Collection:
The applicant/employee provides a urine specimen at a certified collection site, following strict US DOT chain-of-custody protocols.
Laboratory Analysis (e.g., Quest Diagnostics, LabCorp or etc):
The specimen is sent to a SAMHSA-certified laboratory.
Initial Screening: The sample is first tested using an immunoassay screen to quickly detect the presence of drugs.
Confirmation (GC/MS): If the initial screen is non-negative (potentially positive), the sample undergoes Gas Chromatography/Mass Spectrometry (GC/MS) for confirmation. GC/MS is the gold standard—highly specific and accurate for confirming the presence and concentration of controlled substances.
Results Sent to the MRO:
The laboratory does not communicate directly with the employer.
All test results—negative, positive, or otherwise—are reported to a Medical Review Officer (MRO), a licensed physician with specialized training.
What Does the Medical Review Officer (MRO) Do?
Reviews the Lab Results:
The MRO evaluates the confirmed laboratory findings, ensuring the results are scientifically valid.
Contacts the Donor (Applicant/Employee):
If the test is positive or there’s an issue (e.g., adulterated or substituted specimen), the MRO contacts the individual to:
Review any legitimate medical explanations (e.g., valid prescriptions for medications).
Give the individual a fair opportunity to provide supporting documentation (such as pharmacy records, doctor’s notes).
Final Determination:
If the donor has a valid medical explanation for the positive result (e.g., prescription medication), the MRO may report the test as negative to the employer.
If no valid medical explanation is provided, the MRO reports the test as positive (or as a refusal/adulterated as appropriate).
Reporting to Employer:
The MRO only reports the final result to the employer/designated agent—never specific medical details or private health information, just the compliance status:
Negative (cleared for duty)
Positive (not cleared; policy violation)
Refusal to test or tampering (treated as a positive under DOT rules)
Key Takeaway for Clients
The MRO is the gatekeeper protecting both employer and employee, ensuring:
Scientific accuracy, Legal and medical fairness, Compliance with US DOT regulations.
Employers should never act on a non-negative lab result until the MRO completes their review and provides the final, verified report.
Note: The author is not an MD but a TPA:
A source of this field can be found at www.SAMHSA.gov
https://www.samhsa.gov/sites/default/files/mro-guidance-manual-2024.pdf