DOT Proposes Adding Fentanyl to Mandatory Truck Driver Drug Tests
Federal agency seeks to harmonize with HHS guidelines as fentanyl kills 150 Americans daily, but its track record raises implementation concerns
The Department of Transportation announced Tuesday it will add fentanyl and its metabolite norfentanyl to the mandatory drug testing panel for commercial drivers, proposing the most significant expansion of DOT drug testing requirements since 2017.
The 69-page Notice of Proposed Rulemaking, published in the Federal Register on September 2nd, would require all safety-sensitive transportation workers to be tested for the synthetic opioid that now accounts for approximately 70 percent of US overdose deaths but the proposal comes as industry veterans express deep skepticism about the federal government's ability to implement even common-sense safety reforms, pointing to a decade-long pattern of regulatory failures, broken promises, and half-executed initiatives that have left the trucking industry with what one insider called "a really shitty run program."
The DOT's proposal cites alarming statistics that underscore the urgency:
Over 150 Americans die daily from synthetic opioid overdoses, primarily fentanyl
Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine
Drug overdose death rates involving fentanyl increased 279 percent from 2016 to 2021
Fentanyl was the fourth most frequently identified drug in forensic laboratories as of 2021
"Fentanyl accounts for a large proportion of overdose deaths in the United States and is therefore an important public safety concern," the Health and Human Services Department stated in supporting the change.
What's Actually in the 69-Page Proposal
The comprehensive rule change goes far beyond simply adding fentanyl to the testing panel. Here's what DOT is actually proposing:
Fentanyl testing for both urine and oral fluid specimens at 1 ng/mL initial and confirmatory cutoffs
Norfentanyl testing for urine specimens only at 1 ng/mL cutoffs
Updated laboratory reporting requirements to include both substances
Modified Existing Procedures
Morphine cutoff changes: Raising confirmatory test levels from 2,000 ng/mL to 4,000 ng/mL for urine
Elimination of clinical exams: Removing the requirement for Medical Review Officers to conduct physical examinations for codeine/morphine results between certain levels
Biomarker testing authorization: Allowing labs to conduct additional specimen validity tests once approved by HHS
Updated Nomenclature
Marijuana testing analytes renamed from THCA to Δ9THCC (urine) and THC to Δ9THC (oral fluid)
Standardized abbreviations for consistency across laboratories and MROs
Training and Procedural Changes
30-day completion requirement for collector qualification training and proficiency demonstrations
New "fatal flaw" criteria for oral fluid collections
Updated chain of custody form requirements
The Cost Analysis
DOT estimates the rule will cost the industry approximately $18.4 million annually, broken down as follows:
Laboratory screening costs: $18 million annually for testing 6.9 million specimens
Confirmation testing: $216,315 for an estimated 13,110 positive screens
Medical Review Officer costs: $143,156 for reviewing confirmed positive results
Offset savings: $356,400 from eliminating clinical examination requirements
The agency argues that preventing even a single serious accident would justify these costs.
Industry Skepticism
While few dispute the need to test for fentanyl, trucking industry veterans are questioning whether DOT can actually implement the rule effectively, citing a troubling pattern of regulatory incompetence spanning multiple administrations.
Hair Testing’s13-Year Wait
Congress has been pushing for hair follicle testing since 2012. The technology exists, the industry supports it, and it would catch chronic drug users that urine tests miss entirely. Yet after more than a decade of studies, pilot programs, and regulatory reviews, commercial drivers are still providing urine samples in supervised bathrooms like it's 1988.
"We've been promised hair testing for over a decade," said one fleet safety director who requested anonymity. "How are we supposed to trust they'll implement fentanyl testing properly when they can't even figure out hair testing?"
Oral Fluid Testing. The Reg An Industry Can’t Use
DOT finally authorized oral fluid testing as an alternative to urine collection in May 2023, after years of delays. The technology eliminates the privacy concerns of supervised urination while providing more accurate results for recent drug use.
Yet nearly two years later, virtually no carriers are using oral fluid testing due to infrastructure limitations, cost barriers, and implementation hurdles that DOT failed to address before authorizing the alternative.
The National Registry Disaster
The biggest example of regulatory incompetence is the National Registry for medical certifications. DOT had 10 whole years to develop a system that essentially uploads a PDF document to a database.
The final rule took effect in November 2024. Fourteen states, nearly a third of the country, were still unprepared to handle the system. DOT's solution? Create a waiver program to excuse the states that couldn't meet a deadline they'd had a decade to prepare for.
The Implementation Challenge
The rule requires all HHS-certified laboratories to have the capability to test for fentanyl and norfentanyl. But with varying cutoff levels and new confirmation procedures, smaller laboratories may struggle to meet certification requirements, potentially creating testing bottlenecks.
Medical Review Officers must be trained on new verification procedures for fentanyl results, biomarker testing protocols, and updated opioid verification processes. The rule assumes existing MRO certification organizations will handle this training, but provides no enforcement mechanism or timeline.
While the $18.4 million annual cost may seem manageable industry-wide, it represents another compliance burden on small trucking companies already struggling with regulatory overhead. Mom-and-pop operations with a handful of drivers could see their drug testing costs increase significantly.
The rule requires updates to laboratory information systems, chain of custody procedures, and reporting protocols. Given DOT's track record with technology implementations, industry observers worry about system integration failures and data reporting errors.
The Broader Regulatory Breakdown
The fentanyl testing proposal exemplifies broader systemic problems with how the federal government regulates trucking safety:
Over-regulation in some areas, under-regulation in others: DOT can spend years debating the color of warning labels while failing to implement basic safety technologies that already exist and work.
Enforcement inconsistency: Rules get passed but enforcement varies wildly between regions and inspectors, creating an arbitrary compliance environment.
Technology lag: The government consistently trails industry by years in adopting proven safety technologies, then implements them poorly when they finally act.
Process over outcomes: DOT focuses on regulatory processes, comment periods, stakeholder meetings, advisory committees – rather than measurable safety improvements.
Testing for fentanyl is obviously the right thing to do, the question isn't whether we should test for it – we should. The question is whether DOT can actually implement this without creating another regulatory nightmare. Every time DOT announces a new rule, we hold our breath wondering what they'll screw up in the implementation. Good policy ideas consistently get mangled by incompetent execution.
DOT is accepting public comments on the proposed rule through (45 days after Federal Register publication.) Comments can be submitted through the Federal eRulemaking Portal at regulations.gov under docket number DOT-OST-2025-0049.
Given the pattern of regulatory failures, industry observers expect extensive comments focusing not on whether to test for fentanyl, but on implementation concerns and demands for accountability measures to ensure the rule actually works as intended.
Testing commercial drivers for fentanyl represents sound public safety policy that should have been implemented years ago. DOT's consistent inability to successfully implement even basic safety improvements raises serious questions about whether this rule will join hair testing and oral fluid testing in the graveyard of good intentions and poor execution.
The American public deserves both fentanyl testing for commercial drivers and a federal agency capable of implementing such testing effectively. Based on the track record, we may get one but not the other. The trucking system in the United States is broken from the front door to the back door, upstream and downstream, midstream and everywhere in between and the regulatory system that's supposed to fix it is even more broken.