Saturday, March 20, 2010

Should Drivers on Opioids Be Arrested for DUI?

Briefly NotedThe director of the U.S. White House Office of National Drug Control Policy (ONDCP) recently told an international conference that drugged driving while taking prescription medications is a serious and growing problem needing action. Will a crack-down mean that patients taking prescribed pain relievers, especially opioids, could be arrested for driving under the influence (DUI) if involved in accidents or stopped by police for traffic violations?

In published statements before the 53rd United Nations Commission on Narcotic Drugs on March 8, 2010, U.S. “drug czar” Gil Kerlikowske said that drugged driving is an emerging public health threat [see text of speech here]. He warned that, “Far too many people are using drugs and then getting behind the wheel, with deadly results.” While noting that roughly 1 in 8 (12%) weekend nighttime drivers test positive for illicit drugs, he asserted that another 5% have prescription or other pharmaceutical drugs in their systems. Kerlikowske did not specifically point to prescription opioids, or other analgesic agents that might affect alertness, as being responsible for all of the problems; however, there has long been concern about possible consequences of patients driving while taking prescribed pain relievers and being involved in an accident or even a minor traffic violation. There have been anecdotal reports of such patients being arrested for DUI offenses.

CAVEATS: The government’s call for action may be inaccurate and premature. Kerlikowske said his data came from a report by the U.S. National Highway Traffic Safety Administration [NHTSA, 2009, available here]. However, the report itself cites the prevalence of nighttime drivers testing positive for drugs of all types (illicit, prescribed, and OTC; excluding alcohol) as 13.8% to 16.3%, depending on the testing method used, and it does not specifically break out data on prescription drugs. In fact, the most commonly detected drugs were marijuana (8.6%), cocaine (3.9%), and methamphetamine (1.3%). Furthermore, the report warns, “whereas the impairment effects for various concentration levels of alcohol is well understood, little evidence is available to link concentrations of other drug types to driver performance.” The NHTSA report further notes several questions that must be answered to assess the drug-impaired driving problem:
  1. Which drugs impair driving ability?
  2. What drug dose levels impair driving?
  3. Which drugs are associated with higher crash rates?
The report essentially concludes that much more research is needed to determine how drugs, other than alcohol, may affect driver performance. Meanwhile, a comprehensive review of available evidence found that opioid use is not associated with intoxicated driving, motor vehicle accidents, or deaths due to accidents [Fishbain et al. 2002]. Therefore, while drug-impaired driving is a problem of great concern, a cautious approach to finding solutions is needed so that patients well-stabilized on prescribed analgesics and/or other medications are not unjustly criminalized.

> Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff RS. Can patients taking opioids drive safely? A structured evidence-based review. J Pain Palliat Care Pharmacother. 2002;16(1):9-28 [abstract here].
> For further research summaries on driving and opioids, see: IDMU (Independent Drug Monitoring Unit). Opiates and Driving Ability. Undated [available here].