Representative facts: A limousine driver lost control of a vehicle on a steep downgrade, resulting in multiple fatalities. Toxicology testing identified THC, carboxy-THC, and hydromorphone in the driver’s blood. On the pre-employment commercial driver medical examination, the driver had disclosed medical marijuana use. Issues for expert review: · What is the significance of the toxicology findings? · Do the laboratory findings support impairment by cannabis, opioids, or both

Representative facts: An employee subject to random workplace drug testing produced a urine specimen that tested positive for codeine at 2,400 ng/mL and negative for other drugs. The Medical Review Officer certified the result as positive, and the employee was terminated. The employee claimed that poppy seed ingestion explained the result and alleged collection flaws, including that the courier’s name was not printed on the custody and control form. Issues for expert review:

Representative facts: A patient presented to a primary care physician with chronic low back pain. The physician recommended and certified the patient for medical marijuana. Over the following year, the patient used multiple cannabis products, including vape pens, edibles, and capsules. The patient later developed auditory hallucinations, including voices commanding him to harm his wife, and was involuntarily hospitalized with psychosis. Issues for expert review: · Did the cer

Representative facts: A 67-year-old man had a PSA level of 7.1 ng/mL ordered by his primary care physician. A repeat PSA two months later remained elevated at 6.8 ng/mL. Although the patient returned for multiple primary care visits over the next year, no further PSA testing, urology referral, or documented follow-up plan was completed. Approximately 16 months after the last PSA result, the patient presented to the emergency department with back pain and was found to have met