Abstract
Opioids can impair motor skills and may affect the ability to drive; however, the association of opioid use with driving ability is not well established. To examine the risk of motor vehicle collisions (MVCs) among drivers starting opioid therapy compared with that among drivers starting nonsteroidal anti-inflammatory drug (NSAID) therapy. This population-based, retrospective cohort study included all residents of Ontario aged 17 years or older who started new prescription analgesic therapy between March 1, 2008, and March 17, 2019. Initiation of opioid therapy or NSAID therapy, ascertained through prescription dispensing records in administrative data. The primary outcome was an emergency department visit for injuries sustained as a driver in an MVC during the 14 days after starting analgesic therapy. Inverse probability treatment weighting was used to balance baseline covariates, and weighted Cox proportional hazards regression models were used to assess the association between new analgesic therapy and hazard of an emergency department visit after an MVC. Of the 1 454 824 individuals included in the study, 765 464 (52.6%) were new opioid recipients and 689 360 (47.4%) were new NSAID recipients. Most participants were aged 65 years or older (75.2%), and 55.2% were women. Of 194 individuals who had emergency department visits for injuries from an MVC within 14 days of initiating therapy, 98 (50.5%) were opioid recipients (3.41 per 1000 person-years; 95% CI, 2.80-4.15 per 1000 person-years) and 96 (49.5%) were NSAID recipients (3.64 per 1000 person-years; 95% CI, 2.98-4.45 per 1000 person-years). There was no significant difference in the risk of an emergency department visit for MVC injuries between opioid and NSAID recipients (weighted hazard ratio, 0.94; 95% CI, 0.70-1.25). The findings of this study suggest that the hazard of an emergency department visit for injuries relating to an MVC as a driver is similar between individuals starting prescription opioids and those starting prescription NSAIDs. These results may be useful for patients, clinicians, and caregivers when considering new analgesic therapy.
Highlights
Motor vehicle collisions (MVCs) are among the leading causes of unintentional morbidity and mortality in North America.[1,2] In 2018, there were 414 visits to an emergency department (ED) for injuries resulting from motor vehicle collision (MVC) per 100 000 population in Canada[3] and 1058 per 100 000 population in the United States.[4]
There was no significant difference in the risk of an emergency department visit for MVC injuries between opioid and nonsteroidal anti-inflammatory drug (NSAID) recipients
The findings of this study suggest that the hazard of an emergency department visit for injuries relating to an MVC as a driver is similar between individuals starting prescription opioids and those starting prescription NSAIDs
Summary
Motor vehicle collisions (MVCs) are among the leading causes of unintentional morbidity and mortality in North America.[1,2] In 2018, there were 414 visits to an emergency department (ED) for injuries resulting from MVCs per 100 000 population in Canada[3] and 1058 per 100 000 population in the United States.[4] The cause of MVCs is multifactorial, but a potential contributor is use of psychoactive medications such as prescription opioids. We examined the association of new opioid use with hazard of an ED visit related to an MVC with new use of nonsteroidal anti-inflammatory drugs (NSAIDs) as an active comparator because of the minimal psychoactive effects of NSAIDs.[11,12] Previous studies have shown that collisions associated with NSAID exposure are uncommon and are more likely associated with the underlying condition that prompted NSAID therapy.[11,12] NSAIDs make an ideal real-world comparison drug for opioids when evaluating the potential effects of the psychoactive properties of opioids. The objective of this study was to compare the short-term risks of ED visits for injuries from an MVC between drivers initiating prescription opioid therapy and drivers initiating NSAID therapy to differentiate the potential risk between the 2 prescription analgesic options
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