Attached is recommendation language concerning the use of medications by vehicle operators. The recommendations will be issued to Department of Transportation and other Federal agencies. The Board's rationale for the recommendations is not included in the attachment, and the proposed recommendations are subject to further review and editing.

To the U.S. Department of Transportation:

Develop, with assistance from experts on the effects of pharmacological agents on human performance and alertness, a list of approved medications and/or classes of medications that may be used safely when operating a vehicle.

Expressly prohibit the use of any medication not on the U.S. Department of Transportation's list of approved medications (described in Safety Recommendation I-99-xx) for twice the dosage interval before or during vehicle operation, except as specifically allowed, when appropriate, by procedures or criteria established by the applicable modal administration (the Federal Aviation Administration, the Federal Motor Carrier Safety Administration, the Federal Railroad Administration, the Federal Transit Administration, or the U.S. Coast Guard).

Evaluate the applicability of the restrictions described in Safety Recommendation xx-xx-xx for vehicle operators to transportation employees in all safety-sensitive positions. If appropriate, implement such restrictions within 2 years of their implementation for vehicle operators.

In coordination with the modal administrations, establish comprehensive toxicological testing requirements for an appropriate sample of fatal highway, railroad, transit, and marine accidents to ensure the identification of the role played by common prescription and over-the-counter medications. Review and analyze the results at intervals not to exceed 5 years.

To the Federal Aviation Administration:

In coordination with the Department of Transportation and the other modal administrations, establish, with assistance from experts on the effects of pharmacological agents on human performance and alertness, procedures or criteria by which pilots who medically require substances not on the U.S. Department of Transportation's list of approved medications may be allowed, when appropriate, to use those medications when flying.

In coordination with the Department of Transportation and the other modal administrations, develop, then periodically publish, an easy-to-understand source of information for pilots on the hazards of using specific medications when flying.

In coordination with the Department of Transportation and the other modal administrations, establish and implement an educational program targeting pilots that, at a minimum, ensures that all pilots are aware of the source of information described in Safety Recommendation A-99-xx regarding the hazards of using specific medications when flying.

To the Federal Motor Carrier Safety Administration:

In coordination with the Department of Transportation and the other modal administrations, establish, with assistance from experts on the effects of pharmacological agents on human performance and alertness, procedures or criteria by which highway vehicle operators who medically require substances not on the U.S. Department of Transportation's list of approved medications may be allowed, when appropriate, to use those medications when driving.

In coordination with the Department of Transportation and the other modal administrations, develop, then periodically publish, an easy-to-understand source of information for highway vehicle operators on the hazards of using specific medications when driving.

In coordination with the Department of Transportation and the other modal administrations, establish and implement an educational program targeting highway vehicle operators that, at a minimum, ensures that all operators are aware of the source of information described in Safety Recommendation H-99-xx regarding the hazards of using specific medications when driving.

In coordination with the Department of Transportation and the other modal administrations, establish comprehensive toxicological testing requirements for all (or an appropriate sample of) fatal highway crashes to ensure the identification of the role played by common prescription and over-the-counter medications. Review and analyze the results of such testing at intervals not to exceed every 5 years.

To the Federal Railroad Administration:

In coordination with the Department of Transportation and the other modal administrations, establish, with assistance from experts on the effects of pharmacological agents on human performance and alertness, procedures or criteria by which train operating crewmembers who medically require substances not on the U.S. Department of Transportation's list of approved medications may be allowed, when appropriate, to use those medications when performing their duties.

In coordination with the Department of Transportation and the other modal administrations, develop, then periodically publish, an easy-to-understand source of information for train operating crewmembers on the hazards of using specific medications when performing their duties.

In coordination with the Department of Transportation and the other modal administrations, establish and implement an educational program targeting train operating crewmembers that, at a minimum, ensures that all crewmembers are aware of the source of information described in Safety Recommendation R-99-xx regarding the hazards of using specific medications when performing their duties.

In coordination with the Department of Transportation and the other modal administrations, establish comprehensive toxicological testing requirements for all (or an appropriate sample of) fatal railroad accidents to ensure the identification of the role played by common prescription and over-the-counter medications. Review and analyze the results of such testing at intervals not to exceed every 5 years.

To the Federal Transit Administration:

In coordination with the Department of Transportation and the other modal administrations, establish, with assistance from experts on the effects of pharmacological agents on human performance and alertness, procedures or criteria by which transit vehicle operators who medically require substances not on the U.S. Department of Transportation's list of approved medications may be allowed, when appropriate, to use those medications when operating transit vehicles.

In coordination with the Department of Transportation and the other modal administrations, develop, then periodically publish, an easy-to-understand source of information for transit vehicle operators on the hazards of using specific medications when operating transit vehicles.

In coordination with the Department of Transportation and the other modal administrations, establish and implement an educational program targeting transit vehicle operators that, at a minimum, ensures that all operators are aware of the source of information described in Safety Recommendation R-99-xx regarding the hazards of using specific medications when operating transit vehicles.

In coordination with the Department of Transportation and the other modal administrations, establish comprehensive toxicological testing requirements for all (or an appropriate sample of) fatal transit accidents to ensure the identification of the role played by common prescription and over-the-counter medications. Review and analyze the results of such testing at intervals not to exceed every 5 years.

To the United States Coast Guard:

In coordination with the Department of Transportation and the other modal administrations, establish, with assistance from experts on the effects of pharmacological agents on human performance and alertness, procedures or criteria by which vessel operating personnel who medically require substances not on the U.S. Department of Transportation's list of approved medications may be allowed, when appropriate, to use those medications when performing their duties.

In coordination with the Department of Transportation and the other modal administrations, develop, then periodically publish, an easy-to-understand source of information for vessel operating personnel on the hazards of using specific medications when performing their duties.

In coordination with the Department of Transportation and the other modal administrations, establish and implement an educational program targeting vessel operating personnel that, at a minimum, ensures that all operating personnel are aware of the source of information described in Safety Recommendation M-99-xx [number to be determined when issued] regarding the hazards of using specific medications when performing their duties.

In coordination with the Department of Transportation and the other modal administrations, establish comprehensive toxicological testing requirements for all (or an appropriate sample of) fatal marine accidents to ensure the identification of the role played by common prescription and over-the-counter medications. Review and analyze the results of such testing at intervals not to exceed every 5 years.

To the Food and Drug Administration:

In coordination with the Department of Transportation and the other modal administrations, establish a clear, consistent, easily recognizable warning label for all prescription and over-the-counter medications that may interfere with an individual's ability to operate a vehicle. Require that the label be prominently displayed on all packaging of such medications.