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FMCSA & Drug Screening

By on October 12, 2018
Urine sample and prescription drugs symbolizing what can show up in a work related or probation drug testClick here to view my other Medical images

Changes You Need to Know

BY: DR. JOHN McELLIGOTT, DR. JOHN’S MEDICAL SOLUTIONS

As a Medical Review Officer (MRO), I must be certified by a recognized organization, the Medical Review Officer Certification Council (MROCC). All Department of Transportation Certified Medical Examiners (DOT-CME) may or may not be an MRO. However, if a DOT drug screen is done during your DOT exam or if you’re randomly tested, an MRO must review the test results.

In my practice, drug tests are read as negative, positive, or medically negative/high risk. With a positive test result, prescription records are requested to determine if prescribed medications may have affected the test. It is important to know what medications are in play, how they are prescribed, and how they are taken (not everyone follows the instructions exactly as written—sound familiar?).

Test results are sent back to the MRO or the company’s Designated Employer Representative (DER) for record keeping and sometimes, enforcement of company policies. If you’re an owner-operator, you may receive the paperwork from the MRO. Drug tests are called a 5-panel, which later became a 7-panel, due to some psychedelic party drugs that are widely available (rarely found in truckers).

Everyone is aware of the opioid epidemic that has spread across the country. Historically, truckers have been put on opiates by their doctors. Increasingly, CMEs have seen drivers on large amounts of opiates for pain. These synthetic medications are often prescribed by a provider (doctor) without consideration (or even the knowledge) of the fact that truckers are in safety-sensitive positions and could become impaired or addicted.

Changes to DOT Drug Screen

Beginning January 1, 2018, semi-synthetic opiates were added to the 5-7 panel DOT drug screen. These include OxyContin®, Percodan®, Percocet®, Vicodin®, Lortab®, Norco®, Dilaudid®, and Exalgo®. These opiates can be prescribed legally, however, if you are taking any of the above drugs, you must have a letter from your personal doctor stating why you need this type of medication and that you’re able to safely drive an 80,000-lb. rig.

The new regulations state that you will no longer be tested for Methylenedioxyethylamphetamine, also called “MDE” (called “Eve” on the streets). This is an amphetamine like ecstasy. However, 3,4-Methylenedioxyamphetamine (MDA), has been added to testing. This is a psychedelic drug of the amphetamine family that is mainly a recreational drug. Also, the MRO now has the authority to test for the active ingredient in marijuana, THC-V. Sample analysis can differentiate if the THC is smoked or from Marinol, a cancer medicine.

Reasons Not to Certify a Driver

Each CME has the authority to certify or not certify a driver based on his or her own evaluation. Personally, I will not certify drivers taking opiates for the following reasons:

  • Inappropriate prescribing or over treating a condition that can be managed with safer medications or without medications, using time-tested techniques.
  • A driver taking the narcotic may not be adhering to prescription directions (assuming so is “Dancing with the Devil”).
  • Opiates are medications that lower the pain threshold and require larger and larger dosages to control the condition, which can lead to very severe side effects and death.
  • Incapacitating side effects of opioids can lead to sudden hospitalizations.
  • Self-detoxification by a driver can cause severe anxiety and can diminish the ability to operate heavy equipment safely.
  • Self-detoxification is often associated with medication, most commonly a drug called benzodiazepines (sometimes acquired illegally). This drug is contraindicated to opiates and should not be taken at the same time because of the potential for fatal side effects. Death is not unusual due to a return to the original opiate dosage with a benzodiazepine still on board. This is usually preceded by severe seizures.
  • Increased risk of poor judgment.

Personally, for the seven reasons described above, I have not prescribed an opiate or benzodiazepine since 1992. I see trauma and patients with pain on a daily basis and have been a non-narcotic clinic for a long time. This was an easy policy decision based on seeing patients all over the country commit suicide after becoming addicted to hydrocodone.

I’m impressed to see the FMCSA paying attention to this epidemic, which does involve our most precious profession. To learn more about Dr. John’s Medical Solutions, go to docjmd.com.

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