A 1992 transport policy paper from the European Commission showed that every year there are 50000 deaths and 15 million casualties as a result of road-traffic accidents within the European Union. Promoting road safety is one of the most important objectives at an international level and in different countries individually. Human error is the main factor in two-thirds of accidents. Alcohol is a major causal factor too but we often forget that other psychoactive substances, such as illegal drugs and some types of medication, can affect driving ability. In 1991 a European Community directive laid down minimum standards of physical and mental fitness for driving licence applicants, and determined applicants' impaired ability due to alcohol consumption, illicit drug taking, or drugs taken for legitimate medical purposes. The member countries are supposed to have in place by July 1, 1996, regulations necessary to comply with this directive. European Union member states are not finding this easy. Moreover the directive does not cover restrictions on the right to drive while on drug treatment subsequent to the licence being issued. De Gier has estimated, in a study done for the EC directorate on transport, that at least 10% of all people killed or injured in road-traffic accidents were taking some sort of psychotropic medication that may have been a contributory factor. The European Union's Committee for Proprietary and Medicinal Products has accepted, in the context of the pan-European drug registration process, a three-tier warning system to identify the driving hazard potential of drugs. Drugs are classified for their effects on ability to drive and use machinery safely, as: (1) presumed to be safe or unlikely to produce an effect; (2) likely to produce minor or moderate effects; or (3) likely to produce severe adverse effects or presumed to be potentially dangerous. Since Jan 1, 1994, package inserts in Europe have had to include a statement on the drug's effects on ability to drive or use machinery. Unfortunately, it will be several years before this categorisation becomes available for all types of medications. Other aspects that still need clarifying include the difficulty of establishing a connection between drug concentrations in body fluids and driving impairment. Furthermore, the connection between drugs and driving is complicated by the fact that the illness for which the agent is prescribed may itself affect driving and by the taking of other drugs or alcohol at the same time. Doctors should get into the habit of asking patients "Do you drive?" and assessing, for those who do, the extent to which the medication prescribed (and the illness and alcohol consumption) might interfere with their driving. Sometimes we can prescribe drugs of the same therapeutic class which have less effect (e.g., tranquillisers and antihistamines). Such warnings may be effective but legislation and information in package inserts will make the doctor's task easier. (Author/publisher)
Abstract