Federal laws and other regulations

1. Federal laws and other regulations

2. The WAR on Drugs • 1970’s – Controlled Substance Act and development of DEA • 1980’s - the number of federal drug convictions rose sharply between 1980 and 1986 • The total number of individuals convicted of federal drug offenses more than doubled from 5,244 in 1980 to 12,285 in 1986 • President Ronald Reagan • passed the law due to the amount of drug abuse occurring in the military • Executive Order 12564 banning all federal employees (on and off duty) from using drugs • Soon after this law went into effect, smaller corporations adopted the same rules.

3. Substance Abuse and Mental Health Services Administration • Agency within the U.S. Department of Health and Human Services • leads public health efforts to advance the behavioral health of the nation • mission is to reduce the impact of substance abuse and mental illness on America's communities

4. SAMHSA • Division of Workplace Programs oversees programs to eliminate illicit drug use in federal workplaces and helps all workplaces become drug-free • Oversight of federal drug-free workplace programs • Oversight of the National Laboratory Certification Program, which certifies laboratories to conduct forensic drug testing for federal agencies and federally regulated industries

5. Drug-free Workplace Act of 1988 • Law was designed explicitly to target workplace substance use • Compels certain types of safety-sensitive employers to take action against drug use in the workplace, such as by developing a written policy

6. Federal Drug-Free Workplace • Comprehensive programs to address illicit drug use by federal employees • Federal agencies: • Nuclear Regulatory Commission (NCRC) • Department of Transportation (DOT) • Department of Defense (DOD)

7. Florida Drug Free Workplace 1990 • intent was to “promote drug-free workplaces in Florida, in order that employers (would) be afforded the opportunity to maximize their levels of productivity, enhance their competitive positions in the marketplace, and reach their desired levels of success without experiencing the costs, delays, and tragedies associated with work-related accidents resulting from drug abuse by employees.” https://www.myfloridacfo.com/division/wc/pdf/DFWPman.pdf

8. Florida Drug Free Workplace • By using the guidelines set forth in the Workers’ Compensation Law, the workplace will be a safer place. Safer workplaces may mean fewer accidents, and fewer accidents mean lower workers’ compensation costs for the employer. https://www.myfloridacfo.com/division/wc/pdf/DFWPman.pdf

9. Florida Drug Free Workplace Requirements • Written DFWP policy in place • Employee notice and training • Supervisor training • Substance testing • Post employment offer • Reasonable suspicion/for cause • Includes time of injury testing • Rehabilitation • Random

10. FL Drug Free Workplace • TYPES OF TESTING.—Drug testing must be conducted within each agency’s appropriation. An employer may conduct, but is not required to conduct, the following types of drug tests: • (a) Job applicant testing.—An employer may require job applicants to submit to a drug test and may use a refusal to submit to a drug test or a positive confirmed drug test as a basis for refusal to hire the job applicant. • (b) Reasonable suspicion.—An employer may require an employee to submit to reasonable suspicion drug testing. • (c) Random testing.—An employer may conduct random testing once every 3 months. The random sample of employees chosen for testing must be computer-generated by an independent third party. A random sample may not constitute more than 10 percent of the total employee population. • (d) Routine fitness for duty.—An employer may require an employee to submit to a drug test if the test is conducted as part of a routinely scheduled employee fitness-for-duty medical examination that is part of the employer’s established policy or that is scheduled routinely for all members of an employment classification or group. • (e) Followup testing.—If the employee in the course of employment enters an employee assistance program for drug-related problems, or an alcohol and drug rehabilitation program, the employer may require the employee to submit to a drug test as a followup to such program, and on a quarterly, semiannual, or annual basis for up to 2 years thereafter.

11. Substance testing

12. Who Sets the Standards? Drug Testing

13. Collection integrity

14. Standards • Collection site integrity • Collector training and certification • Laboratory standards • Medical Review Officer standards

15. The process

16. Result Report Contact with Donor Contact with Donor Medical Review Laboratory Confirmation Negative Non Negative Non Negative Rapid Test Laboratory Collection Authorization

18. National Survey on Drug Use and Health (NSDUH) 2013 National Survey on Drug Use and Health (NSDUH)https://www.rti.org/sites/default/files/related-content-files/marijuana_use_and_the_workplace.pdf

19. National Survey on Drug Use and Health 2013 National Survey on Drug Use and Health (NSDUH)https://www.rti.org/sites/default/files/related-content-files/marijuana_use_and_the_workplace.pdf

20. State of the StatesMarijuana Legalization http://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html https://www.rti.org/sites/default/files/related-content-files/marijuana_use_and_the_workplace.pdf

21. Marijuana Use and Effect on Work 2013 National Survey on Drug Use and Health (NSDUH)https://www.rti.org/sites/default/files/related-content-files/marijuana_use_and_the_workplace.pdf

22. To test….or not to test When to take action

23. But now they can have a prescription for it!!!!!! What will the drug test report show?

24. My employee told me they are using medical marijuana…………………..

25. History & Overview Cannabis sativa / indica (Marijuana) – documented medicinal use pre-dates 500 B.C. in China. In 1619 King James decreed American colonists grow Cannabis to support expansion – primarily for rope, paper, & fabric. In mid-1800’s, American pharmaceutical companies produced Cannabis products until criminalization in early 1900’s (Marihuana Tax Act 1937). Controlled Substances Act (1970) - declared cannabis a scheduled 1 drug (claiming addicting potential & no medical benefit). In 2004 the US government patented cannabidiol (CBD), the second most abundant cannabinoid, for its neuroprotective benefits.

26. Endocannabinoid System Overview Brain Nervous System Organs Tissues Immune Cells Endocannabinoid System (ECS) Composed of cannabinoid receptors, endogenous ligands, and degradative enzymes. Studies show ECS may effect multiple physiologic systems and disease processes. CB1 – Brain & Nervous System CB2 – Organs, Tissues & Immune Cells Human Cells CB1 CB2 Cell Receptors Ligands Endocannabinoid Anandamide Phytocannabinoid THC, THCV, THCA Synthetic Marinol, Dronabinol Endocannabinoid 2-AG Phytocannabinoid Epidiolex, CBD, CBDA Synthetic Minocycline

27. Foundation of Cannabis Therapy Cannabinoids such as THC & CBD originate in secretions of the Cannabis plant. Cannabinoids interact with CB1, CB2 and other cannabinoid receptor sites in the body and brain. Targeting endocannabinoid receptors to achieve medical benefit: • Variable dosing • Routes of administration • Types of cannabinoids Trichome THC & CBD Secretion

28. Ingested Cannabis Onset = 30 min – 3 hours Effect = Delayed onset lasting up to 12 hours Dose = 2-5mg in naïve user to experience effects Acute Intoxication: Pharmacokinetics InhaledCannabis Onset = Rapidly Effect = 15-30 min & lasting up to 4 hours Dose = 2-5mg in naïve user to experience effects

29. Inhalation Complication Asthma – Exacerbations & poor control Pneumomediastinum and pneumothorax – Caused by deep inhalations & holding Rarely angina and MI Toxic Effects @ Higher Doses Panic Attacks & Anxiety Nausea & Postural hypotension Delirium & Psychosis Acute Intoxication: Side Effects Common Reactions ● Tachycardia ● Increased BP / RR ● Orthostatic hypotension, especially in elderly ● Euphoria or dysphoria ● Impaired coordination ● Difficulty with concentration problems solving, or memory ● Conjunctival injection (red eyes) ● Slurred Speech ● Ataxia

30. LegislationCurrent & Future Updates

31. Qualifying Medical Conditions - Florida Cancer Epilepsy Glaucoma HIV AIDS PTSD Crohn’s ALS Parkinson’s Multiple Sclerosis Medical conditions of the same kind of class as comparable to those above. A terminal condition diagnosed by a physician other than the qualified physician issuing the certification: Chronic Nonmalignant Pain* Supporting documentation is required to certify patients for this condition in the ommu database

32. Becoming a Certified Cannabis Provider • Active & unrestricted license (MD & DO) • Complete 2-hour FMA/FOMA course once every license cycle

33. Marijuana Law – State to State Comparison

34. Medical Marijuana in Practice

35. Patient Enrollment – Certification & Recommendation Certification Requirements ● Obtain voluntary & informed written consent for each certification ● In-Person physical exam ● Medical history assessment ● Diagnose qualifying condition ● <18 year requires 2nd physician ● Determine if pregnant ● Review PDMP database ● Confirm patient has no current active certification in ommu database ● Activate patient as issuing physician

36. Patient must initially apply for and re-apply for medical marijuana card every year Re-Certification Requirements ● Obtain voluntary & informed written consent for follow up certification ● In-Person physical exam before 210 days ● Determine if patient still meets all requirements for ommu program ● Document if adverse drug interaction with any prescription or non-prescription medication ● Document if reduction in use, or dependence on, other types of controlled substances ● Submit report to DOH including information about adverse interaction or reduction in use of controlled substances