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Medical Review Officers Warned Not to Report Positive for Those Legally Prescribed THC


June 1993

In a little-noted but potentially significant development, medical review officers (MROs), the physicians responsible for interpreting the results of employee urinalysis, have been warned not to report those testing positive for marijuana if they are being legally prescribed THC, the primary psychoactive component of marijuana ("FDA Approves THC For AIDS Patients: First MRO Case Report," MRO Alert, April/May 1993, Vol. IV No. 4, p. 2). THC is delta-9-tetrahydrocannabinol.

According to a recent bulletin from MRO Alert, which is published specifically for medical review officers, the FDA approval of THC for treating various conditions, including AIDS wasting syndrome and nausea associated with chemotherapy, has resulted in cases of MROs confronted with urinalysis positive for THC for medical reasons. Although the accuracy of urinalysis remains in question (see April 1993 NewsBriefs), a positive in this case is generally not to be reported to the employer, guidelines stipulate. Below is an excerpt from the April/May MRO Alert newsletter.

"In March of 1993, the Food and Drug Administration approved the use of synthetic ... THC for use in the management of anorexia and nausea associated with Acquired Immunodeficiency Syndrome (AIDS). Soon thereafter, MRO Alert received the first report from an MRO who had a marijuana positive with this as the alternative medical explanation.

The chemical name for the synthetic preparation of THC is dronabinol. It is available under the trade name Marinol ... Marinol is a Schedule II compound, which is formulated in 2.5 mg, 5 mg, or 10 mg gelatin capsules for oral administration. The use of Marinol will result in a positive confirmed THC urine drug test result ...

The MRO should be aware that the package insert for Marinol warns that, because of the drug's profound effects on the mental status, patients should be warned not to drive, operate complex machinery, or engage in activity requiring sound judgment and unimpaired coordination. Therefore, an MRO should determine whether the person who is taking Marinol has a safety sensitive position.

In the Department of Transportation (DOT) program, the MRO should notify the employer that the individual presents a safety risk and should be placed on medical leave. In light of the psychoactive nature of the drug and lack of tolerance to these effects, the use of Marinol should disqualify the individual from safety related transportation activities while taking the prescribed drug.*

Employers should also recognize that the employee has a covered disability under the Americans with Disabilities Act (ADA). Therefore, there is an obligation to make reasonable accommodations, such as in the case where driving is only a small part of the individual's job. If, on the other hand, the job is solely driving, the individual would not be qualified while on Marinol.

With a valid prescription, the MRO should report the test result as a negative. The illicit use of marijuana as an adjunct to AZT is not uncommon. The use of the marijuana plant is still unauthorized (and illegal), and not a legitimate alternative medical explanation under federal programs ... "

*The actual prescribing information for Marinol was checked by NewsBriefs. It stipulates that until it can be determined if the patient will be able to tolerate the effects of THC therapy without impairment, he or she should be warned about driving or other hazardous activity. This is somewhat different from the warning in MRO Alert described above.