Are You Fit to Drive on a Medically Assisted Treatment Program for Opioid Dependence?

How can people on a Medically Assisted Treatment for Opioid Dependence (MATOD) program be safe when driving?

These Frequently Asked Questions come direct from community consultations and our answers straight from official sources. Get up-to-date information on the effect of drugs on your driving; the regulations that apply to driving on methadone (Biodone Forte® or Methadone Syrup®) and buprenorphine (Suboxone® or Subutex®); ways to avoid risky behaviour; and the processes of roadside drug testing.

Scroll down to view our frequently asked questions, or jump straight to the following topic areas:

Driving While On Treatment

Find out answers about your treatment and how you can drive safely. Does methadone or buprenorphine impact on your driving ability? Where should you go for advice? What should you do if you are put on a new medication?

It’s easy to forget how complex the task of driving is. Driving requires many skills – constantly checking the road and traffic conditions and making decisions. Driving involves sensing, knowing, and doing. It is important to clearly understand what is going on around us and then respond.

Driving is a complicated task, and along with sensing, knowing and doing there are other things that affect your driving. Below is a summary of some other things that can also impact on your 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, or cannabis) can affect your driving.

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.

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

During this time, you should seek alternative transport instead of driving. Here are some suggestions for alternative transport to help you get around.

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 that you are safe to drive.

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, checking brakes, mirrors, headlights, blinkers and so on to make sure your car works properly and safely.

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 affect you.

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 of 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 (like injecting it), may impact your ability to drive safely.

The NSW Clinical Guidelines: Treatment of Opioid Dependence recommend:

    • If on methadone, not driving 4 weeks after you begin a program and being especially careful for 3-5 days if you change your dose by 5 mg or more.
  • If on buprenorphine, not driving for at least 2 weeks after you begin a program and being especially careful for 3-5 days after a change of dose.

    Summary of Recommendations for Driving & OAT
Treatment Do Not Drive Be Especially Careful
Methadone (Biodone Forte® or Methadone Syrup®) 4 weeks from start 3-5 days after dose change
Buprenorphine (Suboxone® or Subutex®) 2 weeks from start 3-5 days after dose change

Talk To Your Healthcare Providers

Find out answers about your treatment and how you can drive safely. Does methadone or buprenorphine impact on your driving ability? Where should you go for advise? What should you do if you are put on a new medication?

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 (OTL) or the NSW Users and AIDS Association (NUAA) to give you advice.

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

It is your responsibility to be able to recognise if you are no 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 are labelled with the following:

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 one of the labels below as well.

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. So, it comes back to you as an individual to understand 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.

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.

You can also view our information on Mobile Drug Testing (MDT), which you can find here.

Your healthcare provider has a responsibility to your safety and to the safety of the community. So, 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.

Mobile Drug Testing (MDT)

Find out answers about your treatment and how you can drive safely. Does methadone or buprenorphine impact on your driving ability? Where should you go for advice? What should you do if you are put on a new medication?

NSW Police can test drivers for drugs anytime or anywhere for no reason at all. MDT is random.

However, there are other reasons the Police might pull you over, including:

  • something about you or your vehicle makes a mobile police officer suspicious of you
  • a police officer knows you as a person who uses drugs
  • you are driving oddly or dangerously
  • you are in an accident.

See the NSW Government Transport for NSW page for more information on MDT.

By using saliva sticks, MDT tests for:

  • ecstasy
  • cannabis
  • cocaine
  • methamphetamine (including speed and ice).

Roadside drug tests do not test for opioids or opioid treatment.

MDT does not test for drug impairment. It tests for the presence of drugs. The test may come up positive for drugs, even several days after using them. It’s hard to know how many days after using you might test positive. Drugs stay in people’s bodies for different lengths of time, depending on things like gender, weight and general health. Drugs also tend to stay longer in people’s bodies if they are living with kidney disease, liver disease or cirrhosis of the liver.

A one-off use of a drug will pass through your body more quickly than if you have used for several days in a row.  When thinking about how long drugs stay in your body, consider that small amounts may remain within your system for more than a week.

If your MDT test is positive, you’ll be taken to a roadside testing van or bus, or back to a police station to provide a saliva sample. This sample will also be tested and, if positive, you’ll be banned from driving for 24 hours. All samples are sent to a laboratory for analysis. If the laboratory confirms the positive roadside result, police will contact you and charge you with driving with the presence of an illegal drug. You might lose your licence for a period of time and be required to pay a fine.

If you test positive for illicit drugs and have been driving erratically, you may be charged with driving under the influence (DUI). This is a more serious charge and you could lose your licence for a longer period of time and be required to pay a larger fine.

If you test positive for prescription drugs, you might be charged with DUI if you are driving dangerously.

Remember that if you drive with the presence of an illegal drug, your insurance and registration are null and void. This could have significant financial repercussions if you have an accident.

It is important to remember that it is illegal to drive if you are under the influence of any drug.

If a Police officer has a reasonable belief that a driver is under the influence of a drug, based on how the person is driving, their condition or their behaviour and they pass a roadside breath test, the officer can require the driver to complete a sobriety assessment.

If the driver fails or refuses the assessment, the Police officer can arrest them and require them to undergo blood and urine testing. The tests can identify a wide range of illegal drugs and medication, including opioids and opioid treatment and the concentration in the blood. This can show whether a treatment has been taken in a therapeutic dose as prescribed, and whether other drugs are present.

The results, along with police observations at the roadside, can be used as the basis for charging a driver with the offence of driving under the influence of a drug. This is a serious offence with heavy penalties including fine and loss of licence.

In NSW, all drivers who are involved in fatal crashes, or serious crashes where a person may die, can be taken for mandatory blood and urine tests. The tests can identify a wide range of illegal drugs and medication, including opioids and opioid treatment and the concentration in the blood. This can show whether a treatment has been taken in a therapeutic dose as prescribed, and whether other drugs are present.

All fatal crashes are investigated by NSW Police, and the results of the tests may be taken into account if a driver is charged with an offence.

Remember that if you drive with the presence of an illegal drug in your system, your insurance and registration are not valid. This could have significant financial repercussions if you have an accident – for example you may be responsible for paying for any damage you cause.

A police officer can search a person if they have reasonable grounds to suspect that the person has a prohibited drug in their possession. They can also search a vehicle if they have reasonable grounds to suspect that it contains a prohibited drug, or that one of the passengers has a prohibited drug in their possession or control.

A positive drug test may constitute reasonable grounds to conduct a search of a person, their belongings and their vehicle. However, police can only ask the person to remove outer layers of clothing, hats or footwear. The police cannot conduct a strip search in a place other than a police station unless the seriousness and urgency of the circumstances makes the search necessary.

Police also have additional powers to search persons upon or after arrest. As noted above, police may arrest a person who refuses a drug test or whose sample tests positive. Police may search a person at the time or after their arrest if they suspect on reasonable grounds that it is prudent to do so in order to determine whether the person is carrying a prohibited drug, drug-related items or any other objects that may be connected to an alleged crime or provide evidence of a crime having been committed.

If a driver does submit an MDT and result comes back negative, the police do not have the power to force the driver to undergo further testing, such a blood and/or urine sample testing.

However, if you are unable to provide a sample or refuse to provide a sample the police can require you to provide blood for drug testing. Police can also require a driver or person sitting next to a learner driver to undergo blood and urine testing if the learner driver has been involved in a potentially fatal accident.

Alternative Travel Options

Have you been told not to drive? Are you feeling impaired today? What options are around? Check out some of the alternative options that you could try out instead of driving.

We have given some options for you to explore below to help you plan ahead and ensure you get from point A to point B in one piece.

Family & Friends
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.

Check with Others
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.

Talk to your Health Professionals
If you go to a clinic have a chat to the staff there, such as the Nurse Unit Manager (NUM) or peer workers, for what might be available in your area.

Community Groups and Services
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
Public transport is an option, depending on where you live. Check out what is available in your area. Trip Planner is a great web site for planning NSW travel.

NSW is also trialling On Demand public transport services in many areas. This allows you to book a vehicle to pick you up from either home or a convenient nearby location, and take you to a local transport hub or point of interest. Services can work slightly differently across locations, so visit the Transport NSW website for how you can use these services in your area.

Taxis & Rideshare Services
There are times you might be more cashed up and can catch a taxi or a rideshare service (like DiDi, Go Catch, Ola, or Uber), or even splitting the fare with someone. It can certainly be worth it to keep you, your family and your community safe, but admittedly for most it’s only a short-term option.

Going Low Tech
For some people it is possible to go low tech – walking, skateboarding, riding a bike, or even a horse! Just remember that riding a bike or horse on the open road is the same as driving in terms of being drug tested.

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.

Get More Information

Where can you get more information? There are range of resources and supports you can check out to get more information about your medication and driving safety while on treatment. We’ve listed some of these below.

The Opioid Treatment Line (OTL) is a NSW-wide helpline that provides opioid pharmacotherapy information, referrals and advice to people are on or are seeking treatment.

You can give the Opioid Treatment Line (OTL) a call on:

1800 642 428 (free call)
Monday to Friday 9:30 AM to 5:00 PM

The NSW Users and AIDS Association (NUAA) is a peer-based organisation for people who use drugs. Several NUAA staff members have personal experience of being on a Medically Assisted Treatment for Opioid Dependence (MATOD) program and can offer you information and advice peer-to-peer.

NUAA also publishes a magazine called Users News, which focuses on different topics relevant to people with a lived experience of drug use.

You can give the NSW Users and AIDS Association (NUAA) a call on:

(02) 8354 7300 or 1800 644 413 (free call)
Monday to Friday 9:00 AM and 6:00 PM

or get in contact via their online form.

If you are from another state or territory in Australia, don’t forget that sometimes laws and regulations are different, and that this site has advice specific to people in New South Wales. Talk to your doctor if you are unsure about anything.

There are also other peer-based organisations (like NUAA) for each state or territory; you can check out the Australian Injecting and Illicit Drug Users League (AIVL) website to get in contact with your local peer-based organisation.

You can check out some extra resources below that talk about driving safety. Some are specific for people on treatment, while others are more general:

    • Your Room is a joint initiative by NSW Health and St Vincent’s Alcohol and Drug Information Service. The site contains general advice and information about alcohol and other drugs, plus where you can go to get further support and access to treatment.

Got Another Question?

Have you got a question that we haven’t answered here? Send us a message and we will help you find out the answer. We may even post the question here, but won’t include any details that may identify you.