The medical review process is one that has been created with the goal of ensuring that each donor (person who has given their sample in for a drug test) is given a fair process. The MRO process also includes quality assurance of each step of the collection and laboratory testing procedure. When the MRO office obtains the Custody and Control Form from a collector they will check the form to make sure that the correct collection process has been undertaken and that all the information that is required has been filled out correctly. The MRO office will also do quality assurance when they receive the results from the laboratory confirming that all of the appropriate tests were run on the sample and that all of the information on the results matches what was provided on the form by the donor and collector.
If the result of a test comes in from the laboratory as a non-negative, meaning that there is something which showed up on the test(s) that were run in the laboratory, the MRO office must go through a very specific procedure to allow the donor an opportunity to explain why this could have occurred. The intent of the interview is to allow the donor a chance to explain, and then further, to prove, that the drug which showed up on their results was not due to illicit use.
The interview process begins when the result is received in the MRO office after the CCF and lab results have been quality assured and matched. Although there are no regulations within Canada as to exactly how this process must go many MROs basically follow the United States Department of Transportation’s (DOT) outline of what is required, to give each donor fair process. When testing in a non-DOT environment this process does not have to be followed to the letter (as it is unregulated) and the MRO has the ability to choose to shorten times as they see fit, based on the needs of the employer/contract for which they are reviewing.
The DOT interview process includes calling the donor at least three times within the first twenty-four hours of receipt of the donor’s results. If the donor is not reached within that first twenty-four hours the MRO office will contact the donor’s employer for help; for the DOT this individual is called a Designated Employer Representative (DER) and, within Canadian testing, they are often called the Programme Administrator (PA). The MRO office will call the employer to request help with reaching the donor and, within a DOT program, if the DER is able to reach the donor and pass this information on to the MRO, the donor will then have only three days left (72 hours) to reach the MRO to obtain their interview. If the DER is not able to make direct contact with the donor to tell them to call the MRO, then a total of 10 days will be given from the time of lab results being received at the MRO office, for the donor to call in to obtain their interview with the MRO. If, after ten days of being called twice a day by the MRO office, the donor is not reached, the result will be released as a “Non-contact positive”. A “Non-contact positive” means that the MRO office was unable to reach the donor for their interview and therefore no explanations or prescriptions would have been received to be reviewed, so the result will always be released positive.
As soon as the MRO office is able to contact the donor within whatever timeframe of calling allotted (which could be less time then explained above in a non-DOT environment) they will offer them the option of an interview with the Medical Review Officer. During the interview, the MRO will advise the donor of what their results were and request any explanations as to how the drug(s) may have shown up within their sample. The MRO will then have the donor send in any documentation to prove what they have indicated within the interview. With this information and documentation, the MRO will then be able to make a final determination as to the verified test result for the donor’s test.
This whole process means that there is the possibility of a Non-negative test result coming in and getting verified by the MRO as a Negative test result, with that final verification being the only one that the employer will see. This means that the donor’s privacy is always kept, there is no information about prescriptions or medical issues being passed on to the employer, appropriate use of medication will end with a Negative result. The MRO has the knowledge and experience to ascertain whether the donor is using their medication(s) as prescribed and make the final verification on the result without this information being shared with the employer. If the donor is not able to provide an explanation, and/or documentation to prove their explanation then the MRO will verify the final result as a Positive, and that will be released to the employer.