New UK initiative from 2nd March on driving and legal or illegal drugs

2nd March 2015: 
It was previously an offence to drive whilst impaired through drink or drugs.

New regulations in England and Wales, in place from 2nd March 2015, aim to reduce risk of RTAs caused by drivers who are taking illegal drugs while driving, or legal drugs which impair their ability to drive. 

It is now an offence, as it has been for alcohol, to drive with certain drugs above a specified level in the blood. Sixteen legal (see Table below) and illegal drugs are covered by the law, including cannabis, cocaine, ecstasy and ketamine. 

There is now a zero tolerance approach to 8 drugs most associated with illegal use. There will also be a 'road safety risk based approach' to 8 prescribed drugs most associated with RTA risk. It remains the "driver’s responsibility to decide whether they consider their driving is, or they believe might be, impaired on any given occasion." (page 7)

Recreational drugs are well-established as causes of road traffic accidents (RTAs). DrinkAware lists several important reasons why alcohol leads to accidents. Alcohol

• affects judgement and reasoning
• slows down reactions
• upsets sense of balance and coordination
• impairs vision and hearing
• makes users lose concentration and feel drowsy.

DrinkAware note legal limits for alcohol in the breath as 35 microgram/100 
mL for England and Wales (80 milligram/100 ml in blood) and lower at 22 microgram/100 mL in breath for Scotland (50 milligram/100 ml in blood).

Cannabis use also increases driving risk in several ways and has, for example, been implicated in 1 in 4 RTAs in France.  Furthermore alcohol and cannabis are often used together and in combination can increase risk of a road traffic accident.

For recreational drugs, safety when driving may be impaired both during use and during drug withdrawal.  

Several commonly prescribed drugs are also expected to reduce alertness and lead to increased risk of road traffic accidents.

People who are having difficulty sleeping may already when awake have reduced ability to concentrate on key tasks, including driving. Poor quality of sleep combined with night sedation may  together reduce alertness further.

Other drugs may have sedative effects as a less obvious action – for example opiate like drugs used to treat pain.

Patients who are concerned about the effects of their prescribed drugs on their safety while driving should consult their pharmacist of medical adviser.

The Government's website notes that:
 'the new law provides a medical defence if you’re taking your medicine in accordance with instructions – either from a healthcare professional or printed in the accompanying leaflet – provided, of course, you’re not impaired.'

It also notes that:
'If you’re driving and you’re on prescription medicine, it may therefore be helpful for you to keep some evidence of this with you in case you’re stopped by the police.'

The following blood level limits for prescription drugs are noted to be:

‘Medicinal’ drugs (risk based approach)	Threshold limit in blood
amphetamine	250µg/L
clonazepam	50µg/L
diazepam	550µg/L
flunitrazepam	300µg/L
lorazepam	100µg/L
methadone	500µg/L
morphine	80µg/L
oxazepam	300µg/L
temazepam	1,000µg/L

UK Government's drug driving website

Drug Driving: Guidance for Healthcare Professionals

DrinkAware website

What's new on health matters from Australia?

@HealthMed Recent news concerns infection alerts, raising awareness of the risks of overweight, and ethics of using social networking to undermine efforts to combat drinking and driving.

'Grabbable gut' as clue to being overweight.

How do you engage the public in long-term interest in benefits of keeping weight in check? The recent ‘LiveLighter’ Australian anti-obesity campaign campaign, supported by the The Heart Foundation, aims to improve recognition of overweight as a personal problem. The campaign includes dramatic pictures of internal excess fat, accompanied by images of a man who does not appear realise he has a weight problem - with the reminder that if you can 'grab your gut' ie have enough spare loose abdominal flesh to grasp by the handful, there is a problem.  In other cultures, 'spare tyre', or the advice 'if you jump up and down and it bounces you're overweight' ... have similar resonance. 

Some critics have complained that the campaign further lowers self-esteem in those who already feel under psychological threat - or simply claim that these messages won't work. This overlooks the obvious - increasing failure to perceive that a given build is excessive, with overweight becoming the norm, both in developed and less developed countries.

  Key challenges are more about how to raise awareness that weight is even a problem, why that matters, and what initial and long term sustainable measures will help to keep weight in check and avoid preventable long-term cardiovascular and non-cardiovascular serious health risks.

Raising public awareness is all the more pressing with recognition, for example from recent data from the US NHANESIII study presented at the European Society of Cardiology Congress in Munich, that relative overweight [based on increased waist-hip ratio] is more important than raised weight based on body mass index, for predicting increased risk of serious heart disease and other causes of premature death.

Random roadside alcohol checks

In parallel with public health messages about the risk of drinking with any alcohol in the blood, random alcohol tests are being used in Western Australia to discourage drivers from drinking.

Several different initiatives have been used in other countries. In France, by a new 2012 law breathalyzer kits are compulsory for all cars. In Sweden and the USA, alcohol ignition interlocks have been used for drink drinking offenders, and several other countries have piloted these schemes involving a breathalyzer coupled to the ignition – if any alcohol is detected, the car’s ignition is inactivated. Elsewhere, a timed arithmetic test is used as barrier to starting the car, based on the adverse effects of alcohol on brain function of even modest alcohol intake. Rather than accepting help not to drive when potentially a danger to pedestrians and other road user, some drunk drivers have been reported to use a friend or even pay a sober contact to beat the tests.

In Australia, booze bus spotters have been posting messages on social networking sites to warn drivers of its location. Worrying not least from the question how and when drivers are accessing these messages.

Rise in ’Ross River cases’

RossRiver virus, an RNA alpha virus and member of the togaviridae family of viruses, is spread by mosquito  bites and is endemic in Australia and several South Pacific islands. The illness was first reported in 1928. The main reservoir animals appear to be kangaroos and wallabies.

The features include rash and flu-like syndrome, the acute features usually settling within 12 months, with however some of those infected by the virus reporting subsequent long-term ME like debility.

Why now provide an update on the virus? Public health reports indicate a rapid ~5-fold increase in numbers of cases of Ross River disease in Western Australia over the past 3 years from, 332 in 2009-2010 up to 1570 in 2011-2012. This rapid increase has been attributed to increased numbers of the vector - mosquitos - due to a series of La Niña events [coupling of Pacific Ocean currents with weather patterns].  This has lead to an increase in rainfall in parts of Australia, the resulting humid conditions and increase in ground-water favouring greater breeding by mosquitos.