There may be no area of greater controversy in commercial motor vehicle (CMV) driver clearance than the question of what medications it is safe for a driver to use while driving. There are few regulations prescribing medication use and only a handful of guidance recommendations. The situation is further clouded by the lack of recent recommendations and the lack of objective data in the medical literature.
Disqualifying prescription medications include methadone and insulin. In the case of methadone, the rationale for disqualification is murky – this regulatory requirement dates back decades, and the reasons for requiring disqualification for methadone use but not requiring disqualification for medications of similar ilk are not provided in any FMCSA documents. With insulin, at least the rationale is clear: since the greatest driver risk associated with diabetes is hypoglycemia, prohibiting insulin use makes sense given hypoglycemic risks associated with insulin use.
For all other medications, FMCSA guidance suggests that drivers using medications that could affect driver safety should only be cleared if such medications are prescribed by medical providers who are: 1) familiar with a driver’s job duties; and if 2) such providers state that use of the medications as prescribed will not affect driver safety. Use of forms that assure that such requirements are met is usually the easiest and best way to achieve this. The NRCME Training Institute includes sample forms for this purpose in the Extra Questions & Materials section of our training program.
Risks associated with medication use relate to effects and side effects of the medications themselves, and risks related to the underlying conditions for which such medications are prescribed. The medical examiner should obtain from the treatment provider statements regarding the safety of medication use and regarding driver safety given the underlying condition. Medical examiners should also document discussion with the driver about medications and the conditions for which they are prescribed.
So what medications are we talking about? Basically, any medication that might affect driver alertness and concentration should be considered. Broad categories of concern include narcotic and non-narcotic pain medications, sedative-hypnotics, and benzodiazepines. Some medical experts advising the FMCSA even include such broad classes of medications as antidepressants and beta-blockers. Other specific medications referenced include zolpidem (Ambien) and Chantix.
When assessing a driver using any medication of concern, how and how long the driver has used the medication should be taken into consideration. If a driver has taken a given medication for years, sometimes decades, describes no effects or side effects of concern, and has maintained a perfect driving record during that time, many medical examiners would consider certification of that driver. Even with medications of concern, if the driver has prescribed use only before sleep and describes use consistent with that prescription, many medical examiners would consider medical clearance.
Especially given that there is precious little objective data on which to base certification decisions related to medication use, medical examiners may choose to be circumspect with regard to blanket prohibitions on the use of certain medications. Medical examiners who document driver discussion and who obtain required medical clearance statements from prescribing physicians are meeting expected standards for driver clearance related to medication use.
Steven St. Clair, MD, MPH
Dr. St. Clair is a medical consultant to the NRCME Training Institute, LLC. The NRCME Training Institute, LLC provides an affordable 100% online DOT medical examiner training program which meets and exceeds FMCSA requirements.
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