DOT clearance?

[kcairns]

beautiful Matt keene thanks

[mattkeene]

This should NOT be an issue. In fact SAMHSA has a very nice 21 page pamphlet discussing that one can not discriminate against those on Bup

http://store.samhsa.gov/product/Are-You-in-Recovery-from-Alcohol-or-Drug-Problems-Know-Your-Rights/PHD1091

It specifically points out that "When provided at the appropriate dose to a person stabilized on methadone or buprenorphine, these medications have no adverse effects on intelligence, mental capability, physical functioning, or employability. Research studies demonstrate that MAT patients are comparable to non-patients in reaction time and their ability to learn, focus, and make complex judgments. MAT patients do well in a wide array of work settings, including professional positions, service occupations, and skilled, technical, and support jobs. MAT patients are lawyers, engineers, secretaries, truck and taxi drivers, teachers"

[edibill]

I agreed to write the letter stating that my patient was compliant with my program requirements and was stable on a low dosage of buprenorphine and that buprenorphine was not considered to be mood altering or cause sedation. That's all. The DOT medical examiner can take it from there.

[adavid]

I now why SSLONIM is perplexed by the FMCSA regulation regarding driving on narcotics. I think the basic problem is that we are butting heads with LEGAL SPEAK. One section the regulations lists conditions under which a driver may not be permitted to drive, e.g. it is forbidden to drive if taking narcotics. You have to scroll to an entirely different section of the regulations to read the criteria under which an EXEMPTION from he rules can be had. In Medical Speak we would not separate ideas like that.

[NoDrugs4u]

Ah, so the examiner was following protocol by requiring a letter from the prescribing physician. But the end result is the same, turfing responsibility onto the bup prescribing doctor.

How are we supposed to know if the driver can drive safely on bup. Are we supposed to go on a ride-along with them cross-country? Time to dust off my CB radio. "Breaker one-nine, this is Smokey here, you there Bandit?"

[kcairns]

state of art care for pt you describe does not include restriction from cdl

[entjwb]

I wouldn't hesitate because the Suboxone doesn't cause drowsiness. I have also performed DOT physicals. Even if I think or know the. Medication is safe, it is protocol to get a letter from the prescribing physician.

[adavid]

By Federal Motor Carrier Safety Administration (FMCSA) regulations a commercial driver who is taking a prescribed medication with potential to cause driving impairment.can still be certified fit for duty under certain specified conditions. One ofthe criteria is that the prescribing physician issue a letter to the CDL medical examiner in which he states that the patient is stable on the dose and that the medication is not causing driving impairment.
FMCSA regulations also states that a driver taking any amount of methadone for any reason may NOT be certified fit for duty.

[sslonim]

PS I looked at that again and it looks like it is saying can not use any drug in 1308.11 Schedule I OR amphetamine OR narcotic. So looks like no narcotics allowed. But then why did the DOT doctor even bother to ask you ...if its not allowed?

[sslonim]

1. There is a brief post on this in "Patient Prefers Subutex" by NoDrugs4U on 7/17/15
2. As you may know, to do DOT physicals now we must pass a test and get licensed (oh yeah there's a fee that I think is 4 figures before the decimal) so I don't do this anymore. So 2 issues: 1) what are DOT rules on this (see below)? and your/our role. I think it is up to the DOT doctor to know the rules. You can write a letter saying you feel your patient is safe to drive (if you do) but don't refer to DOT rules - just that based on your knowledge of patient he/she is safe to drive taking Suboxone.
3. So what is the DOT rule ... I just researched it and can't really figure it out.
Check here: https://www.law.cornell.edu/cfr/text/49/391.41 ---> section 391.41b(12) says:
Does not use any drug or substance identified in 21 CFR 1308.11 Schedule I, an amphetamine, a narcotic, or other habit-forming drug.
That looks like no narcotics allowed. But they have a link to 1308.11 and if you click on it, it lists opiates - there are about ? 50 listed and they include codeine, heroin, morphine but I do NOT see buprenorphine, methadone, fentanyl or hydrocodone listed.
So if anyone knows for sure please post.
Sam