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BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors: Leila Procopio-Makuh, C-SAPA Diana Byrnes, C-SAPA

BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

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Page 1: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

BEGINNER DRUG & ALCOHOL PROGRAM

MANAGER TRAINING

FTA 10th Annual Drug & Alcohol Program National ConferenceAtlanta, GA April 28–30, 2015

Instructors: Leila Procopio-Makuh, C-SAPA Diana Byrnes, C-SAPA

Page 2: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 1 – Introduction

Page 3: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:
Page 4: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Purpose and Intent of the Regulations

In 1987 and 1991, major fatal transportation accidents were determined to have been caused by transportation employees under the influence of illicit drugs and alcohol

Congress recognized the safety risk posed to the traveling public and began writing legislation that introduced consistent and cooperative drug and alcohol testing rules, across all modes of transportation

In October of 1991, Congress passed the Omnibus Transportation Employee Testing Act

The rule required each transportation administration to prepare industry specific rules

Page 5: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Legislative and Regulatory History of Federal D&A Testing Regulations

1991: Congress passed the Omnibus Transportation Employee Testing Act (OTETA)

1994: FTA adopted 49 CFR Parts 653 (drug rule) and 654 (alcohol rule)

1995: Compliance required for large public transit agencies

1996: Compliance required for small agencies

1997: FTA Substance Abuse Program audits began. To date, over 1500 transit systems have been audited and re-audited.

Page 6: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Legislative and Regulatory History of Federal D&A Testing Regulations (cont’d)

2001: DOT updated Part 40. FTA also combined Parts 653 and 654 into Part 655

2008: DOT revised Part 40 and mandated direct observation procedures for return-to-duty and follow-up tests

2009: FTA clandestine collection program began

2010: HHS updated drug testing protocols and DOT updated Part 40 accordingly

2013: FTA amended Part 655 to comply with provisions of MAP-21

Page 7: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Why Is Regulatory Compliance Important?

Compliance with DOT and FTA drug and alcohol testing rules (49 CFR Part 40 and Part 655) is a condition of continued receipt of FTA funds under Sections 5307, 5309, or 5311 Annual certification of compliance is required The FTA Administrator has authority to bar a recipient

from receiving federal financial assistance in an amount he/she considers appropriate

49 CFR Part 655 includes criminal sanctions and fines for false statements or misrepresentations

Page 8: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Why Is Regulatory Compliance Important? (cont’d)

All direct grantees, sub-grantees, contractors and service agents are subject to periodic FTA audits to determine compliance Your agency / company may be scheduled for an

onsite audit anytime after a 30 - 45 day notification

An effective drug and alcohol testing program translates into a safer and more productive workplace for your employees and safer and more efficient transportation services for your passengers and the public in general

Page 9: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Applicable Regulations for Transit

49 CFR Part 40 – DOT Office of Drug and Alcohol Policy and Compliance (ODAPC) These regulations define the “what” and the “how” of drug

and alcohol testing (what substances are tested, their cut-off levels, and how specimens are collected, analyzed and how the results are reported)

49 CFR Part 655 – FTA Office of Safety and Security These regulations are transit specific and define the “when”

and the “who” of drug and alcohol testing within the transit industry When testing is required (i.e.; pre-employment, random, post-

accident, etc.) Who is required to comply (i.e.; identifying which employees are

safety-sensitive and thus covered by the testing rules)

Page 10: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

FTA 49 CFR Part 655

Categories of covered employees (we will identify the 5 safety-sensitive functions)

Employee and supervisor training requirements

Prohibited behaviors and conduct

Prohibited substances (the “DOT 5” + alcohol)

Types of drug and alcohol tests (testing circumstances)

Consequences for rule violation

Reporting and record keeping requirements

Requirement to certify compliance

Page 11: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

DOT 49 CFR Part 40

General employer responsibilities

Procedures for drug and alcohol testing

Qualification requirements and roles and responsibilities of service agents – collector, BAT, HHS lab, MRO, SAP, TPA

Drug panel (Marijuana, Opiates, PCP, Amphetamines, Cocaine) and cut-off levels

Confidentiality and recordkeeping requirements (also in Part 655)

Page 12: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Basic FTA (Part 655) Requirements

Employer policy on illegal drug use and alcohol misuse adopted by the Board or highest raking official and distributed to all covered employees

Education and training program for all covered employees, and for supervisors/company officials authorized to make reasonable suspicion testing determination

Testing program which meets the requirements of Part 655 and Part 40

Procedures for SAP referral

Page 13: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

FTA Definitions of Safety-Sensitive Functions (Sec. 655.4)

1. Operating a revenue service vehicle even when not in revenue service

2. Operating a nonrevenue service vehicle when it is required to be operated by a CDL holder

3. Controlling dispatch or movement of a revenue service vehicle

4. Maintaining (including repairs, overhaul and rebuilding) a revenue service vehicle or equipment used in revenue service

5. Carrying a firearm for security purposes

Page 14: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 2 – FTA Policy Statement Requirements

Page 15: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Minimum Policy Requirements(Section 655.15)

1. Identity of designated Contact Person

2. Categories of safety-sensitive employees covered

3. Prohibited behavior and conduct

4. Testing types/categories (circumstances when employees will be required to submit to testing)

5. Testing procedures in accordance with Part 40, as amended (Detailed procedures not required to be included in policy)

Page 16: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Minimum Policy Requirements (cont’d)

6. Statement concerning requirement for a covered employee to submit to drug and alcohol testing in accordance with Part 655

7. Behaviors that constitute a test refusal

8. Consequences for a verified positive drug test result, confirmed alcohol test result of 0.04 or above, or test refusal (including adulteration and substitution)

Page 17: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Minimum Policy Requirements (cont’d)

9. Consequences for alcohol test result of 0.02 BAC or greater but less than 0.04

10. Employer decision on negative-dilute test results where creatinine is above 5 mg/dL

Page 18: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Prohibited Drug Use

DOT tests for Marijuana, Opiates, PCP, Amphetamines and Cocaine using Part 40 cut-off levels. (Sec. 40.87)

Consumption/use of above drugs is prohibited at all times and a covered employee may be tested for the prohibited drugs anytime he/she is on duty

Page 19: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Prohibited Alcohol Use

General Rule: No covered employee can perform or continue to perform a safety-sensitive function with an alcohol concentration of 0.02 or greater

Pre-duty use: Alcohol consumption is prohibited within four hours of the performance of safety sensitive functions

Alcohol (in any form) is prohibited during the performance of safety sensitive functions

During the specified on-call hours of a covered employee who is on call. Employer must give employee opportunity to acknowledge the use of alcohol at the time he/she is called to report to duty

For 8 hours following an accident that requires D&A testing, or until after employee undergoes PA alcohol test

Page 20: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Additional Employer Policy Provisions

Must be clearly identified in the policy as being under company authority (generally through use of different font types, bolding, or underlining)

Testing must be performed using non-DOT CCF or ATF

Must use urine specimen from a separate void if DOT test is also being conducted (e.g., testing for additional drugs after an accident)

The requirements of the Drug Free Workplace Act of 1988 (DFWA) may be incorporated in the policy, but must be identified as being under separate authority

Page 21: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 3- Training Requirements

Page 22: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Employee Education & Training Requirements (Sec. 655.14(b)(1))

Display and distribution of informational materials and community service hot-line numbers

At least 60 minutes on the effects and consequences of prohibited drug use on personal health, safety, and the work environment, and on the signs and symptoms of prohibited drug use

Training on alcohol misuse, Rx and OTC medications is highly recommended

Only initial training is required for compliance purposes

Page 23: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Supervisor Training Requirements(Sec. 655.14(b)(2))

Supervisors/company officials who are authorized to make reasonable suspicion testing referrals should receive:

At least 60 minutes on the physical, behavioral, performance indicators of probable drug use; and

At least 60 minutes on the physical, behavioral, speech, and performance indicators of probable alcohol misuse

Page 24: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 4- Test Types

Page 25: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Test Types/Categories

1. Pre-employment (Sec. 655.41 and Sec. 655.42)

2. Reasonable Suspicion (Sec. 655.43)

3. Post-accident (Sec. 655.4 and 655.44)

4. Random (Sec. 655.45)

5. Return-to-Duty (Sec. 655.46 and Part 40, Subpart O)

6. Follow-up (Sec. 655.47)

Page 26: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Pre-employment Testing

Drug testing is required; alcohol testing is optional. If employer chooses to conduct pre-employment alcohol testing, must follow Part 40 procedures and report alcohol testing data on DAMIS forms

Verified negative test result is required before employee (definition includes applicant) performs any safety-sensitive (S-S) function. FTA does not accept waivers

If test is canceled, employee must retake. A canceled test is neither positive nor negative

Applicants who were tested more than 90 days before they perform S-S function must have a new pre-employment drug test

Any employee who’s been away from his/her safety-sensitive duties for at least 90 days and has been out of the random pool during this time must pass a pre-employment drug test before being allowed to return to S-S duties

Page 27: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Other Pre-employment Requirements

With written consent from the applicant, employer must obtain D&A testing information from previous DOT-covered employer(s) during the previous two years. (Sec. 40.25)

Must also ask the applicant if he/she previously failed or refused to take a DOT pre-employment drug or alcohol test in the previous two years

If applicant/employee had a previous violation, employer must obtain documentation of successful completion of the DOT return-to-duty requirements (including follow-up tests) before allowing employee to perform any S-S function

Employer must document good faith efforts you made to obtain the required information. (Keep copy of letter sent to previous employer(s) and make note of follow-up calls)

Page 28: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Reasonable Suspicion (RS) Testing

Required when a trained supervisor has reasonable suspicion to believe a covered employee has used a prohibited drug and/or misused alcohol

RS determination shall be based on specific, contemporaneous, articulable observations concerning the employee’s appearance, behavior, speech, or body odors. Document testing referral.

RS drug test can be conducted anytime the employee is on duty, regardless of whether or not he/she is performing S-S duty at the time of the determination

RS alcohol test is authorized only if the supervisor’s observations are made during, just before, or just after the employee’s performance of S-S function. If delayed beyond 2 hours, must document reason for delay. If not conducted within 8 hours, cease attempts and document reason for inability to test.

Page 29: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Post-Accident Testing

Accident: An occurrence associated with the operation of a public transportation vehicle, whether or not the vehicle is in revenue service

Fatality: test driver of vehicle and any other S-S employee who could have contributed to the accident

Non-fatality: a) when there’s bodily injury requiring immediate medical treatment away from the scene; b) if the vehicle is a bus, electric bus, van or automobile and one or more of the vehicles involved incurs a disabling damage that requires the vehicle to be towed away from the scene; or c) if the vehicle involved is a rail car, trolley car, trolley bus, or vessel and it was removed from operation

For non-fatal accidents, employer can waive PA tests if driver’s performance can be completely discounted as a contributing factor

Page 30: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Post-Accident Testing Cont.

Must document pertinent info about the accident and decision to test or not to test. Train supervisors to fill out form completely and accurately

Conduct D&A tests as soon as possible after the accident. If alcohol test is delayed beyond 2 hours after the accident, document reason for the delay. After 8 hours, discontinue attempts to test and document why you were unable to test. You have up to 32 hours to test for drugs. If unable to test for drugs within 32 hours, document reason for inability to test

If unable to conduct FTA tests, employer can accept results of tests conducted by Federal, State or local officials under their own authority, provided the tests conform to the applicable testing requirements and employer is able to obtain such results

★The general conference agenda includes sessions specific to this topic.

Page 31: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Random Testing

Must use a scientifically valid method of selection where each employee has an equal chance of being selected

Must be unannounced and unpredictable

Must meet the FTA minimum rates of 25% for drugs and 10% for alcohol. Employer can establish higher rates

Employer must spread testing throughout the year, random period, week and hours that S-S functions are performed

Must ensure that employee reports to the collection site immediately after notification. Delay without valid reason can be considered a refusal to test

Page 32: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Return-to-Duty (RTD) Testing

Applies only to employees who previously violated the policy by testing positive for either drugs or alcohol, or refused a required test. Not the type of test to give someone who is returning from leave of absence

Conducted after employee has completed the SAP-recommended program. Employer determines if it should return employee to S-S position and when

If RTD test is cancelled, employee must be sent back for a retest

Employer must obtain a verified negative drug test result and/or alcohol test result below 0.02

Page 33: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Follow-Up Testing

SAP submits follow-up testing plan to employer after employee has successfully completed the SAP-recommended treatment/education program

Frequency: Minimum of 6 tests during the first 12 months after employee returns to S-S duty

Duration: Minimum of 12 months; maximum of 60 months

Frequency and duration is up to the SAP alone, not dictated by employer, or the union, or labor/management agreement

Page 34: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Follow-Up Testing (cont’d)

Employer must follow SAP’s follow-up testing plan as far as frequency and duration – no more, no less

Follow-up testing is non-negotiable; it is a federal regulatory requirement

Employees subject to follow-up testing also are subject to random testing

Follow-up testing follows the employee through breaks in service or through subsequent employers

Page 35: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 5- Drug Testing Process

Page 36: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Use of a Testing Notification Form

Using a “testing notification form” to officially notify an employee that they must report for a DOT/FTA test, is a best practice for several reasons:1. It provides written documentation that an employee

has been instructed to proceed to a collection site for a DOT/FTA required urine drug test (a requirement to inform employee of the testing authority)

2. It provides the DER with a means of monitoring travel time and time spent at the collection site prior to the collection being performed

3. It provides critical and required testing information to the collector (as described on next slide)

Page 37: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Relaying Information to Collector

The DER must have a means of providing the following required information to the collector (Per 49 CFR Part 40.14): Full name of the employee Unique ID number (SSN, badge number, or other) Lab, MRO and Employer’s contact information (usually pre-

printed on CCF) Reason for test (such as random, post-accident, etc.) Whether the test must be “observed” or not The DOT agency authority (such as FTA)

*Sample notification form on next slide

Page 38: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:
Page 39: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Drug Testing Process – Flow Chart

Page 40: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 6- Urine Collection

Page 41: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Basic Collection Procedures

Urine collectors must meet the qualification requirements in accordance with 49 CFR Part 40, to perform any DOT urine collections

A urine sample collected for the purpose of a DOT required test must always be a split specimen collection (one void separated into two bottles, referred to as the “A” bottle and the “B” bottle) The split sample collection method is an employee protection; The method of splitting the sample affords the employee the right to

have the second bottle, tested at another HHS certified lab

A routine collection allows for the donor’s complete privacy when providing a urine specimen for testing

Employees will be guided and instructed through the collection process by the collector

The employee’s specimen should be in their sight at all times, until it is packaged and sealed for transport to the laboratory

Page 42: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

What is a Refusal to Test?

The USDOT rule (Part 40)defines the actions that can deem an employee to have “refused to submit to a DOT required test”:

If an employee fails to appear for any test (except pre-employment) at the test site in the appropriate time frame (as determined by employer- more on this later)

If an employee fails to remain at the testing site until the collection process is completed (except in pre-employment situations where leaving before the test begins is not considered a refusal to test)

If an employee fails to provide a urine or breath specimen when required

If an employee refuses to permit the observation or monitoring of a collection when it is required

If an employee does not produce a sufficient amount of urine and it is determined that there is no medical explanation (more on this later)

Page 43: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Refusal to Test (cont’d)

If an employee fails to undergo a required medical evaluation

If an employee fails or refuses to submit to a required subsequent test

Failure to cooperate with the testing process (refusal to empty pockets or wash hands, or behaving in a confrontational manner)

For an observed collection, refusal to follow the observer’s instructions to raise clothing above the waist, lower clothing and underpants to mid-thigh, and to turn around to permit the observer to determine if he/she is wearing any type of device that could be used to interfere with the testing process

Page 44: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Refusal to Test (cont’d)

Possession or wearing of a device that could be used to interfere with the testing process

Admitting adulteration or substitution of the specimen to the collector or the MRO

If the MRO reports a verified adulterated or substituted test result

An employee will also be deemed to have refused a post-accident test if he/she does not remain readily available for testing following an accident

Page 45: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Problem Scenarios

“Shy bladder” (inability to provide 40 ml. Of urine within a 3-hour period after employee has been provided with up to 40 oz. of fluid) Discontinue collection and notify DER Employer must refer employee to an examining

physician acceptable to the MRO within 5 calendar days

Temperature out-of-range ( too hot or too cold) Must collect another sample under direct observation. If

employee refuses, this is refusal to test

Employee refusal to initial bottle seals or sign or provide information in Step 5 of CCF Must record employee refusal in Remarks line of CCF. This is

not a refusal to test.

Page 46: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Interactive group exercise: Participants will complete a sample Testing Notification Form and a Federal Custody and Control Form

Instructors will then perform a demonstration of the basic steps in a urine specimen collection

Notification & Mock Collection Activity

Page 47: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 7- HHS Laboratory

Page 48: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

DOT Drug Testing Panel 5 Drug Classes

1. Marijuana

2. Cocaine

3. Amphetamines1. Amphetamine

2. Methamphetamine

3. MDMA (Ecstasy), MDEA, or MDA

4. Opiates1. Codeine

2. Morphine

3. 6-AM (Heroin)

5. Phencyclidine (PCP)

Page 49: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Laboratory Analysis

Analysis is conducted only at Department of Health and Human Services (HHS) certified labs

Urine sample goes through a screening test. If negative, testing process is complete If initial test is non-negative (positive, adulterated,

substituted, invalid), test is confirmed through GC/MS or LC/MS method

Lab also conducts specimen validity testing to determine if the specimen is adulterated, diluted, or substituted

Page 50: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Specimen Validity Testing (SVT)

SVT determines if the specimen is consistent with normal human urine Has it been adulterated, substituted or diluted?

Lab tests the urine to determine if the following are within the “normal” range : Creatinine levels Specific gravity levels pH levels

Page 51: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Lab Results Reported to the MRO

All laboratory drug test results are reviewed and verified by a Medical Review Officer (MRO) before being reported to the employer. The following are lab results reported to the MRO:

Negative Results Negative Negative-dilute*, reported with numerical values (*more on this in a

moment)

Non-negative results Positive Positive dilute Adulterated Substituted Invalid

Page 52: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Lab Results Reported to the MRO (cont’d)

Rejected for testing (with remarks) Test will be reported as cancelled by the MRO. One example of a “rejected for testing” result would

be when a specimen has leaked during transport and there is insufficient volume to perform the test.

Page 53: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Negative-Dilute Test Results

A negative dilute result can be naturally caused by an employee’s consumption of water; however, specimens with greatly diminished creatinine levels are indicative of an attempt to “beat” the test by purposefully diluting a specimen.

If creatinine is above 5mg/dL, it is possible that the employee’s natural consumption of water has caused a dilute result When this happens, an employer may retest but not directly

observed. (Using the same test type as the initial test) Employer must have this outlined in policy and follow it consistently If second test is also negative-dilute, employer considers it a

negative result The second result is always the result of record

Page 54: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Negative-“Super” Dilute Test Results

If a negative dilute result has a creatinine level between 2 – 5 mg/dL,: The MRO must order a retest under direct observation Employer must follow the MRO’s directive and must

proceed with the test as soon as possible after receiving the MRO’s directive

The employee must be given NO advance notice If the second test is also negative-dilute, employer

considers it a negative result The second result is always the result of record

(regardless of result)

Page 55: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 8 – Medical Review Officer (MRO)

Page 56: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

MRO Verification Process

MRO notifies the employee of confirmed positive, adulterated, substituted, or invalid test results and determines if there’s any legitimate medical reason for the test result

If unable to contact employee, MRO staff will notify the DER and have DER instruct the employee to contact MRO within 72 hours. DO NOT ASSUME THAT THIS MEANS TEST WAS POSITIVE.

If DER is unable to contact employee, leave a message for employee and notify the MRO.

Page 57: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Other MRO Responsibilities Following Employee Contact

Inform employee of right to request split specimen within 72 hours

Notify employer of verified test result in a timely manner. If notification is done by phone, DER must have a means to confirm MRO identity

Notify employer when retests are required

If applicable, raise fitness for duty issues with employer

Page 58: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

“No Contact” MRO Verified Result

MRO may verify test results as positive or refusal to test because of adulteration or substitution, or canceled (if test was invalid) without the employee interview if:1. The employee expressly declines to speak with the MRO

2. The employee does not contact the MRO within 72 hours of notification by the DER

3. Neither the MRO nor the DER could contact the employee within 10 days of the MRO’s receipt of the confirmed lab test result

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Module 9- Alcohol Testing

Page 60: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Alcohol Testing Procedures

Screen test uses breath or saliva in conformance with Part 40 procedures, as amended

If screen test is 0.02 or greater, Breath Alcohol Technician (BAT) must conduct a confirmatory test using an EBT that is on NHTSA’s Conforming Products List

Employee will be considered to have refused the test if he/she refuses to sign Step 2 of the DOT Alcohol Testing Form

If confirmatory test result is 0.02 – 0.039, employer must remove employee from S-S duty for at least 8 hours or, if retested, until after the employee’s result is below 0.02

Page 61: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Alcohol Testing Procedures (cont’d)

If confirmatory test is 0.04 BAC or greater, apply consequences required by FTA (i.e., immediately remove from S-S duty and refer to a SAP); then apply company disciplinary policy (e.g., suspension or termination)

If test result is communicated to the employer by BAT by telephone or electronically, must establish a mechanism (e.g. pass code) to establish the identity of the BAT transmitting the result

Page 62: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Alcohol Testing Process – Flow Chart

≥ 0.02% BAC

≥ 0.04% BAC

Page 63: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 10- Substance Abuse Professional (SAP)

Page 64: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

SAP Referral

Required when there is a verified positive drug test result, alcohol test result of 0.04 or greater, or test refusal (including adulteration and substitution)

Applies also to applicants who fail or refuse to take pre-employment test(s)

The SAP assists the employer in deciding whether or not to return an employee to S-S duty after a policy violation

Rule is silent on who pays for the SAP services

Page 65: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

SAP Referral (cont’d)

If employer requires employee to pay for SAP services, include such a statement in the policy

If contract is with a national SAP organization, make sure there is a DOT-qualified SAP in your local area. (See Section 40.281 for SAP credentials)

Page 66: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

SAP Responsibilities

Conduct an initial face-to-face clinical assessment

Evaluate the type and amount of assistance needed and recommend a course of action to the employee

Refer employee to an appropriate education or treatment program

Provide recommendation to the DER in a written report (1st of 2 SAP reports to the DER)

Page 67: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

SAP Responsibilities (cont’d)

Conduct face-to-face follow-up evaluation to determine employee’s compliance with SAP recommendation(s)

Notify the employer in writing when employee is ready to return to safety-sensitive duties (2nd of two SAP reports to the DER)

Provide a follow-up testing plan including frequency and duration and whether the tests will be for drugs only, alcohol only, or for both

Page 68: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 11 – Consortium/Third Party Administrator (C/TPA)

Page 69: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

C/TPA Roles & Responsibilities

May act as intermediary in the transmission of drug and alcohol testing information (See Appendix F to Part 40), only if the employer allows it. Must have agreement in writing

Must maintain all requirements concerning confidentiality and timeliness of reporting

May operate random testing programs for employers

Page 70: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

C/TPA Roles & Responsibilities (cont’d)

May assist employers in making sure that follow-tests are conducted in accordance with the SAP plan

May assist employers in contracting with other service agents, such as, HHS laboratory, collection site(s), MRO, or SAPs

Receive or maintain records concerning drug and alcohol testing programs on behalf of an employer

May not act as DER

Page 71: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

When C/TPAs May Not Act as Intermediaries

Transmission of laboratory drug test results to the MRO

Transmission of medical information from MRO to employers

Transmission of SAP reports to employers

Transmission of positive alcohol test results of 0.02 BAC or above to employers

Page 72: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 12- Record Keeping

Page 73: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

General Rules on Recordkeeping

Drug and alcohol program records must be maintained in a secure location with controlled access

Kept separate from personnel and medical records to maintain confidentiality

Page 74: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Retention Period Requirements

Keep for at least five (5) years: Verified positive drug or alcohol test results of 0.02 or

greater, including CCFs or ATFs Documentation of test refusals (including reports of

adulteration or substitution) SAP referrals and SAP reports Follow-up tests and schedules for follow-up tests Annual DAMIS reports submitted to FTA

Page 75: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Retention Period Requirements (cont’d)

Keep for at least three (3) years: Information obtained from previous employers

concerning drug and alcohol test results of employees you are intending to hire in a safety-sensitive capacity (See Section 40.25).

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Retention Period Requirements (cont’d)

Keep for at least two (2) years: Records of the inspection, maintenance and calibration

of EBTs Collection log books, if used Documents related to the random selection process Documents supporting decision to administer

reasonable suspicion drug and/or alcohol tests Documents supporting decisions on post-accident

testing MRO documents verifying existence of medical

explanation for insufficient urine or breath sample

Page 77: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Retention Period Requirements (cont’d)

Keep for at least two (2) years: Records of the inspection, maintenance and calibration

of EBTs Collection log books, if used Documents related to the random selection process Documents supporting decision to administer

reasonable suspicion drug and/or alcohol tests Documents supporting decisions on post-accident

testing MRO documents verifying existence of medical

explanation for insufficient urine or breath sample

Page 78: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Retention Period Requirements (cont’d)

Keep for at least two (2) years cont’d: Education and training

Training materials on drug use awareness and alcohol misuse, including employer policy.

Document names of employees and dates and times of such training

Documentation of reasonable suspicion supervisor training and certification that it complies with Part 655.14 requirements.

NOTE: Best Practice is to retain training documentation for the tenure of employment of each trainee.

Keep for at least one (1) year: Records related all negative drug and alcohol tests and any

cancelled tests

Page 79: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Reminders Concerning D&A Records

Must be able to withstand legal and administrative challenges. Every test decision must be properly documented

Must be easily accessible, legible and stored in an organized manner

If maintained by a service agent (e.g., TPA), you must ensure that they are available at your principal place of business in the time required by the FTA auditors

Maintain copies of policy, procedures and subsequent revisions

Page 80: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Organize records by calendar year and by month within the CY. If fewer than 20 records per year, no need to separate by month

Maintain records by test type. Keep records of positive and test refusals separate

Keep documents relating to each testing event separate (even for the same employee)

Each testing record should begin with a completed Order for Testing Form indicating employee name, type of test ordered, date and time of test notification and other relevant information.

For post accident tests, include documentation supporting decision to test (e.g., Post Accident Testing Decision Maker Form)

Recommended Method of Record Maintenance

Page 81: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Recommended Method of Record Maintenance

For reasonable suspicion tests, include documentation supporting the supervisor’s decision to test (e.g., Reasonable Suspicion Testing Determination Form). Ensure that supervisor who made the determination received mandated training.

Maintain random selection lists showing employee names selected for each random period, the type of test for which employee was selected (drugs only, alcohol only, or both), and whether or not employee was tested. If not tested, document reason why.

Return to Duty and Follow-up testing records must include documentation of successful completion of SAP recommended program, and SAP recommendation concerning frequency and duration of follow-up testing.

Page 82: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 13- DAMIS Reporting

Page 83: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

DAMIS Reporting Requirements

Annual reporting required of all grantees, subgrantees and contractors

Due to FTA on or before March 15 of each year. Can be corrected after submission. State DOTs and Pass-through agencies may require earlier

submission from their sub-recipients

Electronic submission is preferred using unique User Name and Password assigned by Volpe by January of each year. https://damis.dot.gov

Employers must use the averaging formula in counting the total number of safety-sensitive employees for the calendar year.

Page 84: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

DAMIS Reporting Requirements (cont’d)

For those requiring a second test, the result of the subsequent test will count. (Example: a retest after an initial negative-dilute test result)

If more than one specimen is sent to the lab for the same testing event, they will count together as one collection. (Example: employee initially presented a cold sample and a second collection is required under direct observation)

Grantees are responsible for collecting and submitting reports on behalf of sub-grantees and contractors

Page 85: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

DAMIS Reporting Requirements (cont’d)

Pass-through agencies such as MPOs or county governments also must submit reports. They should enter “zeroes” under D&A testing data to indicate they are a pass-through agency

Do not double-report. When an employer is regulated by multiple DOT agencies, report under DOT agency for which employees are randomly tested, or for which majority of S-S duties are performed

Must maintain DAMIS reports for at least 5 years

Page 86: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

DAMIS Questions?

Call DAMIS Hotline: (617) 494-6336

Or e-mail: [email protected]

Page 87: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Module 14- Resources and Compliance Tips

Page 88: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Web Resources

FTA Transit Safety & Oversight

http://transit-safety.fta.dot.gov

FTA D&A MIS Reporting

http://transit-safety.fta.dot.gov/DrugAndAlcohol/DAMIS

Office of Drug & Alcohol Policy & Compliance

http://www.dot.gov/odapc

Transportation Safety Institute (TSI)

www.tsi.dot.gov

Page 89: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Federal Contacts

Iyon Rosario*, FTA Drug and Alcohol Program Manager

Phone: (202) 366-2010

Email: [email protected]

Patrice Kelly*, Acting Director of the Office of Drug and Alcohol Policy and Compliance

Phone: (202) 366-3784

Email: [email protected]

*Will be speaking during general conference sessions, see agenda for details

Page 90: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

“Must Haves” for the DAPM/DER

1. Copy of most current version of DOT 49 CFR Part 40. www.dot.gov/odapc

2. Copy of FTA 49 CFR Part 655. http://transit-safety.fta.dot.gov

3. Copies of documentation showing that service agents – collectors, BATs, HHS lab, MRO, SAP – meet their Part 40 qualification requirements

4. Copy of current employer policy and prior revisions

5. Copies of DAMIS reports for last 5 years

Page 91: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Tips for Ongoing Compliance

Sign up for automatic updates:

DOT website: www.dot.gov/odapc

FTA website: http://transit-safety.fta.dot.gov

Review quarterly FTA Drug & Alcohol Regulation Updates

Whenever possible, attend Annual FTA Drug & Alcohol Program National Conference, or 3-day TSI Substance Abuse Management and Program Compliance course, or FTA Substance Abuse One-day Seminar.

Page 92: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Tips for Ongoing Compliance (cont’d)

Maintain quality control on all testing documentation forms. Get in the habit of reviewing CCFs, ATFs, Order for Testing Forms, Post Accident Testing Decision Maker Forms, or Reasonable Suspicion Testing Determination Forms for completeness and accuracy and require correction ASAP, if necessary

Periodically monitor testing spread and rates of random testing. Take corrective action as appropriate

Train and retrain supervisors FTA post-accident testing criteria

Page 93: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Tips for Ongoing Compliance (cont’d)

Train and retrain supervisors on how to make reasonable suspicion testing determination

Include drug and alcohol program requirements as part of periodic safety meetings

Conduct periodic mock collections or clandestine collections at your collection site

Maintain up-to-date documentation of service agents’ credentials and qualifications

Conduct periodic onsite audits of your covered contractors. Require quarterly and annual DAMIS reports.

Page 94: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Questions & Answers

Page 95: BEGINNER DRUG & ALCOHOL PROGRAM MANAGER TRAINING FTA 10 th Annual Drug & Alcohol Program National Conference Atlanta, GA April 28–30, 2015 Instructors:

Thank you for attending!