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Assessing Fitness to Drive

Table of Contents

From 22 June 2022 there have been changes to the fitness to drive criteria for substance misuse disorders.

See Summary of changes for more details

9.3 Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the following table. Health professionals should familiarise themselves with the information in this chapter and the tabulated standards before assessing a person’s fitness to drive.

In providing information to the driver licensing authority about the suitability of a 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 before 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 by self-report can be unreliable and may be confirmed by biological monitoring for presence of drugs.

Medical standards for licensing – alcohol and other substance use disorders

Health professionals should familiarise themselves with the information in this chapter and the tabulated standards before assessing a person’s fitness to drive.

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 in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition in Table 3)

Substance use disorder

(For withdrawal seizures refer to acute symptomatic seizures discussion and medical standard.)

A person is not fit to hold an

unconditional licence:

  • if there is an alcohol use disorder such as alcohol dependence or heavy frequent alcohol use; or
  • if there is a substance use disorder such as substance dependence 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 1 month; and
  • there is an absence of cognitive impairments relevant to driving; and
  • there is an absence of end-organ effects that impact on driving (as described elsewhere in this publication).

The person is not fit to drive until they meet the criteria for a conditional licence.

* 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 by self-report can be unreliable and may be confirmed by biological monitoring for the 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 use disorder such as alcohol dependence or heavy frequent alcohol use; or
  • if there is a substance use disorder such as substance dependence 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 3 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).

The person is not fit to drive until they meet the criteria for a conditional licence.

* Where the treating specialist considers a driver’s condition to be stable, well managed, and the driver has good insight, the driver licensing authority may agree to ongoing periodic review by the person’s regular GP on mutual agreement of all practitioners concerned. The initial allocation of a conditional licence must, however, be based on an assessment and information provided by the specialist.

** 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 by self-report can be unreliable and may be confirmed by biological monitoring for the 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 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 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. Older drivers and age-related changes and section 2.2.8. Multiple medical conditions).

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.

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 and step 6).

References and further reading

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  2. Panenka, W. J. et al. Methamphetamine use: a comprehensive review of molecular, preclinical and clinical findings. Drug and Alcohol Dependence vol. 129 167–179 (2013).
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  4. Frishman, W. H., del Vecchio, A., Sanal, S. & Ismail, A. Cardiovascular manifestations of substance abuse: Part 2: Alcohol, amphetamines, heroin, cannabis, and caffeine. Heart Disease vol. 5 253–271 (2003).
  5. Broyd, S. J., van Hell, H. H., Beale, C., Yücel, M. & Solowij, N. Acute and chronic effects of cannabinoids on human cognition – a systematic review. Biological Psychiatry vol. 79 557–567 (2016).
  6. EMCDDA. Drug use, impaired driving and traffic accidents – 2nd edition. European Monitoring Centre for Drugs and Drug Addiction http://bookshop.europa.eu (2014) doi:10.2810/26821.
  7. Parekh, V. Psychoactive drugs and driving. Australian Prescriber 42, 182–185 (2019).
  8. Garrisson, H., Scholey, A., Ogden, E. & Benson, S. The effects of alcohol intoxication on cognitive functions critical for driving: a systematic review. Accident Analysis and Prevention 154, (2021).
  9. Drummer, O. H. Epidemiology and traffic safety: culpability studies. In Drugs, Driving and Traffic Safety 93–106 (Birkhäuser Basel, 2009). doi:10.1007/978-3- 7643-9923-8_7.
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  27. Ogden, E. J. D. et al. When should the driver with a history of substance misuse be allowed to return to the wheel? A review of the substance misuse section of the Australian national guidelines. Internal Medicine Journal 48, 908–915 (2018).
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  29. Royal Australian College of General Practitioners. Prescribing drugs of dependence in general practice, Part C1: Opioids. www.racgp.org.au (2017).
  30. Royal Australian College of General Practitioners. Prescribing drugs of dependence in general practice, Part C2: The role of opioids in pain management. (2017).
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  33. Australian and New Zealand College of Anaesthetists. Faculty of Pain Management: Statement regarding the use of opioid analgesics in patients with chronic non- cancer pain. (2020).