Review Officer Research Articles

The family physician as medical review officer.

The medical review officer is a position established by federal statute in 1988. The role of the medical review officer is to interpret positive urine drug tests in view of the donor's medical history. With more than 4 million workers affected by the Department of Transportation guidelines for workplace drug testing, and many private employers having urine drug screening programs, there is a need for medical review officers. Materials for this report were collected while the first author was pursuing certification from the Medical Review Officer Certification Council. Much of the data was published in the Federal Register from 1988 through 1993. Urine drug testing is divided into three stages: collection, laboratory analysis,and medical review of results. Because the workplace urine drug test is a forensic test, the urine is collected under strict chain of custody. Analysis of specimens is conducted by laboratories that have met stringent technical criteria and are approved by the Substance Abuse and Mental Health Services Administration (formerly the National Institute on Drug Abuse). Family physicians are in a unique position to become medical review officers because of their training and professional roles. Educational programs are available for physicians interested in becoming a medical review officer.

Under the Influence? Drugs and the American Work Force

Commissioned by the National Institute on Drug Abuse (NIDA), the Committee on Drug Use in the Workplace of the National Research Council and of the Institute of Medicine prepared this book to assess the scope of drug use by the workforce, the impact of drug use on work performance, and the effectiveness of drug intervention programs. The committee noted that in the United States, about 24 million urine drug tests are performed annually—18 million by NIDA-certified laboratories, 6 million by noncertified laboratories. Assuming a cost per test of $50 (including laboratory fees, collection site costs, medical review officer costs, and quality control costs, but excluding costs to recruit replacement workers, costs of treatment, and costs of workers' time for the test), the committee estimated that we spend about $1.2 billion per year on drug testing. Such substantial expenditures justify careful attention to the following questions: How prevalent is drug use

Drug Screening in the Public Sector: A Focus on Law Enforcement

The academic and legal literature has clearly established a set of policies suited for inclusion in a comprehensive drug screening program. The employment of urinanalysis, random drug tests, reasonable suspicion tests, and chain of custody procedures are mixed with employee safeguards such as test interpretation by medical review officers, analysis in NIDA certified labs, and confirmatory tests for initial positive results. This paper provides a two-fold, empirical examination of those policies. First, the International Association of Directors of Law Enforcement Standards and Testing were surveyed. The IADLEST members' recommendations represent the standards that law enforcement agencies in each state would consider as their most appropriate professional guidelines. Inasmuch as they fall short of what the literature recommends (and they do in regard to a number of items), it is unlikely that individual police departments would find either the support or courage for recommending stronger policies. Second, a North Carolina survey examines the implementation of these recommendations by municipalities in one of the more advanced states included in the IADLEST survey. In general, municipal police departments are found to follow the North Carolina Criminal Justice Standards Division's recommendations.

The Medical Review Officer's Guide to Drug Testing

Over the last decade, workplace drug testing has become increasingly common in the United States. In 1980, only the military and the nuclear industry tested routinely. Today, most large corporations require preemployment drug screens. Federal drug testing requirements apply to some 7 million Americans. While the manufacture of equipment and chemicals used in drug testing cost $300 million in 1990, more recent estimates suggest that drug testing is now a billion-dollar-a-year industry. The rapid growth of drug testing has given rise to a new role for physicians: medical review officer (MRO). First defined in the 1988 guidelines for drug testing in the federal workplace, an MRO is a physician who reviews the results of drug tests. The MRO offers the employee the chance to provide an explanation for a positive result, such as a prescription for a controlled substance. In addition, MROs have come to serve an important quality control

The evolution of workplace drug screening: a medical review officer's perspective.

In the United States, screening the urine of employees or job applicants for the presence of drugs has become commonplace. A survey of 794 large- and mediumsized companies, conducted by the American Management Association in January 1994, found that 87 percent of them now test job applicants for drug use. In 1987, a similar survey found that 22 percent screened job applicants. Federally mandated drug testing programs with random testing requirements affect millions of workers in the transportation industry, the nuclear power industry, and the United States civil and military services.As some of these programs pass their fifth anniversary since being instituted, it is important to assess the forces that led to their creation. Whether or not these programs are considered successful depends on what one expects to achieve by such widespread testing.

The Medical Review Officer??s Guide to Drug Testing

The Medical Review Officer??s Guide to Drug Testing

Drug Testing and the Toilet Bowl Blues

To the Editor. —Workplace drug testing continues to be a major issue in the United States. As commentators debate the propriety of random workplace drug testing, the knowledge base about the process of drug testing continues to evolve. The formal drug testing programs sanctioned by the Department of Health and Human Services and the Department of Transportation rely on a series of security procedures to discourage the dilution of a specimen or the substitution of a false specimen for a real specimen. One such measure is the placement of bluing in the toilet bowl at the collection site to prevent a specimen "donor" from either substituting toilet water for a urine specimen or diluting a real urine specimen with toilet water. 1 We would like to remind practitioners in the field, especially physicians working as medical review officers, that there are legitimate medications that contain methylene blue (Prosed, Webcon Pharmaceuticals,

Medicines and Drug Testing in the Workplace

Drug testing at work is rapidly becoming the standard in the United States. For drug testing to fulfill its promise as a vital part of the effort to end the drug abuse epidemic, it is essential that the tests be reliable so that people who are not using drugs are not falsely accused and that legitimate medical use of controlled substances not expose employees to harassment or labeling as drug abusers. To merit employee confidence, workplace drug testing needs to be made part of a program that includes these basic elements: (1) a clear and comprehensive policy; (2) secure collection; (3) chain-of-custody procedures; (4) retained positive samples; (5) an initial screening test; (6) a sophisticated confirmatory test; (7) a medical review officer; (8) a retest of retained positive samples in disputed cases; and (9) a system of quality control. In addition, this drug testing program needs to be built on a solid foundation that distinguishes between legitimate use of prescribed medicines and nonmedical drug use. This differentiation is the primary responsibility of the medical review officer.

The Medical Review Officer and Workplace Drug Testing

Rational drug-testing programs attempt to balance the need for accuracy of the process with the need to preserve the rights and dignity of the people being tested. U.S. Department of Transportation regulations prescribe the specifics of how urine specimens are to be collected, how to inform the specimen donor of the process to which he or she will be subjected, and certification of laboratories by the National Institute of Drug Abuse. These guidelines are an effort to assure that each collection site and each laboratory testing the urine of employees adheres to certain basic standards of quality control.

The Medical Review Officer

The role and responsibilities of the medical review officer are considered in relation to drug testing in the workplace. Knowledge of substance abuse disorders, pharmacology and toxicology, laboratory techniques for screening and confirmation, forensic collection techniques, and the relevant rules and regulations that govern drug testing is essential. The means for detecting adulterated urine samples are offered, and a procedure for the management of urine-testing results is provided.

Identifying and Responding to Drug Abuse in the Workplace

A realistic program for managing drug abuse in the workplace requires a clear understanding of the nature and effects of both licit and illicit drugs, as well as a knowledge of reliable methods for identifying and responding to both industry and individual needs. This article reviews the nature and effects of psychoactive drugs and discusses the medical steps to be taken when they are being abused. In addition, an overview of the means for identifying workplace drug abusers is presented. Testing methods and procedures are described, and such problems as false-positive and false-negative test results are clarified. The formation of corporate drug abuse policies is discussed and a continuum of industry interaction with health and drug abuse treatment professionals is presented. The roles of industry medical review officers, employee assistance programs, and other pertinent groups and individuals are also discussed.

Benzodiazepines in a health-catalog product

To the Editor.— A manufacturing company in the Northwest administered a routine preemployment drug test to a 56-year-old engineer. Its results were reported to the medical review officer by the testing laboratory as "positive for benzodiazepines" with the finding of oxazepam, 310 ng/mL, and nordiazepam, 150 ng/mL, on gas chromatography—mass spectrometry confirmation. The prospective employee convincingly denied any use of a prescription medicine, including a benzodiazepine. A repeated test was requested on the retained positive urine sample. It too was reported positive for a benzodiazepine. The prospective employee reported that he had regularly used a nonprescription health product obtained by catalog from a California address. It was a dark-brown, round pill labeled "NAN-LIEN CHUIFONG TOUKUWAN" that had been recommended to him by a colleague at work to treat his chronic neck pains. A sample submitted to the laboratory was analyzed by fullscan gas chromatography-mass spectrometry (Hewlett-Packard 5970). It was

Benzodiazepines in a Health-Catalog Product

To the Editor.— A manufacturing company in the Northwest administered a routine preemployment drug test to a 56-year-old engineer. Its results were reported to the medical review officer by the testing laboratory as for benzodiazepines with the finding of oxazepam, 310 ng/mL, and nordiazepam, 150 ng/mL, on gas chromatography—mass spectrometry confirmation. The prospective employee convincingly denied any use of a prescription medicine, including a benzodiazepine. A repeated test was requested on the retained positive urine sample. It too was reported positive for a benzodiazepine. The prospective employee reported that he had regularly used a nonprescription health product obtained by catalog from a California address. It was a dark-brown, round pill labeled NAN-LIEN CHUIFONG TOUKUWAN that had been recommended to him by a colleague at work to treat his chronic neck pains. A sample submitted to the laboratory was analyzed by fullscan gas chromatography-mass spectrometry (Hewlett-Packard 5970). It was

The Medical Review Officer??s Role in the Department of Transportation??s Drug Testing

The Medical Review Officer??s Role in the Department of Transportation??s Drug Testing

Drug Testing and the Role of the Medical Review Officer (MRO): Governmental/Regulatory Perspective

Drug Testing and the Role of the Medical Review Officer (MRO): Governmental/Regulatory Perspective

Loan quality, commercial loan review and loan officer contracting

By the 1980s most banks had created a new department, commercial loan review, whose primary activity is to systematically assess the continuing quality of loans in the commercial loan portfolio. Conventional wisdom suggests that the purpose of commercial loan review is to serve as an early warning system for spotting credit deterioration. Evidence is presented in this paper that the true purpose of commercial loan review, however, is to address an agency problem between a bank and its commercial loan officers by monitoring their individual loan portfolios. The regulatory implications of these results are discussed.

State Implementation of Permit Requirements Under the 1977 Clean Air Act Amendments

A description is given of a system used in Pennsylvania for data collection and evaluation of new modified stationary sources (MSS) to meet the permit requirements of the Clean Air Act Amendments (CAAA) of 1977. Data collection is managed under three computerized systems: emission inventory, permits, and abatement orders. The computerized permit system provides inputs of not only key dates (commence construction and source startup) but estimates of actual emission rate (AER) for criteria pollutants. Permit review needs are considered according to the level of technical review needed and the organization of the agency so that costs are minimized. Pennsylvania maintains centralized special services (source testing, laboratories, meteorologists) with permit review officers in Regional offices enabling low cost service while maintaining local consultation for permit applicants which fits well with the three levels of permit review implied by the CAAA.

Beyond the Stereotype: Another View of Supplementary Benefits Officers

SUMMARY This paper outlines a series of staff development courses run for the DHSS under the auspices of Leicester University School of Social Work. The two-week courses for Un employment Review Officers offered an introduction to social and psychological in fluences on human behaviour with special reference to the work situation of UROs, and a review of aspects of the social services with which the URO has contact. As a result of these courses another view of Supplementary Benefits staff emerged which conflicted with current stereotypes. The author offers some suggestions regarding the sources of role conflict inherent in the work of UROs and argues for better under standing of the operation of the social security system.