Driver reports using recreational oxycodone

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Daveinfo123

Driver reports using recreational oxycodone

Post by Daveinfo123 » Fri Oct 12, 2018 3:25 pm

Driver reports using recreational OxyContin 18 months previously. The local occupational medicine doctor gave him a 2 year DOT card. I don't think we can require a SAP evaluation, can we? Can I tell the supervisor to be on the look out for safety issues? Besides driving a truck, a secondary task requires nearly perfect concentration, and failures usually result in severe injuries.



Robert Swotinsky MD
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Re: Driver reports using recreational oxycodone

Post by Robert Swotinsky MD » Fri Oct 12, 2018 9:16 pm

Please clarify your role. Are you a local medical examiner performing a fitness for duty exam where the employee gave this history of recreational oxycodone use? Are you a manager? Are you in-house medical staff?

Daveinfo123

Re: Driver reports using recreational oxycodone

Post by Daveinfo123 » Mon Oct 15, 2018 7:39 am

Sorry, no, I am the Corporate Medical Director and this exam was done at hospital based clinic 200 miles away by a doctor I have never met, just the only local hospital that has someone with DOT certification. Is there any action I can take in light of the fact the local guy cleared him for a two year certificate. I assume not.

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Re: Driver reports using recreational oxycodone

Post by Robert Swotinsky MD » Mon Oct 15, 2018 1:55 pm

DOT regulations place responsibility for assuring that drivers are qualified on the employer. So, the employer (or inhouse medical department) is not obliged to accept the local ME's determination. The employer can have qualification criteria that are more strict than the local ME may use. (I don't know, by contrast, if the employer can have qualification criteria that are looser than the local ME.)

I'd suggest the employer place the driver's qualification on hold and order a hair test that includes a specific request for oxycodone analysis. You may also consider asking the driver to authorize his treating physician to print the last year's worth of meds from the state PMP and send that printout to you. If the hair test is negative and the driver is not being prescribed chronic opioid therapy, the driver is probably OK for driving but you may want to have his DOT physical redone in 1 year (not 2 years) because opioid abuse is a condition where relapse is common and it's hard to argue that closer monitoring is not warranted.

Daveinfo123

Re: Driver reports using recreational oxycodone

Post by Daveinfo123 » Mon Oct 15, 2018 3:43 pm

Dr. Swotinsky, do any of these factors make a difference?
1. Employed since 2012
2. No observations of impairment
3. No positive UDS test
4. Cleared by an examiner
5. Past-tense and dated disclosure of usage

Thanks.

Robert Swotinsky MD
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Re: Driver reports using recreational oxycodone

Post by Robert Swotinsky MD » Thu Oct 18, 2018 6:17 am

1. Employed since 2012.
Given the 6-year employment tenure, hopefully the employer will reassign the driver and continue paying him if the driver is removed pending resolution of the oxycodone concern.

2. No observation of impairment.
What would expect to have been observed in this situation? Pinpoint pupils?
3. No positive UDS test.
If there a series of UDS tests that looked for oxycodone and found none, those test results could be used as an alternative to a hair test for oxycodone.
4. Cleared by an examiner.
See my previous response.
5. Past-tense and dated disclosure of usage.
Whether or not this driver has continued using oxycodone recreationally is unknown. But, in general, people who misuse opioids often minimize the amount of use when they describe it to others.

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