Maintenance Therapy with Synthetic Opioids and Driving Aptitude

Abstract

Aims: To assess the influence of methadone and buprenorphine maintenance treatment on the driving aptitude of opioid-dependent patients. Design: Prospective, open label, outpatient maintenance, single-blind (investigator) study. Participants and Setting: Thirty opioid-dependent patients maintained on either methadone or buprenorphine were recruited from the drug-addiction outpatient clinic in Vienna. Measurements: The traffic-relevant performance dimensions of the participants were assessed 22 h after receiving synthetic opioid maintenance therapy, by a series of seven tests constituting the Act & React Test System (ART) 2020 Standard test battery, developed by the Austrian Road Safety Board (ARSB). To test for additional consumption of illicit substances, blood and urine samples were taken at the beginning of the tests. Findings: The patient group only differed from control subjects in two of the ART 2020 Standard tests. During a task to test the subject’s attention under monotonous circumstances (Q1 test), patients had a significantly greater number of reactions (p = 0.027) and a significantly higher percentage of incorrect reactions than control subjects. When driving in a dynamic environment (DR2 test) patients had a significantly longer mean decision time (p = 0.029) and mean reaction time (p = 0.009) compared with control subjects. Interestingly, when separated into treatment groups, the mean decision and reaction times of buprenorphine-maintained patients in the DR2 test did not differ from controls, whereas patients maintained on methadone showed significantly prolonged mean decision (p = 0.009) and reaction times (p = 0.004). In this same test, patients who had consumed additional illicit drugs had a longer mean reaction time compared with control subjects (p = 0.036). Conclusion: The synthetic opioid-maintained subjects investigated in the current study did not differ significantly in comparison to healthy controls in the majority of the ART 2020 Standard tests.

Influence of Peak and Trough Levels of Opioid Maintenance Therapy on Driving Aptitude

“…Any restrictions on their right to drive, if such are necessary, should have a scientific basis. As Schindler et al [38] have stated in their publication, 'the safe operation of a motor vehicle is a learned activity demanding the complex interaction of physical, cognitive, perceptual, and psychological skills and abilities', the results of this study indicate that these skills are not diminished in patients receiving opioid maintenance therapy. However, there is a clear need for more information on road safety and driving capability in these patients.…”

Psychiatric comorbidities in opioid-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study

“…The effects of OAT on patient´s driving ability are controversial (Baewert et al, 2007;Fishbain et al, 2003;Loeber et al, 2012;Schindler et al, 2004). Although OAT might impair driving ability, it does so to a less degree than other psychotropic agents or drugs of abuse (Soyka, 2014).…”

Can Patients Receiving Opioid Maintenance Therapy Safely Drive? A Systematic Review of Epidemiological and Experimental Studies on Driving Ability With a Focus on Concomitant Methadone or Buprenorphine Administration

“…Only 7 studies dealt with the performance among BMPs compared to various control groups (Baewert et al 2007;Lenne et al 2003;Messinis et al 2009;Pirastu et al 2006;Rapeli et al 2007;Schindler et al 2004;Soyka et al 2008), where 6 studies found impairment. The total number of tests revealing impairment was 22 out of a total of 83 (n = 15-22, daily doses ranging from 6.78 to 15.8 mg/day).…”