Sublocade (bupronorphine extended release) and DoT Physical

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Sublocade (bupronorphine extended release) and DoT Physical

Post by applejackson » Sun Apr 12, 2020 10:07 pm

I hope it's ok to post this question here. I've been trying to research this and not getting very far.

I am an addict in recovery who is on Sublocade (bupronorphine extended release, given via injection once/month) who is pursuing a Commercial Divers License For the first time.

When I took my first DoT Physical for my PERMIT (CLP), the doctor noted that I was fine as I was on Sublocade and not Suboxone, and he approved my federal medical card.

Fast fwd 6 weeks later. I had a job offer from a major carrier, contingent on passing a physical and drug screen at a different clinic.
This clinic denied me and claimed a federal guideline preventing certification to anyone on ANY form of bupronorphine.
I had a letter from my prescribing doctor stating that the medication does not have any narcotic effect and has no abuse potential as it is administered in the doctors office.

Would appreciate any clarification or guidance that anyone can give.

Thank you.

Robert Swotinsky MD
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Re: Sublocade (bupronorphine extended release) and DoT Physical

Post by Robert Swotinsky MD » Mon Apr 13, 2020 6:04 am

Buprenorphine is prescribed to treat opioid dependence.

A person with opioid dependence is at increased risk in highly safety-sensitive activities like driving a truck. This is one of the primary reasons that FMCSA put methadone as a recommended disqualifier in the Medical Advisory Criteria that, while "advisory" in nature, appear in the regulation.

You're asking about federal guidelines. The FMCSA had a guideline on its FAQ web page some years ago. FMCSA posted that guideline for about a year and then stopped posting it. My understanding is that with respect to medication use, FMCSA guidance is that the Medical Examiner should consider the effects of the drug and the condition for which the drug is prescribed.

This topic has been covered in more detail elsewhere, e.g., viewtopic.php?f=4&t=418 .

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Re: Sublocade (bupronorphine extended release) and DoT Physical

Post by applejackson » Thu Apr 16, 2020 12:46 pm

Thank you for the reply.

Let me ask this another way.

I am on Sublocade and I have a valid Fed med card. That doctor that signed off on my card mentioned that Suboxone (bupronorphine taken orally and daily) would have been an issue, but Sublocade (ER, taken monthly via injection) was fine.

A second doctor that I saw for a subsequent visit said his clinic had a policy not to approve anyone on any form of bupronorphine.

So, I'm hearing contradictory information and it's affecting my ability to make a living.

The FMCSA states that they do not ban specific medications, and that it's primarily to the discretion of the examiner.

Which brings me to my question:

Clearly, there is a list somewhere that lists Suboxone as a disqualifier. As best as I can tell, that list is a document that doctors use when getting certified to perform the DoT Physical.


In short:

Does the certification process for physicians contain a list of medications that are blanket disqualifiers?

Thank you in advance

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