Skip to 0 minutes and 9 secondsOpiates can cause quite a few side effects, which can affect your patient's ability to do complex tasks. And one of those things, from a safety perspective, would be driving. What advice would you give to prescribers if they are starting a patient on opioids who is also driving? Yeah, a very important question. Sometimes I see this missed in the counselling. What we have done, what I would advocate, is you obviously counsel the patient on this very important topic, but you also send them away with patient information leaflets.

Skip to 0 minutes and 45 secondsSo when I would be initiating a strong opiate for breakthrough cancer pain, I always say that patients should not drive for at least a week, because there are two laws now in England and Wales, the longstanding law that says if you're unfit to drive, whether in this instance secondary to strong opiates, you cannot drive, you should not drive. There is also now a rule that's been out a few years, a legal rule that even if it doesn't impair, you should have at least proof that you are taking the medication on doctor's orders, prescriptions, the right way.

Skip to 1 minute and 22 secondsWhat I do suggest there-- this is not a legal requirement, but I do suggest that patients take a copy of their prescription and keep it in the car. This is well known to help the police if they ever do stop you for a reason. As I say, it's not a legal requirement, but the evidence from what I have seen is that it really does help. So you have the initiation of opiates, but also, this applies to an increase in dose. So any initiation and any increase or change in dose, I would follow the same advice. And then what I would do is sometimes summarise with the patient and ask them to explain what I have explained to them.

Skip to 2 minutes and 3 secondsAnd obviously, I give them information away with them, as well. Good advice. Thank you.

Opioids and driving

In this video Dr Paul Coulter gives practical advice for counselling patients about opioids and driving.

Prescribers have a duty of care to inform patients that opioids can impair driving. Although studies show that driving performance is not affected when the opioid dose is stable, it is known to be impaired when opioids are being initiated, titrated and immediately after being taken for breakthrough pain.

It usually takes around a week for cognition to return to normal after an opioid is started or the dose increased and a few hours after a breakthrough dose. This period of time varies between individuals and the opioid formulation concerned. For instance, it can take up to 12 days to achieve steady-state plasma concentrations of fentanyl with transdermal formulation.

Patients and their carers must be informed that they should only drive if they feel 100% safe to do so. This is a legal responsibility in the UK, where drivers are liable to prosecution for driving or attempting to drive whilst under the influence of prescribed or illicit drugs.

In England and Wales, drivers are liable to prosecution if their blood opioid level is above a certain threshold unless they are following professional guidance, even if their driving is not impaired. Therefore, it is recommended that when driving patients carry evidence of prescribed medicine.

Remember that pain itself can negatively impact on driving performance, either directly or by causing insomnia, depression or anxiety.

Note: If you are located outside the UK you should be aware of national legislation and any guidance about opioids and driving.

Similar advice on operating heavy machinery applies.

What national legislation or local guidance do you have access to in your area?

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Opioid Analgesics: Treating Pain in People with Cancer

Newcastle University

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