Author: Dr. David Thorpe, DC, DACBOH
Trying to figure out what medications will affect a driver’s ability to pass their DOT physical examination can be a confusing and stressful task for a driver or motor carrier. The first thought that comes to mind is that there is some sort of “magic bullet” that will provide a quick and easy answer to this question. Unfortunately this is not the case. There is more to it than simply being able to look up a medication and then having an answer. It involves not only a regulation or guidance provided by the FMCSA (of which there is very little in a way to help guide us through this issue), but also the treating provider and the decision making process employed by the medical examiner.
As President of “Pass My Physical” I frequently get calls from medical examiners, drivers and of course motor carriers asking how they should address this concern. It has been my experience that many of the decisions made by medical examiners are in error and lead to delays in certification that are not necessary. So if you are a driver, or maybe even the safety director looking to ensure you can keep your drivers safely on the road moving freight, what should you do? The answer is to understand how medications are viewed by the medical examiner, and to follow a process that will allow you to navigate your way to medical certification with little or no delay.
What medications are definitely disqualifying?
There are only 2 times when medication use is always disqualifying. If you are using Methadone or a Schedule I drug such as marijuana, peyote or another medication on the long Schedule I list of drugs that are never prescribed, then yes, you will always be disqualified from driving a commercial vehicle. These specific medications are in a special group called “Absolute Disqualifiers”. This means there are no exceptions whatsoever to this rule (even if you live in a state that allows for the use of mar. To make it absolutely clear, there is NO exception to this rule, including medical or legal recreational use of marijuana or religious based ritual use of peyote. The only way around this is to stop using Methadone or a Schedule 1 drug. You might have noticed that Chantix is no longer an absolute disqualifier. It now falls into a category of medications that we will discuss in Part 2 of this blog.
Keep in mind that if a driver is using any drug to treat a disqualifying medical condition, it will be the medical condition that will cause the driver to be disqualified, not the medication being taken. An example would be a driver taking methadone for opioid addiction. If the driver’s medication was switched to saboxone, the driver would still be disqualified because they are still in treatment for opioid addiction. If a driver was taking methadone for pain relief, the driver would be disqualified for taking methadone but could change to another medication such as saboxone and be qualified to drive, even though saboxone is usually used to treat opioid addition.
The good news is that, with the exception of “absolute disqualifying” medications, all other medications can be considered for use in commercial driving. There are still a few restrictions that apply to certain medications when used to treat certain medical conditions. Drivers with a history of stroke cannot be taking anticoagulant medication. And if you are taking insulin for diabetes or an anti-seizure medication to prevent seizures you are only allowed to drive across State lines if you obtain a Federal Insulin or Seizure exemption. If you only drive within your State, you should check your State medical requirements for driving a commercial vehicle when taking these medications. Many States offer an Insulin Use waiver or exemption, and a few let drivers using insulin drive without requiring much more than a letter from the treating provider. At this time, the Federal insulin use exemption take about 3 months to obtain, whereas State exemptions/waiver can usually be obtained in far less time.
So, what about all other types of meds?
To obtain a medical examiner’s certificate when taking medications that are not disqualifying, drivers have to be aware of the type of medication they are taking. Those meds that are of concern, typically have what is referred to as guidance for medical examiners to follow. Examples include amphetamines, narcotics (mostly opioids) or any other medication with a high risk of abuse. The medical examiner must obtain clearance from the prescribing provider for these types of medications prior to certifying the driver. Without that clearance, the medical examiner has no choice but to disqualify the driver.
Certain medications such as opioids like oxycodone may be difficult to get clearance from the prescribing provider. This is a trend among prescribing providers that seems to growing. When this occurs, there are two options. The first is for the driver to work with his provider to change medications, and as long as the new medication controls the medical condition being treated, the driver may be medically certified. Given that there needs to be time for the new medication to take effect, and for the medical condition to show it is being effectively treated with the new medication, this will delay the driver from getting back on the road. The second choice is for the driver to find a new medical provider. It’s not unusual for the new provider to provide clearance for the current medication as prescribed once they obtain a medical history showing treatment effectiveness and any reports of safety related side effects. Again, this might delay obtaining a medical certificate but it could be well worth the effort. A driver should call first to ask whether the examiner has concerns with providing medical clearance for the medication being taken.
There are several other classes of medications where FMCSA guidance is to disqualify the driver. Medical examiners, if aware of FMCSA medication guidance calling for disqualification, will usually do just that. They will disqualify the driver. What they do not understand is that prior to disqualifying the driver, they should perform a case-by-case evaluation. This is the step that greatly increases the chance for the driver to continue driving. This can be used for drivers taking any medication as long as the medication being taken is not an “absolute” disqualifier.
In a case by case evaluation, a medical examiner should get clearance from the prescribing provider even when the medication is not a narcotic, amphetamine or drug with a high risk of abuse. This applies to any medication that is in a class where FMCSA guidelines suggest caution or disqualification. The next step should be for the driver to sign a statement stating they are not having side effects from the mediation while driving. Again, without that, it’s unlikely the driver should be qualified to drive. And lastly, the medical examiner reviews the medication’s classification, intended effects, side effects, half-life, relative dosage, when taken, and how long the driver has been taking that medication. Then the decision whether to certify the driver is made. Following this process greatly increases the chance that a driver previously disqualified will receive a medical certificate, although it will probably be for one year rather than two.
The reason that case-by-case determinations benefits drivers is that it addresses issues of the driver, the public, and the medical examiner. In our litigious circumstances, medical examiners have to consider their risk should a driver be involved in an accident. Using this 3 step process, the medical examiner has clearance from the provider most familiar with the driver’s medical history and any reactions to the prescribed medication. And the driver’s attestation that they are not experiencing any side effects affecting safety is a second defense. And lastly, the case-by-case review performed by the medical examiner is proof that a careful evaluation was performed.
Because medical examiners are not equal in their knowledge and attitude towards going the extra mile to help drivers, a motor carrier or driver who has been disqualified might find it a good idea to look for a medical examiner who knows how to use the medical guidelines to “steer” drivers thru the medical examination process.
What should a driver do to prepare for their exam so that they will not be disqualified?
The answer to this is simple. BE PREPARED WHEN YOU GO IN FOR YOUR EXAM!
This involves a three step process:
- Know the meds you are on, what the dosages are, and how long you have been on them.
- Get off of the medications that are automatically disqualifying if you can, and obtain clearance for all other medications.
- Go to medical examiners who you feel have the driver’s best interest at heart, and will help steer the driver toward what is needed to certify.
It has been my experience in the many years of performing exams, and in consulting with medical examiners and motor carriers that by following the above steps, the driver will significantly increase their likelihood of being certified without any delay. That is why this solution is one of the many solutions that has been put into the Pass My Physical mobile application, including all clearance letters and the cooperative partnerships with national networks of medical examiners who have the added training and understanding to help the driver through this process. The app will not only explain the process listed above, but direct the driver to what is needed to ensure they have the greatest chance to become certified. It will also help them identify medical examiners who are understanding of this process. An all in one solution!
