FAQs

What does a medical review officer do?

A medical review officer (MRO) is the linchpin in an effective drug testing program and the one touch point of all other participants involved in drug testing: the donor, the employer, the collection site, the laboratory and, where applicable, state and federal agencies. In the simplest terms, a MRO receives and reviews non-negative laboratory drug tests and evaluates whether the result has a justifiable medical reason or determines if sample adulteration or substitution has occurred. The medical review officer does this by following a proscribed protocol to ensure chain of custody and employee confidentiality.

Who decides whether to involve a MRO?

If you have employees who perform safety-sensitive functions that are regulated by the Department of Transportation (DOT), the decision to use the services of a medical review officer has already been made for you. DOT regulations, specifically in 49 CFR Part 40.123 Subpart G, outline all requirements pertaining to MROs in regulated drug testing.

For non-regulated drug tests that you undertake under your own company policy and/or in compliance with state laws, you may have a choice whether to use a MRO, depending on what state law says. But, even if not mandated by law, using a MRO is a good practice to ensure accuracy of testing – for your peace of mind and that of your employees – and to reduce the risk of legal liability.

“The use of the medical review officer greatly enhances the validity and reliability of the overall drug testing process. This process helps ensure fairness to the donor and offers more protection to the employer/agency in any case of later litigation due to a ‘positive’ drug test where the donor may have actually had a legitimate medical explanation. It is the job of the MRO to ensure the integrity of the drug test, and without an MRO, there is no assurance of this integrity,” Global HR Research states in a blog post.6

Which drugs will elicit a positive verification by the MRO?

A medical review officer must verify a confirmed positive test for marijuana, cocaine, amphetamines, semi-synthetic opioids (i.e., hydrocodone, hydromorphone, oxycodone, and oxymorphone), and/or PCP unless the employee can present a legitimate medical explanation.10 The employee must be given an opportunity to offer an explanation and the burden of proof rests with him or her. If the MRO finds validity in the medical explanation, the test is verified as negative. Otherwise, it is verified positive.

If the MRO agrees there is a legitimate medical explanation, fitness-for-duty considerations can still be raised with the employer.