Health News Digest


August 1, 2016

Impaired Driving, SAMHSA, And The DOT: It’s…Complicated

By Michael D. Shaw

Federal regulation of the trucking industry dates back to 1935, via the Motor Carrier Act of that year, which extended the authority of the Interstate Commerce Commission (ICC). The ICC itself was created in 1887 in response to public outcry against abuses perpetrated by the railroad industry. For some time, railroad interests were able to use the ICC to fend off increasing competition from the truckers. Likewise, trucking companies already established in 1935—and grandfathered in—could use the same Act to discourage competition from new truckers.

Such, unfortunately, is the near-universal mixed blessing of Federal regulation. Indeed, a ludicrous crazy quilt of rules would spring up, whereby truck freight rates varied wildly by commodity, with some items not having regulated prices. In one widely cited example, regulated rates for hauling cooked poultry were almost 50% higher than the unregulated rates for fresh dressed poultry.

Inevitably, deregulation came into favor with the Motor Carrier Reform Act of 1980, which would primarily affect freight rates. Of course, other forms of regulation would soon follow. The Federal Motor Carrier Safety Administration (FMCSA) was established as part of the U.S. Department of Transportation (DOT), via the Motor Carrier Safety Improvement Act of 1999. FMSCA’s primary mission is to “reduce crashes, injuries and fatalities involving large trucks and buses.”

Pursuant to this worthy goal—among many other of its activities—the agency requires that interstate commercial motor vehicle drivers pass a physical exam every two years, conducted by a licensed examiner—in accordance with 49 CFR 391.41. The resulting certificate (“DOT medical card”) must be carried while driving.

The exam tests for a host of medical conditions, and in the case of blood pressure/pulse rate, certification periods shorter than two years might apply. Also included is the DOT drug test panel (“DOT 5”) checking for heroin, amphetamine, marijuana, cocaine, and PCP. Here’s where it gets interesting.

The use of certain drugs—legal and otherwise—is immediately disqualifying. For example: Methadone, medical marijuana, and anti-seizure medication. Many other drugs are part of a gray area, in which a driver’s individual reaction to the substance may disqualify him; or, even if he is technically certified, he may still not be hired by a given company.

Methadone was originally introduced in the late 1940s as an analgesic—and is currently used for that purpose. However, it is far better known these days for addiction treatment and related maintenance programs. Strangely, even though it is an immediately disqualifying drug, methadone is not part of the DOT drug screening.

DOT has been confronted on this matter, and invokes the bureaucratic shuffle: SAMHSA (Substance Abuse and Mental Health Services Administration) decides which drugs are on the screening panel. And clearly, politics comes into play. PCP, rightly demonized, would nonetheless be a most unlikely substance for working truck drivers to abuse.

Since methadone is used extensively in treatment programs, SAMHSA promotes the rather controversial notion (in its “Know Your Rights” brochure) 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 [Medication-Assisted Treatment] 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, computer programmers, and others.”

This is all very well, except that drowsiness is a recognized side effect of methadone, even if most patients will develop some amount of tolerance to this sedating effect, a few weeks after starting treatment.

It is easy enough to test applicants for methadone, but such assays would apparently run afoul of privacy rights. The end result is that applicants will simply lie about their use of the drug, and this prevarication is surely facilitated by our feckless bureaucratic tag team. Think about that, the next time you see an eighteen-wheeler.