A Medical Review Officer (MRO) is a licensed physician who receives and reviews laboratory results from an employer’s drug testing program. The MRO acts as an independent and impartial gatekeeper, evaluating non-negative test results to determine if a legitimate medical explanation exists before reporting the verified result to the employer. Their involvement is triggered when a laboratory reports a positive, adulterated, substituted, or otherwise invalid test result requiring further medical interpretation. The MRO’s primary function is to contact the donor to conduct a confidential medical interview, ensuring that a legally valid use of a substance is not misidentified as illicit drug use.
The Medical Review Officer’s Role and Call Protocol
The MRO’s first step upon receiving a non-negative lab result is to initiate confidential contact with the donor. This initial call establishes the MRO’s identity and explains that the purpose of the interview is to determine if a medical reason accounts for the laboratory finding. Federal regulations typically require the MRO to make at least three attempts to contact the donor within a 24-hour period.
The MRO confirms the donor’s identity and consent before discussing medical details. The donor is informed that failing to respond to contact attempts will generally result in the test being reported to the employer as a verified positive or a refusal to test. The MRO maintains strict confidentiality, ensuring the employer only receives the final determination—negative, positive, or canceled—without any disclosure of medical conditions or prescriptions.
Questions Regarding Current Prescriptions and Legal Medical Use
The primary line of questioning for a confirmed positive result focuses on legally prescribed medications that could account for the detected substance. The MRO asks for the specific name of the drug, the medical condition for which it was prescribed, and the contact information for the prescribing physician to allow for independent verification.
Inquiries are made about the prescription details, including the dosage, frequency of use, and the date it was filled. The MRO must verify that the drug levels found in the specimen are consistent with the prescribed therapeutic use and dosage. The MRO also investigates the timeline of medication use relative to the sample collection date.
Verification often involves the MRO contacting the dispensing pharmacy or the prescribing physician to confirm the prescription’s legitimacy and details. The MRO’s focus is strictly on confirming that a valid prescription exists and that the drug’s concentration in the sample is medically explained by that prescription. Successfully verifying a legitimate medical explanation leads the MRO to report the result as a verified negative to the employer.
Questions Seeking Alternative or Non-Prescription Explanations
If a valid prescription cannot explain the positive test result, the MRO explores other non-prescription sources of the detected substance. This includes questioning the donor about the recent use of over-the-counter (OTC) medications and dietary intake. For instance, certain cold remedies containing pseudoephedrine can sometimes cross-react with initial screening tests for amphetamines, requiring discussion about recent cold or allergy treatment.
Dietary factors are a frequent area of inquiry, particularly regarding opiate positives. The MRO may ask about the consumption of foods containing poppy seeds, which naturally contain trace amounts of compounds like codeine and morphine. Scientific guidelines establish concentration cut-offs that help the MRO differentiate between dietary exposure and drug use.
The MRO also inquires about the use of hemp products or CBD oils, which can contain trace amounts of tetrahydrocannabinol (THC) and potentially lead to a positive result. Questions may also cover environmental or occupational exposures, such as proximity to certain cleaning solvents. If the laboratory reports an adulterated or substituted specimen, the MRO may ask the donor about any procedural irregularities observed during collection or knowledge of specimen tampering.
Finalizing the Interview and Result Determination
Once the interview is complete, the MRO requires the donor to submit documentation to support their explanation, such as prescription bottles, pharmacy receipts, or a letter from the prescribing physician. The MRO uses this documentation to conduct the necessary verification process, which includes contacting external medical sources to confirm the authenticity of the information. This verification ensures the medical explanation is legitimate and aligns with the test results, protecting the donor.
After all information is collected and verified, the MRO reaches a final determination, which is then reported to the employer. The possible outcomes are a Verified Negative, where a legitimate medical explanation was confirmed, or a Verified Positive, where no such explanation was found. A third outcome is a Canceled Test, which occurs if the MRO discovers a fatal flaw in the collection or testing process that compromises the sample’s integrity.
The final verified result is the only piece of information shared with the employer, preserving the donor’s medical privacy.