Can Patients on Buprenorphine Get a Commercial Driver’s License?


I’ve been seeking an answer for some months now, and it appears to be: “It depends.”

One of my most successful office-based buprenorphine patients was due to renew his commercial driver’s license (CDL). He’s had his CDL for years, and has never had a serious accident. He’s been a stable patient of mine for around four years, and his last illicit opioid use was ten years ago. He started his recovery at a methadone clinic, and then transitioned to another buprenorphine doctor’s office-based practice before he transferred to me four years ago.

He’s held a commercial driver’s license (CDL) all of those years.

Since he has done so well, we’ve discussed the pros and cons of starting a slow taper off buprenorphine. Due to recurring pain issues, he would probably require intermittent opioid medication if he tapered off buprenorphine. Ultimately, we decided he would have a better quality of life and a lower risk of a relapse to uncontrolled opioid use if he remains on buprenorphine indefinitely.

Like so many of my patients, once his addiction was treated, he excelled at his job, and he’s received several promotions over the past few years. However, even though he doesn’t drive a truck every day, he’s still required to keep a CDL in order to keep his job.

When he went for his usual Department of Transportation driver’s exam this year, he was turned down for his CDL. He was told that people on narcotics can’t get a commercial driver’s license.

The Department of Transportation has undergone some changes over the past few years. Back when I was in primary care, any doctor could fill out the DOT form for a patient to get a CDL. Some doctors were rather slap-dash in their efforts, and I suppose that’s why doctors now have to quality to do these CDL exams. Starting a few years ago, doctors must take a training course and pass a test in order to register to do DOT exams. All such doctors are listed on the National Registry of Certified Medical Examiners.

When he was asked about his medications, he lied and told them he wasn’t on any medications. He was conflicted about this; he wanted to tell the truth, but was afraid that if he did so, his livelihood would be in danger. We discussed this issue at one of his visits, and I told him what I knew at the time. Patients maintained on methadone can’t get a CDL if they reveal that to the medical examiner, and I doubted buprenorphine would be viewed any differently. I also told him the DOT doesn’t test for buprenorphine. He passed all DOT exams in the past because the examiner didn’t know he was on maintenance medication. DOT doesn’t test for anything but marijuana, cocaine, opiates, amphetamines, and PCP. (Yes, you read that right. PCP.)

The DOT test will detect opiates, that is, substances derived from the opium poppy, but won’t detect synthetic opioids like methadone, buprenorphine, fentanyl, and the like.

I also told my patient that I did not feel he was impaired from the buprenorphine I prescribed, as he had a tolerance to any sedating effect it could have. I told him I’m much rather meet him on the road than a driver who took Ambien the night before. And I told him it was ultimately up to him to decide what to tell the DOT examiner.

So my patient didn’t tell the DOT examiner that he was on buprenorphine. He was afraid if he did tell the examining doctor, his employer would find out and he would be fired. He was also afraid he wouldn’t be able to get his CDL if he told the truth. As it turns out, he was correct.

As expected, my patient’s DOT drug screen was negative for all substances. However, this examiner checked the state prescription monitoring program, where he saw my patient’s prescriptions for Suboxone. So the examiner denied my patient his CDL.

I felt so badly for my patient. Here he was, as successful as a person can be in recovery, being turned down both because he is taking buprenorphine, and also because he didn’t tell the DOT examining doctor that he was taking buprenorphine.

I wanted to advocate for my patient, and in a misguided effort, wrote a letter to my state’s DOT. It was a great letter, emphatically worded, with data references, but I sent it to the wrong place. Eventually, my patient got a letter from the state DOT saying it was fine with them that he keep driving, but that suitability for a CDL wasn’t under their purview. When I called for more information, they told me I needed to contact the Federal Motor Carriers Safety Administration (FMCSA).

It took repeated calls (six) to this government agency before I was able to talk to someone, but finally I reached a person who gave me the scoop. Her name was Angela, and she told me that if my patient was on methadone, there was no way he could get a CDL. She also said that with buprenorphine, it was decided on a case-by-case basis, and that I would need to talk to the physician doing my patient’s DOT exam, and that the decision was ultimately up to this person. She also said my patient had the right to seek a second opinion about his CDL.

OK, I thought. Now we’re getting somewhere. Before my patient spent time and money talking to a doctor for a second opinion, I thought I should try talking to the first doctor who had turned him down. This doctor was on staff at the same teaching hospital where I did my residency in Internal Medicine about a billion years ago, so I hoped he would be educated and open to the facts I wanted to present.

After all, I thought, science was on my side. Studies have not shown differences of reaction times and driving abilities between patients maintained on buprenorphine and normal controls. There is no evidence that I’m aware of that shows maintained patients shouldn’t be behind the wheel. That fact, plus my patient’s successful recovery should convince this doctor.

It did not.

I’ll spare my readers painful details, but this doctor was not open to what I had to say. I felt like this doctor was so hung up on the fact that my patient had lied that he couldn’t hear anything else I was saying. Yes, I told him, my patient did lie, but he did so out of fear that his boss would find out about his substance use disorder, and that he would lose his job. He has a wife and kids to support, and I think many people would lie in similar circumstances.

After I had harped on that for some time, this doctor said that people prescribed narcotics can’t get a CDL, that was that, case closed.

When doctors say things like that, I get confused. I hate the term “narcotic,” because it means different things to different people. To some, it means opioids. To others, it means illicit drugs. If we look at the root of the word, “narco,” which means sleep, a narcotic is a substance that puts people to sleep.

So what does the FMCSA mean when they use the word “narcotic?”

For the purposes of my conversation with this doctor, it meant my patient would not be getting his CDL.

I went to the website of the FMCSA to see exactly the wording of their statement. Here it is:

If a driver uses a drug identified in 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. There is an exception: the prescribing doctor can write that the driver is safe to be a commercial driver while taking the medication. In this case, the Medical Examiner may, but does not have to certify the driver.”

I thought 21 CFR 1308 would give me more exact information, but when I found it on the internet, it does not. It’s just the law that categorizes potentially addicting drugs into Schedules 1-5.

Does this mean that any person filling a controlled substance can’t get a commercial driver’s license? Really? Will there be any people left to drive trucks if everyone prescribed a controlled substance is excluded from driving?

Or will this unfairly apply only to patients on medication-assisted treatment? I don’t know.

Anyway, my patient took a copy of the letter I had written for him to another DOT examining physician, for a second opinion. This doctor granted him a time-limited CDL, and my patient is OK for now.

For now. He’s still worried about his job security in the future, and so am I. Several of my patients are on buprenorphine, and I worry if they will also be denied. I’m happy to advocate for them – assuming they are doing well – but it feels a bit unfair to me.

I have patients on methadone and buprenorphine through our opioid treatment program (OTP). They can get CDLs without problem, because their data is more protected than my office-based patients. OTP data is not posted on the prescription monitoring program in my state because privacy laws prevent this. There has been talk recently about changing this law. But for now, a patient attending the OTP, on the same medication as my office-based patient who was initially denied his CDL, can be granted a CDL because OTP records are held to a higher standard of confidentiality.

The Veterans Administration, where large quantities of controlled substances are prescribed, does not (yet) report to the state prescription monitoring program, so those patients’ medications also would not be revealed to a DOT medical examiner.

It’s a weird world.

If my patient is turned down in the future for his CDL, would he qualify for disability? It seems like that should be the case, and that’s another question I have.

But my patient wants to work. He doesn’t want to go on disability.

I understand that driving commercially is a safety-sensitive job, and people doing those kinds of jobs aren’t granted the same confidentiality about drug use and addiction as people doing other jobs. It’s the same in other safety-sensitive jobs, like medical professionals, pilots, and the like. I drive frequently, and I do want all drivers to be safe.

But I would like for decisions about who can drive and who cannot to be made on the basis of science and fairness, not on persona bias or happenstance.


35 responses to this post.

  1. Dr. Burson, have you considered getting the CDl examiner certificate? I agree with the irony (and illogic) about someone on methadone in an OTP being able to get a CDL but not someone on buprenorphine in an OBOT.


  2. I just knew you were talking about me. I live in wilmington,nc. I’ve read your blog for sometime, year or so. Your awesome. Really. I’m 58 now & been clean & sober since july 10 ’93. The first 10 years clean in the program with no methadone or subs. Then kidney stones and opioids & I had a decision to make. I had remembered how well methadone worked for me in my early twenties so I started at coastal horizons 10 years ago. Long ago they would kick you methadone after 6 or 9 months. I was on monthly takehomes at coastal & colonial in wilmington for 10 years. Drug screens Every month. I weaned down to 30mg at colonial and switched to suboxone 2 + years ago. Sick, lord was I sick. Apparently skipping 1 day then starting subs wasn’t enough time. I have since left the clinics and have been seeing a private suboxone doctor for a couple years. After reading your blog topic, in my head, I have lost my job, home and family because I’m not going to be able to renew my Comercial license. My medical card expires this December & I’m getting to old to do much besides drive a truck. Nah really like what I do and make a decent living. Anyway, maybe something will change between now and then. Amazing to me you can show a decades worth of clean monthly alcohol & drug screens and not be eligible. You would think that about the disability, being denied and all. Probably take a year to get approved & who can go that long with no income.
    Thank you so much for what you do.


  3. Geez…I always tell my patients that it will unlikely be picked up on a drug screen but I did not even consider the examining doctor checking the PMP. Technically I thought if you were not treating the patient with the drug, you were not to check the PMP unless you were going to prescribe a controlled substance. Just food for thought…


    • It really shook me up when I read that. I had to think about it. I was in clinics up until January 2014. My last dot physical was December 2014.Maybe they started checking your prescriptions after that or maybe he was just one out of a hundred that does it. Due for another dot physical this coming December. Privacy law’s have kept me ok but now? This doctor has never had anything but clean screens from me so i wonder if he would write a letter for me. He may be concerned that he would be taking responsibility for me which doesn’t sound good. Maybe you could share your letter with him. I’m not sure he even knows what I do for a living. I think 5 minutes is the most I’ve seen him at a time in 2+ years going in once a month. I don’t think I am complaining, I do live a spiritual life and go to meetings but sometimes I do feel a bit better leaving there after more conversation. Any suggestions would be greatly appreciated. Thanks


      • The solution appears to be that you should ask your doctor if he knows DOT examiners that are educated about MAT. Since the studies show no impairment, your doctor should feel good about advocating for you, particularly since you are doing so well.
        Five minutes per visit – that’s not much…
        As it turns out, it may be against the prescription monitoring program rules for physicians doing DOT exams to disqualify based on PMP findings. It appears that this is actually not allowed in NC – more about this in an follow up blog.

    • Exactly! As it turns out, this doctor probably violated the regulations around using the state’s PMP.


  4. Posted by Ben on December 16, 2016 at 3:06 am

    You sir are an awsome dr and go far and above nost out there i dont know who you are or where you are from but your patients are truly blessed to have you


  5. Posted by Anonymous on March 21, 2017 at 12:57 pm

    Great article Jana! I needed to get my DOT Card for work (I DO NOT NEED A CDL) I just need to drive a vehicle over 10,000lb think Ford F-450 SuperDuty.

    I work for a state agency (Maryland). My company sends us to a clinic specifically set up for hazmat physicals/ DOT cards.

    I did not know suboxone (bupe) was a disqualifier and I figured I should write it down on my intake sheet, bc I thought it would show up on the drug test…

    Would you recommend:

    a)Going back and not writing it down, it was months ago
    b)going to one of their different locations in the hopes that my info won’t show up
    c)Find out who my FMCSA Medical Examiner is, and get him to write me a waiver. That’s not the Doctor I spoke to at the clinic is it? I ask because he was telling me he thinks the law is ridiculous
    d) Use my own money to go to another certified medical examiner on the National Registry, AND THIS TIME, don’t write down suboxone on my intake papers
    e) Something else??

    Any info you can provide would be greatly appreciated and again: I’m in the state of Maryland, and I only need a DOT card (NOT A CDL).

    Thank you very much for any help


    • I don’t understand – did you get your DOT card when you told the doctor you were on buprenorphine?


      • Posted by GIMMEDOT on March 28, 2017 at 11:29 pm

        No. I need to get my DOT card. I went in for the hazmat physical/DOT testing, and I wrote down “Suboxone” on the list of medications I was on (bc I didn’t know bupe would not show up as opiates in the urinalysis).

        So this Doc tells me “Unfortunately you can’t get your DOT card until you’re off of subs. Not only that, but once Im off them, I need to wait two weeks, then bring in a signed note from the person who was prescribing the suboxone, saying I am no longer taking it and am past any possible withdrawal symptoms”??

        Again, I’m not trying to get my CDL, just a DOT Card to drive a vehicle over 10,000lbs. I don’t need to cross state lines. The only medication specifically mentioned in Maryland is methadone.

        But now if I’m understanding this correctly, I can be on subs and have a DOT. But I would need the doctor (who prescribes my subs to write me an exception).

        Any help’s appreciated, thank you.

      • I think your Suboxone doctor needs to step in to help. I was fortunate that a doctor friend of mine contacted me and said his office did DOT exams and if I wrote a letter describing how the patient was doing, and advocating for that patient to get a DOT card, he would make sure it happened.
        I think at the very least your doctor could send the DOT examiner a letter advocating for you, and describing the studies that show no decrease in reaction times in maintained patients, compared to controls not on any medication.
        You are right – methadone is the only medication where you can’t get a CDL. I don’t know the difference between CDL and DOT card. The data behind that decision is shaky, but DOT won’t budge on that one.
        I think that once you’ve gone for a DOT exam, that may be in the computer and a new examiner may ask you about your first visit to a different provider.

  6. Posted by KasSandra McNellis on May 10, 2017 at 4:48 pm

    Does anyone know if the same applies for someone trying to get a drivers lisence reinstated at hearing? I had DUI’s 10+ years ago and I’m going to request a hearing to hopefully get reinstated. I haven’t drank in 10 years but have been prescribed suboxone as a pain management. I know it don’t show up on drug screens but will the DAD look up what prescription I am currently taking?


  7. Posted by KasSandra McNellis on May 10, 2017 at 4:50 pm

    DAAD that was suposed to be in place of DAD. Silly auto correct!!!


  8. I would agree with the comment above. Probably half of all commercial truck drivers would be unemployable if they were honest about their history. Consequently cheating is rampant and drivers who buy opiates on the street can keep driving while drivers who buy buprenorphine with a legal prescription lose their jobs. the situation is wrong and the DOT and employers need to change thier attitudes. Buprenorphine does not interfere with driving performance. Current policies do not promote safety.


  9. Posted by Michael on July 25, 2017 at 9:05 pm

    JUst found this posting after being denied my dot cert. my employers sent me to renew and me being the honest fool that I am was told by the dr that I should seek other employment. “Do no harm” is the hypocratic oath but with one swipe of her pen,I, my wife, and three children could potentially be in harms way based on this individuals biasses. In the end I own that my bad judgments in life, is the underlying causality. I just don’t know, should I just except the judgements of others, but for how long.


    • The DOT still maintains that patients on methadone can’t get CDLs. There is no such dictate for patients on buprenorphine. You may need to get some legal advice.


  10. Posted by stacey on August 16, 2017 at 7:23 pm

    I read your article and I agree with you 100 percent! I am curious about my own ability to obtain a CDL after being on opioids for a few years since having cancer. I am wondering since I stopped taking them a few months ago if they would hold it against me. I didn’t take the medication every day but It was a high dose. I honestly DID not suffer any withdrawal at all thank GOD!! I do not know how that is possible but all I took was ibuprofen and Tylenol around the clock for the first 4 weeks and I did it all without my doctor whom wanted to keep me on the pain medications. I took back 2 months worth of medications to her and said here I want off! I haven’t been taking them she was very concerned that I stopped them told me to stay on them and how was I feeling and how did I come off of them. At this office they check you GS chemistry every 3 months and do pill counts at every visit and in between. This is honestly all besides the point I don’t know how some folks get hooked while others don’t and I do have severe addiction that runs in my family but it’s with alcohol as far as I know. I didn’t want to take any chances with my health. My scans are NED and have been since 2013. I am blessed truly. I want to know if I could be denied because of my health history. I have gotten no real answers and I’m worried.
    I truly appreciate you sharing your parents story it was very helpful.
    Thank you in advance for any and all suggestions,


    • I doubt you will have problems getting a CDL.


    • Posted by Chris Long on November 2, 2017 at 5:02 pm

      Hi Stacey!
      It’s my experience with Oxycontin, Dilaudid etc, that if one takes the drugs as prescribed, they rarely get addicted.

      I had a bad motorcycle wreck several years ago and lived on Oxys for about three years. My wife thought I should quit and so I just stopped. Nothing happened other than very minor discomfort.

      I had no idea about what dope sickness is like and simply figured that I was immune to addiction somehow.

      After a year or so of enduring pain in my leg, I told my wife that I was either going to have it cut off, or going back on my meds.

      I did the latter, obviously.

      Well, I found out that if one toys with these things, one WILL get hooked and I found out the hard way!

      I had switched to Morphine since it was less expensive than Oxycontin and still had doses sitting on my nightstand when the withdrawal hit. I thought, genuinely that I had a massive case of food poisoning! All I had to do was crush one a snort it to stop the drama that I was experiencing! I had no clue.

      Eventually, we called the paramedics and one of them gave me a shot which he said would help for about an hour. He was spot on to the minute when the vomiting and diarrhea returned. The docs in the emergency room along with the paramedics all presumed that I was looking for a fix and never once said, “You DO realize that you are withdrawing and not suffering from food poisoning! Right?” If they had, I’d have gone home and took a dose and got on with my life or at least never touched them again having already endured the worst part!
      Instead, I unknowingly went home and resumed my doses and am now on suboxone therapy.
      I’m currently weaning off.

      Anyway, I guess my point is, really, just don’t play with fire, because you WILL get burned!
      If you take them as prescribed, you will probably be Ok.

      I’m REALLY glad you didn’t go through what I went through as it is a truly disgusting and messy process, if you know what I mean… not to mention the pain from the stomach cramps!

      Take care!


    • Posted by April jones on February 9, 2018 at 10:44 pm

      Your question did not but make me feel bad about taking my pain meds WHILE HOLDING A CDLs. I DONT SEE WHY IT WOULD EFFOECT U AT ALL , if ur NOT ON THEM ANYMORE


  11. Posted by Ashley on August 23, 2017 at 11:10 am

    I think its ABSOLUTELY ridiculous for doctors to automayically deny your dot card with out eveb questions asked and assuming you cant drive. How is someone supposed to turn theor life around with all these walls. Suboxone hekps with withdrawls it does not impaire driving . And its ok a to have medical weed prescribed and drive when on a license exam it says its illegal to drive under influence of marijuana cause it impairs vision !!!!


  12. My doctor was blamimg dot regulations, so i called and i was told its up to the provider . And i let the provider know what was said and she still was saying that who i spoke with througj dot at rmv was wrong ! She didnt even do physically she automatically disqualified me before i even went into room!!!


  13. Posted by Dale on October 18, 2017 at 4:35 pm

    Just went today in Tennessee. After passing all exams, waited for doctor. She asked me about suboxone as I put it under prescriptions I was currently taking. She then said that it disqualifies me for my DOT card. I was upset to say the least and asked if I could leave. She said let me double check to make sure. She came back after a couple minutes and immediately apologized and said it was methadone that would disqualify a person. All I need to do now if get a letter from my sub doctor. I do have a form from them for my sub doc stating once they get letter they will make their determination. But was assured once I brought that to her she would give me my DOT card. I also believe you have to have your DOT card before being able to obtain a CDL.


  14. Posted by Chris Long on November 2, 2017 at 4:41 pm

    Dear Doc Jana, I would just like to add my voice here to the others that you are truly a wonderful doctor who lives by common sense rather than the somewhat arbitrary rules of the world! Your patients are indeed lucky to have you as their physician!

    Your article here answered all of my questions on this subject precisely and very clearly!

    Wonderful post and thank you very much!


  15. Posted by Chad on January 9, 2018 at 7:35 pm

    I found this very helpful and I really appreciate you. People like you doctor , are so rare these days . Thank you for caring so much .


  16. Posted by T A on February 15, 2018 at 8:47 pm

    Dr Jana,

    My doctor gave me a one month sample of Contrave for weight loss. I am about 50-60 pounds overweight. I do take BP meds and it’s under control. I hold a CDL since 1995 and recently had a DOT physical and passed with no issue. My regular doctor just gave me a full physical, blood work, stool samples etc and everything came back normal. He believes if I lose some weight he can begin to reduce my BP meds. Reading the comments in the blog about buprenorphine is causing me pause. I am taking the Contrave for two days but I feel the difference in that I have no appetite or cravings. I can not find Contrave on a banned list of substances but, I may not be looking in the right place. Could you please give me some insight. I have never had a substance abuse problem or depression. This will be the first time I have ever taken a medication like this.


    • Contrave contains naltrexone, an opioid antagonist, and bupropion. Neither is a controlled substance and neither will cause any high. Maybe you are thinking that Contrave contains buprenorphine – it’s confusing, since spelling is so close, but bupropion is a completely different medication. No buprenorphine is in Contrave.


  17. Posted by NDelogu on February 28, 2018 at 8:20 pm

    Just thought you’d like to know — starting 1/1/18, FMCSA and other DOT agencies now tests for opioids. So lawful use is going to come up on the drug tests and lead to the need for an updated DOT medical exam


    • DOT already tests for opiates.


    • Posted by Hana on March 10, 2018 at 11:09 pm

      The DOT test already tested for opioids, on 1/1/18 an expanded opiate panel went into effect to include 4 semisynthetic opioids (hydrocodone, oxycodone, hydromorphone, and oxymorphone). Methadone and bupe are still not tested for.


  18. Posted by RheumTrucker on March 4, 2018 at 10:49 pm

    Great post!
    I’m a long haul trucker with twenty years experience. I was diagnosed with RA in 2010 and although my disease activity is low to moderate- thanks to biologics (Orencia) and Arava -I still use hydrocodone.
    My last DOT physical was early in 2017. I went to see my usual guy at the local truckstop and as usual had my full medication list and a note from my doctor. He was on vacation and the substitute didn’t even know some of the meds I was on, and was getting ready to deny me because of the Arava (seriously) so I just asked him if he would mind me coming back when the regular Doc came back. He not only agreed, but was relieved lol!
    I was renewed for the full two years which surprised me with current issues facing many of us. We ended up chatting about it and I found some interesting things I thought I’d pass along.
    At the end of the day it’s up to the DOT examiner, but a patient can go see someone else if they fail.
    Chantix and Methadone are the only two drugs that the FMCSA has outlawed. Yes, you read that correctly…. Chantix. I guess the idea that a trucker might want to kick the habit is unsafe in the wizened eyes of the FMCSA.
    My advice to other drivers is to tell the truth but have a note. Unless they take Chantix, of course, then you’ll have to either tell a lie or go on Welfare.


  19. Posted by Christopher on March 28, 2018 at 2:55 pm

    Have been waiting to see someone, specifically a Dr. Weigh in on this. It is a “grey area” that has been overlooked for to long. More drivers than one might think are in this very situation. My gratitude & thanks to Dr Burson for taking this issue on. 20 yr safe professional driver.


  20. Posted by Sean on April 17, 2018 at 3:14 pm

    Greatly appreciate this information as I am currently going to truck driving school to get my CDL and I’ve been taking buprenophine for almost a year now. It’s been troubling me and I’m not sure who to talk to. Your patient is lucky to have a doctor that is so supportive. Nice to see there are still people (doctors especially) in the world who do things like you did for others. Im guessing my best course of action is to be honest with the doctor at the time of my physical.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: