Timing, inconsistencies, treatment: this is how the drug crackdown risks unconstitutionality

The Gip of Siena highlights a particular medico-legal aspect: the novelty also affects cases in which the substance is taken for therapeutic reasons, already known and investigated in the past. In Italy, the prescription of medicines takes place in different contexts, hospital-extra hospital. Frequently, patients undergo polypharmacotherapy. Both specialists and general practitioners prescribe, for example, benzodiazepines for the treatment of multiple clinical conditions. These drugs are prescribed by both specialists and general practitioners.

The benzodiazepines are psychotropic drugs (widely prescribed and taken by the general population) whose effects can lead to impaired driving and are potentially investigable in the context of road traffic. Moreover, given the different clinical conditions for which they are prescribed, it is not possible to identify a priori a specific category of patients and/or associations that represent them.

To assess the extent of the issue, it is useful to point out that the 2013 OsMed (Aifa) report shows that in Italy, among class C drugs, benzodiazepine derivatives (anxiolytics in particular) made up the largest expenditure with 378.7 million euros. Similar data 10 years later: the OsMed report of 2023 gives an account that benzodiazepine derivatives with anxiolytic activity were the drugs with the highest expenditure, amounting to 387.5 million euro. And non-benzodiazepine hypnotic drugs, 'Z drugs', must be added, with a total expenditure exceeding 530 million euros.

In a publication that appeared in 2016 in the Rivista Società Italiana di Medicina Generale (R. Torta et al.) it was indicated that 5% of the Italian general population (about 3 million people) were chronic benzodiazepine users (among adults 1 in 10; in the elderly population 1 in 4).

We are therefore faced with a context of prescription/use of medicines that affects a large part of the population and thus of potential drivers.

It should also be emphasised that patients often undergo treatment with several drugs, e.g. opioid therapy combined with benzodiazepines, so it is difficult to assess the overall effect of the therapy on driving ability.

Thus the need once again emerges for some aspects of the reform to be examined and deepened. It will necessarily be necessary to take into account the provisions of Legislative Decree 59/2011, in particular on the subject of the consumption of psychotropic substances (Annex III, letter F), including the fact that the assessment of a driver's fitness would be referred to the local medical commission. That assessment could hardly be contradicted at roadside checks on the basis of laboratory data alone.

But to date this is a mere common sense option not legitimised in the wording of Article 187 of the Highway Code. It is therefore desirable for the Constitutional Court to clarify this aspect as well.

*Complex structure Uco Forensic Medicine, Giuliano Isontina University Health Authority.