KINNECT can provide expert support when an employee returns a non-negative drug and alcohol result with declared use of a prescribed medication.
Instant drug screening is a common inclusion in many occupational health programs, from pre-employment assessments to health monitoring medicals as well as onsite drug & alcohol screening programs. But what happens when a non-negative result is returned?
An initial non-negative result does not mean that illicit substances are involved. Prescription medications can trigger a non-negative result too and a laboratory report can only tell you with the medication is consistent with the declared use. The lab report can’t tell you whether the medication being used has been legitimately prescribed, is being used as directed or if it might be masking the use of an illicit drug. Even if the medication is legitimate, how do you know if you should be concerned about potential work safety implications of the prescribed medication?
Our Medical Review Officer (MRO) Service can assist you to manage the next steps. Our MRO can determine whether the substances detected in a laboratory report represent legitimate therapeutic use or an innocuous source and also advise you if there are any safety concerns that may impact the individual’s work and what to do next. Furthermore, the service can also verify a positive result and give you the tools you need to manage the individual via your company’s drug and alcohol policies.
What is an MRO?
The KINNECT Medical Review Officer (MRO) assists organisations to interpret results of alcohol and other drugs results, has expert knowledge on medications and their side effects.
An MRO is a doctor who has undertaken specialist training to become an MRO and is accredited by the Australian Medical Review Officers Association (AMROA).
KINNECT’s MRO’s are medical practitioners who have:
- Independently certified competence in the field of interpreting drug and alcohol test results;
- Knowledge of substance use disorders;
- Knowledge of the relevant legal standards and regulations that apply in our society; and
- Practical knowledge of the specific regulations that apply to your workplace.
MROs are independent specialist practitioners who adhere to privacy, confidentiality and record keeping standards in accordance with relevant legislation.
If you don’t have an MRO, KINNECT’s MRO Service ensures that your organisation has timely access to appropriate information to assist in the management of workers who have returned a ‘confirmed positive’ result from the laboratory.
The Benefits
The benefits of KINNECT’s MRO Service is:
- Available during business hours (and by special arrangement 24/7); anywhere in Australia via telemedicine;
- Teleconsult with individuals in a timely manner for laboratory confirmed non-negative initial test results to review declared use of prescribed medication;
- Provides additional specialist information ensuring you are compliant with relevant legislation;
- Determines whether declared medication use is legitimate or illicit.
- Provides advise on whether declared use of prescribed medication poses any potential risk to the person’s ability to do their job safely.
How it Works
Employee Returns a Non-Negative Result in either:
Onsite Random Drug & Alcohol Test
On-Call Incident and/or Suspicion Testing
Pre-Employment or Health Surveillance Medical
Step 1
Request an MRO Service
You receive a LAB report resulting from a non-negative screening with declared prescribed use of medication and ask KINNECT to arrange an MRO service.
Step 2
MRO Completes Teleconsult with Donor (applicant / employee)
The MRO will review supplied information and consult with the individual. This consultation, conducted over the phone, will discuss with the individual any declared medication use, and clarify what evidence the MRO needs to inform their assessment.
Step 3
MRO Assessment
The MRO will complete the review of the chain of custody and laboratory report. The MRO will determine if the results represent either legitimate therapeutic use, an innocuous source or illicit use.
Step 4
MRO Issues Report
The outcome of the Medical Review Officer Assessment and Recommendations will be one of the following three categories:
1. MRO Verified Negative. No concerns about fitness for work
Verified negative, the workers legitimate medication use presents no immediate risk should they perform their role.
If the result is ‘MRO verified negative’, this information is also shared directly with you. If this occurs during an activity for which you’ve engaged KINNECT (for instance a pre-employment assessment), it will trigger the continuation of the activity. Our review doctor will incorporate the findings of the MRO review into their assessment.
2. MRO Verified Negative. Concerns about fitness for work
Verified negative, however workers legitimate medication use presents a potential risk when performing their role.
If the result is ‘MRO verified negative’, however concerns about safety remain, the MRO will advise you to consider a fitness for work review. This review will provide you with further expert advise and opinion relating to the individual’s specific job role. KINNECT can send the MRO report to the KINNECT who signed off a previous medical assessment, or in the case of blanket or random testing where the individual may have not had a previous medical assessment, the MRO report can be reviewed by KINNECT’s Chief Medical Officer.
An updated fitness for work certificate will be issued. Please note this service carries an additional cost of $165.00 + gst.
3. MRO Verified Positive
The medication the worker has declared has not been found to be of legitimate therapeutic use of medication lawfully prescribed. Worker should be managed according to the company’s AOD Policy.
The MRO will submit their report to your company via KINNECT and we facilitate the MRO finding being conveyed directly to your nominated contact. The situation is best managed in accordance with your drug and alcohol policy and procedures. KINNECT finalises the encounter unless specifically advised otherwise.
How is an MRO different to a Fitness for Work Assessment?
While these MRO services are often used in related circumstances a Fitness for Work Assessment is not the same as an MRO Service.
The scope of the MRO service is limited to there is or isn’t legitimate therapeutic use of prescribed and whether the use represents any safety risks.
A Fitness for Work Assessment is needed to provide a more detailed assessment of the immediate and/or longer term workplace safety risk issues related to the reasons for the medication use well as other matters relevant to the situation. The Fitness for Work Assessment will be conducted by a KINNECT doctor that has knowledge about the individual’s specific job role, or by a Chief Medical Officer in the event the individual doesn’t have a previous medical assessment to reference.
MRO Services and Medicinal Cannabis
With the increasing popularity of medicinal cannabis as a form of treatment in Australia, employers need to understand risks posed to the workplace.
KINNECT’s MRO services can be engaged to:
- Review AOD policy and procedures.
- Ascertain whether the declared or claimed use of prescribed medicinal cannabis is ‘legitimate therapeutic use’ or being used to mask recreational use.
- Explore whether the declared use poses any material risk to the person’s ability to do their job safely, especially for safety-sensitive and safety-critical roles that involve use of mobile plant (vehicles) or high-speed equipment where good judgement is paramount.
Frequently asked questions on medicinal cannabis in the workplace:
What steps should employers take when they learn of an employee using medicinal cannabis?
- Ensure your workplace AOD policy includes provisions dealing with medicinal cannabis. This is especially important where duties typically involve driving, operating mobile machinery or high-speed equipment.
- Use KINNECT’s MRO services to independently assess if the declared use of medicinal cannabis is ‘legitimate therapeutic use’ or being used to hide recreational use.
- Use KINNECT’s MRO services to investigate and better understand the impacts of the declared use on the worker’s or other employees’ safety in the workplace.
What are the safety risks associated with someone using medicinal cannabis at work?
Like many prescription drugs, medicinal cannabis can cause unwanted side effects including drowsiness, dizziness, nausea and impaired neurocognitive function, attention and short-term memory.
Medicinal cannabis comes in five different formulations for use in Australia, classified by the Therapeutic Goods Administration (TGA). The formulation, amount of THC (Delta-9-tetrahydrocannabinol) and route of administration (inhaled or swallowed) will influence the impact cannabis has on the cognitive abilities of your worker.
Whilst prescribed medicinal cannabis use is legal in Australia, it remains illegal for a driver to operate a vehicle while impaired, or with any amount of THC in their body. Even with formal negative testing of THC detected in urine or oral fluids, there are time periods where a worker known to use medicinal cannabis should not operate safety-sensitive mobile plant or high-speed equipment.
Are there any ER/IR issues that an employer must be aware of, when dealing with this situation?
Yes, the concept of drug-free workplaces has changed, and it can be a challenge for employers who are not prepared.
As with all medications that affect performance, employers may be required to make reasonable accommodations for employees who use medicinal cannabis. However, what ‘reasonable accommodations’ refers to depends on many factors and may even require a specialist legal opinion.
Policies, procedures and the handling of workers subject to random drug testing – which includes testing for cannabis (THC) – needs to accommodate a worker with ‘legitimate therapeutic use’. For this reason, it is important for employers to review their AOD policies and ensure they accommodate workers who need to use medicinal cannabis for their health and wellbeing. At the same time, policies and procedures should deter workers who partake in recreational use and create risk for themselves and your business.
Employers should also be conscious that employees using medicinal cannabis may face stigma and discrimination from co-workers or management as a result of their lawful use of medicinal cannabis.
How can KINNECT support employers with managing medicinal cannabis use in the workplace?
KINNECT’s MROs have undertaken specialist training and are certified by the relevant accreditation body as competent in the assessment of alcohol and other drugs for safety sensitive workers. They possess the expertise to thoroughly evaluate a worker’s prescription for medicinal cannabis, ensuring it meets the legal prescription and supply requirements including variations across the States and Territories.
Using their comprehensive knowledge, KINNECT’s MROs can also review your AOD policies to ensure they address risks for safety sensitive roles, while also allowing for ‘legitimate therapeutic use’ where required.
By initially investigating a worker’s prescription and supply documentation, KINNECT’s MROs can make informed judgments regarding the validity of the possession and nature of the cannabis use. Understanding the different formulations and their modes of administration provides critical information that may have implications for the role you need that worker to do. This is the basic level of MRO specialist services provided by KINNECT.
At a deeper level, KINNECT’s sign-off doctors can consider an initial assessment by an MRO and provide further advice based on other information collected during the various assessments you may have asked KINNECT to perform. Consequently, in addition to considering the specific condition for which the medicinal cannabis was prescribed, KINNECT’s sign-off doctors can consider factors such as the worker’s other medications and medical conditions, the role and rostering requirements and where the work is to be performed.
If concerns are raised, KINNECT’s sign-off doctors may recommend either:
a) A specialist Occupational Physician assessment of the worker, the role, the types of accommodations that might be needed, and whether any adjustment might be considered reasonable or unreasonable by the Fair Work Ombudsman, Anti-discrimination courts or commissions or;
b) that further information is required and advise from whom, including if a comprehensive assessment is required by a psychiatrist or addiction medicine specialist.
More detailed MRO services and engaging sign-off doctors require a greater investment, so employers should endeavour to understand their risk before embarking on these activities. The risk decision of an employer depends on their tolerance, and you may choose not to invest in such a program and accept the risks associated with your decision.
KINNECT are available to support your requirements as best we can. If you would like to speak with one of our specialist MROs to better understand the risk to your workplace, reach out to us.
MRO Services and MDMA and Psilocybin
The Australian Therapeutic Goods Administration (TGA) has approved the use of psychedelics substances MDMA and psilocybin for the treatment of some specific mental health conditions which do not respond to other treatments. Prescription and use are only approved under strictly controlled medical settings.
As the nature condition being treated is usually incompatible with safety critical work, the declaration by the worker is sufficient to question an employee’s ability to work safely. A “standard MRO service” is not required, instead, employers need to critically review the risks posed to their workplace.
KINNECT’s specialist MRO services can be engaged to:
- Review AOD policy and procedures.
- Explore whether the condition (implied to exist by their declared use) poses any material risk to the person’s ability to do their job safely for non-safety-sensitive roles, particularly those roles which involve the operation of high-speed equipment, control of processing plant, or operating mobile plant and machinery – any situation where good judgement is vital.
Frequently asked questions on MDMA and psilocybin in the workplace:
What steps should employers take when they learn of an employee using MDMA or psilocybin?
- Review the safety-sensitive risks of the role performed by the employee. The condition for which the medication can be lawfully prescribed is INCOMPATIBLE with safety critical tasks.
- Ensure your workplace AOD policy includes provisions dealing with MDMA and psilocybin. This is especially important where duties typically involve driving, operating machinery, operating mobile machinery or high-speed equipment.
- Use KINNECT’s Specialist MRO services to investigate and better understand the impacts of the declared use on the worker’s or other employees’ safety in the workplace.
What are the safety risks associated with someone using MDMA or psilocybin at work?
Adverse effects of MDMA (sufficient to distract from attention and time critical control requirements):
• Detachment from one’s own mind or body
• Disorganised thoughts
• Headache
• Nausea
• Faintness
• Panic attacks
• In rare cases it can cause a sudden loss of consciousness or trigger seizures
Adverse effects of psilocybin:
• Are are similar to MDMA but less well documented
• There is a risk of triggering psychotic episodes in pre-disposed individuals, which is why it is used only under the supervision of an authorised psychiatrist
Are there any ER/IR issues that an employer must be aware of, when dealing with this situation?
Yes, the concept of drug-free workplaces has changed, and it can be a challenge for employers who are not prepared.
As with all medications that affect performance, employers may be required to make reasonable accommodations for employees including those who legitimately use MDMA or psilocybin. However, what ‘reasonable accommodations’ refers to depends on many factors and may even require a specialist legal opinion.
is predicated on what tests are being performed as part of your requirements. The standard tests used for most drugs of abuse screening do not include specific tests for MDMA or psilocybin. For this reason, it is important for employers to review their AOD policies and ensure they: (i) screen for the appropriate panel of drugs for your assessed risk, and (ii) deal with workers appropriately, especially those who legitimately need medication that might also impair their cognitive functions. Critically, policies and procedures should deter workers who partake in recreational use of party drugs containing psychedelic substances and create risk for themselves and your business.
Employers should also be aware of their potential vicarious liability for unlawful discrimination and harassment faced by your employees suffer from the mental health conditions associated with needing these medications.
How can KINNECT support employers with managing MDMA or psilocybin use in the workplace?
KINNECT’s MROs have undertaken specialist training and are certified by the relevant accreditation body as competent in the assessment of alcohol and other drugs for safety sensitive workers. They possess the expertise to assess the situation and advise you.
More detailed MRO services and engaging sign-off doctors require a greater investment, so employers should endeavour to understand their risk before embarking on these activities. The risk decision of an employer depends on their tolerance, and you may choose not to invest in such a program and accept the risks associated with your decision.
KINNECT are available to support your requirements as best we can. If you would like to speak with one of our specialist MROs to better understand the risk to your workplace, reach out to us.
Meet our Medical Review Officers
Dr. Graeme Edwards
Dr. Edwards is a Senior Consulting Physician with extensive experience in Occupational and Environmental Medicine. His experience of over 25 years includes working as a consultant and medical adviser for a wide variety of companies and industries.
Dr. Edwards’ qualifications include a Bachelor of Medicine, Bachelor of Surgery and Bachelor of Medical Science from The University of Queensland. As part of his education, Dr. Edward’s wrote a thesis in Neuroanatomy and Neurophysiology specialising in pain. His current work includes being a Queensland representative for The Australasian Faculty of Occupational and Environmental Medicine (AFOEM) Council and the Director of Work & Health Risk Management.
Dr. Benjamin Lam
Dr Benjamin Lam has worked in the field of Occupational Medicine since 2013. His experience spans several industries including mining, railway and oil and gas and he performs a wide variety of work including pre-employment medicals, workplace rehabilitation and health surveillance assessments. In addition to providing MRO Services, he performs industry specific medicals including AHP railway medical assessments, OGUK and AMSA medical assessments.
Medical Review Officer (MRO) Referral Form
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