Elsevier

Accident Analysis & Prevention

Volume 109, December 2017, Pages 123-131
Accident Analysis & Prevention

Use of prescription opioids and motor vehicle crashes: A meta analysis

https://doi.org/10.1016/j.aap.2017.10.004Get rights and content

Highlights

  • Use of prescription opioids is significantly associated with increased risks of motor vehicle crash involvement.

  • Prescription opioid use is also associated with crash culpability.

  • Primary care physicians, patients and public health professionals should be concerned of the possible crash risk from opioid use.

  • Further research and evidence based guidelines are needed in order to improve driving safety.

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.

Introduction

In the United States and many other industrialized countries, driving is an essential activity of daily living and is correlated with independence and access to employment and social activities (Borgeat, 2010; Fricke and Unsworth, 2001). Operating a motor vehicle is a complex task that requires a variety of skills such as eye-hand coordination, manual dexterity, and sensory-perceptual, cognitive and physical abilities (Walter et al., 2001; Weiler et al., 2000). Driving under the influence of drugs (DUID) has become a serious safety concern because of the marked increase in per capita consumption of prescription drugs, particularly opioid analgesics (Brady et al., 2014; Wilson et al., 2014), and the aging of the driver population (Colby and Ortman, 2014). Motor vehicle crashes (MVCs) are the second leading cause of unintentional injury mortality in the United States, surpassed only by drug overdose (National Center for Health Statistics, 2016; Sise et al., 2014). From 2014–2015, there was a 3.6% increase in fatality rate per 100 million vehicle miles traveled in the US (National Highway Traffic Safety Administration, 2016).

Prescription opioids (e.g., oxycodone and hydrocodone) are widely used for pain management and can cause sedation, drowsiness, nausea, impaired cognition and can interfere with psychomotor functioning (Altilio et al., 2007, Monárrez-Espino et al., 2013). Opioids may also impair reaction time, alertness, attention and concentration during driving (Manchikanti and Singh, 2008; Menefee et al., 2004; Ramaekers, 2003; Verster et al., 2006). The prevalence of prescription opioids detected in fatally injured drivers in the United States has increased from 1.0% in 1995 to 7.2% in 2015 (Chihuri and Li, 2017). Annual numbers of prescriptions for opioid analgesics have quadrupled from 76 million in 1991 to nearly 300 million in 2014, with an estimated 3900 people initiating nonmedical use of prescription opioids daily (Brady et al., 2014; Center for Behavioral Health Statistics and Quality, 2015).

The effects of prescription opioids on driving ability have been studied using both experiment and observational studies but the results are inconsistent. Previous reviews of experimental studies reported conflicting evidence (Borgeat, 2010, Fishbain et al., 2002, Fishbain et al., 2003, Kress and Kraft, 2005, Tan, 2007, Leung, 2011, Orriols et al., 2009, Soyka, 2014, Strand et al., 2013). There is inadequate epidemiological evidence for the association between opioid use and MVC risk. A recent systematic review of observational studies suggests that exposure to some prescription opioids might be significantly associated with an increased risk of MVCs (Rudisill et al., 2016), whereas an earlier meta-analysis found inconclusive evidence for the association between opioid use and MVC risk (Monárrez-Espino et al., 2013).

The inconsistent results may be due to differences in study designs, time periods, and study samples (e.g., opioid-naïve subjects, chronic opioid users on stable doses, chronic opioid users on changing dosages or combined). Given the increasing prevalence of prescription opioid use and abuse, it is important to better understand the role of opioids in motor vehicle crashes. The objective of this study was to synthesize the epidemiologic evidence for the association between use of prescription opioids and the risk of MVCs.

Section snippets

Study eligibility

Studies were included if they: 1) used an epidemiologic design ensuring that exposure (prescription opioids) preceded the outcome (MVC or culpability given a crash), such as cohort, case-control, nested case control and case-crossover studies; 2) included exposure to intravenous, oral or transdermal prescription opioids as defined under the Anatomical Therapeutic Chemical classification N02 group (World Health Organization Collaborating Centre for Drug Statistics Methodology, 2013) such as

Results

The comprehensive database search identified 2,388 records. After removing 472 duplicates, 1916 records were screened. The screening ruled out 1799 records because they did not meet the inclusion criteria. The full-text articles for the remaining 117 records were reviewed for eligibility; of them, 15 met the inclusion criteria and were included in the meta-analyses, including 10 studies assessing the association between prescription opioid use and MVC involvement and 5 studies assessing the

Discussion

Results of this meta-analysis indicate that prescription opioid use by drivers is associated with significantly increased risks of MVC involvement and culpability. Specifically, drivers who use prescription opioids are more than twice as likely as other drivers to be involved in MVCs and 47% more likely than other drivers to be responsible for the involved MVC. These findings are consistent with recent evidence from driving simulation studies (Soyka, 2014; Strand et al., 2013) and epidemiologic

Conclusions

The existent epidemiologic literature indicates that use of prescription opioids by drivers is associated with significantly increased risks of MVC involvement and culpability. Pooled data indicate that drivers who test positive for, or have recently used prescription opioids, are more than twice as likely as other drivers to be involved in MVC and are 47% more likely than other drivers to be culpable for the involved crashes. Further research is needed to understand the impact of the ongoing

Conflict of interest

None.

Acknowledgements

This research was supported in part by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (grant 1 R49 CE002096). The contents of the manuscript are solely the responsibility of the authors and do not necessarily reflect the official views of the funding agency.

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