Opioids - High stakes on the highway due to chronic pain
An all-too-common occurrence is when a commercial motor vehicle (CMV) driver goes in for a medical recertification, and the driver is taking oxycodone (opioid) to treat a condition, such as a chronic back issue.
Carriers should know what happens after the Certified Medical Examiner (CME) becomes aware of opioid use.
The medical standard
A surprise may be that non-CDL and CDL drivers can fail their medical exam if they cannot meet the standard in section 391.41(b)(12) - Scheduled Drug Use.
A CME cannot qualify any driver who uses Schedule I drugs or substances, including marijuana.
However, if the prescription exception requirements are met, a CME may qualify an individual who uses an amphetamine or other prescribed drug or substance, such as an opioid, listed on Schedules II through V in 21 CFR 1308.12 through 1308.15. The schedules are maintained by the U.S. Drug Enforcement Administration and referenced in DOT regulations.
The prescription exception
A drug or substance can be prescribed to a CMV driver by a properly licensed medical practitioner. The prescriber must:
- Be familiar with the individual’s medical history, and
- Confirm and advise the individual that the drug or substance will not adversely affect the individual’s ability to operate a commercial motor vehicle safely.
There are two ways for the CME to meet the prescription exception:
- Request documentation from a compliant prescriber, or
- Use the voluntary Driver Medication Form (MCSA-5895) with the driver’s consent.
Can the driver be drug tested?
CMEs may request additional testing (e.g., x-ray, sleep study) when performing driver physicals, including a drug test. The CME may request a non-Department of Transportation (DOT) drug test to aid in the physical qualification determination, including when signs indicate the individual may not have disclosed the use of a scheduled drug or substance.
Note: The results of a non-DOT drug test during a physical exam are not covered under 49 CFR Part 382, even if the driver holds a CDL. Therefore, the use of a substance abuse professional (SAP) is not required if the test returns positive.
No prescription
Suppose a driver admitted to taking opioids that were left after a prescription expired, but only when their shoulder bothered them at night so they could sleep.
A driver cannot be medically qualified and take Schedule II through V drugs without meeting the prescription exception. The driver will fail the exam if there is no prescription from a qualified prescriber or the medication is not used within the confines of a prescription. The new exam result nullifies the prior medical card, even if time remained until expiration. The driver remains medically unqualified until the medication issues are resolved.
The certification decision
Before making a decision, the examiner may request a non-DOT drug use assessment to determine either if improper use is occurring or the need for treatment. If there is no longer a valid medical reason for taking the drug, addiction may be the concern.
Examples of how CME’s may handle the certification decision:
- Add qualifiers to the medical examination report (MER) or ”long form,” such as the drug in question cannot be taken within a certain number of hours before operating a CMV, or
- Issue a short-duration certification of one year or less.
The final medical certification determination rests with the CME, who is familiar with the duties, responsibilities, and demands of being a commercial driver.
Keys to remember: Both CDL and non-CDL drivers are prohibited from taking Schedule I drugs. Drivers can only take Schedule II through V drugs with a prescription from a licensed provider when use does not cause safety concerns.