Licence Appeal Tribunal File Number: 16759/MED

An appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a decision of the Registrar of Motor Vehicles to suspend a licence pursuant to Section 47(1) of the Act.

Between:

Biljana Mitrovic

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Biljana Mitrovic, Appellant

For the Respondent: Stephen Grootenboer, Agent

Held by teleconference: April 7, 2025

OVERVIEW

1Biljana Mitrovic (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend her Class G licence under s. 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”) after the Registrar received an unsolicited Medical Condition Report (MCR) from a physician stating that the appellant suffers from a medical condition that may affect her ability to drive safely.

2The Registrar has the authority under s. 47(1)(g) of the Act to suspend or cancel a driver’s licence for any sufficient reason. Section 14(1)(a) of O. Reg. 340/94 under the Act (the “Regulation”) states that a holder of a driver’s licence must not suffer from any mental, emotional, nervous or physical condition or disability likely to significantly interfere with their ability to safely drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Minister of Transportation may require a driver to provide satisfactory evidence that they are able to drive safely.

3The Registrar takes the position that the appellant suffers from a medical condition, namely substance use disorder, that is likely to significantly interfere with her ability to drive safely and that this provides sufficient reason to suspend her licence under s. 47(1)(g) of the Act.

4The appellant appeals the suspension under s. 50(1) of the Act. She denies that she suffers from substance use disorder and denies that she suffers from a medical condition which interferes with her ability to drive safely.

5Pursuant to section 50(2) of the Act, after a hearing the Tribunal may confirm, modify, or set aside the decision or order of the Registrar.

ISSUES

6The issue in this appeal is whether the appellant suffers from a medical condition that is likely to significantly interfere with her ability to drive a motor vehicle safely.

7To resolve that issue, I will address the following questions:

i. Does the appellant suffer from substance use disorder?

ii. If so, is this likely to significantly interfere with her ability to drive a motor vehicle safely?

8The Registrar bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

9Having considered all the evidence and submissions and for the reasons that follow, I find that the Registrar has satisfied its burden to establish that the appellant suffers from a medical condition that is likely to significantly interfere with her ability to drive a motor vehicle safely and I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

ANALYSIS

Does the appellant suffer from substance use disorder?

10The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely substance use disorder.

11The Registrar’s position is supported by a MCR dated October 20, 2023, completed by Dr. K.

12Emergency room physician, Dr. K, submitted an unsolicited MCR reporting that the appellant suffers from an uncontrolled substance use disorder due to benzodiazepine use, is non-compliant with treatment recommendations, and is using this substance prior to driving.

13Following the submission of the MCR, the Registrar suspended the appellant’s driver’s licence effective November 10, 2023, and requested the completion of a Substance Use Assessment Form.

14The appellant denied that she suffers from a substance use disorder.

15The appellant testified that she has taken benzodiazepines for the past 32 years. She testified that prior to Dr. K’s submission, she had four physicians either retire or pass away which limited her access to a family doctor or psychiatrist. Therefore, she went to several Emergency Departments to ask for a referral to a psychiatrist to address her anxiety disorder and to receive a prescription for benzodiazepines. She testified she doesn’t normally drink alcohol, but had consumed a couple of beers before she went to the Emergency Department where she met Dr. K.

16Under cross-examination the appellant testified that she takes the benzodiazepine alprazolam approximately three times per week to manage symptoms of social anxiety including panic attacks. She testified her pattern of benzodiazepine use has not changed since her licence has been suspended. She testified she has been referred to three treatment programs by her previous doctor who was an addictions specialist. The appellant described two inpatient programs she had attended, but she was unable to finish either program. She testified one program she did not finish due to bedbugs in the facility, and the second program she left as conditions were not tolerable for several reasons. She testified she did attend an online outpatient program for three to four months and submitted a certificate of completion as evidence to support her attendance. She testified she has returned to the online program as of four months ago and attends weekly sessions.

17The appellant’s submitted certificate documents that she attended a three-week intensive online program, not a three month program. The letter states that the program includes educational workshops, art expression, wellness sessions, guided at-home practice exercise, and individual counselling sessions. The letter does not state anywhere that it addresses substance use or addiction.

18The appellant testified that she has never changed her benzodiazepine use following any treatment programs, and that she only attends these programs in order to get her licence back, not to try and reduce or discontinue her benzodiazepine use. Under cross-examination the appellant testified that she has no future plans to attempt to reduce her benzodiazepine use as the medication is effective at controlling her symptoms of anxiety.

19The appellant testified that she has now had a family physician for over a year, and was referred to a psychiatrist who she had an appointment with approximately three months ago. She testified the psychiatrist had written a letter to her family physician stating that her benzodiazepine use did not affect her functioning. This letter was not submitted to the Tribunal or the Registrar.

20While the appellant does not agree with a diagnosis of substance use disorder, she has not provided any medical evidence to dispute the diagnosis and testified that she is consuming benzodiazepines in the same dose and frequency that she was at the time that the MCR was submitted that stated she suffered from an uncontrolled substance use disorder.

21I find the medical evidence in this case relevant and persuasive. Based on the information available, I find that the Registrar has established on a balance of probabilities that the appellant suffers from substance use disorder.

Is the appellant’s medical condition likely to significantly interfere with her ability to drive a motor vehicle safely?

22I find that the Registrar has proven on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with her ability to drive a motor vehicle safely.

23In addition to the MCR submitted by Dr. K and the appellant’s evidence at the hearing, the Registrar’s position is also supported by the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”).

24Within these Standards, the Registrar relies on Chapter 15. This Chapter describes substance use disorders in general and the concerns with driving safely. The Registrar stated that adverse effects of benzodiazepines include sedation, drowsiness, cognitive and psychomotor impairment, impaired coordination, vertigo, dizziness, and blurred or double vision. The Registrar also stated that research has indicated that benzodiazepine use is associated with a significant risk of adverse driving outcomes.

25Furthermore, the CCMTA Standards document that Health Canada advises these sedative-hypnotic drugs should only be used for short periods (e.g. less than two months for anxiety) because of their addictive potential and they are subject to developing dependency. Moreover, long term adverse effects of benzodiazepine use may include cognitive decline, unwanted sedation and impaired coordination.

26Specifically Standard 15.6.3 states that drivers would be eligible for a licence if they:

i. Meet the criteria for remission and/or has abstained from the substance for 12 months.

ii. Earlier re-licensing may be considered upon favourable recommendation from an addictions specialist and/or treating physician recognized by the licensing authority, and the successful completion of a drug rehabilitation program.

iii. The functional abilities necessary for driving are not impaired.

iv. Where required a road test or other functional assessment shows that the functional abilities for driving are not impaired.

27Section 14(2)(a) of the Regulation allows the Registrar to consider the CCMTA Standards when determining whether the requirements of s. 14(1) are met. The Tribunal may take the CCMTA Standards into consideration but are not bound by them.

28The Registrar stated that no medical information has been received to show that the medical condition has resolved or improved to the point that it would not affect the appellant’s ability to drive. The Registrar stated that the law has been applied reasonably and correctly, that their decision is in line with the national medical standards, and on the balance of probabilities, the appellant does have a condition that will interfere with her ability to drive safely.

29The appellant argued that consuming benzodiazepines does not impact her ability to drive safely.

30The appellant disagreed with the written documentation from Dr. K that she used benzodiazepines prior to driving. She testified that she had told Dr. K that she had taken the medication Gravol prior to driving when experiencing stomach upset, but not benzodiazepines. While the appellant testified that she takes alprazolam whenever she is required to attend a social function, she testified that on these occasions, she has her sister drive her. Under cross-examination the appellant testified as to the sedating effects of Gravol, as she takes Gravol before going to bed to assist with sleep approximately three times per week.

31The appellant testified that she had asked her family physician to complete the Registrar’s requested Substance Use Assessment Form, but he had told her that more time was required before completing the Form. Under cross-examination she testified she has an appointment with her family physician every month or two and has asked him at each appointment for over a year to complete this Form and each time he states that more time is required.

32The appellant testified that the loss of her driver’s licence has resulted in hardships. She has been taking taxis and Ubers to run errands and does not feel comfortable taking public transit. The appellant testified that she is a great driver, great at parking, follows the rules of the road, lets people pass in front of her, wears her seatbelt, checks her mirrors, keeps her car maintained and she has taught others to drive. She testified she has gained weight and is not functioning since having her licence suspended. She wants her life back and needs her licence to run errands and so she can help in caring for her elderly mother.

33I considered the appellant’s position that her benzodiazepine use will not impact her ability to drive safely. However, this is weighed against:

i. the scientific research that benzodiazepine use is associated with a significant risk of adverse driving outcomes;

ii. the medical evidence from Dr. K stating the appellant is using this substance prior to driving;

iii. the appellant has not provided a medical opinion or any evidence that is inconsistent with the medical evidence which supports the Registrar’s position that her condition is likely to significantly interfere with her ability to drive a motor vehicle safely;

iv. the appellant has asked her family physician for support in reinstating her licence, and he has not completed the Substance Use Assessment Form, despite multiple requests.

34Although not bound by the CCMTA Standards, they can be considered when making the decision for the reason that these Standards are the result of a lengthy and intensive process to provide medical standards based on the best evidence available and with a focus on functional ability to drive rather than exclusively on medical diagnoses. I am persuaded to apply them here. My review of the evidence shows that none of the conditions recommended for relicensing outlined in the CCMTA Standards have been met.

35I acknowledge the burden that the lack of a driver’s licence is having on the appellant. However, the ongoing use of regular benzodiazepine use is concerning, along with the lack of any submitted medical evidence to support the safety of driving under this circumstance.

36As such, for the reasons cited, I am satisfied on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with her ability to drive safely.

Conclusion

37I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely substance use disorder, and that condition is likely to significantly interfere with her ability to drive a motor vehicle safely.

ORDER

38For the reasons set out above, pursuant to subsection 50(2) of the Act, I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.