Medical Review Officer Certification Council-MRO Competencies Document

COMPETENCIES OF THE MRO
(Updated: May 2004)

The Medical Review Officer operates in a multidisciplinary environment in which skills and knowledge in a variety of subject areas relating to drug and alcohol testing are required. For the purpose of this examination, the subject areas are divided as Chemical Dependency; Regulations and MRO Responsibilities; Laboratory, Toxicology and Pharmacology; Clinical Aspects; and Collections and Procedures.

I. CHEMICAL DEPENDENCY (10%)
Although the skills of the MRO may be quite different from those of the addiction medicine specialist, the MRO must be knowledgeable about and have clinical experience in the field of substance abuse disorders. MROs may be called upon to be a general resource for substance use issues. General knowledge in the area of substance abuse will enable the MRO to:

-- recognize chemical dependency as a primary disorder.
-- recognize the clinical and behavioral signs of substance abuse and dependency disorders.
-- describe the natural history and epidemiology of alcohol and drug abuse.
-- interact effectively with employee assistance and substance abuse professionals in the management of individuals identified with alcohol or substance use disorders, and workplace substance abuse prevention and control programs.
-- serve as a resource to the employer on issues of aftercare monitoring, return-to-work and medical qualifications for the performance of safety sensitive tasks.

II. REGULATORY ISSUES & MRO RESPONSIBILITIES (40%)
The MRO must be and remain knowledgeable about applicable rules including DOT Part 40, MRO guidelines, and DOT agency regulations which impact organizations for whom the MRO evaluates drug test results. The MRO is often called upon to assist clients in the implementation of legally defensible policies and programs. Therefore, the MRO must be able to advise organizations about both regulated and non-regulated drug and alcohol testing procedures. Knowledge in the area of regulatory issues and MRO responsibilities will enable the MRO to:

-- interact effectively with other program participants, including: employees, employers, DERs, SAPs, TPAs, other health care workers, laboratories and collection sites.
-- advise employers and employees about the requirements of public and private sector drug free workplace programs.
-- advise employers in the development and implementation of effective workplace substance use policies and procedures.
-- comply with applicable laws and federal regulations in the review, interpretation and reporting of drug test results, including confidentiality, documentation, record maintenance and storage, and release of information.
-- develop a standard operating procedure for conducting an effective MRO interview which complies with applicable regulations.
-- recognize and address the major legal and regulatory issues that face the MRO other service providers and employers in the establishment and implementation of drug testing programs.
-- serve as an expert consultant or witness on matters involving drug testing.
-- adhere to and uphold the professional code of ethics relating to drug testing.
-- evaluate and help manage collector services, laboratory services, and other services in the program to ensure reliability, confidentiality, efficiency, appropriateness, and promptness of these services in response to the employer’s needs.

III. TOXICOLOGY, PHARMACOLOGY AND LABORATORY ISSUES (15%)
The MRO must be knowledgeable of the toxicology & pharmacology of drugs of abuse. While the MRO is not a laboratory director, the MRO must know what goes on in the laboratory and how quality is assured. Knowledge in these areas will enable the MRO to:

-- describe and recognize the clinical presentation and toxic effects of drugs of abuse and alcohol, including mechanisms of action, pharmaco/toxicokinetics, half-lives, metabolism, excretion, tolerance, abuse potential and interactions.
-- recognize both trade names and generic names for substances that are likely to appear in a drug screen, interfere with a drug test, or be presented to the MRO as a donor explanation for a positive drug test.
-- recognize the appropriate analytical methods for drug and alcohol screening and confirmation, and properly interpret results, with consideration of limits of detection, sensitivity, specificity, limitations, interferences, cost and availability.
advise clients regarding the use of various matrices and technologies for drug testing.
-- evaluate drug and alcohol laboratory testing services.
-- describe laboratory QA, QC, and certification requirements to an employer or other interested party.
-- efficiently transmit and receive drug test data and information while maintaining donor confidentiality.
-- evaluate laboratory findings relating to specimen validity.
-- recognize the basic types and mechanisms of action of performance enhancement drugs (e.g. stimulant, growth, blood).

IV. CLINICAL ASPECTS (20%)
The MRO must be familiar with clinical issues related to drug and alcohol use and testing, including medical explanations for positive or indeterminate tests and medical qualifications for performance safety sensitive tasks. Knowledge in these clinical areas will enable the MRO to:

-- recognize clinical evidence of drug use and impairment.
-- recognize the effects of drugs of abuse and alcohol including intoxication, withdrawal, tolerance and other toxicities.
-- evaluate alternative medical explanations for laboratory drug test results (including positive, substituted, adulterated and invalid specimens).
-- evaluate the inability to produce urine specimens.
-- recognize and appropriately respond to conditions which may render an individual unfit and/or unqualified for duty, including: (1) unauthorized drug use, (2) authorized prescription or over-the-counter drug use, (3) drug/alcohol addiction, and (4) illness.

V. COLLECTIONS AND PROCEDURES (15%)
Although the MRO does not routinely collect urine, he or she must thoroughly understand collection procedures and chain of custody issues, as well as correctable and fatal flaws. Knowledge in the area of collections and procedures will enable the MRO to:

-- describe and apply appropriate procedures for urine specimen collections, including unwitnessed, witnessed, split specimen and insufficient quantity collections.
-- describe and apply appropriate procedures for the use of custody and control forms.
-- identify and address procedural errors.
-- describe and apply appropriate procedures for alcohol testing.
-- serve as a consultant to BATs, STTs and employers on alcohol testing procedures.