The MRO

What is an MRO?

The position of Medical Review Officers was first outlined in 1988 within the US Federal Department of Transportation’s drug testing regulations.1 Since then, it has become an integral and necessary part of workplace drug testing procedures across the US and Canada.
A Medical Review Officer is an impartial, licensed physician who analyses laboratory results from drug testing programs and provides medical explanations for specific drug test results.2 MROs can be independent contractors or employees of a Federal agency, and act as the point of contact between the test facility, the donor, the collector, and the agency’s representative.3

What does an MRO do?

Working independently, an MRO upholds the integrity of drug testing procedures, and assures the accuracy of test results by determining evidence of adulteration, substitution, and/or validity of drug test results. An MRO also protects the confidentiality of the drug testing information,
determines whether or not the drug test laboratory has abided by the set standards and rules of the workplace from which the sample originated, and also investigates any alternatives that may explain a positive test result.5

The MRO also serves an important role in protecting the employee, and alleviating employee fears that they will be falsely accused of being drug users.6 In the occurrence of a positive test result, the MRO provides the employee with an opportunity to explain the positive result in the event that the presence of the drug is due to a prescription or a doctor’s recommendation. MROs also serve to protect employees by making sure that correct test panels are used and that the test and any following procedures are conducted properly.7

An MRO reviews all collected specimens that are reported as positive, substituted, adulterated, rejected, or invalid for testing, and determines the correctness of the report. She then:

  • Ensures that all negative/dilute or negative tests are reviewed and reported correctly to the state agency,
  • Reviews all blind samples and investigates any inconsistent results,
  • Medically assesses the person who provided the sample when such services are requested,
  • Determines the accuracy and validity of the test as well as recommends further testing if necessary, and
  • Maintains all records with confidentially.

While reviewing samples, the MRO must:

  • Ensure that the drug test panel was used correctly,
  • Verify that the collection of the sample was conducted properly,
  • Contact any employee who has tested positive for drugs and collect that employee’s medical and prescription history, and
  • Report positive and negative drug test results to the employer.8

What qualifications does an MRO have?

A qualified MRO must abide by the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs, and be:

  • A licensed physician with a Doctorate in Medicine or Osteopathy,
  • An expert in the toxicology and pharmacology of illicit drugs and substances,
  • Successfully reviewed by an MRO certifying body, and
  • Professionally trained in:
    • the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs,
    • procedures for the collection of Federal agency specimens,
    • the chain of custody for drug test specimens (including reporting and protocol), and
    • procedures for reviewing, interpreting, and reporting results.9

In addition to the authorization of prescribe controlled substances consistent with Drug Enforcement Agency (DEA) rules and regulations, the American College of Occupational and Environmental Medicine (ACOEM) states that the MRO must also have knowledge of:

  • the pharmacology of drugs of abuse,
  • accepted pharmacological treatment and standard prescribing practices for specific disease process,
  • ethical considerations in workplace drug testing programs,
  • laboratory testing methodology and quality control,
  • laws and regulations related to the use of illicit and licit substances,
  • chemical dependence and addiction behavior, and
  • employee assistance programs and rehabilitation.10

Are MROs subject to any restrictions?

An MRO cannot be an agent or employee of any laboratory or Instrumental Initial Test Facility (IITF), nor can they have any financial interest in the laboratory where they review the results of the drug tests. If the MRO has any such agreements with the laboratories being used for the process, the resulting situation would be considered a conflict of interest.11

 

  1. “Qualifications of Medical Review Officers (MROs) in… : Journal of Occupational and Environmental Medicine.” LWW, journals.lww.com/joem/Fulltext/2003/01000/Qualifications_of_Medical_Review_Officers__MROs_.19.aspx.
  2. “Medical Review Officers.” US Department of Transportation, United States Department of Transportation, 29 May 2012, www.transportation.gov/odapc/mro.
  3. “Medical Review Officer (MRO) | Duties & Functions of a Drug Testing MRO.” Confirm BioSciences, www.confirmbiosciences.com/knowledge/terminology/what-is-medical-review-officer/.
  4. “Medical Review Officers.” US Department of Transportation, United States Department of Transportation, 29 May 2012, www.transportation.gov/odapc/mro.
  5. “Medical Review Officer (MRO) | Duties & Functions of a Drug Testing MRO.” Confirm BioSciences, www.confirmbiosciences.com/knowledge/terminology/what-is-medical-review-officer/.
  6. “Qualifications of Medical Review Officers (MROs) in… : Journal of Occupational and Environmental Medicine.” LWW, journals.lww.com/joem/Fulltext/2003/01000/Qualifications_of_Medical_Review_Officers__MROs_.19.aspx.
  7. “Medical Review Officer (MRO) | Duties & Functions of a Drug Testing MRO.” Confirm BioSciences, www.confirmbiosciences.com/knowledge/terminology/what-is-medical-review-officer/.
  8. “Medical Review Officer (MRO) | Duties & Functions of a Drug Testing MRO.” Confirm BioSciences, www.confirmbiosciences.com/knowledge/terminology/what-is-medical-review-officer/.
  9. “Medical Review Officer (MRO) | Duties & Functions of a Drug Testing MRO.” Confirm BioSciences, www.confirmbiosciences.com/knowledge/terminology/what-is-medical-review-officer/.
  10. “Qualifications of Medical Review Officers (MROs) in… : Journal of Occupational and Environmental Medicine.” LWW, journals.lww.com/joem/Fulltext/2003/01000/Qualifications_of_Medical_Review_Officers__MROs_.19.aspx.
  11. “Medical Review Officer (MRO) | Duties & Functions of a Drug Testing MRO.” Confirm BioSciences, www.confirmbiosciences.com/knowledge/terminology/what-is-medical-review-officer/.

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