dathijs, a 23-year-old man, was doing well. He had overcome substance abuse, was even reducing his prescribed methadone dosage, and enjoyed a structured working day repairing steam locomotives in a workshop. However, everything changed when he had to fill out a form about his medication use. Due to his methadone use, the insurer refused to cover the workshop if Mathijs worked there, causing him to lose his daily activity overnight. But is this fair?

Can methadone users drive safely, operate machinery, and use tools? Information on this matter is often unclear and contradictory. Most Dutch methadone leaflets state things like “do not drive, as methadone reduces reaction and concentration abilities, making you unfit to participate in traffic. Do not use tools or operate machinery.” However, the KNMP, the Dutch association of pharmacists, takes a more nuanced view. Recently, they reviewed driving advice for methadone with pharmacists, doctors, and driving ability specialists. According to them, people undergoing maintenance treatment with methadone should not drive for the first three months, but are able to do so afterward.

Consulting with a doctor
Not all methadone users experience side effects that impact their driving skills or ability to operate machinery. Several studies indicate that drowsiness and reduced reaction time occur in 10 to 30 percent of users, meaning 70 to 90 percent do not have these issues. However, the guidelines do not account for this. In many English-written leaflets (for the same methadone), it states instead that users must first become accustomed to methadone and should consult a doctor before driving or operating machinery again.

Duration and dosage
Like with alcohol, it seems reasonable to consider how long ago a person took their last dose. However, this is not addressed in leaflets and guidelines. The Central Bureau of Driving Licenses states, “If you use medicinal drugs [like methadone], you likely cannot drive. How long do drugs stay in your blood? Opiates: after a single dose, you can drive again after about 5 hours. Unless you take a daily dose: then it’s 12 to 15 hours.” According to KNMP medication specialists, you can drive again normally after three months, regardless of when your last dose was taken. The CBR also allows driving if the last dose was taken 12 to 15 hours prior.

One might expect the amount of methadone to influence this, but there is no scientific literature on the effect of dosage on these issues, says emeritus professor of addiction care Wim van den Brink. More research is needed, but it’s clear that most methadone users (70 to 90 percent!) do not experience the feared side effects after a while. It’s thus important that leaflets, guidelines, and insurance companies consider the specific circumstances of ex-users. Methadone use alone is not a sufficient reason to exclude someone from various activities.

Mathijs shares this view. He started with 120 mg of methadone a few years ago and is now down to 40 mg per day, a significant difference. However, due to the broad generalization of methadone users, he still cannot return to his workshop.

By: Geert Battjes