What does the new legislation for ‘drug driving’ mean for doctors when providing patients with prescription advice?

18 February 2015

The new criminal offence of ‘drug driving’ is due to come into force on 2 March 2015 in England and Wales by virtue of the introduction of a new section into the Road Traffic Act 1998 (the RTA 1998). The Drug Driving (Specified Limits) (England and Wales) Regulations 2014 supplements a new offence under section 5A of the RTA 1998 which will place an increased emphasis on ensuring that doctors document prescription advice and adhere to the General Medical Council (GMC) guidance in Good practice in prescribing and managing medicines and devices (2013).

What is the new law?

The new offence is an addition to the existing rules on drug impaired driving and fitness to drive (Section 4 Road Traffic Act 1988). The changes will give the police powers to test and arrest drivers who are suspected of driving whilst having certain controlled drugs in excess of the specified levels in their body. Conviction carries a possible prison sentence. 

What medications are included?

The new law sets out the specific limits for 16 different drugs, which include;

  • eight general prescription drugs and/or licensed medicines, such as diazepam and morphine; and 
  • eight illicit drugs, which fall within a zero tolerance group, such as cocaine and ketamine.

What does that have to do with prescription advice?

The legislation provides for a statutory “medical defence” for the new offence. A patient would generally be entitled to raise the statutory “medical defence” if;

  1. the drug was lawfully prescribed, supplied, or purchased over-the-counter, for medical or dental purposes; and
  2. the drug was taken in accordance with advice given by the person who prescribed or supplied the drug, and in accordance with any accompanying written instructions (so far as the latter are consistent with any advice of the prescriber).

Whilst it is the driver’s responsibility to decide whether they consider their driving is, or might be, impaired due to their medication, it is the responsibility of the doctor to give suitable clinical advice to patients regarding those medications. The legislation will not change the way that doctors currently prescribe medications. However, it such cases, there will be a greater focus on the advice that doctors have given and have recorded as having been given.

Good practice in prescribing and managing medicines and devices explains how the principles in Good Medical Practice, apply to decisions about prescribing and managing medicines. Doctors will want to ensure that they are familiar with the guidance documents and their professional obligations.

Our advice

In line with their current professional practice, doctors will already be advising patients of the risk and side effects of medications. However, in light of the new legislation doctors may wish to consider the following points when advising patients on the use of prescription medication:

  • provide the patients with clear information about the risks and side effects of the medication, what to do in the event of such a side effect, how to take the medication, and how to adjust the dose if necessary.
  • ensure that the patient had understood the information and encourage them to ask questions if required.
  • refer patients to the information in the medicine patient information leaflets.
  • take into account when prescribing medication and providing advice the circumstances that may increase the risk of a patient’s driving being impaired such as;
    • taking another prescribed medication;
    • taking over the counter medication;
    • starting, increasing or decreasing the medication dosage;
    • taking non-prescription and herbal medicines;
    • drinking alcohol; and 
    • taking illegal drugs.
  • ensure suitable arrangements are in place for monitoring and follow up review of the medication, and ensure that any repeat prescriptions are made having considering the needs, risks and any changes to the patient’s condition.
  • when prescribing unlicensed medicines ensure patients are provided with information about the license for their medicine and that a clear, accurate legible record of the reasons for prescribing such medication is made. 
  • if prescribing over telephone or video link ensure that an adequate assessment can be undertaken, explain the risks to the patient, and confirm their understanding bearing in mind the limitation of the communication method. 
  • report both actual and potential adverse drug reactions as soon as possible. 
  • ensure notes are clear and full, and contain and accurate and legible record of all advice given about the medication, driving whilst taking medication, including any written advice, and other factors which may impact on the patient's fitness to drive, such as drinking alcohol.
  • in such cases, where patients ask for a report if they are stopped and tested and found to have exceeded the specified limit for a medication, doctors should assist but bear in mind their duty of confidentiality and disclose only the minimum amount of information necessary for the purpose.

For more information on this or other regulatory issues affecting doctors please contact Julie Norris in the Regulatory and Professional Discipline department.

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