Last updated: November 27, 2023
The Department of Transportation (DOT) regulates the safety-sensitive workforce. That includes employee drug testing. When does a test result present a DOT safety concern? The DOT drug testing regulations stipulate that test results be reviewed by a Medical Review Officer (MRO). It’s the MRO’s responsibility to deem that a test result is a safety concern.
Safety concerns are issues that arise from a positive drug test. After reviewing the result, the MRO contacts the employee, notifies them of the result, and gives them a chance to explain any medical explanation that effected the drug test.
Resolving the issue
The MRO, then, gives the employee five days to provide supporting evidence of their claim. This includes having the physician writing a letter of explanation in regard to the positive result and their patient’s need for the prescription. In addition, employees can use this time to change the medication to one that doesn’t pose a safety concern. The process includes the employee’s physician contacting the MRO to discuss alternatives.
The DOT added the 5 day clarification period regulations just prior to implementing the DOT drug test change in January 2018. In an effort to combat the opioid epidemic plaguing our nation, the DOT added four semi-synthetic opioids to its test panel. Physicians heavily prescribed these pain medications prior to the realization of their 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 as to whether the employee may continue working or not. In the interest of safety, most employers will simply pull the employee to avoid a workplace accident resulting in a catastrophic claim.
Who is an MRO?
The MRO can be someone working with your drug testing company or a licensed physician of your own choosing. However, they 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
To qualify as an MRO for the DOT, physician’s 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)
There will be a test.
In addition, 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 in a timely manner
- Protect the confidentiality of company drug testing information
MRO’s provide employers with added protection, in that there is little chance of an employee accusing their employer of an inaccurate test result. The MRO consults with a scientist, usually a representative of the laboratory, concerning the result before notifying the employee there’s been a problem with the test.
Then, they work with the employee to rectify the situation if possible.
After the fact
Once the DER receives notification of a safety concern, the DER also requires 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.
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 pertaining to prescription medications been clearly communicated to the employee through, both, company policy and training?
- Is this the first time that the employee has failed to disclose this type of information?
After careful consideration, the DER makes the determination as to the 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 can end the previous sentence with the word “everyone,” by the way.
Physicians prescribe pain medications with the intention of dulling the senses to provide 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 that the medication responsible for a positive DOT drug test will not impair the employee’s ability to perform their safety-sensitive function, it’s taken into consideration.
Still, it’s a tough call.
MROs take the lion’s share of responsibility in making that initial call. It becomes a weighty decision, indeed, 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…
Yes, it can be a very tough call.
MROs willingly shoulder the responsibility.
Thanks for that.