Medical Review Officer (MRO) Services

Medical Review Officer (MRO) is a licensed physician responsible for receiving and reviewing laboratory results generated by an employer’s drug testing program. Regulations require that Medical Review Officers have knowledge about the pharmacology and toxicology of prescriptions as well as illicit drugs. An MRO should also have knowledge of the federal agency drug testing regulations and guidelines from the Department Of Transportation.

As a Medical Review Officer (MRO), we must act as an independent and impartial “gatekeeper” and advocate for the accuracy and integrity of the drug testing process. Nationwide Testing Association, Inc., is required to review the documents for possible errors, interview donors who have non-negative results to determine if there is a legitimate medical explanation for their results, and provide feedback to employers regarding performance problems, if necessary.

At Nationwide Testing Association, Inc., our Medical Review Officers (MRO) are certified by a nationally recognized MRO certification board. We ensure that our MROs maintain their certifications by retaking and passing the exam every five years.

Medical Review Officer (MRO) Process

The first part of the process is the collection; the employee/donor/applicant will go into the collection site to provide the required specimen. The collection site will follow applicable protocols and will ship the specimen, along with the lab copy of the Custody and Control Form (CCF), to the laboratory to begin testing. The collection site should also transmit the Medical Review Officer and the DER copy of the CCF to the correct parties.

Once the laboratory receives the specimen, they will begin conducting the required testing. Once completed, the laboratory will transmit the results to the MRO to review and report.

After the Custody and Control Form (CCF) is received, the donor’s name and id number are entered into the system. The Custody and Control Form is then processed so that it will link to the result.

When the lab results are received through an electronic interface, they are immediately downloaded into our system. During this process, the result links to the client, the donor record, and the Custody and Control Form. The system will also determine an applicable status for the result based on pre-set identifiers and criteria

If the lab result is non-negative the system will automatically assign that result to our Medical Review Office, they are then reviewed by our Medical Review Officers. Each donor with a non-negative result will have the opportunity to speak with an MRO regarding their results.

If the lab result is negative, they will report to the company automatically through the system. If the laboratory results appear positive, the MRO will interview the donor to discuss the results and then the final report will be distributed to the company. The medical review process offers an opportunity for the donor to provide a valid medical explanation for any questionable results. Our process is designed to protect individuals and employers from wrongful accusations. We exceed all federal and state regulations and help you maintain a safer workplace!

Contact us today to learn about the Nationwide Difference!

Fentanyl – What the Employer Needs to Know

By now, most employers are aware of the Opioid Epidemic. But are they aware of another dangerous epidemic that is growing? Fentanyl- a potent opioid has been steadily on the rise. And even more disturbing, is the combination of Fentanyl and Cocaine, and the combination of Fentanyl and Heroin. The City of Baltimore, a city heavily affected by the opioid epidemic, recognizes that most of the heroin on the street is now almost always laced with the highly dangerous synthetic opioid fentanyl, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

Public Health Challenges

A recent study highlighted some public health challenges caused by fentanyl-adulterated cocaine:

  1. First responders and those present at the scene of a cocaine overdose may consider administering Naloxone even if the patient denied using opioids.
  2. Fentanyl is very dangerous and powerful and dramatically increases the risk of lethal overdose.
  3. Opioid-naïve individuals that have been using fentanyl-free cocaine lack a potentially life-saving tolerance for opioids. Adding fentanyl to their drug of choice puts this group at an even higher risk of fatal overdose.
  4. Opioid-naïve cocaine users are typically not targeted by current harm reduction strategies and public messages concerning opioid overdose. A lack of education and access to critical resources, including naloxone —the lifesaving overdose reversal drug— render this population more vulnerable to a fatal overdose.

What Steps Can the Employer Take?

Consider adding Fentanyl to your current non-DOT testing program. But even more important is educating your management team and employees on the dangers of substance abuse. An effective substance abuse policy paired with employee education will not only enhance your testing program but may save a life.


*Nolan, M. L., Shamasunder, S., Colon-Berezin, C., Kunins, H. V., & Paone, D. (2019). Increased presence of fentanyl in cocaine-involved fatal overdoses: implications for prevention. Journal of Urban Health, 1-6.

What Happens to a Specimen after Collection?

What happens to a specimen immediately after it is collected?

1. From the point of collection, the specimen is packaged & sent to the laboratory via carrier or FedEx.

2. Specimens are processed in a strategic fashion by the certified laboratory. Once the specimen arrives at the lab, the specimen and the accompanying COC are unpackaged. The COC and the specimen vials are scanned at multiple points in each process for record keeping & also to guarantee accuracy.

3.The specimen is divided into equal parts for the testing process & the first immunoassay test is conducted. If the preliminary finding suggests that the specimen is positive, it is sent to another part of the lab for GC/MS confirmation testing. Another primary reason for dividing the specimen is to also reserve a portion in the event that a split specimen test is requested by the donor.

4. The specimen is then tested via the GCMS or Gas Chromatography/Mass Spectrometry. Gas chromatography-mass spectrometry (GC-MS) combines the features or gas-liquid chromatography (GC) and mass spectrometry (MS) & makes it possible to identify different substances within the sample. Initial (immunoassay) and confirmatory (gas chromatography-mass spectrometry [GS-MS]) tests are the methods most frequently utilized for drug tests. Implementing these tests allows a high level of sensitivity and specificity. The approach also reduces the chance for false positives or false negatives greatly.

5. The exact findings of the screening test are confirmed and the laboratory generates an official report to record their findings. The report will include the specific test performed, the panels or drugs that the specimen was tested for, and the final verdict for each panel (positive, negative, or a cancelled specimen as a whole). Positive results will also feature the appropriate quantitative level for the verified substances and corresponding panels listed.

6. Normal negative results are reported immediately by the applicable reporting arrangements determined by the lab account profile.

7. If a result is positive, it is sent to the MRO or Medical Review Office for a final review. Multiple attempts are made to contact the donor in an effort to obtain a valid medical explanation. Quality and accuracy are of utmost importance to NTA, Inc. as the valid medical explanation is determined. Since drug tests are based on the detection of drug metabolites, it is of primary importance that the correct medication causing the positive is identified. In short, the goal of the Medical Review process and steps is to verify that the prescription serving as the contributing factor was legally prescribed to the donor prior to the drug test collection date. The Medical Review Officer or Medical Review Assistants attempt to contact the donor adhering to a high-level of procedural standards and practices based on the type of test being processed, for example;

7a. DOT Results are processed in accordance of DOT Regulations and federal guidelines and with respect to the Medical Review Officer’s responsibility.
7b. NON-DOT Results are processed according to NON-DOT procedures and are generally processed by our highly-qualified Medical Review Office Assistant Staff.

8. If the laboratory determines that a result is cancelled, the MRO Office will review the result and attempt to make contact with the donor as outlined above. A cancelled result can be attributed to a multitude of scenarios and findings. Examples of Cancelled Result causes or contributing factors include fatal flaw detection or rejection, abnormal PH, immunoassay interference, or abnormal creatinine level.

9. Once the full medical review process has concluded, the result is reported to the client as a verified result, negative result, or cancelled result.

  •          Normal Negative tests are usually reported within 24-48 hours from the time they enter the laboratory for analysis.
  •          Positive or Cancelled tests are usually reported from the laboratory within 5-7 business days from the time they are received for processing.

NTA, Inc. has one of the best Medical Review Offices in the country and we guarantee that diligent care is taken for each result that we review and process!

FDA Says Beware Of CBD For These Reasons

The U.S. Food and Drug Administration (FDA) wants the American public to know that cannabidiol (CBD), the non-intoxicating component of the cannabis Sativa plant, might not be as safe and effective in the grand scheme of their overall health and wellness as they are being told.

Other than one prescription drug product to treat rare, severe forms of epilepsy, the FDA has not approved any other CBD products, and there is very limited available information about CBD, including about its effects on the body. Therefore, the FDA wants to clarify a couple of critical points surrounding CBD before more of the public jumps on the bandwagon.

Research shows CBD can cause liver damage. The FDA admits that it does not yet have a real understanding of the potential health risks associated with CBD. But liver damage is one of the side effects that it has uncovered in its limited study. The agency wrote, “ The FDA identified certain safety risks, including the potential for liver injury.”

The University of Arkansas for Medical Sciences did a study that found high doses of CBD brought about liver damage in mice within 24 hours. Many of the animals died or were close to death within three or four days. Critics have argued that the dosage used in this study was extreme, but the highest dosage used (615 mg/kg for 10 days) was “The allometrically scaled mouse equivalent of the maximum recommended human maintenance dose.” So while the dosage leading to liver damage in mice was, in fact, high, there are epileptic children in the U.S. right now being administered a comparable amount. This is the reason that doctors must monitor the liver enzymes of these patients. In clinical trials, 5 to 20% experienced liver issues. As a result, some patients were permanently removed from the study to prevent the damage from escalating.

Even doctors in Colorado, where marijuana is legal for any purpose, monitor the liver enzymes of patients who decide to treat themselves with CBD or Marijuana, according to a report from STAT News.

The most common side effects associated with CBD based products include: “Sleepiness, Sedation, and lethargy; Elevated Liver Enzymes; Decreased Appetite; Diarrhea; Rash; Fatigue; Malaise and Weakness; Insomnia; Sleep Disorder; Infections.”

According to a news release from the FDA, “More severe side effects include “thoughts about suicide, attempts to commit suicide, feelings of agitation, new or worsening depression, aggression, and panic attacks.”

The cannabis industry has been trying to convince the public that CBD can remedy their pain, help with anxiety, pull them out of depression, give them a healthy heart, and even protect them from cancer. The FDA worries that all of the unsubstantiated allegations floating around about how CBD can help relieve or even cure medical conditions will give consumers a false sense of hope. The FDA writes, “ Misleading and false claims associated with CBD products may lead consumers to put off getting important medical care, such as proper diagnosis, treatment, and supportive care.”

It is essential to make sure you stay educated. Don’t just buy into the CBD hype blindly. If you need help educating your staff on CBD use in the workplace, give our office a call at 1.800.452.0030 ext. 203.

What is the difference between Screen Threshold and Confirm Threshold on the NTA, Inc. test results?

The Screen Threshold and Confirm Threshold are the standard cutoff levels that the laboratory uses when testing a specimen.

When the laboratory first receives the specimen, they run the Immunoassay test or Screen test. Immunoassays use antibodies to detect the presence of a drug or metabolite in the urine. Antibodies are proteins that chemically bind with specific substances called antigens; in this case, a drug or drug metabolite. The first column of numbers on the NTA test results under Screen Threshold are the quantitative cutoff levels for this test.
The primary disadvantage of immunoassays is that the antibodies are seldom specific to a single drug or drug metabolite; therefore, the antibodies may bind with other substances. This is called cross-reactivity and can result in false positives. Because of this, if a substance shows positive (or above the screen threshold), the specimen is sent on for the GC/MS (Gas Chromatography/Mass Spectrometry) test, or Confirmation Test. The second column of numbers on the NTA, Inc. test under Confirm Threshold are the quantitative cutoff levels for this test.

The GC/MS test is a very sensitive and specific test, and the procedures for performing this test are very complex. In short, however, this test separates and very specifically identifies the components of the specimen, making it a highly reliable test for confirmations.

The Screen and Confirm Thresholds on the NTA, Inc. results are simply the cutoff levels for each substance on each particular test. They have nothing to do with one another, and do not reflect levels that are found in a specimen.

Drug Overdose Deaths Hit Record High

The Centers for Disease Control and Prevention (CDC) reported that 70,237 people in the United States died of drug overdoses in 2017. The age-adjusted rate of drug overdose deaths increased from 6.1 per 100,000 standard population in 1999 to 21.7 in 2017. Drug overdose ranks as the leading cause of death for adults under age 55.

The CDC also reports that Fentanyl replaced Heroin as the deadliest drug. Fatalities involving Fentanyl increased by more than 45% in 2017.

Other key findings from the CDC Data include:

  • The drug overdose death rate in 2017 was 9.6% higher than in 2016.
  • Heroin overdose death rates were seven times higher in 2017 than in 1999.
  • Almost 14,000 Americans died from a cocaine-related overdose in 2017.
  • Overdose rates were significantly higher for males than for females.
  • West Virginia, Ohio, Pennsylvania, and Washington, DC recorded the highest drug overdose death rates in 2017.
  • Texas, North Dakota, South Dakota, and Nebraska experienced the lowest drug overdose death rates in 2017.

Is it time to review your workplace drug and alcohol testing program?  Give us a call today at 1(800) 452-0030!