. So your investment was to come back coding positive, following poppy seed use, I would expect the morphine concentration to be very high. Okay, makes sense. Thank you. Good. Thank you. There's a couple people with their hand up Dr. Peterson. One is has their name shows his iPhone. I'm not sure who it is. Okay, and cook. So that's right. All right. Well, I see. Yeah, I see. I see Mr. iPhone or Miss iPhone on my top left. And then young Kang is next. So can you show your face? And please, if not, at least, ask your question. Welcome. There we go. So that's, that's me. Hi. I'm in the I'm in Ontario in the Toronto region, certified MRO, and I consult for two regulatory colleges. Just wanted to discuss a case that's ongoing. Pharmacists that's on stimulants for the ADHD, tested positive for amphetamines by GCMS. But being prescribed Ritalin, and the addictions physician and the pharmacist insists that the positivity for the amphetamine is due to the Ritalin, the methylphenidate. Now, I haven't seen anything to back this up and haven't come across this before. And there's a whole lot of other people on on amphetamines, and I don't see them coming up for Ritalin. I'm just looking for your experience on this, if there's anything I need to consider further. Thank you. Ritalin has a very different chemical structure to the amphetamines. And I know of no reason why Ritalin would metabolize to amphetamine or methamphetamine. Yeah, it's not it's not a reason for the presence of the amphetamine. Is your panel testing for Ritalinic acid at all? No, it's just reported as Ritalin, not Ritalinic acid. No. Well, I can check with the lab. Yeah. And any reason I should follow up on that? You understand what I'm getting at, Mike? I mean, Yeah, I do. Ritalinic acid is obviously the metabolite of Ritalin. And again, I wouldn't expect that to arise from the presence of amphetamine or methamphetamine. So yeah, the answer is the same. Okay. So I think your donor is double dipping. They may be enjoying their Ritalin, but they're taking something else. As I thought. Thank you. Thank you for your question. All right. Yong Kang, we're ready for your question. Oh, sure. Hi. Oh, hey, my name is Yong Kang, and I'm a newly certified MRO from the Chicago area. So I do have a question regarding the, I'll give you an example. A patient tested positive for amphetamine, and he showed a prescription, which was prescribed probably two months ago, before the drug test, only like 10, 15 tablets Adderall. So if that's the case, how we go about it? So the prescription was written for 10 tablets. Is that right? Right. Yeah. All right. And but it was written for as needed, or was it supposed to be taken twice a day or anything like that? Do you know? That said a daily. It said daily. Okay. And he never got it refilled. It's what you're saying. Okay. Now, unfortunately, if this is a DOT test, the Department of Transportation would tell you that as long as he has a prescription for the controlled substance that is in his name, whether or not it was written a month ago, and he should have used up the number of tablets or whatever, they would tell you that that is still a negative, a negative test. However, Dr. Kang, what the DOT has intimated and what the practice, for example, in our MRO practice with with that is, while we would call it a negative, we would put a safety concern on that negative report to the employer, indicating that we have some concerns about how this medication or this medication is being taken for this employee. Don't forget under DOT testing and under the federal program, and certainly under the Nuclear Regulatory Commission, all of these individuals are in safety sensitive positions. Now, it may be somewhat different for the program that you're talking about, but I'm simply telling you what the kind of the standard of practice is relative to that. Sure, sure. So there's really no like a time limit between the prescription was rating and the drug test collected. Now, there was a large, a very in depth discussion of that in the preamble, we call the preamble to the last Department of Transportation regulation that was issued in 2018, or 17, I guess it was, it became effective in 2018. And the DOT there opined, along with support from the Department of Justice and the DEA, and whomever else that there was no such thing as a an expiration date on controlled substance prescriptions. So that is really the basis for what, what the DOT's position is on that. Okay, good. Thank you. Thank you. Good to know. Thank you. Thank you for your question. Okay. Does anyone have any questions about preparing for the MRO CC exam, studying for it, or tips in that area? Or any of you students who are wanting to hear from the mat from the master, Chris, in this case? Can't could I just go back to one question that I think we kind of maybe skipped over the second part. I don't know whether I heard Dr. Pete mentioned or not. But there was a question about delta eight testing. Did you did you get to that mic or not? No, I didn't. I can get to it. Oh, yeah. Why don't you mention that? Because I hear that a lot from even from our, our staff. And certainly I hear it in the professional health monitoring arena. Yeah let's let's talk about DOT and the federal government for that matter. There is no requirement except in the U.S. military for Delta A THC testing. The labs would be expected at this point given the literature and the public interest to have validated their assay to ensure that they can separate the Delta 8 isomer from the Delta 9. And that would be checked on the annual inspections and also checked I would believe under the proficiency testing that those labs go through. There's obviously CBD falls into that category again the lab would have been expect that they've you know confirmed that they can separate CBD which is not difficult to separate from Delta 9 THC in their procedures. Outside of the DOT and the military and the Nuclear Regulatory Commission I would expect labs to follow the same procedures because that quote unquote has become the standard of care today in the marijuana testing arena. The ability to separate the Delta 8 from the Delta 9. It's not a hard separation it's a routine chromatographic one but I would expect them to have that information on record. So Mike in the non-federally regulated testing are many companies now beginning to ask the labs to test for Delta H Delta A THC? Yeah they are. I'm not sure what they're doing with the results but they're asking that question yes. I don't but I don't I Donna may know more than I but I don't believe DOT is moving down that path at all at this point. No I can't imagine that they are they got enough trouble with what's going to happen with the legalization of marijuana and Delta 9. So it is interesting epidemics. Yeah of course I live in a strange state but our state legislature just this week as a matter of fact has put forth a bill to take Delta 8 off of the market. In other words they're bucking up against the definition of the hemp farm bill and this whole business about actually making Delta 8 right a substance that cannot be sold. And I thought it was interesting that the pro-cannabis lobby in arguing against this bill and this what may become a unilateral decision by our governor who could do anything it seems like. But anyway I won't get into that but they have said that the Delta 8 THC market in Florida has out distanced medical marijuana CBD combined in terms of the revenue. And so they of course presented to the legislature all of the jobs and all of the businesses that would be lost if in fact Delta 8 could not be sold in Delta 8 THC could not be sold in Florida. So it just gives you an example. And the governor of Texas who is similar to the governor of your state they have recently passed a senate law that you remember how many of you remember when crack got higher prison sentences than powdered cocaine way back in the 80s and 90s? Sure. Well they've passed a law now that says if the lab detects Delta 8 THC it's less than a it's a lower sentence than if it's Delta 9 THC and they passed a law that fentanyl is a much higher sentence than heroin and morphine. For distributing or yeah. And the crime labs here are absolutely furious because it means by sort of conservative standards not meaning conservative politically but conservative in number of people they're going to have to hire a thousand registered certified criminals which is that is truly impossible. So yeah let's see how this goes. So if I can just follow up I was a little confused so I've been a little confused. So for DOT and Delta 8 and CBD are they distinguishing between Delta 8 and Delta 9 THC or are they just coming back as THC positive? I know a lot of times I'm seeing patients who are THC positive say oh I use CBD I use Delta 8 and I'm reporting them out as positive I don't know if they are separating them out or not. The labs are distinguishing them be assured of that they're just they're not allowed to report it under a DOT test. Yeah so when you get a DOT result that says positive for THC that is positive for THC 9 Delta it's not for 8 Delta or it's not for cannabidiol. I'm sorry? Oh you broke up on my end I apologize can you repeat what you said? Say it repeat repeat yourself Donna. Okay what the certified laboratories for reporting out test results are and they reported out as positive for THC or positive for THCA that means that it had it was over the confirmation cutoff for 9 Delta not for 8 Delta or for CBD cannabidiol. So a person that says to you that they are positive on a drug test at a certified lab under DOT or HHS or NRC nuclear regulatory commission who says to you I'm using CBD or I'm only using 8 Delta your response is the CBD that you're using has THC in it right and the or the 8 Delta that you are using has product that you're using has 9 Delta THC in it. Okay so basically you say that whatever they're using it does contain 9 THC and that's what's showing up positive so it's not Delta 8 or cannabinoid or cannabis I mean or CBD yes but but that whatever they're ingesting or taking does break down into 9 THC. No let's just step back here the urine positive metabolite for THC is the Delta 9 am isomer of THC that Delta 9 isomer of THC can be present as a contaminant if you want to call it of that to the Delta in the Delta 8 that they may have purchased and in the CBD they may have purchased. Okay that that the contaminant being present in the Delta 8 or the CBD can lead to a positive Delta 9 THC metabolite finding in the urine of the donor. Oh yeah so it's just it's contaminated it doesn't break down into THC 9 but it's contaminated with because it's hard to you know get a pure substance so it's contaminated with 9 THC which causes the positive. Okay that's helpful. And CBD is this where the confusion comes in CBD can be converted to Delta 8 THC synthetically not in the body but synthetically outside the body there is a method but simple synthetic route to convert CBD to the Delta 8 isomer. Okay thank you that's really helpful I know I get asked that all the time and all these people are saying I just use CBD I use THC I use Delta 8 I use CBD oil you know so yeah that's helpful to say that it's contaminated that's that's helpful to respond to them. And DOT has issued guidance on that on several occasions in the last two or three years. Yes right and basically you know what again what you you need to tell people is that if you're buying a CBD product that says that it is legal and which means that it has to have less than 0.3 percent THC weight to volume okay that's one thing however there is no regulation on the production of CBD products at all so whether or not they have 0.3 percent or less THC as a component or contaminant or whatever of that CBD is anybody's guess and in fact some studies that have been done I don't call them studies but some where CBD products have been purchased off the shelf and reference laboratories have have tested those products for the amount of cannabidiol or T89 you know THC in them they are way off from how they are labeled so it's kind of a buyer beware. Great and that's that's actually very helpful and how to respond to some of these you know donors you know because I always I'm always like a little hesitant how to respond when they say oh how do I get it if it's you know CBD is legal it's Delta 8 it's not Delta 9 so yeah so that that comment is really helpful the contamination that's really helpful okay thank you. We are open to additional questions. One thing I did want to comment on was for those of you who are already certified a couple of topics we discussed tonight are covered in our newsletter there's an article about it by prescriptions that was done and I think the June edition and in the September edition there was an article about Delta 8 versus Delta 9 so you might want to log in and take a look at those articles for a little more information on that. Thank you and I'm going to go ahead and turn it over to our next speaker and I'm going to turn it over to Chris. Thank you Chris. Any other comments on how the course is going where you're finding it easy any places which uh or are there other things you want to bring up? I'll just say I love these Q&A's I did my test you know maybe a year and a half two years ago and I always try to log in I always learn something new every time so these are really helpful so thank you guys. You're welcome. Dr. Peterson there is a question in the Q&A as an MRO do you report it as positive if Delta 9 THC and Delta 8 are present and the donor endorsed CBD use? I don't quite understand the question as an MRO I will of course be guided first by whether it's a federally regulated test or a non-federally regulated test and if it's non-federally regulated by the policy of the employer the federal tests are going to test only for Delta 9 THC and the federal agencies both SAMHSA and DOT have very strongly stated that if you have a positive Delta 9 THC there is no legitimate medical explanation and that would include the use of CBD or other products. In the non-federally regulated world it's a very different situation and it depends upon the state it depends on the employer's policies and it depends on what arrangements you have with the employer. So I don't understand when you say the donor endorsed CBD use a lot of donors tell me that they take CBD and they think that that will explain any finding but as we just said if it does not explain a Delta 9 THC because that means that either they were taking marijuana as well or there were contaminates and the Delta 8 THC varies all over the map and it's increasingly being used and sold for vaping. Any further comments Donna I see you nodding. Yeah I mean I just think that again that you if you have a positive from a certified laboratory and now I think your question said that the laboratory you're using is reporting to you that they found both cannabidiol they found Delta 8 and they found Delta 9 is that what you're saying? I have not seen any laboratory reports for that even the ones that I do for you know for the professional health monitoring programs. Mike do you know if there are labs that are doing that? I think there's some labs that are doing it for some employers yes okay but no in any sort of formal program such as obviously the regulated testing or the medical programs or the sports programs no I don't see that at all. But so I've heard of some employees doing it. Okay but ordinarily what you should do is just report that as a you can either say positive for marijuana or you can say positive for THC that's how it should be reported. Okay good well I do want to encourage all of you as you go through the course and as you begin to practice as an MRO if you have questions it's very helpful if you write them down and send them to ACOM in advance. There's an announcement that goes out every month reminding people of the date and there's always a statement if you have questions let us know but starting tomorrow before you get that notice if you do have questions on any of the Q&As or anything that isn't clear in the in the presentations you are welcome to submit those in writing early and if we get them early enough we'll actually write back to you personally. We are going to be updating a couple of the presentations we're going to be recording them in Philadelphia so there will be in a month or two an updated presentation on oral fluids and on some of the statistics on the prevalence of marijuana use and on substance use disorder and its treatment. So we'll be updating a few of the tabs in the online course but it's basically still up to date and intact and we'll be just refreshing it within the next couple of months. So if you have any questions at any time please feel free to contact one of us you have our information in the syllabus or to contact ACOM. So if that's it I'm going to say going once. Thank you Heather for all you do particularly the week before the very week of the conference. Thank you to all the ACOM staff for what you're doing. Thank you Donna. Thank you Mike. Thank you Chris. We'll be seeing each of each other in the next few days and we hope to talk to many of you next month. So we'll see you in May. Donna the rays are winning. Are they? All right. Sorry I can't help. I have to contribute to her. Donna you now need to stay in the dark. That's what you need to do. All right. Everybody safe travels to Philly if you're attending and we'll talk to you soon. Thanks. Okay. Bye. Bye. Bye.

monthly faculty call

online MRO course

Philadelphia conference

participant questions

drug testing

renal failure

substituted specimen

Ritalin

Delta-8 THC