Approximately 20% of the exam items are within this competency area

Competency Statement

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:

• recognize and describe the pharmaco/toxicokinetics of drugs of abuse and alcohol.

• 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 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 enhancing drugs. 

Topics on Examination

• Drugs of abuse

• Alcohol

• Analytical methods, new technologies

• Laboratory quality control and COC

• Laboratory certification

• Laboratory communication with the MRO

• Alcohol testing (analytical issues)

• Specimen validity testing

References

• Swotinsky RB, Smith DR, The Medical Review Officer's Manual.  Beverly Farms, MA, OEM Press, 4^th ed. 2010, pages 95-130; 191-216.

• Peterson KW, American College of Occupational and Environmental Medicine, Drug and Alcohol Testing Medical Review Officer Course Syllabus and Resource Manual, updated annually.  Sections on toxicology, pharmacology and laboratory issues.

• American Society of Addiction Medicine, Medical Review Officer Course Manual, updated annually.  Sections on toxicology, pharmacology and laboratory issues.

• Ropero-Miller JD, Goldberger BA, et al, Handbook of Workplace Drug Testing, AACC Press, 2^nd ed. 2008.

• Garriott JC (ed), Medicolegal Aspects of Alcohol, Lawyers & Judges Publishing Company, Inc., 5^th edition, 2008.

• Swotinsky RB, ed.  MRO Update.  American College of Occupational and Environmental Medicine (newsletter).

•  MRO List Server (moderated by Dr. Karl Auerbach) – to subscribe, send an email to  Karl_Auerbach@urmc.rochester.edu with the subject "SUBSCRIBE MRO"

• MRO Testing Q&A, an on-line discussion forum about workplace drug and alcohol testing moderated by Robert Swotinsky, http://www.occ-doc.net/MRO_{_}information.htm

• MROCC:  http://www.mrocc.org

• U. S. Department of Transportation, Office of Drug and Alcohol Policy and Compliance:  http://www.dot.gov/ost/dapc

• GPO Gate - Free source of Federal Register documents:  http://www.ssdc.ucsd.edu/gpo & http://www.gpo.ucop.edu/search/default.html