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)
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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.
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General Purpose of Health History and Physical Examination
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.
Key Points for Medications Use Examination
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.
Record
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.
Remember
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.
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