Welcome to this last segment of ACOM's MRO online course. In this segment, we will provide you with information to help you keep up to date and identify many useful resources. Let's start by briefly reviewing some recent changes in federal regulations. As you know, the Department of Health and Human Services made some substantial changes in October of 2017. These were the first changes in quite a while. They added four semi-synthetic opioids to the traditional federal opiate panel. They also tightened up the pH range for adulterated specimens, moving the pH from less than three to less than four. They stopped testing for MDEA, but still continued testing for MDMA and MDA. The HHS said that the MRO may report safety concerns, although we've already noted the difference between HHS and DOT in that area. And finally, they required MROs to receive training on the new regulations before they could be implemented. A couple of months later, the DOT harmonized their Part 40 with the 2017 changes from DHHS. But the big difference was that they said the MRO must report safety concerns, and they instituted their policy for the five-day pause, which we've discussed. They also underscored that DNA is not allowed for drug testing under federal standards. In 2019, HHS released their final oral fluid standards in the Oral Fluid Mandatory Guidelines. So finally, there is an alternative to urine testing. The collection devices for oral fluids have to be approved by FDA and HHS. The specimens must be analyzed in the SAMHSA-certified laboratories. They called for a split-specimen collection, just as in urine testing. And although the regulations went into effect in January of 2020, it's going to take an estimated year to a year and a half for the labs to be ready to implement these protocols. The DOT has not yet created harmonizing regulations. So they are working on that, and it's expected that they will publish their own Part 40 update sometime late in 2020. Federal hair testing regulations are still not approved. Although Congress mandated this in 2015 and put an emphasis on having this done very quickly, the implementation has proved to be very slow. Standards were proposed. They were approved by the Drug Testing Advisory Board. They were sent to the Office of Management and Budget. And they are still delayed in review. So the FAST Act, Fixing America's Surface Transportation Act, has proved to be very, very slow. Now let's turn to some useful resources that will be helpful to you after completing this course. In addition to the MRO syllabus, we've also prepared a supplement to the syllabus, which contains the things that we think are second most important. And this is available online for course participants. So this includes the most recent mandatory guidelines for urine and oral fluid, the most recent version of DOT's Part 40, the Summary of State Laws written by Dr. Smith, the Table of Contents of the HHS MRO Manual, and more information about specimen collection procedures, summaries of the drug and alcohol rules, procedures for doing breath alcohol testing, and some sample contracts with clients. If that is not enough, there's also an online MRO Resource Manual. And this includes a number of background documents, such as federal questions and answers and case studies. It includes practical tools, such as a specimen collection manual and MRO review materials. And most importantly, it includes a detailed set of the highlight articles from the MRO Update Newsletter covering more than two decades. A number of useful books and newsletters are available. Robert Switinsky's MRO Manual was last published in 2015, and I understand a new version is in the works but is waiting for the final release of the DOT Oral Fluid Guidelines. The SAMHSA MRO Manual is very useful, although it's focused on federal employees. Dr. Jim Ferguson's MRO Team Manual has a lot of useful charts and diagrams and practical procedures. There's a wonderful and detailed handbook of workplace drug testing and ACOM's MRO Update Newsletter. Here you see the covers of Switinsky's most recent MRO Manual and Ferguson's MRO Team Manual. And here's the cover of SAMHSA's MRO Manual. In this digital age, the websites of a number of federal agencies can be very useful. And here you see the links to SAMHSA and a current list of certified labs. Although it's a little hard to read, here is the face page of SAMHSA's Division of Workplace Programs, and this title page is on Drug-Free Workplace Programs. The SAMHSA website contains extensive material on workplace drug testing and on conducting drug tests. This drills down just a little deeper into the federal drug-free workplace programs. The DOT website is extremely useful, and they now have a listserv where you can automatically get updates of DOT programs and policies. Here's the current face page of the DOT Office of Drug and Alcohol Policy and Compliance. You see that it begins with notification about drug testing under COVID. DOT also offers extensive guidance and materials for medical review officers. And for a number of years, they have regularly issued a set of questions and answers pertaining to Part 40. Earlier, I mentioned the Centers for Disease Control guidelines about opioids, and here you see two links to their materials. Here are two MRO forums. The first, the MRO listserv, is maintained by Dr. Carl Auerbach at the University of Rochester. Questions can be posed by any MRO. There's no expert who's answering the questions, but you'll get many, many responses from seasoned MROs. The second one is developed through MROCC, and there, the editor is Robert Swietynski, and you will often get authoritative answers to questions. Among professional societies, ACOM is known for designing and conducting MRO training and training on drug testing issues. The MROCC has focused on credentialing and testing and certifying MROs, and the AAMRO does both MRO training and certification. ACOM offers a number of drug testing courses, including the live day-and-a-half fast track, the two-day comprehensive course, and now this online course, which is being inaugurated in 2020. ACOM also offers an MRO assistant training program, which is a one-day course, and it has been completely updated and revised in 2020. ACOM prepared an audio or video webinar on the addition of the synthetic opioids in 2017 and 2018, and at their annual meetings, there is often a program called MRO Controversies, which deals with the latest issues. I've included in this syllabus tab a wonderful PowerPoint presentation from Donna Smith, which goes into much more detail about the status and what lies ahead for federal drug testing programs. Well, congratulations. You've made it. We're at the end of this MRO training program, and I'm now going to cover the very last of the self-assessment questions. So have you now completed all 15 segments of this course, including the presentations and the questions and answers? If so, then you will now need to fill out course evaluations. You'll be able to claim CME credit and receive certificates of completion, and that will be useful in then applying for MRO certification. If you have not completed all the segments, then it's time to go back, finish them up, and then complete this program. Thank you for your patience. You are pioneers, and we really appreciate your choosing to do this online program.

federal regulations

Department of Health and Human Services

MRO training

DOT Part 40

workplace drug testing