DRAFT – SHOS MRO POLICY ON MEDICAL MARIJUANA REPORTING
Michigan’s law on medical marijuana use has left Medical Review Officers (MRO’s) as well as employers and other
parties in an uncertain position in approaching these cases. The landscape may change as case law evolves, but at this
point the Spectrum Health Occupational Services MRO’s wish to clarify our approach. This should help assure
consistency as well as help our client employers in understanding the rationale and implications of our reports.
Rationale and Conclusions
As our clients know, Medical Review of drug test reports allows for separation of legally prescribed medication use from
illicit use, and in when appropriate reversal of laboratory-positive results to negative reports to employers. Even when
medication use is legally prescribed, safety concerns may be identified in the review process, and employers are notified
of that along with the negative drug test report. Medical marijuana use does not fit this process well however, because
although legal under state law it remains illegal federally, also because without a true prescription there is no way to
judge whether the medication is being used ‘as prescribed’. Simply identifying a safety concern and suggesting a ‘Fitness
For Duty’ exam would not fully address those concerns. For consistency and defensibility we will continue to follow
federal law and Department of Transportation regulations and will not overturn positive marijuana laboratory reports
based on Michigan medical marijuana recommendations. These reports will continue to indicate ‘positive’ for
marijuana.
Our clients are also aware that according to the Americans with Disabilities Act (ADA), employers may not discriminate
against an individual with a qualified disability for obtaining treatment, or the side effects of that treatment. However,
ADA expressly states that employers may prohibit the use of illegal drugs. The definition of an illegal drug under ADA
means drugs, the possession of which is unlawful under the federal Controlled Substances Act. Thus, an employee with
a legal recommendation for marijuana, who is using it to treat the symptoms of a qualified disability, is not actually
protected under ADA due to the division between state and federal law.
Recommendations to employers
We are all aware that negative employment consequences stemming from recommended medical marijuana use are
being challenged in court. Therefore, although we will encourage donors in the review process to report their medical
marijuana use to the employer, you may also wish to actively inquire whether there is a medical recommendation in
these cases prior to acting upon the report. Your testing policy should address this situation; legal counsel is highly
recommended in creating the policy and may need to be considered case by case. If requested, we could pursue
verification of the medical recommendation via a similar process to that used for other medications, although we would
not overturn a positive result. If your policy does allow accommodation for medical marijuana use but there are safety
or performance concerns, requesting a Fitness For Duty examination would remain an option.
We will continue to monitor developments in this area and would consider a modified stance if circumstances so dictate.
Meanwhile, open lines of communication with our clients will remain our most useful tool. When the waters are cloudy,
direct discussions can help to clarify and may be initiated from either direction. Your questions, concerns and comments
are most helpful and welcome.
Dr. Richard Rasmussen, MD
Medical Director
Spectrum Health
Employee Health Services