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Department of Defense Drug Demand Reduction Program
(DDRP)
Drug Testing Advisory Board Meeting May 20, 2016
COL Tom Martin, USA
Director, Drug Testing and Program Policy Office of the Under Secretary of Defense for Personnel and Readiness
Personnel Risk Reduction
DDRP Mission/Regulatory Guidance
• Mission: • Deter illicit and prescription drug abuse by military service
members and DoD civilian personnel in testing designated positions (TDPs) to maintain military readiness and safety
• Provide drug abuse prevention, education, and outreach services to military personnel and their families
• Identify new drugs of abuse entering the illicit drug culture and develop testing procedures to detect their use
• Regulatory guidance is found in: • DODI 1010.01 Military Personnel Drug Abuse Testing Program • DODI 1010.09 DoD Civilian Employee Drug-Free Workplace
Program • DODI 1010.16 Technical Procedures for the Military Personnel
Drug Abuse Testing Program • Executive Order 12564--Drug-Free Federal Workplace
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DDRP Driving Factors
• Drug abuse in the general U.S. 18-25 year old male group is estimated to be 17-20%– the population from which the Service recruits their enlisted personnel
• Before DoD instituted drug testing among Service personnel, drug use was a significant recurring problem • Vietnam (estimated over 5% of returning service members
addicted to heroin) • 1981 CVN Nimitz aviation mishap – 14 killed, 48 injured, 7 aircraft
destroyed, 11 aircraft damaged, $150M in damages, six deceased with detectable levels of marijuana
• Notable increase in abuse/misuse of prescription pain medications
• Personnel abusing illicit drugs or prescription medications are a safety hazard resulting in the potential loss of equipment, resources, and lives 3
DoD DDRP Leadership
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ADVICE & GUIDANCE POLICY
Secretary of Defense HON Ashton Carter
Deputy Secretary of Defense HON Robert Work
USD(Personnel & Readiness) HON Peter Levine (Acting)
EXECUTION
Secretary of the Army HON Patrick Murphy
(Acting)
Secretary of the Navy HON Ray Mabus
Secretary of the Air Force HON Deborah Lee James
Executive Director Force Resiliency Dr. Margaret Harrell
Director, PRR Mr. Leonard Litton
DoD DDRP Leadership
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ADVICE & GUIDANCE POLICY
EXECUTION
USD(Personnel & Readiness) HON Peter Levine (Acting)
Director, DDRP COL Tom Martin Accident Reduction Risk Systems
Executive Director Force Resiliency Dr. Margaret Harrell
Director, PRR Mr. Leonard Litton
Army Program Manager LTC Karen McCart
Navy Program Manager CDR Eric Welsh
Air Force Program Manager Dr. Michael Hlubek
Chief, Forensic Toxicology, AFMES CDR Tom Bosy
Drug Testing Laboratories QUALITY ASSURANCE
SPECIAL TESTING
BIOCHEMICAL TESING ADVISORY BOARD (BTAB)
DDRP Responsibilities
• USD(P&R) Oversight of the Department of Defense (DoD) drug testing programs • Issues policy, directives, and guidance • Advocate for funding • Develops procedures and standards for drug
testing laboratories • Maintain a certification and inspection program
for DoD-certified drug testing laboratories • Establish Biochemical Testing Advisory Board
(BTAB)
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Military Services
• Operate forensic drug testing laboratories with sufficient capacity • Meet certification requirements • Participate in Quality Assurance program • Develop Medical Review Process
• Implement computerized, random selection
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Chief, Division of Forensic Toxicology Armed Forces Medical Examiner System (AFMES)
• Technical expertise to DDRP • Manage external QC and proficiency testing
programs • Manage external QA program through Laboratory
inspections • Coordinate laboratory certification / recertification
actions • Evaluate all significant non-conforming events • Serve as Chair of BTAB
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BTAB Organization
• Advise Director, DDRP on technical and policy issues • Two divisions
• Technical (drug testing) • Personnel Policy
• Composition • Services’ Technical and Personnel Program Representatives
• Voting members • Military and/or civilian
• Chair • Chief, FORTOX, AFMES • Non-voting member
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BTAB Functions
• Methodologies and new technologies for drug testing
• External proficiency testing • QA procedures • Certification, decertification, recertification • Addition/deletion to drug testing panel • Policy changes • Research projects • Prevalence testing
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BTAB Process
• Data driven decisions • Minimize bureaucratic paperwork (“red tape”) • Stepwise procedure
• Objective data presented to BTAB from various sources • Surveillance testing • Literature review • Congressional interest • News Media reports, etc
• Evaluate data and make decision recommendation to DDRP • Capability • Capacity • Cost
• Policy change approved and implemented • DoD QA oversight
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BTAB Process
• Rapid response to changing threat • Prevalence testing • Emerging synthetic drugs
• “Spice” - Synthetic Cannabinoids • “Bath Salts” – Synthetic Cathinones / Phenethylamines • Supplement Additives
• Additions • Ecstasy, Oxycodone/Oxymorphone • Hydrocodone/Hydromorphone • Benzodiazepines
• Deletions • LSD • MDEA • Barbiturates
Adjusting the Testing Panel
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BTAB
•Significant opioid misuse within the military •Increased heroin positive members •High visibility from Chairman, Joint Chiefs of Staff
Prevalence Testing
•15,856 specimens •Coordinated by AFMES •Positive results for hydrocodone and hydromorphone; valid prescription yes/no
BTAB
•Analyze and review results •Illicit positive rate 0.2% •Recommendation to DDRP
DDRP
•Determine resource availability •Advocate for additional funding •Recommendation to USD(P&R) to add to the testing panel
USD(P&R)
•Issue Policy change •Notification to Services of pending change to panel
Services
•Notification to personnel •Opportunity to seek treatment •Testing initiated
DoD Laboratories
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US Army FTDTL Tripler AMC, HI
US Navy DSL San Diego, CA
US Navy DSL Great Lakes, lL
US Army FTDTL Fort Meade, MD
US Navy DSL Jacksonville, FL
US Air Force DTL Lackland AFB, TX
Current Panel of Tested Drugs
• Marijuana (THC) • Cocaine (BZE) • Amphetamine & Methamphetamine • Designer Amphetamines / Ecstasy • Heroin • Oxycodone/Oxymorphone • Hydrocodone/hydromorphone • Codeine/Morphine (100% Opiates Testing on 1 Oct 2012) • Benzodiazepines: nordiazepam, oxazepam, temazepam,
lorazepam , and α-OH alprazolam (100% on 1 Oct 2013) • Synthetic Cannabinoids (December 16, 2013) • Special request for unusual or novel drug testing conducted
at AFMES
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DOD CUTOFFS
500 50 150 300 500 10 100 300 200 10
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Screening (ng/mL)
• Amphetamines • Cannabinoids • Cocaine • Opiates • Designer Amps • 6-AM • Oxycodone • Hydrocodone • Benzodiazepines • Synthetic cannabinoids
Confirmation (ng/mL) • d-Amphetamine • d-Methamphetamine • THC metabolite • Benzoylecgonine • Codeine • Morphine • MDMA/MDA • 6-AM • Oxycodone • Oxymorphone • Hydrocodone • Hydromorphone • Benzodiazepines* • Synthetic cannabinoids** 1
100 100 15 100 2,000 4,000 500 10 100 100 100 100 100
*Nordiazepam; Oxazepam; Temazepam; Lorazepam; α-OH Alprazolam
**JWH18 COOH; JWH73 COOH; UR144 COOH; MAM-2201; UR-144
Current Situation (Positive Drug Distribution)
Unique Active Duty Positive Service Members 2010 (10,790)
2011 (8,988)
2012 (8,837)
2013 (8,948 )
2014 (7,948 )
2015 (7,067)
Marijuana 6,937 5,535 5,454 5,000 4,498 4,279
Cocaine 2,309 2,025 1,714 1,195 1,120 1,209
d-Amphetamine 976 971 973 899 752 590
d-methamphetamine 502 507 478 439 384 310
MDMA (Ecstasy) 751 415 154 150 148 227
MDA (Adam) 334 204 101 98 91 174
PCP 3 0 0 NT NT NT
Codeine (39% testing in FY 2012) 104 104 144 209 158 115
Morphine (39% testing in FY 2012) 165 174 194 237 169 146
Oxycodone (35% testing in FY 2012) 402 305 485 775 439 213
Oxymorphone (35% testing in FY 2012) 746 604 840 1,368 784 434
Hydrocodone (39% testing in FY 2012) NT NT 187 554 285 156
Hydromorphone (39% testing in FY 2012) NT NT 232 622 334 200 Heroin 104 136 118 122 115 109
~40% decrease in opiate positives, but prescription medication abuse cause for concern!
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Current Situation (Positive Drug Distribution)
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Unique Active Duty Positive Service Members 2010 (10,790)
2011 (8,988)
2012 (8,837)
2013 (8,948 )
2014 (7,948 )
2015 (7,067)
α-hydroxy-alprazolam (23% testing in FY 2013) NT NT NT 40 120 131
Lorazepam (23% testing in FY 2013) NT NT NT 13 63 40
Nordiazepam (23% testing in FY 2013) NT NT NT 33 90 44
Oxazepam (23% testing in FY 2013) NT NT NT 134 351 208
Temazepam (23% testing in FY 2013) NT NT NT 92 256 154
JWH-018* NT NT NT NT 98 132
JWH-073* NT NT NT NT 106 120
UR-144* NT NT NT NT 131 49
MAM-2201* NT NT NT NT NT 0
AB-CHMINACA* NT NT NT NT NT 2
*40% testing in 2014 and 2015 -- -- -- -- -- --
Synthetic Marijuana (Spice)
• “Spice” products present unique challenges • Large number of Spice drug variants that are
continually changing • Requires a low cost automated screening procedures
to facilitate large population random testing • DoD response
• Random testing started December 16, 2013 • 0.018 positive rate (similar to MDMA) in FY 2015
• Adding four metabolites May 2015 • MAM-2201 • AB-CHMINACA • AB-FUBINACA • AB-PINACA
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Overall Military Positive Rate
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0
0.5
1
1.5
2
2.5
3
3.5
4
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2004
2007
2008
2009
2010
2011
2012
2013
2014
2015
Positive Rate by Component
21
0.88
0.72 0.7 0.72 0.67
0.6
1.66
1.53
1.28 1.4
1.34 1.25
2.36
2.13
1.73 1.73
1.59 1.62
1.16 0.83
0.76
0.96
0.81 0.91
0.00
0.50
1.00
1.50
2.00
2.50
2010 2011 2012 2013 2014 2015
%
Active DutyReserveGuardMilitary Applicants
Active Duty Positive Rate
22
1.4
1.15 1.19 1.21
1.05
0.93
0.39 0.32
0.28
0.36 0.38 0.35
1.06
0.77
0.68
0.54 0.61
0.55
0.3 0.27 0.27
0.37 0.39 0.38
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
2010 2011 2012 2013 2014 2015
%
Army
Navy
Marine Corps
Air Force
Reserve Positive Rate
23
0
0.5
1
1.5
2
2.5
2010 2011 2012 2013 2014 2015
% ArmyNavyMarine CorpsAir Force
National Guard Positive Rate
24
2.77
2.47
2.01 1.99 1.89 1.9
0.43 0.39 0.36 0.44 0.43
0.5
0
0.5
1
1.5
2
2.5
3
2010 2011 2012 2013 2014 2015
% Army
Air
DoD Agencies’ Testing Results
FY TDPs Tested TDPs Positive
TDP Positive
Rate Applicants
Tested Applicants
Positive
Applicant Positive
Rate
Combined Positive
Rate
2015 115536 393 0.34 40158 107 0.27 0.32
2014 116108 413 0.36 27845 77 0.28 0.34
2013 117041 443 0.38 24146 97 0.4 0.38
2012 114374 420 0.37 30295 121 0.4 0.37
Automated MRO Review Process
• Compares positive result to the individual’s military prescription record
• Implemented on May 1, 2012 • Decreased manual MRO process (MRO “Wash”) • Tricare/DoD pharmacy dependent • FY 2015 Summary
• Oxycodone = 86% (12,586 positives “washed”) • Benzodiazepines = 67% (11,838 positives “washed”) • Amphetamine = 46% (11,443 positives “washed”)
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In God We Trust, Everybody Else Must
Pee In The Bottle