There are 3 steps to a drug test: Collection, Laboratory analysis, and MRO. As an employer, it is important that you understand these steps and the role they play when managing an effective and efficient drug testing program. Read below for details on each important step in the drug testing process:
1 Collection
The first step in a drug test is the collection of the specimen from the donor. This is performed by a qualified Specimen Collector using a Custody and Control Form (CCF) that accompanies the specimen throughout the testing process. The Collector is responsible for filling out the CCF accurately and completely; both the Collector and the specimen donor sign and date the CCF. Strict procedures must be followed to ensure the collection is compliant and accurate. The donor is afforded privacy for providing the urine specimen unless circumstances warrant direct observation procedures as required by the employer, the MRO, or applicable federal regulations. For DOT drug tests, the urine specimen is subdivided and poured into 2 specimen containers (plastic bottles with caps), each bottle is labeled and sealed and placed in a clear plastic bag with a copy of the CCF. The packaged specimens are shipped to a SAMHSA-certified drug testing laboratory via FedEx or a lab courier service.
2 Lab Analysis
The specimens arrive at the laboratory and are entered into the laboratory’s database using the unique specimen ID number on each bottle and the CCF. A typical lab processes thousands of specimens every day. After checking the specimen packaging and the CCF, the lab personnel open the specimen bottle and prepare the specimen for initial analysis which is done using immunoassay technology. The split specimen bottle (Bottle B) remains sealed and is kept at the laboratory for future testing that may be requested by the donor. Specimens that test negative on the initial immunoassay analysis are reported to the MRO as negative. If the initial analysis detects drugs in the specimen, a second portion of urine is taken from the bottle and analyzed using mass spectrometry technology to confirm the presence of specific drugs or drug metabolites. Only if the specimen has tested positive on both the initial immunoassay and on the mass spectrometry confirmation analysis is it reported as a positive test to the Medical Review Officer.
In addition to analyses for drugs, each specimen undergoes specimen validity testing to determine if it is diluted, has been adulterated or substituted, or is invalid for testing. The specimen validity findings are reported to the MRO.
3 MRO Review
Once the specimen has been analyzed and the findings certified by the laboratory personnel, the result is sent to the Medical Review Officer (MRO). Two possibilities:
- Negative Result: The MRO team matches the CCF to the result and reports the result to the employer
- Non-Negative Result (positive, adulterated, substituted, or invalid): A Medical Review Officer contacts the donor for an interview to determine if there is a legitimate/medical reason for the non-negative result. If the donor has an explanation that the MRO determines to be acceptable. For the positive result, the MRO will report the test to the employer as a Negative. If the MRO determines there is not a medical explanation for a positive result (i.e., no valid prescription provided), then the test will be reported as Positive. If there is no acceptable medical explanation for an adulterated or substituted result, the MRO will report the test as Refusal to Test. If there is an acceptable explanation for the adulterated/substituted specimen, the MRO will report a canceled test. For specimens that are invalid for testing, the MRO will report a canceled test, and if there is no reasonable explanation for the specimen being invalid for testing, the MRO will order another drug test to be conducted on the individual and direct observation collection procedures must be used. The Non-Negative review process can take anywhere from 1 to 10 days depending on donor availability/cooperation, validation of medical information, and regulatory requirements.
Pro tips
For the quickest turnaround time, send employees for testing early in the day to ensure the specimen is shipped the same day.
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