CDL B Denied

Will buprenorphine show up in drug tests? Can nurses take Suboxone? Can I do drug court on methadone or buprenorphine? My PO says NO medication-assisted treatments.
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Lillyval
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CDL B Denied

Post by Lillyval » Wed Jan 30, 2019 8:52 am

My friend who is on 8mg Suboxone is a CDL B driver. He was offered a better paying job with a major corporation and had to go to their doctor fo get his new CDL medical indorsement. Well, he disclosed he was on Suboxone (it is already on his previous med card) and they denied him. After telling him he would be approved, a week later they said it was too much of a liability for them.

Of course I suggested he get a letter from his prescriber, and from his former DR who gave the CDL endorsement- which he did. He has been stable for 5 years on maintenance and driving the whole time! My argument was that someone on a stable dose is not impaired.

Here’s the real kicker, because the current denial overrides his existing endorsement, he can no longer legally drive for his CURRENT job. His wife has a life threatening illness. If he loses his job and health insurance it will be catastrophic.

So of course I went searching, believing he could beat this - but the opposite is true. Doctors are doubling down on denying Suboxone users CDL endorsements because of liability. For those interested, read the following thread and also the link in the 2nd post.

http://www.occ-doc.net/forum/viewtopic.php?t=418#p1208

Summary:
1. FMCSA (federal regulator) leaves the decision about fitness with buprenorphine to the discretion of the doctor- methadone is automatically disqualifying. He does have the legal right to get a second opinion, but this corporation will only accept the endorsement from THEIR doctor.

2. Drs believe (and it may be true) that if there is an accident buprenorphine will be blamed

3. Some Drs say Suboxone is admission of being a drug addict- which is automatically disqualifying. (one asshole said if the person is not an addict they should be on Subutex, clueless that Subutex is becoming almost impossible to get now)

4. No one will acknowledge that they think the patient is impaired, but they do. My friend’s examiner said the issue is he could forget his medication and go into withdrawal. He is a day driver, not long haul. Plus non Suboxone patients get sick sometimes too, and they call out!

5. One doctor on the thread argues that people on Suboxone don’t go through the proper sleep cycle, making them unfit to drive.

I know this topic has been discussed here before. Anyone with any new information or insights?

*Some have said he should not have disclosed. However, doctors now routinely run PMP reports (prescription monitoring program) which show all controlled substances. So if he hadn’t disclosed, they could have denied him for lying.

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Re: CDL B Denied

Post by jennjenn » Wed Jan 30, 2019 9:36 am

That’s actually one of the most mistaken things I’ve ever heard! These ppl thinking they know what a long term suboxone patient is ‘feeling’ just amazes me! They have no personal knowledge themselves but THINK they know what this man will be experiencing out there driving. It pisses me off! There needs to be someone or some ppl on their advisory board to give them personal experience. This medication isn’t dangerous for ppl to drive on, especially someone who’s been taking it 5 years. Wow I just don’t know what else to say, I really don’t.
Jennifer

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Re: CDL B Denied

Post by Lillyval » Wed Jan 30, 2019 9:54 am

I know. His Suboxone doctor went ballistic when she found out. She contacted the company doctor and said he was in NO way impaired. They said it’s just company policy, period. End of story.

Their overblown fear of liability, and casual dismissal of facts, could basically ruin my friends life. Luckily, he has an appointment with the doctor who previously signed his endorsement, and he believes he will be able keep his current job. I pray to God it works out. At this moment his CDL has been invalidated by that company doctor, and he can’t legally drive.

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Re: CDL B Denied

Post by razor55 » Wed Jan 30, 2019 12:56 pm

Remember back in the day when nobody new much about suboxone? Remember when we here thought if we just could educate and show how great this medication worked? 7 8 10 years ago this treatment was still new and the aavg person had no idea what it was or even cared, Never tested for it. Now we have the negitivve press that this med is just another opiate, witch it is not. couple that with our sew happy world and nobody wants to risk it. Sad days indeed.. Ill say it again, as a whole, no one wants people with a SUD on an opiate drug. Or any drug. Oh ya , i almost forgot , total Ab is the only way in peoples minds.. So ive got a newbie in group, one week and doing great. my clinic Still forces newbies to go to 12 step meetings 4 days a week for the first 6 months. She leaves my meting, goes across the hall for NA and in 10 mins starts to hear an old time talk about thoses , evil, untrusting,sick people that take that suboxone! Im not making this shit up. Im so angry at the clinic im ready to quit. My god man, when will this crap ever end....... :roll: :x :x :x Sorry for your friend Lilly, just BS total....rr

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Re: CDL B Denied

Post by SisterMorphine » Wed Jan 30, 2019 8:13 pm

wow, that's really terrible.
then theres the ups driver who gets a dui after a wreck in the company vehicle and even had an open container
and the tractor trailer driver who was on heroin and weed the morning he caused a near fatal wreck.

i wish that past performance records were taken into consideration. or a sobriety test.

that's a really really awful situation for him and his family.
Get your shit together and live your life." Black Snake Moan

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Re: CDL B Denied

Post by Amy-Work In Progress » Wed Jan 30, 2019 8:36 pm

Wow. Just wow.

Between your story, Lilly, and yours, Razor, it's depressing!

I hate that this type of ignorance is literally killing people. We just cannot educate our society fast enough!

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Re: CDL B Denied

Post by razor55 » Wed Jan 30, 2019 9:38 pm

No we cant Amy but we can try. and i know you will indeed change some minds as you move forward.

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Re: CDL B Denied

Post by docm2 » Thu Jan 31, 2019 9:29 am

https://janaburson.wordpress.com/2016/0 ... s-license/

Dr. Burson has blogged about this a couple of times. The comments are helpful as well.

Besides this post she did a followup a few weeks later.

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Re: CDL B Denied

Post by Lillyval » Thu Jan 31, 2019 10:03 am

Yes Razor, I do remember 8-10 years ago, back when I was in a high maintenance dose. I was also doing NA (which as you know, ended badly), and I was practicing “rigorous honesty”. So, I would voluntarily tell my doctors, and not only did they not know what it was, they didn’t care to hear about it.

Also, around the same time I was attending an urban NA group where the main drug of choice was crack. I asked someone at my first meeting if they had an opinion on Suboxone and the people I spoke to didn’t even know what it was.

I still believe in honesty as a recovery (and life) principle. But I’m looking for work and I’m NOT going to disclose I’m on Suboxone unless I’m forced to. It’s just self preservation.

Also, if you really want to quit your job see if you can find another one first. I quit a job on moral principle, and now I’m sitting here unemployed. What you hear in the news about full employment is BS. And the older you get, the more reluctant they are to hire you. Remember when experience was valued? Now it’s all about how much they perceive it’s going to cost to insure you.

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Re: CDL B Denied

Post by BlueLight » Thu Jan 31, 2019 10:41 am

Lillyvale, isn’t that the truth! The jackholes in Washington DC keep preaching people need to work longer and even up to and into your 70s, yet age discrimination in the workplace starts in by the time you are in your fourties. Employers all want the latest, greatest skills, but refuse to pay adequately for you to do it on your own, after hours, much less give you a salary bump after you do attain the skills. And heaven forbid if you expect the employer to offer you any training during their time. It’s ridiculous.

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Re: CDL B Denied

Post by Lillyval » Thu Jan 31, 2019 1:31 pm

Thank you for saying that, Bluelight. It’s such a blow to my self esteem every time I don’t get a job, but I know there is definitely age discrimination involved.

I know it’s true because my own intern got a job as a substance abuse counselor in less than a month. She is 27 with a BA in social work and exactly no counseling experience. I have a masters degree, went through a CADAC program in addition to my masters, and have three years experience as a full time substance abuse counselor.

I wish her no ill will, and hope she is successful. But I’m over 50, and a lot of places will not accept your application without dates (like HS graduation). They do it in such a way that you can’t prove it’s age discrimination. There was a really good article about this in Politico recently, if anyone is interested.

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Re: CDL B Denied

Post by BlueLight » Thu Jan 31, 2019 6:12 pm

I no longer put dates on my high school or college education as most resume formats don’t have them listed either. And I only put my last 15 to 18 years of experience. Only after I get the job and they request the info for a background check do I supply it. F’**k’em. In instances where they are required upfront I’ll list when I went back for my masters in 2002 - 2004, a decade+ since my undergrad.

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Re: CDL B Denied

Post by Lillyval » Fri Feb 01, 2019 3:39 pm

DOCM2 - thank you for that link. I had already found it and sent it to my friend, but I appreciate you posting it here. I finally got a chance to read all the comments and it brought up two questions:

1). One provider commented that the PMP was designed so that a doctor who is going to PRESCRIBE a controlled substance can check to see if the patient is already being prescribed it (or other controlled substances) by another doctor. The PMP doesn’t exist so that medical professionals can do a “fishing expedition” to see what a patient is on, when they are not prescribing him anything. In short, was the doctor in Dr. Burson’s case justified in looking at the PMP after the patient had already passed the drug screen?

2) Dr. Burson said that MAT being administered in a clinic does not go into the PMP records. At least in her state, the PMP only lists medications dispensed at a pharmacy. So even though methadone automatically disqualifies someone from getting a CDL, methadone patients may be getting approved if they don’t disclose, while Suboxone patients are being denied?

Dr. Burson also rightfully stated that she would rather have a person stable on Suboxone driving than someone who had taken an Ambien the night before.

Interesting note: Chantix is the only other drug besides methadone that automatically disqualifies someone from a CDL.

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Re: CDL B Denied

Post by docm2 » Fri Feb 01, 2019 9:03 pm

Suboxone distributed at a treatment clinic would not be reported to the state PMP. Neither does the VA, but that is supposed to change.
In our state medical marijuana does not get reported as well.
I think it depends on the state whether a clinician can check the PMP regardless of consideration to prescribe a controlled substance.
I have a message in to an occupation medicine clinic to see whether they do/can routinely check when do DOT cards or employment physicals. That was two days ago so it may get ignored.

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Re: CDL B Denied

Post by Lillyval » Tue Feb 05, 2019 8:02 am

My friend went back to his previous doctor and got his medical clearance, so he can legally drive again. However, he is now planning tapering off Suboxone, which may not be in his best interest. But I don’t blame him based on what he just went through. It would have been one thing not to get the new job, but he almost lost his CURRENT job because of it.

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Re: CDL B Denied

Post by BlueLight » Tue Feb 05, 2019 9:17 am

Good to hear he’s ok, at least for now. He may want to try the Vivitrol shot once he’s off the Suboxone for a few months and confident he won’t relapse on opiates. The other thing he may want to try is getting to 2 mg or a little less, maybe 1.75 mg, as many times buprenorphine won’t show up on a immunoassay/ drug cup test due to cutoffs. He can test himself for as little as $3 each. https://www.meditests.com/doa-bdc.html

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Re: CDL B Denied

Post by docm2 » Tue Feb 05, 2019 11:59 am

Bluelight, I have a half dozen on 2 mg or less (one takes .125 twice a day) and they are still positive. Back when I worked in a pain medicine clinic Butrans at all doses would be present as well.
Cups vary in their sensitivities, wouldn't count on a low dose defeating the system.

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Re: CDL B Denied

Post by BlueLight » Tue Feb 05, 2019 12:10 pm

Good to know Doc, thanks.

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Re: CDL B Denied

Post by docm2 » Wed Feb 06, 2019 3:03 pm

Below is the response I got from a medical examiner. Delayed because his first answer looked like a legal brief rather than something useful. This is from a practitioner in Minnesota, so other states may be different.
As I expected, since an ME does not have a physician/patient relationship they do not check the state database for controlled substance prescriptions.
I do have two patients with CDL's in Minnesota, one was denied an added qualifier to drive buses so he still drives for a courier service.

21 CFR 1308.11 (391.42(b)(12)) or any other substance such as amphetamine, a narcotic, or any other habit forming drug, The driver is medically unqualified.
Individual examiners struggle with the question. In the medical handbook, which has been taken off the Internet for medical examiners, Suboxone is medically not recommended for commercial drivers. The medical handbook is to be updated at this time. The handbook was to be released last year it has not. As a strict statutory obligation of the medical examiner's disqualify in regards to medication, very few medications exist which are absolute disqualifiers in in terms of the FMCSA. To date, I have not found an examiner, who is boarded and practices occupational medicine who would allow a driver to drive under this medication. So, it becomes a standard of care.
In terms of the PMP, each state regulates who may look at that information. My understanding is that the medical examiner in regards to a commercial driver is to serve public safety. I'm not aware that the PMP allows an individual serving public safety to look up a commercial driver's drug use. I've never done, is that evaluation of the trucker does not establish a patient physician relationship which allow me to review that information. Each state will have its own rule.

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Re: CDL B Denied

Post by Lillyval » Thu Feb 07, 2019 8:25 am

Thank you for following up on this docm2. I passed this information along.

Someone playing devils advocate this discussion asked me why the corporate doctor who invalidated my friend’s CDL didn’t have his regular driver‘s license revoked as well? If he is unsafe to drive a truck then how is he safe to get behind the wheel of a car?

Those of us (like me) who would like to create a legal precedent allowing stable buprenorphine patients to drive professionally could lose big and all buprenorphine patients could be deemed unfit to drive.
We’ve had two poster’s here who I can think of off the top of my head who got in car accidents and were charged with DUI because they were on Suboxone.

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