By Nadine Wentzell, Chair, IAMRO
As Chair of the above-noted body, I am pleased to introduce our recently formed not-for-profit specialty organization. I suspect this is a new entity to most readers of this newsletter, and as such, my intent here is to provide you with an overview of who we are, how we came to be, and our focus and initiatives.
Who we are
IAMRO is a professional membership association of physicians and medical practitioners who provide Medical Review Officer (MRO) services in their respective countries of practice, health professionals and auditors who are Subject Matter Experts (SMEs), and forensic toxicologists who work in the field of workplace drug and alcohol testing.
Our vision
We believe in creating a world where consistency, fairness, and scientific rigor in workplace drug testing become a universal standard. Our vision is to foster safer, healthier, and more productive work environments by transcending borders, boundaries, and cultures. We understand that safe and healthy workplaces are a global concern, and we are committed to supporting the medical professionals who are responsible for ensuring that safety is upheld.
Our mission
Our mission is simple yet ambitious: to set the standard for workplace drug testing worldwide. We provide the tools, training, and advocacy that empower MROs and employers to implement fair and scientifically sound procedures. Through comprehensive education, international procedural consistency, and commitment to scientific integrity, we strive to help build healthier workplaces across the globe.
How we came to be
In September 2022, at the International Forum for Drug and Alcohol Testing (IFDAT) conference in Salzburg, Austria, an Expert Panel discussion centered around international MRO networking. Presenters Prof. Dr. Serap Annette Akgür (Turkey), Dr. Monica Eneholm (Sweden), Dr. Trevor Maze (UK), and Dr. Todd Simo (USA), led a discussion which focused on the need for cross-border professional support, how a network could be achieved, considerations for moving forward, current examples, and the establishment of an IFDAT MRO Working Group.
At the end of the session, due to extraordinary international attendee interest, multiple hallway conversations ensued, and by the end of that day a meeting of stakeholders from every part of the globe was convened. In that meeting, an informal working group was created. That group resulted in members of the panel and interested conference attendees making a commitment to begin the process of creating an international organization.
Overarching tenets
The world is becoming very small. Global organizations are looking far and wide for vendors who can fulfill their requirements. Our vision is to have a network of knowledgeable experts who provide consistency by “following the sun”, allowing organizations to leverage the same drug-free workplace rules regardless of where they operate geographically. Having “In-Region” MRO services is logically efficient, linguistically optimal, and affords country-specific rules to be handled by local experts, with an international resource base, as need be. The overarching tenet was to create a standard to enable organizations who operate globally to have confidence in their application of an accredited/certified approach that is consistent with in-region medical expertise, as it relates to their individual drug-free workplace programs.
Our focus and initiatives
Since that first “informal” meeting in September 2022, our dedicated group of individuals have met regularly to create an International Standard for MROs, identifying required activities and responsibilities, and clarifying the numerous components of the verification process.
Since only three countries have a codified MRO accreditation in place, the bases for the Standard were the Australia/New Zealand model and the regulations of the US DOT 49 CFR Part 40, Subpart G – Medical Review Officers and the Verification Process. The focus was to organize the information in a logical sequence, formatted for readability, and written in plain English to be easily interpreted by anyone, regardless of their language of origin.
The elements for “standardization” included strong recommendations for two contributing components that are not in the scope of MRO practices: collection practices, where we urge utilization of chain of custody procedures; and, laboratory analyses, where we encourage consistent and valid scientific methodologies.
For the medical review procedures, we defined the standards to be utilized by MROs in the performance of their work. We specifically covered the topics of the review of the external chain of custody, interpretation of the laboratory results, donor contact, donor interview, verification of the results, and reporting to the employer. The overarching goal is to offer employers drug testing programs that are fair and consistent with due processes for all parties.
Our starting point, process and structure
Our model prioritized collaboration of like-minded and motivated Subject Matter Experts (SMEs). As noted previously, our priority was to have a document written in plain English and understandable. We began by collaboratively establishing ground rules for our meetings, with collective agreement on the approach to be used and priorities of the group, led by two facilitators, George Gilpatrick and myself.
Board Members
Prof. Dr. Serap Annette Akgür
Dr. Charles Appleton
Dr. Monica Eneholm
George Gilpatrick
Joe Lofgren
Dr. Trevor Maze
Jo McGuire
Dr. Wim Schielen
Dr. Todd Simo
Nadine Wentzell
Board Executives
Chair – Nadine Wentzell
Chief Medical Officer – Dr. Todd Simo
Treasurer – Joe Lofgren
Secretary – George Gilpatrick
Administratively, the International Association of Medical Review Officers (IAMRO) is registered as a not-for-profit organization in the US and is recognized as doing business as IAMRO. The Board of Directors was formalized in August of 2023. The first Board meeting, which included operational by-laws, was held prior to the European Workplace Drug Testing Society (EWDTS) conference in October 2023, in Istanbul, Turkey. At this conference Dr. Trevor Maze, Dr. Todd Simo, and myself, as Chair, first introduced our organization and intended initiative.
Key areas for the MRO
Specific areas of the Standard include MRO qualifications, responsibilities, laboratory relationships, functions in review of laboratory results, donor notification, verification processes and prohibitions, “uncommon” situations, transmission of results, and administrative functions.
Finalized standard
Our ongoing discussion and debate included peer review, consensus on the final draft, and fine-tuning along the way, so that after 42 iterations we had a finalized document. Yes, you read that correctly. It took that many iterations until we finally had a document on which we could all agree, and which met our collective goals. As of August 2024, the first component of our initiative became a reality: our Standard was finalized.
European application
I am pleased to advise that as of October 2024, a second exciting milestone of our Association was accomplished: EWDTS accepted the IAMRO Standard as an EWDTS guideline and recommends that all European countries undertaking legally defensible workplace drug testing use this Standard as a working template for their MROs.
Additional areas of accreditation or certification have been initiated, and others are being explored. Most recently, discussions have begun regarding a submission to the European Accreditation Agency for application of ISO certification.
Important points about the standard
The intent of the Standard is to provide an outline for MRO performance in jurisdictions where no such guidance currently exists, and to complement in situations where guidance is already in effect. It is not intended to overrule or replace existing legislation, regulations, protocols, or other requirements.
The Standard delineates various scenarios where an employer, or its service agent, intends to engage an MRO. The specific scenarios referenced are:
- Laboratory positive results only review
- Laboratory non-negative results review
- Comprehensive review of all laboratory results.
Application of the Standard supports consultation with a toxicologist as a complementary and informative component of the MRO review process, as applicable and appropriate.
Finally, and most importantly, the Standard is the foundation on which the MRO training and procedures of the IAMRO are based. It is not intended to be used in isolation or applied in the absence of these or any additional IAMRO components.
Standardized training
Following the last point of the previous section, the IAMRO has created the framework for international MRO training. The curriculum includes much of what has been identified as included in the Standard, with emphasis on what to do in situations of a positive test result review, “troubled test” review, and the administrative functions of an MRO. The training is intended to concentrate on the practical application of the Standard with a focus on “what to do when.” We are pleased to announce that the first IAMRO training will be held on April 12-13, 2025, in Barcelona, Spain, immediately following the EWDTS 14th Symposia. More information will be available on our website in the near future.
For more information
Our website, www.iamro.org, is a hub for physicians and medical professionals around the world. Information about our global Standard is available, there’s a sign-up section for in-person MRO training sessions, and a wide array of resources and tools designed to support the work of MROs. It’s also a place for sharing insights, best practices, and engaging a global community of peers who are dedicated to excellence in workplace health and safety.
Additionally, our website includes information on our priorities for the coming year, initiatives we’re establishing to align with those priorities, and our focus on growing our associate membership internationally.
Our site is not exclusively for MROs. We openly welcome others to join us: interested individuals, associates or affiliates who share our motivation in creating a future where consistency, fairness, and scientific rigor form the foundation of every workplace drug testing program.
If you’re looking for more information on IAMRO and/or are interested in becoming an association member, please visit our IAMRO website, www.iamro.org.