Guidance

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 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
✘- 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.
✘- 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.

Definition of controlled drinking

Drinking within government recommended health guidelines (currently 14 units per week).

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.

Group 1
Car and motorcycle
Group 2
Bus and lorry
Dependence confirmed by medical enquiry
Also refer to alcohol related seizure below
✘- 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 required, with normalised blood parameters if relevant.
✘- 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.

Abstinence is required, with normalised blood parameters if 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
Examples

■ hepatic cirrhosis with chronic encephalopathy

■ alcohol induced psychosis

■ cognitive impairment
✘- Must not drive and must notify the 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 the DVLA.

Licence will be refused or revoked until recovery is satisfactory.

Seizures associated with alcohol 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 alcohol misuse or dependence should be applied.

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 ’til 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 below)
■ ‘ecstasy’ (MDMA)
■ ketamine
■ other psychoactive substances, including LSD and hallucinogens
✘- 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.

Relicensing may require an independent medical assessment and urine screen arranged by the DVLA.
✘- 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.
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 persistent misuse below.

Methadone/buprenorphine programmes - see guidelines below.
✘- 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.
✘- 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 persistent 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 persistent misuse or dependence for licensing purposes (albeit, clinical dependence may exist).

Note on methadone/buprenorphine treatment programmes

Full compliance with an oral methadone maintenance programme supervised by a consultant specialist or an appropriate health care practitioner 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

Applicants or drivers complying fully with a consultant or appropriate healthcare practitioner supervised oral methadone maintenance programme may be licensed subject to favourable assessment and normally annual medical review. Applicants or drivers on an oral buprenorphine programme may be considered applying the same criteria. There should be no evidence of continuing use of other substances including 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 supervised by a consultant or specialist GP
  • the treatment is for management of opiate dependence
  • oral treatment only (not parenteral) but 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 is no toxicological evidence of drug misuse
  • there is no adverse effect from treatment likely to affect safe driving
  • there is no alcohol misuse or dependence
  • there are no other relevant medical conditions, eg mental health issues
  • there should be no other disqualifying conditions (these include seizures and cardiac problems).

Group 2 and C1/D1

Applicants or drivers complying fully with a consultant or appropriate healthcare practitioner supervised oral methadone 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 with favourable random urine tests and assessment. Expert panel advice will be required in each case.

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 supervised by a consultant or specialist GP
  • the treatment is for management of opiate dependence
  • oral treatment only (not parenteral) but 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 is no toxicological evidence of drug misuse
  • there is no adverse effect from treatment likely to affect safe driving
  • there is no alcohol misuse or dependence
  • there are no other relevant medical conditions, eg mental health issues
  • there should be no other disqualifying conditions (these include seizures and cardiac problems).

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 after-care that recurrence would mean they must stop driving and must notify the DVLA.

Published 11 March 2016
Last updated 26 September 2019 + show all updates
  1. Guidance for ketamine misuse and dependence has been amended – both conditions now require 6 months off driving

  2. Update on guidance regarding methadone or buprenorphine treatment programmes.

  3. ‘Controlled drinking’ defined.

  4. Clarification that all Group 1 requirements (including abstention, etc) also apply to Group 2 licensing.

  5. Minor updates.

  6. Content updated.

  7. Change to the information under alcohol dependence and alcohol-related seizure.

  8. First published.