Abstract:AIMSTo assess potential change in medicine exposure and association with the risk of road traffic crash across a time period that started before the implementation of a grading system warning of the effect of medicine on driving performance.
METHODSData from three French national databases were extracted and matched: the national health care insurance database, police reports and the national police database of injurious crashes. Drivers involved in such crashes in France, from July 2005 to December 2011 and i… Show more
“…The previous analysis of 2005–2011 data suggested an increase in exposure to benzodiazepine anxiolytics and z-hypnotics in 2010–2011 (Orriols et al, 2016). The follow-up conducted as part of this study in subsequent years showed that the use of these prescription drugs among drivers involved in a road traffic crash is stabilizing.…”
Section: Resultsmentioning
confidence: 97%
“…Due to their high levels of consumption and association with crash risk, the two classes most represented in terms of attributable fraction were benzodiazepine anxiolytics and z-hypnotics (zolpidem and zopiclone) (Barbone et al, 1998; Chang et al, 2013; Engeland et al, 2007; Gjerde et al, 2015; Gustavsen et al, 2008; Hemmelgarn et al, 1997; Orriols et al, 2011; Ravera et al, 2011; Smink et al, 2010). A first observation of exposure trends to benzodiazepine anxiolytics and z-hypnotics among drivers involved in road traffic crashes was made, suggesting a transient downward trend in exposure following the implementation of the color-graded pictogram system (Orriols et al, 2016). Given that consumption levels of psychotropic prescription drugs are likely to change rapidly, particularly among drivers whose average age is increasing, it seems necessary to continue to monitor the level of exposure to prescription drugs and the resulting risk of road traffic crashes.Fig.…”
Background
In France, benzodiazepine anxiolytics and z-hypnotics (zolpidem and zopiclone) account for the largest share of road traffic crash risk attributable to exposure to prescription drugs. The aim of this study was to monitor the evolution of the use of these prescription drugs and their association with crash risk over a period that began before the implementation of a color-graded pictogram system printed on prescription drug boxes.
Methods
Data from three French national databases were extracted and linked: the national health care insurance database, police reports, and the national police database of injurious crashes. Drivers involved in an injurious crash in France, from July 2005 to December 2015, and identified by their national identifier were included. The association with crash risk was estimated using a responsibility analysis comparing the use of benzodiazepines and z-hypnotics among drivers responsible or not for the crash.
Results
A total of 97,936 responsible and 103,522 non-responsible drivers involved in an injurious crash were included. The proportion of drivers exposed to benzodiazepine anxiolytics or z-hypnotics remained stable among responsible and non-responsible drivers. Among controls from the general population, the proportion of exposed individuals tended to increase. The association with crash risk remained almost constant over the study period. The odds-ratio for benzodiazepines ranged between 1.42 [1.24–1.62] at the beginning of the study period and 1.27 [1.09–1.47] at the end.
Conclusion
Given the increase in exposure in the control group from the general population, the stability of exposure for responsible and non-responsible drivers can be interpreted as a relative effectiveness of the pictogram on driver exposure levels. On the other hand, while the intrinsic effect of a prescription drug cannot be modified, a decrease in risk could have been expected if drivers adapted their behavior as promoted by the pictogram. Our results therefore suggest that no significant change occurred in driving behaviors or consumption patterns.
“…The previous analysis of 2005–2011 data suggested an increase in exposure to benzodiazepine anxiolytics and z-hypnotics in 2010–2011 (Orriols et al, 2016). The follow-up conducted as part of this study in subsequent years showed that the use of these prescription drugs among drivers involved in a road traffic crash is stabilizing.…”
Section: Resultsmentioning
confidence: 97%
“…Due to their high levels of consumption and association with crash risk, the two classes most represented in terms of attributable fraction were benzodiazepine anxiolytics and z-hypnotics (zolpidem and zopiclone) (Barbone et al, 1998; Chang et al, 2013; Engeland et al, 2007; Gjerde et al, 2015; Gustavsen et al, 2008; Hemmelgarn et al, 1997; Orriols et al, 2011; Ravera et al, 2011; Smink et al, 2010). A first observation of exposure trends to benzodiazepine anxiolytics and z-hypnotics among drivers involved in road traffic crashes was made, suggesting a transient downward trend in exposure following the implementation of the color-graded pictogram system (Orriols et al, 2016). Given that consumption levels of psychotropic prescription drugs are likely to change rapidly, particularly among drivers whose average age is increasing, it seems necessary to continue to monitor the level of exposure to prescription drugs and the resulting risk of road traffic crashes.Fig.…”
Background
In France, benzodiazepine anxiolytics and z-hypnotics (zolpidem and zopiclone) account for the largest share of road traffic crash risk attributable to exposure to prescription drugs. The aim of this study was to monitor the evolution of the use of these prescription drugs and their association with crash risk over a period that began before the implementation of a color-graded pictogram system printed on prescription drug boxes.
Methods
Data from three French national databases were extracted and linked: the national health care insurance database, police reports, and the national police database of injurious crashes. Drivers involved in an injurious crash in France, from July 2005 to December 2015, and identified by their national identifier were included. The association with crash risk was estimated using a responsibility analysis comparing the use of benzodiazepines and z-hypnotics among drivers responsible or not for the crash.
Results
A total of 97,936 responsible and 103,522 non-responsible drivers involved in an injurious crash were included. The proportion of drivers exposed to benzodiazepine anxiolytics or z-hypnotics remained stable among responsible and non-responsible drivers. Among controls from the general population, the proportion of exposed individuals tended to increase. The association with crash risk remained almost constant over the study period. The odds-ratio for benzodiazepines ranged between 1.42 [1.24–1.62] at the beginning of the study period and 1.27 [1.09–1.47] at the end.
Conclusion
Given the increase in exposure in the control group from the general population, the stability of exposure for responsible and non-responsible drivers can be interpreted as a relative effectiveness of the pictogram on driver exposure levels. On the other hand, while the intrinsic effect of a prescription drug cannot be modified, a decrease in risk could have been expected if drivers adapted their behavior as promoted by the pictogram. Our results therefore suggest that no significant change occurred in driving behaviors or consumption patterns.
“…In addition to the use of various analytical methods for sensitivity analyses, studies have concerned the determination of the denominator in case-population studies 27 or the effect of exposures to different drug classes and risk of car accidents, [48][49][50][51] using links to external registries 52 and original analytical methods. 53 There are other groups working on similar ventures.…”
Section: Other (Methodological Research)mentioning
The French health care system is based on universal coverage by one of several health care insurance plans. The SNIIRAM database merges anonymous information of reimbursed claims from all these plans, linked to the national hospital-discharge summaries database system (PMSI) and the national death registry. It now covers 98.8% of the French population, over 66 million persons, from birth (or immigration) to death (or emigration), making it possibly the world's largest continuous homogeneous claims database. The database includes demographic data; health care encounters such as physician or paramedical visits, medicines, medical devices, and lab tests (without results); chronic medical conditions (ICD10 codes); hospitalisations with ICD10 codes for primary, linked and associated diagnoses, date and duration, procedures, diagnostic-related groups, and cost coding; date but currently not cause of death. The power of the database is correlatively great, and its representativeness is near perfect, since it essentially includes the whole country's population. The main difficulty in using the database, beyond its sheer size and complexity, is the administrative process necessary to access it. Recent legislative advances are making this easier. EGB (Echantillon Généraliste de Bénéficiaires) is the 1/97th random permanent representative sample of SNIIRAM, with planned 20-year longitudinal data (10 years at this time). Access time is 1 to 3 months, but its power is less (780 000 subjects). This is enough to study common issues with older drugs but may be limited for new products or rare events.
“…Hypnotics increase sleepiness. Several epidemiological studies have highlighted an association between the use of benzodiazepines or "Z-drugs" (Zopiclone and Zolpidem) and increased accidents [22][23][24][25]. A review of 27 controlled studies confirmed an increased accident risk for Zolpidem, Zopiclone, Temazepam, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, and Triazolam [26] volunteers and driving simulators have confirmed this risk, which has been shown to be dependent on the dose, time between the dose and the test and the half-life of the hypnotic [27][28][29].…”
Driving accidents due to hypovigilance are common but the role of hypnotics is unclear in patients suffering from sleep disorders. Our study examined factors influencing accidents and near miss accidents attributed to sleepiness at the wheel (ANMAS). Using data from an online questionnaire aimed at patients with sleep disorders, we analysed the associations between ANMAS, sociodemographic data, symptoms of sleep disorders, severity of insomnia (Insomnia Severity Index (ISI)) symptoms of anxiety and depression (Hospital Anxiety and Depression scale with depression (HADD) and anxiety (HADA) subscales), chronic sleepiness (Epworth sleepiness scale ESS), hypnotic use and information about sleep habits. Hypnotics were hierarchically grouped into Z-drugs, sedative medication, melatonin and over the counter (OTC) alternative treatments. Of 10802 participants; 9.1% reported ANMAS (Men 11.1% women 8.3%) and 24.4% took hypnotics (Z-drugs 8.5%, sedative medication 8%, melatonin 5.6% and alternative treatments 2.5%). Logistic regression analysis identified the following risk factors for ANMAS: moderate (
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