Medical review officer (MRO)

Scope

These requirements apply to MROs involved in the drug testing process as it relates to drivers of commercial motor vehicles (CMVs) in interstate, intrastate, and foreign commerce.

Regulatory citations

• 49 CFR 40.121 — Who is qualified to act as an MRO?
• 49 CFR 40.123 — What are the MRO’s responsibilities in the DOT drug testing program?
• 49 CFR 40.125 — What relationship may an MRO have with a laboratory? 

Key definitions

• Medical review officer (MRO): A licensed physician who is responsible for receiving and reviewing laboratory results generated by an employer’s drug testing program and evaluating medical explanations for certain drug results.

Summary of requirements

The MRO acts as an independent and impartial “gatekeeper.” The MRO is an advocate for the accuracy and integrity of the drug testing process.

The MRO’s duties include:

• Providing a quality assurance review of the drug testing process;
• Determining whether there is a legitimate medical explanation for confirmed positive, adulterated, substituted, and invalid drug test results from the laboratory;
• Investigating and correcting problems where possible, and notifying appropriate parties where assistance is needed;
• Ensuring the timely flow of test results and other information to motor carriers; and
• Protecting the confidentiality of drug testing information.

An MRO’s medical review of a driver’s drug test results does not constitute an established doctor-patient relationship.

The MRO may not enter into any relationship with a motor carrier’s laboratory that creates a conflict of interest or the appearance of a conflict of interest. An MRO may not derive any financial benefit by having a motor carrier use a specific laboratory.

Basic knowledge. An MRO must be knowledgeable about:

• And have clinical experience in controlled substances abuse disorders, including detailed knowledge of alternative medical explanations for laboratory confirmed drug test results;
• Issues relating to adulterated and substituted specimens as well as the possible medical causes of specimens having an invalid result; and
• Part 40, the Department of Transportation (DOT) MRO Guidelines, and applicable DOT agency regulations, and must keep current on any changes to these materials.

The MRO must subscribe to the Office of Drug and Alcohol Policy and Compliance’s (ODAPC) listserve.

Qualification training. Qualification training must provide instruction on the following subjects:

• Collection procedures for specimens;
• Chain of custody, reporting, and recordkeeping;
• Interpretation of drug and validity test results;
• The role and responsibilities of the MRO in the DOT drug testing program;
• The interaction with other participants in the program; and
• Part 40 provisions and DOT agency rules including changes and updates, guidance, interpretations, and policies affecting the performance of MRO functions, as well as issues that MROs confront in carrying out their duties.

Following completion of the qualification training, the MRO must satisfactorily complete an examination administered by a nationally-recognized MRO certification board or subspecialty board for medical practitioners in the field of medical review of DOT-mandated drug tests.

Requalification training. During the five-year period from the date on which the MRO successfully completed the exam previously mentioned, the MRO must complete requalification training. The requalification training must meet the same requirements as the qualification training previously mentioned.

Following completion of the requalification training, the MRO must complete an examination administered by a nationally recognized MRO-certification board or subspecialty board for medical practitioners in the field of medical review of DOT-mandated drug tests. The exam must cover all the elements of the qualification training previously mentioned.

Record retention. The MRO must maintain documentation showing they currently meet all of the training requirements. This information must be provided on request to DOT agency representatives and to employers and C/TPAs who are negotiating to use the MRO’s services.