We have all heard about the opioid crisis in America. It has reached such an epidemic state that both Federal and State agencies have pushed forward laws and regulations in and attempt to positively impact this epidemic. This is true in the trucking industry also. As the crisis has mushroomed into a national epidemic the number of truck and bus drivers testing positive has sky-rocked also. Recent federal data shows that positive drug tests for those working in safety sensitive positions within the department of transportation, including truck and bus drivers, has jumped by 77% since 2006.
THE SILENT PROBLEM
Career truck drivers are very familiar with chronic pain. The work of a truck driver often leads to problems that include muscular, nerve, and joint pain. Too often, doctors have been prescribing opioids to treat this pain to allow them to do their jobs. Unfortunately, the ease of obtaining these addictive medications has been a big reason for the over-utilization and addiction to opioids thereby leading to this crisis.
As we all know, federal regulations state that truck drives are prohibited from driving while using opioids unless permitted by the doctor that prescribes them. It used to be that truckers were required to self-report their use to their safety departments or during the DOT physical examination. Often times however they would fail to do so because of the fear of not being able to obtain their medical certificate.
WHY THE CONCERN IN THE TRUCKING INDUSTRY?
The concern with these medications, whether they are legitimately taken or not relates to their side-effects. Some of these side effects will most likely not interfere with the safe operation of a commercial motor vehicle. Many however can significantly impair a driver.
The most common side effects include the following:
- Sedation (being tired)
- Abdominal pain
You can see where some if not most of the above will impact a driver’s ability to drive safe. That is why there are warnings on labels indicating that those taking these medications should not drive or use heavy machinery. This is often overcome with strict recommendations from the prescribing physician, such as take these only at night (or prior to sleep), and on off days when a driver will not be subject to the issues associated with these side effects
A NEW REGULATION AND ITS EFFECT
As a consequence to the opioid crisis, and the increased number of positive drug tests being seen within the trucking industry, the FMCSA proposed a new rule in January of 2017 that would add four opioids to its drug-testing panel. This law went into effect on January 1st of 2018. Adding opioids to the panel was intended to eliminate the failures of self-reporting and hopefully lead to a decrease in opioid use by truck and bus drivers.
The new law, made two more significant changes. First, it replaced the test for MDEA or Ecstasy with MDA (methylenedioxyamphetamine). Both drugs are closely related and have a stimulating and hallucinogenic effect on the body. MDA stays in a person’s system longer however, and causes more aggression
WHAT ARE THE NEW DRUGS TESTED?
The four new substances that are mandated in a drug screening panel include hydrocodone, hyrdromorphone, oxymorphone and oxycodone. These are all frequently prescribed pain killers. The DOT says this new rule is designed to enhance safety, prevent opioid abuse, and combat the nations growing opioid epidemic.
Common brand names for these medications included within the new drug panel include, but are not limited to:
THERE ARE SOME VALID CONCERNS WITHIN THE TRUCKING INDUSTRY
Even though the overall response to the expanded drug panel has been mostly positive, there are some very valid concerns. First and foremost, these medications are prescription medications, and not street drugs. Truck drivers that take these medications often have legitimate reasons for taking these meds. It seems unfair that truck drivers that properly utilize legally prescribed medications in a safe way should be punished. Fortunately, there is some leeway in the interpretation of test results.
What is thought is that if these drugs are in your system, even for legitimate reasons (and used properly so that their side effects do not impair a driver), the driver will still test positive. This is not true however. The MRO (the Medical Review Officer) that reviews the result, will always look to see if a positive result is prescription related or not. If it relates to a legal prescription, they can log the result as a negative even when the driver is taking the opioid. There is a catch to this however. The MRO can utilize a five-day waiting period, if they are concerned about safety. This will lead to the driver being prevented from operating a rig until they are off the medication, or it gives the MRO time to consult with the driver’s physician and gather more information necessary to make a decision (they cannot challenge the physician however even if they are concerned that the medication is over prescribed). Either way, it can involve time out of the cab. The final decision by the MRO is a very delicate balancing act that can effect both driver and motor carrier.
SO WHATS A TRUCKER TO DO IF THEY TAKE PRESCRIPTION OPIOIDS?
First and foremost if they have a legitimate prescription it is in the driver’s best interest to disclose this information to a collection agent and of course the MRO should you be subject to a random or pre-employment drug test. Never refuse to take a drug test! DOT regulations state that a refusal to test is an automatic failure.
You can also take steps to help reduce the chance the MRO will recommend your removal from duty by”
- Provide proof of your prescription, such as a bottle label or note from your treating provider. Make sure this information is properly provided to the collecting agent or MRO when they call (they will always attempt to contact the donor in the event of a positive result prior to release the result so always answer the phone if it rings!).
- Obtain medical clearance from your treating provider for its use and the specific stipulations of use, prior to any DOT physical. By doing so, you will eliminate delays in certification. Realize, that all medical examiners understand that opioid use is prohibited by the FMCSA unless it is prescribed and the side-effects do not interfere with the safe operation of a CMV. If you do not bring this medical clearance in ahead of time, then the CME will have no options than to disqualify you. This will lead to the need to obtain this clearance anyway, and you will be out of the cab for a least a few days.
Lastly, and in closing, drivers need to look into and consider alternative pain medications and treatment methods other than taking opioids. Do not attempt however to quit “cold turkey”. This can be dangerous and potentially life-threatening. Discuss alternative pain management options with your doctor. Look for alternatives that are not opioids medications. Look into physical medicine to see if there are alternatives that do not utilize medicine, but rather encourage exercise to manage pain. You may even consider alternative therapies such as acupuncture for pain management. No matter what you use, if it manages you pain, you will be much better off whether you simply consider the fact you will be less likely to be away from driving or that you will just be healthier overall.
Keeping drivers healthy and on the road!
Dr. David Thorpe
Pass My Physical