Department of Defense 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 of abuse entering the illicit 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

2 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 ) • 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

Secretary of Defense HON Ashton Carter

Deputy Secretary of Defense HON Robert Work POLICY USD(Personnel & Readiness) Executive Director Force Resiliency ADVICE & GUIDANCE HON Peter Levine (Acting) Dr. Margaret Harrell

Director, PRR Mr. Leonard Litton

EXECUTION

Secretary of the Army Secretary of the Navy Secretary of the Air Force HON Patrick Murphy HON Ray Mabus HON Deborah Lee James (Acting)

4 DoD DDRP Leadership

USD(Personnel & Readiness) HON Peter Levine (Acting)

Executive Director Force Resiliency Dr. Margaret Harrell

Director, PRR POLICY Mr. Leonard Litton ADVICE & GUIDANCE

Director, DDRP Accident Reduction Risk Systems COL Tom Martin BIOCHEMICAL TESING ADVISORY BOARD (BTAB) EXECUTION Army Program Manager Navy Program Manager Air Force Program Manager Chief, Forensic Toxicology, AFMES LTC Karen McCart CDR Eric Welsh Dr. Michael Hlubek CDR Tom Bosy

QUALITY ASSURANCE Drug Testing Laboratories SPECIAL TESTING

5 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)

6 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

7 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

8 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

9 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

10 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

11 BTAB Process

• Rapid response to changing threat • Prevalence testing • Emerging synthetic drugs • “Spice” - Synthetic • “” – Synthetic / Phenethylamines • Supplement Additives • Additions • Ecstasy, /Oxymorphone • / • • Deletions • LSD • MDEA •

12 Adjusting the Testing Panel

•Significant misuse within the military •Increased heroin positive members BTAB •High visibility from Chairman, Joint Chiefs of Staff

•15,856 specimens •Coordinated by AFMES Prevalence Testing •Positive results for hydrocodone and hydromorphone; valid prescription yes/no

•Analyze and review results •Illicit positive rate 0.2% BTAB •Recommendation to DDRP

•Determine resource availability •Advocate for additional funding DDRP •Recommendation to USD(P&R) to add to the testing panel

•Issue Policy change USD(P&R) •Notification to Services of pending change to panel

•Notification to personnel •Opportunity to seek treatment Services •Testing initiated

13 DoD Laboratories

US Navy DSL Great Lakes, lL

US Army FTDTL Tripler AMC, HI

US Army FTDTL Fort Meade, MD

US Navy DSL Jacksonville, FL

US Navy DSL San Diego, CA US Air Force DTL Lackland AFB, TX 14 Current Panel of Tested Drugs

• Marijuana (THC) • (BZE) • & • Designer / Ecstasy • Heroin • Oxycodone/Oxymorphone • Hydrocodone/hydromorphone • / (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

15 DOD CUTOFFS

Screening (ng/mL) Confirmation (ng/mL) • d-Amphetamine 100 • Amphetamines 500 • d-Methamphetamine 100 • Cannabinoids 50 • THC metabolite 15 • Cocaine 150 • Benzoylecgonine 100 • Opiates 300 • Codeine 2,000 • Designer Amps 500 • Morphine 4,000 • 6-AM 10 • MDMA/MDA 500 • Oxycodone 100 • 6-AM 10 • Hydrocodone 300 • Oxycodone • Benzodiazepines 200 100 • Synthetic cannabinoids 10 • Oxymorphone 100 • Hydrocodone 100 *Nordiazepam; Oxazepam; Temazepam ;

Lorazepam; α-OH Alprazolam • Hydromorphone 100 • Benzodiazepines* 100 **JWH18 COOH; JWH73 COOH; • Synthetic cannabinoids** 1 UR144 COOH; MAM-2201; UR-144 16

Current Situation (Positive Drug Distribution)

2010 2011 2012 2013 2014 2015 Unique Active Duty Positive Service Members (10,790) (8,988) (8,837) (8,948 ) (7,948 ) (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! 17 Current Situation (Positive Drug Distribution)

2010 2011 2012 2013 2014 2015 Unique Active Duty Positive Service Members (10,790) (8,988) (8,837) (8,948 ) (7,948 ) (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 ------

18 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 19 Overall Military Positive Rate

4 3.5 3 2.5 2 1.5 1 0.5 0 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

20 Positive Rate by Component

2.50 2.36

2.13

2.00

1.73 1.73 1.66 Active Duty 1.59 1.62 1.53 Reserve 1.50 1.4 1.34 Guard 1.28 1.25 % Military Applicants 0.96 1.00 1.16 0.91 0.83 0.81 0.76 0.88

0.72 0.72 0.7 0.67 0.50 0.6

0.00 2010 2011 2012 2013 2014 2015

21 Active Duty Positive Rate

1.6

1.4 1.4

1.19 1.21 1.2 1.15

1.06 1.05

1 0.93

Army 0.77 0.8 Navy 0.68 Marine Corps % 0.61 Air Force 0.6 0.54 0.55

0.39 0.38 0.36 0.35 0.4 0.32 0.28 0.37 0.39 0.38 0.3 0.2 0.27 0.27

0 2010 2011 2012 2013 2014 2015

22 Reserve Positive Rate

2.5

2

1.5 Army % Navy Marine Corps 1 Air Force

0.5

0 2010 2011 2012 2013 2014 2015

23 National Guard Positive Rate

3 2.77

2.47 2.5

2.01 1.99 2 1.89 1.9

% 1.5 Army Air

1

0.5 0.43 0.44 0.43 0.5 0.39 0.36

0 2010 2011 2012 2013 2014 2015

24 DoD Agencies’ Testing Results

TDP Applicant Combined TDPs Positive Applicants Applicants Positive Positive FY Tested TDPs Positive Rate Tested Positive Rate 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”)

26 In God We Trust, Everybody Else Must Pee In The Bottle

27