Declaring the Result of Drug Test – Who Has the Final Say on Prescriptions

Medical Review Officers (MROs) are licensed physicians who play an imperative role in authenticating if there is a legitimate medical/legal explanation for a controlled substance to be present in an employee’s specimen, (i.e., a valid prescription). Even if the “non-negative” result is for a Schedule I drug (which are considered to have no medical value), the MRO will still attempt to interview the employee to determine if there is a valid reason for the presence of the substance.

Long acknowledged for their defensibility and employee privacy protections, federally mandated drug tests (e.g., under the Department of Transportation regulations) require the involvement of an MRO. These federal testing protocols are considered best practice for drug testing even for non-DOT employees and include these steps:

1. An employee provides a urine specimen at a controlled collection site using a chain of custody form.
2. The specimen is shipped, under specific protocols, to a federally certified laboratory for testing. There, a portion of the specimen undergoes a scientific analysis that is said to be 92-98% accurate.
3. If the specimen is “at or above” the federal cut off level on the initial screening analysis, the specimen then goes through a confirmation testing process called gas chromatography mass spectrometry (GC/MS) to look for the chemical signature of the drugs designated in the test. If the drug or its metabolites are present at or above the pre-announced level, then the specimen is ruled scientifically positive. HOWEVER –
4. Before the employer OR the employee is notified of the scientific results, one final check is done. An MRO will analyze the result and attempt to contact the donor to confirm if there is a verifiable reason for the substance in question to be in the donor’s system.

The MRO verification process:
The MRO will attempt to contact the donor at least 3 times within 24 hours. If this connection is unsuccessful, the MRO will request the employer to instruct their employee/donor to contact the MRO within the next 72 hours.

1. If this connection is not made within the next 72 hours, the MRO will report the result back to the employer as a non-contact positive.

**Working Partners® encourages employers to be proactive by informing their employees of this verification step, and to answer any calls from an unknown number they may receive during this timeframe.

If the MRO is successful in contacting the donor, the verification of a prescription may include the following:

1. The MRO may contact the donors corresponding pharmacy that dispensed the prescription.
2. The donor may provide a hardcopy receipt from the pharmacy that dispensed the prescription.
3. The MRO may contact the prescribing physician directly.

Once the MRO authenticates a valid reason for the drug being in the employee’s system, the drug test result is sent back to the employer as a negative.

Two Important Notes!

1. Per the Department of Transportation, a prescription medication that is being used by the employee after its expiration date can still be considered a valid medical explanation for a non-negative test if the MRO can authenticate that there is/was a valid prescription.
2. If the employee has a valid prescription, but this medication could cause adverse side effects for an employee who is occupying a safety sensitive position, the MRO may send a safety concern warning to the employer suggesting they have this employee undergo a fitness for duty examination.

Questions to ask yourself as an employer:

1. Are you sure you have an MRO involved in your drug testing process? (don’t assume!)
2. Do you have your MROs contact information so that you can reach out with any questions on specific test results?
3. Do you have a clear, operational rule regarding an employee’s legitimate use of prescribed medications, and when that medication could adversely affect the employee’s safety or productivity?

Employees have a right to take the medications they need, and you have a right to ensure that their medication use is not negatively affecting the job, safety of the employee, or the safety of others. A best practice Drug-Free Workplace program helps you to balance these rights through clear, operational guidance and DOT-mirrored testing.

Copyright 2024 Working Partners®