March 2012 Lisa Busse FirstLab, Inc.

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Changes to Part 40 effective Oct 1, 2010  Part 40 changes necessary to conform to revisions in the DHHS Guidelines published in Nov  OTETA requires DOT to follow the DHHS requirements for testing  Most of the changes relate to the DHHS certified laboratory procedures

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Testing for MDMA (Ecstasy)—with confirmation testing for MDMA, MDA (hug drug), and MDEA (Eve)  Lower cutoff levels for cocaine and amphetamines  Mandatory initial testing for heroin was added to the opiates screening test

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  DOT projects that the lower cut-off levels for cocaine and amphetamines will produce a 30% increase in laboratory confirmed positive tests for both cocaine and amphetamine/methamphetamine

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Cocaine Positives Spike 33% After New Government Rule for Safety-Sensitive Workers  Amphetamines Positives Jump Nearly 26% After New Rule, Continuing Upward Trend  Quest Diagnostics Drug Testing Index™

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement. Due to lower cut-offs -- FL DOE 2011:  4 positives that would not have been detected if DOT had not lowered the cut- offs  3 cocaine and 1 amp/meth

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Specimen Collection procedures remain the same  Record keeping requirements for employers, MROs, collectors, etc. remain the same  Alcohol testing procedures remain the same  DOT did not adopt the use of “instant drug tests” for DOT drug testing programs

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  The DHHS revised the federal custody and control form (CCF)  Effective date for the new CCF is Oct 1, 2010  Be sure all old forms are discarded

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  DOT requires that employers provide collectors with information about the donor and the drug test when the employee presents for a specimen collection 1.Name of employee (or applicant) being tested 2.Employee SSN or other ID number 3.SAMHSA laboratory name and address 4.Employer name, address, phone number, fax number 5.DER name and telephone number 6.MRO name, address, phone number, and fax number 7.The DOT agency (e.g. FMCSA) which regulates the employee’s safety-sensitive duties – TESTING AUTHORITY 8.Test reason (e.g. pre-employment, random, etc.) 9.Whether the test is to conducted under direct observation or not NOTE: # 3, 4, 5, 6, 7 can be preprinted on CCF

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Any drug test conducted on Florida school bus drivers as part of physical examination or other annual exam is not a federal DOT drug test.  Drug test should be conducted using a non-federal custody and control form or other form issued by the State  Even though Florida has adopted the FMCSA standards for physical qualifications of school bus drivers, the drug test is not a test conducted under Part 382.

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  You may receive a negative test result from the MRO that also has a “safety warning or notice” indicated.  Safety notices are issued by the MRO when the driver has disclosed in the interview with the MRO medications he/she is taking that MAY cause a “risk to safety”  Either the side effects of the medication may cause mental or motor functioning impairment, or  The medical condition for which the medications are prescribed may be a problem for safely performing driving duties

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Employer responsibilities when the MRO issues a safety notice:  Tell driver he/she cannot continue to drive until his/her medications/medical condition is evaluated and he/she has been “cleared” to drive  Options for evaluating the driver’s “fitness to drive” based on medications/medical conditions:  Have driver submit statement from prescribing physician that he/she is aware of driver’s duties and in the physician’s opinion the driver can safely drive while taking the meds.  Have driver go to an occupational health physician or physician who conducted his/her driver physical examination and be “cleared” for driving duties while taking meds as prescribed

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Narcotic painkillers, Opioids, are leading classification of abused drugs today  Oxycodone and hydromorphone are not detected on DOT drug test panel  Tranquilizers are also frequently abused/misused drugs and are not detected on the DOT drug screen  Other prescription drugs with high abuse potential include Tramadol (Ultram) and Soma (sleep- inducing drug)—not detected on DOT drug test

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  K2 or "Spice" is a mixture of herbs and spices that is typically sprayed with a synthetic compound chemically similar to THC.  K2 is typically sold in small, silvery plastic bags of dried leaves and marketed as incense that can be smoked.  Resembles potpourri.  Usually smoked in joints or pipes, but some users make it into a tea.  Psychological effects are similar to those of marijuana and can include paranoia, panic attacks, and giddiness

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.

 DEA listed the major components in Spice/K-2 as Schedule I illicit drugs in December 2010  No medical use for the compounds found in Spice/K-2  Use is not detected in drug test for marijuana  Several laboratories have developed assays to detect Spice/K-2 in urine.  Has not been added to DOT drug panel

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Blue Silk, Ivory Wave, Ocean Burst, Red Dove, and Vanilla Sky all sound relaxing but “bath salts” named for their fine, crystalline powdery appearance are the latest designer drug trends to hit the area.  Marketed and sold as bath salts, these substances are not intended for human consumption.  Are packaged as bath salts and are relatively easy to prepare and ingest to get high.  The white bath powders can be snorted or smoked. Preparation is quite similar to preparation of powdered methamphetamine or cocaine for "snorting."

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.

 Hair and Oral Fluid Labs: ◦ FDA Clearance for analyses but no certification process  Oral Fluid currently on fast track for certification.  Hair testing … waiting.

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Intoxicationminutes to hours  Impairmentminutes to hours  Under influenceminutes to hours  Bloodminutes to days  Oral Fluid (saliva)minutes to days  Urinehours to days  Sweatweeks  Hairdays to years

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement.  Less Invasive Collection  Multiple Sampling May Be Possible  Greater Specimen Stability (e.g., hair)  Lower Disease Risk in Specimen Handling (e.g., hair, sweat)  Easier Shipment and Storage  Differences in Window of Detection  Example: Pre-employment (Hair) vs. Post-Accident (Oral Fluid)  May Be More Difficult to Substitute/Adulterate

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement. Advantages  Long time window for drug detection  Easy to collect, handle, store  Second collection capability  Noninvasive  “Beating” a hair test may be more difficult than with urine  Able to expand panel ** Disadvantages  May not detect recent use  Environmental contamination is a concern  Controversial issues unresolved (e.g., color bias)  Dose/time relationships not established  New science with few controlled studies

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement. Total of 11,733 Tests Of the 11,733 tests, 60 were verified positive Less than 1% Positive Rate

This information is confidential and proprietary to First Hospital Laboratories, Inc. and is provided to recipient with the understanding the recipient will observe and comply with all terms and conditions of our non-disclosure agreement. FirstLab