John’s cancer patients were prescribed opioids. This key warning was missing

Cancer survivor Suellen Kirkegaard had been given six months to live when she was prescribed opioids, a group of strong, highly addictive painkillers.

Doctors had discovered a metastatic melanoma three years after her breast cancer surgery and treatment. Immunotherapy – then limited and expensive – offered the only hope of improving her prognosis.

“The oncologist I’d had for my breast cancer … [was able to get immunotherapy] for me on compassionate grounds,” she said. “Otherwise, six months wasn’t a lot to look forward to.”

Kirkegaard responded well to the treatment, but needed opioids to curb painful side effects; arthritis, joint pain, fatigue and regular bouts of pancreatitis.

“Without the pain medication, I just would not have been able to function at all,” she explained.

While Kirkegaard understood opioids could be addictive, it wasn’t until she met Dr John Gillett, a Toowoomba-based palliative care doctor and Queensland University of Technology PhD researcher, that she learned about the risks associated with driving.

“The medications say ‘do not operate heavy vehicles’ and I’m thinking, yeah, I’m not going to be driving a truck,” Kirkegaard said.

“It was only when he [Gillett] mentioned opioids and the capacity to drive [that it] crossed my mind.”

Nearly 3 million Australians are prescribed opioids each year. While strong painkillers such as morphine, oxycodone and fentanyl are not classed as sedatives, they can cause heavy drowsiness and fatigue.

Patients rely on health professionals to explain possible cognitive impairment, but through his research, Gillett found both doctors and pharmacists were failing to perform this duty of care.

“I [spoke] to a couple of younger women who said, ‘can we drive? Can we drop the kids off to school? I’m taking these drugs, but nobody can tell me what to do’,” Gillett said.

“They wanted to ask the question, but nobody wanted to answer.”

Reasons for the oversight were varied, Gillett explained.

In one study focused on pharmacists, many discussed the risk of impairment, but did not explicitly tell patients this related to driving, assuming they would make the connection themselves.

“No, I probably never ask if they are driving or not,” one pharmacist told Gillett, continuing that they encourage patients to “decide how impaired you are and then you decide if you think you’re right to drive”.

Another pharmacist implied that GPs bore greater responsibility to manage driving and opioid use: “I’ve even seen them drive their car and they haven’t even been able to walk in the door, so to me they shouldn’t be driving,” they said.

“But the doctors will still sign off that they’re capable of driving, and I don’t know how they can do that.”

Separate research exploring doctors’ role in assessing drivers found GPs gave mixed advice depending on their experience and relationship with patients.

Many doctors had not received consistent education on driving-impairing medications.

“The book is very clear on epilepsy and it’s pretty clear on diabetes, but on medication, it’s quite vague,” one senior doctor said.

“I think that pushes a lot of … responsibility and guesswork back onto the GP.”

Overall, Gillett found health professionals leave it up to patients to self regulate driving and initiate concerns.

“[Doctors are] not going to say ‘oh, I’m worried about these drugs you’re taking, but I know nothing about them’, and then pass that over to the patient,” Gillett said.

“That’s probably going to be worse than saying nothing.”

Gillett was recently asked to be involved in GP training on the topic of auditing driving privileges, and has written submissions on assessing fitness to drive guidelines.

He said recent cases highlight the importance of improving education across the health sector and ensuring GPs and pharmacists give patients consistent advice.

In 2024, bus driver Brett Button was sentenced to more than two decades in prison for the fatal crash that killed 10 people and injured 25 following a wedding in the NSW Hunter Valley the previous year.

Throughout the case, the court heard that Button had an opioid dependency and had taken a large amount of the painkiller Tramadol through the day of the accident. He admitted he was impaired as a result of the drugs, but did not believe when he got behind the wheel on the day of the crash.

“No one’s mentioned about the responsibility of doctors and pharmacists to inform [the driver],” Gillett said.

Kirkegaard no longer takes opioids but agreed with Gillett’s calls for consistency and education.

“You lose so much with a cancer diagnosis, from your hair to your dignity, your self-image … you want your independence [and] some form of normality,” she said.

“But you don’t want to put other people at risk either. A car on the road with someone behind it that’s not fully switched on, so to speak, isn’t good either.”

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