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Dangers of prescription drugs and driving under scrutiny

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  1. Beenthere2Hippie
    [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

    About Author

    Beenthere2Hippie
    BT2H is a retired news editor and writer from the NYC area who, for health reasons, retired to a southern US state early, and where BT2H continues to write and to post drug-related news to DF.

Comments

  1. HarmRedThera
    I drive while immensely tired. I used to do it all the time, especially in grad school and in my consulting job. I've nearly died multiple times on the interstate between Lexington and Louisville. I dont' think there is a test for that. I took antidepressants for nearly 9 years, but never had the sedating effects. Those could be tested for. Finally, someone could have smoked a joint two weeks ago and still have THC present in their system, which could also be tested for. I think this article is a great example of the difficulty if not futility of expanding definitions of impaired driving in a way that is reasonable.

    Meanwhile, hundreds if not thousands die of preventable car accidents due to impaired driving. I've lost my sister to an auto accident that appeared drug related. A good friend of mine lost her father when she was a little girl to a drunk driver. Tens of millions of Americans drive in some form of impairment according to the above examples every day, which makes the impetus to find some form of regulation immensely strong as well as potentially extremely harmful to the lives of those same tens of millions of Americans as well as the entire economy.

    Great, messy article!
  2. imdoingit
    I have been driving for years and taking my meds and not one crash,moving viellation, anything,but I take my meds the way there procribed,driving on my meds isnt any diffrant than driving with a cup of coffee, but at first when i started my meds I didnt drive, the doc said that i should let somone else drive til I get used to them and now like i said it no diffrant than drinking with a cup of coffee and driving,
  3. jazzyj9
    Great article. I'm sure there are lots of meds that impair driving ability. Lots of psychiatric meds cause sedation. Seroquel is notorious for that. Sleep deprivation can also impair driving. I was driving back home after working the night shift and got stuck in traffic. I thought I would have to pull over because I have never felt that impaired before.
  4. Diverboone
    Driving under the influence does not only relate to alcohol but drugs as well. In Tennessee, driving or in physical control of any motor vehicle while under the influence of any legal or illegal drug including any intoxicant, marijuana, controlled substance, drug or substance affecting the central nervous system or combination thereof that impairs the driver’s ability to drive safely can be grounds for a DUI conviction according to § 55-10-401. Further, just because a doctor prescribed you a medication, this is not a defense for driving under the influence.
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