Characteristics of Prescription-Opioid-Impaired and Other Substance-Impaired Drivers in Rural Appalachian Kentucky

A descriptive analysis of drivers under the influence of opioids in Kentucky

Despite the ongoing opioid epidemic and evidence of the increasing prevalence of driving under the influence of opioids, particularly in rural communities, there remains a limited understanding of those who drive under the influence of opioids. The current study aims to fill this gap in the literature by examining drivers under the influence of opioids (DUIOs) using the clinical substance use assessment records of a statewide sample of drivers convicted of driving under the influence (N = 15,917); first identifying differences between DUIOs and drivers under the influence of other, non-opioid substances, followed by an examination of factors associated with driving under the influence of opioids in combination with other substances, and finally, comparing rural and urban DUIOs (N = 1,571). Bivariate analyses were used to compare groups, while a logistic regression model was used to identify correlates of other substance involvement. DUIOs differed from drivers under the influence of other, non-opioid substances, such as being more likely to be convicted in a rural community (65.7% vs 53.6%) and to be under the influence of multiple substances at the time of arrest (42.0% vs 7.1%). Among DUIOs, a rural conviction (p =.016) and meeting DSM criteria for an alcohol (p <.001) and drug use disorder (p <.001) were positively associated with driving under the influence of opioids in combination with other substances. Results also highlighted a number of differences between rural and urban DUIOs, including other substance involvement. Urban DUIOs were more likely to report alcohol involvement in their DUI arrest (16.7% vs 9.1%), and rural DUIOs were more likely to report other, non-opioid drug involvement (36.9% vs 29.1%). Results suggest a possible need for different prevention and treatment approaches depending on rural/urban environment, which is noteworthy given limited treatment availability and other barriers to substance use treatment in rural communities.

A systematic review of factors associated with illegal drug driving

Drug driving is a serious problem worldwide that can increase the risk of road crashes. This systematic review seeks to identify factors associated with drug driving (i.e., driving after consuming drugs other than alcohol) to highlight gaps in existing knowledge and inform the design of more effective countermeasures. A search of the literature was conducted for the period January 1, 2005 to July 31, 2021 using six different databases. The search protocol followed PRISMA guidelines and was registered in PROSPERO (#CRD42021234616). Studies that met inclusion criteria compared drug drivers with either non-drug drivers, alcohol-only drivers or drug drivers from an earlier time period, to identify factors specifically associated with drug driving, rather than common to all drivers. Two hundred and nineteen publications met the inclusion criteria and were included within the review. Based on the findings, a logic model was developed that presents the factors associated with drug driving. Various sociodemographic, psychosocial and legal factors emerged as the main factors associated with illegal drug driving. At the sociodemographic and psychological levels, drug drivers were more likely to be single, young males who often drive after using cannabis and who score high on sensation-seeking and impulsivity scales. The key social factor found to be associated with drug driving was peer acceptance/disapproval of the behaviour. At the legal level, the review suggested that the effectiveness of current enforcement approaches to drug driving vary among jurisdictions around the world due to differences in the level of perceived certainty of apprehension and the chances of punishment avoidance. Future research into the anticipated and actual rewards for drug driving is needed to inform the development of more effective countermeasures.

A Comparison of Appalachian and Non-Appalachian Kentucky DUI Offenders

Purpose

To help fill this void in the literature, the current study uses a statewide sample to examine how Appalachian DUI offenders differ from non-Appalachian DUI offenders in a predominantly rural state.

Methods

Assessment records for 11,640 Kentucky DUI offenders who completed an intervention in 2017 were examined. Appalachian DUI offenders were compared to non-Appalachian metro and non-metro DUI offenders. Demographic information, DUI violation details, DSM-5 substance use disorder criteria, and referral information were compared using ANCOVAs and logistic regression models.

Results

More than one-fourth of the sample was convicted in an Appalachian county. Compared to non-Appalachian DUI offenders, Appalachian offenders were significantly older and more likely to have a prior DUI conviction, to meet DSM-5 criteria for a drug use disorder, and to drive drug-impaired. Referral and intervention compliance also varied across groups.

Implications

Results suggest that Appalachian DUI offenders are more drug-involved and have increased risk of recidivism. Findings indicate a need for practitioners to consider the distinct needs of Appalachian DUI offenders during service delivery. Future research should explore alternative intervention methods for preventing continued impaired driving in Appalachia given limited treatment availability in the region.