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Document name:
Drugs and Driving: Update
Portfolio
Document type:
Medicines Management
Communication
Staff group to whom it applies:
All prescribers, pharmacy and clinical staff
within the Trust
Distribution:
The whole of the Trust
How to access:
Intranet
Issue date:
Feb 2015
Next review:
Feb 2016
Approved by:
Drug and Therapeutics Sub-Committee
Developed by:
Mark Payne, Senior Clinical Pharmacist
Director leads:
Medical Director
Contact for advice:
[email protected]
Communication: Drugs and Driving: Update
Introduction
The Department for Transport has introduced a new offence of driving with certain controlled
drugs above specified limits in the blood; this is likely to come into force on 2 March 2015. As
the list of drugs covered by this legislation includes medications which we may prescribe /
supply to our clients all clinicians should be aware of the impact these changes should have on
their practice.
Abbreviations
MHRA – Medicines and Healthcare products Regulatory Agency
Impairment of ability to drive
The guidance on advising patients about the risk which medications may pose to their
fitness to drive remains unchanged: at the point of prescription, and at regular reviews of
medication which may affect driving ability the following advice should be given:
 Check the leaflet that comes with your medicine for information on how your
medicine may affect your driving ability
 It is against the law to drive if your driving ability is impaired by this medicine
 Do not drive while taking this medicine until you know how it affects you (especially
just after starting or changing the dose of the medicine)
 Do not drive if you feel sleepy, dizzy, unable to concentrate or make decisions, or if
you have blurred or double vision
Patients should be advised that if they drive whilst their ability is impaired that this is a crime
in itself, and the fact that the medication is prescribed for them is not a defence to
prosecution.
New legislation
The new offence refers to driving, attempting to drive or being in charge of a vehicle with a
specified controlled drug in the body, in excess of a specified limit (Section 5A of the Road
Traffic Act 1988 as amended in April 2013). The drugs to be covered by this offence are
defined in regulations supporting the offence and are listed below.
Those individuals who have taken their medicine(s) in accordance with the advice of the
prescriber or supplier of the medicine(s) (and/or the product information included in the
medicine pack) who are found to have a blood level higher than that specified in the
regulations are entitled to raise the statutory “medical defence” at any stage (see below for
full explanation), and might then not be asked to provide a blood sample.
If the police had evidence that the patient's driving was impaired due to drugs, whether
prescribed or not, they can prosecute under the existing offence of driving whilst impaired
through drugs offence described in section 4 of the Road Traffic Act 1988, for which there is
no statutory “medical defence”
Medicines / drugs which are affected by the new regulations
The following substances will covered by the regulations with effect from March 2015
Low levels allowed by law
- commonly abused drugs
- less likely to be used for therapeutic
effects
- any dosing likely to breach
regulations
Higher levels allowed by law
- subject to misuse
- commonly used in therapeutic
practice
- therapeutic dosing unlikely to
breach regulations
Cannabis (THC)*
Cocaine (and a cocaine metabolite, BZE)
MDMA (Ecstasy)
Lysergic Acid Diethylamide (LSD)
Ketamine
Heroin/diamorphine metabolite (6-MAM)
Methylamphetamine
Clonazepam
Flunitrazepam
Oxazepam
Diazepam
Lorazepam
Temazepam
Methadone
Morphine
Amphetamine***
***Whilst amphetamine will not be included in the current regulations to go before Parliament in 2014 it is expected to be included later in
2015 once a limit has been agreed [June 2015 D&T approved update – law changed 14Apr15 which adds amfetamine to the existing list
of drugs specified in The Drug Driving (Specified Limits) (England and Wales) Regulations 2014]
The statutory "medical defence"
This new offence does not alter in any way the clinical advice that should be given to
patients in future, which, as now, is based on a proper professional judgement for each
patient of what is the appropriate discussion concerning the risks of their medicines.
A patient who was investigated for drug driving would generally be entitled to raise the
statutory “medical defence” if:
a) The drug was lawfully prescribed, supplied, or purchased over-the-counter, for
medical or dental purposes; and
b) The drug was taken in accordance with advice given by the person who
prescribed or supplied the drug, and in accordance with any accompanying
written instructions (so far as the latter are consistent with any advice of the
prescriber).
Recommendations
1. Prescribers can continue to use these medications where clinically appropriate and
within the terms of their license / Trust policy
2. Periodically review the total amount of sedative medication, particularly when
prescribing any new sedative medication, and document these reviews.
3. Although blood levels have been set for the purposes of regulation, there is no need to
monitor these in clinical practice, as this is independent of therapeutic effect.
4. When prescribing these medications for inpatients it is not necessary to inform the
patient, however at the point of authorising leave / discharge these issues must be
addressed.
5. All community patients should be advised about the risk before the legislation comes
into effect. (See Appendix B for standard letter advising of the risk)
6. Where it is necessary to prescribe one of the specified medications the following advice
should be given, and a record of this made in the clinical notes:
a. To check their medication information leaflet to see what effects the medication
may have on them
b. Not to drive where they feel that their fitness to drive may be impaired
c. To avoid driving immediately following;
i. Initiation / change of dose until the effects of this are known
ii. Changes to other medications they take, as these may interact
iii. Changes to their physical health, as these may combine with the
medication to affect their fitness to drive
d. To avoid drinking any alcohol and then driving as there may be additive effects
on fitness to drive
7. All patients prescribed these medications should be advised to keep copies of suitable
evidence with them whilst driving e.g. copy of prescription.
The MHRA has produced an information leaflet which may be helpful to facilitate these discussions.
Appendix A- Version Control Sheet
This sheet should provide a history of previous versions of the policy and changes made
Version
Date
Author
Status
Comment / changes
0.1
Oct 2014
Mark Payne
Draft
1.0
Feb 2015
Mark Payne
Approved
June
2015
Jane Riley
Approved
Updated wording in line with D&T review
Added letter advising of the risk
(D&T approved update – law changed 14Apr15
which adds amfetamine to the existing list of drugs
specified in The Drug Driving (Specified Limits)
(England and Wales) Regulations 2014]
Name of office/team
Location address
Address
Address
Address
Postcode
DATE
Name
Address
Postcode
Tel:
Fax:
Ref:
Email address
Dear ,
Re: Changes to the law regarding medication and driving
On the 2nd of March 2015 the law regarding prescribed medication and driving is changing,
there will be legal limits introduced on the amount of the following medications which you can
have in your system:
Clonazepam
Diazepam
Methadone
Flunitrazepam
Lorazepam
Morphine
Oxazepam
Temazepam
Amphetamine
If you are prescribed one of these medications, please keep a copy of your prescription with
you when you are driving as proof that you are taking this under the direction of a prescriber.
Please note: if at any time you are concerned that your fitness to drive is impaired due to
medication please do not drive. Having a copy of your prescription will not prevent you from
being prosecuted in this situation.
Yours sincerely,
Name
Title
Cc:
if required