General Considerations for Safe Vehicle Driving and Substance Misuse
Incompatibility with Safe Driving:
Chronic misuse of drugs is incompatible with safe vehicle driving.
Careful individual assessment is necessary for drivers misusing alcohol or other substances (prescribed or illicit).
Poly-Substance Use:
Substance misuse often involves multiple substances, not confined to a single drug class.
People may change substances over time, necessitating comprehensive assessment.
Assessment Challenges:
Patients may understate or deny substance use due to fear of consequences.
Cognitive effects of substance use can complicate accurate history taking.
Use a range of indicators for assessment, including self-report and objective tests.
Objective Testing:
Urine drug screens, oral fluid testing, and blood testing provide recent drug use evidence but limited historical context.
Hair testing offers a longitudinal detection window over months.
Specialist Involvement:
Secondary opinion from addiction specialists may be required.
Biological monitoring (e.g., supervised drug screening) and relevant investigations might be necessary, especially for commercial vehicle drivers.
Complex Cases:
Comorbid conditions like mental illness, acquired brain injury, or chronic pain may require specialist assessment.
On-road practical driving assessments can help determine fitness to drive.
Alcohol Dependence
Screening Tools:
The Alcohol Use Disorders Identification Test (AUDIT) is useful for screening alcohol dependence.
AUDIT score ≥ 8 indicates a high likelihood of hazardous or harmful alcohol consumption.
Interpretation should include a global assessment with other clinical evidence.
Referral and Interventions:
Consider referral to addiction specialists, especially for commercial vehicle drivers.
Alcohol ignition interlocks prevent car starting if the driver has been drinking.
States and territories have alcohol interlock programs for offenders or voluntary use for dependent individuals.
Zero BAC condition can be set independently or continue post-interlock program.
Courts:
A court may order an alcohol interlock condition as part of the sentencing for a drink-driving offence.
The court may also impose an interlock condition during the licence restoration process for a driver convicted of a drink-driving offence.
Driver Licensing Authorities:
Driver licensing authorities can impose an alcohol interlock condition independently of the court.
This may occur as part of administrative measures taken following drink-driving offences or in specific circumstances deemed necessary by the licensing authority.
Voluntary Programs:
Drivers who are found to have alcohol dependence may voluntarily participate in alcohol interlock programs.
This voluntary use can be encouraged as a preventive measure to avoid future offences and promote safer driving.
Opioid Dependence
Stable Doses and Safety:
Patients on stable doses of opioids for chronic pain or maintenance therapy (buprenorphine, methadone) may not have higher crash risk if stabilized.
Unsanctioned opioid use or sedatives pose impairment risks.
Specialist Referral:
Short-acting opioids, especially parenteral forms, are incompatible with safe driving.
Refer patients using these for specialist assessment (addiction medicine, addiction psychiatry, pain medicine).
Guidance on Opioid Prescribing:
Refer to guidelines from:
Royal Australian College of Physicians’ Prescription Opioid Policy.
Australian and New Zealand College of Anaesthetists and Faculty of Pain Management.
Royal Australian College of General Practitioners’ prescribing guidelines.
Local health agency websites.
Non-Cooperation in Cessation of Driving
Risk Mitigation:
If the person continues to drive against advice, consider the risk to other road users.
Take reasonable measures to minimize risk, including notifying the driver licensing authority.
Refer to confidentiality, privacy, and reporting guidelines for health professionals.
