Treatment Track: Optimizing Utilization and Outcomes of Urine Drug Testing

1. Treatment Track:
Optimizing Utilization and
Outcomes of Urine Drug Testing
Presenters:
• Louis E. Baxter, Sr., MD, FASAM, President and CEO,
Professional Assistance Program of New Jersey, Inc.
• Michael C. Barnes, JD, Executive Director, Center for
Lawful Access and Abuse Deterrence (CLAAD), and
Member, Rx Summit National Advisory Board
• Elaine Jeter, MD, MolDx Medical Director, Palmetto GBA
• Kenneth L. Kirsh, PhD, Vice President, Clinical Research
and Advocacy, Millenium Health
Moderator: Andrea Grubb Barthwell, MD, FASAM,
President, Two Dreams Outer Banks

2. Disclosures
• Louis E. Baxter, Sr., MD, FASAM; Michael C. Barnes, JD; and
Elaine Jeter, MD, have disclosed no relevant, real or apparent
personal or professional financial relationships with proprietary
entities that produce health care goods and services.
• Kenneth L. Kirsh, PhD – Employment: Millennium Health
• Andrea Grubb Barthwell, MD, FASAM – Advisory Boards: Caron
Foundation, Alvee Laboratories; Consulting Fees: Millennium
Laboratories, Braeburn Pharmaceuticals, GW Pharmaceuticals;
Partner: Treatment Partners, LLC, Encounter Medical Group, PC;
Stock Ownership: Hythian

3. Learning Objectives
1. Identify the obstacles currently related to
appropriate use of UDT in substance use
management.
2. Describe a research-based clinical approach for
employing UDT in management of substance
use disorders.
3. Explain civil and criminal liability for
practitioners related to waste, fraud and abuse
in UDT.
4. Advocate state and federal policy responses to
UDT liability concerns.

4. Optimizing Utilization and Outcomes
of Urine Drug Testing:
Statements of Consensus
Louis E. Baxter, Sr., MD, FASAM

5. Disclosure Statement
• No relevant real or apparent personal or
professional financial relationships with
proprietary entities that produce health care
goods and services

6. Preview
• Consensus project
• Background
– Terminology
– Methodology
• Consensus
– General
– Test Selection
– Diagnosis
– Active Treatment
– Chronic Care

7. Need for Consensus
• Lack of clinical knowledge
• No guidelines or recommendations
• Unethical behaviors
• Responsive payer restrictions

8. Consensus Development
• Nine independent panelists met on 2/21/14
for 8-hour discussion
– Hosted by NAATP
– Assisted by ASAM and CLAAD
• Debated and revised paper over 12 mos.

9. Overview of Substance Use Testing
• To identify presence/absence or concentration
of specific substances & metabolites
• Should be exclusively for therapeutic purposes
in addiction medicine
– Prevent or deter use
– Identify or diagnose use
– Support abstinence in active treatment & chronic
care management

10. Pain & Addiction
• Pain guidelines are inadequate for addiction
medicine (see next slide)
– Do not address overlap of people in pain who also
have SUDs
– Do not support testing frequently enough

11. Risk Stratified UDT for Pain & Addiction Care
Pain Addiction
Pain Clinical Guidelines1
Low Risk 1-2/year + targeted
Moderate Risk 2-4/year + targeted
High Risk 4/year + targeted
Assessment & Diagnosis
Duration of period determined by clinician,
clinical setting, presentation
**Phase of Active Treatment
Phase I – Early engagement <30 days
Phase II – Middle stabilization > 30 day < 90 days
Phase III – Late Consolidation > 91 days < 2 yrs
**Phases of Recovery
Phase I – Early recovery > 2 yrs < x < 5 yrs
Phase II – Moderate/Stable Recovery > 5 yrs < 10
yrs
Phase III – Mature Recovery > 10 yrs
1. Multiple national guidelines
2. ASAM policy
Addiction – with new
pain syndrome
R/O reactivation of
addiction through common
reward pathways
manage addiction
*Pain & Addiction
Pain –
critical incident in active pain
treatment
R/O addiction
•Clinician determines: Then a) return to pain pool or, b) continue in active addiction treatment
Step 1 – Assessment/Diagnosis – to characterize disease
Step 2 – Early Stabilization – (Role of UDT – detect issues & deter
progression) – until 30 days without unexpected results
Manage risk of exposure & addiction to
determine which pool a client returns to

12. Terminology
Preliminary Qualitative Definitive Quantitative
Immunoassay Chromatography – mass spectrometry
Presumptive Confirmatory
Qualitative Quantitative
Point-of-care / in-office / lab-based In-office / lab-based
Screen Confirmation
Semi-quantitative / quasi-quantitative Absolute level, creatinine corrected
Simple test (cup / strip / dip / cassette) Complex test
Class or specific drug identification Specific drug identification

13. Methodology Comparison
Preliminary Qualitative Definitive Quantitative
Rapid (depending on location) 24 – 72 hours
Presumptive screen (presence /
absence)
Concentration of parent drugs &
metabolites
Low specificity (substance class)
High specificity (can detect specific
substance and metabolites)
Low sensitivity (high cut-off value)
High sensitivity (can detect low
concentrations)
$25 $66 – 165
False positives / negatives,
inaccuracies more likely
False positives / negatives unlikely
Cannot detect all drugs or illicit
substances
Provides reports of all drugs,
metabolites, and substances present

14. Consensus: General
• Urine is the specimen of choice (except for
alcohol)
– Easy to collect
– Minimally invasive
– Relatively affordable
– Wide selection of analytes

15. Consensus: General
• Balance quality and cost
– Understand benefits of methods and frequency
– Inadequately informed attempts to reduce costs
may worsen health and increase costs

16. Consensus: General
• Clinicians should obtain proper training
– Test selection
– Administration
– Interpretation
• If not possible, collaborate and consult with
lab toxicologists or obtain expert medical
review

17. Consensus: Test Selection
• Testing decisions should be individualized
based on clinical evaluation
– Patient history
– Community trends
– Prescribed medications
– Circumstantial considerations
• Document in medical record
– Bases for decisions
– Medical response to result

18. Consensus: Test Selection
• Utilize preliminary qualitative tests when rapid
result is necessary
– Point-of-care/cup test
– Rapidity and cost savings are lost if sample must
be sent to lab
• Utilize definitive quantitative tests when
accurate information is necessary
• Sample integrity checks can help identify
deceptive behaviors

19. Consensus: Test Selection
• Use comprehensive-definitive drug panel
(CDDP) for most thorough and accurate results
• In case access to CDDP is restricted, carefully
select definitive quantitative analytes
– Collaborate w/ lab to account for trends in
community & population
– Use H&P to narrow test selection

20. Consensus: Diagnosis
– Primary care
– Urgent care
– Pain
– Psychiatry
– Obstetrics
– Peri-operative
– Addiction
• Early diagnosis can lead to improved outcomes
• Universal & routine clinical screening (not necessarily
testing)
• Conduct a history & physical (H&P), and add testing
as necessary

21. Consensus: Diagnosis
• Review patients for substance use during first
consult and periodically thereafter
• Clinical considerations in choosing when and
how to test
– Indicators of risk (e.g., family history or legitimate
Rx for a controlled substance)
– Evidence of use (e.g., self-report or needle marks)
– Information necessary to direct care
– Cost constraints

22. Consensus: Diagnosis
• Substance use alone is insufficient to
substantiate presence of SUD
• Screening, Brief Intervention, and Referral to
Treatment (SBIRT) has numerous benefits
– Decreases stigma
– Reduces profiling (including pregnant women)
– Improves health outcomes
– Reduces costs of untreated SUD

23. Consensus: Diagnosis

24. Consensus: Active Treatment
• Test on regular basis and at random intervals
• Collection process: aim to reduce patient’s
ability to undermine test results
• Give same quality of care to:
– Patients in MAT/not in MAT
– Patients in office-based setting, methadone clinic,
elsewhere

25. Consensus: Active Treatment

26. Consensus: Active Treatment
• If evidence of use after period of abstinence
– Consider testing to ascertain nature & extent of
use
– Resume testing schedule for abstinence of  30
days
• May need to intensify treatment

27. Consensus: Chronic Care Management
• Patients with >2 years of abstinence
– Often self-directed in recovery
– Testing is less prescriptive and may be driven by
individual’s self-identified need
• Test on regular basis & at random intervals
• If test is positive, establish an active treatment
plan appropriate to recent use

28. Consensus: Chronic Care Management

29. Summary
• Decisions should be individualized
• Preliminary qualitative (point-of-care/cup) for
rapid result
• Definitive quantitative for accuracy
• Document in medical record
– Bases for decisions
– Medical response to result

30. Conclusion
• Thank you

31. Optimizing Utilization and
Outcomes of Urine Drug Testing
Michael C. Barnes
April 7, 2015

32. Conflict of Interest Disclosure
The Center for Lawful Access and Abuse Deterrence (CLAAD) receives funding
from businesses in the health care industry that share CLAAD’s mission to
reduce prescription drug fraud, diversion, misuse, and abuse while
advancing consumer access to high-quality health care. CLAAD’s funders
include pharmaceutical companies, treatment centers, and laboratories,
and are disclosed on its website, www.claad.org.
CLAAD is managed by DCBA Law & Policy. DCBA also provides legal and policy
counsel to professionals and businesses whose activities align with
CLAAD’s mission. To avoid conflicts of interest, DCBA adheres to
the District of Columbia Rules of Professional Conduct §§ 1.7-1.9.

33. Preview
• Policy landscape
• Responses
– Restrictions
– Enforcement
• Legal bases
• Factual bases
• Recommendations
– Practice
– Policy
• Progress
• Predictions
• Conclusion

34. Policy Landscape
• 21.5 million Americans with SUDs
• 90 percent untreated
• 120 people die every day of overdoses
• Stigma
– Social
– Structural

35. Policy Landscape
• Therapeutic approaches reduce costs and recidivism
• Need to expand non-punitive interventions and
referrals to treatment
– Education
– Employment
– Criminal justice
• Knee-jerk opposition to testing for substance use
(confusion w/ forensic model)
• Kick “up”, not “out” (health care and social safety net
programs)
• Sentencing reform and voting-rights restoration

36. Policy Landscape
• Significant UDT expenditures
– Medicare paid $457 million for 16 million tests (2012)
– Sales at UDT labs reached an estimated $2 billion
(2013)
• Unethical practitioners have seized on the surge
in spending
• Aggressive federal action to reduce healthcare
waste, fraud, and abuse: $4.3 billion recovered
(2013)

37. Response:
Restrictive Coverage Policies
• BCBS of Alabama proposed to deny coverage of any
definitive testing
• Medicaid per-member limits on testing: GA: 25 per
year, NY: 2 per week, VT: 8 per month, NJ: 2 per month
• What contributes to ill-advised testing coverage policy?
– Lack of knowledge about the practice of addiction
medicine
– Lack of understanding about current testing technology
– Confusion w/ forensic model

38. Response: Enforcement
(Legal Bases)
• Stark law: prohibits referrals of Medicare/Medicaid
patients if physician or family member has financial interest
• Anti-kickback statute: prohibits exchange of value to
induce/reward a referral of federal health care program
business
• Criminal health care fraud statute: prohibits schemes to
defraud health benefit programs, including private plans
• False Claims Act: prohibits claims for payment/approval to
gov’t known to be false
• Bank, mail, wire fraud: prohibits schemes to defraud using
a financial institution, postal service, or wire

39. Response: Enforcement
(Factual Bases)
• Physician-owned or family-owned labs
– Includes management firms
• Physician owns firm
• Firm owns lab
– Includes requiring employees to refer
• Leasing
– Office space to lab
– Lab equipment to physician
Evaluating Motives: Two Simple Tests to Identify and Avoid Entanglement in Legally Dubious Urine Drug Testing Schemes, JOURNAL
OF OPIOID MANAGEMENT (Forthcoming 2015)

40. Response: Enforcement
(Factual Bases)
• Clinical trials and registry arrangements:
paying to submit patient data, answer patient
questions, or review registry report
• Free supplies or services to a referral source,
including labs reviewing doctors’ orders and
determining whether there is a need for UDT
Evaluating Motives: Two Simple Tests to Identify and Avoid Entanglement in Legally Dubious Urine Drug Testing Schemes, JOURNAL
OF OPIOID MANAGEMENT (Forthcoming 2015)

41. Response: Enforcement
(Factual Bases)
• Improper markups, coding, and billing
– Interpretation of results that a lab performed but
for which the practitioner bills
– Using codes to circumnavigate prohibitions against
more expensive tests
• Medically unnecessary tests, including results
not reviewed by a physician
Evaluating Motives: Two Simple Tests to Identify and Avoid Entanglement in Legally Dubious Urine Drug Testing Schemes, JOURNAL
OF OPIOID MANAGEMENT (Forthcoming 2015)

42. Practice Recommendations:
Evaluating UDT Proposals
• Does the patient’s health depend on the service?
• Will my decisions be influenced by the potential
for profit?
• Does the proposal appear to avoid the spirit of
the law while possibly complying with the letter
of the law?
– Circumvention schemes are disfavored if not expressly
illegal
– Do you want to serve as the test case?

43. Policy Recommendations
• Employ UDT to expand interventions and treatment
• Educate the uninformed
– Identify and avoid participating in legally dubious UDT schemes
– Follow best practices
• Isolate and enforce against bad actors
• Advance ethics, efficiency, and transparency
– Eliminate wasteful practices and payment policies
• Inaccurate technology
• Duplicative testing
– Document medical necessity and the bases of UDT selections
– Help appeal unjust denials of care

44. Progress
• New paradigms and literature
– Common terminology
– Stages of care: screening/diagnosis, active treatment,
chronic care management (2+ year continuum)
– Documentation of best practices
– Education and enforcement on waste, fraud, and
abuse
• Consensus on the need for change
• Outline of next steps

45. Predictions
• Continued opposition based on confusion w/ forensic
model
• Frequency of UDT relative to stage of care
– Rapid results to help stabilize (presumptive)
– Days of abstinence over 2+ year continuum (definitive)
• No blanket orders; individualized testing
• No “confirmation” of presumptive w/ presumptive
• Bundled services
– 40+ substances, including their analytes
– Quantitative results
– Flat fee w/ single billing code
CMS Jurisdiction 11 Part B Controlled
Substance Monitoring and Drugs of Abuse
Coding and Billing Guidelines

46. Conclusion
• Thanks to Cindy Lackey, Nancy Hale, Karen
Kelly, and co-presenters
• Questions and discussion at end of session
• Contact
– LinkedIn.com/in/michaelcbarnes
– @mcbtweets
– www.claad.org
– @claad_coalition
• Thank you

47. Optimizing Utilization and
Outcomes of Urine Drug Testing
Elaine K Jeter, MD
Palmetto GBA

48. Disclosures
Elaine Jeter, MD, has disclosed no relevant, real
or apparent personal or professional financial
relationships with proprietary entities that
produce health care goods and services.

49. Medicare Administrative
Contractors (MACs)
• 10 Jurisdictions – multiple states
• 8 Contractors
• Palmetto
• Noridian
• Novitas
• NGS -
• WPS
• First Coast
• CGS
• Cahaba

50. Problems
• Blanket UDT orders
• Absent medical record documentation of tests
ordered, results of cup or IA, clinical history
• Self-referral testing to maximize reimbursement
• Semi-quant IA billed with specific quant codes
• Cup testing, followed by IA, referral to partnered
lab arrangement with change of DOS repeat IA
and definitive testing

51. UDT Policy
• L35105 – Controlled Substances Monitoring
and Drugs of Abuse Testing
• Provides covered indications and testing
frequency for:
– Symptomatic patients, multiple drug ingestions
and/or patients with unreliable history
– Patients with substance abuse or dependence
– Patients on chronic opioid therapy

53. “G” Code Proposal
• HCPCS – quarterly update
• Gxxxx – Definitive drug testing by mass
spectroscopy, with confirmation when
indicated, >40 drugs, metabolites and illicits;
per encounter; includes specimen validity
testing (pH, specific gravity, oxidants,
creatinine)
• Asked CMS not to recognize existing 21 quant
codes and 58 new codes

54. What Happened to Comprehensive
“G” code?
• 2015 CPT drug codes – not adopted by CMS
• Palmetto’s G code proposal – not adopted by
CMS
• CMS cross-walked 2014 CPT codes to “G” codes
• Palmetto issued Coding/Billing Guidelines
• Requires short text string in SV101-7 claim field
• Created CSPAN text string with # of drugs > 8
• Tiered reimbursement: 8-14; 15-34; >35

55. Questions?
Elaine.jeter@palmettogba.com

56. Optimizing Utilization and
Outcomes of Urine Drug Testing
Kenneth L. Kirsh, PhD
Vice President, Clinical Research and Advocacy
Millennium Health
Principal Investigator
Millennium Research Institute

57. Disclosure Statement
• Kenneth L. Kirsh, PhD wishes to disclose he is
employed as Vice President of Clinical
Research and Advocacy for Millennium Health
and Principal Investigator at Millennium
Research Institute.
• He will present the following content in a fair
and balanced manner.

58. Learning Objectives
1. Identify the obstacles currently related to
appropriate use of UDT in substance use
management.
2. Describe a research-based clinical approach for
employing UDT in management of substance
use disorders.
3. Explain civil and criminal liability for
practitioners related to waste, fraud and abuse
in UDT.
4. Advocate state and federal policy responses to
UDT liability concerns.

59. Urine Drug Testing (UDT) Rationale
•
• Prescription medications?
• Non-prescription medications?
• Illicit substances?
Gourlay DL, Heit HA, Caplan YH. Urine Drug Testing in Clinical Practice: the Art and Science of Patient Care.
2010. Stamford, CT: PharmaCom Group, Inc.
UDT provides objective information
regarding medication use and patient risk
for substance abuse or misuse
UDT should be used in conjunction with other
monitoring tools to optimize outcomes

60. UDT Results in SUD Patients:
Results From a National Profile
Passik SD, et al. Trends in drug & illicit use from urine drug testing from addiction treatment clients. Poster #3.
International Conference on Opioids (ICOO): Basic Science, Clinical Applications & Compliance, Annual Meeting,
Boston, MA. June 9-11, 2013.

61. Study on UDT National Profile: Results
Condition/Category Occurrence
% of Total
Specimens
Millennium
Average
1: Specimens in full agreement with reported medications
2082 48.5% 39.7%
2: Specimens with unreported prescription medication(s)
detected 1097 25.6% 34.0%
3: Specimens with reported prescription medication(s) not
detected 291 6.8% 10.6%
4: Specimens with unreported prescription medication(s)
detected & reported prescription medication(s) not detected 119 2.8% 7.7%
5: Specimens with illicit substance(s) detected
241 5.6% 2.0%
6: Specimens with illicit substance(s) & unreported medication(s)
detected 399 9.3% 3.8%
7: Specimens with illicit substance(s) detected & reported
medication(s) not detected 28 0.7% 1.1%
8: Specimens with illicit substance(s) detected & unreported
medication detected & reported medication(s) not detected 32 0.7% 1.0%
Passik SD, et al. Trends in drug & illicit use from urine drug testing from addiction treatment clients. Poster #3. International Conference
on Opioids (ICOO): Basic Science, Clinical Applications & Compliance, Annual Meeting, Boston, MA. June 9-11, 2013.

62. Study on UDT National Profile: Results
Drug or Drug Class Negative Office Results Positive Office Results
*Based on laboratory
testing results
True Negatives
(TN)*
False
Negatives
(FN)*
% of Positives
Missed by
POCT
True
Positives
(TP)*
Clinically
False
Positives
(FP)*
% of POCT
Positives That
Were Incorrect
Opiates 2590 182 29.9 427 123 22.4
Oxycodone/Oxymorphone 2933 81 31.3 178 125 41.3
Methadone 2924 29 27.9 75 62 45.3
Benzodiazepines 2323 349 36.5 606 78 11.4
Amphetamines 3036 112 43.9 143 39 21.4
Barbiturates 2632 34 40.0 51 14 21.5
Tricyclic Antidepressants 1479 24 34.8 45 144 76.2
Cocaine 3211 38 40.0 57 8 12.3
Marijuana 2579 140 20.7 536 145 21.3
MDMA 3147 1 50.0 1 182 99.5
PCP 2275 0 0.0 0 32 100.0
Passik SD, et al. Trends in drug & illicit use from urine drug testing from addiction treatment clients. Poster #3. International Conference
on Opioids (ICOO): Basic Science, Clinical Applications & Compliance, Annual Meeting, Boston, MA. June 9-11, 2013.

63. CASE VIGNETTES:
Clinical Lessons Learned From SUD
Counselors and Definitive Testing
Rzetelny A, et al. Clinical drug testing in substance-use treatment: A qualitative study of counselors’ use of
definitive drug testing results in their work with clients. Submitted for publication.

64. Case Vignettes From Counselors
• Impact of UDT Transition on Therapy:
The relationships “worsened for a little while
because people were upset that they were being
tested at their treatment court and then by us,
and we were the ones that were finding that
they were using and their treatment court
wasn’t finding that. It kind of made us the bad
guys, but after you educated them about how
much more sensitive the testing is that we were
doing, they kind of got the message.”
Rzetelny A, et al. Clinical drug testing in substance-use treatment: A qualitative study of counselors’ use of definitive drug testing results
in their work with clients. Submitted for publication.

65. • UDT as a Clinical Tool:
• Definitive drug testing could provide an
opportunity to:
“Foster healthy conversations with clients
about their drug use. You can kind of catch
people when they are not telling the truth or
when they are in denial. So if someone is in
denial you can kind of work on helping them
in another way.”
Rzetelny A, et al. Clinical drug testing in substance-use treatment: A qualitative study of counselors’ use of definitive drug testing results
in their work with clients. Submitted for publication.
Case Vignettes From Counselors

66. The Model of Sobriety Case:
• Client consistently tested negative on IA prior to LC-MS/MS testing
– The counselor explained being surprised that: “she was not ready to stop
using…we were able to pick up on that after we caught her relapses...she
was probably doing it before, but because of the [previous IA-lab] testing
we were unable to pick it up. Whatever games she played before it didn’t
work [any more].”
• Initial denials were dramatic but eventually she entered one of her first true
periods of abstinence, as suggested by consistently negative LC-MS/MS test
results
• Nevertheless, during a weekend pass she died tragically following a relapse
associated with marital discord
– Counselor explained, “her peers look at her and see her and see that they
might have learned a lesson. They think ‘wow, I thought she was doing
good (sic) but she continued to relapse.’ …knowing that she was
continuing to use …they probably learned a lesson because there is a
saying in the room that some of us will die for others to live…”
Rzetelny A, et al. Clinical drug testing in substance-use treatment: A qualitative study of counselors’ use of definitive drug testing results
in their work with clients. Submitted for publication.
Case Vignettes From Counselors

67. Legal Ramification Case:
• Woman with hx of crack cocaine use
– Criminal justice IA tests negative weekly, but treatment center
found cocaine positive with LC-MS/MS
– Initial denial gave way to greater honesty and making further
progress with her recovery
• Counselor stated, the positive cocaine result with LC-MS/MS was: “a
catalyst therapeutically as far as acknowledging that there was a
recent relapse and figuring out what we now had to do to move
forward. …I think that she maybe opened up a little bit more about
guilt and disappointment in herself. I think there was a vulnerability
that happened but it was therapeutically useful.”
• Criminal justice system added 2 months to treatment mandate but
she did not return to prison
• She was given more structure and monitored more closely
Rzetelny A, et al. Clinical drug testing in substance-use treatment: A qualitative study of counselors’ use of definitive drug testing results
in their work with clients. Submitted for publication.
Case Vignettes From Counselors

68. The Catch Me Please Case:
• Client UDT positive for clonazepam after more than a year of treatment and
consistently negative IA results
• No denial, instead “…there was a deep sense of shame and failure …she was
tearful and crying and saying the moment that she [relapsed] she wanted to go
straight to her staff counselor and tell him but she couldn’t bring herself to
disappoint him in that way. …it was kind of like she was waiting for [the
positive LC-MS/MS result] to happen so she could say it.”
• Entered a new level of progress in her therapy, revealing old sources of
emotional pain she related to SUD
– Monitored more closely and tested negative for several months
– Recently experienced a new relapse, but remarkably, this time, she did not wait for the
positive toxicology to report it
– Her previous experience had helped to build a new level of confidence and trust, this
new relapse was much shorter and less intense.
Rzetelny A, et al. Clinical drug testing in substance-use treatment: A qualitative study of counselors’ use of definitive drug testing results
in their work with clients. Submitted for publication.
Case Vignettes From Counselors

69. Summary
• Prescription drugs, and the opioid class in
particular, have wide ranging impact on society
• UDT can be an important tool in SUD treatment
• Differences exist between UDT technologies,
impacting rates of false positives and false
negatives
• Understanding these differences is important to
avoid misjudging patients and harming
therapeutic relationships

70. Treatment Track:
Optimizing Utilization and
Outcomes of Urine Drug Testing
Presenters:
• Louis E. Baxter, Sr., MD, FASAM, President and CEO,
Professional Assistance Program of New Jersey, Inc.
• Michael C. Barnes, JD, Executive Director, Center for
Lawful Access and Abuse Deterrence (CLAAD), and
Member, Rx Summit National Advisory Board
• Elaine Jeter, MD, MolDx Medical Director, Palmetto GBA
• Kenneth L. Kirsh, PhD, Vice President, Clinical Research
and Advocacy, Millenium Health
Moderator: Andrea Grubb Barthwell, MD, FASAM,
President, Two Dreams Outer Banks