handful_of_pillsWhat if an employee has a positive drug test—and it’s caused by his prescribed medication?

Legit question. And it happens.

With prescription drug abuse out of control, many companies now choose to test for more than the 5 main classes of drugs in a standard 5 Panel test—which typically includes marijuana, cocaine, amphetamines, PCP and opiates (morphine, codeine, and often heroin). But when you include tests for things like benzodiazepines (e.g. Xanax), (e.g. phenobarbital) and oxycodone (e.g. Oxycontin), you’re going to detect use of legitimately prescribed medicines.

So what then?

The critical role of the Medical Review Officer (MRO)

All positive test results—and for our clients, even all negatives—are reviewed by our Medical Review Officer. The MRO is the gatekeeper whose job it is to protect the donor’s privacy and the employer’s liability. MROs are licensed physicians with training in substance abuse testing, and are a critically important part of the drug testing process.

If your employee’s sample tests “hot” for any drug, the MRO contacts that person for an explanation. If the donor can provide a verifiable prescription, the MRO may report the result as a negative.

But if the donor’s job is safety-sensitive, and the MRO believes the legitimate prescription may present some safety concerns, the MRO may report it as “Negative with safety concern.”

If the MRO cannot reach the donor, or the donor cannot provide a legitimate, verifiable medical explanation for the failed test, the result is labeled as positive, and it then becomes the employer’s decision on how to proceed.

Ideally the decision on “how to proceed” is described in the company’s written policy. Most well written policies have all bases covered or, at a minimum, are written with enough discretion built in that the employer can address issues within legal boundaries AND in a manner that is practical for the employer’s business. Many, unfortunately, don’t and aren’t. If you’re not sure about your policy, let us know. We can help.

What about medical marijuana?

Glad you asked!

Illinois (like many other states) has approved medical marijuana, and as the rules and procedures are rolled out, you’ll be hearing more about it.

The simple answer is that the industry has decided to follow federal law, and federal law treats all Schedule I drugs the same: illegal. Even if a donor presents a valid, state- and doctor-approved medical marijuana permit, the lab and MRO will report it as a positive.

No conflicts

Four major players are involved in the drug testing process: collector, administrator, lab and MRO. Often one entity will play more than one role, but the lab and MRO must be separate. Part of the MRO’s role is to oversee the integrity of the process, so it’s important that s/he not be associated with the lab.

Who uses an MRO?

All Department of Transportation mandated test results – both positive and negative – are reviewed by the MRO.

Some companies send only positives to the MRO. We send every one. Why? We believe it creates a more defensible process. In federally mandated drug testing, the MRO is the only one authorized to receive test results from the lab. The MRO also confirms that the collector properly completed the Custody and Control Form. We believe our clients are better protected when the MRO reviews all lab results.

The U.S. Department of Transportation (49CFR Part 40) has established testing standards and protocols that have been tested in the courts. For this reason, non-DOT employers are advised to model DOT protocol in their policies and procedures.

If an employee on prescription meds passes an MRO-reviewed drug test, and is not able to perform his or her job duties, an employer can and should document behaviors and may use those for grounds for dismissal. Of course you should always consult your HR attorney before taking action. If you need one, let us know. I gotta guy.