Drug Driving: Proposed Regulations – Analysis of Consultation Responses

6. Views on a Limit for Amphetamine (Q5)

6.1 The consultation document discussed options for a drug driving limit for amphetamine. The point was made that amphetamine has some medical use in specific circumstances. In particular, it is often used to treat Attention Deficit Hyperactivity Disorder (ADHD) among children and adolescents, and its use among adults diagnosed with ADHD is becoming more common. However, amphetamine (and drugs containing it) are also frequently used illicitly.

6.2 The consultation document noted that adult ADHD is a developing branch of medicine, and there is currently a lack of evidence upon which to determine the road safety risk of prescribed drugs containing amphetamine on drivers with ADHD, or the appropriate blood threshold limits for adults taking prescribed medications containing amphetamine.

6.3 The expert panel had recommended a limit of 600 g/L. However, upon publication of their report 'Driving under the influence of drugs', the UK Government had received comments on the report which suggested this limit was too high. Another expert group had proposed a limit of 100 g/L (which would be above the standard dosage for most people being treated for ADHD). Another suggestion was that the limit should be set at 50 g/L, which is the same as that in France and the Netherlands.

6.4 The consultation asked for comments on the limit for amphetamine, and Question 5 asked:

Question 5: Do you have a view as to what limit to set for amphetamine? If so please give your reason(s).

6.5 Altogether 20 of the 43 respondents (19 organisations and 1 individual) made a comment at Question 5. Of these, 17 offered a view about what the drug driving limit for amphetamine should be. As Table 6.1 shows, there was no clear consensus about a specific limit. However, it would appear that the majority (10 out of 17) wanted the limit to be set lower than the expert panel's recommendation of 600 g/L.

Table 6.1: Respondents' views about the limit for amphetamine

6.6 As Table 6.1 shows, three respondents did not state a preference for a specific limit, but rather made more general statements about the limit. For example: 'There should be a limit set for amphetamine' (as it can adversely affect an individual's ability to drive); 'Amphetamine should have a limit rather than a zero tolerance limit' (because of its use in the treatment of ADHD and substance misuse); and 'Any limit set should be at the lower end of advice given by [the] expert panel'.

6.7 It is not clear from the comments made by those who wanted a 'zero tolerance' limit what they understood 'zero tolerance' to mean, and whether it was intended to mean a 'lowest accidental exposure limit' as discussed in the consultation document.

6.8 The largest group of respondents commenting on this question were those with an interest in road safety, motoring and licensing. Altogether, seven of the 17 respondents who made a comment regarding a possible limit for amphetamine were in this category. Three of the seven were in favour of the expert panel's recommended limit of 600 g/L, two preferred a limit of 100 g/L, and two wanted a 'zero tolerance' approach to be taken.

6.9 Respondents' arguments in favour of a particular limit were as follows:

• 50 g/L: This limit was seen to be consistent with that in other European countries.
• 100 g/L: It was argued that this limit would be above the therapeutic dose of amphetamine (for people taking the drug legitimately), but it would allow the larger group of people who are taking the drug illegally to be identified. There was a view that a higher limit (for example, 600 g/L) would fail to identify many people taking amphetamine illegally.
• 600 g/L: This limit was seen to be consistent with the arrangements proposed by the Government for the eight other controlled drugs which can be taken legally under prescription. Respondents argued that the limit should be set at the point at which driving is likely to be impaired; and that, without evidence of impairment, there was 'no reasonable basis for setting a lower limit'. One respondent, commenting on the point made in the consultation document - that some people felt the expert panel's recommendation of 600 g/L was too high - said that the reasons for choosing this limit were explained clearly in the expert panel's report, while those who objected to this limit provided no counter-arguments - except to say that it seems too high. The point was made that setting a lower limit would result in higher costs, including higher costs to the taxpayer from pursuing additional prosecutions.
• Zero tolerance: A 'zero tolerance' approach was considered to be appropriate for amphetamine because 'amphetamine is an illegal drug', and because the number of adults taking amphetamine on prescription is very small. The point was made that if an adult taking amphetamine had been assessed as competent to drive, they should simply carry their repeat prescription with them so that it can be used as a medical defence.

6.10 Two respondents suggested that the Government should seek further information before deciding upon a limit. One respondent in favour of the proposed 50g/L limit suggested that the Government should find out why other European countries have set the limit for amphetamine at this lower level. A second respondent thought that further information should be obtained about 'the mean therapeutic dose for adults taking ADHD medications' before a limit was set.

6.11 Other issues highlighted by respondents were as follows:

• Amphetamine is also used for the treatment of hypersomnia and narcolepsy in adults, and these conditions should be considered in the setting of limits, and in terms of an allowable medical defence.
• After heroin, amphetamine was reported to be one of the most commonly injected street drugs in the UK.
• Amphetamine was reported to have a short half-life, and therefore it would be important for a blood test to be undertaken quickly to secure a conviction for drug driving.
• The DVLA should be notified about patients being prescribed amphetamine.
• It was noted that the first-line treatment for ADHD is methylphenidate (Ritalin), which would not be identified in an amphetamine saliva screen. The point was made that dexamphetamine was an alternative treatment, and that this is not the same as amphetamine. There was a query about whether dexamphetamine would be identified through amphetamine drug screening.