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

20

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

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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