Why a Medical Review Officer (MRO) may not be beneficial to the employer.

By: Dan R. Berkabile

Nevada law requires any laboratory that tests human biological specimens to be regulated by the State as a medical laboratory. As such, the laboratory is required to report the results of its testing in a prescribed manner. For drug testing, the report must list the drugs screened for and their cutoff levels. Drugs reported positive or negative must refer to this list on the report. If the prescribed medication accounts for a drug reported positive, it can be noted on the report as, “the drug identified is consistent with prescribed medication, or language similar to this. Additional information may be given.

MRO’s are mandatory in federal drug testing. They are optional in private drug testing. I suppose private employers pay the additional const for a MRO thinking it will reduce their liability, not believing that following state guidelines is as sage. However, it must be remembered that the State is regulating their testing anyway.

In using the MRO, if an applicant was taking prescribed medication equal to a positive finding, the MRO would report the results to the employer as negative. The applicant would be hired without any knowledge to the employer about the prescription. The employer would have to depend entirely upon the applicant to reveal any possible interference the prescription medication may have on job performance and safety.

However, without the MRO, the laboratory report goes directly to the employer and none of this would be a concern. The notation on the report already shows that the laboratory conducted a medical review under its laboratory director a pathologist. The report would also be received sooner by the employer.

It is true that prescription medications are confidential. The American Disabilities Act (ADA) stresses this. However, I believe the intent of ADA is not directed so much toward abused drugs typical in pre-employment drug screening. If a person has a prescription for one of the abused drugs, I believe the employer should know about it. The possibilities are codeine, amphetamine, methamphetamine (speed), morphine (metabolite of heroin), and more recently, marijuana. (A good question would be: would a MRO exclude a positive finding for marijuana if the person showed that a doctor prescribed it?)

In the latest Nevada legislative session, a representative of a large labor union testified before a senate subcommittee concerning the passage of a proposed drug testing bill. I was presenting during this meeting. The following is a word by word transcription from public records of the portion of this individual’s testimony concerning medical review officers:

“We believe that in using a lab such as (the lab was named), thy have qualified people on staff including medical officer (I believe the meaning here is medical doctor or pathologist), and when we get the test results back from the lab, they have done their primary test, they have done their confirming test, they have looked at that, and any test that we have ever had challenged by an employee, and they have that option to challenge a test, not to retest, but to challenge it, have always come back in the positive. My concern would be if we were to interpret that MRO must be used one hundred percent of the time, we’re going to add an expense for that MRO testing. As an example, in one case lab charges an addition al $6.00 to have every test result review by an MRO. Additionally, if it’s post testing, now we’re adding time on that we’re going to have somebody out of a job until we get the test results back. Whatever that time may be, hours or days, it’s additional exposure to injury.” (The last sentence refers to a person remaining on the job.) The individual further mentioned the delay that MRO review brings about in hiring new workers.

In Nevada, a laboratory that performs drug testing must be licensed as a clinical laboratory. As such, the laboratory is directed by a licensed pathologist who is responsible for all results reported by the laboratory. Under these regulations another doctor in the system going over results is not necessary, and is only a waste of time and money, as the labor representative above explained.

Dan R. Berkabile

Forensic Chemist

Services Offered

A list of drug tests we offer to our local Las Vegas clients, click on the image to see a larger version.

Hair Testing and Urine Testing

Urine has always been an effective method of drug testing. However the test typically only reaches as far back as 9 to 10 days. On the other hand, Hair Testing can detect past months of usage.

The results below are based on companies of varying sizes and show the difference in the testing of urine and hair. American Toxicology believes that the best fingerprint of drug use is obtained by testing both hair and urine. The following illustrates the comparisons between hair and urine testing of four of our clients.

Company 1: # of total tests: 10,558

Drug……………….Pos/Urine…………..Pos/Hair
Amphetamines…………29…………………….158
Cocaine………………...256…………………...730
Heroin………………….0………………………...0
PCP…………………….1………………………...2

Company 2: # of total tests: 3,953

Drug……………….Pos/Urine…………..Pos/Hair
Amphetamines…………12………………………50
Cocaine………………...11…………………........28
Heroin………………….1…………………….…...1
PCP…………………….0………………………....0

Company 3: # of total tests: 209

Drug……………….Pos/Urine…………..Pos/Hair
Amphetamines…………0………………………....3
Cocaine………………...1…………………............7
Heroin………………….0…………………….…...1
PCP…………………….0………………………....0

Company 4: # of total tests: 52

Drug……………….Pos/Urine…………..Pos/Hair
Amphetamines…………0…………………………1
Cocaine………………...1…………………............3
Heroin………………….0………………………....0
PCP…………………….0………………………....0

Results indicate that hair and urine testing is far superior tot urine testing alone in identifying drug users attempting to become employed. Over 2/3 of the applicants testing positive by hair would have passed the urine test and became part of the employee population. Marijuana is not shown in this example because it is best detected in the urine.

Because it takes approximately a week for ingested drugs to show up in hair above the scalp, American Toxicology strongly suggests using both urine & hair testing for a complete history of drug usage to help maintain a drug-free work environment. Studies continue to show that marijuana (THC) is best detected in urine. THC is a fat soluble drug that stays in the body much longer than any of the hard drugs. As a result, the body will shed THC for weeks or even months. Once again, for optimal results American Toxicology strongly recommends a Hair & Urine test for all clients.