Pharmacist raises concerns over patient losing driver licence

Kaikoura Pharmacy owner David McKee has grave concerns about the Christchurch Opioid Replacement Service’s recent decision to strip one of his opioid-substitution patients of their driver licence, based on urine test results.

“I’ve got grave concerns – I fully understand the necessary requirements to ensure safety for both the patient and the public. But the impact of losing his licence could be catastrophic – his employer won’t be tolerant of his inability to get to work, and he won’t be able to get to the pharmacy,” Mr McKee says.

The patient has been part of the CORS programme for many years now. As part of the programme all patients have their urine tested either once a month or every three months.

In November last year, the patient tested positive for 1700 micrograms per millilitre (mcg/ml) for THC, Mr McKee says.

“The programme told him he needed to get the levels to 500mcg/ml in time for his next quarterly urine test. The patient reduced his THC level to 1000mcg/ml.”

But Mr McKee says CORS decided that was not low enough and wrote to inform NZ Transport Agency Waka Kotahi (NZTA). The patient’s licence was subsequently revoked for six months.

The patient called Mr McKee, being “highly distressed” about the situation.

“The patient said they’ll kill themselves – that their vehicle is their connection to life and work and getting to the pharmacy for their opioid substitution treatment (OST),” he says.

“They said they would leave the programme and go back to using and just drive anyway.”

Mr McKee, together with the patient’s GP, wrote a letter to the programme asking for a stay on the licensing decision.

“We explained that at one point we had worked to get our patient’s THC levels to zero to pass a drug test at work. We said if they were given another three months, we knew we could help them to reduce it further.”

CORS then told Mr McKee the letter from himself, and the GP, would be treated as a complaint – “which means it will now take a long time to be dealt with...”

CORS has a driving protocol sighted by Pharmacy Today, and Mr McKee, which was sent to CORS pharmacy providers in February.

This gives CORS discretion to report a positive test, Mr McKee says.

“Basically, it says they want to ensure everybody’s safe. But it creates quite a few questions – we’ve got a lot of patients who are receiving prescribed THC – they’re not getting their levels tested, they’re not getting their licences pulled – which is slightly concerning.”

Patrick McAllister, Health New Zealand Te Whatu Ora interim general manager Specialist Mental Health Services Waitaha Canterbury, says “the CORS programme is legally obliged to notify NZTA under section 18 of the Land Transport Act if people continue to drive against medical advice.

“There has been no recent change in policy.”

The policy was initially developed in 2008 after a recommendation from the coroner and is a legal requirement for all health services in New Zealand, Mr McAllister says.

“Clients are advised of this obligation when they are first admitted to the programme and then again when we have clinical evidence that their drug or alcohol use alone or in combination with Opioid Substitution Treatment (OST) is likely to impair driving. All clients are given the opportunity/time to reduce their use before a notification is actioned.”

CORS makes notifications to NZTA, and all clients sign a “consent to treatment” form, and CORS’ obligations to notify NZTA are discussed as part of this, Mr McAllister explains.

“When NZTA receive a Section 18 notification they take one of three actions: revoking the licence, requiring the licence holder to undergo further assessment, and imposing conditions or limitations on the licence.”

Te Whatu Ora does not hold records on how many licences have been revoked following notifications to NZTA.

Both Mr McKee and Pharmacy Today have made enquiries of other pharmacies in the South Island to see if the sharing of information with NZTA by OST programmes had been happening more often.

One pharmacist also from the South Island, who did not want to be identified, said they had had one OST patient come in complaining that they had lost their licence recently, because they tested positive for a high level of a prescription drug.

The pharmacist says they support driver licences being revoked when testing positive for other drugs, because there had been a number of fatal car accidents caused by drug driving in his area.

“As a citizen I agree with it – as a pharmacist, I can see it will drive patients away.”

The National Association of Opioid Treatment Providers is the representative body of primary and secondary care providers involved in opioid-substitution treatment.

The National Association of Opioid Treatment Providers is the representative body of primary and secondary care providers involved in opioid-substitution treatment.

“So, from my perspective, just knowing what the urine says doesn’t necessarily tell you whether someone’s driving whilst impaired, but the service, obviously, may have a whole lot of other information and context that we don’t know about.”

There has been “a lot of talk” among services about their different interpretations of, and responsibilities under, the new drug roadside-testing legislation which passed its third reading last week, Ms Walters says.

“My understanding of the new legislation is that if there is impairment whilst driving alongside a high level of a substance on the bill’s list, then a person can be prosecuted.”

The new roadside-testing legislation has “…wider implications not just for prescribers but pharmacists and health professionals who are interacting with people”, Ms Walters says.

“It’s the health professional’s responsibility to make sure that if they become aware that someone is driving whilst impaired then they have a responsibility to report that to Waka Kotahi.”

When asked if he thought CORS may have recently clarified their driving protocol in time for the new legislation enabling roadside drug testing, Mr McKee says, “…ultimately the answer is yes, but their approach seems a little heavy for someone who I’ve never had any issues with for the many years he has been on the programme. Out of the blue he was asked to have his urine tested, and he said, ‘F off’ and I think that annoyed someone.”

If one person is tested then everyone needs to be tested, Mr McKee says.

“He has had his licence revoked with no support to enable him to function with what he has to do, day-to-day. I know CORS have a job to do and I know what they require, but all I was asking for was a further three months to enable the patient to comply with their requirements, which he would have done, but we were told that it wasn’t possible.

“He’s now coming to [get] pick-ups and takeaways on an electric bike so, really, what’s the difference? He’s still on the road."