Can I pass a commercial driver (CDL) who is taking lorazepam (Ativan) as needed (PRN) for grief after the death of his daughter?

Commercial Driver Taking Lorazepam PRN Cannot Be Medically Cleared to Drive

A commercial driver taking lorazepam (Ativan) as needed for grief following the death of his daughter should not be medically cleared to drive due to significant impairment risks that could compromise public safety.

Effects of Lorazepam on Driving Ability

Lorazepam is a benzodiazepine that significantly impairs driving ability through several mechanisms:

• Research shows lorazepam causes significant impairment to driving and psychomotor abilities regardless of blood concentration 1
• Common side effects include sedation, dizziness, weakness, unsteadiness, and disorientation 1
• Even therapeutic doses used for anxiety management (0.5-1 mg orally) can cause impairment 2

Specific Concerns for Commercial Drivers

Commercial drivers (CDL holders) are held to higher medical standards due to:

• Operating larger vehicles that pose greater public safety risks
• Longer driving hours increasing risk of medication-related impairment
• "As needed" (PRN) usage pattern creates unpredictable blood levels and effects
• Grief following daughter's death may compound medication effects

Evidence from Driving Studies

The evidence against allowing benzodiazepine use in drivers is substantial:

• A case-control study found anxiolytics like lorazepam significantly increase traffic accident risk (OR = 1.54,95% CI 1.11,2.15) 3
• Lorazepam can impair driving even when it's the only medication being taken, with concentrations as low as 0.01 mg/L 1
• Motor vehicle accidents due to prescription drug impairment have increased in the past decade, with benzodiazepines specifically identified as high-risk medications 4

Regulatory and Legal Considerations

There are significant legal and regulatory issues to consider:

• 17 states have "per se" laws making it illegal to drive with certain drugs in the body 4
• 43 states train drug recognition experts who can detect medication-related impairment 4
• Commercial drivers are subject to stricter medical qualification standards than non-commercial drivers
• Medical examiners have a responsibility to protect public safety

Alternative Approaches

Instead of clearing this driver to return to work while taking lorazepam:

1. Recommend grief counseling and non-pharmacological interventions for managing grief
2. If medication is necessary, consider non-sedating alternatives for managing grief symptoms
3. The driver could potentially return to commercial driving after:
   • Complete cessation of lorazepam
   • A washout period (typically 5 half-lives, which for lorazepam is approximately 2-3 days)
   • Evaluation by a mental health professional confirming fitness for duty

Conclusion

Based on the evidence of driving impairment associated with lorazepam, the unpredictable nature of "as needed" dosing, and the heightened safety requirements for commercial drivers, this driver should not be medically cleared to operate a commercial vehicle while taking lorazepam, even on a PRN basis.