“The Value of Drug Monitoring in Chronic Opioid Therapy Patients” delivered by Dr. Harry Leider, M.D., MBA, and Chief Medical Officer of Ameritox, Inc. This presentation was delivered during the ”Managing a Patient’s Pain in Today’s Regulated Environment” portion of the 2009 ASPMN Annual Conference.

1. “ Managing a Patient’s Pain in Today’s Regulated Environment” ASPMN 2009 NATIONAL CONFERENCE Lunch Symposium September 14, 2009 Moderated by Mary Milano-Carter

5. The Value of Urine Drug Monitoring in Chronic Opioid Therapy Patients Harry Leider, MD, MBA Chief Medical Officer, Senior VP Ameritox, Inc.

6. Harry L. Leider, MD, MBA, FACPE Dr. Leider has over 20 years experience as a physician executive. He currently is the Chief Medical Officer and Senior Vice President of Ameritox, a national medication adherence company. Prior to joining Ameritox, he was the Chief Medical Officer of XLHealth, a Disease Management firm and Medicare health plan. Dr. Leider serves as a core faculty member for the American College of Physician Executives, and is the organization’s President and Chairman of the Board. He serves on the editorial boards of: Disease Management and Health Outcomes , Physician Executive, and Disease Management . He is a founding board member of the Disease Management Association of America, and is on the Board of the Institute of Aging at the University of Pennsylvania. Dr. Leider obtained a BA from Pennsylvania State University, an MD from the University of Pennsylvania, and while a Robert Wood Johnson Clinical Scholar, earned his MBA from the University of Washington. Dr. Leider is currently a Senior Scholar in the School of Population Health at Thomas Jefferson University.

16. Retention Time in Urine Note: Interpretation of retention time must take into account variability of urine specimens, drug metabolism and half-life, patient’s physical condition, fluid intake, and method and frequency of ingestion. These are general guidelines only. 0 Drug Approximate Retention Time Amphetamines 48 hours Barbiturates Short-acting (eg, secobarbital), 24 hours Long-acting (eg, phenobarbital), 2-3 weeks Benzodiazepines 3 days, if therapeutic dose ingested Up to 4-6 weeks after extended dosage (ie, 1 or more years) Ethanol 2-4 hours Methadone Approximately 3 days Propoxyphene 6-48 hours Cannabinoids Moderate smoker (4 times/wk) 5 days Heavy smoker (smoking daily) 10 days Chronic smoker 20-28 days

19. Choice of Urine Screening Methodology Dependent on Desired Specificity Urine Drug Screening 0 GC=gas chromatography; MS=mass spectrometry; HPLC=high-performance liquid chromatography. Laboratory-based Drug-specific Identification MS GC HPLC Synthetic/ Semisynthetic Opioids: Methadone, Fentanyl, Oxycodone Immunoassay Natural Opiates: Morphine Codeine

20. Federally Mandated Immunoassay Screening and Confirmation Cutoff Concentrations 0 * Cutoff concentrations used for drugs in federally regulated testing, particularly opioids, are too high to be of value in clinical practice. * * * * Marijuana Cocaine Opiates Amphetamine 5-45 Days 50 ng/mL 2-3 Days 30 0 n g / mL 1-2 Days 200 0 n g / mL 1-5 Days 100 0 n g / mL Phencyclidine 8-30 Days 25 n g / mL The Federal Five *

22. Interpretation of UDT Results Wolff K, et al. Addiction . 1999;94:1279-1298. Patient has taken drug Patient has not taken drug Positive result True positive False positive Negative result False negative True negative

23. Error Rates in Point of Care Testing Ameritox data on file

24. Patented Methodology The Rx Guardian Report presents customized results for every patient using its patented methodology to generate ranges based on the patient’s height, weight, gender, age, and prescribed dosage.

26. Interpreting the Report