Last updated : December 16, 2024
The Office of the Assistant Secretary for Transportation Policy (Policy Office) coordinates with the Department of Transportation (DOT) and other Federal agencies to share the responsibility for determining transportation-related safety activities.
The Policy Office coordinates and executes the DOT’s safety initiatives in the following ways:
- Reviews and analyzes domestic transportation policy regarding DOT leadership decisions and actions;
- Analyzes data and recommends policies for reducing transportation fatalities and injuries;
- Develops, coordinates, and evaluates public policy on transportation safety issues;
- Coordinates national transportation policy initiatives relating to safety matters; and
- It looks for opportunities to advance the Department’s safety mission.
Can drug testing ever present a DOT safety concern?
The answer to the question is yes. Since employee drug testing is part of the safety protocol results can cause safety concerns. Medical Review Officers (MROs) are responsible for determining if a drug test result is a safety concern.
Who is an MRO?
The MRO can be someone working with your third-party administrator (TPA) or a licensed physician of your choosing. Whoever you choose must be trained and certified to qualify as a Medical Review Officer.
Initially, the physician must be knowledgeable in the following areas:
- Controlled substances—including clinical experience in dealing with controlled substance abuse disorders and detailed knowledge of alternative medical explanations for laboratory-confirmed drug test results
- Issues related to adulterated and substituted specimens, including possible medical causes
- Have gained knowledge regarding the DOT MRO Guidelines and regulations that apply directly to your employer
Qualification training
To qualify as an MRO for the DOT, physicians must complete the following training:
- Urine specimen collection procedures
- Chain of custody, reporting, and recordkeeping
- Interpretation of drug and validity tests results
- Role and responsibilities of an MRO
- Interaction process with DERs and SAPs (Substance Abuse Professionals)
Additionally, MROs complete requalification training every five years.
What do they do?
The MRO’s responsibility is to review any positive or inconclusive test results to:
- Determine if there is a legitimate reason for confirmed laboratory results that are positive, adulterated, substituted, or inconclusive
- Ensure employers receive the determination promptly
- Protect the confidentiality of company drug testing information
MROs provide employers with added protection because there is little chance of an employee accusing their employer of an inaccurate test result. The MRO consults with a scientist, usually a laboratory representative, concerning the result before notifying the employee about the test result causing issues.
Then, they work with the employee to rectify the situation if possible.
How is that process carried out?
After reviewing a positive drug test result, the MRO notifies the employee and gives them a chance to give any medical explanation that could have affected the drug test. The employee then has five days to provide supporting evidence of their claim.
One requirement is for the employee to have their physician write a letter of explanation regarding the positive test result and their patient’s need for the prescription. The employee should
In addition, employees can use this time to ask for a change in medication to something that won’t pose a safety concern. The process also includes the employee’s physician contacting the MRO to discuss the possible alternatives.
The DOT added the 5-day clarification period regulations just before implementing the DOT drug test change in January 2018. That is when the DOT added four semi-synthetic opioids to its test panel to combat the opioid epidemic. It started because physicians heavily prescribed these pain medications before realizing they had a highly addictive nature. Sadly, by then, they were all over the black market.
If evidence is produced, the MRO notifies the DER (Designated Employer Representative) that the result is considered a “negative with safety concern.” In addition, if the medication is changed the MRO duly notes it in their report.
A “negative with safety concern” result indicates two things to the DER:
- The positive result was indeed due to a valid medical explanation.
- Even though the medical reason is valid, the employee may be impaired while performing a safety-sensitive job.
The DOT leaves it to the employer’s discretion whether or not the employee continues working. Unless there is a change in medication, employers remove the employee from duty to avoid the risk of an accident which could likely result in a catastrophic claim.
After the fact
Once the DER receives notification of a safety concern, they require the employee to produce medical evidence. It must be in writing from the prescribing physician and clarify whether or not the employee should continue safety-sensitive functions while under the influence of the medication.
The DER also consults with the MRO to identify the specific drug causing the safety concern. They then determine whether or not to remove the employee from duty while waiting for the doctor’s notice to arrive. If it’s one of the drugs on the DOT test, regulations demand the employee be removed from service until completing a customized return to duty process.
Failure to produce medical evidence
If the employee fails to provide medical evidence providing a valid reason for having the drug in their system, the DER must consider the following:
- Is the employee truly in a safety-sensitive position?
- Has the failure to disclose information about prescription medications been clearly communicated to the employee through company policy and training?
- Is this the first time the employee has failed to disclose this type of information?
After careful consideration, the DER determines what disciplinary measures followed from that point, if any.
Planning for the future
Drug abuse in the workplace happens every day. Someone caught in the throes of addiction doesn’t always realize the risk they’re taking by going to work under the influence of drugs. Or, perhaps, they’ve just grown past the point of caring.
Employers who drug test do so for the safety of everyone in their employ. And, in the case of the safety-sensitive employer, we could end the previous sentence with the word “everyone.”
Physicians prescribe pain medications to dull the senses enabling the patient to feel some relief. Employees with a valid medical prescription aren’t immune to the effect. If they were, it would be useless for them to take it in the first place. If the physician truly believes the medication won’t impair the employee’s ability to perform their safety-sensitive function, they can speak up in the employee’s defense.
That’s a big risk though. One that most physicians aren’t willing to make.
When the issue involves a DOT drug test, MROs take the lion’s share of responsibility in making that initial call. It becomes a weighty decision—especially, if you’re looking at a drug test with a safety concern attached and it’s one of your best employees. And, of course, any employee might have a family heavily depending on their income—
It can be a really tough call and MROs willingly shoulder the responsibility for making it.
Thanks for that.
