Drug or alcohol misuse or dependence: assessing fitness to drive
Advice for medical professionals to follow when assessing drivers with drug or alcohol misuse or dependence.
| ✘- 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 use disorders
DVLA have 2 standards for alcohol use disorders. These standards are for:
- persistent alcohol misuse and alcohol dependence without any high-risk features
- alcohol dependence with one or more high-risk features
The high-risk features are either or both:
- alcohol withdrawal seizures (not alcohol associated seizures)
- medication assisted alcohol withdrawal needed or required
The presence of one or more high-risk features is used to identify individuals with a physiological dependence on alcohol who are at an increased risk of relapse into dependant drinking.
Guidance on diagnosis of alcohol use disorders can be found in the Internal Classification of Diseases (11th revision) produced by the World Health Organisation, relevant codes 6C40.2 and 6C40.1, or the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) for alcohol use disorder, relevant code FS10.20.
For both Group 1 (car or motorcycle) and Group 2 (lorry or bus):
- licensing may require satisfactory medical reports from a doctor
- DVLA may need to 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 markers. | ✘- 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 |
✘- 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 |
Definition of controlled drinking
Controlled drinking means drinking at a level and in a manner which their clinician confirms acceptably controls their alcohol use disorder and their alcohol use is unlikely to impact on personal, social, and work responsibilities.
Alcohol dependence
Guide to definition of dependence
| Group 1 Car and motorcycle | Group 2 Bus and lorry | |
|---|---|---|
| Dependence confirmed by medical enquiry with one or more high-risk features. | ✘- 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 require ongoing 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 require ongoing abstinence for at least 5 years from the onset of abstinence which will be monitored 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 methadone or buprenorphine maintenance programme may be licensed subject to favourable assessment and normally annual medical review. There should be no evidence of continuing use of other substances including non-prescribed 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 for management of opiate dependence and managed according to the guidance detailed in the publication ‘Drug misuse and dependence. UK guidelines on clinical management’ (known as the ‘Orange Book’)
-
oral or 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 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 methadone or buprenorphine 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.
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 for management of opiate dependence and managed according to the guidance detailed in the publication ‘Drug misuse and dependence. UK guidelines on clinical management’ (known as the ‘Orange Book’)
-
oral or 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 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
Should the above assessment be successful, and the application accepted, either a licence will be issued or medical enquiries will be undertaken. Medical enquiries take place when there is a known or suspected relevant medical condition.
Updates to this page
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Changes to the ‘Note on methadone/buprenorphine treatment programmes Group 1’ – revision of medical standard (Group 1 and Group 2) Changes to the High-risk offenders section to clarify licensing decision process. Alcohol dependence – the wording has been revised (but not revised the standard).
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Changes to the section regarding alcohol dependence and misuse and the definition of controlled drinking. These will improve diagnostic clarity, reduce the abstinence period for drivers from ‘ongoing’ to set periods with DVLA monitoring.
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Introduction of a new standalone section for 'high risk offenders' to make the guidance itself clearer, and to relocate it from sitting in the 'alcohol-related seizure' section. Minor amendments to the 'alcohol-related seizure' section to make clearer what standards should be applied. Removal of minor duplication regarding benzodiazepines under 'drug misuse or dependence' section.
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Clarification of methadone/buprenorphine treatment programme standards
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Clarification of the alcohol dependence standards required both to regain and to retain both Group 1 and Group 2 licences. Clarification that the standards for opioid misuse/dependence mirror those for opiate misuse/dependence. The introduction of standards for the synthetic cannabinoids and synthetic benzodiazepines. Addition of subcutaneous long acting buprenorphine to section covering methadone/buprenorphine treatment programmes.
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Guidance for ketamine misuse and dependence has been amended – both conditions now require 6 months off driving
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Update on guidance regarding methadone or buprenorphine treatment programmes.
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‘Controlled drinking’ defined.
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Clarification that all Group 1 requirements (including abstention, etc) also apply to Group 2 licensing.
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Minor updates.
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Content updated.
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Change to the information under alcohol dependence and alcohol-related seizure.
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First published.