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.

15mg/kg every 3 weeks. Median dose of RT was 4500cGy whole pelvis concurrent with cisplatin. Most common HDR brachy dose was 5Gy x 5Fx and a median of 75.5 Gy equivalent dose at 2 Gy per fraction (EQD2). Toxicities were scored using RTOG criteria. Analysis was performed using chi-square and independent t-test. Results: Twenty-one pts were identified with a median age of 47 years (range 27-69). Primary tumor stages were FIGO IB2(N)Z 1, IIA Z 5, IIB Z 4, IIIA Z 0, IIIB Z 10, IVA Z 1. Ten (48%) pts presented with node positive disease. Bev was administered for a median of 5 cycles (range 1-10) and started on average 9.5 months after completion of RT. After a mean follow-up of 17.1 months since initiating bev, a total of 9 pts have been observed to develop a severe (grade 3+) toxicity: 6 (29%) bowel perforations and 3 (14%) fistula formations. These occurred at a mean of 2.3 and 4.7 months after initiation of bev, respectively. All fistulas appeared to be due to treatment related toxicity and none of the 6 perforations occurred in the setting of recurrent disease. Two bowel perforations were fatal. In pts with and without complications, mean time from RT to bev was 6.0 (range 1-12) and 12.4 months (range 2 to 27), respectively (PZ0.044). Mean EQD2 in pts with complications vs. without was 74.7Gy and 75.37Gy, respectively (pZ0.796). Two pts (20%) with FIGO I/II disease and 7 pts (63.6%) with FIGO III/IV disease had complications (pZ0.044). Conclusion: In this limited series of pts, a significantly higher rate of severe bowel toxicity was observed. It is hypothesized that this may be due to the use of bev within the immediate recovery period of HDR brachytherapy for cervical CA. Upon analysis, correlations for development of toxicity included timing of bev administration and tumor stage. Additional caution and safety testing might be warranted in pts receiving angiogenesis inhibitors in the immediate period post definitive therapy.