Chapter 11

Drug Testing and Adulteration

MEDICAL REVIEW OFFICER (MRO)

1. Error checking.
   The MRO receives copy 4, the MRO copy that is mailed from the collector and copy 2, the laboratory copy, for purposes of comparison. The MRO or his staff will compare the two forms to see if any of the information has been changed or altered, either by the laboratory or the collector. If they are the same then they are filed to await test results from the laboratory. If they are not the same, some action must be taken. In some cases an affidavit may correct an unintentional error and in other cases the test may have to be deemed invalid.
   
   
2. Reporting negative test results.
   The reporting of a negative test result is merely administrative. The MRO issues a negative report, adds his/her signature, mails the report to the employer, and the testing process is complete.
   
   
3. Reporting positive test results.
   Upon receiving positive test results from the laboratory, the MRO must immediately attempt to contact the donor to determine if prescription or over-the-counter medication may have caused the positive test result. If so, the MRO will verify the medication with the donor's physician and report the results to the employer, along with evidence of a valid prescription or medication. If no medication can account for the positive test result, then the MRO will notify the donor that the test will be reported as positive and offer the employee the option of having the "B split" specimen tested at a different laboratory. (Most employers do not pay to have the split specimen tested and since GC/MS testing is very expensive, few donors decide to test the split specimen. It is very seldom that a split specimen test contradicts the original GC/MS test results.) Positive test results are sent to the employer who will follow the company policy as to the disposition of the donor's employment.
   
   
4. Reporting abnormal specimens.
   Many times an MRO will receive "abnormal" test results from the laboratory, due to dilution or adulteration. If the results of the test are positive despite the abnormal specimen then the same process is followed as a positive test. Here are some other actions that might take place.
   
   

   Dilution of a specimen occurs when both the creatinine and specific gravity of the specimen are low enough that intentional dilution is suspected. If the specimen shows up as negative then the MRO reports it to the employer as "negative but suspect of intentional dilution" and requests that the next testing of this individual be under "direct observation" of the collector (must be same gender collector).
   
   Adulteration generally occurs because the donor placed a substance directly into to the specimen cup at the time of collection. If certain specific substances are detected, such as glutaraldehyde, the MRO will immediately report the test as positive due to intentional adulteration (technically considered a refusal to test or failure to cooperate with the testing process) and report it to the employer as such.