Drug Driving: Proposed Regulations – Analysis of Consultation Responses

7. Other Medications Which Should be Considered (Q6)

7.1 The consultation document asked whether there were any other medicines which should be considered by the regulations. Question 6 asked:

Question 6: Are there any other medicines that we have not taken account of that would be caught by the 'lowest accidental exposure limit' we propose for the 8 illegal drugs? If so please give your reason(s).

7.2 Altogether 22 of the total 43 respondents (all organisations) made a comment that was relevant to Question 6. As this was not an 'agree / disagree' question, no summary table is provided.

7.3 Twelve of the 22 respondents simply stated that they either were not aware of any other medicines that should be taken into account by the 'lowest accidental exposure limit', or they said they felt unable to comment on the question.

7.4 However, the other 10 respondents offered suggestions about additional medicines which they believed should be considered in the legislation.^[7] The respondents who made more substantive comments were mainly from medical, clinical or research bodies, from pharmacy groups, or from charities that support people living with chronic pain.

7.5 Respondents commented that there are a range of medications, including a number of over-the-counter medications, which can affect driving ability. In addition, respondents identified other controlled drugs, non-controlled drugs frequently prescribed for pain relief, and so-called 'legal highs', which they suggested should be considered for inclusion in any regulations. Those mentioned specifically (and the comments respondents made about them) were:

• Buprenorphine, oxycodone, fentanyl, tramadol (opioids sometimes prescribed for pain relief)
• Anti-epileptics and tricyclic antidepressants (both used for pain relief and also often misused)
• Legal high salvia and mephedrone (increasingly popular among young people)
• Synthetic cannabinoids (increasingly used by young people to avoid detection in drug tests; some have a higher potential for harm than cannabis itself)
• Magic mushrooms (have similar intoxicating effects to LSD, and the prevalence of use is also similar to LSD)
• Antihistamines (can be purchased over-the-counter; some can cause drowsiness, and so affect driving ability).

7.6 The point was made that it is often a combination of drugs (or a combination of drugs and alcohol, either above or below the legal limits) that can cause impairment. It was suggested that this may present difficulties when attempting to identify any single drug above a specified limit for the purposes of prosecution.

Concerns about unintended consequences

7.7 Several respondents made the point that morphine is the main strong opioid drug used in the treatment of severe pain, and that there is no evidence that any other opioid drug provides more effective analgesia. However, this group of respondents believed that if morphine was the only opioid drug included in the list of prescribed drugs, there may be pressure from patients on prescribers to begin prescribing alternative opioids (including oxycodone, fentanyl and buprenorphine), which would not be detected by screening. It was felt that some patients may not feel reassured that they have a medical defence in relation to prescribed morphine; and that they may prefer to be prescribed a drug which would not put them at risk of arrest. The point was made that this would have significant implications for prescribing costs to the NHS. One respondent queried whether the proposals had been discussed with the Health Department.

7.8 It was thought that the change in legislation might also result in illicit opiate users switching to other opiates in order to continue to drive without risk of arrest.

Respondents' further suggestions

7.9 Comments on this question included a suggestion that further pharmacological and epidemiological data should be gathered so that dose equivalents associated with impairment for other strong opioids could be derived and made available for drug-detection purposes. As an interim measure, it was suggested that scientists and clinicians could agree dose equivalents for all strong opioids based on their analgesic efficacy, as these data are already available. This would allow prescribers to alert patients when their drug regimen is likely to be impairing.

7.10 Several respondents also suggested that procedures should be reviewed and may need to be improved in relation to: (i) prescribers alerting patients about the effects of their medication on driving; and (ii) notifying the DVLA about patients whose medical condition or prescription may impair their driving. One respondent, a road safety organisation, commented that some patient information leaflets for stronger opiate medications state clearly that the patient should not drive when taking these medications. However, the leaflets for less strong medications state: 'do not drive if affected', thus leaving the decision to the discretion of the patient. This issue may need to be addressed with drug manufacturers.

7.11 A respondent from the police suggested that the police could assist in providing data from drug test results, which would help to identify the drugs most commonly detected in drivers over the last five years.