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Points of Order

12.30 pm

Mr. Patrick McLoughlin (West Derbyshire) (Con): On a point of order, Mr. Speaker. Will you hold an inquiry in light of what happened in questions to the Chancellor of the Duchy of Lancaster? It is a rather serious matter that all six questions on the Order Paper were tabled by Conservative Members. I wonder whether something has gone wrong with the shuffle because I cannot believe—

Mr. Speaker: Order. I think that the hon. Gentleman is going a bit too far. I assure him that it was a very fair random ballot.

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Pharmaceutical Labelling (Warning of Cognitive Function Impairment)

12.31 pm

Mr. Andrew Dismore (Hendon) (Lab): I beg to move,

A psychoactive pharmaceutical is one that has a direct action on the brain and thus exerts clinical effects such as reducing depressive symptoms or anxiety, or inducing a good night's sleep. They are also used to treat panic attacks, post-traumatic stress disorder, obsessive-compulsive disorders and allergies. The direct action on the brain needed to alleviate the symptoms also has the potential to affect other nervous functions involved in the accurate performance of the tasks of daily living—whether at home, on the roads or in the workplace—including the rate of information processing, alertness and attention, visual processes, motor co-ordination and memory. I would hazard a guess that many have used such perfectly legal drugs without knowing that if they were then to take to the roads, their judgment could be just as impaired as it would have been if they had been drinking alcohol to such an extent that they were well above the legal limit.

Over a five-month period, Professor Hindmarch of Surrey university conducted a pilot study in which blood samples were collected from people at two hospitals who had suffered accidental injuries. The results implied strongly that the presence of tricyclic antidepressants and benzodiazepines led to an increased risk of accidental injury.

In a different pilot study, information on contributory factors in road accidents was collected by 15 police forces in 2002 and 2003. The influence of drugs was recorded as a contributory factor in about 1 per cent. of injury accidents, which was on a par with the effect of excess alcohol, although it is not clear what proportion of those drugs were legal or illegal. In 2001, the Transport Research Laboratory published a study to measure the incidence of drugs in fatal road accidents. A study published in 1989 found a 5.5 per cent. incidence of medicinal drugs and a 3 per cent. incidence of illegal drugs. Those figures were relatively low compared with the 35 per cent. incidence of alcohol. However, the 2001 study, which was based on results collected between 1996 and 2000, found that the incidence of drugs in the blood samples of road traffic fatalities was three times higher than in the previous study, while the incidence of alcohol had fallen.

A Canadian study of fatal road accidents in 1981 found that drivers who had used benzodiazepines were found culpable in 98 per cent. of the cases examined. Drivers involved in fatal road accidents who had been taking antihistamines were found culpable in 72 per cent. of cases.

There is no defined limit of drug use as there is for alcohol, and no such clear cut test as the random breath test. Moreover, the law does not make a distinction between illegal or misused drugs and over-the-counter or prescription drugs that are taken as directed by a GP or other medical practitioner.
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Just as we have come to welcome a culture that emphasises the need for warnings about alcohol levels—a culture in which driving while drunk is no longer tolerated and for most employees drunkenness at work is a dismissible offence—it is time to ensure that those using psychoactive drugs are aware of their effect. The Driver and Vehicle Licensing Agency provides advice to medical professionals. Doctors and pharmacists should provide information when dispensing prescriptions or other medicines. The Department for Transport is researching UK health professionals' attitude to providing fitness-to-drive advice to the public, including an examination of advice given in relation to medication. However, that is not enough.

Clearer labelling seems to me to be an excellent way of both alerting the public about the unexpected hazards of what they are taking to cure their ills and promoting a clear safety message by triggering the need to consider the risks before driving or embarking on potentially hazardous work. Who would be willing to wield a dangerous power tool if they knew that their reactions might be seriously impaired? Now, a pharmacy sticker might state, "Do not drive if you feel drowsy," or "May cause drowsiness," but by the time that someone feels drowsy, it is already too late—the safe limits have been exceeded. Inside the package, there may be a tightly folded patient information leaflet. If one is able to unwrap it, one might find print so small and illegible that one needs a magnifying glass to read it. To those of our fellow citizens or visitors to our shores who speak little or no English, it is of no use at all, and as the language used is rarely plain English, it is of little use to the rest of us. Such warnings are not adequate: the labelling is ambiguous and unhelpful and the patient is extremely unlikely to have insight into the actual level of drowsiness caused in the brain. My Bill would require the external packaging of medicines known to have an effect on judgment to be prominently marked. I propose a red triangle, meaning simply that use of the medication could seriously impair the user's judgment.

The main classes of medication—there are others—that would fall into the red triangle category would be benzodiazepines and tricyclic antidepressants, both of which are available only on prescription, and antihistamines, which are available over the counter to treat common complaints such as hayfever and conjunctivitis. A report compiled by Loughborough sleep research centre identified medicines available over the counter that have the potential to cause drowsiness and therefore to be hazardous. The literature makes it clear that one antihistamine sub-group, the classical H1 receptor, is especially sedating—it is even used for the relief of temporary sleep disturbance in some cases. The impairment caused by the recommended dose of at least two of the drugs is greater than that caused by the
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legal blood alcohol concentration limit for driving in this country. The elderly are especially vulnerable to the sedative effects of those drugs.

I do not suggest that the drugs are dangerous in themselves or that their use should be curtailed, either in prescription or in over-the-counter sales. Instead, because they will continue to be used regularly by large numbers of people, I advocate a red triangle marking to stand as an unambiguous warning that the ability to drive or to work safely might well be impaired on taking the drug. That would give users more control over their activities and an option to seek different medication if appropriate. Choice and control are paramount in avoiding preventable accidents.

That view has already been adopted in other countries. In Canada, a warning symbol was introduced under the Controlled Drugs and Substances Act 1996. The European Commission has acknowledged the benefits of such a system and referred to the need for appropriate labelling of medicines in the European road safety action programme for 2003 to 2010, which aims to half the number of people killed on the roads by the end of that period. In countries such as France, the Netherlands and Denmark, a clear system of symbols is used: green if it is safe to drive, amber if caution is needed, and red to show that one must not drive. Red triangle symbols are in use in Denmark, France, Italy and Norway, and other versions of the symbols are used in Austria, Belgium, Italy and Spain. The UK is lagging behind.

We need to place on certain medicines a visible warning that will leave no one in any doubt about their potential effects. The red triangle is an obvious visible warning stating, "Be careful what tasks you choose to do. Do not drive. Do not operate machinery." We need to act now to cut deaths and injuries on the road, in the workplace and at home. I hope that my Bill to achieve those objectives will find favour with the House today.

Question put and agreed to.

Bill ordered to be brought in by Mr. Andrew Dismore, Ms Karen Buck, Mr. Stephen Pound, Mr. Martin Salter, Sir Archy Kirkwood, David Hamilton, Dr. Alan Whitehead, Angela Eagle, Miss Anne Begg, Alan Keen and Mr. Neil Gerrard.

Pharmaceutical Labelling (Warning of Cognitive Function Impairment)

Mr. Andrew Dismore accordingly presented a Bill to make provision for a warning symbol to be prominently displayed on the packaging of pharmaceuticals which act on the brain and central nervous system so as to impair dangerously the consumer's ability to carry out certain activities; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 20 May, and to be printed [Bill 50].

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