Opioids on the Highway: What the Research Means for Truckers

Is the driver in the next lane impaired by opioid use? It's a question with growing relevance for everyone who shares the road — including professional truckers.

The share of fatally injured drivers who tested positive for prescription opioids rose sharply over two decades, climbing from 1 percent in 1995 to over 7 percent in 2015, according to a study from Columbia University's Mailman School of Public Health.

"The take-away message is that the use of prescription opiates could have a big risk and impacts driving safety for everyone," said Guohua Li, MD, DrPH, professor of epidemiology and anesthesiology and a co-author of the study.

Li and his team analyzed toxicological data for more than 36,000 drivers who died within one hour of crashes across six states between 1995 and 2015. They found the share of drivers testing positive for prescription opioids rose steadily over the period; the three most commonly detected were hydrocodone, oxycodone, and morphine. Among those who tested positive for opioids, 30 percent had elevated blood-alcohol concentrations and 67 percent tested positive for other drugs.

What About Truckers?

Commercial truck drivers were included in the study but not analyzed separately because the number of fatally injured truckers was too small. From earlier work, Li noted that commercial drivers were less likely to test positive for alcohol and drugs than car drivers, because truckers are subject to mandatory testing programs.

That could change if a federal proposal to add opioids to the testing panel becomes a rule. To align drug testing with federal health guidelines, the Department of Transportation proposed adding four opioids — hydrocodone, oxycodone, oxymorphone, and hydromorphone — to the panel. Li estimated that if it became a regulation, roughly 3 to 4 percent of truck drivers might test positive.

A Complicated Legal Picture

Currently, a truck driver who uses opioids prescribed by a physician may drive as long as they are certified fit for duty by a DOT-certified medical examiner. Many truckers have taken prescription pain relievers for years without impairment. The legal picture is complicated, though: unlike blood-alcohol levels, where 0.08 percent by volume is considered legally impairing, there is no legal standard for opioid impairment.

"There is no way to test for opioid impairment just by testing a blood or urine sample," Li said. "All the tests show is that the driver has used this substance recently. Whether the driver is impaired — that's a more nuanced medical question, and you have to go through additional assessment."

He stressed balance: if a driver has chronic pain, takes a stable prescribed dose, and has adapted to the medication's effects under a doctor's guidance, the prescription alone should not significantly harm driving safety. Still, opioids are sedatives and can cause drowsiness, slower reaction time, and diminished alertness.

The Bigger Picture

The opioid epidemic's toll extends far beyond the road. According to the Centers for Disease Control, more than 183,000 people died in the U.S. from prescription-opioid-related overdoses between 1999 and 2015, and over 1,000 people are treated in emergency rooms each day for misusing prescription opioids.

Li supports adding opioids to the truck-driver drug panel. "I think it's sensible given that the use of opiates has been on the rise," he said, while calling for more research into crashes and injuries tied to driving under the influence of opioids — alone or in combination with alcohol and other drugs.

For carriers and owner-operators, the message is practical: know what's in the medicine cabinet, talk openly with a DOT medical examiner about any prescription, and never get behind the wheel when alertness or reaction time may be compromised.

Source: Fleet Owner