From the Research
The Medical Review Officer (MRO) procedure for Department of Transportation (DOT) safety risk medications involves a systematic review process when prescription medications are detected in drug tests, with the most recent guidance found in 1. First, the MRO should verify the legitimacy of the prescription by contacting the employee and requesting documentation from their prescribing physician. Common safety-sensitive medications requiring review include:
- Opioids (such as oxycodone, hydrocodone)
- Benzodiazepines (like alprazolam, diazepam)
- Certain stimulants (including amphetamines used for ADHD) The MRO must determine if the medication use poses a safety risk based on the specific job duties, medication dosage, duration of treatment, and potential side effects. If the MRO determines the medication poses a significant safety risk, they should inform the employee and employer while maintaining medical confidentiality about the specific condition. The MRO may recommend temporary reassignment to non-safety-sensitive duties or medical leave until the medication regimen is adjusted or completed, as supported by the findings of 1 which highlight the importance of medication safety in high-risk settings. This process balances workplace safety with appropriate medical treatment by ensuring that employees in safety-sensitive positions are not impaired by medications that could affect their performance and potentially cause accidents, in line with the principles outlined in 2 and 3. Key considerations for the MRO include:
- The potential for drug-drug interactions, as discussed in 4
- The role of pharmacists in medication safety, as emphasized in 3
- The need for ongoing monitoring and assessment of medication safety, as highlighted in 1 By following this systematic review process and considering the latest evidence and guidelines, the MRO can ensure that employees in safety-sensitive positions are protected from the risks associated with certain medications, while also respecting the need for appropriate medical treatment.