Abstract
The prevalence of prescription opioids detected in fatally injured drivers has increased markedly in the past 2 decades in the United States. It is unclear whether driver use of prescription opioids plays a role in fatal crash causation. To assess the association between driver use of prescription opioids and the risk of being culpable of crash initiation in fatal 2-vehicle crashes. This pair-matched study was based on data from the Fatality Analysis Reporting System for drivers involved in fatal 2-vehicle crashes on US public roads between January 1, 1993, and December 31, 2016. Data analysis was conducted from December 8, 2017, to December 7, 2018. Testing positive for prescription opioids compared with testing negative, and blood alcohol concentrations (BACs) based on toxicological testing results. Culpability of crash initiation and adjusted odds ratios and 95% CIs. A total of 36 642 drivers involved in 18 321 fatal 2-vehicle crashes were included. The most common driving error leading to fatal 2-vehicle crashes was failure to keep in lane (7535 [41%]). Drivers culpable of initiating the crashes were more likely than their nonculpable counterparts to test positive for prescription opioids (918 [5.0%] vs 549 [3.0%]; P < .001), alcohol (BAC ≥0.01 g/dL, 5258 [28.7%] vs 1815 [9.9%]; P < .001), and both substances (1.0% vs 0.3%, P < .001). The adjusted odds ratio of crash initiation was 2.18 (95% CI, 1.91-2.48) for drivers testing positive for prescription opioids compared with drivers testing negative, and increased with BACs (BAC 0.01-0.07 g/dL: adjusted odds ratio, 1.97; 95% CI, 1.75-2.22; BAC ≥0.08 g/dL: adjusted odds ratio, 8.20; 95% CI, 7.42-9.07; compared with BAC <0.01 g/dL). There was no significant interaction effect on crash initiation between prescription opioid use and alcohol use. Driver use of prescription opioids was associated with initiation of 2-vehicle crashes, independent of alcohol use. Clinicians should take into consideration the adverse effect of opioid analgesics on driving safety while prescribing these medications and counseling patients.
Highlights
Driving under the influence of drugs is a public health concern in the United States and around the world.[1,2,3,4,5] In the United States, motor vehicle crashes are the second leading cause of unintentional injury deaths after drug overdose.[6]
Drivers culpable of initiating the crashes were more likely than their nonculpable counterparts to test positive for prescription opioids (918 [5.0%] vs 549 [3.0%]; P < .001), alcohol (BAC Ն0.01 g/dL, 5258 [28.7%] vs 1815 [9.9%]; P < .001), and both substances (1.0% vs 0.3%, P < .001)
The adjusted odds ratio of crash initiation was 2.18 for drivers testing positive for prescription opioids compared with drivers testing negative, and increased with blood alcohol concentration (BAC) (BAC 0.01-0.07 g/dL: adjusted odds ratio, 1.97; 95% CI, 1.75-2.22; BAC Ն0.08 g/dL: adjusted odds ratio, 8.20; 95% CI, 7.429.07; compared with BAC
Summary
Driving under the influence of drugs is a public health concern in the United States and around the world.[1,2,3,4,5] In the United States, motor vehicle crashes are the second leading cause of unintentional injury deaths after drug overdose.[6]. In 2016, 11.5 million people aged 12 years or older reported that they had misused prescription opioids in the previous year.[16] Among patients who receive prescription opioids for chronic pain, 21% to 29% misuse them and 8% to 12% develop an opioid use disorder.[17] the overall opioid prescription rate per 100 persons has declined from 72.4% in 2006 to 66.5% in 2016, prescription rates remain high at more than 214 million total annual opioid prescriptions.[16] About 25% of US counties dispense opioid prescriptions enough for their entire respective populations and in some counties prescription rates for opioids are up to 7 times the national rate.[16,18] The prevalence of prescription opioids detected in drivers who died within 1 hour of crash increased from 1% in 1995 to 7.2% in 2015.15 Hydrocodone, oxycodone, and morphine are the most commonly detected prescription opioids among fatally injured drivers.[15] Few epidemiological studies have assessed the role of prescription opioids in fatal motor vehicle crash initiation
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