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Another DOT Beauty... Subutex

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Guest UVAPAC

I was hoping to get some quick thoughts on a patient who is presenting to our office tomorrow for a DOT PE, who has been on Subutex (Suboxone) for 4 years.  She does not have a CDL license, however requires an "endorsement" to operate a Van transporting people.  She has a letter from her treating physician, who is a board certified psychiatrist, stating she has been stable on the medication for 4 years, and in his opinion has no contraindication to operating a motor vehicle.

 

My gut instinct is to decline this patient.  Any thoughts or opinions otherwise?

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It's a narcotic (opioid) and 21 CFR 1308.11 (391.42(b)(12)) says "nope". Any addictive potential medication disqualifies. Methadone also excludes. I formerly did DOT exams but not since changes (no longer in that setting) but online info at FMCSA website is my source for this response.

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Guest UVAPAC

It's a narcotic (opioid) and 21 CFR 1308.11 (391.42(b)(12)) says "nope". Any addictive potential medication disqualifies. Methadone also excludes. I formerly did DOT exams but not since changes (no longer in that setting) but online info at FMCSA website is my source.

It does say that there is an exception to the rule, and that is if they have documentation from treating physician stating medication, dose, why they are taking, and that it does not interfere with their ability to drive.  That being said it does make it very clear that just because someone gets this letter, does not mean we have to qualify them.

 

I also found this in a Q&A section of FMCSA previous guidebook:  

 

  • Methadone and Suboxone differ in some areas but generally used for the same treatment plan
  • Detoxification and pain therapy
  • FMCSA recommends that CMV drivers who take these prescribed medications should not be found medically qualified to operate a commercial motor vehicle.
  • Suboxone has a long therapeutic duration
  • 25-40 times more potent than other agonist opioids
  • FMCSA’s standards are minimum health requirements
  • Medical examiner make determination whether driver’s medical, including diagnoses and/or treatment plans, has a direct impact on public safety

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My thinking goes like this: this driver is either on the road with pain that requires Suboxone to control, or they are on the road with pain that is not controlled with Suboxone. Neither will fly when it's me signing the card. It's an easy "no."

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