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You may be wondering if a buprenorphine/naloxone prescription will raise a red flag during your Department of Transportation (DOT) medical examination because it’s used to treat opioid use disorder.
The Federal Motor Carrier Safety Administration (FMCSA, a division of the DOT) doesn’t allow on-duty commercial drivers to possess or be under the influence of opioids and other narcotics. How will the DOT medical examiner handle your history of opioid use disorder? And will they disqualify you for taking a medication that’s technically a narcotic?
Although the medical examiner has the final say in whether you can safely drive a commercial vehicle, having a buprenorphine/naloxone prescription isn’t an automatic disqualification. Read on to learn more about how the DOT handles prescription medication and controlled substances.
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The FMCSA is a division of the DOT that’s responsible for promoting safety among motor carriers. Its ultimate goal is to reduce the number of injuries and deaths associated with large trucks and buses. Drugs (both prescribed and illicit) are among the many substances the FMCSA regulates to ensure the safety of drivers, passengers, and other people sharing the road.
Regulations are published in The Motor Carrier Safety Planner. Chapter 6, Section 3.3 describes rules concerning drugs. It says no on-duty driver can possess or be under the influence of the following:
Schedule I drugs are not allowed under this prescription exception. For certain other controlled substances, a driver may still qualify if the medication is prescribed by a licensed medical professional who knows the driver’s medical history and advises that it won’t interfere with safe driving.
At first, you might think buprenorphine/naloxone disqualifies you from a commercial driver’s license (CDL) because buprenorphine is technically a narcotic. Even though it’s used to treat opioid use disorder, it’s also an opioid.
The human nervous system has four types of receptors that opioids can bind to. Buprenorphine blocks activity in two receptors while stimulating (activating) the other two receptors.
Buprenorphine binds very strongly to certain opioid receptors, which can make it harder for other opioids to have their usual effects. However, other opioids can still affect the body, and overdose is still possible.
These properties make buprenorphine useful for minimizing opioid withdrawal symptoms without causing intoxication. Buprenorphine activates opioid receptors enough to reduce withdrawal symptoms and cravings. However, buprenorphine can cause sedation and may impair driving, particularly when treatment starts or the dose changes.
Buprenorphine/naloxone is not an automatic disqualification for a commercial driver. However, having a valid prescription alone isn’t enough. The prescribing provider must advise that the medication won’t interfere with safe driving, and the medical examiner makes the final decision about whether the driver qualifies.
For a prescription to be valid, it must be prescribed by someone with a medical license that meets federal, state, and local regulations. The DOT medical examiner will ask for details about the prescription and the prescribing doctor to verify its validity. They may also ask your healthcare provider if you’re capable of safely operating a commercial motor vehicle.
A history of opioid use disorder doesn’t automatically prevent you from qualifying for a CDL. Taking buprenorphine/naloxone shows that you’re receiving treatment, but the medical examiner will still consider your current condition and whether you can safely operate a commercial vehicle.
Listing it on your Medical Examiner Report Form (Form MCSA-5875) doesn’t automatically mean you’ll fail the exam. However, it’s ultimately up to the medical examiner to decide if you meet the medical requirements for a CDL.
Buprenorphine/naloxone doesn’t show up on a typical 5-panel drug test, which is the type of test used by the DOT. Other opioids, like codeine, hydrocodone, heroin, and morphine, do show up on the 5-panel drug test. An employer would have to specifically request a buprenorphine test to detect it. Naloxone doesn’t show up on routine drug tests.
Buprenorphine is usually detected through a urine sample, but it can also show up in blood, saliva, and hair. Buprenorphine can be detected in urine for up to seven days after your last dose, in blood up to two days, and in saliva up to three days.
Exactly how long buprenorphine remains in your system depends on a variety of factors, such as how much you take, how long you’ve been taking it, and your personal metabolism.
If an employer does run a buprenorphine test and it comes back positive, they should ask you for an explanation. You can provide prescription information to show that you’re using buprenorphine legally.
Passing the medical exam and getting your CDL is just one hurdle you’ll need to cross when becoming a commercial driver. Employers may have stricter policies about whether certain medications make it unsafe for you to drive.
However, you do have some legal protections under the Americans with Disabilities Act (ADA). An employer can’t legally turn you down for a job just because you take buprenorphine/naloxone.
With a valid prescription, buprenorphine/naloxone is considered medically assisted treatment (MAT). The ADA protects your right to employment while undergoing MAT. If an employer has concerns, they must assess whether you can safely do your job and provide reasonable accommodation.
If they determine you can’t do your job safely and there’s no way to reasonably accommodate your buprenorphine/naloxone use and overall opioid use disorder treatment, they can legally decide not to hire you or to terminate employment.
If you’re worried about passing the medical exam for your CDL, plan ahead.
Be honest with yourself about your current ability to drive safely. Buprenorphine/naloxone side effects can make driving difficult or dangerous.
In clinical trials, people who took buprenorphine/naloxone were more likely to experience low blood pressure compared to people who took a placebo. Low blood pressure can cause dizziness, blurred vision, drowsiness, or loss of consciousness, all of which can be especially dangerous when experienced behind the wheel.
Failing the DOT physical doesn’t necessarily end your dreams of being a CDL driver. You can request another exam at any time, but the examiner will want to know how your health has improved since the previous exam.
For example, if your use of buprenorphine/naloxone causes concern due to side effects, you could discuss an alternative treatment plan with your healthcare provider, start the new treatment, and redo the medical exam.
If you have a verified positive DOT drug test, you have 72 hours after being notified to request testing of the split specimen at a second certified laboratory. This is not a new drug test or a new sample collection.
If you don’t request a retest or the second test comes back positive, you’ll need to complete a process called return-to-duty. The name can be a little confusing, as you’ll need to complete the return-to-duty process even if you’re seeking your CDL for the first time and not “returning” to previous employment. Return-to-duty requires meeting with a substance abuse professional (SAP), completing their recommended education or treatment, and passing another drug test.
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