I was wondering about the patients who currently take Suboxone. I practice in an area where drug abuse is epidemic. I know methadone users are disqualified but was also wondering about Suboxone. I am uncomfortable with the thought of any of these substances being taken by drivers….but also don’t want to be prejudicial. I can’t find any information on this particular substance.
FMCSA does not specifically address Suboxone (
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You are correct, the examiner does have the discretion to determine the effects of the medication being used and whether the underlying condition is controlled or may contribute to unsafe operation of the vehicle. We don’t disagree on that.
My personal practice has been to disqualify most commercial drivers on any narcotic – there is just no way I can defend my certification of such a driver knowing the opiate mess in this country should there be an accident.
Then there is the whole issue of a driver in pain having the strength and ability to carry on the job of commercial driving, which ain’t all sitting behind the wheel – it’s climbing, coupling and uncoupling trailers, maintenance, lifting, etc, etc. So not always just about the meds but the underlying condition.
Thanks again for your comments and insights, Frank
Also
From The RX websight concerning Suboxone: “Caution patients that SUBOXONE sublingual tablets may impair the mental or physical abilities required for the performance of potentially dangerous tasks such as driving or operating machinery. Caution should be taken especially during drug induction and dose adjustment and UNTIL individuals are reasonably certain that buprenorphine therapy does not adversely affect their ability to engage in such activities”. Enough said. no, here’s another thing.
Fhe fore-mentioned study sighted in the comments above lumps methadone and suboxone together. Also it refers to only one study and that study doesn’t mention the dosage the subjects took. Was it a normal prescribed dosage of say 8,4,or 2mg or was it a much larger dose. What sort of evidence is that. These so called studies were not actual double blind studies using placebos, they were random test administered after car accidents and the age group 29-38 suggest age and drug abuse had more to do with the crash than buprenorphine, because it’s also mentioned that other drugs were present in their systems. That is not evidence of any kind. There is too much ignorance in the medical field in this country when it comes to addiction and recovery.
Thanks, Frank, that is why this discussion is so lively and I appreciate your comments and opinions.
There are also too many attorneys that would love to fry a physician on the wrongful death stand because they allowed an opiate using commercial driver to kill someone.
Suboxone bonds to receptors it is or has nothing to do with an opiate at all im not a doct but i can read
I thought the medical field side of life was based off Facts not hear say or assumptions but then again im a no body anyways so what do i know lol
under CURRENT treatment for addiction to a schedule 1 drug. Suboxone is such a treatment. The examiner DOES have discretion over whether the use of Suboxone or any other schedule 2 drug used for any other condition (pain) interferes or carries risk of crash of a commercial vehicle.
Illogical to say the least. So Suboxone is safe for pain if a doctor says so but not safe for addiction treatment? That makes even less sense. It’s the same damn drug, with, I imagine, the same physical reactions, except in the case of the recovering person the result is more positive as the recovering person would be less inclined to use any other drug. You can’t say that in the case of someone in pain who may resort to stronger pain killers. But why mention logic when there’s a rule in place. I’ll say no more.
One last comment: Lawyers are going to fry doctors for less any chance they get, it shouldn’t frighten doctors to the extent that a slight risk should prevent a greater benefit. Lawyers will be lawyers nothing’s gonna change that. Now I really am done. Courage is what brings about positive change.
So I hurt my back, while driving commercial trucks, I was prescribed percocet, this went on for a few years, I wish more lawyers went after the doctors that prescribed these painkillers at will. I was pretty healthy and other than trying marijuana a few times in high school, I never even thought of doing an illegal drug like cocaine, in fact people who used repulsed me. It took a man in a white coat to introduce me to the perfect drug that could infect me. I was mid twenty when this injury took place and i did get better. I had no issue getting off the medication, actually ignorance is bliss I am sure I had withdrawals but I probably just thought I was sick. Over that 2 year span I had somee other stuff happen lost a sibling to cancer and broke up with a girlfriend but none of those issue got me down with my back medication forcefield up. I was great for about 4 years dont get me wrong that euphoric bliss had burned a spot in my memory. Hurt my back again and again. Reunited and it feels so good… at this time I was a territory manager and trainer. I noticed I started enjoying giving my training vs slightly apprehensive without the percocet. So I fooled myself for awhile but once I started getting nervous as my prescription ran out and other sign like my inner conscience humming the Popeye theme song when I would take my percocet. It was the 4th of July weekend when angel on my shoulder finally beat the devil on my shoulder. I got help I was issued Suboxone after spending the weekend admitted to get help. My life sort of fell apart almost divorced been through 3 sales jobs were the rubber just isnt hitting the road, always kept my class A CDL and just got hired for nice a wage and sign on bonus only to end up here, sweating my DOT physical because there might be a doctor ready to decline my ability to provide for my wife and children to cover his rear(AKA concerned about public safety, it does sound better…) not because there is scientific proof. Sounds like me when I clean the garage when in doubt throw it out, man the callousness of your selfishness, 100% ending a chance of a job to cover decimalled percentage of being possibly held accountable for a passing DOT physical because as a doctor who should be setting the example by educating yourself on the drug or drugs in question. The resources you have at your disposal are endless, let a pharma rep buy you lunch and pick his brain, call a colleague who can educate you, or contact your local state rep to let him shoulder the burden and in the same breath identifying an issue for him, but please do not stop people who have self corrected a problem in their life(possibly created by a white coat wearer) because you are worried about your insurance premium rising. Obviously a biased opinion but I have never experienced drowsiness in fact the opposite is true in my case, besides the drowsiness was probably included by pharma who is worried about lawsuits too. I have read your responses and you really seem to truly care but for the love of… Jim he’s a doctor not a chiropractor, yes I’d be okay with chiropractors doing there research in a forum. (This is all coming from a man who wants the warning on painkiller “Warning this medication produces the same effect and addictiveness as Heroin, or just parenthesis’s (HEROIN). Lastly my question, if I bring a note from my provider explaining my medication I might be okay?
That’s quite a story. I’ve probably answered your question many times here. Only your examiner can make that final determination.
Another Doctor inhibiting peoples recovery by disqualifying there livelihood out of an irrational fear. Suboxone at low doses as my doctor has attested to has absolutely no effect on driving. I am on 2mg daily and I have driven thousands of miles and drive with my kids in the car frequently. If I thought there was any chance that I couldn’t drive safely I would never risk my children. Doctors who claim it’s not safe to drive have no idea what they’re talking about. Coffee drinking probably causes more accidents since it’s a known and proven stimulant.
At the risk of sounding like a broken record, once again, there are certain rules, that are law, that examiners must follow. One of those rules is that a commercial driver may not be under CURRENT treatment for addiction to a schedule 1 drug. Suboxone is such a treatment. The examiner DOES have discretion over whether the use of Suboxone or any other schedule 2 drug used for any other condition (pain) interferes or carries risk of crash of a commercial vehicle.
In MY EXPERIENCE over 35 years, I have not been comfortable with any driver taking this or similar medications, or most narcotics for that matter, as it is nearly impossible for me to assure myself in the event of a fatal or disabling crash, that the medication OR UNDERLYING condition did not contribute to the crash.
And I can’t live with that responsibility to public safety that I would have certified that driver as being safe.
Other examiners may have a driver they are comfortable with the situation, just my opinion.
You are so full of crap. More people die on the roads from drivers that didn’t get enough sleep than just about anything. Should we have to take a test every single day to drive just to make sure we got enough sleep? Should we ban cell phones iPods and radios so we can’t be distracted while driving? Driving has risk. Whether you are a recovering addict or a Dr for 35 years
Nice to meet you too, Wayne. Agree with you on sleep, which is why we also screen and test commercial drivers for sleep apnea. Other distractions are a problem, agree there too, don’t have a test for that. Also agree we have to weigh risks the best we can and make determination decisions based on those risks.
You’re deciding to automatically disqualify people based on very stigmatized data is obviously only to cover your own interests especially noting you show zero interest in supporting or helping find a new and better way. That being said your candor only proves better how stigmatized people are who are simply doing the right and responsible thing. It also encourages those people to lie so they can keep their jobs to feed their families. Also what’s interesting is the fact that Doctors just like you along with deceptive greedy pharmaceutical companies played a huge part in causing this problem to begin with. Over prescribing highly addictive opioids for pain. Now it seems those same companies and doctors now further victimize those same patients
Thanks for your thoughts, John. Let me address some of them:
-automatically disqualify – Suboxone is not an “automatic disqualifier” but heroin addiction is and presumably current treatment for heroin addiction would be. It is up to the medical examiner to make the final determination.
–zero interest in … find a new and better way — not sure exactly what you mean here, but it is not the examiner’s role to make a diagnosis or prescribe any treatment for a driver, only to make a determination of the risk to public safety given an opiate addiction and the current treatment thereof.
–greedy doctors and pharmaceutical companies — I don’t disagree with this sentiment. While there are most doctors who truly wish to alleviate pain and suffering, there are far too many who “take the easy way out” when it’s time to wean narcotic use or explore alternative treatments, and some that are indeed downright greedy. I’ve personally known a few physicians (some whom I’ve fired over the years) who wound up in jail from fraudulent prescribing. And yes, pharma companies and their hard sales tactics have been deplorable.
I’ve been thinking about getting into driving trucks for a living to avoid lay offs constantly. I work in shipyard n take suboxon but its accepted out there . My question is do u tell the companies u try to hire on with that u take suboxon or not ? Oh n big r , who u work for n how do u get past ur company’s rules taking the suboxon? Thanks !
A driver withholding any medical information during their exam would be cause for disqualification. Current treatment for heroin addiction would be cause for disqualification.
i was in a pain management place for my shoulder surgery and became addicted to pain pills prescribed to me. then i went to suboxone clinic to get off suboxone and its hard to come off of. i wish i never took it and dealt with lortab withdrawals. i had my class B CDL while going to the clinic. then i moved away for a few years then when i come back to get my medical card they asked what drugs i took and i told em suboxone and they said i wasnt allowed to take any narcotics. but i had years before all legally. he said get off that before we can move forward but man that stuff is the devil. it does not get you high it just takes away your symptoms of withdrawal. i cant stand when people chime in with their 2 cents never had taken the drug. i was prescribed 8mg 2 times a day. i can take 1 mg a day. youo would think i had it kicked but its been over a year and without that 1mg im sick. on the toilet every 5 min cold sweats no energy but give me that 1 mg and im fine. not high i dont want to do any other drugs i just want a good paying job doing what ive always done. i honestly couldnt get a call back from Mcdonalds and i have an Associates degree. but my family business involves driving trucks and i cant do it because big pharma got its claws in me
I agree with greg! Sit at your desk for ten or eleven hrs and then we will dim the light and lets see if u get sleepy! Been on suboxone for prob 7 years now and i challenge anyone to any driving test or reflex test. No wonder nobody wants there cdl anymore and if u can give it up your much better off! The pay aint high enough for the absolute aggravation!! Like i read somewere else all cdl holders should all at same time stop driving for 1 week ! Im in!
Thanks for your thoughts, Mark
there is a good review article tha addresses this topic –
ACOEM Practice Guidelines: Opioids and Safety-Sensitive Work
JOEM Volume 56, Number 7, July 2014 –
A meta study – that concludes there is a 29% increased of accident –
==================================================
“Both weak and strong opioids have been consistently associated with increased risk of motor vehicle crashes (MVC) in all large epidemiological studies of work- ing age adults sufficiently powered to detect motor vehicle crash risk with the risk estimates ranging from 29% to more than 800% increased risk.51–56 , 58–60 There also is some evidence suggestive of a dose-response relationship.51 , 55
Thanks for this valuable reference!
There lies the problem. I am not a drug abuser, nor taking Suboxone for drug abuse, but for the treatment of pain. I went the vicodin route. When it was time to get off of Vicodin, I felt horrible. I was put on a low dose of Suboxone and it helped immensely. It also worked GREAT for mild Arthritis pain.
There is NO similarity between Methadone and Suboxone. I’ve done the homework. A LOT of it. With Suboxone, there are virtually NO side affects. I forget I am even on it. Ive driven a lot of miles while on Suboxone. No accidents.
The DOT needs to review much more. They’re basing their decisions based on the stigma attached to Suboxone users rather than the medication itself. THAT is not right at all. In fact, it ridiculous! Many great drivers are getting messed over because of stigma! DOT needs to get on the ball and review hours of duty and drive time rather than spend so much time and putting the blame on medications. Drivers are having accidents because sitting at a steering wheel for 10-11 hours is mentally tiring. They dont want to admit it because theyll lose money. Pay drivers better with less duty hours. ITS THE ANSWER!!!
Greg, thanks for your thoughts here. I’m not aware of any recent studies or medical expert panel reports FMCSA has put out regarding Suboxone specifically. Although the medical examiner does have the discretion to certify a driver using narcotics, habit forming drugs, and drugs which may impair driving, the problem is that if there is an accident, it is highly likely such a drug would be cited as a causal or contributing factor. It would be very difficult for the medical examiner in this case to justify their decision and could risk their certification as a medical examiner, and could even be held liable for certifying such a driver.
You are right that fatigue is a leading contributor to crashes, and fatigue has many causes, including the effects of certain drugs like suboxone and many others.
Again, as medical examiners we are in the position of erring on the side of public safety, not as an advocate for the individual driver. I don’t disagree that there needs to be more research in this area. But until there was clinical evidence and medical expert opinion from FMCSA on the safety of such drugs in relation to crash risk, I would continue to disqualify drivers on these drugs.
I’ve been driving a truck for 14 years and never been in a accident. I also take Suboxone 1× a day which has never effected my ability to drive. I understand the worries behind it but look as a commercial driver it is safe. I don’t even think you can overdose on it.100%safe in my book..
Good to hear you have never had an accident. Suboxone is used for current treatment of narcotics/heroin addiction and as such, a driver would generally be disqualified.
I have been on Suboxone for over 10 years. For me, it is a great pain reliever. I have never been on heroin. Just took pain pills (as prescribed, of course) after being in a very bad car accident 15 years ago. It is not always for heroin addiction. This drug increases my awareness, concentration and has become almost like an antidepressant for me. I have never been diagnosed with clinical depression but it seems to make everything a little brighter since I am not in so much pain any more. I have never been sleepy or groggy in the least bit. I can’t understand why a DOT medical examiner would not let me drive under these circumstances. You say being addicted is a disqualifier. So there are NO OTHER truck drivers out there who have been addicted to something at one time or another? I don’t believe that in the least bit. If DOT wants to disqualify Suboxone, it should be on their disqualifying meds list. Some drivers are ok to drive on it; some aren’t. It all depends on which medical examiner you get. Sometimes, the carrier tells the DOT docs what they can and cannot approve as far as their drivers.
CURRENT addiction is a disqualifier. Other uses for medications may be considered by the medical examiner and aside from schedule I illicit drugs, they have discretion over whether to qualify a driver or not based on many factors – underlying condition, effects of the medication, ability to perform the job duties, etc.
I concur with Greg. Also: The fmcsa states specifically states that methadone specifically disqualifies CMV drivers. Suboxone is/was not specifically listed as it was not on market when the fmcsa prejudicially targeted people trying to better their lives through MAT. That said, it’s only a matter of time before the powers at the fmcsa add: suboxone, subutex, bupenephrine, noloxone, vinase, etc. As it stands the ME has the discretion to certify or not, any CDL driver that is prescribed ANY medication EXCEPT-methadone or insulin. I personally would rather share the road with a driver taking legally prescribed MAT meds, rather than have a driver on the rollercoaster of active addiction causing highs & lows! Inconsistant rest/sleep patterns, erratic thought patterns, varried degrees of alertness etc. Common sense makes a good case for medication assisted treatments vs. Chaos!
***More drivers than you’d think are on powerful opioids, either for pain issues, then become dependent upon same meds. Eventually leading from dependency to addiction to those same opioid meds. Or worse find the illicit Hell of Heroin!
Chris, thanks for your insightful comment.