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Leon SJ, Trachtenberg A, Briscoe D, Ahmed M, Hougen I, Askin N, Whitlock R, Ferguson T, Tangri N, Rigatto C, Komenda P. Opioids and the Risk of Motor Vehicle Collision: A Systematic Review. J Pharm Technol 2022; 38:54-62. [PMID: 35141728 PMCID: PMC8820048 DOI: 10.1177/87551225211059926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Background: Opioid analgesics are among the most commonly prescribed medications, but questions remain regarding their impact on the day-to-day functioning of patients including driving. We set out to perform a systematic review on the risk of motor vehicle collision (MVC) associated with prescription opioid exposure. Method: We searched Medline, PubMed, EMBASE, Scopus, and TRID from January 1990 to August 31, 2021 for primary studies assessing prescribed opioid use and MVCs. Results: We identified 14 observational studies that met inclusion criteria. Among those, 8 studies found an increased risk of MVC among those participants who had a concomitant opioid prescription at the time of the MVC and 3 found no significant increase of culpability of fatal MVC. The 3 studies that evaluated the presence of a dose-response relationship between the dose of opioids taken and the effects on MVC risk reported the existence of a dose-response relationship. Due to the heterogeneity of the different studies, a quantitative meta-analysis to sum evidence was deemed unfeasible. Our review supports increasing evidence on the association between motor vehicle collisions and prescribed opioids. This research would guide policies regarding driving legislation worldwide. Conclusion: Our review indicates that opioid prescriptions are likely associated with an increased risk of MVCs. Further studies are warranted to strengthen this finding, and investigate additional factors such as individual opioid medications, opioid doses and dose adjustments, and opioid tolerance for their effect on MVC risk.
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Affiliation(s)
- Silvia J. Leon
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Aaron Trachtenberg
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
| | - Derek Briscoe
- Max Rady College of Medicine,
University of Manitoba, Winnipeg, MB, Canada
| | | | - Ingrid Hougen
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Max Rady College of Medicine,
University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Askin
- Neil John Mclean Library, University of
Manitoba, Winnipeg, MB, Canada
| | - Reid Whitlock
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Thomas Ferguson
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Claudio Rigatto
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Paul Komenda
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
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Lim ZW, Wang ID, Liu FC, Chung CH, Hu JM, Tsai PY, Chien WC. Non-apnea sleep disorder and its risk for all kinds of injuries: A 14-year follow-up for a nationwide population-based retrospective study. Medicine (Baltimore) 2021; 100:e24766. [PMID: 33663092 PMCID: PMC7909222 DOI: 10.1097/md.0000000000024766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
Non-apnea sleep disorder (NASD) increases the risk of motor vehicle accidents. However, systemic review of NASD and its risk for all causes of injury is lacking. The aim of the present study was to provide a detailed demographic data on NASD and all causes of injury in a 14-year follow up.Our study utilized outpatient and inpatient data from the Longitudinal Health Insurance Database between 2000 and 2013 in Taiwan. We enrolled 989,753 individuals aged ≥20 years who were diagnosed with NASD as outpatients ≥3 times or inpatients ≥1 time. We matched the study cohort with a comparison cohort by age, index date and comorbidities at a ratio of 1:4. We used Cox proportional hazards regression to analyze the association of NASD and the cause of injury.In this 14-year follow up study, patients with NASD had 12.96% increased risk of injury compared to that of the control cohort. Fall was the first place of the cause of injury with 670.26 per 105 PYs. In the stratified age group, patients aged ≧65 years had the highest risk of injury (adjusted HR= 1.381; P < .001). Kaplan-Meier analysis showed that the incidence of injury between the with- and without-NASD cohorts started from the first year and persisted until the end of the follow-up.Our study demonstrates that NASD patients were associated with higher risk of all causes of injuries, with falling being the most prevalent diagnosis. The general public should be more aware of this neglected issue of NASD.
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Affiliation(s)
- Zhu Wei Lim
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua
| | - I-Duo Wang
- Department of Internal Medicine, Tri-Service General Hospital
| | - Feng-Cheng Liu
- Division of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital
- School of Public Health, National Defense Medical Center, Taipei
| | - Je-Ming Hu
- Division of Colorectal Surgery, Department of Surgery
| | | | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital
- School of Public Health, National Defense Medical Center, Taipei
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan
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Li G, Chihuri S. Prescription opioids, alcohol and fatal motor vehicle crashes: a population-based case-control study. Inj Epidemiol 2019; 6:11. [PMID: 31245260 PMCID: PMC6582661 DOI: 10.1186/s40621-019-0187-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/19/2019] [Indexed: 11/28/2022] Open
Abstract
Background The prevalence of prescription opioid use among drivers has increased markedly in the past two decades. The purpose of this study is to assess the associations of prescription opioid use and alcohol use with the risk of fatal crash involvement in US drivers. Methods We performed a population-based case-control study using toxicological testing data from two national data systems. Cases (n = 3606) were drivers involved in fatal motor vehicle crashes selected from the Fatality Analysis Reporting System and controls (n = 15,600) were drivers participating in the 2007 and 2013 National Roadside Surveys of Alcohol and Drug Use by Drivers. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) of fatal crash involvement associated with prescription opioid use with and without the presence of alcohol. Results Overall, cases were significantly more likely than controls to test positive for prescription opioids (5.0% vs. 3.7%, p < 0.001), alcohol (56.2% vs. 7.1%, p < 0.0001), and both substances (2.2% vs. 0.2%, p < 0.001). Relative to drivers testing negative for prescription opioids and alcohol, the adjusted ORs of fatal crash involvement were 1.72 (95% CI: 1.37, 2.17) for those testing positive for prescription opioids and negative for alcohol, 17.92 (95% CI: 16.19, 19.84) for those testing positive for alcohol and negative for prescription opioids, and 21.89 (95% CI: 14.38, 33.32) for those testing positive for both substances. The interaction effect on fatal crash risk of prescription opioid use and alcohol use was not statistically significant on either additive or multiplicative scale. Conclusions Prescription opioid use is associated with a significantly increased risk of fatal crash involvement independently of alcohol use. Concurrent use of prescription opioids and alcohol is associated with a 21-fold increased risk of fatal crash involvement.
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Affiliation(s)
- Guohua Li
- 1Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY 10032 USA.,2Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA.,3Department of Epidemiology, Columbia University Mailman School of Public Health, 622 West 168th St, PH5-505, New York, NY 10032 USA
| | - Stanford Chihuri
- 1Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY 10032 USA.,2Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA
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Chihuri S, Li G. Use of prescription opioids and motor vehicle crashes: A meta analysis. ACCIDENT; ANALYSIS AND PREVENTION 2017; 109:123-131. [PMID: 29059534 DOI: 10.1016/j.aap.2017.10.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/17/2017] [Accepted: 10/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Opioid analgesics are a major driver of the ongoing opioid epidemic in the United Sates, accounting for about two thirds of drug overdose fatalities. There are conflicting reports regarding the effects of prescription opioids on driving safety. A meta-analysis was performed to assess the epidemiologic evidence for the association between use of prescription opioids and the risk of motor vehicle crashes. METHODS Studies examining the association between driver prescription opioid use and motor vehicle crash involvement or crash culpability and published in English were identified through a comprehensive search of 15 bibliographic databases. Eligible articles were fully reviewed and summarized. Study quality was assessed using the Newcastle-Ottawa Scale. Overall summary odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through random effects models. RESULTS Overall, 15 studies were included in the meta-analysis; of them, 10 assessed the association of prescription opioid use with the risk of crash involvement and 5 assessed the association of prescription opioid use with the risk of crash culpability. Reported crude ORs associated with prescription opioid use ranged from 1.15 to 8.19 for the risk of crash involvement and from 0.75 to 2.78 for the risk of crash culpability. Summary ORs based on pooled data were 2.29 (95% CI: 1.51, 3.48) for crash risk and 1.47 (95% CI: 1.01, 2.13) for crash culpability. CONCLUSIONS The existent epidemiologic evidence indicates that use of prescription opioids by drivers is associated with significantly increased risks of crash involvement and crash culpability. Further research is needed to understand the epidemiologic patterns of prescription opioid use in the driver population and the interaction effects between opioids and alcohol on driving safety.
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Affiliation(s)
- Stanford Chihuri
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY, United States; Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Guohua Li
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY, United States; Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
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Weir N, Fischer A, Good P. Assessing the practice of palliative care doctors: what driving advice do they give patients with advanced disease? Intern Med J 2017; 47:1161-1165. [PMID: 28762600 DOI: 10.1111/imj.13571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is little research and no clear guidelines for clinicians to follow when instructing patients with advanced disease about driving. AIMS To investigate current practice in providing advice to patients with advanced disease and identify areas of consensus or variation with the Australian driving guidelines. METHODS An online survey was distributed to Australian members of the Australian and New Zealand Society of Palliative Medicine. Responses were analysed using descriptive statistics. RESULTS The survey was distributed to 322 Australian and New Zealand Society of Palliative Medicine members and received 92 responses (29% response rate). Most respondents were aware of the driving guidelines (76%) and about half of the respondents had read the driving guidelines (55%). The majority of respondents had been asked to provide advice about driving to their patient or patient's caregiver (91%). Most respondents had asked a patient to stop driving (94%), but only 27% had reported a patient to the Driver Licensing Authority. Only 14% of respondents were in consensus with the guidelines in providing driving advice to a patient with asymptomatic brain metastases. Most doctors (64%) advise patients to refrain temporarily from driving post-short-acting oral morphine, with 4 h (36%) being the most common time period for not driving. CONCLUSIONS This is the first survey investigating the practice of Australian doctors in assessing fitness to drive of patients with advanced disease. The survey found wide variability in practice and substantial discordance with current driving guidelines.
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Affiliation(s)
- Nashringi Weir
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia
| | - Amanda Fischer
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia
| | - Phillip Good
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Queensland, Australia
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Rudisill TM, Zhu M, Kelley GA, Pilkerton C, Rudisill BR. Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review. ACCIDENT; ANALYSIS AND PREVENTION 2016; 96:255-270. [PMID: 27569655 PMCID: PMC5045819 DOI: 10.1016/j.aap.2016.08.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 06/17/2016] [Accepted: 08/02/2016] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Driving under the influence of prescription and over-the-counter medication is a growing public health concern. A systematic review of the literature was performed to investigate which specific medications were associated with increased risk of motor vehicle collision (MVC). METHODS The a priori inclusion criteria were: (1) studies published from English-language sources on or after January 1, 1960, (2) licensed drivers 15 years of age and older, (3) peer-reviewed publications, master's theses, doctoral dissertations, and conference papers, (4) studies limited to randomized control trials, cohort studies, case-control studies, or case-control type studies (5) outcome measure reported for at least one specific medication, (6) outcome measure reported as the odds or risk of a motor vehicle collision. Fourteen databases were examined along with hand-searching. Independent, dual selection of studies and data abstraction was performed. RESULTS Fifty-three medications were investigated by 27 studies included in the review. Fifteen (28.3%) were associated with an increased risk of MVC. These included Buprenorphine, Codeine, Dihydrocodeine, Methadone, Tramadol, Levocitirizine, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, Temazepam, Triazolam, Carisoprodol, Zolpidem, and Zopiclone. CONCLUSIONS Several medications were associated with an increased risk of MVC and decreased driving ability. The associations between specific medication use and the increased risk of MVC and/or affected driving ability are complex. Future research opportunities are plentiful and worthy of such investigation.
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Affiliation(s)
- Toni M Rudisill
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA; Injury Control Research Center, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - Motao Zhu
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Injury Control Research Center, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - George A Kelley
- Department of Biostatistics, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - Courtney Pilkerton
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
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Krashin D, Murinova N, Jumelle P, Ballantyne J. Opioid risk assessment in palliative medicine. Expert Opin Drug Saf 2016; 14:1023-33. [PMID: 26084635 DOI: 10.1517/14740338.2015.1041915] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pain management with opioids is a fundamental element of palliative medicine. Since the risks of chronic opioid therapy have emerged, a reassessment of these risks in the setting of palliative care is warranted. AREAS COVERED This article presents information about opioid-related risks including i) sedation, cognitive impairment and falls; ii) constipation; iii) addiction to opioids and associated aberrant behavior; and iv) death due to respiratory depression. For this article, the medical literature was searched using PubMed and Web of Science for appropriate terms including 'palliative care' and 'opioid risk.' Medical subject headings were used to identify suitable articles including 'Analgesics, Opioid', 'Pain/drug therapy,' 'Palliative Care' and 'Hospice Care.' Further sources were identified by following cross-references within the literature and with the help of the University of Washington library staff. EXPERT OPINION Palliation of severe pain at the end of life is probably the most widely accepted indication for chronic opioid therapy. At increased doses, adverse effects of opioids may limit or interfere with the benefits of treatment. Careful screening and follow-up will allow risk factors to be recognized and addressed when possible. The use of adjunctive treatments for pain may reduce opioid requirements and yield better outcomes.
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Affiliation(s)
- Daniel Krashin
- University of Washington, Department of Psychiatry , Box 359896, 325 Ninth Ave, Seattle, WA 98104 , USA
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Burch HJ, Clarke EJ, Hubbard AM, Scott-Ham M. Concentrations of drugs determined in blood samples collected from suspected drugged drivers in England and Wales. J Forensic Leg Med 2012; 20:278-89. [PMID: 23622475 DOI: 10.1016/j.jflm.2012.10.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 08/08/2012] [Accepted: 10/28/2012] [Indexed: 10/27/2022]
Abstract
This communication reports the blood concentrations of alcohol and drugs from 376 cases of alleged driving under the influence of drugs analysed at the Forensic Science Service Chorley and London laboratories between February 2010 and March 2011. The samples were analysed for alcohol, amphetamine, benzodiazepines, cocaine, MDMA, opiates, γ-hydroxybutyrate (GHB), ketamine, methadone and methylmethcathinone (the 4-isomer of which is known as mephedrone). The results were interpreted with respect to the number and type of drugs of abuse detected and the concentrations measured. Alcohol was quantified in 113 cases (30%), and of these a level in excess of the prescribed UK limit for driving of 80 mg% was present in 90 cases. In 80 cases, only the concentration of alcohol was measured, the concentrations of both drugs and alcohol were measured in 33 cases. In the remaining 263 cases, only the concentrations of relevant drugs of abuse were measured. The most common drug of abuse quantified was cocaine which was detected in 92 cases, either as the active drug or as its major metabolite benzoylecgonine, followed by diazepam which was quantified in 76 cases. Concentrations of some new drugs, and drugs rarely reported in driving under the influence cases are also presented.
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Affiliation(s)
- Hilary J Burch
- The Forensic Science Service, London Laboratory, 109 Lambeth Road, London SE1 7LP, UK
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Affiliation(s)
- Karen L. Cross
- Hospice & Palliative Carecenter, Winston-Salem, North Carolina
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