The Role of Medical Review Officers & the Integrity of Drug Testing

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The science and the practical day-to-day practice of screening job applicants and employees for substances of abuse have come a long way in the past three-plus decades. Today there are myriad drug testing methods to choose from including lab-based urine, oral fluid and hair testing, urine and oral fluid point-of-care devices that yield rapid results, and electronic chain-of-custody processes, all of which combine to give employers a multitude of options toward achieving their drug-free workplace objectives.
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But in the end, it always comes down to one thing: an accurate result. And when it comes to ensuring an accurate result, the hands-on, personal involvement of a certified medical review officer (MRO) is critical. The DOT regulations refer to the MRO as the “Gatekeeper” of the results. In their duties they have the right to review results and talk to donors. During the verification and review process they may also talk to certifying scientist at laboratories, talk with pharmacies, and have discussions with collectors or collection site managers.

Back in the early 1990s there was a popular mantra among drug testing providers: "do it right or don't do it all." And the U.S. military is often credited as the origin of the saying regarding drug test results: "If in doubt, throw it out." The services of an MRO ensure that drug testing is done right and that there is no doubt about a final result be it positive or negative.

For many years the gold standard of drug testing involved sending a urine specimen to a laboratory for analysis. If the initial screen was non-negative it would be confirmed at the lab with a second testing method, usually gas-chromatography/mass spectrometry (GC-MS). If it was confirmed positive, it would be reviewed by an MRO who would contact the donor to eliminate any legitimate explanations for the positive results before it was reported to the employer.

Today, even with so many options available for how to conduct drug testing, the lab-confirmation process and MRO verification remain essential. Yet, some employers may be tempted to cut corners in an ill-advised attempt to speed up the process or save money by skipping the confirmation test or bypassing the verification of the result by an MRO. However, do so is a prescription for trouble as both confirmation testing and MRO review represent the right way to conduct drug testing and are actually required by many state drug testing laws.

3 Reasons to Use an MRO

The use of a qualified MRO achieves three important objectives:
1. It establishes a layer of protection from liability for the employer.
2. It helps employers comply with legal requirements imposed by many state drug testing laws and federal drug testing regulations.
3. It helps avoid accusing someone of failing a drug test when, in reality, there was a legitimate medical explanation for a positive test result.

Protecting the integrity of a drug testing program should be every employer's goal. MROs help achieve that objective. As they interview an individual whose sample is confirmed positive by the laboratory, they can discover something that results in a legitimate reversal of the confirmed result.

One major drug testing provider who chose not to be identified by name shared that in the previous year MROs reversed 17% of confirmed positives from traditional 5-panel tests and 21% from expanded panels that included prescription drugs. Further, this company discovered that more than 70% of donors who test positive for prescription drugs can produce a valid prescription. This means that Medical Review Officers are doing a lot of work behind the scenes, most of which is never seen, but that is incredibly valuable.

MROs also review custody and control forms to ensure proper collection protocols were followed during the collection process. Errors during the collection process can result in a test being cancelled. The MRO may ask questions regarding the collection process.

State Laws

Perhaps because of the reversal rate cited above, as well as other important reasons, some state drug testing laws require the use of MROs. When reviewing state drug testing laws consider these key issues:
· A mandatory state law may or may not include an MRO-related requirement. If it does, look for the exact requirement. Some state laws mirror the federal regulations while others can be quite unique.
· Look for non-drug testing laws that include drug testing requirements. Good examples are states with workers' compensation regulations that require the use of an MRO in order for an employer to move to deny or reduce workers' comp benefits.
· Distinguish between mandatory drug testing laws and voluntary laws. Voluntary laws only apply to those companies that participate in the voluntary program. Many voluntary state drug testing laws follow federal drug testing procedures and, as such, require the use of MROs.
· Finally, check whether a state requires MRO review of both positive and negative results.

Following are a few examples of state laws related to MRO services:
New York— the NY Department of Health requires that all drug test results be reported to an MRO prior to being released to an employer. This includes both positive and negative results.

Maryland—the law specifically requires an MRO to review "pre-employment" initial screen positives.

Industry-Specific Laws—In Virginia use of an MRO is required in the mining industry as well as in workers' comp cases. Kentucky also specifically requires the use of an MRO in the mining industry.

Workers' Comp Laws— Alabama is one of several states that allow employers to challenge workers' comp claims based on a positive drug test. Employers in Alabama must conduct drug testing in accordance with the DOT regulations even when it's not a DOT testing situation. The DOT regulations, of course, require the use of an MRO. Other states with similar laws include Arkansas, Illinois, and New Mexico to name a few.

DOT Procedures Required—There are a number of states that require employers to follow the procedural elements of the Department of Transportation (DOT) regulations in non-DOT drug testing situations. For example, as part of Tennessee's voluntary drug testing law participants in the state workers' comp discount program must follow DOT testing standards including using an MRO. The same is true in Wyoming among others.

It is not uncommon for employers conducting non-regulated testing to request that their MROs follow DOT procedures wherever possible. The DOT regulations include a requirement that MROs review negative test results as well as positive results. The review of negative drug tests can provide protections for both the employee and the employer.

Conclusion
The science of drug testing is typically beyond legal challenges these days. But that does not mean that such a challenge is impossible. In the event of a legal challenge, employers do not want to try to defend a drug test result that has not been verified by a certified MRO who can attest to the integrity of both the result and the procedures that were followed in producing that result.
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Regardless of state law requirements, it is always wise to include the services of a Medical Review Officer in a workplace drug testing program.

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