5 Drug or Alcohol Misuse or Dependence - DVLA Assessing Fitness to Drive Guide

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PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

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The 'Assessing fitness to drive: guide for medical professionals' is produced by the Driver and Vehicle Licensing Agency (DLVA) and is a guide for medical professionals to help them with enquiries from the public about driving with various conditions.

Advice for medical professionals for drivers with drug or alcohol misuse or dependence.

X - Must not drive! - May continue to drive subject to medical advice and/or notifying the DVLA√ - May continue to drive and need not notify the DVLA

Alcohol misuse

Guide to definition of misuse

There is no singular definition to embrace all the variables within alcohol misuse – but the DVLA offers the following:

A state that causes, because of consumption of alcohol, disturbance of behaviour, related disease or other consequences likely to cause the patient, their family or society present or future harm and that may or may not be associated with dependence.

The World Health Organization's classification (ICD-10) code F10.1 is relevant.

 Group 1
car and motorcycle
Group 2
bus and lorry
Persistent alcohol misuse
confirmed by medical enquiry and/or evidence of otherwise unexplained abnormal blood markers
X- Must not drive and must notify the DVLA.

Licence will be refused or revoked until after:

♦ a minimum of 6 months of controlled drinking or abstinence, and
♦ normalisation of blood parameters.

The patient should be referred for advice from medical or other sources during the period of no driving.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked until after:

♦ a minimum of 1 year of controlled drinking or abstinence, and
♦ normalisation of blood parameters.

The patient should be referred for advice from medical or other sources during the period of no driving.

Alcohol dependence

Guide to definition of dependence

There is no singular definition to embrace all the variables within alcohol dependence – but the DVLA offers the following:

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

  • a strong desire to take alcohol
  • difficulties in controlling its use
  • persistent use in spite of harmful consequences
  • and with evidence of increased tolerance and sometimes a physical withdrawal state.”

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

The World Health Organization's classification (ICD-10) code F10.2 is relevant.

 For both driving groups:

♦ licensing will require satisfactory medical reports from a doctor
♦ the DVLA may need to arrange independent medical examination and blood tests
♦ referral to and the support of a consultant specialist may be necessary.

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Dependence confirmed by medical enquiry
Also refer to alcohol related seizure below
X- Must not drive and must notify the DVLA.

Licence will be refused or revoked until after a minimum of 1 year free of alcohol problems.

Abstinence is usually required, with normalised blood parameters if relevant.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked in all cases of any history of alcohol dependence within the past 3 years.

 Group 1
car and motorcycle
Group 2
bus and lorry
Examples

♦ hepatic cirrhosis with neuropsychiatric impairment

♦ alcohol induced psychosis

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked until:

♦ recovery is satisfactory
♦ any other relevant medical standards example, Chapter 4, psychiatric disorders .

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

Seizures associated with alcohol use are not considered provoked in terms of licensing.

If there is more than one seizure, the regulations governing epilepsy will apply to drivers in both groups (see Appendix B).

 Group 1
car and motorcycle
Group 2
bus and lorry
Solitary seizureX- Must not drive and must notify the DVLA.

Licence will be refused or revoked for a minimum of 6 months after the seizure.

Subsequent licensing requires satisfaction of the fitness standards elsewhere in this chapter whenever there is a background of alcohol misuse and/ or dependence to the seizure, and will include requirements for:

♦ an appropriate period free from persistent alcohol misuse and/or dependence
♦ independent medical assessment

Blood analysis and consultant specialist reports usually necessary.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked for a minimum of 5 years after the seizure.

Subsequent licensing requires:

♦ no underlying cerebral structural abnormality
♦ no epilepsy medication for at least 5 years
♦ maintained abstinence from alcohol if previously dependent
♦ review by a specialist in addiction and a specialist in neurology.

High-risk offenders with alcohol problems

Defined in terms of the alcohol-related driving convictions below, the courts notify the DVLA of high-risk offenders.

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

  • questionnaire
  • serum CDT assay
  • any further testing indicated.

If a licence is awarded, the 'till 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.

Definition

The high-risk offender scheme 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.

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 driver.

 Group 1
Car and motorcycle
Group 2
Bus and lorry

Drug group


♦ cannabis
♦ amphetamines (but see methamphetamine drug group Y below)
♦ 'ecstasy' (MDMA)
♦ ketamine
♦ other psychoactive substances, including LSD and hallucinogens
X- Must not drive and must notify the 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.

Except in the case of ketamine:

♦ for a minimum of 6 months drug-free after misuse, or
♦ for a minimum of 12 months that must be free of dependence
♦ and may require an independent consultant or specialist assessment and urine screen arranged by the DVLA.

X- Must not drive and must notify the 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 the DVLA.

Note on methadone

Full compliance with an oral methadone maintenance programme supervised by a consultant specialist may allow licensing subject to favourable assessment and, usually, annual medical review. Similar criteria may apply for an oral buprenorphine programme. There should be no evidence of continued use of other substances, including cannabis.

 Group 1
Car and motorcycle
Group 2
Bus and lorry

Drug group

♦ heroin
♦ morphine
♦ methadone (note on compliance above)
♦ cocaine
♦methamphetamine

Benzodiazepines

Note on therapy versus misuse below.
X- Must not drive and must notify the 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 the DVLA.

X- Must not drive and must notify the 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 the DVLA.

Note on benzodiazepines

The non-prescribed use of these agents and/or the use of a supratherapeutic dosage outside BNF guidelines constitutes misuse or dependence for licensing purposes – whether in a programme of substance withdrawal or maintenance, or otherwise.

The prescribed use of these drugs at the therapeutic doses listed in the BNF, without evidence of impairment, does not amount to misuse or dependence for licensing purposes (albeit, clinical dependence may exist).

Seizure associated with drug use

Seizures associated with drug use are not considered provoked In terms of licensing.

If there is more than one seizure, the regulations governing epilepsy will apply to drivers in both groups (see Appendix B).

 Group 1
car and motorcycle
Group 2
bus and lorry
Solitary seizureX- Must not drive and must notify the DVLA.

Licence will be refused or revoked for a minimum of 6 months after the seizure.

Subsequent licensing requires satisfaction of the fitness standards elsewhere in this chapter whenever there is a background of substance misuse or dependence to the seizure, and will include requirements for:

♦ an appropriate period free from persistent alcohol misuse and/or dependence
♦ independent medical assessment
♦ usually, urine analysis and consultant specialist reports.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked for a minimum of 5 years after the seizure.

Subsequent licensing requires:

♦ no underlying cerebral structural abnormality
♦ no epilepsy medication for at least 5 years
♦ maintained abstinence from alcohol if previously dependent
♦ review by a specialist in addiction and a specialist in neurology.

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

© Crown copyright. Reproduced under the terms of the Open Government Licence.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
DVLA
Current Version:
Peer Reviewer:
DVLA
Document ID:
13234 (v5)
Last Checked:
17/06/2016
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