What Happens if You Fail a DOT Physical Drug Test?

Getting Cleared to Return Following a Failed DOT Drug Test

People operating commercial motor vehicles must follow strict guidelines under the United States and the New Mexico Department of Transportation. One of the most important provisions is to drive safely and sober, passing a drug or alcohol test at all times. But what happens if you fail a DOT physical drug test?

At Icarus Behavioral Health, an accredited treatment facility in Albuquerque, New Mexico, we know that the Department of Transportation views the use of substances, illegal or not (like marijuana and alcohol) very seriously. If you are in a safety sensitive job under the umbrella DOT regulations, a positive result can lead to a host of headaches.

We invite you to keep reading to learn how a physical exam with a positive DOT drug screen will usually be handled.

Why Does a DOT Physical Include a Drug Test?

Commercial driver’s license holders must pass a drug test during a yearly physical exam to ensure the safety of the public and the driver. Commercial drivers operate large, heavy vehicles for long hours and cross state lines. It’s crucial that drivers are alert and able to respond to any hazards along the way quickly.

The US Department of Transportation requires drug testing as part of the Federal Motor Carrier Safety Administration (FMCSA) rules. The regulations set up by federal and state DOTs and FMCSA can help prevent accidents and injuries. The drug and alcohol test specifically helps:

• Detect legalized drugs (alcohol, marijuana) as well as illegal drugs (cocaine, meth, heroin, etc)
• Protect public safety on America’s roadways
• Stay compliant with federal laws for commercial vehicle operators
• Increase accountability and early intervention when a driver has a failed drug test result

These rules are more than punitive measures. They ensure that every CDL and CMV driver is competent and capable of driving.

Do CDL Drivers Take Yearly Drug and Alcohol Tests?

During each DOT employee’s DOT physical exam, they receive a 5-panel drug test that is less comprehensive than DISA drug testing. This covers not only CDL drivers but also includes other safety-sensitive jobs. The standard test looks for:

• Marijuana
• Cocaine
• Amphetamines, which include methamphetamine, MDMA, and ecstasy
• Opioids, including semi-synthetic oxycodone and hydrocodone
• Phencyclidine (PCP)

The annual DOT drug test does not detect alcohol.

Alcohol Testing Regulations

Interestingly, an employer subject to DOT’s current rules are not required to conduct pre-employment drug testing for alcohol before hiring a candidate. DOT only requires an alcohol test in the following specific circumstances:

Post-accident Drug Test

If a DOT driver has an accident, they’re usually required to undergo both alcohol and drug tests. However, the employer has a little bit of latitude with this drug test based on the severity of the incident.

Reasonable Suspicion Alcohol Test

If a supervisor or manager suspects an employee is using drugs or alcohol, the CDL driver can be subject to testing.

Random Drug Test

A 2025 rules change required employers to randomly test at least 10% of their drivers for alcohol use annually. The alcohol test rule change goes above and beyond the 2019 requirement to test a minimum of 50% for drug use.

Return-to-Duty Process and Follow-up Tests

Drivers with a positive result for alcohol or drugs must undergo comprehensive testing before returning to the job. They may also be subject to additional DOT drug tests at a medical examiner’s discretion.

What Happens to a Commercial Driver’s License with a Positive Result?

When a CDL driver fails a DOT drug test, they face immediate consequences:

Substance Use Results in Immediate Removal from Safety-Sensitive Functions

What happens when someone tests positive on a DOT drug or alcohol test? First, the rules dictate that the driver be removed from any safety-sensitive position, such as operating machinery or driving. This prohibited status is a non-negotiable federal law.

Return to Duty Process Requires Meeting with a Substance Abuse Professional (SAP)

The employee with a failed drug test meets with a DOT-qualified Substance Abuse Professional (SAP) for an evaluation. After the evaluation, the SAP creates a personalized action plan. The driver cannot move forward in reinstating the CDL license until they complete this step.

Completing Required Substance Abuse Programs

DOT and FMCSA regulations require employees to successfully complete all counseling, outpatient treatment, or educational opportunities recommended. Progress and participation must be documented and verified before the reinstatement process continues.

Follow-up Evaluation with the SAP

Upon program completion, the employee meets with the same SAP that determined the appropriate drug abuse program. They’ll confirm follow-through with the treatment plan and provide verification that the driver is mentally fit to complete the return to duty process.

Return to Duty DOT Drug or Alcohol Test

As part of the return to duty process, the employee must pass an alcohol and/or drug test given under direct supervision. That means a technician stays with the driver during sample collection. A negative result on this drug or alcohol test is necessary before the employer can allow them back on the job.

Follow-up Tests

After going back to the job, the employee is subject to random alcohol and drug tests for up to 5 years. The frequency and duration of the follow-up tests are determined by the substance abuse professional (SAP) who had set the treatment plan earlier in the return to duty process.

Reporting to the FMCSA Drug and Alcohol Clearinghouse

According to current regulations, the results of the return-to-duty process must be sent to the FMCSA Drug and Alcohol Clearinghouse. This national clearinghouse tracks the results of failed or refused alcohol and drug tests for drivers across the United States.

Once the information is in the clearinghouse, the State of New Mexico can reinstate the driver’s license. In addition to the DOT, current and potential employers. and the employees themselves, can view the DOT drug test information in the Drug and Alcohol Clearinghouse.

Ron Failed a DOT Drug Test and Followed the Return to Duty Process

‘Ron,’ 34, failed his employer’s random DOT drug test. He had used marijuana with some buddies the previous weekend, which was legal in New Mexico. He really did not understand that weed was legal in New Mexico still not federally legalized and would lead to a failed drug and alcohol test conducted by his employer.

Ron was taken off the schedule and met with his employer’s designated SAP for a treatment plan. He felt super embarrassed that he didn’t know that marijuana would cause a DOT drug test fail and could jeopardize his job with a top trucking industry employer.

Because Ron didn’t have a long history of abusing drugs or drinking alcohol, the SAP allowed him to attend 15 days of outpatient treatment at Icarus New Mexico, which was located near his house. Ron learned healthier ways than smoking weed to deal with the stress of being away from his wife and baby during long work weeks.

The Icarus New Mexico counselors also educated him on the dangers of smoking weed and how it could potentially decrease his lung capacity and lead to additional health consequences.

Getting Cleared by DOT Protocols to Get Back to Work

After his DOT- and employer-mandated program ended, Ron became eligible for the return-to-duty process. He met again with the SAP, who was satisfied with his progress, and passed a new DOT drug test.

His employer, a top trucking company, ensured his DOT drug test and recovery results were in the clearinghouse.

Ron was finally able to return to duty, knowing he now has the stress management tools to avoid future drug use and will pass all future follow-up tests with flying colors.

What Else Does the DOT Physical Cover?

DOT physicals ensure that drivers spending time behind the wheel have the ability to handle their vehicle, even during long drives and in often highly stressful situations. Testing is bi-annual for most drivers.

However, when a certified medical examiner requests it, annual testing for drivers with certain medical conditions or who take certain medications may become mandatory.

Besides overall health, the doctor will screen for the following before issuing a DOT medical card:

Vision Testing

• At least 20/40 vision in each eye, with or without corrective lenses
• A field of vision of at least 70° horizontally
• The ability to identify traffic signal colors

Hearing Testing

Able to hear a forced whisper at 5 feet, with or without a hearing aid

General hearing levels

Blood Pressure and Pulse Rate

• A check for high blood pressure or an irregular heartbeat
• Hypertension requiring prescription medication usually triggers a DOT physical every year instead of every 2 years

Urinalysis

• Urine screen for blood sugar levels, proteins, or other indications of diabetes, kidney disease, or other health issues
• This urine test is different than the separate DOT drug test

Physical Exam

• The doctor checks for overall wellness and discusses medical history
• Listens to the lung and chest for typical sounds
• Checks the abdomen for hernias or tender spots that can become a problem
• Assess the mobility and strength of the driver’s limbs and spine
• Checks reflexes, balance, and mental alertness
• Discusses medications, including blood pressure or anti-seizure medications

In some cases, the examiner may order follow-up tests for conditions including sleep apnea, cardiac issues, or diabetes. If the physical is successful with no drugs found in the system, the doctor issues a medical certificate for 1 to 2 years, which permits the DOT driver to continue working.

Icarus New Mexico Provides Proven Drug and Alcohol Treatment Support

If you operate a commercial motor vehicle and need help after failing a DOT drug test, discuss your desire to attend treatment at Icarus New Mexico with the SAP. Our drug and alcohol treatment programs have helped scores of clients get clean, sober, and ready to reclaim their everyday lives.

Employer group health plans provide coverage for mental health treatment, and we are happy to work with the top insurers in New Mexico.

A quick call to our admissions team is free and confidential, and we will tell you your total out-of-pocket costs (sometimes $0).

Call us today for a free insurance benefit review and to learn more about how we can support your return to duty process.