This story appears in the Nov. 3 print edition of Transport Topics.
ALEXANDRIA, Va. — Doctors who advise federal regulators said last week that truck drivers should be kept off the road if they’re taking prescribed drugs such as OxyContin and Percodan, but they declined to recommend changes because current rules allow drivers legal use of the drugs.
However, in a joint meeting, two key committees that advise the Federal Motor Carrier Safety Administration forwarded to the agency a slate of recommendations they said would help certified medical examiners evaluate the fitness of truck drivers who legally use drugs authorized by the government.
The agency tasked the medical review board to update recent research on the government’s Schedule II drugs and offer recommendations if changes are needed.
Schedule II opioid drugs have a high potential for abuse and can cause side effects. They are considered dangerous and potentially can lead to psychological and physical dependence, medical experts and the federal government have said.
Current FMCSA regulations allow drivers to use prescribed Schedule II drugs if their treating physician and a medical examiner feel their use will not impede the safe operation of a motor vehicle, said Gina Pervall, chairman of the medical review board and a physician who is medical director for Occupational Medicine Services at Johns Hopkins University.
By contrast, the Federal Aviation Administration does not permit airline pilots to fly while using opioids and a number of other drugs.
“Because we have a regulation in place, we can’t just change it,” Pervall said after a joint meeting of the medical board and the Motor Carrier Safety Advisory Committee on Oct. 27. “We’d have to change the rule.”
That could take years, she said.
So instead of calling for an outright ban, the two committees recommended that FMCSA require that a primary treating physician fill out and sign a standardized questionnaire to verify that a patient is taking the drug properly and not exhibiting side effects “that would adversely affect the driver’s ability to operate a commercial motor vehicle.”
“The questionnaire is a big deal,” said Steve Owings, MCSAC chairman and founder and president of Atlanta-based Road Safe America.
“Medical examiners only get a snapshot of the driver,” Pervall said. “So the questionnaire is to give the medical examiner some support from someone who is familiar with this particular driver and his history, his medications and his responses to the medications.”
She added, “It’s really a tool that will support the examiner in saying this person is fit, that he’s taking his medications and not having side effects related to them. Or conversely, that he’s not fit because of these medications and side effects that he’s having.”
Other recommendations the two committees approved included educating medical examiners on potentially dangerous narcotic drugs and certain over-the-counter drugs that can cause drowsiness, to issue guidance for driver use of narcotics and to convene a panel to further study Schedule II drugs.
In a national study of hospital emergency room visits for opioid overdoses, more than 67% of the overdoses involved prescription opioids, including methadone, followed by heroin, other unspecified opioids and multiple opioids, according to research published in the medical journal JAMA Internal Medicine.
“Opioid overdose exacts a significant financial and health care utilization burden on the U.S. health care system,” the study said. “Most patients in our sample overdosed on prescription opioids, suggesting that further efforts to stem the prescription opioid overdose epidemic are urgently needed.”
The five-member medical board and other medical experts advising the board said that recent research offers “moderate evidence” that opioid use can carry with it increased risk of fatalities, injuries, crashes and unsafe driver actions.
However, the research has concluded that there is “weak evidence” to support the contention that legal use of Schedule II stimulants increases crash risk.
If FMCSA acts on the questionnaire recommendation, it would require a medical examiner to send the form to the primary treating physician if a driver lists any Schedule II prescribed drugs on a medical examiner form. The treating physician then would fill out the form and return it to the medical examiner.
Although the two committees overwhelmingly approved the recommendations, there was debate over whether some primary physicians would sign the questionnaire due to liability concerns.
“A doctor would need to have his head examined to sign this form,” said Todd Spencer, a member of the MCSAC and executive vice president of the Owner-Operator Independent Drivers Association.
Albert Osbahr III, a member of the medical review board and a physician who is director of Occupational Health Services at Catawba Valley Medical Center in North Carolina, pointed out that a common problem is that truck drivers don’t always honestly answer questions about their medical history when they fill out their portion of the medical examiner’s form.
Mitch Garber, a physician with Engineering Systems Inc. and a member on the medical board’s expert drug panel, said another problem is that an estimated 40% or more of patients don’t take their drugs in the properly prescribed manner.