Has there been any discussion on this in the recent past? I have in mind a known crack user who told me that he had just bought a very powerful motorcycle. I expressed concern, he DNA'd his last appointment, I (almost jokingly) predicted that he had had an accident on his bike - and so it turned out.
This must be a frequent occurrence - lots of our users are using on top but still driving to their appointments, but my impression is that we tend to turn a blind eye to this, although others than the user are at risk. The situation is clear in mainstream general practice for the usual causes of unfitness to drive eg epilepsy, dementia etc - ie lots of warnings that it is their responsibility to inform the DVLA but if we know that they continue driving then it is our duty to tell the clients / patients what we intend to do, and then inform. What if the keyworker knows, not the doctor? Is the onus then on them to go through the same procedure? I can see no reason why it HAS to be the doctor, even though we have a clear protocol in place. What do others do?

Most recent discussion I think Jim: http://smmgp.groupee.net/eve/f...011045922#5011045922

Cheers
Simon

I took somones car keys off them about two weeks ago. I told him he was intoxicated and with his permission phoned a relative to collect him.

Thanks for this - I think that it has made things clearer for me. As I understand it, if the client is stable and in treatment, then it really is not our problem. No issue here. BUT if he/she is known to be using on top - and I note from the Orange Guidelines that cocaine is deemed to be a higher risk than heroin (but interestingly less than alcohol and benzos (is crack cocaine the same risk as cocaine? I would have thought much more myself) - then the process of telling him that "we will inform unless ..." starts. And after the subject has arisen, then surely it would be unethical for me NOT to drug test, not for any legal reason but to clarify the ethics of whether I inform the DVLA or not? Does this have to be the doctor? Why should the same not apply to the keyworker? Or pharmacist if applicable?
I like the crude risk assessment tool. I am sure I will be using that again.