Reporting of medical conditions

Health care professionals play a key role in identifying medically impaired and at-risk drivers. In accordance with section 18.2(1) of The Drivers and Vehicles Act, a physician or optometrist is required to report any individual with a medical condition that could impair their ability to drive safely.

To help you identify at-risk drivers, MPI has partnered with the Continuing Professional Development Medicine program at the University of Manitoba to offer a Continuing Medical Education (CME) accredited online learning module about driver fitness and assessing fitness to drive. The online learning module is free of charge. Click here to register.

Conditions that must be reported include, but are not limited to those that affect vision, physical or cognitive abilities, as well as conditions that could make a person subject to a sudden loss of awareness while driving, such as epilepsy, cardiac arrhythmias and sleep disorders.

It is helpful to provide details of your concerns. For physical impairments, outline areas affected and degree of limitation; for concerns regarding cognition, include cognitive screening results (i.e., Montreal Cognitive Assessment, Trail making test part B.)

To facilitate the reporting process, Driver Fitness has created a simple reporting form that may be faxed or mailed to Driver Fitness. The receipt of this form initiates a driver fitness review.

Reports from sources other than health care professionals

A driver fitness review can also be triggered by a driver’s self-declaration, police or accident report, concerns from members of the public, or follow-up medical reports that identify medical conditions that may affect the ability to drive safely.

When concerns are reported

If the medical information received from a health care professional indicates a risk to public safety, the driver’s licence will be suspended by Driver Fitness. Recommendations by the health care provider regarding licence suspension are helpful, but not required, and Driver Fitness makes the determination on whether suspension is warranted. A suspension will remain in effect until medical reports are provided and it is determined that the individual meets the medical standards.

If the information indicates no immediate concerns, the driver will maintain their driver’s licence and a medical/vision report will be requested.

In some cases, further medical information, specialist reports, or driving assessments may be required to determine if the medical condition affects ability to drive safely.

Once it is determined that the medical standards are met, Driver Fitness may require periodic medical and/or vision reports to monitor the medical condition and driving record.

If it is determined that the driver’s condition fails to meet the medical standards and their licence is suspended, they will have the right to appeal this decision.

Assessing medical fitness

Driver Fitness utilizes the medical standards for drivers published by the Canadian Council of Motor Transport Administrators (CCMTA) to assess fitness to drive. The standards were developed by medical advisors (physicians) and driver licensing administrators from Canadian provinces and territories, and establish basic medical qualifications for drivers with medical conditions that may impact their ability to drive safely.

The functions necessary for driving are cognitive, sensory (vision, touch), and motor (physical). Driving is a multifaceted perceptual-motor skill that usually takes place in a complex environment requiring the functions to operate together.

The types of impairment resulting from medical conditions can be classified as persistent or episodic and the effect of each on driving ability is assessed differently.

If you have questions about the medical standards for drivers or your role in reporting patients whose medical conditions may affect driving, please contact one of our registered nurses directly on our Health Care Professional’s Line 204-953-4925.

Episodic impairments

With episodic impairments, the event is sporadic, unpredictable, and lasts for a short time. Episodic impairments do not have any ongoing measurable, testable, or observable impacts on the functional ability to drive. Examples of episodic impairments include, but are not limited to:

• seizures
• myocardial infarctions
• hypoglycemic reactions
• blackouts or fainting spells due to transitory illnesses

When the medical event occurs, there is no question that the individual is not competent to drive and may be incapacitated. Determining driver fitness for episodic impairments therefore focuses on medical assessments and the likelihood the event will recur. Generally, the medical standards for episodic impairments reflect medical research and/or consensus medical opinions to assist in driving decisions. In most cases, drivers who experience episodic impairments are monitored by their health care providers and driving privileges are suspended until such time as the condition has cleared (completely or for an established period of time), or has been stabilized. Drivers with episodic impairments do not require functional driving assessments because there are no ongoing, measureable effects on driving other than when the event occurs, which cannot be predicted.

Persistent impairments

Persistent impairments, such as cognitive and motor deficits resulting from a stroke, are generally enduring. This could also include drivers with multiple medical conditions where the resultant cumulative effect could cause them to be unfit to drive.

Drivers with medical conditions that have persistent impairments generally require a functional assessment, in addition to a medical assessment, to determine fitness to drive. Examples of these medical conditions may include, but are not limited to:

• stroke
• cognitive deficits, including dementia
• multiple medical conditions
• multiple sclerosis
• Parkinson’s disease
• head injury
• vision deficits

Functional assessments measure the effect of persistent impairments on an individual’s ability to drive. They involve observing or measuring the functions required for driving and can reveal subtle, persistent impairments that may go undetected during a health care provider’s in-office examination.

Impairment by drugs

Patients need to be aware that many drugs, including prescribed medications, can impair their ability to drive. Many drugs, whether used alone or in combination with other medications, have the potential to affect driving performance. Patients should be advised accordingly.

This includes sedatives and hypnotics, opioids, stimulants, muscle relaxants, antihistamines, anti-nauseants, antidepressants and antipsychotics. Anti-Parkinsonian drugs, particularly dopamine agonists, can be associated with excessive daytime somnolence. With all of these classes of drugs, driving should be avoided completely if significant worrisome side effects are experienced.

Substance use disorder

Driver Fitness follows the standard for Substance Use Disorder as recommended in the CCMTA medical standards for drivers. Individuals diagnosed with moderate to severe Substance (including alcohol) Use Disorder, in accordance with the definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association, are prohibited from holding any class of licence unless the condition is in remission. Health care providers are advised to be particularly aware of high-risk criteria such as the presence of tolerance, use of the substance in hazardous situations, and continued use in spite of significant health problems caused by the use of the substance.

Cannabis and driving performance

While the degree of risk varies, multiple studies have demonstrated an association between cannabis use and increased risk of crashes.

Acute inhalation or ingestion of cannabis can result in perceptual distortion, cognitive impairment, and euphoria. This can result in impaired driving performance, manifested by slow reaction time, altered perception of danger, difficulty with multiple sensory inputs, and impaired decision-making ability. These effects typically last three to six hours but can be present for up to 24 hours after a single use.

Advice to users of cannabis

Many drivers are unaware of the risks of using cannabis prior to driving. Health care providers are advised to counsel patients known to consume cannabis in accordance with the recommendations outlined in the Guidance in Authorizing Cannabis Products Within Primary Care March 2021 (cfpc.ca), released by the College of Family Physicians of Canada in March 2021.

Per the Guidance Document (Recommendation 13), a patient should be advised:

• Wait at least six hours before driving if using via the inhalational route.
• Wait at least eight hours before driving if using via the oral route.
• If using daily, their serum THC level may be higher than legal allowable limits, even if they do not feel impaired.
• Combining cannabis and alcohol seriously increases risk and should be avoided.
• The recommendations above apply to typical driving with a Class 5 licence, and limitations/times can increase with other licence classes or additional safety-sensitive work.

Impaired driving charges

Driving while impaired by drugs is a criminal offence in Canada. This applies equally to drugs used recreationally and to over-the-counter or prescribed medication, including cannabis.

In 2018 the government of Canada amended the Criminal Code to introduce new impaired driving provisions specific to drugs and the combination of drugs and alcohol. The changes included establishing concentration limits on a number of drugs, including tetrahydrocannabinol (THC), when operating a vehicle. The Criminal Code changes also included the introduction of approved drug screening equipment which, when used by police officers roadside, can help detect drug use. Impairment by drugs, or the combination of alcohol and drugs, can be determined by tests conducted by police officers. An individual who fails a Physical Coordination Test can be subject to an administrative suspension and downward movement on the Driver Safety Rating Scale. An individual may be asked to complete a more detailed Drug Recognition Evaluation and Classification Assessment conducted by a specially trained drug recognition expert. If the conclusion is that a specific class of drugs is the cause of the impairment, a body fluid sample is demanded. If the suspected drug is confirmed, the driver may be charged with impaired driving, with penalties equivalent for driving while impaired by alcohol.

Out-of-province drivers

If you examine a patient who is not a Manitoba resident and determine that their medical condition may interfere with their ability to drive safely, please notify the driver’s applicable driver licencing authority. Manitoba Public Insurance will not forward medical information it receives to the driver’s home licencing authority. The provincial and territory licencing addresses are as follows:

Alberta
Government of Alberta Ministry of Transportation, Driver Fitness and Monitoring Branch
Main Fl., Twin Atria Building
Alberta Transportation
4999 - 98 Ave.
Edmonton, AB T6B 2X3
Ph: 780- 427-8230
Fax: 780- 422-6612

British Columbia
BC Office of the Superintendent of Motor Vehicles,
Road Safety BC
PO Box 9254, Stn Prov. Govt.
Victoria, BC V8W 9J2
Ph: 250-387-7747 (Toll-free: 1-800-663-7867, request transfer to 387-7747)
Fax: 250-387-4891

New Brunswick
Registrar of Motor Vehicles
Department of Public Safety
Motor Vehicle Branch
PO Box 6000
Fredericton, NB E3B 5H1
Ph: 506-453-2410
Fax: 506-453-7455

Newfoundland and Labrador
Dept. of Government Services and Lands
Motor Vehicle Registration
Medical Review Officer
Box 8710
St. John’s, NF A1B 4J5
Ph: 709-729-0345
Fax: 709-729-4360

Northwest Territories
Road Licensing & Safety Division
Department of Transportation Government of the Northwest Territories
Box 1320
Yellowknife, NT X1A 2L9
Ph: 867 873-7406
Fax: 867-873-0120

Nova Scotia
Service Nova Scotia & Municipal Relations
Road Safety Programs
1505 Barrington St., 9th Fl.
North Halifax, NS B3J 3K5
Ph: 902-424-5732
Fax: 902-424-0772

Nunavut
Motor Vehicles Division
Department of Economic Development & Transportation
Govt. of Nunavut
PO Box 10
Gjoa Haven, NU X0B 1J0
Ph: 867-360-4615
Fax: 867-360-4619

Ontario
Registrar of Motor Vehicles
Medical Review Section
Ministry of Transportation
2680 Keele St.
Downsview, ON M3M 3E6
Ph: 416-235-1773 (Toll-free: 1-800-268-1481)
Fax: 416-235-3400 or 800-304-7889

Prince Edward Island
Registrar, Highway Safety
Box 2000
Charlottetown, PEI CIA 7N8
Ph: 902-368-5210
Fax: 902-368-5236

Québec
Service de l’évaluation médicale et du suivi du comportement
Sociéte de l’assurance automobile du Québec
333, boul Jean-Lesage, N-4-34
CP 19600
Québec, QC G1K 8J6
Ph: 418-643-5506 (Toll-free: 800-561-2858)
Fax: 418-643-4840

Saskatchewan
Saskatchewan Government Insurance
Medical Review Unit
2260-11th Ave., 3rd Fl.
Regina, SK S4P 2N7
Ph: 306-775-6176 (Toll-free: 800-667-8015, ext. 6176)
Fax: 306-347-2577 or 866-274-4417

Yukon
Driver Sanctions Coordinator
Government of Yukon
Motor Vehicles Branch (W-22)
Department of Highways and Public Works
Box 2703
Whitehorse, YT Y1A 2C6
Ph: 867-667-3563
Fax: 867-393-6220

Resources

Medical standards for drivers

Driver Fitness CPD module

The Drivers and Vehicles Act