Table of Contents

9.3 Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the following table.

In providing information to the driver licensing authority regarding suitability of the driver for a conditional licence, the health professional will need to consider the driver’s substance use history, response to treatment and their level of insight. For example, in the case of patients with more severe substance use problems who have had previous high rates of relapse and fluctuation in stabilisation, a longer non-driving period and/or the use of an alcohol interlock should be considered prior to granting a conditional licence. Similarly a strong response to treatment and well-documented abstinence and recovery may enable provision of a conditional licence after the minimum period. Remission may be confirmed by biological monitoring for presence of drugs.

It is important that health professionals familiarise themselves with both the general information above and the tabulated standards before making an assessment of a person’s fitness to drive.

Medical standards for licensing –Alcohol and other substance use disorders
Condition

Private standards

(Drivers of cars, light rigid vehicles or motorcycles unless carrying public passengers or requiring a dangerous goods driver licence – refer to definition)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition)

Substance use disorder

(For withdrawal seizures refer to Acute symptomatic seizures text and standards.)

A person is not fit to hold an unconditional licence:

  • if there is an alcohol or other substance use disorder, such as substance dependence or heavy frequent alcohol or other substance use that is likely to impair safe driving.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • the person is involved in a treatment program and has been in remission* for at least one month; and
  • there is an absence of cognitive impairments relevant to driving; and
  • there is absence of end-organ effects that impact on driving (as described elsewhere in this publication).

* Remission is attained when there is abstinence from use of impairing substance/s or where substance use has reduced in frequency to the point where it is unlikely to cause impairment. Remission may be confirmed by biological monitoring for presence of drugs.

An alcohol interlock may form part of the approach to managing driving for alcohol dependent people (refer to section 9.2.2 Alcohol dependence and Appendix 5).

A person is not fit to hold an unconditional licence:

  • if there is an alcohol or other substance use disorder, such as substance dependence or heavy frequent alcohol use or other substance use that is likely to impair safe driving.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by an appropriate specialist (such as an addiction medicine specialist or addiction psychiatrist) as to whether the following criteria are met:

  • the person is involved in a treatment program and has been in remission* for at least three months; and
  • there is an absence of cognitive impairments relevant to driving; and
  • there is absence of end-organ effects that impact on driving (as described elsewhere in this publication).

* Remission is attained when there is abstinence from use of impairing substance/s or where substance use has reduced in frequency to the point where it is unlikely to cause impairment. Remission may be confirmed by biological monitoring for presence of drugs.

IMPORTANT: The medical standards and management guidelines contained in this chapter should be read in conjunction with the general information contained in Part A of this publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing, suspending or cancelling, or reinstating a person’s driver licence (including a conditional licence) lies ultimately with the driver licensing authority.

Licensing decisions are based on a full consideration of relevant factors relating to health and driving performance.

Conditional licences

For a conditional licence to be issued, the health professional must provide to the driver licensing authority details of the medical criteria not met, evidence of the medical criteria met, as well as the proposed conditions and monitoring requirements.

The nature of the driving task

The driver licensing authority will take into consideration the nature of the driving task as well as the medical condition, particularly when granting a conditional licence. For example, the licence status of a farmer requiring a commercial vehicle licence for the occasional use of a heavy vehicle may be quite different from that of an interstate multiple combination vehicle driver. The examining health professional should bear this in mind when examining a person and when providing advice to the driver licensing authority.

The presence of other medical conditions

While a person may meet individual disease criteria, concurrent medical conditions may combine to affect fitness to drive, for example, hearing, visual or cognitive impairment (refer to Part A section 2.2.7 Multiple medical conditions and age-related change).

Reporting responsibilities

Patients should be made aware of the effects of their condition on driving and should be advised of their legal obligation to notify the driver licensing authority where driving is likely to be affected. The health professional may themselves advise the driver licensing authority as the situation requires (refer to section 3.3.1 and step 6 of the assessment and reporting process).

References and further reading

  1. Monash University Accident Research Centre. Influence of chronic illness on crash involvement of motor vehicle drivers, 2nd edition, November 2010. Available: http://monashuniversity.mobi/muarc/reports/muarc300.html.
  2. Barr AM, Panenka WJ, MacEwan GW, Thornton AE, Lang DJ, Honer WG, Lecomte T. The need for speed: an update on methamphetamine addiction. Journal of Psychiatry and Neuroscience. 2006; 31(5): 301–313.
  3. Brust JCM. Neurologic complications of substance abuse. Journal of Acquired Immune Deficiency Syndromes. 2002; 31; S29–S34.
  4. Frishman WH, Del Vecchio A, Sanal S, Ismail A. Cardiovascular manifestations of substance abuse: part 2, alcohol, amphetamines, heroin, cannabis and caffeine. Heart Disease. 2003; 5(4): 253–271.
  5. Drummer O. Epidemiology and traffic safety. In: Versteer J, Pandi-Perumal J et al (eds). Drugs, driving and traffic safely. Birkhauser Verlag, 2009.
  6. Austroads. The Austroads report on drugs and driving in Australia, 2000.
  7. Borkenstein R, et al. The role of the drinking driver in traffic accidents. Blutalkohol: Alcohol, Drugs and Behavior. 1974; 2(Supplement1).
  8. Zador PL. Alcohol-related relative risk of fatal driver injuries in relation to driver age and sex. Journal of Studies on Aalcohol. 1991; 52(4): 302–310.
  9. Logan B. Methamphetamine and driving impairment. Journal of Forensic Sciences. 1996; 41(3): 457–464.
  10. Wachtel SR, de Wit H. Subjective and behavioural effects of repeated d-amphetamine in humans. Behavioural Pharmacology. 1999; 10: 271–281.
  11. Silber B, et al. The effects of dexamphetamine on driving performance. Psychopharmacology. 11 Nov 2005; 536–543.
  12. Papafotiou K, Stough C, Silber B. Detection of dexamphetamine-induced impairment with sobriety testing, driving performance, blood and saliva analysis. 2003, VicRoads.
  13. Hurst PM. The effects of D-amphetamine on risk taking. Psychopharmacologia. 1962; 3: 283–290.
  14. Fischer B, et al. Toking and driving: Characteristics of Canadian university students who drive after cannabis use – an exploratory study. Drugs: Education, Prevention and Policy. 2006; 13(2): 179–187.
  15. Asbridge M, Poulin C, Donato A. Motor vehicle collision risk and driving under the influence of cannabis: evidence from adolescents in Atlantic Canada. Accident Analysis and Prevention. 2005; 37(6): 1025–1034.
  16. Davey J, Davey T, Obst P. Drug and drink driving by university students: an exploration of the influence of attitudes. Traffic Injury Prevention. 2005; 6(1): 44–52.
  17. Alvarez FJ, Fierro I, Del Rio MC. Cannabis and driving: results from a general population survey. Forensic Science International. 2007; 170(2–3): 111–116.
  18. Walsh GW, Mann RE. On the high road: driving under the influence of cannabis in Ontario. Canadian Journal of Public Health 1999; 90(4): 260–263.
  19. Jones C, et al. Preventing cannabis users from driving under the influence of cannabis. Accident Analysis and Prevention. 2006; 38(5): 854–861.
  20. Berghaus G, et al. Meta-analysis of empirical studies concerning the effects of medicines and illegal drugs including pharmacokinetics on safe driving. 2011, University of Würzburg.
  21. Ogden E, et al. The relationship between accident culpability and presence of drugs in blood from injured Victorian drivers. In: 19th International Council on Alcohol Drugs and Traffic Safety. 2010: Oslo.
  22. Ashton CH. Pharmacology and effects of cannabis: a brief review. British Journal of Psychiatry. 2001; 178: 101–106.
  23. Coffey C, et al. Cannabis dependence in young adults: an Australian population study. Addiction. 2002; 97(2): 187–194.
  24. Asbridge M, Hayden JA, Cartwright JL. Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. British Medical Journal. 2012. 344: e536.
  25. Mura P, et al. Use of drugs of abuse in less than 30-year-old drivers killed in a road crash in France: a spectacular increase for cannabis, cocaine and amphetamines. Forensic Science International, 2006. 160(2–3): 168–172.
  26. Meier MH, et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences, 2012. 109(40): E2657–E2664.
  27. Skegg DC, Richards SM, Doll R. Minor tranquillisers and road accidents. British Medical Journal. 1979; 1(6168): 917–919.
  28. Seppälä K, et al. Residual effects and skills related to driving after a single oral administration of diazepam, medazepam or lorazepam. British Journal of Clinical Pharmacology. 1976; 3(5): 831–841.
  29. Berghaus G.a.G., H. In: Concentration-effect relationship with benzodiazepine therapy. 14th International Conference on Alcohol, Drugs & Traffic Safety. September 21–26, 1997. International Council on Alcohol, Drugs & Traffic Safety. 1997. Annecy, France.
  30. Ogden E, et al. Responsibility for non-fatal collision: the abuse of benzodiazepines, in ICADTS. 2013: Brisbane.
  31. Babor TF, Higgin-Biddle JC, Sanders JB, Monteiro MG. The Alcohol Use Disorder Identification Test: Guidelines for use in primary care, 2nd edition 2001. World Health Organization, Department Mental Health and Substance Abuse. Available: http://apps.who.int/iris/bitstream/10665/67205/1/WHO_MSD_MSB_01.6a.pdf.
  32. Royal Australian College of General Practitioners. Prescribing drugs of dependence in general practice. Available: http://www.racgp.org.au/your-practice/guidelines/drugs-landing/.