Abstract
Introduction: Patients in stable Opioid Maintenance Treatment (OMT) for opioid-dependence are, as a rule, considered fit to drive a car. Polypharmacotherapy, however, is common in opioid-dependent patients, and its association with driving fitness is not well known. Therefore, we examined driving fitness of 22 OMT patients of whom the majority were multidrug-treated patients. Material and methods: The assessment included a standard on-road driving test, clinical neurological examination, and cognitive driving-related tests. The OMT patients were grouped on the basis of their psychoactive medications into two groups. The first group was considered to have a low probability for drug-related driving impairment (n=10). This group included patients treated with opioid agonist alone or along with the second generation antidepressant or lithium. The second group included patients with probable drug-related driving impairment (n=12). All patients in this group were given at least one benzodiazepine (BZD) drug, Results: In neurological evaluation all OMT patients met the basic requirements for driving. In the driving test, all patients in the group with ‘improbable drug-related driving impairment’ and all except one in the group with ‘probable drug-related driving impairment’ were found fit to drive. However, in the driving test total score and two driving-related cognitive tests, the group with ‘probable drug-related driving impairment’ scored significantly lower than the improbable group (p=0.021, 0.001, and 0.028, respectively). Two cases with ‘probable drug-related driving impairment’ are described in detail. Conclusions: The results of this case series give support for the notion that OMT patients in stable treatment, in general, are fit to drive. When assessing the driving fitness of individual OMT patients with polypharmacy, combining pharmacological and non-pharmacological information is essential, as shown by two case descriptions.
Highlights
Patients in stable Opioid Maintenance Treatment (OMT) for opioid-dependence are, as a rule, considered fit to drive a car
The study participants were unpaid volunteer opioid-dependent patients admitted for OMT in the addiction clinics of Helsinki, Tampere, or Jyväskylä area
Four volunteer patients were excluded on the basis of a positive drug screen for illicit drug use
Summary
Patients in stable Opioid Maintenance Treatment (OMT) for opioid-dependence are, as a rule, considered fit to drive a car. Polypharmacotherapy, is common in opioid-dependent patients, and its association with driving fitness is not well known. On the basis of systematic review, it has been concluded that short-term treatment with an opioid drug is associated with cognitive deficits and reduces driving fitness [2]. Opioid-dependent patients, have high tolerance for opioid effects and many of them feel that they are competent to drive soon after a stable maintenance dose has been achieved. Statistics show that opioid users have elevated risk of traffic accidents, while experimental evidence on effects of long-term OMT on driving is limited [5]
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