OTP and Driving

In recent times, there has been a growing focus on the issue of driving while on OTP. There has been some misinformed commentary on the matter in the media, which have helped promote some misunderstandings in the community.

Driving is a complicated task and it is important to keep in mind that many factors can affect your ability to drive. These include: driving experience, the weather, the time of day, road conditions, your state of mind, tiredness, whether you are speeding and whether you are under the influence of alcohol or other drugs, including prescribed medication (such as OTPs).

So what are the rules around driving on OTP? Can you drive on the program? Below are some frequently asked questions that came directly from community consultations. The answers are straight from official sources. You can also take the OTP Road Sense Quiz from User’s News #92.

How does my methadone or buprenorphine medication affect my driving? 

There is good evidence that driving or operating heavy machinery after dosing with methadone or buprenorphine does not increase your risk of accident or injury. However, this doesn’t mean you will always be OK to drive. You should be on a stable dose of methadone or buprenorphine before driving. Also consider that a range of medications and drugs (especially alcohol, benzodiazepines, and cannabis) can affect your driving.  

For example, if you are more sedated than usual from lack of sleep or using alcohol or other drugs, you can be less attentive and run the risk of a “micro-sleep” (or “nod”). If you have missed a dose and are in withdrawal, your muscles can be jerky and less powerful, or you might be teary and sneezy which could affect your sight. Coordination, judgement and reaction time can all be affected. 

You are more likely to be affected in the first weeks after starting your medication, when you are going up or down on your dose, if you miss doses or take more than your prescribed dose. The first four weeks of starting methadone and the first two weeks of starting buprenorphine are especially high-risk periods where you should avoid driving.  

During these higher-risk time, you should seek alternative transport instead of driving. Depending on your circumstances, you may want to think about;  

  • Walking or riding a bike.

  • Catching public transport.

  • Asking a friend or family member to give you a lift.

  • Talking to clinic staff to see if they can help arrange transport.

  • Putting a note up in your clinic to see if anyone is willing to carpool. 

  • Contacting a charity, church group, or community group like Rotary or Men’s Shed to see if they are able to help arrange transport.  

Can other medications or drugs combine to affect my driving? 

Driving can be far less safe if you also use other drugs or alcohol on top of your dose. Adding in prescription medications, such as other opioids, ‘benzos’, anti-epileptics, anti-depressants, anti-psychotics, and/or pregabalin (known as Lyrica®, and given for nerve pain, anxiety and epilepsy) can really make a difference to how well you drive.  

You should talk to your doctor or pharmacist if the medications you are taking can increase your fatigue, make you more sleepy, or can impact on your driving ability. Do not assume you are safe to drive. 

Are there other safety factors to think about?  

There are many things you need to think about to make sure you are safe to drive. Even when you are on a steady dose and aren’t using other drugs or alcohol, being tired, emotional or sick will affect how you drive. It’s important to know when you are safe and when you are not.  

It’s also vital you keep your car in good condition. You should regularly check brakes, mirrors, headlights, blinkers and so on to make sure your car works properly and safely.   

How can I know if I am safe to drive? 

Ask your doctor or pharmacist, who can give you advice about whether or not it is safe for you to drive. Check the label on your medications, as some can affect how you drive. If a drug is prescribed to you and you are taking it exactly as advised, you will know how to manage the risks. 

You should also use your common sense. People often know when they shouldn’t be driving. 

You should not drive when under the influence of illicit drugs, even if you use them daily. There are simply too many things that can change the way the drug might effect you.  

Are there rules about when I can’t drive if I am on a methadone or buprenorphine program? 

You are OK to drive if you are stable on your dose and are not affected by significant amounts of other medications or drugs. Driving gets safer when your body and brain get used to taking the same dose for methadone or buprenorphine over a long period of time. You should not drive for several days following any dose change. 

Missing or increasing your dose, as well as changing your route of administration (such as injecting it), may impact your ability to drive safely.   

The NSW Clinical Guidelines: Treatment of Opioid Dependence (2018) recommends not driving 4 weeks after you begin a methadone program and being especially careful for 3-5 days if you change your dose by 5 mg or more. With buprenorphine you should not drive for 2 weeks after you begin a program and being especially careful for 3-5 days after a change of dose. 

Methadone (Biodone Forte® or Methadone Syrup®) 

Do not drive:  4 weeks from start 

Especially Careful : 3-5 days after dose change 

Buprenorphine (Suboxone® or Subutex®) 

Do not drive: 2 weeks from start 

Be especially careful: 3-5 days after dose change 

How do I get guidance about when I should drive? 

One of the responsibilities of your healthcare providers (including pharmacists, clinic nurses, case workers, peer workers and doctors) is to help ensure your safety while taking medication. This includes advising you about driving safely.  

The best thing you can do is to talk honestly with your doctors about your fitness to drive. You should make them aware of all your current stresses and challenges and all the medications you are taking, especially if your doctor didn’t prescribe them.  

Then you should ask them to explain the effects those drugs may have on your ability to drive and offer some advice about when you should or shouldn’t be driving. You can also ask your pharmacist, clinic nurse, or peer worker, as they will be able to give you advice as well. Don’t forget you can even contact the Opioid Treatment Line for advice on (free call) 1800 642 428.

You should also talk in a general way about how illicit drugs and/or alcohol might add to the mix in your case. 

Do I need a card from the doctor to give to police to say I am on a program? 

There is no need for a card. You do not have to tell police you are on a program and Mobile Drug Tests do not test for opioids. 

Why is it my responsibility to know when I am fit to drive? 

It is your responsibility to be able to recognise when you may not be fit to drive. Your safety and the safety of others depends on it. 

Many medications that cause sedation or drowsiness are required to have labels by the Therapeutic Goods Administration (TGA). The TGA is part of the Commonwealth Department of Health and its role is to keep Australians safe through regulating medications. You may notice that methadone and buprenorphine carry a label like the one on the right.

If you get takeaways you would have seen this label on your medication bottles or packs. This labelling means that it is your responsibility to think about how the medication affects you, to not mix it with alcohol, and not to drive if you are feeling drowsy. Other medications that you are prescribed may also have similar labels.

There are many other medications that can also affect your driving, including some over-the-counter medications such as cold and flu tablets. Be sure to follow the advice on the label or product information sheet inside, speak to your doctor about the medications you are currently taking, and speak to your pharmacist for more information or if you are unsure about anything. 

Different people are affected differently – gender, body size, and general health can all play a part in how quickly a person processes drugs or how much they are affected by different drugs. It comes back to you as an individual to figure this out or seek information from healthcare providers if you are unsure. 

It is important to be able to recognise when you may not be fit to drive. Your safety and the safety of others depends on it.  

What if I ignore my doctor’s advice about driving? Are there legal implications? 

Your healthcare provider has a responsibility to your safety and to the safety of the community. If you ignore their advice to stop driving, they may have to report you to the Roads and Maritime Service (RMS). The RMS will then assess whether you require additional driving aids to assist your medical condition (such as hand-operated breaking) to drive safely, or whether a conditional licence is appropriate. In some cases, you may need to stop driving completely. These decisions are made by the RMS with input from your doctor and other healthcare providers. 

It is also important to recognise that if you have a medical condition that impacts your ability to drive safely long-term, you also have an obligation to inform RMS. Such medical conditions can include: epilepsy, seizures, diabetes, heart disease, dementia, and sleep disorders, among others. 

If you attend treatment while intoxicated and intend to drive, the clinic nurses, doctors, and/or pharmacists also have a duty of care to ensure your safety and the safety of the community. Ensuring your safety may include contacting the police. It will also result in either a reduced dose, your dose being withheld, or being asked to return later in the day. 

If I’m not safe to drive, how am I going to get around? 

Explore the options and plan ahead to make sure you get from point A to point B in one piece.  

Your family, friends and neighbours are good options for transport and are often happy to support you while you adjust to treatment, especially if you explain you are trying to keep everyone safe and make important changes to your life. 

You could try asking people on the program who live near you if you could car pool. Put a sign up on the notice board at your clinic. If you have been on the program for a while, think about others who are new and maybe offer them a lift to and from the clinic. Have a chat to the staff at your clinic, such as the Nurse Unit Manager (NUM) or peer workers, for what might be available. 

You might also ask your local Council, community groups or charities. For example, some charities or church groups have volunteers that might give you a lift to the clinic or help with things like health needs or shopping while you get stable on your dose. You won’t know if you don’t ask. If your clinic is at a hospital, you may be able to take advantage of free buses that go from the hospital to the nearest train station.  

Public transport is an option, depending on where you live. Check out what is available in your area. Trip Planner is a great website for planning NSW travel. There are times you might be more cashed up and can catch a taxi or a rideshare service (like Go Catch, Ola, or Uber), or can split the fare with someone.

Do I have any other options so I can drive and still take care of my health needs?  

Methadone is an opioid and depending on the amount you are prescribed, when you were last dosed and how long you have been on the program, you might feel sedated from time to time. People on buprenorphine tend to say they feel more alert. Because of this, the guidelines around methadone call for greater care and longer safety lead times than those that apply to buprenorphine. You can check out what the safety lead times are for these medications here. 

If you prefer driving or need to drive to get around, it might be worth discussing with your prescriber about swapping over to buprenorphine. This can be particularly helpful if you need to balance the use of ‘benzos’, anti-depressants or other meds that have a sedating effect.    

Where can I find out more information? 

Try checking out these links: