Opioids 2018-FMCSA versus ODAPC/MRO rules and Safety Warnings by MRO to Employer/Donor/CDL Driver taking then out-of-service for long-term opioids
See also my posting on this matter in the MRO section and Dr. Swotinsky's single response (and no other responses) April 18, 2018. viewtopic.php?f=1&t=1268
We do In-House MCSA-5875 exams, have an in-house MRO (me) and have in-house fitness-for-duty obligations with no exceptions in this large municipal government. We are an employer with intracity/intrastate CDL drivers for street services, sanitation and the Department of Airports/Parks-Recreations. Most have the CDL/MCSA-5876, which is mandatory to operate CMV here, but some are what I called "credentialed" for CDL with little or rare use of CDL/CMV but must carry the CDL/MCSA-5876 and be DOT randomly drug tested to maintain this credential as required by the employer/departments.
There are 3 confusing and conflicting federal regulations that are not currently in synchronized format as this pertains to FMCSA CDL/CMV and use of opioids/opiates long term for otherwise stable pain control:
1. First is 21 CFR Part 1308, which does NOT have a blanket disqualification for opiate or habit-forming drug at all, and in fact only obligates the parties to have the prescriber acknowledge that the patient drives CDL and has been warning of safety/somnolence.
2. Second is 49 CFR 391.41 and National Registry (NRCME, no Handbook exists since 2013, only 3 pages of rules) that does NOT have a blanket disqualification for opiate/opioid and leaves the judgment of the condition (back pain) and the painkiller use up to the NRCME registered CDL Medical Examiner (with an exception for methadone).
3. Third is the 49 CFR Part 40 Drug Test MRO regulations and now the "HHS" level certified MRO regulation (see Dr. Ferguson's web-based MROCC update course for MRO actions on opioids that is a directive for “HHS” level certified MRO’s, whatever that means) (January 2018) who must in fact issue a BLANKET disqualification recommendation (49 CFR 40.327 and 40.135) for donor who is MRO-verified negative for opioids, unless the Prescriber contacts the MRO/Employer Authority (??CDL Examiner or Occupational Health Doctor Authority) that the medication has been changed.
1. How do we manage highly unionized CDL operators who have different doctors at US Healthworks who pass everybody when they consult them, Prescriber Family Doctors/Pain Specialists who refuse to change the prescription to non-opioid, and then Employer HR/Administrative staff who tell us the driver/donor will lose his job if he cannot retain his CDL/MCSA-5876 or CDL driving privileges and place us Fitness For Duty/MRO/CDL M.E. in a corner?
2. How do we explain conflicting NRCME practitioner outcomes and the out-of-synchony Federal regulations to these Unionized CDL Employees who are losing their job and to their Prescribers/Doctors for these Safety Warnings?
NOTE TO OTHERS IN THE HOUSE: A safety warning to our employer is NOT just a recommendation or a “Warning” at all: Employer Department HR/Administrators must have the safety warning in writing here from our Occupational Doctors ( and they the Employers then take that as an order to take the driver out of service permanently, after 150 days accommodation limit)?
I have witnessed cases where our CDL Drivers brought in 2-year pass on their medical certificates by NRCME certified Medical Examiners (Not our City/Employer In-House Medical Examiners) who did not care that the driver uses and reported Hydrocodone on MCSA-5875 page 1/2.
Any responses are greatly appreciated.
Occupational Medical Examiner, NRCME Registry Certified 2013-2023
Doctor Full Time for Large Municipal Government Employer
(MROCC Certified MRO since 2008)
(Board Certified Internist who is also Part-time Hospitalist for Rehab. Hospital and Urgent Care Emergency Physician for Large ED Partnership since 1998)
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