I Gave My Sample, Now What?


It is typically the MRO’s final determination that is sent to an employer and serves as the result of record for an applicant or existing employee.

This information is provided for educational purposes only. Reader retains full responsibility for the use of the information contained herein. 


     Have you ever wondered what happens to your sample once that sample has been provided at a collection facility? Maybe you are an employer that contracts with a Third-Party Administrator (TPA) and are unaware of the overall drug testing process while always planning on a seamless process provided by your contractor. On the surface this information may seem irrelevant; however, having some insight into the overall drug testing process may be beneficial in understanding turnaround times for drug testing, and how a breakdown in one step of the process can lead to potential delays in results.

     In this article we will take a closer look at each step of the drug testing process, beginning with how the sample leaves the collection facility, and ending with the delivery of a result to the employer. This process is specific to lab-based testing. Many employers now utilize instant testing options to bypass some of the time associated with lab-based testing, but keep in mind that even instant test outcomes still occasionally require laboratory confirmation.   


     The Courier 

     Once a collection has been completed, and the sample has been appropriately sealed and placed in a tamper-evident bag, the bag is then placed in a secure area to be picked up and shipped to the lab. This secure area is often a lock box that can be accessed only by collection facility personnel and the courier responsible for transporting the sample to the lab.  

      Many collection facilities are not located near their testing laboratories, so the courier is not able to deliver the sample directly. Instead, the courier will deliver the sample to the airport where a shipping company will assume responsibility of the shipping process.  

      Regardless of lab location, most samples can arrive at their respective lab within 24 to 48 hours. This time may change based on flight availability, weather delays, or any other unforeseen obstacles in the shipping process.  


      The Laboratory 

      Upon arriving at the lab, a sample will go through a series of steps before a result is determined. The first step is called accessioning. It is the intake process in which a laboratory technician analyzes the specimen bag, enters and records specimen identification numbers to ensure consistency, and ensures that the integrity of the sample has not been compromised. If the sample passes this step, it is now eligible to begin the testing process.  

     The first phase of testing is called screening. During this initial testing phase, the laboratory will utilize sophisticated instrumentation to determine if any illicit substances are in the sample above a pre-determined level known as a cut-off level. Cut-off levels vary depending on the drug and employers can test for a variety of drugs; as such, employers are wise to use certified labs that have met stringent quality control requirements. If no illicit substances are detected above the cut-off levels for any of the drugs included in that employer’s drug-test panel, the result can be reported as negative to the Medical Review Officer (MRO), and ultimately the employer. This process can usually be completed in 24 hours or less from the time a sample has been received at the lab.   

      However, if an illicit substance is detected above the cut-off level during the screening phase, the sample will then move towards a second phase of testing known as confirmation testing. The lab, utilizing a sophisticated testing process typically involving either gas chromatography/mass spectrometry (GC/MS) or liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS), targets metabolites specific to an illicit substance or substances. Confirmation testing not only identifies specifically what illicit substance has been found in the sample, but also how much of that substance is in the sample. Confirmation testing cut-off levels can be different than the initial screen cut-off levels depending on the drug. A confirmed positive test result is then reported to the MRO who will begin the medical review process. 


     The Medical Review Officer 

     Once the lab has completed all necessary testing for a sample, that result is then released to the MRO. In workplace drug testing, laboratories rarely release results directly to an employer as the MRO plays a key role in the resulting process. It is typically the MRO’s final determination that is sent to an employer and serves as the result of record for an applicant or existing employee.  

     Federal regulations, often regarded as industry standards even for non-federal testing, require an MRO to be an MD or DO. Additionally, an MRO must meet certain criteria specific to substance abuse and misuse. This education and background qualify an MRO to make the necessary considerations for an employee or applicant during the final step in the overall drug testing process.    

     Once an MRO receives a negative result from the lab, the result will swiftly be passed along to the employer with the MRO’s signature, identifying it as the final, MRO-reviewed result. This process is usually completed electronically which causes very little delay in an employer receiving a result.  

     If MROs receive a positive result from the lab, they are then tasked with interviewing the employee or applicant to determine if there is a legitimate reason for a laboratory positive result. For instance, an individual may have a prescription medication that caused the positive result at the lab. If during the interview and verification process the MRO determines that the prescription is legitimate, the MRO will typically convert the result to negative and report this as the final result to the employer.  

      One caveat to this process is that some prescription medications may have side effects that can jeopardize safety in the workplace, despite a prescription being valid. Depending on the type of testing (federal, state, etc.) certain processes may be implemented by the MRO and employer to address these instances. 



     Lab-based drug testing is far more than just providing a sample at a collection facility. Despite the reliability of same-day shipping, cutting-edge laboratory technology, and streamlined MRO procedures, delays can still occur. Employers may often overlook the details of the testing process and count on their contractor or TPA to handle all the necessary steps. Having a general understanding of the overall lab-based drug testing process can be useful to employers wondering what is a causing result to take so long, or to an applicant wondering when they can begin their new job.



Have questions about the testing process?    

Contact NMS Management Services for more info: 800.269.0502

This information is provided for educational purposes only. Reader retains full responsibility for the use of the information contained herein. 

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