Use Of Generic Drugs Research Articles

Assessing prescribing practices in Indian health facilities: a comprehensive review

Prescription patterns play a critical role in healthcare delivery, affecting the efficacy of medication therapy and resource utilization. Rational prescribing practices are essential for safe and effective healthcare, necessitating comprehensive prescriptions containing medication details, prescriber information, and patient instructions. This review explores prescription completeness and rationality, utilizing WHO prescribing indicators and other completeness metrics, across Indian healthcare facilities. A systematic search was conducted in PubMed and Google Scholar for original research articles published between 2013 and 2023, focusing on WHO-recommended prescribing indicators and completeness criteria. Inclusion criteria covered articles in English, spanning primary, secondary, or tertiary care settings. Data from selected articles were extracted and analysed. Data were synthesized from sixty-seven studies, depicting various prescribing practices. The assessment encompassed prescribing, patient care, and facility indicators. Findings highlighted challenges such as illegible prescriptions, incomplete details, polypharmacy, brand name dominance, and inappropriate antibiotic use. Despite WHO recommendations, generic prescribing was limited. This review reiterates the need for interventions to enhance prescription quality, patient safety, and cost-effectiveness. Recommendations include adopting electronic prescribing systems, standardizing prescription formats, conducting regular prescription audits, implementing educational programs, promoting generic drug use, and adhering to essential medicines lists. These multifaceted strategies can improve prescribing practices and ultimately contribute to enhanced healthcare outcomes in India.

Assessing the impact of COVID-19 on prescription patterns and antibiotic use: Insights from three military health facilities

BackgroundThe COVID-19 pandemic disrupted health systems globally and there are suggestions it impacted antibiotics prescribing patterns in clinical practice. ObjectivesThis study aimed to assess the effects of the COVID-19 pandemic on the prescribing patterns in three Nigerian military health facilities and investigate the factors associated with antibiotic prescriptions. MethodsThis was a two-year cross-sectional retrospective study. Three hospitals and a total of 11,590 prescriptions were purposively and conveniently sampled respectively. The World Health Organisation (WHO) and International Network of Rational Use of Drugs (INRUD) prescribing indicators were used to assess for polypharmacy, injection use, use of antibiotics, use of generic drugs and prescriptions from essential drug lists for the periods of the pandemic and before the pandemic. Indicators from both periods were compared for statistical significance using the independent t-test. Generalized linear modelling was applied to assess the factors associated with antibiotic prescriptions. The relationship between the receipt of antibiotics and independent variables was presented using incident risk ratios (IRR). ResultsOur findings showed that all five WHO/INRUD prescribing indicators were above the reference limit for the two-year study period. The study found there was a significant statistical difference between the COVID- and non-COVID-19 periods, with polypharmacy and antibiotic use indicators elevated during the pandemic compared to the latter. COVID-19 (IRR = 1.09), comorbidity (IRR = 1.74), pregnancy (IRR = 0.93), out-of-pocket payments (IRR = 1.10) and the inpatient department (IRR = 1.51) were associated with antibiotic prescriptions. ConclusionsThis provides insight on impact of the pandemic on prescription patterns and advocates for stewardship programs in clinical settings to ensure the rational use of drugs.

Association of hemoglobin-to-red blood cell distribution width ratio and depression in older adults: A cross sectional study

BackgroundThe association between hemoglobin-to-red blood cell distribution width ratio (HRR) and the depression in old adults was not clear. MethodsWe extracted data on depression, general characteristics, lifestyle, medical history, drug use, and blood indicators from the National Health and Nutrition Examination Survey 2005–2018 to investigate the relationship between HRR and depression. ResultsA total of 4141 individuals were evaluated, among whom 266 (6.4 %) were identified as having depression. HRR was significantly lower in the low depression group, and Spearman correlation analysis revealed an inverse association between HRR and depression scores (r = −0.148, P < 0.001). Multiple linear regression showed that HRR was associated with depression after adjusted for general characteristics, life style, medical history, drug use and blood indicators (P = 0.010). ROC analysis demonstrated that in participants with depression, the area under the curve (AUC) for HRR was 0.612, surpassing both Hb(0.586) and RDW(0.401). These findings were statistically significant (P < 0.05). LimitationsOnly participants aged 65–79 years are selected for this study and this was a cross-sectional study that can only represent an association between HRR and depression, but not a cause-and-effect relationship. ConclusionsHRR, being more potent than Hb or RDW, emerges as an independent risk factor for depression. It has the potential to facilitate early depression detection, aiding in the prevention of clinical deterioration or relapses, and could also serve as a viable treatment target.

A comprehensive review addressing the factors influencing generic drug substitution

Generic drug substitution is a common practice in healthcare systems worldwide to promote cost-saving treatments while maintaining therapeutic effectiveness. Several factors influence this substitution, including regulatory policies, safety and efficacy considerations, patient and physician preferences, and market dynamics. This review comprehensively analyzes how these factors interact and influence generic drug substitution in healthcare settings and across various therapeutic classes and highlight the importance of balancing cost-saving measures with maintaining patient safety and therapeutic efficacy. Policies and guidelines established by health authorities in each country influence the approval, interchangeability, and substitution of generic drugs. Bioequivalence and therapeutic equivalence are critical factors, particularly in drugs with narrow therapeutic indexes. Moreover, physicians’ acceptance and willingness to prescribe generic drugs, as well as patient acceptance and compliance with generic drug use, play a vital role in promoting generic substitution.

Necessity for a System Implementing Therapeutic Drug Monitoring in Outpatient Settings Based on the Actual Use of Voriconazole Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan: A Descriptive Epidemiological Study.

Voriconazole (VRCZ) is an antifungal drug that necessitates therapeutic monitoring (TDM). Typically, TDM is recommended for patients undergoing long-term outpatient treatment. However, in Japan, insurance reimbursement for TDM is only permitted for inpatients. There is a concern that VRCZ use is growing among outpatients, although information regarding this issue remains unavailable. Therefore, we aimed to clarify the use of VRCZ by utilizing data from the National Database of Health Insurance Claims and Specific Health Checkups in Japan. The use of branded and generic oral VRCZ from 2013 to 2019 was calculated using the defined daily doses/1000 inhabitants/d (DID) for each receipt type. Oral VRCZ was used more frequently in the outpatient setting than that in the inpatient setting, with use increasing over time. The use of generic drugs began in 2016 and accounted for 52.5% of the use in 2019 among outpatients. Considering outpatient prescriptions, 76.4-81.0% were dispensed at insurance pharmacies, indicating the need for community pharmacist involvement. Accordingly, the appropriate use of VRCZ in ambulatory care should be promoted in collaboration with community pharmacists, and a reimbursement system should be established to implement TDM in ambulatory care.

Lebanese pharmacists’ knowledge of generic drugs and factors affecting their use and selection following the pandemic and the economic crisis: A pilot cross-sectional study

Background Pharmacists are crucial in lowering pharmaceutical expenditures by substituting brand-name drugs for generic drugs. They are expected to understand the principles and practices of generic drug substitution for high-quality patient care. Some key areas of knowledge include bioequivalence and therapeutic equivalence, regulatory requirements, drug interchangeability, and adequate patient counseling. Objectives This study aims to assess the knowledge, perception, and practice of generic drug substitution among pharmacists in Lebanon following the crises and the factors affecting the prescription and selection of generic drugs. Methods A pilot descriptive cross-sectional study targeting 80 Lebanese pharmacists was conducted over 2 months (September-October 2022), in which data were collected using a uniform survey. Results Overall, pharmacists had a good knowledge of generic drugs in terms of active ingredients (97.5%), pharmaceutical form (85.0%), lower cost (88.7%), bioequivalence to the brand before (95.0%), and therapeutic equivalence. Nevertheless, 22.5% reported that generic drugs are less safe than brands, and 22.5% said they cause side effects or did not know. Among the possible factors that influence the prescription of generic drugs, 35.0% of pharmacists reported that the financial situation of the patient is among the least important factors, while the lack of possible alternatives (45.0%) and the difference in prices (40.0%) were the most important ones. The price of different generics on the market was among the most important factors (36.3%) affecting the selection of generic drugs, followed by the patient’s. preference (26.3%). Only 11.2% considered the information given by pharmaceutical firms could affect their choice, and 10.0% considered the presence or not of excipients with known effects in the formulation. Conclusion Most pharmacists in Lebanon were familiar with generic drugs and supported generic drug substitution. Factors affecting generic drug use and prescription should be further explored to clarify misconceptions and reduce possible adverse events.

Disentangling opioids-related overdose syndemics: a scoping review.

This article reviews research investigating the synergistic interaction of opioid-related morbidity and mortality with other social, psychiatric, and biological conditions, to describe how and why it is syndemic. Opioid-related overdose syndemics are driven by commercial interests, emerging in communities facing social and economic disadvantage, and interacting with a range of other health conditions. We included articles that empirically investigated an opioid-related syndemic, discussed syndemic co-factors associated with opioid use, or framed opioid consumption conceptually in relation to syndemics. Most articles were conducted in and first authored by investigators from North America. These articles were published in journals focused on general public health (n=20), drug use and addiction (n=18), and infectious disease or HIV (n=15). Most original research articles (n=60) employed quantitative methods. Unlike scholarship from other disciplines, specifically the controversial "Deaths of Despair" (DoD) framework, most research on opioid-related overdose syndemics fails to fully articulate the macro-structural drivers of localized disease clustering. Instead, the syndemics scholarship emphasizes the clinical manifestations of opioid and substance use, illustrating a problem in translation at the heart of syndemic theory. Moreover, syndemics scholarship on opioid impacts remains largely disconnected from the wider DoD discourse, which represents a missed opportunity for equity-oriented research. Re-directing attention to the sociopolitical forces that shape opioid-related overdose syndemics is necessary to prevent future commercially-driven health crises and repair lives harmed by these deadly syndemics.

Why purchase generic medicine? A theory of planned behavior perspective

AbstractThe use of generic drugs reduces healthcare expenditures, especially for those of lower socio‐economic status. This research employs a descriptive research design and utilizes a cross‐sectional survey to investigate the behavioral intention of patients toward generic medicines, supported by the theory of planned behavior. A structured instrument was used to gather data from 410 respondents who were aware of and consuming generic medicines. A structural equation modeling (SEM) analysis was performed with the semopy library in Python programming. The results demonstrate that all the constructs, namely, attitude, subjective norm, and perceived behavioral control in relation to buying generic medicines, have a significant relationship with behavioral intention to purchase generic medicines. Among all three constructs, perceived behavioral control has the strongest link with behavioral intention. Furthermore, family monthly medical expenses moderate the relationship between all three constructs of planned behavior and behavioral intention. This study could help healthcare professionals and policymakers to understand consumer intention and design information and educational programs accordingly to increase the awareness and usage of generic medicines. The outcome indicates that consumers prefer to purchase generic medicines due to the similar active ingredients, dosage, side effects, and effectiveness, as well as the low cost compared to branded ones.

Therapy of childhood acute lymphoblastic leukemia in resource-poor geospaces.

The therapy of children with acute lymphoblastic leukemia (ALL) in limited resource geospaces is challenging and must balance safety, efficacy, availability, and affordability. We modified the control arm of the St. Jude Total XI protocol for outpatient delivery including once-weekly daunorubicin and vincristine in initial therapy, postponing intrathecal chemotherapy until day 22, prophylactic oral antibiotics/antimycotics, use of generic drugs, and no central nervous system (CNS) radiation. Data were interrogated from 104 consecutive children ≤12 years (median, 6 years [interquartile range (IQR), 3, 9 years]. All therapies were given in an outpatient setting in 72 children. Median follow-up is 56 months (IQR 20, 126 months). A total of 88 children achieved a hematological complete remission. Median event-free survival (EFS) is 87 months [95% confidence interval (CI), 39, 60], 7.6 years in low-risk children (3.4, 8 years) whereas 2.5 years (1, 10 years) in high-risk children. The 5-year cumulative incidence of relapse (CIR) is 28% (18, 35%), 26% (14, 37%) in low-risk children and 35% (14, 52%) in high-risk children. Median survival for all subjects is not reached but must exceed 5 years. A total of 36 children relapsed at a median of 12 months (5, 23 months). Outcomes were comparable to those reported in the control arm of the Total Therapy XI study, but inferior to current treatment protocols in high-income countries. The average cost of the first 2 years of therapy was $28,500 USD compared with an average cost of approximately $150,000 USD in the US, an 80% saving. In conclusion, using an outpatient-based modification of the St. Jude Total XI protocol, we obtained good results with relatively few hospitalizations or adverse events and at a substantial saving. This model can be applied in other resource-poor geospaces.

Does Bad Medical News Reduce Preferences for Generic Drugs?

Policy makers and insurers promote the use of generic drugs because they can deliver large savings without sacrificing quality. But these efforts meet resistance from the public, who perceive generic drugs as inferior substitutes for brand name counterparts. Building on literature showing that negative emotions reduce risk-taking, the authors hypothesize that receiving bad medical news (i.e., negative information about one’s health) prompts patients to favor brand name over generic drugs as means to safeguard their health. The evidence exploits low-density lipoprotein cholesterol test results, where a discontinuity from clinical guidelines enables the authors to estimate the causal effect of bad medical news. Using data covering patients’ prescription drug choices across drug classes, the authors find that patients receiving bad medical news become 8% more likely to choose the brand name alternative. The findings are reinforced by a secondary analysis incorporating the similar context of hemoglobin A1c (blood sugar) testing. The authors also find that bad medical news reduces preferences for generics most strongly among drugs of direct clinical relevance for each test, but the effect also manifests among non–clinically relevant drugs.

RWD77 $0 Drug Copay Program Increases Generic Drug Use Among Members with Diabetes in Louisiana: Six-Month Outcomes Analysis

Blue Cross and Blue Shield of Louisiana (BCBSLA) designed the $0 Drug Copay (ZDC) program to reduce financial barriers by offering $0 copays for certain drugs, mostly generics, used to treat certain chronic conditions for eligible members with copay pharmacy benefits. The ZDC program has improved medication adherence and clinical outcomes, and reduced health care costs—as published in ISPOR’s Value in Health and the American Journal of Managed Care. This study’s purpose was to examine medication use patterns in members with diabetes.

Імунобіологічна реактивність організму корів за дисфункції яєчників

It is known that the immune status of the female organism changes dynamically at all stages of both the physiological and pathological state of the reproductive system. The work presents the results of scientific research and analysis of immunological studies in cows with ovarian dysfunction. We studied the nature and peculiarities of the relationships between the indicators of immunity and sexual function of infertile cows before and after treatment. The purpose of the research was to find out the dynamics of some morphological and biochemical blood indicators and the immune status of the body in cows with functional disorders of the ovaries. Certain regularities of the immune status in cows with persistent corpus luteum of the ovary and hypofunction of the ovaries have been established. The results of our research confirmed and supplemented previously established data on changes in hematological and immunological indicators in cows with ovarian pathology. It was established that the development of this pathology was accompanied by an immunodeficient state of the body, disorders of the cellular and humoral links of immunity, and a decrease in indicators of non-specific protection. Ovarian dysfunction in cows mainly develops against the background of immunosuppression and deficiency of indicators of cellular protection of the body, which was supplemented by a decrease in the content of erythrocytes, hemoglobin and total protein in the blood. A significant increase in the content of “0” mononuclear cells in the blood of sick cows indicates a violation of the mechanisms of lymphocyte differentiation, which negatively affects the formation of the body’s immune response. The imbalance of individual lymphocyte populations indicates the need for immunocorrection in order to increase the content of B and T cells, which will, accordingly, lead to a decrease in the share of low-active “0”-lymphocytes, and will contribute to the restoration of the immune defense mechanisms of the cows’ body. The decrease in indicators of individual factors of immunobiological reactivity of the body of cows with gonadal pathology substantiates the need for the use of general stimulating drugs with an immunomodulating effect.

Clinical Equivalence between Generic Versus Branded Antibiotics: Systematic Review and Meta-Analysis.

Regulatory authorities authorize the clinical use of generic drugs (GD) based on bioequivalence studies, which consist of the evaluation of pharmacokinetics after a single dose in vitro or in healthy individuals. There are few data on clinical equivalence between generic and branded antibiotics. Our aim was to synthesize and analyze the available evidence on the clinical efficacy and safety of generic antibiotics compared to their original formulations. A systematic review was performed on Medline (PubMed) and Embase and validated through Epistemonikos and Google Scholar. The last search was conducted on 30 June 2022. Meta-analyses of clinical cure and mortality outcomes were performed. One randomized clinical trial (RCT) and 10 non-randomized intervention studies were included. No differences in clinical cure were observed between groups in the meta-analysis (OR = 0.89, 95% CI [0.61-1.28]; I2 = 70%, p = 0.005). No difference was observed between groups when considering the use of carbapenems for overall mortality (OR = 0.99, 95% CI [0.63-1.55]; I2 = 78%) or death associated with infections (OR = 0.79, 95% CI [0.48-1.29], I2 = 67%). Most of the studies were observational, and the duration of follow-up, the characteristics of the participants, and the sites of infections were heterogeneous. Due to the uncertainty of the evidence, it is not possible to contraindicate the use of generics, which is an important strategy to expand access.

Hematopoietic cell transplants in resource-poor countries: challenges and opportunities

ABSTRACT Introduction Numbers of hematopoietic cell transplants continue to increase globally but most of this activity is in resource-rich countries. Limitations to increasing transplant activity in resource-poor countries include lack of sophisticated personnel and infrastructure, complexity in identifying and accessing donors, unavailability of some new drugs and high cost. Areas Covered We searched the biomedical literature for hematopoietic cell transplants and resource-rich and resource-poor countries. Recent advances which potentially make transplants more accessible in resource-poor countries include: (1) outpatient transplants; (2) grafts stored at 4°C; (3) less intensive pretransplant conditioning; (4) use of generic drugs; (5) less complex and costly donor access; and (6) increased collaboration with transplant centers in resource-rich countries. Expert Opinion We reviewed publications on the limitations and solutions discussed above. Paradoxically, most data we analyzed originate from resource-rich countries. We found no convincing epidemiological data to support a recent increased transplant rate in resource-poor countries yet but hope to see increases soon.

Defining and measuring 'inhalant' use in population-based surveys.

The term 'inhalants' is commonly used to describe a group of drugs that are characterised by the route of administration. There are three main sub-groups of inhalants; volatile solvents, alkyl nitrites, and nitrous oxide. These drugs all have different pharmacological properties, use patterns, and potential harms; yet they are sometimes grouped together in survey instruments. This critical review aimed to present a comparative analysis of how these inhalant drugs are defined, and use measured, across a range of population-level drug use surveys. Population-level drug use surveys of youth (n=5) and general population (n=6), which measured use of at least once type of inhalant drug, were analysed as case studies. The types of inhalants surveyed were extracted, as well as definitions of these drugs, from code books or survey methods. Differing definitions were used between surveys, and included differences between countries, and between surveys intended to measure youth and general population drug use. Of the six general population surveys; five reported nitrous oxide use, five reported volatile solvent use, and four reported alkyl nitrite use. Of the five youth-specific surveys; three reported volatile solvent use, whereas only one reported on alkyl nitrite use, and one reported nitrous oxide use. There is no consistent approach used to define or measure the use of inhalant drugs, which has implications for global comparisons and understanding drug use in different populations. We conclude that the term 'inhalants' should be discontinued, due to the limited value in continuing to group very different types of drugs solely on the basis of their route of administration. Improving the epidemiology of volatile solvents, alkyl nitrites, and nitrous oxide as distinct drug types will be of benefit to harm reduction, treatment, and prevention efforts, and ensure these are targeted appropriately to population groups and context of use.

Shortages of Prescription Drugs Due to Compliance and Quality Issues in Japan

Several good manufacturing practice (GMP) compliance issues and their associated quality problems that have been revealed since 2020 have led to large-scale recalls and supply suspensions of drug products in Japan. This paper provides an overview of the causes and countermeasures for supply disruptions of low-molecular-weight chemical pharmaceutical agents, focusing on quality-related issues. A recent increase in the use of generic drugs emphasized the importance of strengthening active pharmaceutical ingredient (API) supply chains and ensuring GMP compliance among drug manufacturers. In addition, increasing recalls in the drug products of certain marketing authorization holders due to storage stability problems strongly suggests the need to improve their development process considerably. Other measures to stabilize the supply of pharmaceuticals, including increasing stockpiles of APIs, were also discussed.

A study on assessment of knowledge and attitude about generic medicines among interns in a tertiary care hospital

According to a WHO report, approximately 55 million people in India are still living in poverty as a result of household out-of-pocket expenses for health care, particularly medications. Thus, it is imperative to keep healthcare costs as low as possible without limiting access to high-quality care. Increasing the use of generic medications can raise affordability of healthcare without sacrificing the standard of care. Doctors' prescriptions play an extremely significant role. In order to identify potential obstacles to the use of generic drugs, it may be helpful to understand the doctor's perspective about generic drugs.A cross-sectional study was carried out using a validated questionnaire that included questions to evaluate the participant’s knowledge and attitude on generic medicines. Data was collected using google forms and Chi square test was used to list association of knowledge and attitude.It was observed that attitude among interns were extremely significant whereas the knowledge was insignificant.According to the study, knowledge about generic drugs were not significant however they had significant attitude towards it so educating interns and medical students about generic drugs will promote more awareness about prescribing generic medicine.

Knowledge, perception and acceptance of generic drugs in the general Lebanese population: A cross-sectional survey among adults.

Many governments encouraged generic use to enhance health equality and minimise health expenditure. The lack of knowledge and acceptance of generic medicines are the main barriers to their use. This study aimed to assess population knowledge and perception towards generic drugs, identify their primary sources of information and examine which variables are independently related to their acceptance. An observational cross-sectional study was performed targeting the Lebanese adult population. Overall, 385 patients participated in the study. Data were collected using a uniform survey from six public healthcare centres. The participants reported a distrust towards generic drugs; they either said that they were not as effective as the brand (36.9%), were of less quality than the brand (38.5%) or had more side effects than the brand (38.4%). Around 52% said they would never buy a generic drug, and two-thirds (68.6%) preferred using a brand drug over a generic one. After adjusting for socio-demographics, a high income (odds ratio (OR) = 3.7), knowing that brands and generics have the same active ingredients (OR = 2.28) and that brands and generics were equally effective (OR = 6.46) were the strongest independent predictors for the willingness to buy generic drugs. A lack of knowledge and misperceptions about generic drugs limited the use of generic drugs, and therefore must be addressed.

Study of Factors to Increase the Usage Rate of Generic Drugs in Platelet Aggregation Inhibitors.

To reduce pharmacy-related medical expenses, it is necessary to reduce drug costs. One way to achieve this is by increasing the usage rate of generic drugs. The purpose of this study was to identify platelet aggregation inhibitors (PAIs) that contribute to high drug costs and are sold as brand-name drugs in order to increase the usage rate of generic drugs, and to analyze the factors that affect the usage rate of generic drug. We conducted a cross-sectional study based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan (NODJ) of the Ministry of Health, Labor and Welfare and datasets containing related medical information from official statistical surveys such as the Basic Survey on Wage Structure. Monthly personal income in each prefecture were negatively correlated with outpatient out-of-hospital and outpatient in-hospital prescriptions of the PAIs clopidogrel (75 mg), cilostazol (50 mg), cilostazol (100 mg), and ticlopidine (100 mg), but not between monthly personal income and outpatient out-of-hospital prescription of ticlopidine (100 mg). For outpatient out-of-hospital prescriptions and outpatient in-hospital prescriptions, negative correlation was generally observed between the usage rate of generic drug and monthly personal income, except for ticlopidine (100 mg), which has the lowest price among the brand-name drugs. The usage rate of generic PAIs is negatively correlated with monthly personal income. Promoting the use of generic drugs among high-income earners might be necessary to further increase the usage rate of generic drug.

Strong predictors of offender drivers: Drug and alcohol addiction and the inability to dissociate binge alcohol or drug consumption from driving. Revoking their driver’s licence may not be enough

The causes underlying traffic offender behaviour might be the tip of the iceberg that represents a persistent burden on global health and serves to detect other serious social, family, work problems. Better understanding and prevention of recidivism following a First-time driving under the influence conviction and analysis of High Risk offender driver behaviors are needed. This study seeks to identify the factors that predict an offender driver profile, analysing not only drivers’ general use of alcohol and/or drugs, but also their ability to dissociate the use of alcohol and other substances from driving. A total of 315 drivers — 97 offenders (95.9 % men) and 218 non-offenders (47.2 % men) responded to a battery of self-report evaluation questionnaires on: alcohol use habits (measured with the AUDIT); drug use (measured with the DAST-20); the ability of dissociating alcohol and substance use from driving; educational level; self-reported traffic violations, errors and lapses (measured with the DBQ, Driver Behaviour Questionnaire); and sociodemographic questions. The model showed good fit indicators (R2 = 0.74). It also displayed good predictive power: (1). It correctly classified 91 % of participants as offender or non-offender drivers. (2). More specifically, its sensitivity was 88 %, having correctly classified offenders as offenders. And its specificity was 92 %, having correctly classified non-offenders as non-offenders. The findings underscores that not only is alcohol use a key predictor of offending behaviour, but so is drug use. These addictions are a health problem, and their consequences are more serious when the afflicted individual drives a vehicle. This article makes evident that repeat offenders have a lower ability of dissociating alcohol and substance use from driving than do non-offender drivers. Non-offenders are shown to be more capable than offenders of dissociating consumption from driving: offender drivers are unable to dissociate the consumption of more than 5 spirit drinks, or the consumption of cannabis, from driving. More than half of non-offender drivers admitted to driving after having had 1 or 2 beers. Along these same lines, we found that offenders believe they have fewer lapses than non-offenders. This could be due to the optimism bias of bold offender drivers, who overestimate their abilities and underestimate their lapses. We also found that offender drivers have a lower educational level. Revoking the High Risk offender’s driver’s licence may not be enough. Instead, High Risk Offenders should be given the support they need to give up the consumption of alcohol and drugs, at least while driving. This could be achieved if they receive motivational interventions and are referred for detoxification treatment.