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Gutiérrez-Abejón E, Criado-Espegel P, Pedrosa-Naudín MA, Fernández-Lázaro D, Herrera-Gómez F, Álvarez FJ. Trends in the Use of Driving-Impairing Medicines According to the DRUID Category: A Population-Based Registry Study with Reference to Driving in a Region of Spain between 2015 and 2019. Pharmaceuticals (Basel) 2023; 16:ph16040508. [PMID: 37111265 PMCID: PMC10145018 DOI: 10.3390/ph16040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
The European DRUID (Drive Under the Influence of drugs, alcohol, and medicines) program classifies medications into three categories according to their effect on one’s fitness to drive. The trend in the use of driving-impairing medicines (DIMs) in a region of Spain between 2015 and 2019 was analyzed through a population-based registry study. Pharmacy dispensing records for DIMs are provided. The use of DIMs on drivers was weighted according to the national driver’s license census. The analysis was performed considering the population distribution by age and sex, treatment length, and the three DRUID categories. DIMs were used by 36.46% of the population and 27.91% of drivers, mainly chronically, with considerable daily use (8.04% and 5.34%, respectively). Use was more common in females than in males (42.28% vs. 30.44%) and increased with age. Among drivers, consumption decreases after 60 years of age for females and after 75 years of age for males. There was a 34% increase in the use of DIMs between 2015 and 2019, with a focus on daily use (>60%). The general population took 2.27 ± 1.76 DIMs, fundamentally category II (moderate influence on fitness to drive) (20.3%) and category III (severe influence on fitness to drive) (19.08%). The use of DIMs by the general population and drivers is significant and has increased in recent years. The integration of the DRUID classification into electronic prescription tools would assist physicians and pharmacists in providing adequate information to the patient about the effects of prescribed medications on their fitness to drive.
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Simmons SM, Caird JK, Sterzer F, Asbridge M. The effects of cannabis and alcohol on driving performance and driver behaviour: a systematic review and meta-analysis. Addiction 2022; 117:1843-1856. [PMID: 35083810 DOI: 10.1111/add.15770] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Cannabis and alcohol are frequently detected in fatal and injury motor vehicle crashes. While epidemiological meta-analyses of cannabis and alcohol have found associations with an increase in crash risk, convergent evidence from driving performance measures is insufficiently quantitatively characterized. Our objectives were to quantify the magnitude of the effect of cannabis and alcohol-alone and in combination-on driving performance and behaviour. METHODS Systematic review and meta-analysis. We systematically searched Academic Search Complete, CINAHL, Embase, Scopus, Google Scholar, MEDLINE, PsycINFO, SPORTDiscus and TRID. Of the 616 studies that underwent full-text review, this meta-analysis represents 57 studies and 1725 participants. We extracted data for hazard response time, lateral position variability, lane deviations or excursions, time out of lane, driving speed, driving speed variability, speed violations, time speeding, headway, headway variability and crashes from experimental driving studies (i.e. driving simulator, closed-course, on-road) involving cannabis and/or alcohol administration. We reported meta-analyses of effect sizes using Hedges' g and r. RESULTS Cannabis alone was associated with impaired lateral control [e.g. g = 0.331, 95% confidence interval (CI) = 0.212-0.451 for lateral position variability; g = 0.198, 95% CI = 0.001-0.395 for lane excursions) and decreased driving speed (g = -0.176, 95% CI = -0.298 to -0.053]. The combination of cannabis and alcohol was associated with greater driving performance decrements than either drug in isolation [e.g. g = 0.480, 95% CI = 0.096-0.865 for lateral position variability (combination versus alcohol); g = 0.525, 95% CI = 0.049-1.002 for time out of lane (versus alcohol); g = 0.336, 95% CI = 0.036-0.636 for lateral position variability (combination versus cannabis; g = 0.475, 95% CI = 0.002-0.949 for time out of lane (combination versus cannabis)]. Subgroup analyses indicated that the effects of cannabis on driving performance measures were similar to low blood alcohol concentrations. A scarcity of data and study heterogeneity limited the interpretation of some measures. CONCLUSIONS This meta-analysis indicates that cannabis, like alcohol, impairs driving, and the combination of the two drugs is more detrimental to driving performance than either in isolation.
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Affiliation(s)
- Sarah M Simmons
- Department of Psychology, University of Calgary, Alberta, Canada
| | - Jeff K Caird
- Department of Psychology, University of Calgary, Alberta, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Alberta, Canada
| | - Frances Sterzer
- Department of Psychology, University of Calgary, Alberta, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Jang SE, Bradshaw YS, Carr DB. Comparison of the Impacts of Under-Treated Pain and Opioid Pain Medication on Cognitive Impairment. Cureus 2022; 14:e22037. [PMID: 35155054 PMCID: PMC8824639 DOI: 10.7759/cureus.22037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: To guide clinicians in balancing the risks and benefits of opioids when treating pain, we conducted two systematic reviews: 1) the impact of pain on cognitive function, and 2) the impact of opioids on cognitive function. Methods: Part one addressed the impact of pain on cognitive impairment; Part two considered the impact of opioids on cognitive impairment. PubMed was used to search for eligible articles. For part one, 1786 articles were identified, of which 23 met our eligibility criteria. For part two, among 584 articles, 18 were found eligible. Results: For part one, 16 studies concluded that patients with chronic pain showed impaired cognitive function; six studies found that chronic pain does not worsen cognitive function; one study concluded that the impact of pain on cognitive function differs based on the underlying cognitive status. For part two, 15 studies found that using opioids to control pain did not cause significant cognitive impairment, while three studies concluded the opposite. Studies evaluating older subjects did not observe different results from those in the whole population for both reviews. Conclusion: The published literature indicates that moderate to severe pain can impair cognitive function, and that careful use of opioid analgesics in such subjects does not necessarily worsen cognition. Although our results are insufficient to support clear guidance due to heterogeneity of cohorts and outcomes, this study may assist primary care providers by rendering explicitly the factors to be considered by providers caring for this population with pain when opioids are considered.
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Seward J, Stavrinos D, Moore D, Attridge N, Trost Z. When driving hurts: characterizing the experience and impact of driving with back pain. Scand J Pain 2021; 21:445-456. [PMID: 33641275 DOI: 10.1515/sjpain-2020-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Driving is one of the most widespread aspects of daily living to people in the United States and is an active process that requires various cognitive functions, such as attention. Chronic low back pain (CLBP) is one of the more prevalent and costly health conditions in the world, with individuals who report CLBP also reporting significant impairment across different domains of daily life both physically and cognitively. However, despite the prevalence of these two constructs, research detailing the experience of driving in pain remains largely underrepresented. This cross-sectional study sought to characterize the driving experience of people who experience CLBP, focusing on the psychological constructs related to chronic pain like pain catastrophizing, affective responses (irritability, anxiety, fear), and self-reported driving behaviors and outcomes. METHODS This study distributed an online questionnaire measuring pain, disability, and other psychological constructs commonly associated with CLBP like pain catastrophizing through M-turk to 307 U.S. participants with recurring CLBP and regular driving activity. Participants also answered questions regarding driving in pain, affective responses to driving in pain (i.e., irritability, anxiety, and fear), driving behaviors and violations, driving avoidance habits as a result of pain, opioid use, using pain medication while driving, and recent vehicle collisions within the past three years. Bivariate correlations were used to compare study variables, and one-way ANOVA's were used to compare means between participants with and without a collision history within the past three years. RESULTS Findings demonstrated significant positive associations not only between the psychological factors commonly associated with chronic pain, such as pain intensity, pain disability, pain catastrophizing, and the cognitive intrusion by pain, but also statistically significant relationships between these measures and pain intensity while driving, affective responses to driving in pain, driving violations, and driving avoidance habits. Additionally, in comparison to participants with no collision history within the past three years, participants who had been driving during a vehicle collision reported greater pain catastrophizing and cognitive intrusion by pain scores. CONCLUSIONS To our knowledge, the current study is the first to characterize driving experience specifically among individuals with CLBP, with attention to the relationship among key sensory, affective, and cognitive psychological metrics as well as self-reported driving history and behavior. The current findings reinforce multiple associations between pain and cognitive-affective variables that have been observed in literature outside the driving context, including pain intensity, anger, inattention, and behavioral disruption. Given that driving is a pervasive, potentially risky behavior that requires some form of cognitive focus and control, the current findings point to a continued need to examine these associations within this specific life context. We believe we have laid a groundwork for research considering the role of psychological pain variables in a driving performance. However, the nature of our analyses prevents any sort of causality from being inferred, and that future experimental research is warranted to better understand and explain these mechanisms underlying driving in pain while accounting for participant bias and subject interpretation.
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Affiliation(s)
- Joshua Seward
- Department of Psychology, University of Alabama, Birmingham, AL, USA
| | - Despina Stavrinos
- Department of Psychology, University of Alabama, Birmingham, AL, USA
| | - David Moore
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK.,Research Centre for Brain and Behaviour, Liverpool John Moores University, Liverpool, UK
| | - Nina Attridge
- School of Science, Loughborough University, Loughborough, UK
| | - Zina Trost
- Virginia Commonwealth University, Richmond, USA
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Akhurst J, Lovell M, Peacock A, Bruno R. A Systematic Review and Meta-Analysis of Cognitive Performance among People with Chronic Use of Opioids for Chronic Non-Cancer Pain. PAIN MEDICINE 2021; 22:979-993. [PMID: 33502504 DOI: 10.1093/pm/pnab005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Opioids, often prescribed for chronic non-cancer pain, may adversely affect cognition. Research has not been synthesized in recent years, during which time academic interest has increased. This study presents meta-analyses on cognitive performance in people taking opioids for chronic non-cancer pain (CNCP). METHODS We ran systematic literature searches in EMBASE, Medline, and PsycINFO. Eligible studies included people taking opioids for CNCP, an opioid-free group (i.e., case-control) or session (e.g., pre-post), and objective cognitive assessments. Using random-effects meta-analyses, we computed pooled effect sizes for differential task performance for each study design across five domains (motor performance, attention, working memory, executive functions, memory). RESULTS Seventeen studies were included. Case-control studies covered three control types (healthy, CNCP, taper-off). Pre-post studies were grouped into five follow-ups (four to six and six to nine weeks; three, six, and 12 months). Effect sizes ranged from 0.02-0.62. Cases showed small magnitude impairments in attention and memory compared with healthy controls. Although limited by small sample sizes, there was no clear evidence of impairment in cases compared with opioid-free controls with CNCP. Cases showed some cognitive improvements from opioid-free baseline to follow-up. Effects were strongest for attention and working memory and were apparent from four weeks to six months follow-up. Other effects were small and nonsignificant. CONCLUSIONS Opioid therapy for CNCP did not worsen cognitive performance and improved it for some domains. People who take opioids for CNCP may evidence deficits in attention and memory, but this is unlikely to translate to global impairment and likely relates to pain more so than opioids.
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Affiliation(s)
- Jane Akhurst
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia
| | - Monica Lovell
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia
| | - Amy Peacock
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, New South Wales, Australia
| | - Raimondo Bruno
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, New South Wales, Australia
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Cameron-Burr KT, Conicella A, Neavyn MJ. Opioid Use and Driving Performance. J Med Toxicol 2021; 17:289-308. [PMID: 33403571 DOI: 10.1007/s13181-020-00819-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 09/21/2020] [Accepted: 11/09/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The USA is in an opioid epidemic, with an increased number of individuals taking psychoactive drugs while executing the tasks of everyday life, including operating a motor vehicle. The pharmacology of opioids has been widely studied, but the effects of opioids on psychomotor function, driving performance, and the risk of motor vehicle collision remain less clear. Clinicians are faced with the challenge of controlling patient pain while also reconciling conflicting messages from the literature about how safe it is for their patients taking opioids to engage in potentially dangerous routine tasks. DISCUSSION This review assesses the current literature regarding opioids as they relate to neurocognitive function, driving performance, and accident risk. Manuscripts are categorized by study context and subject matter: controlled experimental administration, illicit use, prescription use, retrospective forensic toxicology, and polydrug consumption. CONCLUSION Illicit use, initiation of therapy, and opioid use in combination with other psychoactive medications are contexts most clearly associated with impairment of driving-related functions and/or operation of a motor vehicle. Clinicians should counsel patients on the risk of impairment when initiating therapy, when co-prescribing opioids and other psychoactive drugs, or when a patient is suspected of having an opioid use disorder.
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Affiliation(s)
- Keaton T Cameron-Burr
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Albert Conicella
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Mark J Neavyn
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
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Dora-Laskey AD, Goldstick JE, Arterberry BJ, Roberts SJ, Haffajee RL, Bohnert ASB, Cunningham RM, Carter PM. Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample. West J Emerg Med 2020; 21:831-840. [PMID: 32726253 PMCID: PMC7390550 DOI: 10.5811/westjem.2020.3.44844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/08/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment. Methods Participants (aged 25–60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use. Results Among participants completing the screening survey (n = 756; mean age = 42.8 [standard deviation {SD} =10.4]), 37.8% reported past three-month prescription opioid use (30.8% of whom used daily), and 14.7% reported past three-month DAPO. Of screened participants, 22.5% (n = 170) were eligible for the extended study survey. Unadjusted analyses demonstrated that participants reporting DAPO were more likely to use opioids daily (51.1% vs 15.9%) and had higher rates of opioid misuse (mean Current Opioid Misuse Measure score 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]) chronic pain (80.7% vs 42.7%), and driving after marijuana or alcohol use (mean intoxicated driving score 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]) compared to patients not reporting DAPO (all p<0.001). Adjusting for age, gender, employment, and insurance in a logistic regression model, participants reporting DAPO were more likely to report a chronic pain diagnosis (odds ratio [OR] = 3.77, 95% confidence interval [CI], 1.55–9.17), daily opioid use (OR = 3.81, 95% CI, 1.64–8.85), and higher levels of intoxicated driving (OR = 1.62, 95% CI, 1.07–2.45). Alcohol and marijuana use, depression, and opioid misuse were not associated with DAPO in adjusted analyses. Conclusion Nearly one in six adult patients seeking ED care reported DAPO. The ED may be an important site for interventions addressing opioid-related drugged driving.
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Affiliation(s)
- Aaron D Dora-Laskey
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan, Department of Psychiatry, Ann Arbor, Michigan.,University of Michigan Addiction Center, Ann Arbor, Michigan
| | - Jason E Goldstick
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan
| | - Brooke J Arterberry
- University of Michigan Addiction Center, Ann Arbor, Michigan.,Iowa State University, Department of Psychology, Ames, Iowa
| | - Suni Jo Roberts
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
| | - Rebecca L Haffajee
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan.,University of Michigan School of Public Health, Department of Health Management and Policy, Ann Arbor, Michigan and RAND Corporation, Boston, Massachusetts
| | - Amy S B Bohnert
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan, Department of Psychiatry, Ann Arbor, Michigan.,University of Michigan, Department of Anesthesiology, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan.,Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan
| | - Patrick M Carter
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan
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The Trends in Opioid Use in Castile and Leon, Spain: A Population-Based Registry Analysis of Dispensations in 2015 to 2018. J Clin Med 2019; 8:jcm8122148. [PMID: 31817357 PMCID: PMC6947376 DOI: 10.3390/jcm8122148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 01/19/2023] Open
Abstract
Opioids are driving-impairing medicines (DIM). To assess the evolution and trends of opioid analgesics use between 2015 and 2018 in Castile and Leon (Spain), a population-based registry study was conceived. The length of opioid use and its concomitant use with other DIMs were studied. Analyses were done considering age and gender distributions. Adjusted consumption for licensed drivers is also presented. Of the 5 million dispensations recorded between 2015 and 2018, opioid analgesics were dispensed to 11.44% of the general population and 8.72% of vehicle drivers. Increases among daily users (2.6 times higher) and chronic users (1.5% higher) were noted, supporting the overall increase in opioid use (1.5%). The use of multiple drugs including other DIMs was a common finding (mean ± SD, 2.54 ± 0.01). Acute use (5.26%) and chronic use (3.20%) were also frequent. Formulations combining opioid analgesics with nonopioid analgesics were preferred. The use of opioids increased in Spain between 2015 and 2018. Concomitant use with other DIMS especially affects women and the elderly. Frequent use of opioid analgesics with other DIMs is a serious problem for drivers and increases the risk of accidents. Promoting safe driving should be a main objective of health authorities, to be achieved by developing and implementing educational activities for healthcare professionals and patients.
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9
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Perrier J, Amato JN, Berthelon C, Bocca ML. Primary insomnia patients' performances during simulated car following and urban driving in the afternoon. J Sleep Res 2019; 28:e12847. [PMID: 30931545 DOI: 10.1111/jsr.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/29/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
According to epidemiological studies, insomnia is associated with an increase in risk of traffic accidents. Recent investigations revealed that patients with insomnia had driving performance impairment under monotonous conditions. However, it is unclear whether other driving abilities may be impacted by insomnia, especially those needing more attentional resources than those involved in monotonous driving. Other findings revealed that impaired performances are more likely to occur with the increase of cognitive demands. However, such tests did not reflect difficulties in situations of everyday life expressed by patients with insomnia, such as driving in an urban environment with traffic and critical situations. Therefore, behaviour in situations encountered in everyday life has to be explored. The aim of the present study was to assess driving performances of patients with insomnia in daily routine tasks such as urban and car-following tests. For this purpose, 15 patients with insomnia and 16 good sleepers performed an urban test of driving with original risk scenarios and a car-following test during the middle afternoon. No significant behavioural difference between patients with insomnia and good sleepers has been found in both the urban test and the car-following test, showing that patients with insomnia have no impairment in behaviour implicated in daily contexts driving tasks of short period of time performed in the late afternoon. Although our results provide a first step towards knowledge of behavioural performance during daily routine driving tasks in patients with insomnia, future studies are needed using on-the-road driving tests and/or different population of patients with insomnia before generalisation.
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Affiliation(s)
- Joy Perrier
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France
| | - Jean-Noël Amato
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France
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Marshansky S, Mayer P, Rizzo D, Baltzan M, Denis R, Lavigne GJ. Sleep, chronic pain, and opioid risk for apnea. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:234-244. [PMID: 28734941 DOI: 10.1016/j.pnpbp.2017.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/15/2017] [Accepted: 07/15/2017] [Indexed: 01/21/2023]
Abstract
Pain is an unwelcome sleep partner. Pain tends to erode sleep quality and alter the sleep restorative process in vulnerable patients. It can contribute to next-day sleepiness and fatigue, affecting cognitive function. Chronic pain and the use of opioid medications can also complicate the management of sleep disorders such as insomnia (difficulty falling and/or staying asleep) and sleep-disordered breathing (sleep apnea). Sleep problems can be related to various types of pain, including sleep headache (hypnic headache, cluster headache, migraine) and morning headache (transient tension type secondary to sleep apnea or to sleep bruxism or tooth grinding) as well as periodic limb movements (leg and arm dysesthesia with pain). Pain and sleep management strategies should be personalized to reflect the patient's history and ongoing complaints. Understanding the pain-sleep interaction requires assessments of: i) sleep quality, ii) potential contributions to fatigue, mood, and/or wake time functioning; iii) potential concomitant sleep-disordered breathing (SDB); and more importantly; iv) opioid use, as central apnea may occur in at-risk patients. Treatments include sleep hygiene advice, cognitive behavioral therapy, physical therapy, breathing devices (continuous positive airway pressure - CPAP, or oral appliance) and medications (sleep facilitators, e.g., zolpidem; or antidepressants, e.g., trazodone, duloxetine, or neuroleptics, e.g., pregabalin). In the presence of opioid-exacerbated SDB, if the dose cannot be reduced and normal breathing restored, servo-ventilation is a promising avenue that nevertheless requires close medical supervision.
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Affiliation(s)
- Serguei Marshansky
- CIUSSS du Nord de l'Île de Montréal, Hôpital Sacré-Cœur, Québec, Canada; Hôpital Hôtel-Dieu du Centre Hospitalier de l'Université de Montréal (CHUM), Faculté de Médecine, Université de Montréal, Québec, Canada
| | - Pierre Mayer
- Hôpital Hôtel-Dieu du Centre Hospitalier de l'Université de Montréal (CHUM), Faculté de Médecine, Université de Montréal, Québec, Canada
| | - Dorrie Rizzo
- Jewish General, Université de Montréal, Montréal, Québec, Canada
| | - Marc Baltzan
- Faculty of Medicine, McGill University, Mount Sinai Hospital, Montréal, Canada
| | - Ronald Denis
- CIUSSS du Nord de l'Île de Montréal, Hôpital Sacré-Cœur, Québec, Canada
| | - Gilles J Lavigne
- CIUSSS du Nord de l'Île de Montréal, Hôpital Sacré-Cœur, Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Department of Stomatology, CHUM, Montréal, Québec, Canada.
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11
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Strand MC, Vindenes V, Gjerde H, Mørland JG, Ramaekers JG. A clinical trial on the acute effects of methadone and buprenorphine on actual driving and cognitive function of healthy volunteers. Br J Clin Pharmacol 2018; 85:442-453. [PMID: 30515857 PMCID: PMC6339962 DOI: 10.1111/bcp.13818] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 11/30/2022] Open
Abstract
Aims The present study assessed the acute effects of methadone and buprenorphine on actual on‐road driving performance and neurocognitive function. Methods Methadone (5 and 10 mg per os) and buprenorphine (0.2 and 0.4 mg sublingual) were administered to 22 healthy volunteers in a five‐way, double‐blind, randomized, placebo‐controlled, double‐dummy, cross‐over study. Driving performance was assessed with an on‐road driving test. The primary outcome measure was standard deviation of lateral position (SDLP), a measure of road tracking control. Laboratory tests were used to measure cognitive function (e.g. reaction time and attention) and questionnaires were used to assess subjective measures of mood and sedation. Results There was no significant main effect of treatment on SDLP. Yet, analysis of individual drug‐placebo contrast data revealed that buprenorphine 0.4 mg significantly increased SDLP. Driving impairment was mild and below the impairment threshold of a blood alcohol concentration of 0.5 mg ml−1. Four participants stopped their driving test while under the influence of either opioid due to sleepiness. Both opioids produced impairments of cognitive task performance and increased sleepiness particularly at the highest dose. Conclusions Analgesic doses of buprenorphine produced mild impairing effects on driving and related cognitive skills, while methadone impaired cognitive task performance but not driving performance. Large individual variations were observed for both drugs. Patients should be informed about the possibility of driving impairment when initiating opioid treatment.
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Affiliation(s)
- Maren Cecilie Strand
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, University of Maastricht, Maastricht, The Netherlands
| | - Vigdis Vindenes
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Jørg Gustav Mørland
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, University of Maastricht, Maastricht, The Netherlands
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12
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Webster JM, Dickson MF, Mannan F, Staton M. Characteristics of Prescription-Opioid-Impaired and Other Substance-Impaired Drivers in Rural Appalachian Kentucky. J Psychoactive Drugs 2018; 50:373-381. [PMID: 30204565 DOI: 10.1080/02791072.2018.1514477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Previous studies have highlighted the prescription opioid epidemic in rural Appalachia and its associated risk behaviors; however, no studies have examined prescription-opioid-impaired driving as a consequence of this epidemic. The purpose of the present study was to describe prescription-opioid-impaired drivers in rural Appalachian Kentucky and examine how they are similar to and different from other substance-impaired drivers from the region. A sample of convicted DUI offenders from rural Appalachian Kentucky completed a confidential research interview focused on their substance use, mental health, and criminal activity. Prescription-opioid-impaired drivers (n = 33) were compared to other drug-impaired drivers (n = 29) and to alcohol-only-impaired drivers (n = 44). Overall, prescription-opioid-impaired drivers had a similar prevalence of illicit substance use and criminal activity, including impaired driving frequency, to other drug-impaired drivers, but had a higher prevalence of illicit substance use and more frequent impaired driving when compared to alcohol-only-impaired drivers. Study implications include the importance of comprehensive substance abuse assessment and treatment for DUI offenders and the need for tailored interventions for prescription-opioid-impaired and other drug-impaired drivers.
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Affiliation(s)
- J Matthew Webster
- a Department of Behavioral Science and Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
| | - Megan F Dickson
- b Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
| | - Faiyad Mannan
- c College of Medicine , University of Kentucky , Lexington , KY , USA
| | - Michele Staton
- a Department of Behavioral Science and Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
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Abstract
BACKGROUND Driving under the influence of certain drugs is not allowed, and roadside drug testing is being considered an important tool for deterring driving under the influence of them. This study aimed to assess the presence and concentration of opioids, as well as their combined use with other drugs (laboratory confirmation after the on-road screening) in Spanish drivers between 2011 and 2016. METHODS In Spain, mandatory roadside breath alcohol and oral fluid drug testing (screening) are carried out by the Traffic Police using Dräger Alcotest® 6810 device, and Dräger DrugTest® 5000, DrugWipe®, or Alere™ DDS®2 Mobile Test System. For positive cases in the period covered, 65,244, confirmation analysis and quantification using chromatographic techniques were performed. RESULTS Opioids were confirmed in 8.6% of positive cases, being 7.2% positives to 6-acetylmorphine (6-AM), 6.5% to morphine, 5.4% to codeine, and 4.1% to methadone. The majority of the confirmed tests for morphine (96.5%), codeine (88.4%) and methadone (81.9) were also positive for 6-AM. The presence of other drugs, particularly cocaine and cannabis, was very common. Concentration values reached important levels. Positive results for morphine (0.1%), codeine (0.6%) or methadone (0.4%) alone were very infrequent. CONCLUSIONS Drivers with a confirmed positive roadside test for morphine, codeine, and methadone had also consumed heroin and/or other illicit drugs, such as cocaine and/or THC, and at relevant concentrations. Improving interventions to combat the problem of driving under the influence of driving-impairing substances is a priority.
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Gutierrez-Abejón E, Herrera-Gómez F, Criado-Espegel P, Alvarez FJ. Use of driving-impairing medicines by a Spanish population: a population-based registry study. BMJ Open 2017; 7:e017618. [PMID: 29170289 PMCID: PMC5719315 DOI: 10.1136/bmjopen-2017-017618] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/04/2017] [Accepted: 09/18/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To assess the use of driving-impairing medicines (DIM) in the general population with special reference to length of use and concomitant use. DESIGN Population-based registry study. SETTING The year 2015 granted medicines consumption data recorded in the Castile and León (Spain) medicine dispensation registry was consulted. PARTICIPANTS Medicines and DIM consumers from a Spanish population (Castile and León: 2.4 million inhabitants). EXPOSURE Medicines and DIM consumption. Patterns of use by age and gender based on the length of use (acute: 1-7 days, subacute: 8-29 days and chronic use: ≥30 days) were of interest. Estimations regarding the distribution of licensed drivers by age and gender were employed to determine the patterns of use of DIM. RESULTS DIM were consumed by 34.4% (95% CI 34.3% to 34.5%) of the general population in 2015, more commonly with regularity (chronic use: 22.5% vs acute use: 5.3%) and more frequently by the elderly. On average, 2.3 DIM per person were dispensed, particularly to chronic users (2.8 DIM per person). Age and gender distribution differences were observed between the Castile and León medicine dispensation registry data and the drivers' license census data. Of all DIM dispensed, 83.8% were in the Anatomical Therapeutic Chemical code group nervous system medicines (N), which were prescribed to 29.2% of the population. CONCLUSIONS The use of DIM was frequent in the general population. Chronic use was common, but acute and subacute use should also be considered. This finding highlights the need to make patients, health professionals, health providers, medicine regulatory agencies and policy-makers at large aware of the role DIM play in traffic safety.
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Affiliation(s)
- Eduardo Gutierrez-Abejón
- Technical Direction of Pharmaceutical Assistance, Gerencia Regional de Salud de Castilla y Leon, Valladolid, Spain
| | - Francisco Herrera-Gómez
- Pharmacology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Castilla y León, Spain
- Department of Nephrology, Complejo Asistencial de Zamora, Zamora, Spain
| | - Paloma Criado-Espegel
- Technical Direction of Pharmaceutical Assistance, Gerencia Regional de Salud de Castilla y Leon, Valladolid, Spain
| | - F Javier Alvarez
- Pharmacology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Castilla y León, Spain
- CEIC/CEIm Área de Salud Valladolid Este, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Weinstock J, April LM, Kallmi S. Is subclinical gambling really subclinical? Addict Behav 2017; 73:185-191. [PMID: 28531824 DOI: 10.1016/j.addbeh.2017.05.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/08/2017] [Accepted: 05/13/2017] [Indexed: 01/01/2023]
Abstract
Gambling disorder and substance use disorders (SUD) overlap in terms of etiology and diagnostic constructs (e.g., preoccupation, loss of control), yet diagnostic thresholds for the disorders are different. Currently, endorsing 2-3 gambling disorder criteria does not warrant a diagnosis while endorsing 2-3 SUD criteria does. The aim of this study was to examine whether subclinical gamblers (i.e., endorsing 2-3 gambling disorder criteria) experience psychosocial dysfunction equivalent to individuals who are diagnosed with mild severity SUD (i.e., 2-3 SUD criteria) and whether this level of dysfunction is significantly different from individuals with no psychopathology. Data are from the first wave of Quinte Longitudinal Study, a large epidemiological sample (N=4121). Psychometrically supported measures assessed for psychosocial functioning and the presence of Axis-I psychiatric disorders. Cross-sectional analysis examined 7 domains of psychosocial functioning using ANCOVA, which allowed for the inclusion of covariates, to test for difference between subclinical gamblers and individuals with no psychopathology and individuals with mild severity SUD. Equivalency testing compared subclinical gamblers in relation to mild severity SUD. Subclinical gamblers reported significantly poorer psychosocial functioning in relation to individuals endorsing no current psychopathology. Subclinical gamblers were also equivalent to and not significantly different from individuals with mild severity SUD. Subclinical gamblers experience similar psychosocial impairment to those individuals who endorse mild severity SUD, and this significantly differed from healthy individuals. The threshold for diagnosis of gambling disorder therefore warrants re-examination.
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Fierro I, Colás M, González-Luque JC, Álvarez FJ. Roadside opioid testing of drivers using oral fluid: the case of a country with a zero tolerance law, Spain. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:22. [PMID: 28490343 PMCID: PMC5424296 DOI: 10.1186/s13011-017-0108-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/05/2017] [Indexed: 11/17/2022]
Abstract
Background Opioids can impair psychomotor performance, and driving under the influence of opioids is associated with an increased risk of accidents. The goals of this study were i) to determine the prevalence of opioids (heroin, morphine, codeine, methadone and tramadol) in Spanish drivers and ii) to explore the presence of opioids, more specifically whether they are used alone or in combination with other drugs. Methods The 2008/9 DRUID database regarding Spain was used, which provided information on 3302 drivers. All drivers included in the study provided a saliva sample and mass-chromatographic analyses were carried out in all cases. To determine the prevalence, the sample was weighted according to traffic intensity. In the case of opioid use combinations, the sample was not weighted. The detection limit for each substance was considered a positive result. Results The prevalence of opioids in Spanish drivers was 1.8% (95% CI, 1.4–2.3). Polydrug detection was common (56.2%): of these, in two out of three cases, two opioids were detected and cocaine was also detected in 86% of the cases. The concentration (median [Q1-Q3] ng/ml) of the substances was low: methadone 1.71 [0.10–15.30], codeine 40.55 [2.10–120.77], 6-acetylmorphine 5.71 [1.53–84.05], and morphine 37.40 [2.84–200.00]. Morphine was always detected with 6-acetylmorphine (heroin use). Conclusions Driving under the influence of opioids is relatively infrequent, but polydrug use is common. Our study shows that 6 out of 10 drivers with methadone in their OF (likely in methadone maintenance programs) are using other substances. This should be taken into account by health professionals in order to properly inform patients about the added risks of mixing substances when driving.
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Affiliation(s)
- Inmaculada Fierro
- Institute for Alcohol and Drug Studies, Pharmacology and Therapeutics, Faculty of Medicine, & CEIC/CEIm Hospital Clinico Universitario de Valladolid, 47005, Valladolid, Spain
| | - Mónica Colás
- Directorate General for Traffic (Dirección General de Tráfico), 28071, Madrid, Spain
| | | | - F Javier Álvarez
- Institute for Alcohol and Drug Studies, Pharmacology and Therapeutics, Faculty of Medicine, & CEIC/CEIm Hospital Clinico Universitario de Valladolid, 47005, Valladolid, Spain.
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