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This is an era of significant change for the Medical Bureau of Road Safety. With new drink driving legislation moving through the Oireachtas, the recent introduction of drug driving regulations, the slow passage of the Public Health (Alcohol) Bill, and rapid developments in technology there is much to keep Director Prof Denis Cusack and the Bureau staff busy.
Prof Cusack, who has been Director of the Bureau since 1997, regards its work as vital at the most basic level.
“The work is important because it’s about saving lives and it is also about cutting down on serious injuries. It is that human cost of course. But also the economic cost of losing that person to work, or the cost of looking after that person or rehabilitating them; it’s huge,” Prof Cusack told the Medical Independent (MI) in his office on the University College Dublin (UCD) Belfield Campus.
“We can’t be complacent, but if you go back to the 1970s, we had a smaller population, less cars and more than 600 people were dying each year in road traffic accidents.
“We are down now to 150-160 [road deaths per year on average]. That’s still unacceptable and our aim for 2020 is to get it down into the 120s. But we are making huge progress; this [the Bureau] is part of it, a lot of other people are contributing to it as well.”
Prof Cusack regards the high profile, but slow moving, Public Health (Alcohol) Bill as vital to the Bureau’s work.
“I liaise fairly closely with my colleague and [ex-] classmate of mine Prof Frank Murray [Chair of the RCPI Policy Group on Alcohol] because we have a common interest in how alcohol affects driving and indeed in my other role as coroner [for County Kildare], sadly a lot of deaths have alcohol associated with them,” he said.
“There was a perception that drink driving was a thing of the past. But our figures from the last few years shows that it is still a very big problem. In fact, the biggest drugs-driving problem is alcohol, because alcohol is a drug, a social drug that is licensed and permitted.
“We haven’t completely tackled that. We have brought in a huge number of measures. It has improved over the years.”
With his experience as a coroner, Prof Cusack predicts the country faces serious long-term health challenges because of binge drinking.
“This is a health crisis that we are going to face. Because the pattern of excessive drinking and binge drinking is going to lead to liver damage,” he warned.
“We are going to see more and more people in their 30s and their early 40s, with liver impairment and liver failure, something that 30 or 40 years ago you wouldn’t have seen in the same people until maybe they were into their 50s or 60s.
“That’s going to be a problem. One of the causes is the availability of alcohol at a very low price. The minimum pricing is a very good part of this [Public Health Alcohol Bill].”
But while drink driving has been on the agenda of the Bureau for the last half century, other drugs, often illegal, are now also a major focus of its work.
“I’ve been Director of the Bureau for over 20 years and we have seen huge change since 1997. Then we had a big focus on alcohol, very little to do with [other] drugs,” Prof Cusack commented.
Last April witnessed the introduction of new drug testing regulations for driving. The drugs test- ing enable gardaí to test motorists whom they suspect of driving under the influence of drugs. The new drug testing devices involve testing a sample of a driver’s oral fluid for the presence of cannabis, cocaine, opiates (eg, heroin, morphine) and benzodiazepines.
“Drugs have always been a problem. But we know that it is increasing. It has been reported as well with the huge increases in prescribed drugs, the Z drugs, the benzodiazepines and codeine,” explained Prof Cusack.
He acknowledged that the new drug driving regulations were “slow to take off because the Garda [Síochána] obviously had to have time to train enough gardaí on roadside drug testing”.
But that pedestrian pace has not continued and, according to Prof Cusack, the Bureau has now issued 308 certificates under the new rules.
“So the answer is yes, it is a big change, it is having an impact.”
Prof Cusack is keen to dampen the fears of patients who may be raising concerns with their doctors about taking prescribed medicine.
”So people who are medications prescribed, or even over the counter, if they are taking it in accordance with the prescription and they themselves know not to drive if they are feeling drowsy or affected in any way, then there should be no worry,” said Prof Cusack.
The most recent annual report from the Bureau published in January showed that cannabis was the second most common drug (after alcohol) detected in tested drivers.
“Road safety is not about whether the drug is legal or illegal, it is about — does it affect your driving?” said Prof Cusack.
“There is no doubt we are going to face this, as the debate about medicinal cannabinoids increases and even the debate around decriminalisation. I think something like 30 countries in the world have some form of licensing or decriminalisation of cannabis. The Dáil and Seanad are debating this whole area at the moment. That’s going to be an issue [for the Bureau] in the future as well.”
In August 2016, the Bureau published a five-year plan and among the looming challenges it noted were budgets and legal cases.
In terms of funding, Prof Cusack said, “like any publicly funded body we have to be aware that our money is not limitless”.
“So in our plans we very much respond to what the Dáil and Seanad ask us to do. Obviously we have an input on what we are capable of, in order for it to make sense you have to have money and resources.
“Sometimes in the health sphere this is probably one of the problems. Great ideas are brought into law, but without the staffing or resources.
“So people who are taking their medications prescribed, or even over the counter, if they are taking it in accordance with the prescription and they themselves know not to drive if they are feeling drowsy or affected in any way, then there should be no worry,” said Prof Cusack.