Panel says legal drugs may impair driving, too

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By Todd Dills

A five-doctor panel tasked with reviewing the health standards for commercial driver’s license holders stated at its January meeting that while only Schedule I drugs are restricted, Schedule II drugs also may pose an increased crash risk. A lack of peer-reviewed literature doesn’t mean the risk isn’t present, said the members of the Medical Review Board, created by the federal highway funding bill passed in August 2005.

Having focused on procedural matters at its August 2006 public meeting and on insulin-treated diabetics at its November 2006 public meeting, the board focused on habit-forming drugs during its meeting on Wednesday, Jan. 10.

Schedule I drugs such as amphetamines and narcotics can disqualify people from holding CDLs. But Schedule II opoids, sedatives and stimulants — including such well-known drugs as methadone, morphine, OxyContin, Dilaudid and Ritalin — are not mentioned in the CDL regulations. Schedule II drugs are legal and medically valid but carry a risk of abuse and dependency.

The available scientific evidence is inconclusive in addressing whether the licit use of a prescribed Schedule II drug impairs driving ability and makes a driver a greater crash risk, reported Dr. Stephen Tregear, director of special projects for ECRI, a nonprofit health research agency.

In many cases, it may be the condition for which the drug is prescribed, not the drug itself, that should be ruled on by the Federal Motor Carrier Safety Administration, noted Natalie Hartenbaum, president and chief medical officer of OccuMedix, a health and safety consulting firm. Hartenbaum cited the example of a patient taking OxyContin for pain who shortened the interval between doses as his dependency increased, thus steadily but slowly ramping up his impairment level.

The board’s Jan. 10 recommendations to the FMCSA included more research into the effect of prescribed Schedule II drugs on drivers, more research into other agencies’ and countries’ medical evaluations of transportation workers, and more research into whether drug tests should be expanded to include additional medications not now subject to testing.

Larry Minor, director of the U.S. Office of Bus and Truck Standards and Operations, said expanding drug tests “would be quite an undertaking, involving the entire DOT.”