[IMGL=checkpoint]http://www.drugs-forum.com/forum/attachment.php? attachmentid=35250&stc=1&d=1381279406[/IMGL]CHICAGO – Experts say millions get behind the wheel every day under the influence of powerful medications that, while perfectly legal, can have dangerous consequences on the road. Narcotic painkillers such as codeine and oxycodone can cause fatigue and mental clouding, while sedatives can slow reflexes. A National Highway Traffic Safety Administration study name a range of other drugs, from antidepressants to beta blockers to allergy pills as “potentially driver-impairing medications.”
That puts many patients in a difficult dilemma. They’re allowed to drive with these meds in their systems, but there’s no easy way to know the dosage or drug interactions that could make driving unsafe. If they’re pulled over or involved in a crash, a doctor’s order may not save them from being charged with DUI.
“If you think that a medication or combination [of drugs] is affecting your ability to drive safely, it’s immaterial whether you’ve been prescribed them,” said Michael Ori, who prosecutes traffic offenses for the Lake County, Illinois state attorney’s office. Much of the research on prescription drugs and driving has centered on narcotic medications. Scientists have long believed that patients on stable, long-term regiments of opioid—opium-like painkillers—develop a tolerance that allows them to drive safely, but recent studies have complicated that picture.
One study found that high doses of painkillers render a driver more likely to be involved in a crash, a conclusion that prompted a medical journal to editorialize that doctors should “weight the risk of road trauma into our decisions about the benefits and harms of opioid.” Another study found that motorists taking the medications are more like to perform “unsafe driving actions” that make them responsible for roughly 150 fatal crashes in the U.S. each year. That might not sound like many, considering that more that 200 million opioid painkiller prescriptions are written each year, but research statistician Sacha Dubois said his calculations were conservative: They didn’t include crashes in which people were maimed rather than killed, for instance, or those in which painkillers were mixed with alcohol. This is like a plane crash a year,” he said. “If any company had a plane crash where everybody died, we’d be concerned about it.”
Chicago-based prosecutors say that have brought charges against drivers who appeared to be intoxicated by lawfully prescribed medications, but th4e cases aren’t easy to win. If a motorist has any trace of an illegal drug such as cocaine or heroin in his system, he is presumed to be under the influence. If he’s staking what his doctor prescribed, prosecutors have to prove he was impaired. They try to do that through field sobriety tests or the results of a blood screen (typically given only when there’s a crash), but that can leave plenty of room for an attorney to sow reasonable doubt.
“It’s the exception for the state to win a case like that, not the rule,” said lawyer Donald Ramsell, a specialist in DUI laws. James Zacny, a University of Chicago anesthesiology professor who has studied the effects of opioid painkillers on driving, said those drugs, when used alone at an appropriate dose. Can actually improve performance by allowing the motorists to focus on the road instead of their pain. The problem comes when opioids are combined with other drugs, such as sedatives, he said. The interaction’s effect on driving has not been well-researched, but Zachy said it would likely cause problems. “It’s a synergistic effect, like one plus one equals three, he said. “It’s a stronger effect than if you doubled the dose of the opioid.”
Some doctors are cautious even when drug interactions are not an issue. Lynn Webster, a Salt Lake City physician who is president of the American academy of Pain Medicine, said he advises patients taking narcotic painkillers to stay off the road unless they can prove they’re not impaired with a session in a driving simulator. There’s no firm criteria to guide physicians and patients about when it’s safe to drive with painkillers or medications, and some experts say the subject—rife with tough decisions about sacrificing one’s independence—is rarely discussed. One longtime pain patient from outside of Chicago said he has never spoken to his physician about it. The man, a 66-year-old retired materials handler who asked not to named to preserve his privacy, said that since 2009 he has taken Vicodin and tramadol, both opioids, to deal with severe spinal pain stemming from rheumatoid arthritis.
He is careful not to take more pills than directed or drink alcohol, he said, and doesn’t believe the drugs have affected his driving. The one moving violation on his record since he started taking pain medication, a 2010 ticket for running a red light, was simply bad judgment and nothing to do with his meds, he said. “I’ve never felt out of control. I’ve never felt incapacitated. You grow accustomed to this. The only thing that changes are the levels of pain during the day. I would think that not taking pain relief is detrimental to you driving.”
Dr. Brian Wilhelmi, a Phoenix physician who has researched opioid-related DUIs, said that as America grows older and more obsess—two populations particularly reliant on prescription drugs—the problem will demand more attention from doctors, policymakers and law enforcement professionals. “I think this is an issue that will reach a tipping point with these kinds of accidents, and we’ll decide to get serious,” he said. “I definitely sense that it’s coming down the road.”
Chicago Tribune/October 3, 2013