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Re: Remeron, baclofen, and trazodone

Posted: Tue May 07, 2019 8:06 am
by Robert Swotinsky MD
Use of any of these medications does not definitively establish disqualification per DOT standards or regulations or per standards of practice. (There is, of course, even less guidance on the combined use of these medications.) DOT guidelines suggest certain wait periods for depression, e.g., w/suicidal attempt or ideation, because psychiatric depression does not make for a better truck driver.

Re: Remeron, baclofen, and trazodone

Posted: Wed May 08, 2019 1:11 pm
by Dr Jeff
Personally, at a minimum I would request a note from the prescribing physician(s), indicating they are aware of the donors job description. Wonder how others would handle? Pretty sedating cocktail there...

Re: Remeron, baclofen, and trazodone

Posted: Wed May 08, 2019 1:24 pm
by DSCockrum
Try using the DOT's CMV Driver Medication Form, MCSA-5895. This form includes the federal regulations about medications as well as a detailed "job description." It asks the treating clinician (TC) to specifically answer whether he/she thinks the driver is able to meet the job requirements based on the meds. If the form is returned without all of the medications discussed that you know about, you can tell the driver he/she needs to have this form completed by every TC that is seen for any medical condition. It may not completely solve the problem, but certainly ties the TC to a more specific verification. It is assumed that private TCs will be less likely to sign off if they have to sign acknowledgement of the job demands - though I am not aware of any data supporting this point.

Re: Remeron, baclofen, and trazodone

Posted: Wed May 08, 2019 3:11 pm
by Robert Swotinsky MD
I don't have a definitive answer about Remeron, baclofen, and trazodone and fitness to drive. But, I do offer this advice about getting sign-offs from the prescribers:

My practice has been to ask for the treating clinician to sign off on safety if/when I suspect the treating clinician has concerns about safety. For example, if the donor is on lots of oxycodone and I don't want to qualify him/her, I may ask the treating provider for a "safe to work note," and upon receiving the treating provider's response that "I'm not signing that," I've now got a stronger logic for not qualifying.

Otherwise, I find that asking for sign-offs from the prescribers is an administrative exercise with an outcome that depends on the diligence of the examinee and his/her access to a cooperative treating clinician. It's like a scavenger hunt - collect these signatures, and you'll get a DOT card.

Allow me to digress: During my initiation into a fraternity at MIT years ago, back in the day when cocaine was a soft drink additive, I was going through hazing. I was given a number of tasks including collecting 10 signatures of Wellesley students on a board of wood, each signing a statement on this board of wood acknowledging that they were the ugliest woman at Wellesley. To get the 10 signatures, I asked the prettiest co-eds I could find. Some said yes.... it took a while, but I got 10 signatures. Signing the statement didn't make it true that they were the ugliest women at Wellesley.

I've not aware that having prescribers sign off on their patient's safety while prescribed opioids provides for more thoughtful or accurate information, either. And, if the examiner is going to restrict the applicant anyway, then having asked for the signature puts everyone in an awkward spot.

If a DOT examiner is thinking of disqualifying the driver based on the meds, then collecting treating clinician sign-offs attesting to the absence of a problem is going to introduce more confusion about the process. If the DOT examiner was going to disqualify the driver anyway, then why bother asking for sign-offs from the treating clinicians?

Re: Remeron, baclofen, and trazodone

Posted: Thu Apr 02, 2020 7:22 pm
by pbreslinbennett
I agree that requesting clearance to drive from a treating clinician is fraught with hazard. Providers who aren't CMEs don't have a full appreciation of the demands placed on commercial drivers and FMCSA's requirements, and they may not be aware of the patient's full medical history. In addition, if the driver has a health problem that would make the provider recommend against certification, the relationship between the patient and that provider may be undermined. If the provider clears the patient and you still can't certify, you have an angry driver on your hands.

When I am uncertain about a driver's condition, and/or in doubt I should certify, I ask the patient if I may speak with his or her provider, then fax a signed release of information to that provider. These calls have been very helpful. I have found that when PCPs or specialists understand a commercial driver's job, and the potential for harm to self or others created by a particular health concern, they appreciate the opportunity to talk through the situation, and we both go away having learned something.