Drug or alcohol misuse or dependence: assessing fitness to drive

✘- Must not drive

! - May continue to drive subject to medical advice and/or notifying DVLA

✓- May continue to drive and need not notify DVLA

Alcohol misuseuse disorders

Guide

DVLA tohave definition2 ofstandards misuse

Therefor isalcohol nouse singulardisorders. definitionThese tostandards embraceare allfor:

• persistent thealcohol variablesmisuse withinand alcohol misusedependence –without buthigh-risk DVLAfeatures
• alcohol offersdependence thewith following:high-risk features

The high-risk features are:

A

• alcohol statewithdrawal thatseizures causes,(not becausealcohol associated seizures)
• medication assisted alcohol withdrawal needed or required

The presence of consumptionthese high-risk features is used to identify individuals with a physiological dependence on alcohol who are at an increased risk of alcohol,relapse disturbanceinto dependant drinking.

Guidance on diagnosis of behaviour,alcohol relateduse diseasedisorders orcan otherbe consequencesfound likelyin tothe causeInternal Classification of Diseases (11th revision) produced by the patient,World theirHealth familyOrganisation, orrelevant societycodes present6C40.2 and 6C40.1, or futurethe harmDiagnostic and thatStatistical mayManual of Mental Disorder (DSM-5) for alcohol use disorder, relevant code FS10.20.

For both Group 1 (card or maymotorcycle) notand beGroup associated2 with(lorry dependence.or bus):

The*licensing relevantmay classificationrequire codesatisfactory formedical alcoholreports misusefrom isa Worlddoctor *DVLA Healthmay Organizationneed F10.1to (ICD-10).arrange independent medical examination and blood tests

Persistent alcohol misuse

	Group 1 car and motorcycle	Group 2 bus and lorry
Persistent alcohol misuse including alcohol dependence without high-risk features, confirmed by medical enquiry and/or evidence of otherwise unexplained abnormal blood markersmarkers.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked until after: ■ a minimum of 6 months of controlled drinking or abstinence, and ■ normalisation of blood parametersabstinence	✘- Must not drive and must notify DVLA. Licence will be refused or revoked until after: ■ a minimum of 1 year of controlled drinking or abstinence, and ■ normalisation of blood parametersabstinence

Definition of controlled drinking

DrinkingControlled withindrinking governmentmeans recommendeddrinking healthat guidelinesa (currentlylevel 14and unitsin pera week).

Alcoholmanner dependence

Guidewhich totheir definitionclinician ofconfirms dependence

Thereacceptably iscontrols notheir singular definition to embrace all the variables within alcohol dependenceuse –disorder but DVLA offers the following:

“A cluster of behavioural, cognitive and physiologicaltheir phenomena that develop after repeated alcohol use,use including:

• ais strongunlikely desire to takeimpact alcohol
• difficultieson inpersonal, controllingsocial, its use
• persistent use in spite of harmful consequences
• and withwork evidence of increased tolerance and sometimes a physical withdrawal state”

Indicators may include any history of withdrawal symptoms, tolerance, detoxification or alcohol-related seizures.responsibilities.

The

Alcohol relevant classification code for alcohol dependence

Guide isto Worlddefinition Healthof Organization F10.2 (ICD-10).

dependence

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Dependence confirmed by medical enquiry Alsowith referhigh-risk to alcohol related seizure belowfeatures.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked until a minimum of 1 year’s abstinence from alcohol consumption has been attained. Continued licensing will thereafter require ongoing abstinence.abstinence for at least 3 years from the onset of abstinence which will be monitored by DVLA	✘- Must not drive and must notify DVLA. Licence will be refused or revoked until a minimum of 3 years’ abstinence from alcohol consumption has been attained. Continued licensing will thereafter require ongoing abstinence.

Forabstinence bothfor drivingat groups: ■least licensing5 willyears require satisfactory medical reports from a doctor ■ DVLA may need to arrange independent medical examination and blood tests ■ referral to and the supportonset of aabstinence consultantwhich specialistwill may be necessarymonitored by DVLA

Alcohol-related disorders

	Group 1 car and motorcycle	Group 2 bus and lorry
Examples ■ hepatic cirrhosis with chronic encephalopathy ■ alcohol induced psychosis ■ cognitive impairment	✘- Must not drive and must notify DVLA. Licence will be refused or revoked until: ■ recovery is satisfactory ■ any other relevant medical standards for fitness to drive are satisfied (for example, Chapter 4, psychiatric disorders)	✘- Must not drive and must notify DVLA. Licence will be refused or revoked until recovery is satisfactory.

Alcohol-related seizure

The relevant standards for any associated alcohol dependence should be applied.

Seizures associated with alcohol use may be considered provoked in terms of licensing (for details see neurological disorders and Appendix B).

Drug misuse or dependence

The relevant classification codes for drug misuse or dependence are World Health Organization F11 to F19 inclusive (ICD-10).

The below requirements apply to cases of single-substance misuse or dependence, whereas multiple problems – including with alcohol misuse or dependence – are not compatible with fitness to drive and licensing consideration, in both groups of drivers.

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Drug group ■ cannabis ■ amphetamines (but see methamphetamine drug group below) ■ ‘ecstasy’ (MDMA) ■ ketamine ■ other psychoactive substances, including LSD and hallucinogens	✘- Must not drive and must notify DVLA with persistent misuse or dependence. Medical enquiry confirming the problem will result in licence being refused or revoked: ■ for a minimum of 6 months, which must be free of misuse or dependence Relicensing may require an independent medical assessment and urine screen arranged by DVLA.	✘- Must not drive and must notify DVLA with persistent misuse or dependence. Medical enquiry confirming the problem will result in licence being refused or revoked: ■ for a minimum of 1 year, which must be free of misuse or dependence Relicensing will usually require an independent medical assessment and urine screen arranged by DVLA.

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Drug group ■ opiates (for example, heroin, morphine) ■ opioids (for example, codeine) ■ benzodiazepines ■ synthetic benzodiazepines ■ synthetic cannabinoids ■ methadone (note on compliance above) ■ cocaine ■ methamphetamine Methadone/buprenorphine programmes - see guidelines below.	✘- Must not drive and must notify DVLA with persistent misuse or dependence. Medical enquiry confirming the problem will result in licence being refused or revoked for a minimum of 1 year, which must be free of misuse or dependence. Relicensing may require an independent medical assessment and urine screen arranged by DVLA.	✘- Must not drive and must notify DVLA with persistent misuse or dependence. Medical enquiry confirming the problem will result in licence being refused or revoked for a minimum of 3 years, which must be free of misuse or dependence. Relicensing will usually require an independent medical assessment and urine screen arranged by DVLA.

Note on methadone/buprenorphine treatment programmes

Group 1

Applicants or drivers complying fully with a consultant or appropriate healthcare practitioner supervised oral methadone maintenance programme may be licensed subject to favourable assessment and normally annual medical review. Applicants or drivers on an oral buprenorphine programme may be considered applying the same criteria. There should be no evidence of continuing use of other substances including cannabis.

Application may be considered when all of the following conditions can be met:

• stable on the programme for a minimum of 1 year

• the treatment programme is supervised by a consultant or specialist GP

• the treatment is for management of opiate dependence

• oral/sublingual treatment only (not parenteral) but subcutaneous long-acting buprenorphine or naltrexone implants may be considered

• there has been compliance with the programme (adherence to prescription and appointments, and toxicology testing with sustained stability)

• no non-prescribed psychoactive drug use during the programme or extra use of prescribed drugs such as methadone, buprenorphine, benzodiazepines

• there is no toxicological evidence of drug misuse

• there is no adverse effect from treatment likely to affect safe driving

• there is no alcohol misuse or dependence

• there should be no other disqualifying conditions (as specified in the other chapters of this guidance)

Group 2 and C1/D1

Applicants or drivers complying fully with a consultant or appropriate healthcare practitioner supervised oral methadone maintenance programme may be considered for an annual medical review licence, once a minimum 3-year period of stability on the maintenance programme has been established with favourable random urine tests and assessment. Expert panel advice will be required in each case.

Application may be considered when all of the following conditions can be met:

• stable on the programme for a minimum of 3 years

• the treatment programme is supervised by a consultant or specialist GP

• the treatment is for management of opiate dependence

• oral/sublingual treatment only (not parenteral) but subcutaneous long-acting buprenorphine or naltrexone implants may be considered

• there has been compliance with the programme (adherence to prescription and appointments, and toxicology testing with sustained stability)

• no non-prescribed psychoactive drug use during the programme or extra use of prescribed drugs such as methadone, buprenorphine, benzodiazepines

• there is no toxicological evidence of drug misuse

• there is no adverse effect from treatment likely to affect safe driving

• there is no alcohol misuse or dependence

• there should be no other disqualifying conditions (as specified in the other chapters of this guidance)

Seizure associated with drug use

Seizures associated with drug use may be considered provoked in terms of licensing (for details see neurological disorders and Appendix B).

In addition, the relevant standards for any associated drug misuse or dependence should be applied.

Relicensed drivers with former drug misuse or dependence should be advised as part of their aftercare that recurrence would mean they must stop driving and must notify DVLA.

High-risk offenders

The definition ‘high-risk offender’ applies to drivers convicted of the following:

• one disqualification for driving or being in charge of a vehicle when the level of alcohol in the body equalled or exceeded either one of these measures:
  • 87.5 mcg per 100 ml of breath
  • 200.0 mg per 100 ml of blood
  • 267.5 mg per 100 ml of urine
• two disqualifications within the space of 10 years for drinking-driving or being in charge of a vehicle while under the influence of alcohol
• one disqualification for refusing or failing to supply a specimen for alcohol analysis
• one disqualification for refusing to give permission for a laboratory test of a specimen of blood for alcohol analysis

Defined in terms of the alcohol-related driving convictions above, the courts notify DVLA of drivers convicted of an offence.

An independent medical examination will be arranged when an application for licence reinstatement is received by DVLA. The assessment may include:

• questionnaire
• serum CDT assay
• any further testing indicated

If a licence is awarded, the ’til 70 licence is restored for Group 1 car and motorcycle driving. Consideration may be given to a Group 2 licence.

If a high-risk offender has a previous history of alcohol dependence or persistent misuse but has satisfactory examination and blood tests, a short period licence is issued for ordinary and vocational entitlement but is dependent on their ability to meet the standards as specified.

A high-risk offender found to have a current history of alcohol misuse or dependence and/or unexplained abnormal blood test results will have the application refused.