National Transportation Safety Board
Washington, DC 20594
Office of the Chairman

March 23, 2017

US Department of Transportation
Docket Management Facility
1200 New Jersey Avenue, SE
West Building, Ground Floor, Room W12–140
Washington, DC 20590-0001
Attention: Docket DOT–OST–2016–0189; Regulatory Identification Number 2105–AE58
Dear Sir or Madam:
The National Transportation Safety Board (NTSB) has reviewed the US Department of
Transportation’s (DOT) notice of proposed rulemaking (NPRM) titled “Procedures for
Transportation Workplace Drug and Alcohol Testing Programs: Addition of Certain Schedule II
Drugs to the Department of Transportation’s Drug-Testing Panel and Certain Minor
Amendments,” which was published at 82 Federal Register 7771 on January 23, 2017. The NPRM
primarily requests comments on the DOT’s proposed rule change to add four opioids
(hydrocodone, hydromorphone, oxymorphone, and oxycodone) to its urine drug-testing panel. The
NTSB provides the following comments on this proposed rule change.
One of the first NTSB accident investigations in which the effects of opioids were included
in the probable cause involved a light rail train that failed to stop and struck a bumping post at the
Baltimore-Washington International Airport Light Rail Station on February 13, 2000. Eighteen
people were injured, five of them seriously. The NTSB determined that the probable cause of the
accident was “the train 24 operator’s impairment by illicit and/or prescription drugs,” which
included prescription oxycodone, codeine, and cocaine. 1
Perhaps the most well-known accident where an operator’s use of prescription opioids
caused or contributed to the accident is the allision of the M/V Cosco Busan with the
San Francisco–Oakland Bay Bridge on November 7, 2007. The harbor pilot, who was in charge of
the vessel at the time, was using a variety of medications including three opioids (hydrocodone,
pentazocine, and propoxyphene), each in high doses, as well as two benzodiazepines and multiple
other psychoactive and sedating medications. The NTSB determined that the probable cause of the

1

National Transportation Safety Board, Maryland Transit Administration Light Rail Vehicle Accidents at the
Baltimore-Washington International Airport Transit Station Near Baltimore, Maryland, February 13 and August 15,
2000, NTSB/SIR-01/02 (Washington, DC: National Transportation Safety Board, 2001).
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accident was “the failure to safely navigate the vessel in restricted visibility as a result of (1) the
pilot’s degraded cognitive performance from his use of impairing prescription medications.” 2
More recently, on April 3, 2016, in Chester, Pennsylvania, a train struck a backhoe and
group of maintenance-of-way workers on the same track. The toxicology specimens from the
maintenance-of-way supervisor who died in the accident tested positive for oxycodone, morphine,
and codeine. 3 The NTSB is still investigating the accident and has not yet determined a probable
cause. However, this accident also highlights the importance of testing maintenance-of-way
workers, who will be subject to the Federal Railroad Administration’s drug and alcohol testing
requirements starting later this year.
The NTSB commends the DOT for proposing to expand the list of drugs it requires testing
for to include four commonly prescribed and frequently abused opioid drugs. The NTSB notes that
the current testing identifies only morphine, codeine, and heroin among opiates. The additional
four proposed substances include (1) oxycodone (often prescribed with the name OxyContin, or
in combination with acetaminophen as Roxicet or Percocet); (2) oxycodone’s active metabolite
oxymorphone (also often prescribed as a separate drug with the name Opana); (3) hydrocodone
(often prescribed in combination with acetaminophen under the names Norco, Lortab, and
Vicodin); (4) and hydrocodone’s active metabolite hydromorphone (also prescribed as a separate
drug with the names Dilaudid, Exalgo, and Palladone).
The NTSB believes including these drugs in the DOT urine drug-testing program will have
several beneficial effects on transportation safety. The US Drug Enforcement Administration
designates all of these drugs as Schedule II controlled substances with a significant potential for
abuse. These drugs also all carry warnings about operating vehicles or machinery because of their
psychoactive and sedative effects. In general, new users of these drugs and those with escalating
doses are at increased risk of crashing while driving; although those on stable, chronic doses may
not be significantly impaired. 4 The addition of these substances to the DOT urine drug-testing
program will likely deter misuse of these substances and ensure those who do use them are doing
so legitimately and will have their use of the medications medically reviewed.
Further, the NTSB supports allowing medical review officers (MROs) to conduct
additional testing (that is, D- and L- stereoisomers of methamphetamine and
tetrahydrocannabivarin) to ensure a positive test is adequately verified. The NTSB used the D- and
L- stereoisomer testing in a recent accident investigation to support the finding that the truck driver
who struck a line of stopped traffic resulting in six fatalities and multiple injuries “had illegally

2

National Transportation Safety Board, Allision of Hong Kong-Registered Containership M/V Cosco Busan with
the Delta Tower of the San Francisco–Oakland Bay Bridge, San Francisco, California, November 7, 2007,
NTSB/MAR-09/01 (Washington, DC: National Transportation Safety Board, 2009).
3
Toxicology data is available in the public docket for this ongoing accident investigation, NTSB accident
identification DCA16FR007, which is available via the NTSB Docket Management System website.
4
A. Mailis-Gagnon, S.F. Lakha, A. Furlan, K. Nicholson, B. Yegneswaran, and R. Sabatowski, “Systematic
Review of the Quality and Generalizability of Studies on the Effects of Opioids on Driving and
Cognitive/Psychomotor Performance,” Clinical Journal of Pain 28, 6 (2012): 542-55.

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used methamphetamine prior to the crash, and its effects degraded his driving performance.” 5
Therefore, the NTSB believes that additional tests will increase the accuracy of test verification.
The NTSB appreciates the opportunity to comment on this notice.
Sincerely,

5

National Transportation Safety Board, Multivehicle Work Zone Crash on Interstate 75, Chattanooga, Tennessee,
June 25, 2015, NTSB/HAR-16/01 (Washington, DC: National Transportation Safety Board, 2016).