MRO Donor Interview & Verification 2 — Questions and Answers
Question 1: Which of the following substances detected on a DOT drug test could result in a verified negative if the donor presents a valid current prescription?
- Cocaine metabolite (benzoylecgonine)
- Amphetamine (Correct answer)
- Phencyclidine (PCP)
- Marijuana metabolite (THCA)
Correct answer: Amphetamine
Amphetamines have legitimate prescription uses (e.g., Adderall, Vyvanse) and a valid prescription can support a verified negative report; cocaine, PCP, and marijuana metabolites have no accepted prescription context in DOT federal testing.
Question 2: Under DOT regulations, when a donor claims a prescription during the MRO interview but cannot immediately produce documentation, the MRO should:
- Report a verified positive immediately since documentation was not provided
- Cancel the test and require a new collection within 24 hours
- Allow a reasonable time (up to 5 business days) for the donor to provide documentation while independently verifying (Correct answer)
- Refer the matter to the employer's medical review board
Correct answer: Allow a reasonable time (up to 5 business days) for the donor to provide documentation while independently verifying
Per 49 CFR §40.135, the MRO must allow the employee a reasonable opportunity to provide documentation and can also independently verify the prescription with the prescriber or pharmacy.
Question 3: A donor's specimen tests positive for opiates. The donor claims to have eaten a large amount of poppy seeds before the test. How should the MRO respond?
- Automatically accept the explanation and report a verified negative
- Evaluate whether the specific morphine concentration is consistent with poppy seed ingestion at the DOT cutoff level (Correct answer)
- Automatically report a verified positive since poppy seed claims are never accepted under DOT
- Order a hair follicle confirmation test before making a determination
Correct answer: Evaluate whether the specific morphine concentration is consistent with poppy seed ingestion at the DOT cutoff level
At the DOT morphine cutoff of 2,000 ng/mL, normal poppy seed ingestion typically cannot produce concentrations at this level, so the MRO must evaluate the specific concentration against the claimed explanation.
Question 4: A donor presents a valid medical marijuana card issued by their state to explain a positive THC result on a DOT drug test. The MRO must:
- Report a verified negative since the donor has legal state authorization
- Report a verified positive since federal DOT regulations do not recognize marijuana as having accepted medical use (Correct answer)
- Cancel the test and refer the donor to a Substance Abuse Professional
- Place the result on hold pending clarification from the state health department
Correct answer: Report a verified positive since federal DOT regulations do not recognize marijuana as having accepted medical use
Under federal DOT regulations, marijuana has no accepted medical use regardless of state law; the MRO must report a verified positive even when the donor holds a valid state-issued medical marijuana card.
Question 5: During verification of a positive opiate result, the donor reveals a valid prescription for oxycodone for chronic pain. What additional determination must the MRO make?
- Only that the prescription is current and the prescriber holds a valid DEA number
- Whether the prescribing physician has determined the employee is medically qualified to perform safety-sensitive duties while taking the medication (Correct answer)
- The complete list of all other medications the donor takes
- Whether the donor's employer specifically prohibits opioid use in company policy
Correct answer: Whether the prescribing physician has determined the employee is medically qualified to perform safety-sensitive duties while taking the medication
The MRO must verify not only that the prescription is valid but also whether the treating physician has cleared the employee to safely perform safety-sensitive functions while on the medication.
Question 6: A donor claims that an over-the-counter (OTC) cold medication explains their positive amphetamine result. The MRO should:
- Accept the explanation automatically since OTC medications are legally available
- Reject the explanation since only prescription medications are considered valid
- Evaluate whether the OTC medication's active ingredient could pharmacologically explain the positive result at the detected concentration (Correct answer)
- Request a new specimen immediately and disregard the claimed explanation
Correct answer: Evaluate whether the OTC medication's active ingredient could pharmacologically explain the positive result at the detected concentration
The MRO must evaluate OTC medication claims by assessing whether the medication's active ingredients could plausibly produce the positive result at the concentration detected by the laboratory.
Question 7: When reporting a verified positive result to the employer's DER, which of the following should the MRO generally NOT disclose?
- The specific drug or drug class that tested positive
- The verified result status (positive, negative, cancelled, etc.)
- The specific numerical concentration of the substance detected (Correct answer)
- Whether a split specimen test has been requested
Correct answer: The specific numerical concentration of the substance detected
The MRO reports the drug identified and the verified result to the employer but does not typically disclose the specific numerical concentration, which is medical information beyond what the employer needs to know.
MRO Donor Interview & Verification 2
Which of the following substances detected on a DOT drug test could result in a verified negative if the donor presents a valid current prescription?