The role of the Medical Review Officer (MRO) has been greatly impacted by cannabis legalization. This position helps balance the needs of the employer and employees by acting as a gatekeeper as it relates to employees’ personal health information (PHI). MROs also work as a check and balance to verify the accuracy of the drug testing process, as well as to develop effective workplace drug testing programs that take a holistic view of safety-sensitive roles to achieve drug deterrence and risk mitigation goals.