Steering Clear of Trouble: An Exhaustive Guide to DOT Disqualifying Medications

Commercial vehicle (CMV) vehicle drivers routinely take medications to treat or manage medical conditions. However, according to U.S. Department of Transportation (DOT) guidelines, many of these medications can disqualify an individual from holding a commercial driver’s license (CDL) – and take them off the road.

DOT disqualifying medications include:

• Amphetamines
• Narcotics or their derivatives
• Opium derivatives (including codeine)
• Marijuana (medical or recreational)
• Phencyclidine 
• And more

DOT physicals and random drug tests screen for disqualifying medications. However, the use of these medications (and a failed DOT drug test) doesn’t always prohibit a CMV driver from legally getting behind the wheel. Accommodation can be made at the discretion of the medical examiner or prescribing physician.

In this blog, we explore what DOT disqualifying medications are, why they matter, and how employers and drivers can comply with DOT regulations.

Importance of Safe Medication Use for CDL Drivers

Commercial trucking is critical to the U.S. economy, but it is also a risky occupation for both drivers and the public. According to the Federal Motor Vehicle Carrier Safety Administration (FMCSA), trucking industry workers experience the third highest fatality rate, accounting for 12% of all worker deaths. About two-thirds of these fatalities involve highway crashes.

Many factors contribute to these incidents, including the use of medications and their side effects. The ability to operate a CMV without impairment is essential to safe driving. Any medications or drugs that interfere with a driver’s abilities can result in disqualification from obtaining or holding onto a CDL.

Risks of Impaired Driving

Prescription and illegal medications can increase the potential for highway accidents.

Medications, particularly those that have a narcotic component, cause side effects such as drowsiness, slow reaction times, confusion, impaired judgment, and dizziness, and have a direct impact on concentration.

Even over-the-counter medications have their risks. A study by the FMCSA found that 17% of large truck crashes involved the use of over-the-counter drugs—a much higher percentage than those caused by illegal drug use (2%).

Regulatory Oversight

To increase highway safety, the DOT has established guidelines to regulate the use of medications and testing for medications for CDL drivers.

To comply with DOT regulations, employers must establish a DOT physical exam and drug testing program to screen incumbent CMV drivers and applicants for drug use. Prior to the exam, the driver must disclose all medication use, including prescribed, illegal, over-the-counter, and supplements.

The following positive test results will result in the driver being disqualified from operating a CMV:

• A positive drug test for any illegal substance on the list.
• A positive result for prescription medication use if that medication is not prescribed by a physician.

Both violations must be reported to the FMCSA’s Drug and Alcohol Clearinghouse, where the violation is listed for a period of five years. It is illegal for any company to hire or continue to hire a driver with a known reported violation.

Note: Accommodations may be made if a driver has a prescription for a disqualifying medication. The final qualifying decision is at the discretion of the individual’s physician and the FMCSA-certified medical examiner who performs the DOT physical exam.

DOT Disqualifying Medications: An Overview

DOT disqualifying medications are listed in the FMCSA Motor Carrier Safety Planner.

Types of Disqualifying Medications

The list of DOT disqualifying medications for CDL is extensive and contains hundreds of drugs, both legal and illegal.

For instance, the DOT banned medications list encompasses categories such as painkillers, anti-inflammatories, depressants, stimulants, hallucinogenic substances, opiates, opium derivatives, cannabimimetic agents, and more.

Reason for Disqualification

The use of DOT disqualifying medications understandably brings up concerns about driver safety.

CMV drivers have challenging jobs, but they often put their own health at risk by using medication or drugs (legal and illegal). According to American Addiction Centers, 27.6% of CMV drivers admit to consuming drugs, including amphetamines (21%) and cocaine (2.2.%), which helps them stay awake for a long time. Even prescription drugs like Adderall and Ritalin are abused by drivers to help them remain alert.

But the consequences are alarming. The potential for addiction, drowsiness, and impaired motor skills can put drivers and the public at risk of catastrophic accidents, injury, and death.

Detailed List of Prohibited Drugs for CDL Drivers

According to the DOT, no driver may be on duty and possess, or be under the influence of, any of the following drugs or substances:

• Any 21 CFR 1308.11 Schedule I substance
• Any type or formulation of an amphetamine
• Any type or derivative of a narcotic
• Any other substance that would impede a driver’s ability to safely operate a vehicle, including misused or abused prescription drugs, or marijuana, medicinal, or otherwise.

21 CFR 1308.11 Schedule I refers to the Electronic Code of Federal Regulations (eCFR) schedule of drugs and other substances assigned a Drug Enforcement Agency (DEA) Controlled Substances designation.

Below is an overview of the most common types of DOT disqualifying medications and why they are disallowed:

1. Amphetamines

Amphetamines are a stimulant commonly used to treat ADHD and narcolepsy. Brand names include Adderall, Vyvanse, and Dexedrine. Although intended to increase focus and concentration, the side effects of amphetamines can be dangerous and include blurred vision, high or low blood pressure, headaches, anxiety, and dizziness. Amphetamines are also very addictive and easily abused.

2. Opioids

Opioids are used for pain relief and fentanyl, codeine, morphine, hydrocodone, hydromorphone, and others. Brand names include OxyContin and Vicodin. The side effects of opioids are especially alarming for drivers and can seriously impact their ability to safely operate a vehicle. Side effects include dizziness, confusion, slow breathing, nausea, drowsiness, and impaired thought.

3. Marijuana

Although legalized in many states, the DOT still considers marijuana a disqualifying drug, even when prescribed for medical use. Marijuana can reduce a driver’s alertness, impair judgment, and cause disorientation, dizziness, and even psychosis.

4. Cocaine

Cocaine is on the DOT banned medications list for good reason. Cocaine use can cause paranoia, headaches, impaired memory, and sensitivity to light and sounds. It can also increase the risk of heart attack, seizure, and other coronary diseases.

5. Phencyclidine (PCP)

PCP is an illegal drug and is automatically considered a DOT disqualifying medication. PCP’s side effects include hallucinations, mood disorders, loss of sensation, blurred vision, dizziness, and more.

A positive test result for any of the substances on this list – or a prescription medication for which the driver does not have a prescription – will disqualify a driver from operating a CMV or obtaining a CDL. However, drivers do have a loophole. If the drug is prescribed and the prescribing doctor says the driver can safely drive a CMV they may still be qualified although the medical examiner can reject that opinion if they disagree.

Prohibited Prescription Drugs

While most DOT drug tests prioritize the detection of illegal and habit-forming drugs like opiates, marijuana, and more, the DOT list of prohibited drugs for CDL drivers also includes common prescription drugs.

For example, opioids make the DOT list of banned medications, yet they are often prescribed to treat moderate or severe pain, such as that experienced after an accident or injury.

In addition, certain anti-depression medications, like benzodiazepines (Valium, Xanax, and Klonopin) are prohibited by the DOT because they can impact mood, judgment, alertness, and coordination. However, short-acting anxiety medications are not disqualifying if they have cleared the driver’s system.

If unsure, drivers should consult their physician to understand if a medication is banned by the DOT.

Disallowed Over-the-Counter Medications

CDL drivers should also avoid certain over-the-counter medications that may contain DOT disqualifying drugs, including sleep aids, cough suppressants (such as those that contain codeine), and inhalants.

Understanding DOT’s Role in Medication Regulation for CDL Holders

The DOT list of disqualifying medications is designed to ensure that CDL drivers are not taking legal or illegal drugs that will interfere with their ability to operate a truck or CMV safely and legally.

Under DOT regulations, all drivers must be screened for drug and medication use before they can be approved to operate a CMV.

Regulatory Guidelines

Any DOT-regulated businesses, such as trucking companies, must implement and manage drug and alcohol screening programs.

As part of such programs, CMV drivers are required to undergo pre-employment DOT physicals and drug tests.

As part of the DOT physical, a driver must submit a urine sample to test for drug metabolites (also known as a four-panel drug test). The test is designed to scan employees’ use of opiates, marijuana, cocaine, and methamphetamines. Tests can also be performed to look for benzodiazepines, ecstasy, methadone, and Oxycodone.

Drivers must disclose drug use on a medical questionnaire prior to the DOT physical. If taking prescription medication, a copy of the prescription must be provided.

Once employed, the DOT requires that drivers are randomly tested throughout the year or if reasonable suspicion is inferred. Testing is also required as part of a return-to-duty and/or follow-up exam (if a driver previously tested positive or violated the prohibition) or as part of a post-accident investigation.

According to DOT regulations, drivers are only considered medically qualified to drive a CMV if:

1. They do not use any drug or substance identified in 21 CFR 1308.11 Schedule I, an amphetamine, a narcotic, or other habit-forming drug.
2. They do not use any non-Schedule I drug or substance that is identified in the other Schedules in 21 part 1308 except when the use is prescribed by a licensed medical practitioner, as defined in § 382.107. The practitioner must be familiar with the driver’s medical history and must be able to advise the driver that the substance will not adversely affect the driver’s ability to safely operate a commercial motor vehicle.

Medical examiners are required to give careful consideration to the effects of medications on a driver’s ability to operate a CMV safely before rendering the driver qualified.

Enforcement and Penalties

When is a driver disqualified from obtaining a CMV due to drug use?

• A driver will be disqualified if they use a Schedule I substance, take a prescription medication without a valid prescription, or any drugs on the DOT medication restrictions list.
• A CDL driver who has a valid prescription for a non-schedule I medication may not be disqualified if the doctor declares that the medication will not impair their ability to operate a CMV (however, a medical examiner can overrule the prescribing physician and still disqualify the driver).

If a driver fails a DOT drug test, the results must be reported to the FMCSA’s Drug and Alcohol Clearinghouse.

Fines and penalties can be imposed on DOT-regulated companies that fail to comply with disqualifying medication guidelines and screening requirements.

Tips for CDL Drivers on Complying with DOT Medication Guidelines

To prepare for the DOT physical exam and drug test, drivers must understand what the exam involves and any potential mitigating factors, such as pre-existing medical conditions or medications that are considered disqualifying.

To avoid any missteps or delays, drivers should:

• Provide documents detailing their medical history as well as copies of prescriptions.
• Avoid taking any kind of drug that could interfere with test results.
• Have a conversation with their prescribing physician about the upcoming exam and any issues they should anticipate. If taking a disqualifying medication, drivers should request a statement from their doctor stating that the drug does not interfere with their ability to safely operate a CMV and bring it to the exam appointment.

Maintaining Safety on the Road: Understanding and Adhering to DOT Disqualifying Medications (H2)

Regulations prevent commercial motor vehicle (CMV) drivers from using medications that are deemed disqualifying by the DOT. The consumption of any prohibited medication can significantly impair a driver’s capacity to remain vigilant, make rational decisions, and operate a CMV in a safe manner.

Non-compliance carries serious penalties. A driver may not be eligible for a CDL or may be terminated from service. Additionally, the FMCSA may impose punitive damages on trucking companies that fail to comply with DOT drug testing, reporting, and enforcement regulations.

If you have questions or are looking to start or optimize your DOT physical examination and DOT drug testing program, please contact us to learn more about how Acuity can help.

Learn more about Acuity Occupational Health Services.