CMA Driver’s Guide - Determining Medical Fitness to Operate Motor Vehicles - 10th Edition

Sep 18, 2026

Guide for physicians on determining medical fitness to operate motor vehicles, organized into functional assessment, medical standards, and practical methods for evaluation. Covers driver licensing requirements, reporting responsibilities and patient access, and considerations for driving cessation. Includes chapters addressing alcohol and drugs, aging-related risks, dementia and cognitive screening, sleep disorders, psychiatric disorders, and nervous system conditions, with guidance on assessment, disclosure, counselling, and follow-up decisions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages155

Reading Time6 h 31 min

AccessFree to download

Section 1: Introduction

A guide for physicians

Functional assessment

Medical standards for fitness to drive

The physician’s role

Public health

Levels of medical fitness required by the motor vehicle licensing authorities

Driver’s medical examination report

Physician education on driver evaluation

Payment for medical and laboratory examinations

Classes of drivers’ licences and vehicles

Section 2: Functional assessment—emerging emphasis

Overview

Standards

Assessment

Finding an occupational therapist

Section 3: Reporting—when and why

Overview

Reporting

Patient’s right of access to physician’s report

Section 4: Driving cessation

Overview

Voluntary driving cessation

Involuntary driving cessation

Planning for retirement from driving

Strategies for discussing driving cessation

Compliance

Section 5: Alcohol

Overview

Assessment: Clinical history

Section 6: Drugs

Overview

Clinical history

Common drugs

Sedatives and hypnotics

Opioids

Hallucinogens

Cannabis – recreational and medical use

Section 7: Aging

Overview

Red flags—the 3Rs

Hidden disease

Multiple comorbidities

Section 8: Dementia

Overview

Earlier Canadian dementia guidelines

Updated guideline recommendations

Reporting according to stage of dementia

Cognitive screening tools

When fitness to drive remains unclear

Counselling and disclosure

Follow-up after loss of licensure

Countermeasures

Driving and Dementia Roadmap

Section 9: Sleep disorders

Overview

Assessment

Obstructive sleep apnea

Narcolepsy

Other sleep disorders

Section 10: Psychiatric disorders

Overview

Functional impairment

Assessing fitness to drive

Specific disorders

Psychoactive drugs

Section 11: Nervous system

Overview

Syncope

Seizures

Head injury and seizures

Disorders affecting coordination, muscle strength, and control

Determining medical fitness to operate motor vehicles CMA Driver’s Guide 10th Edition © 2023 CMA Impact Inc. or its licensors This is an Open Access publication distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4 . 0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: [https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by-nc-nd/4.0/](licenses/by-nc-nd/4.0/) For further permissions, contact [permissions@cma.ca](permissions@cma.ca). Library and Archives Canada Cataloguing in Publication CMA driver's guide : determining medical fitness to operate motor vehicles.– 10th edition. Includes bibliographical references. ISBN 978-1-897490-56-3 (PDF) Automobile driving–Physiological aspects–Handbooks, manuals, etc. Automobile drivers– Medical examinations–Handbooks, manuals, etc. Automotive medicine–Handbooks, manuals, etc. I. Canadian Medical Association, issuing body Disclaimer: This guide is for information purposes and is not a substitute for medical diagnosis, and physicians are encouraged to use their best clinical judgment to determine a patient’s medical fitness to drive. The naming of any organization, product or alternative therapy in this book does not imply endorsement by the Canadian Medical Association or CMA Impact Inc., nor does the omission of any such name imply disapproval by the Canadian Medical Association or CMA Impact Inc. Neither the Canadian Medical Association nor CMA Impact Inc. assumes any responsibility for liability arising from any error in oromission from the book, or from the use of any information contained in it. Également disponible en français. CMAJ Driver’s Guide—10th Edition Contents vii Acknowledgements vii Scientific Editorial Board vii Contributing authors viii CMA staff viii CMAJ Group staff and contractors 1 Section 1: Introduction 1 1.1 A guide for physicians 1 1.2 Functional assessment 2 1.3 Medical standards for fitness to drive 2 1.4 Methods 3 1.5 The physician’s role 3 1.6 Public health 4 1.7 Levels of medical fitness required by the motor vehicle licensing authorities 5 1.8 Driver’s medical examination report 5 1.9 Physician education on driver evaluation 5 1.10 Payment for medical and laboratory examinations 6 1.11 Classes of drivers’ licences and vehicles 6 1.12 Contact us 7 Section 2: Functional assessment—emerging emphasis 7 2.1 Overview 7 2.2 Standards 8 2.3 Assessment 2.3.1 Office assessment 2.3.2 Functional assessment 9 2.4 Finding an occupational therapist 10 Section 3: Reporting—when and why 10 3.1 Overview 13 3.2 Reporting 14 3.3 Patient’s right of access to physician’s report 15 Section 4: Driving cessation 15 4.1 Overview 15 4.2 Voluntary driving cessation 16 4.3 Involuntary driving cessation 16 4.4 Planning for retirement from driving 17 4.5 Strategies for discussing driving cessation 18 4.6 Compliance 19 Section 5: Alcohol 19 5.1 Overview 19 5.2 Assessment: Clinical history Contents | i 22 Section 6: Drugs 22 6.1 Overview 23 6.2 Clinical history 23 6.3 Common drugs 6.3.1 Sedatives and hypnotics 6.3.2 Non-prescription antihistamines, motion-sickness medications, and muscle relaxants 6.3.3 Opioids 6.3.4 Central nervous system stimulants 6.3.5 Hallucinogens 6.3.6 Inhalants 6.3.7 Antidepressants and antipsychotics 6.3.8 Antiseizure medications 6.3.9 Conscious sedation in an outpatient setting 6.3.10 Anti-infective agents 6.3.11 Anticholinergics 6.3.12 “Designer drugs” and herbal preparations 6.3.13 Antiparkinsonian drugs 6.3.14 Cannabis – recreational and medical use 29 Section 7: Aging 29 7.1 Overview 30 7.2 Red flags—the 3Rs 30 7.3 Hidden diseas

FAQs

What is the document’s purpose for clinicians?

It provides guidance for physicians to determine a patient’s medical fitness to operate motor vehicles using clinical judgment and defined medical standards.

How does the guide structure assessment and standards for driving fitness?

It emphasizes functional assessment and outlines medical standards, methods, and different levels of fitness required by motor vehicle licensing authorities.

Which medical conditions are specifically addressed for driving fitness decisions?

Alcohol use, drug effects, aging, dementia, sleep disorders, psychiatric disorders, and nervous system conditions such as seizures and syncope are covered with assessment and reporting considerations.

Sep 18, 2026

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