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EFFECTS OF PSYCHOACTIVE CHEMICALS ON COMMERCIAL DRIVER HEALTH AND PERFORMANCE: STIMULANTS, HYPNOTICS, NUTRITIONAL, AND OTHER SUPPLEMENTS SUMMARY This synthesis is the product of CTBSSP Project MC-19 and meets four principal objectives: (1) it provides a narrative technical review of the scientific and analytical literature, summa- rizing what is documented about the effects of psychoactive chemical substances on equipment operator performance, in particular insofar as the substances have application to commercial driver safety and health; (2) presents an extensive bibliographic listing of published literature on these topics; (3) suggests possible procedural discrepancies and information gaps in the examination process as it pertains to driver use of prescribed or self-administered medications by means of a convenience survey sampling of a small number of medical providers (n = 23) who conduct Commercial Driver Medical Examinations; and (4) by a convenience sample of more than 30 commercial carrier managers, reports views on access to user-friendly information and guidance regarding chemical substances that commercial drivers (employees) sometimes ingest. Many medications produced by the pharmaceutical industry are prescription drugs and require licensed medical providers. Additionally, a modest number of over-the-counter medications to which drivers avail themselves can be used to self-medicate, whether drivers are diagnosed with an ailment or not. Third, an abundance of nutritional supplements and other readily available products (e.g., energy boost bars, drinks, and dietary measures) are being aggressively advertised to commercial drivers with representations that these products will help drivers maintain alertness on the job, sustain safe driving performance, and improve their health and well-being. Many substances in this latter category are prominently displayed for sale at convenience stores at highway rest and refueling stops, shopping centers, and elsewhere. This synthesis provides information to assist the commercial transportation safety community and the FMCSA in addressing issues involving the proliferation and availability of numerous chemical substances available to and sometimes used by commercial drivers. The primary focus was to examine what is known about driver performance and/or driver health, as each may be positively or negatively affected by the proliferation of chemical substances (from whatever the source). Additional attention is given to what is known about the possible interaction effects resulting from taking two or more of these substances simultaneously, which drivers may occasionally do. A voluminous amount of published scientific literature and hundreds of laboratory study reports pertinent to these topics were identified and reviewed during this synthesis project. The literature makes clear that numerous psychoactive medications (whether prescribed or available over the counter) and other readily available chemical substances have measurable effects on human operator performance of tasks akin to those of commercial drivers, and therefore may also impact job performance (both positively and negatively). Some hypnotics, stimulants, and nutritional supplements have been safely used in various sustained work settings. Successful applications of pharmaceutical intervention have primarily been witnessed in select military operations wherein limited use, acute administration of varying sleep aid and stimulant compounds is permitted with a goal to "get military operators through a particular
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2 mission." Military policies require that such applications be in accordance with rigorous rules that include: (1) first establishing a person's exposure and experience with particular compounds, (2) obtaining voluntary consent to use the chemicals, and (3) the chemicals and medications be administered and used under close medical and safety supervision--conditions unlikely to be practical in commercial transportation work settings. The synthesis literature review reaffirmed that there are only a few viable chemical sub- stances that commercial drivers can legitimately and safely use as sleep aids (hypnotics) or as alertness enhancers (stimulants) during transportation operations and these are described in this report. The limited amount of research literature on many readily available nutritional supplements and other chemical substances likely to be ingested by commercial drivers makes more tenuous any assessments of their effects on worker performance and health. Because some of these supplements are widely sold in the United States, this synthesis concluded that more solid laboratory research work is needed on some, especially to delineate their possible effects on drivers' levels of alertness and safe driving performance. Although companies employing commercial drivers may have policies regarding employee use of chemical substances, this synthesis report suggests there is a need for additional infor- mation to inform decision making by companies on chemical substances that might be used by commercial drivers, under various circumstances and operational use protocols. The survey of a small number of Commercial Driver Medical Examiners suggests that fur- ther research could be helpful to inform development of an evidence-based list of approved medications and supplements to support more consistent practice among medical examiners with respect to drugs, medications, and issuing advice on driver fatigue countermeasures. All three elements of this synthesis (literature review and two convenience surveys) point to the lack of detailed user-friendly information about the numerous chemicals, drugs, sup- plements, popular energy enhancement products, and other chemical substances that might have an impact on commercial drivers' performance and health. Many other areas where addi- tional research may be called for also are identified in this report.