Psychoactive Medications and Crash Involvement Requiring Hospitalization for Older Drivers: A Population‐Based Study

Meuleners, Lynn; Duke, Janine M.; Lee, Andy H.; Palamara, Peter; Hildebrand, Janina; Ng, Jonathon Q

doi:10.1111/j.1532-5415.2011.03561.x

Cited by 65 publications

(49 citation statements)

References 46 publications

(91 reference statements)

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“…As expected, the risk for older drivers to crash increased with exposure to BZDs [8], [11], [13], [14], either with or without concomitant use of other psychotropic medications. However, the association varied across categories of marital status.…”

Section: Discussionsupporting

confidence: 76%

The Role of Marital Status in the Association between Benzodiazepines, Psychotropics and Injurious Road Traffic Crashes: A Register-Based Nationwide Study of Senior Drivers in Sweden

et al. 2014

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BackgroundAmong senior drivers, benzodiazepines (BZDs) have a documented effect on the risk of road traffic crashes (RTCs). It remains unclear however if BZDs play the same role when considering marital status. Therefore, we aimed to investigate the role of marital status in the association between BZD use and injurious RTCs among senior drivers.MethodsMatched case-control study based on five national Swedish registers (n = 154 225). Cases comprised the first non-alcohol-related injurious RTC sustained by drivers aged 50–80 years from July 2005 to December 2009 and controls included registered residents with a valid license who did not crash during that period. Four controls were matched to each case by sex, age and place of residence. Conditional logistic regression analysis for injurious RTC was performed with adjustment for occupation and number of medications. The main exposure was dispensation of BZDs, alone or in combination with other psychotropic medications, 1–30 days prior to the crash date stratified by marital status.ResultsBZD use, alone or in combination with other psychotropic medications, increased the risk of being involved in an RTC (BZD only: adjusted OR: 1.26, 95% CI: 1.17–1.36; BZDs and other psychotropics: adjusted OR: 1.25, 95% CI: 1.12–1.41). Compared to married drivers, those divorced (1.48, 1.43–1.53) and widowed (1.54; 1.45–1.63) had higher adjusted ORs. Marital status modified the association between BZDs and RTCs, particularly among younger male drivers.ConclusionsBoth BZDs and marital status independently affect the risk for senior drivers to be involved in an RTC. However, marital status plays a role in the association between BZD use and RTCs and this may have implications for targeting risk populations for RTCs among senior drivers.

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Section: Discussionsupporting

confidence: 76%

The Role of Marital Status in the Association between Benzodiazepines, Psychotropics and Injurious Road Traffic Crashes: A Register-Based Nationwide Study of Senior Drivers in Sweden

et al. 2014

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“…Of 836 unique articles identified, 99 pharmacoepidemiologic studies were eligible: 20 methodological contributions, 9 review papers, and 70 empirical applications, Figure . Of the 70 pharmacoepidemiologic empirical applications, 47% were identified by all 3 searches, 36% were identified in both MEDLINE and EMBASE but not the Web of Science citation search, and 10% were identified uniquely from the Web of Science seminal paper citation search, Figure .…”

Section: Resultsmentioning

confidence: 99%

Case‐crossover study design in pharmacoepidemiology: systematic review and recommendations

Consiglio

Burden

Maclure

et al. 2013

Pharmacoepidemiology and Drug

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“…[97][98][99][100][101] Sedation may also contribute to a possible increased risk of motor vehicle crashes in drivers using prescription opioids, with a relative increase of 20-50%. 102 103 Studies conflict, however, and pain, other drugs, or comorbid conditions may also contribute. 104 105 Nonetheless, patients receiving long term opioids (median dose, 60 mg morphine equivalents) for pain showed reduced reaction time, attention, and psychomotor speed in laboratory testing.…”

Section: Other Adverse Effectsmentioning

confidence: 99%

Opioids for low back pain

Deyo

Korff

Duhrkoop³

2015

BMJ

443

329

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Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence in other acute pain conditions. Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy. Randomized controlled trials have high dropout rates, brief duration (four months or less), and highly selected patients. Opioids seem to have short term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic non-cancer pain conditions is about 30%. Given the brevity of randomized controlled trials, the long term effectiveness and safety of opioids are unknown. Loss of long term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction. Screening for high risk patients, treatment agreements, and urine testing have not reduced overall rates of opioid prescribing, misuse, or overdose. Newer strategies for reducing risks include more selective prescription of opioids and lower doses; use of prescription monitoring programs; avoidance of co-prescription with sedative hypnotics; and reformulations that make drugs more difficult to snort, smoke, or inject.

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Psychoactive Medications and Crash Involvement Requiring Hospitalization for Older Drivers: A Population‐Based Study

Abstract: Psychoactive medication usage was associated with greater risk of a motor vehicle crash requiring hospitalization in older drivers.

Cited by 65 publications

References 46 publications

The Role of Marital Status in the Association between Benzodiazepines, Psychotropics and Injurious Road Traffic Crashes: A Register-Based Nationwide Study of Senior Drivers in Sweden

The Role of Marital Status in the Association between Benzodiazepines, Psychotropics and Injurious Road Traffic Crashes: A Register-Based Nationwide Study of Senior Drivers in Sweden

Case‐crossover study design in pharmacoepidemiology: systematic review and recommendations

Opioids for low back pain

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