Effects of Opioids on Driving Ability

Abstract

Driving has been regarded as an activity of daily living that is important in maintaining a person's independence in the community, access to employment, and social activities. Many patients, however, using opioid medications on a regular basis (Chronic Opioid Analgesic Therapy: COAT) to ameliorate their intractable pain have been restricted from driving out of concern that skills would be impaired and driving safety compromised by these medications. Yet there are no driving studies which have explored the effects of using opioid analgesics for an extended period of time. This pilot study was designed to determine the effects of medically prescribed, stable opioid use on the driving abilities of patients with persistent, nonmalignant pain. Sixteen patients with chronic nonmalignant pain on COAT, who met criteria for participation in the study, underwent a comprehensive off-road driving evaluation using measures which have been shown to be sensitive in predicting on-road driving performance. The evaluation consisted of a pre-driver evaluation (PDE), a simulator evaluation (SDE), and behavioral observation during simulator performance. Patients in the COAT group were compared to a historical control group of 327 cerebrally compromised patients (CComp) who had undergone the same evaluation and then passed an on-road, behind-the-wheel evaluation (BTW Pass; n = 162) or failed (BTW Fail; n = 165). Results revealed that COAT patients generally outperformed the CComp patients as a group by equaling or exceeding PDE and SDE scores of the BTW Fail patients as well as the BTW Pass patients on all measures that differentiated the groups. Notably, COAT patients had a relatively poorer performance than CComp patients on specific neuropsychometric tests in the PDE; however, the differences were not statistically significant and did not imply a systematic pattern of scores that reflected domain-specific deficits. Behaviorally, COAT patients were generally superior to CComp patients, also; however, COAT patients had greater difficulty in following instructions and as well as a tendency toward impulsivity, like the BTW fail group. While there was general support for the notion that COAT did not significantly impair the perception, cognition, coordination, and behavior measured in off-road tests that have been regarded as requisite for on-road driving, methodological problems may limit the generalizability of results and recommendations are made for research beyond a pilot study.

Use of Opioid Analgesics for the Treatment of Chronic Noncancer Pain ‐ A Consensus Statement and Guidelines from the Canadian Pain Society, 2002

“…A study of cancer patients taking stable, long term opioid therapy compared with a group taking no opioids demonstrated no significant difference in functions related to driving ability (32). This observation has been duplicated in subsequent studies (33)(34)(35)(36)(37)(38). Cognitive deficits in opioid-treated patients are more often due to the concurrent use of sedative medications such as benzodiazepines.…”

Prevalence of Self-Reported Prescription Drug Use in a National Sample of U.S. Drivers

“…Findings regarding opioids are less consistent; experimental studies show moderate effects on driving with no clear doseresponse relationship (Strand et al, 2016), whereas a review of epidemiological studies showed statistically significant associations between opioids and road traffic crashes in 17 of 25 studies (Gjerde et al, 2015). The greatest risks from this drug class may be among opioid-naive patients rather than those on long-term therapy (Dassanayake et al, 2011;Fishbain et al, 2003;Galski et al, 2000;Leung, 2011;Wilhelmi & Cohen, 2012), suggesting that drug tolerance plays an important role in determining opioid-related driving risks.…”

Opióides e a cognição de doentes com dor crônica: revisão sistemática

“…Desses, dois foram ensaios randomizados, do tipo crossover e duplo-cego 8,9 , dois foram ensaios clínicos controlados 10,11 , três foram ensaios clínicos não-controlados [12][13][14] , dois foram relatos de caso 15,16 , dois estudos foram classificados como ensaios que usaram voluntários saudáveis para a formação do grupo de comparação 17,18 . Os desenhos dos estudos de melhor qualidade 8,9 , controlados e randomizados, mostraram que pacientes com dor crônica não-oncológica em uso de opióide não apresentam alteração da função cognitiva.…”

“…Os desenhos dos estudos de melhor qualidade 8,9 , controlados e randomizados, mostraram que pacientes com dor crônica não-oncológica em uso de opióide não apresentam alteração da função cognitiva. A maioria dos estudos de menor qualidade, não-randomizados, também não referiu alteração da função cognitiva [10][11][12][13][14][15][16][17] , sendo que alguns mostraram melhora de algumas funções, como a atenção/concentração e velocidade psicomotora 10,[12][13][14][15] . Somente um estudo que utilizou voluntários no grupo de comparação concluiu pela piora na atenção e memória dos pacientes tratados com opióides 18 Além da variabilidade dos estudos quanto ao desenho, observouse grande variabilidade quanto ao número de sujeitos estudados, tipo e dose de opióides, e testes utilizados para avaliação cognitiva.…”