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70 reported to vary by region, for factors that are unclear 2 specialized companies. Representing more than 25,000 com- from the survey. Medical examiner comments indicated pany drivers, and more than 4,000 leased/owner-operator that those who did communicate information about the drivers, the range of the number of drivers was from a mini- driver exams to the employers mostly were required to mum of 10 drivers per company to a maximum of more than explain only if a driver did not "Pass." 6,200 drivers, with an average of 816 drivers per company. No lists of prohibited drugs were made available by the medical examiners to employers (motor carriers). Although 29 of the 31 respondents in the survey indicated that their company had some form of policy regarding driver use of chemical substances, only 24 indicated that they had Suggestions for Further Research policies concerning prescription medications, 24 for alcohol, 23 for illegal drugs, and 12 for OTC medications. When asked The results of the survey of the medical examiners who con- if they had policies regarding other chemical substances, duct CDM examinations prompted a number of suggestions eight declared they had a policy concerning sleep aids, six for for further research: legal stimulants, and three for nutritional supplements. To support development of an evidence-based list of In answer to the more open-ended questions on the survey, approved medications and supplements. a number of the companies expressed interest in obtaining The current testing required under Part 40 for ille- more usable information, education, and guidance on the many gal drugs of abuse does not fully address accident- chemical substances available to their drivers (employees). associated medication questions for legally prescribed Some companies requested information on what chemical medications or supplements. Research could be under- substances are acceptable for use by commercial drivers and taken to examine the potential for expanded drug test- which chemicals are not suitable. This in itself suggests that one ing of drivers to expand knowledge of actual med- outcome of this survey done for this synthesis study would be ications taken (rather than only those admitted) in to develop more informative guidance information; "hand out" pre-employment, randomly, and in post-accident materials on the most common forms of chemical substances settings (similar to rotational testing for drugs of used by commercial drivers. abuse performed by the U.S. military). Expanded post- accident testing for medications, as well as illegal drugs, has been called for in other settings (e.g., Expert OVERALL CONCLUSIONS FROM THE SURVEY Panel on Licit Schedule II drug use). OF MEDICAL EXAMINERS AND MOTOR CARRIER MANAGERS A methodology could be developed to address acci- dent causal inference that would cover the use of med- Solid information packages are not available. All ications and other chemical substances (accident risk three elements of this synthesis on chemical substances modeling, similar to fatigue risk modeling). (literature review, and surveys of carriers, employers, To support more consistent practice among medical and medical examiners) point to the lack of detailed examiners of commercial drivers with respect to drugs, information about the numerous chemicals, drugs, sup- medications, and fatigue advising: plements, popular energy enhancement products, and Specific medical examiner training materials could so on that might have an impact on commercial drivers' be developed that would focus on medications, sepa- performance and health. Such information, presented rate from the underlying medical conditions, with a in user-friendly packages, could be of benefit to three view to framing them in the context of previously communities: (1) commercial drivers and their employ- investigated accidents where the medications have ers; (2) medical providers who either treat commercial played a role as a causal associated factor. motor vehicle (CMV) drivers or who perform medical Research could be undertaken toward compiling an certification exams of drivers; and (3) representatives of anthology of accidents with medications as causal the commercial driving safety community, researchers, associated factors be published and analyzed from the and policy makers, who all must stay abreast of pharma- point of view of the medical examiner. In particular, ceutical developments, nutritional supplement market- this treatise should cover those chemical substances ing, and medical practices that involve the influence of identified in commercial driving settings. psychoactive chemical substances with CMV driving and roadway safety issues. MOTOR CARRIER POLICIES REGARDING Additional research needed on some chemical sub- CHEMICAL SUBSTANCES stances. As specified throughout the literature review, and highlighted in the conclusions, transportation researchers With American Transportation Research Institute assistance, concerned with CMV safety issues can identify numer- 31 company surveys were returned from safety and health ous areas where additional research may be called for officials and other company management personnel. Those regarding the chemical substances available to com- that returned surveys (mostly truck carriers) consisted of mercial drivers and that may impact driver performance 16 for-hire, 7 private, 7 truckload, 5 less-than-truckload, and and health.