 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through AllCEUs. Register at allceus.com slash counselor toolbox. Well, as always, I'd like to welcome everybody to today's presentation. Today we're going to take a little bit of a different path, if you will, and diverge from trauma and counseling specifics and hit more of a legal, ethical kind of aspect. We're going to cover the rule changes and some things that substance abuse professionals need to be aware of. We're going to review the function of the substance abuse professional. And, you know, if you're not a SAP, just being aware, a substance abuse professional is a specific designation from the Department of Transportation for someone who does an evaluation on a person who's in what we call a safety sensitive position to determine what level of treatment they may need. So we're going to review the function of the SAP and how the SAP and LPC, LCSW may function together on an interdisciplinary team, wow, in a co-occurring disorders treatment facility. And I'll give you a hint. You know, the LPC may be the one providing treatment. The SAP just does the evaluation and the follow-up evaluation. So you may get a referral from somebody and you may be providing services, treatment services to somebody who has been evaluated by a substance abuse professional. We'll review DOT policy on recreational and medical marijuana to ensure that everyone is familiar with the restrictions on any of their clients who may fall under DOT supervision. We'll review, as per regulations, the final rule changes of the definition of service agent, the procedures for the revised federal drug testing custody and control form, and the final rule regarding the procedures for transportation, workplace, drug, and alcohol testing programs. So let's get on with it. The substance abuse professional is a person who evaluates employees who have violated a DOT drug and alcohol program regulation. So the person being referred to an SAP is somebody who has tested positive for some substance. The SAP makes recommendations concerning education, treatment, follow-up testing, and after care that can last for up to 60 months. Now, the analogous sort of thing that you can think of is the professional intervention boards that most professions have, nursing, counseling, if any of us happen to test positive for substances or whatever, where we may need to be monitored by an agency for up to 60 months. And the SAP conducts a follow-up evaluation prior to returning to work. They represent the major decision point an employer may have in choosing whether or not to place an employee back into a safety-sensitive position. So it's really important that the SAP is kind of on their game. SAPs, and this is one of those things that differs from what we normally do, the SAP is the advocate for neither the employer nor the employee. Since you're doing the evaluation on the employee, you're not their advocate necessarily. Your function is to protect the public interest. So it's a little bit different than your normal evaluation. SAP reports, you know, just going to go over a few of those things that need to be in there. And SAP conducting the required evaluations must send the written reports required by this section in writing directly to the employer and not to a third party or entity for forwarding to the employer. You may however forward the document simultaneously to the employer and other treatment providers. So, you know, it's important to know who is supposed to get copies of this record. It doesn't just go in your file and never emerges from there. It has to be disseminated. As an employer, you must ensure that you receive SAP written reports directly from the SAP performing the evaluation and that no third party or entity changed the SAP's report in any way. So it's going to be on letterhead. It's going to be in some non-modifiable format like PDF and I will tell you PDFs are modifiable. There are programs out there where you can modify just about anything. So you want to have a hard copy document on your letterhead. The SAP's written report concerning a follow-up evaluation determines the employee has demonstrated successful compliance and also must be on the SAP's own letterhead. So we want to make sure that we're maintaining, if you will, chain of custody of this report along the way so it doesn't get modified by anyone. As an SAP, you must also provide these written reports directly to the employee if the employee has no current employer and to the gaining DOT employer in the event the employee obtains another transportation industry safety-sensitive position. So if Jim Bob is working for a cross-country trucking place and tests positive for drugs is evaluated and when it's evaluated, when he's tested, he gets fired. They say that's a no-go. We have a zero-tolerance policy. Well, then he's unemployed. So after you do this, where do you disseminate the information? In this case, you do give a copy to the employee or former employee and then if he or she happens to get another position, you're going to provide that report to the new employer. And a lot of you are probably going, if you haven't been working as an SAP, you're probably kind of tensing up now going, but what about HIPAA and all that stuff? It doesn't apply. That's the short version. There are exceptions, but in general, it doesn't apply. As an SAP, you're to maintain copies of your reports to the employer for five years and your employee clinical records in accordance with federal, state, and local laws where everywhere I've been, we have to maintain them for seven years. So five years isn't just a flash in the pan. You have to maintain electronic medical records. Like with any electronic medical records, you need to make sure that it's backed up on a hard drive or somewhere and duplicated because especially it's a hard drive. A sector of that disk could go bad in five years or you go to a boot up disk in five years and it's data technology or whatever. So it's important to make sure that you're going to be accessible seven years from now. If it's in the cloud, there could be a crash of the cloud server. There's a lot of stuff. You want to have what my husband calls redundant backups. If there's a hurricane or a flood in your office and all of your electronics get drowned, you also want to make sure you have an offsite backup somewhere to prevent that. So it can be a cloud or it can be somewhere else. It's important to make sure that all of those locations are HIPAA and high tech compliant. As an SAP, you are to maintain copies of your records. You must make these records available on request to the DOT agency representatives such as inspectors conducting an audit or a safety investigation. So if NTSB shows up at your door, you're going to need to provide those records to them at that point. You know, kind of supersedes everything else. You don't need an additional court order. 49 CFR Part 40, Section 40-40.329C. You know, don't worry so much about that because you can read the regulations. But you must make available to an employee on request a copy of all SAP reports. However, and this is the big thing, you know, of course we want people to be able to access their records. That's kind of part of HIPAA. But you must redact follow-up testing information from the report before providing it to the employee. We don't want them knowing when they're going to be tested because then they can plan for it. So we want to redact that information, both the frequency, the types of testing, and you're probably not going to have the dates of the testing. But if Jim Bob knows, you know, in the fourth year, he's only going to be tested four times and it's random and he's tested once in January, once in March, and twice in May, then he knows that for the rest of the year he's not going to be tested. So it's a free-for-all. So you want to make sure that, you know, they don't know the frequency with which they're going to be tested. So you want to redact that. And SAP can cancel follow-up testing after 12 months. But why would you? Follow-up testing is an effective deterrent. If all the tests are negative, isn't that what we want? You know, thinking about it, yes, they're expensive. You know, no doubt it's expensive to get these drug tests. Even if it's a urine test, it, you know, 45, 60 bucks a shot to get it, get a urine test done. And it takes time and it's a hassle. Well, yeah, but it is keeping the general public safe. So again, you're advocating for the safety of the public, not so much for the financial concerns of the client. If a driver has had no accidents for a year, would you consider canceling insurance on the bus? So that's a analogy you can make. You wouldn't cancel insurance. You know, I, you know, have a really good driving record so far, but I wouldn't cancel my driving driver's insurance just because, you know, I've been lucky and it's legally mandated. But that's beside the point. Some SAPs require a full five years of follow-up testing with only a few tests in the final two or three years. So if you feel bad for people for having to pay a bunch of money and the inconvenience, you can start spacing it out. But it's still important ideally to maintain that testing. If they can stay clean for five years, they can stay clean. Critical points. The follow-up testing plan is confidential and not to be shared with the employee and preferably not anybody else. The employer knows what it is. You don't want HR and the HR assistant and other people knowing. The more people that know, the more likely it is that the employee will be able to find out. So that is highly confidential. An employee's labor agreement can't limit the SAP's authority or place any restrictions on the SAP's follow-up testing plan. So, you know, any unions can't say, well, you can only do follow-up for three years. No, that's not the case. You know, the labor union doesn't have any say in this particular aspect of the life of a person in a safety-sensitive position. Now, as an LPC who's providing treatment, you may get that report and you may know the testing schedule for the person. But again, that's not something that they're allowed to know. So just being cognizant of that. If you have paper files, don't leave it out or they can see it, you know, all that kind of stuff. State initiatives will have no bearing on the Department of Transportation's regulated drug testing program. So whether marijuana is legal as a recreational drug or legal as a medical drug in your state, it's irrelevant. The DOT's Drug and Alcohol Testing Regulation does not authorize the use of any Schedule 1 drugs, including marijuana, for any reason. Even if it's prescribed by a doctor. Drug tests are still considered positive even if there's information that a physician recommended the employee use medical marijuana when states have passed medical marijuana initiatives. So just because the doctor says they need it doesn't mean they can have it and be in a safety-sensitive position. They need to find a different position if they need to take Schedule 1 medications. Marijuana remains a drug listed as Schedule 1 of the Controlled Substances Act and it remains unacceptable for any safety-sensitive employee subject to drug testing to use marijuana. So when we think about safety-sensitive employees, we're talking anybody kind of regulated by the DOT, higher level bus drivers, you know, not somebody who's driving necessarily a 15-passenger van but if you're driving a Greyhound, if you're driving cross-country, if you're flying, if, you know, some maritime operators, anybody who may be transporting people. Service agents. Now the definition of service agent changed a little bit as the substance abuse professional standard, if you will, I don't know what to call it, has been in existence and it requires the involvement of a lot of different players, if you will. In order to minimize confusion, they broaden the definition of service agents. Service agents play an integral role in many DOT regulated employers' drug and alcohol testing programs as advisors providing services to main compliance with DOT regulations. Service agents who are focused on compliance typically increase efficiencies and contribute to the safety of the public. So now we've got auditors and consultants that help employers with their DOT programs. We have the people who do the testing. We have the people who handle the medical records. We have the people who transport the urine samples. There's a lot of people involved. So now they're just all under the umbrella of service agent. Any person or entity other than an employee of the employer who provides services to employers and or employees in connection with the DOT drug and alcohol testing requirements is considered a service agent. This includes but isn't limited to urine specimen collectors, breathalyzer technicians, saliva technicians, laboratories, medical resource officers, the substance abuse professional, and contracted treatment providers. To act as service agents, persons and organizations must meet DOT qualifications if applicable. So there are certain regulations in order to do the breath testing, in order to do the urine testing or be an SAP, you have to meet certain DOT requirements. And you can go on the DOT website and look that up if you're interested, if you're not already an SAP. Service agents are not employers for purposes of this part. So, you know, we're not talking about, you know, Greyhound, for example, they're not a service agent. We're talking about the people who Greyhound implement their policy. The DOT added a new section reiterating that in the DOT testing program, only urine specimens can be collected and analyzed at Health and Human Services certified laboratories. So no blood, no hair, no saliva, no sweat. The DOT added language further emphasizing the existing DOT prohibition on the use of DNA testing on DOT drug testing specimens. So you have this specimen in there and if for some reason somebody wants to run a DNA test on it, the DOT says no. This was collected in order to get drugs, identify drug use, not to determine any sort of genetics or do any sort of DNA testing. So that's a big no-go. In 2017, the Department of Transportation published the final rule in the federal register changing the collection form. It added four semi-synthetic opioids, which are hydrocodone, oxycodone, hydromorphone and oxymorphone. So those weren't showing up before, so they added the semi-synthetics and added MDA as an initial test analyte and removed the testing for MDEA, which are metabolites, if you will, of MDMA. But they changed what they were looking at. In 2017, they approved the federal drug test and control form and authorized the continued use of the old form until June 30th of 2018. So if you happen to be in a place where you are doing the collections, know that your form has to change by June 30th, 2018. DOT regulated employers and their service agents are to continue using the old CCF until further notice from the DOT's office of Drug Control and Policy, which they have updated. And they've said that as of January 1st of 2018, you can start using the new form, but by June 30th, you must use the old form. So there's a six-month leeway to use up all your old forms if you want to. What's the difference? Not a whole lot, but there are a few. They removed a checkbox, the letters DOT and hash line in front of the text, specific DOT agency. They've added the new analytes and they've removed the other analytes that we just talked about. So they adjusted what they're looking for and made a little change in how it's filled out. So some questions and answers come up because, you know, this is an evolving field. One question that was answered during the verification interview, if the medical resource officer learns about legally prescribed medication that would make the employee medically unqualified or would pose a significant safety risk, what do they do? And the response from the DOT, so you're doing your evaluation, you find out that this person is in a safety sensitive position and they're on prescribed methadone or they're prescribed medical marijuana. What do you do? It requires the MRO to tell the employee to have his or her prescribing physician contact them to discuss the medical resource officer's concern about the medication. If the prescribing physician doesn't speak with the medical resource officer within five business days, the medical resource officer will report the information about the legally prescribed medication to the appropriate third party. So the medical resource officer is saying, you know, I'm giving you a chance so we can talk this out and see if there are other alternatives. But if I don't hear from your doctor in five days, then I'm going to have to report it regardless. There is a little bit of an ethical dilemma that comes up and I don't know the answer to it. If you are a clinician and you're working with somebody who's in a safety sensitive position and you find out that they are using marijuana or heroin or whatever the case may be which would make them unable to work in a safety sensitive position if they were found out, is it your responsibility to their employer in that because of the safety sensitive nature of their position and I don't know the answer to that question. Obviously, if you're the SAP you're going to make those reports but if you are just a treating clinician they haven't been test, they haven't tested dirty yet you know, they're flying under the radar and you find out about it what are your ethical responsibilities. And another question was can the medical resource officer report that information to a third party even before the five business days have elapsed and the answer is yes there could be instances where you wouldn't have to wait those days for instance if the doctor calls back that day how do you make that happen but I guess it does then you may be reporting it within under five days because if the physician says that person needs to be on this medication then the MRO has the responsibility to inform the employer if the employee expressly declines to have his or her physician speak with the medical resource officer he says no you're not talking to my doc, I don't care then the medical resource officer has no choice but to go directly to the employer and finally, if the MRO learns of a medical condition or diagnosis that's likely to result in the employee medically unqualified under any DOT regulation the MRO must report that information under the procedures immediately so if you find out that the person has um uh you know I can't think of any condition right now but if they have something that would disqualify them because it makes them unsafe if they have narcolepsy or something um then sometimes because of the safety, the public interest clause it's essential to report that information right away and not wait the five days um um and yes when we're talking about ethics and if you are not working with an SAP if you're just working with a client and you find out that they're using drugs and they're in a safety sensitive position would that fall under duty to warn in order to protect the public safety my feeling and again this is not an answer I would have to consult my attorney if that ever came up but my feeling would be that since you don't have any specifically identifiable victims and especially if they're not currently under the influence if there's no imminent danger then Tarasoff wouldn't apply but you know I would really like clarification on that another group of people that fall under this are um air traffic control workers so it's really important I have worked with some air traffic control workers and it's really important to pay attention to you know what's going on there another question that was asked and I'm going to kind of simplify this one is the United States Coast Guard the DOT agency with respect to this regulation and basically the summation is the United States Coast Guard uses this drug testing regulation for drug testing but not alcohol so if the person test positive for alcohol the Coast Guard has their own set of regulations if the person test positive for drugs then they fall under the um policy of the Department of Transportation okay issues of release of information I told you earlier that you know you're probably listening to this and going oh but HIPAA I need release no um actually in this particular situation um it is presumed assumed whatever when the person takes a safety sensitive position they are basically saying I kind of wave my HIPAA rights with regard to this particular issue you know not just general counseling if the person tests positive for alcohol or drugs and they're in a safety sensitive position you're not going to sign releases of information the service agent including the substance abuse professional cannot require an employee to sign a consent release waiver of liability or indemnification agreement with respect to any part of the drug and alcohol testing process as an employer they also cannot require the employee to sign it so for SAPs to do their job they have to have access to all information without restrictions so they can't be going well I can tell you this little bit or I can get this little bit they need to have pretty much unfettered access a release of information gives the employee control over exchange of information they can say no you can only have this you can only have assessment data but you can't have treatment data or you can have testing data or whatever and the SAP in order to make their final evaluation and their initial will need you know a broad array of information what would be the SAP's recourse if the employee revokes a release you know if you are working with them and they relapse and they revoke their release then you can't call the employer and go positive so or told me that he's been using so then you're in a sticky wicket so basically the way this particular program works and it's very specific to the DOT is that you really don't need those releases your coordinating treatment and coordinating public safety if you will our employers and their service agents required to obtain employee written authorizations in order to disclose drug and alcohol testing information in the DOT drug and alcohol testing program employers and service agents are not required to obtain written employee authorization to disclose drug and alcohol testing information where disclosing the information is required by 49 CFR part 40 so you can't just go willy-nilly disclosing it to Hither and Jan it needs to go to the employer and the service agents and involved in this particular process however you don't need a release in order to coordinate with that interdisciplinary team even if drug and alcohol testing information is viewed as protected under the health insurance portability and accountability act of 1996 it is not necessary to obtain employee written authorization where DOT requires the use or disclosure of otherwise protected health information under 49 CFR part 40 so again I know I've said this on two slides but this is one of those things that we want to have the exact verbiage we want to have it from the horse's mouth so to speak if we're going to do something that's counter to HIPAA unless otherwise stipulated by 49 CFR part 40 or DOT agency and US Coast Guard regulations use or disclosure of the DOT drug and alcohol testing information without a consent or authorization from the employee is required without a consent is required by the omnibus transportation employees testing act of 1991 49 CFR part 40 and DOT and US Coast Guard regulations just kind of reiterating consequently an employer or service agent in the DOT program may disclose the information without the written authorization from the employee under many circumstances like I said it's not a free for all employers need no written authorizations from employees to conduct DOT testing you don't need to have an informed consent and have them agree to the urine testing by being in a safety position sensitive position they already agreed to it collectors need no written authorizations from employees to perform urine collections to distribute federal drug testing custody and control forms or to send specimens to laboratories so these forms you're going to send you know a copy to the employers and they know that testing happened and whatever you don't need releases to do that that's part of the program screening test technicians and breath alcohol technicians need no written authorizations from employees to perform saliva or breath alcohol tests as appropriate or to report the results of these tests to employers labs need no written authorizations to perform DOT drug and validity testing or to report test results to medical review officers and finally medical review officers need no written authorizations to verify drug test results discuss alternative medical explanations with prescribing physicians and issuing pharmacists to report results to employers or to confer with substance abuse professionals evaluating physicians or to report other medical information so you know it's a case it happens where a medical resource officer will get drug test results and go these look a little bit hinky you know I'm wondering what's going on or maybe Jim Bob had his wisdom teeth out and he was prescribed opiates for a week and he wasn't working during that week but a little bit still showed up in his drug test so you know the medical resource officer may talk with a prescribing physician and go what was the date of the surgery what was the prescription for the drugs you know so they can determine whether it should be out of his system and then obviously they're probably going to recommend a retest in order to make sure that the levels are continuing to go down SAPs need no written authorizations from employees to conduct SAP evaluations to confer with employers to confer with medical resource officers or to confer with appropriate education and treatment providers or provide reports to employers so if somebody comes in again you don't have to have a written authorization to confer with the people on the multidisciplinary team third party administrators need no written authorizations from employees to bill employers for service agent functions so if you work at an agency like I worked at a place called Meridian and if I was providing the counseling services to Jim Bob then Meridian didn't need assigned release in order to build the employer for services even though that acknowledged that Jim Bob was seeking services well that was part of his treatment plan anyway so evaluating physicians need no written authorizations from employees to report evaluating information and results to MROs or to employers as appropriate and this is another one of those areas where with that information that we had earlier if you are an evaluating mental health professional and you find out about this and the person is in a safety sensitive position do you need to report do you need to release of information obviously they're probably not going to give it to you what are your rules employers and service agents need no written authorizations from employees to release information to requesting federal state or local safety agents agencies with regulatory authority over them or the employees if the department of children and families is auditing you you don't need to release so you can for auditors for auditing purposes you can do it pre-employment alcohol testing can an employer wishing to conduct pre-employment alcohol testing do so and where does that fall within this whole SAP drug alcohol policy mess a DOT regulated employer except for under coast guard rules wishing to conduct a pre-employment alcohol testing under DOT authority may do so if certain conditions are met and this is kind of critical here the testing must be accomplished for all applicants so you can't just do it on this person over here and not the other five applicants and the testing must be conducted as a post offer requirement so the job is yours as long as you test clean you can't do it ahead of time and then rule somebody out not offer them the job in addition the testing and its consequences must comply with the requirements of part 40 so you know it has to be done chain of custody all legal square and upright you're not going to be doing an onsite breathalyzer test by you know just some random technician has to be done by the rules follow up testing plans only the employer can order follow up tests you know we keep talking about that and I said the employer will know because only the employer can order follow up tests this cannot be delegated to the substance abuse professional or any other service agent and every once in a while the employer will call the licensed professional counselor who is treating the person to say we need to have drug tests done you know this frequently or whatever that's not okay because it cannot be delegated to me as the as another service provider the employer has to be the one to order the follow up tests and it will be done at a health and human services approved facility the SAP cannot determine dates for follow up tests so you're the SAP is not going to say you want to do one in March March April June and October the SAP will say we need to have nine done during the year an employee cannot add non-dot tests under independent authority to the SAP's testing plan so anything they can't just add anything that they're looking for it has to be these specific drugs that are on that drug collection form nothing more nothing less look at follow up tests as a tool to be used when something isn't right but it doesn't meet criteria for a full DOT test for a full SAP evaluation and follow up tests again are a deterrent some follow up tests can be random dates on a calendar and some should be strategic for example on Friday before a three day weekend or on the Monday after a three day weekend or then Tuesday when the employee returns to work I had some employees at one point one employee who every Monday would call in sick to work and we became suspicious that he had relapsed because he was at work the other days but every Monday he would call in sick because he was too hungover so there are strategic times when you might expect to test somebody if there's a big concert in town you don't necessarily need to know what kind of music they like but if there's a big concert in town that might be a good time to test somebody or right before a holiday or right after a holiday new drug and alcohol abuse evaluation technologies now this is kind of cool for those of us even if you're not an SAP in car breathalyzers and most people have probably heard about these where people who have a DUI in car they have to blow under the legal limit in order to be able to turn their car on so that's a great preventative thing and it also keeps a record of the breath test which can be reviewed by the probation or parole officer or whoever presumptom substance tests identify a suspicious substance material or surface where traces of drugs are thought to be instead of testing individuals through biological methods such as urine or hair so you know if you walk into the cab of jimbab semi and it reeks of marijuana a presumptive test might look at the residue that's in the in the ashtray or some of the residue that's on the windshield because you know smoke goes everywhere in order to identify whether there's residue of marijuana there sweat patches are attached to the skin to collect sweat over a long period of time which is up to 14 days so it's really hard to monkey with the test and you can't take any of the measured drugs for that 14 days so and if somebody can stay clean for 14 days a lot of times they are pretty well on their way to being able to stay clean for a longer period they're relatively tamper resistant only a limited number of drugs can be detected though cocaine PCP opiates heroin morphine amphetamine methamphetamine and THC and each patch runs I did a google search on it runs between 46 and 85 dollars so they can be kind of expensive but they do give you a really good picture of kind of what's going on inconclusive results can be produced by variations in sweat production rates in donors so you know people who sweat a whole lot or don't sweat hardly at all may produce some inconclusive results especially those that sweat a whole lot and kind of like drain the patch and obviously certain medications you know may give false positives so it's important to know what medications your people are on and what they might turn up for they are more vulnerable to contamination not tamper but contamination than other common forms of testing so you know tampering would be trying to alter the results so it still showed results but they were in your favor contamination would be you know you use some weird sort of soap or something and it contaminated the sample and it just can't be read at all and it's just it's jelly now that's all it's used for so those are things to kind of be aware of with different people but in terms of monitoring even if you're working with someone who's not in the DOT program you know in terms of monitoring these are all things that may be used to monitor people who are in recovery for alcohol and drug problems new drugs of concern you know again this applies to all of us not just SAPs there's one that's called gray death it contains U47700 heroin and fentanyl oh my gosh U4770 was made into a schedule one drug on in 2017 so you know that's a schedule one drug and heroin and fentanyl we know are going to be in your opiate categories in June 2012 there was a bill that was passed that classifies 26 synthetic chemicals used to make fake weed K2 spice whatever you want to call it bath salts so that bill now made those drugs and metabolites for those drugs illegal dextromethorphan sometimes can be mixed with pseudoephedrine or methamphetamine now dextromethorphan is cough suppressant when you get robitussin DM the DM stands for dextromethorphan when you get the long acting cough suppressants they're pretty much straight up dextromethorphan um if they mix it with pseudoephedrine which is pseudo-fed you've got nyquil I guess that would be daiquil but people can mix those in really high levels in order to get high teenagers have been known to use it rectally in order to increase the rate of absorption in order to get the dissociative effects so it's out there these are things that we need to be aware of dextromethorphan is not going to show up on a unless you use a really high dose and you've got a really comprehensive test not going to show up in a urine screen so we do want to listen for those cratum is a stimulant at low doses and hypnotic at higher doses it is not a scheduled substance it comes from a plant people chew the leaves and it is being researched as a treatment for opiate withdrawal but do you really want somebody who's driving an 18-wheeler on a hypnotic I'm thinking so and for the people that we work with in general regular counseling we may hear of people experimenting with this just so you know what it is and it is kind of an up and comer because it's not regulated yet so more people are going to this and carfentanyl is another one of those synthetic opioids it is a hundred more times more potent than fentanyl and fentanyl is like 30 times more potent than heroin it's a thousand times more potent than heroin 10,000 times more potent than morphine wow and the estimated legal dose is only two milligrams it does not take much carfentanyl in order to suppress respiration and kill somebody those are on the market they're being blended obviously if you're getting street drugs you don't know the exact consistency because there's not quality standards which is why we are seeing some more overdoses while we're on opiates remember that people can start developing a tolerance in three to five days but their tolerance quickly goes away so if they were used to taking four times the adult dose of opiates and they don't use for a couple of weeks and they go back and they start out with four times the adult dose of opiates it could kill them because their body has already started to recoup or reorganize around not having it in their system another reason that people are overdosing because they're not starting low and going slow so to speak when they start using again current trends workforce testing positive for drugs has steadily increased over the last three years to a ten year high of 4.0 that's scary you would think because use of a lot of drugs is going down but workforce positive tests are going up post accident positivity increased 6.2% in 2015 from 2014 rates so it increased 6% in one year 30% since 2011 so the people who are getting into accidents at work that are causing liability issues that are increasing workers compensation rates and stuff you know or potentially could you know we're seeing a dramatic increase in positive tests post accident positivity for safety sensitive positions has risen 22% since 2011 one way that we can and I guess I should put this on a different slide one way to beat the cheaters so to speak is directly observed collections and if you've never done one it is not the most comfortable thing to do in the world because a directly observed collection means you're watching that person do their business you know you're all up in their stuff and that prevents them from using false samples you know I can tell you all kinds of ways that women and men I don't watch men you have somebody of the same gender supervised but women that I've supervised try to beat the test so I wouldn't notice directly observed collections will prevent them from sneaking in anyone else's urine or adulterants like bleach that can nullify the test okay so SAP's have a responsibility for the safety of the public for the for most communications regarding an employee with a service agent or employer releases of information are not required so again that's not talking to their family that's not you know you want to talk to people that are in that multi-disciplinary treatment team new technologies like sweat patches and in-car breathalysers are available to assist in monitoring so they can be considered the SAP will want to weigh the validity of those positive tests or false positives false negatives all that kind of stuff urine tests are really the still the gold standard the ones that are sent off to the lab and go through mass spectrometry your onsite urine collection cups although they're really handy really only have about a 65 to 70% accuracy rate so you can get false positives which means it says somebody used when they really didn't but you can also get false negatives so they used and the drug test doesn't pick it up so you know recognize that they're it's good as a deterrent but if it comes up positive or you have a suspicion that it should be positive and it didn't it needs to be sent off from mass spectrometry that is in a treatment sort of situation that doesn't apply for the DOT follow-up testing which always has to be done through mass spec federal drug testing custody form the CCF has been revised to add synthetic opioids and it can be used beginning January 1st which was 6 weeks ago but it must be used beginning I believe I said June 30th of this year alrighty everybody I know that was a lot of legal mumbo jumbo are there any questions if there are most likely I'll have to try to look up the answers for you but you know alrighty everybody next week we have some more exciting CE presentations coming up I don't remember exactly what they are right now but you know I try to intersperse some of the legal and ethical ones in with more treatment oriented more fun ones so to speak and if you're interested in reading more about being an SAP if you are not already you can just go google DOT SAP and it will come up and it has the substance abuse professional overview who can do it unless something's changed and they just haven't updated the verbiage LPCs cannot become SAPs certified addictions professional or an LCSW or an LMFT but LPCs kind of got left out of that that's one kind of bummer alrighty everybody have a fabulous weekend try to stay dry and don't forget it's half price chocolate today bye if you enjoy this podcast please like and 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