The Role of the Medical Review Officer (MRO) in Workplace Drug Testing
An essential component of any drug testing program is a comprehensive final review of laboratory results, which includes review of appropriate documentation, as well as an interview with the donor of the specimen to discover whether or not an acceptable medical explanation exists for the laboratory result.
A confirmed positive test result reported from a laboratory does not automatically identify an employee or job applicant as having misused drugs, nor does a laboratory result of invalid, substituted, or adulterated automatically identify a person as having tampered with a specimen.
A physician with a detailed knowledge of possible legitimate medical explanations must determine drug test results in the context of all information including the test result and the donor interview.
Typically, certifying organizations and/or governmental regulations define that a Medical Review Officer (MRO) must be a currently licensed physician holding medical degrees from an accredited college of medicine. These doctors generally must have the following training:
o Knowledge regarding the pharmacology and toxicology of illicit drugs
o The training necessary to serve as an MRO, including training in:
- -Specimen collection procedures, Interpretation of test results
- -Chain of custody reporting
- -Guidelines for workplace drug testing programs established through
- -Procedures for interpretation and review
- -Complete continuing education as specified by the MRO’s certifying entity
o Successfully completed examination through nationally recognized accreditation authority, including recertification as specified.
The MRO serves as the common point of contact between all participants in a drug test including the donor, the collector, the test facility or laboratory, and the employer’s designated representative. The MRO has the following responsibilities:
o Review all positive, adulterated, rejected for testing, invalid, and (for urine) substituted test results
o Ensure that specimens reported as negative and (for urine) negative/dilute are properly reviewed and reported to the employer designated representative
o Discuss potential invalid results with the laboratory to determine whether further testing is warranted
o Complete action required procedurally by MRO’s certifying organization or governmental agency standards such as reviewing the chain of custody of the specimen, interviewing the donor when required (e.g., to verify the existence of prescribed medication that could explain the result and/or to collect evidence of the prescription), making a determination regarding the result, and reporting the verified result to the employer.
o Maintain all records in accordance with certifying organization or governmental agency standards
o Conduct a medical evaluation of the donor or a review of the examining physician’s findings and make a determination of “refusal to test” or “cancelled test” when a collector reports that the donor was unable to provide a urine specimen
o Monitor the frequency of errors and notify responsible parties to take corrective action to prevent recurrence
o Perform quality assurance methods as required certifying organization or governmental agency procedures
o Request additional testing (as allowed) to help in the determination of a final result for a donor specimen.
All in all, the MRO works on behalf of the employer, not the laboratory, to ensure that established procedures are followed and that the donor (an employee or prospective employee) is respected according to local laws.