Maintenance therapy with synthetic opioids and driving aptitude

Schindler, S.D.; Eder, Harald; Peternell, A.; Ortner, R.; Kraigher, D.; Opgenoorth, E; Fischer, Gabriele

doi:10.1016/s0924-977x(01)80489-2

Cited by 5 publications

(5 citation statements)

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“…Cognitive function plays a central role in the psychotherapy and social functioning of MMT patients, including decision-making, driving ability and related issues (Dittert et al 1999;Lenné et al 2003;Schindler et al 2004;Pirastu et al 2006;Mintzer 2007). Few studies have focused on length of methadone treatment as a possible confounding factor for cognitive function.…”

Section: Discussionmentioning

confidence: 99%

Cognitive function in short- and long-term substitution treatment: Are there differences?

Soyka

Zingg

Koller

et al. 2010

The World Journal of Biological Psychiatry

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Cognitive impairment in drug-dependent patients receiving methadone maintenance treatment has been reported previously, although the literature is limited and results remain controversial. Long-term effects under stable methadone maintenance treatment (MMT) and the possibility of improvement in cognitive performance during long-term substitution treatment have rarely been investigated. We performed a comparative study investigating differences in cognitive functions under short- and long-term methadone treatment to test the hypothesis that patients perform better under long- than under short-term MMT. Seventy-seven patients were assessed cross-sectional either at least 30 days after the start of MMT (short-term group, n=35) or after at least 6 months of MMT (long-term group, n=42) with a comprehensive neuropsychological test battery on intelligence, learning and memory, attention and executive functions. Urine screenings were performed immediately before neuropsychological testing to check for concomitant drug use. Our findings may suggest, with all due caution, a slightly better performance of the long-term group in executive functions and visuo-construction. No group differences were found in attentional functions and learning and memory. More longitudinal research and studies controlling for the effects of dosage and duration of opioid addiction are necessary to examine whether cognitive ability may improve under long-term MMT.

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Section: Discussionmentioning

confidence: 99%

Cognitive function in short- and long-term substitution treatment: Are there differences?

Soyka

Zingg

Koller

et al. 2010

The World Journal of Biological Psychiatry

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“…17 , 29 , 36 , 48 , 62 , 71 Although exceptions have been reported 67. Very few of these studies have focused on older adults.…”

Section: Discussionmentioning

confidence: 99%

Comparative Cognitive and Subjective Side Effects of Immediate-Release Oxycodone in Healthy Middle-Aged and Older Adults

Cherrier¹,

Amory²,

Ersek³

et al. 2009

The Journal of Pain

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This study measured the objective and subjective neurocognitive effects of a single 10mg dose of immediate-release oxycodone in healthy, older (>65 years) and middle age (35 -55 years) adults who were not suffering from chronic or significant daily pain. Seventy-one participants completed two separate study days and were blind to medication condition (placebo, 10 mg oxycodone). Plasma oxycodone concentration peaked between 60 and 90 min post dose (p<0.01) and pupil size, an indication of physiological effects of the medication peaked at approximately 90 to 120 min post dose (p<0.01). Significant declines in simple and sustained attention, working memory and verbal memory were observed at one hour post dose compared to baseline for both age groups with a trend toward return to baseline by five hours post dose. For almost all cognitive measures there were no medication by age interaction effects, which indicates that the two age groups exhibited a similar responses to the medication challenge. This study suggests that for healthy older adults who are not suffering from chronic pain, neurocognitive and pharmacodynamic changes in response to a 10 mg dose of immediate release oxycodone are similar to those observed for middle age adults.Perspective-Study findings indicate that the metabolism, neurocognitive effects, and physical side effects of oral oxycodone are similar for healthy middle-age and older adults. Therefore, clinicians should not avoid prescribing oral opioids to older adults based on the belief that older adults are at higher risk for side effects than younger adults.

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“…Patients with a history of substance abuse or who are in opioid maintenance programs may also skew data on impairment. Such patients have been found to have higher rates of misuse, abuse, or concomitant illicit drug use that can compromise study results (71).…”

Section: Es223 Creating Balanced Duid Policymentioning

confidence: 99%

A Framework for “Driving Under the Influence of Drugs” Policy for the Opioid Using Driver

Wilhelmi¹,

Cohen²

2012

Pain Phys

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Background: Driving under the influence of drugs (DUID) is a term used to designate the action of driving an automobile after the consumption of drugs or medications other than alcohol that interfere with the capacity to operate a vehicle safely. Unlike recreational drugs, prescription medications pose a unique challenge to those attempting to harness their benefits yet protect the driving public. As studies demonstrate a steady increase in opioid use and abuse in the United States, these same constituencies must regulate a significant percentage of drivers who are under the influence of opioids. Objective: This article examines current DUID policy and attempts to present unified suggestions for improvement based on best scientific evidence of opioid-induced psychomotor impairment. Study Design: Literature Review Methods: A literature search was conducted regarding the epidemiology of opioid use and abuse, psychomotor effects of opioids, DUID, and state policy concerning DUID. A total of 23 epidemiological studies, 3 studies on acute psychomotor effects, 32 on chronic psychomotor effects, and selected pertinent law and policy were reviewed. Results: Current state law concerning DUID is variable and often relies on prosecutorial discretion to provide protection of the driving public and prosecution of the truly impaired. Limitations: The design of various studies included in this review imposes limitations on the epidemiological data extracted. Relationships between opioids and automobile accidents are commonly reviewed in retrospect. The data on opioid-induced psychomotor impairment and its effects on driving an automobile require further direct study to examine current inferences. Conclusions: A sizable percentage of the driving public has detectable levels of opioids within their bodies. The best available evidence demonstrates psychomotor impairment following acute administration of opioids or an increase in opioid dosage, but impairment diminishes with chronic, stable opioid usage. Policy makers must account for this evidence when balancing the benefit of pain relief against the need for public roadway protection when drafting DUID legislation. Key words: Driving under the influence of drugs, DUID, psychomotor impairment, opioids, regulation, automobile accident(s), driver impairment, prescription drugs, chronic opioid analgesic therapy, driving under the influence

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Maintenance therapy with synthetic opioids and driving aptitude

Cited by 5 publications

References 0 publications

Cognitive function in short- and long-term substitution treatment: Are there differences?

Cognitive function in short- and long-term substitution treatment: Are there differences?

Comparative Cognitive and Subjective Side Effects of Immediate-Release Oxycodone in Healthy Middle-Aged and Older Adults

A Framework for “Driving Under the Influence of Drugs” Policy for the Opioid Using Driver

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