Is Amphetamine (Adderall) use disqualifying for a Department of Transportation (DOT) physical?

From the Guidelines

Adderall can be disqualifying for a DOT physical, but it depends on individual circumstances, and the most recent evidence suggests careful evaluation is required. The Federal Motor Carrier Safety Administration (FMCSA) does not automatically disqualify drivers taking Adderall (amphetamine/dextroamphetamine), but it requires careful evaluation, as stated in the guidelines for evaluating the effects of psychotropic drugs on motor vehicle driving performance 1. Drivers prescribed Adderall for ADHD must obtain a letter from their treating physician stating the medication is well-tolerated, the condition is stable, and the medication doesn't impair driving ability.

The concern stems from Adderall being a Schedule II controlled substance with potential side effects like increased blood pressure, heart rate, and possible impairment of judgment or reaction time, as highlighted in the guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Some medical examiners may be more conservative than others in their assessment. If you're taking Adderall, bring all documentation about your diagnosis, treatment plan, and a letter from your prescribing doctor to your DOT physical appointment.

Key considerations for the DOT medical examiner include:

• The driver's medical history and current health status
• The dosage and duration of Adderall treatment
• The presence of any side effects or interactions with other medications
• The driver's ability to safely operate a vehicle while taking Adderall, as assessed by the examiner and supported by the prescribing physician's letter. It is essential to note that the examiner needs to see that the driver has been on a stable dose for at least 30 days with no significant side effects, and the medication does not impair driving ability, as emphasized in the clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents 1.

From the FDA Drug Label

Amphetamines may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or vehicles; the patient should therefore be cautioned accordingly The use of Amphetamine (Adderall) may be disqualifying for a Department of Transportation (DOT) physical, as it may impair the ability to operate vehicles.

• The FDA drug label warns about the potential impairment of operating machinery or vehicles.
• Patients should be cautioned about this potential risk. 2

From the Research

Amphetamine Use and DOT Physical

• The use of amphetamine, also known as Adderall, for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) is a common practice 3, 4, 5, 6, 7.
• However, the question of whether amphetamine use is disqualifying for a Department of Transportation (DOT) physical is not directly addressed in the provided studies.
• The studies primarily focus on the efficacy and safety of amphetamines in treating ADHD in children and adults, as well as the potential risks and side effects associated with their use 4, 6, 7.
• The DOT physical is a separate evaluation that assesses an individual's fitness for duty, and the use of amphetamines may be considered in this evaluation, but the provided studies do not provide clear guidance on this issue.
• It is likely that the DOT physical evaluation would consider the individual's medical history, including the use of amphetamines, as well as other factors such as the individual's overall health and ability to perform their job safely 3, 5.

Key Findings

• Amphetamines are effective in reducing the symptoms of ADHD in children and adults 6, 7.
• The use of amphetamines is associated with potential side effects, including decreased appetite, insomnia, and abdominal pain 4, 6, 7.
• The quality of the evidence for the use of amphetamines in treating ADHD is generally low to very low due to the high risk of bias in many of the studies 6, 7.

Implications

• The use of amphetamines for the treatment of ADHD is a common practice, but the potential implications for a DOT physical are not clearly established in the provided studies.
• It is likely that the DOT physical evaluation would consider the individual's medical history, including the use of amphetamines, as well as other factors such as the individual's overall health and ability to perform their job safely 3, 5.