Why use an MRO for Non-DOT Drug Testing?

The Indispensible, Irreplaceable, Invaluable Role of Medical Review Officers…

By Bill Current

President of the Current Consulting Group…

The science of drug testing, as well as the practical day-to-day practice of screening job applicants and employees for substance abuse, has come a long way in the last 30 years.  Today there are myriad drug testing methods to choose from including urine, oral fluid and hair testing, point-of-collection devices that yield near-instant results, and electronic chain-of-custody processes, all of which combine to give employers a multitude of options toward achieving their drug-free workplace objectives.  But in the end it always comes down to one thing: an accurate result. And when it comes to ensuring an accurate result, nothing can replace the hands-on, personal involvement of a trained and licensed medical review officer (MRO) whose job it is to ensure that at least positive drug test results are, in fact, accurate.

Back in the early 1990s there was a popular mantra among drug testing providers: “do it right or don’t do it all.”  And the U.S. military is often credited as the origin of the saying regarding drug test results: “If in doubt, throw it out.” For many years the gold standard of drug testing involved sending a urine specimen to a laboratory for analysis. If the initial screen was non-negative it would be confirmed at the lab with a second testing method, usually gas-chromatography/mass spectrometry (GC-MS). If it was confirmed positive it would be reviewed by an MRO who would contact the donor to eliminate any legitimate explanations for the positive results before it was reported to the employer.

Some employers are tempted today to skip the confirmation test and rely solely on the result of instant test device or to bypass the verification of the result by an MRO to save money. Both supposed shortcuts are not only ill-conceived, but they may be illegal in some states, and in the end cost employers even more money.

3 Reasons to Use an MRO

The use of qualified MROs achieves three important objectives:

1. They create a layer of protection from liability between the employer and the drug test result.

2. They help employers comply with legal requirements imposed by many state drug testing laws and federal drug testing regulations.

3. They help avoid accusing someone of failing a drug test when there was a legitimate medical explanation such as the use of a prescribed drug.

Protecting the integrity of a drug-testing program should be every employer’s goal. MROs help achieve this objective. As they interview an individual whose sample is confirmed positive they can discover something that results in a reversal of the laboratory result—reporting a confirmed positive test as a negative.

One major drug testing provider confidentially shared that MROs reversed 17% of confirmed positives from traditional 5-panel tests and 21% from expanded panels that included illicit and prescription drugs. Further, this company discovered that more than 70% of donors who test positive for prescription drugs can produce a valid prescription.

MROs also review custody and control forms to ensure proper protocols were followed. Review of the CCF enables the MRO to ensure that the specimen test result received by the employer is in fact for the specimen that the employee provided.”

State Laws

Perhaps because of this reversal rate some state drug testing laws actually require the use of MROs.  When reviewing state drug testing laws consider these key issues: 

  • A mandatory state law may or may not include an MRO-related requirement.  If it does, look for the exact requirement.  Some state laws mirror the federal regulations while others can be quit be unique. 
  • Look for non-drug testing laws that have drug testing requirements.  Good examples are states with workers’ compensation laws that sometimes require use of an MRO in order for an employer to move to deny or reduce workers’ comp benefits. 
  • Distinguish between mandatory drug testing laws and voluntary laws.  Voluntary laws only apply to those who companies that participate in the voluntary program. 
  • Finally, check whether a state requires MRO review of both positive and negative drug test results, which some states do.

Following are a few examples of state laws related to MRO services:

New York— the Department of Health requires that all drug test results be reported to an MRO prior to being released to an employer.  This includes both positive and negative results.  However, this does not necessarily mean the result has to be verified by an MRO.

Maryland—the law specifically requires MRO review “pre-employment” initial screen positives, but says nothing about employee test results.

DOT Procedures required—There are a number of states that require employers to follow the procedural elements of the DOT regulations in non-DOT drug testing situations.  For example, as part of Tennessee’s voluntary drug testing law participants in the state workers’ comp discount program must follow DOT testing standards including using an MRO.  The same is true in Wyoming among others.

Most employers conducting non-regulated testing request that their MROs follow DOT procedures wherever possible. The DOT requires the MRO to review all negative and positive results. The review of drug test results ensures protections for both the employee and the employer.

Industry-Specific Laws—In Virginia use of an MRO is required in the mining industry as well as in workers’ comp cases.  Kentucky also specifically requires the use of an MRO in the mining industry.

Workers’ Comp Laws— Alabama is one of several states that allow employers to challenge workers’ comp claims based on a positive drug test.  Employers in Alabama must conduct drug testing in accordance with the Department of Transportation (DOT) regulations even when it’s not a DOT testing situation.  The DOT regulations, of course, require the use of an MRO.  Other states with similar laws include Arkansas, Illinois and New Mexico just to name a few.


Regardless of state law requirements, it is always wise to include the services of a Medical Review Officer in a workplace drug testing program. Accurate drug test results that exclude positive results from people who have legitimate prescriptions and who are using such drugs in the prescribed manner ensure the integrity of a company’s program. MROs help make that possible.


About Bill Current:

Bill Current is the president of Current Consulting Group (CCG), a consulting firm founded to assist companies in the drug testing industry increase revenue and grow their businesses. Bill works with many of today’s leading providers of drug testing and background screening services. He also works directly with small businesses and large corporations to help them improve their return on investment in drug testing.

Bill publishes the “Online Ultimate Guide to State Drug Testing Laws,” a subscription service that keeps employers and drug testing providers up to date on state drug testing laws. Click here to find more information about the The Ultimate Guide to State Drug Testing Laws 2011. He also publishes and edits the e-newsletter State Drug Testing Laws Monthly.

Bill is the co-author and co-publisher of The 21 Series, a comprehensive educational series of guides for best practices in drug testing. Along with Joe Plaia, Bill addresses the key issues of drug testing from the perspective of “getting the most out of drug testing by doing it right” through the 21 Series guides.

Bill is also the author or co-author of 10 books on substance abuse prevention and drug testing. His most popular title, “Why Drug Testing?,” is available directly from Current Consulting Group (CCG).  He has also written numerous magazine articles, white papers and formal reports related to drug-free workplace issues as well as drug testing technologies and methodologies.

He has been a popular presenter at conferences and corporate meetings for the past 24 years… and more recently at webinars sponsored by SAPAA and DATIA, which merged with the National Drug & Alcohol Screening Association (NDASA) in 2023, as well as other leading providers of drug testing.

Bill is the former executive director of the American Council for Drug Education and was the first director of the Institute for a Drug-Free Workplace. In those capacities and in his present role at Current Consulting Group (CCG), Bill has had the unique opportunity of working closely with private and public sector officials in an effort to identify the most effective methods for addressing America’s ongoing problem of substance abuse and its devastating financial and human impact on workplace.

Bill is the author of the “Annual Report on Drug Testing Industry Trends.”  Initiated in 1999, this report features the results of interviews with leading employee screening providers on the current state of drug testing and background screening services and their predictions for the future of the industry

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