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 The most common error leading to fatal crashes, whether or not
opioids were involved, was drivers veering out of their lanes,
according to the results published in JAMA Network Open.
"This shows that the ongoing national opioid epidemic has spilled
over to our national highway system with deadly consequences," said
study coauthor Dr. Gouhua Li, founding director of the Center for
Injury Epidemiology and Prevention at the Mailman School of Public
Health of Columbia University in New York City. "Drivers who caused
the crashes were about twice as likely to have taken prescription
opiates as the non-initiators of the crashes."
To take a closer look at the impact of drugs on fatal vehicle
crashes, the researchers turned to the Fatality Analysis Reporting
System (FARS) which is compiled and maintained by the National
Center for Statistics at the U.S. National Highway Traffic Safety
Administration.
FARS keeps detailed data on all motor vehicle crashes that occur on
U.S. public roads and result in at least one fatality. The
researchers analyzed data from 18,321 fatal two-car crashes. The
most common driver error causing those crashes, "failure to keep in
lane," occurred in 7,535 instances, the researchers found.
Drivers who were found to have caused the crashes were more likely
than those who were not at fault to test positive for prescription
opioids (918 versus 549) and alcohol (5,258 versus 1,815). As a sign
that the problem has been growing, the proportion of crash
initiators with prescription opioids in their system increased from
2 percent in 1993 to 7.1 percent in 2016.
Among the 1,467 drivers testing positive for prescription opioids,
32 percent were positive for hydrocodone, 27 percent for morphine,
19 percent for oxycodone, 14 percent for methadone and 9 percent for
other prescription opioids.
Because of its design, the study can only show an association rather
than proof that opioids cause crashes, said Dr. Andrew Stolbach, a
medical toxicologist and emergency medicine physician at the Johns
Hopkins Hospital in Baltimore, Maryland.
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Moreover, it does not suggest that people who are taking opioids for
chronic pain are having accidents because of the drugs, said
Stolbach, also an associate professor of emergency medicine at the
Johns Hopkins University School of Medicine. "You can have
psychomotor and cognitive impairment in people who are not used to
taking them," he explained.
"But there is scientific literature, using driving simulators, for
example, that shows that when a person builds up tolerance many of
the psychomotor and cognitive effects that would affect driving are
not detected. And that suggests that people on a chronic and stable
opioid prescription can drive safely," Stolbach said.
The same is not true for people taking opioids for an acute injury
such as a burn or a broken limb, he noted.
Dr. Ajay Wasan, who wasn't involved in the study, questioned its
focus on any use of prescription opioids among drivers involved in
crashes, describing it as "very misleading, since this is really
abuse, not use."
Given that studies have shown that people taking prescription
opioids chronically are not impaired when driving, these kinds of
accidents, especially those where people drifted out of their lanes,
are most likely due to opioid abuse, said Wasan, who is vice chair
for pain medicine in the anesthesiology department at the University
of Pittsburgh and president elect of the American Academy of Pain
Medicine.
Moreover, Wasan expects that the number of accidents involving
people taking prescription opioids will turn out to have gone down
in more recent years because of the decline in the number of
prescriptions written for opioids.
"This sensationalizes an issue when there is a need for better
science and clarity," Wasan said.
SOURCE: https://bit.ly/2GNDszH JAMA Network Open, online February
15, 2019.
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