49 CFR 391.41(b)(12)(i)(ii)(A)(B)

"A person is physically qualified to drive a commercial motor vehicle if that person —

Does not use a controlled substance identified in 21 CFR 1308.11 Schedule I, an amphetamine, a narcotic, or any other habit-forming drug.

Exception. A driver may use such a substance or drug, if the substance or drug is prescribed by a licensed medical practitioner who:

Is familiar with the driver’s medical history and assigned duties; and

Has advised the driver that the prescribed substance or drug will not adversely affect the driver’s ability to safely operate a commercial motor vehicle."

Regulations Versus Medical Guidelines (Guidance)

The effects and/or side effects of medications may interfere with safe driving. The driver may experience an altered state of alertness, attention, or even temporary confusion. Other medications may cause physical symptoms such as hypotension, sedation, or increased bleeding that can interfere with task performance or put the driver at risk for gradual or sudden incapacitation. Combinations of medications and/or supplements may have synergistic effects that potentiate side effects, causing gradual or sudden incapacitation.

The demands of commercial driving may complicate adherence to prescribed dosing intervals and precautions. Irregular meal timing, periods of sleep deprivation or poor sleep quality, and irregular or extended work hours can alter the effects of medicine and contribute to missed or irregular dosing. Physical demands may increase pain and the need for medication.

Three types of medications may be used by the commercial driver:

• Prescription.
• Over-the-counter (OTC).
• Supplements and herbs.

Every year, more medications are available without prescription and provider supervision. Nonprescription medications are not necessarily safe to use while driving

In the advisory criteria general information, you are instructed to discuss common prescriptions and OTC medications relative to the side effects and hazards of these medications while driving. In addition, educate the driver to read warning labels on all medications.

The general purpose of the history and physical examination is to detect the presence of physical, mental, or organic conditions of such character and extent as to affect the ability of the driver to operate a commercial motor vehicle (CMV) safely. This examination is for public safety determination and is considered by the Federal Motor Carrier Safety Administration (FMCSA) to be a "medical fitness for duty" examination.

As the medical examiner, your fundamental obligation is to establish whether a driver uses one or more medications and supplements that have cognitive or physical effects or side effects that interfere with safe driving, thus endangering public safety.

The examination is based on information provided by the driver (history), objective data (physical examination), and additional testing requested by the medical examiner. Your assessment should reflect physical, psychological, and environmental factors.

Medical certification depends on a comprehensive medical assessment of overall health and informed medical judgment about the impact of single or multiple conditions on the whole person.

During the physical examination, you should ask the driver to provide a complete history of medication use, including OTC medications and food and herbal supplements. The FMCSA Medical Examination Report form includes health history questions and physical examination checklists. Additional questions should be asked to supplement information requested on the form. You may ask questions to ascertain the level of knowledge regarding appropriate use of the medication while driving.

  Regulations — You must review and discuss with the driver any "yes" answers

Does the driver use medications to:

• Treat cardiovascular disease?
• Reduce hypertension?
• Control blood glucose level?
  • Oral hypoglycemics?
  • Insulin (regardless of route)?
• Control seizures or treat epilepsy?
• Treat nervous or psychiatric disorders?

Did the driver list all medications (including OTC medications) used regularly or recently?

Recommendations — Question that you may ask include

Does the driver experience:

• Dizziness or light-headedness?
• Hypotension?
• Sedation?
• Depressed mood?
• Cognitive deficit?
• Decreased reflex responses?
• Unsteadiness?

  Regulations — You must evaluate

On examination, does the medication have:

• The desired effect on the underlying disease (e.g., blood pressure is lowered)?
• Side effects that interfere with safe driving (e.g., uncontrollable tremor or orthostatic hypotension)?

Important considerations for medication use while driving

Does the medication:

• Indicate the presence of underlying disqualifying disease or injury?
• Effectively treat the disease or medical condition?
• Exhibit side effects that interfere with safe driving?
• Have side effects that interfere with lifestyle functions such that the driver may cease to comply with treatment (e.g., decreased libido).
• Have potential for gradual or sudden incapacitation, or exacerbation of underlying medical condition, due to missed dose (e.g., seizure, psychosis)?
• Require monitoring to maintain a therapeutic dose or prevent toxicity (e.g., Coumadin)?
• Interact with other drugs, food, and/or alcohol, interfering with the ability to drive?

Does the driver:

• Understand and comply with medication plan, including monitoring?
• Know what warning signs might indicate medication toxicity, interaction, etc.?
• Store medications properly when driving long haul or cross country?
• Read and understand warning labels on medications and supplements?
• Consult the treating healthcare professional and/or a pharmacist before using new medication or combining medications while driving.

  Regulations — You must document discussion with the driver about

• Any affirmative history, including:
  • Onset date, diagnosis.
  • Medication(s), dose, and frequency.
  • Any current limitation(s).
• Potential negative effects of medication use, including OTC medications, while driving.
• Any abnormal finding(s), noting:
  • Effect on driver ability to operate a CMV safely.
  • Necessary steps to correct the condition if appropriate, or reasons for disqualification.
• Any additional tests and evaluation.

Medical fitness for duty includes the ability to perform strenuous labor and to have good judgment, impulse control, and problem-solving skills. Overall requirements for commercial drivers as well as the specific requirements in the driver role job description should be deciding factors in the certification process.

The following link to select medication topics and medication regulations/guidance key points: