Health care professionals play a key role in identifying medically impaired and at-risk drivers. In accordance with section 157(1) of The Highway Traffic Act, a physician or optometrist is required to report any individual with a medical condition that could impair their ability to drive safely.
Physicians and optometrists who report drivers in accordance with the legal requirement above are protected from litigation pursuant to section 157(2) of The Highway Traffic Act.
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.
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.
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.
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.
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:
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, 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:
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.
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.
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.
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.
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 Preliminary Guidance Document on dried cannabis, released by the College of Family Physicians of Canada in September 2014.
Per the Preliminary Guidance Document (Recommendation 10), a patient should be advised to not drive for at least four hours after inhalation, for six hours after ingestion, or for eight hours if a subjective "high" or euphoria is experienced, regardless of the route of administration.
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.
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:
AlbertaGovernment of Alberta Ministry of Transportation, Driver Fitness and Monitoring BranchMain Fl., Twin Atria BuildingAlberta Transportation4999 - 98 Ave.Edmonton, AB T6B 2X3Ph: 780- 427-8230 Fax: 780- 422-6612
British ColumbiaBC Office of the Superintendent of Motor Vehicles,Road Safety BCPO Box 9254, Stn Prov. Govt.Victoria, BC V8W 9J2Ph: 250-387-7747 (Toll-free: 1-800-663-7867, request transfer to 387-7747)Fax: 250-387-4891
New Brunswick Registrar of Motor VehiclesDepartment of Public SafetyMotor Vehicle BranchPO Box 6000Fredericton, NB E3B 5H1Ph: 506-453-2410Fax: 506-453-7455
Newfoundland and LabradorDept. of Government Services and LandsMotor Vehicle RegistrationMedical Review OfficerBox 8710St. John’s, NF A1B 4J5Ph: 709-729-0345Fax: 709-729-4360
Northwest TerritoriesRoad Licensing & Safety DivisionDepartment of Transportation Government of the Northwest TerritoriesBox 1320 Yellowknife, NT X1A 2L9Ph: 867 873-7406Fax: 867-873-0120
Nova ScotiaService Nova Scotia & Municipal RelationsRoad Safety Programs1505 Barrington St., 9th Fl.North Halifax, NS B3J 3K5Ph: 902-424-5732Fax: 902-424-0772
NunavutMotor Vehicles DivisionDepartment of Economic Development & TransportationGovt. of NunavutPO Box 10Gjoa Haven, NU X0B 1J0Ph: 867-360-4615Fax: 867-360-4619
OntarioRegistrar of Motor VehiclesMedical Review SectionMinistry of Transportation2680 Keele St. Downsview, ON M3M 3E6Ph: 416-235-1773 (Toll-free: 1-800-268-1481) Fax: 416-235-3400 or 800-304-7889
Prince Edward IslandRegistrar, Highway SafetyBox 2000Charlottetown, PEI CIA 7N8Ph: 902-368-5210Fax: 902-368-5236
QuébecService de l’évaluation médicale et du suivi du comportementSociéte de l’assurance automobile du Québec333, boul Jean-Lesage, N-4-34CP 19600Québec, QC G1K 8J6Ph: 418-643-5506 (Toll-free: 800-561-2858)Fax: 418-643-4840
SaskatchewanSaskatchewan Government InsuranceMedical Review Unit2260-11th Ave., 3rd Fl.Regina, SK S4P 2N7Ph: 306-775-6176 (Toll-free: 800-667-8015, ext. 6176)Fax: 306-347-2577 or 866-274-4417
YukonDriver Sanctions CoordinatorGovernment of YukonMotor Vehicles Branch (W-22)Department of Highways and Public WorksBox 2703 Whitehorse, YT Y1A 2C6Ph: 867-667-3563Fax: 867-393-6220