Abstract
BackgroundThe prevalence of prescription opioid use among drivers has increased markedly in the past two decades. The purpose of this study is to assess the associations of prescription opioid use and alcohol use with the risk of fatal crash involvement in US drivers.MethodsWe performed a population-based case-control study using toxicological testing data from two national data systems. Cases (n = 3606) were drivers involved in fatal motor vehicle crashes selected from the Fatality Analysis Reporting System and controls (n = 15,600) were drivers participating in the 2007 and 2013 National Roadside Surveys of Alcohol and Drug Use by Drivers. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) of fatal crash involvement associated with prescription opioid use with and without the presence of alcohol.ResultsOverall, cases were significantly more likely than controls to test positive for prescription opioids (5.0% vs. 3.7%, p < 0.001), alcohol (56.2% vs. 7.1%, p < 0.0001), and both substances (2.2% vs. 0.2%, p < 0.001). Relative to drivers testing negative for prescription opioids and alcohol, the adjusted ORs of fatal crash involvement were 1.72 (95% CI: 1.37, 2.17) for those testing positive for prescription opioids and negative for alcohol, 17.92 (95% CI: 16.19, 19.84) for those testing positive for alcohol and negative for prescription opioids, and 21.89 (95% CI: 14.38, 33.32) for those testing positive for both substances. The interaction effect on fatal crash risk of prescription opioid use and alcohol use was not statistically significant on either additive or multiplicative scale.ConclusionsPrescription opioid use is associated with a significantly increased risk of fatal crash involvement independently of alcohol use. Concurrent use of prescription opioids and alcohol is associated with a 21-fold increased risk of fatal crash involvement.
Highlights
The prevalence of prescription opioid use among drivers has increased markedly in the past two decades
Cases included in the study were similar to those eligible drivers excluded from the analysis due to missing toxicological testing data in crash circumstances, but were younger, more likely to be male (80.8% vs. 77.9%, p = 0.0034), more likely to have had a license suspension within the previous 3 years (59.1% vs. 51.9%, p < 0.0001), and more likely to be involved in nighttime crashes (68.4% vs. 62.3%, p < 0.0001)
Among the cases testing positive for alcohol, 87.5% had Blood Alcohol Concentration (BAC) ≥0.08 g/dl, compared with 19.7% of the alcohol-positive controls
Summary
The prevalence of prescription opioid use among drivers has increased markedly in the past two decades. Findings from epidemiological studies are conflicting, with most studies reporting significantly increased risks of crash involvement and crash culpability associated with prescription opioid use (Bruera et al 1989; Monárrez-Espino et al, 2013; Gjerde et al 2015; Rudisill et al 2016; Chihuri and Li 2017b, 2019) and others reporting no evidence of increased risk (Bachs et al 2009; Ray et al, 1992; Sims et al, 1998; Dussault et al, 2002) These inconsistences are likely caused in part by the increasing prevalence of prescription opioid use in drivers and differences in research methods and study populations. The purpose of this study is to assess the associations of prescription opioid use and alcohol use with the risk of fatal motor vehicle crash involvement
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