Fentanyl and Driving Impairment

Abstract

The incidence of fentanyl in forensic toxicology analyses in the U.S. has dramatically increased over the past several years. The increase in death cases has been well studied, however little has been reported on the impact to drug impaired driving. Fentanyl driving under the influence of drugs (DUID) case data from 2014 to 2019 is presented. The data was obtained from three toxicology laboratories in the Northeast, Southeast, and Midwest regions of the U.S. Fentanyl whole blood concentrations ranged from 0.1 ng/mL to 157 ng/mL in living drivers with a 466% to 524% increase in fentanyl positive DUID cases from 2014 to 2019 depending on the U.S. region. The vast majority of fentanyl cases involved poly-drug use. Twenty case histories are presented where fentanyl was the only drug identified. The mean (SD) fentanyl concentration for these cases was 5.2 ± 3.8 ng/mL with a median of 3.7 ng/mL and the concentrations ranged from 2.0 to 16 ng/mL. Naloxone administration was documented in exactly half of these cases similar to another study involving carfentanil impaired driving. The case histories also demonstrate that some recreational opioid users may display limited signs of impairment either due to tolerance or naloxone administration. The top three observations in common among the cases were the driver was found unresponsive behind the wheel, the vehicle left the travel lane or roadway, and the driver was involved in a crash. The increase in fentanyl use not only poses a risk for overdose and death, but is also a significant concern for traffic safety. This study supports the movement of fentanyl from a Tier II drug to Tier I due to its significant potential for impairment and increase in prevalence in impaired driving cases.

Heroin and fentanyl in Dallas County: A 5‐year retrospective review of toxicological, seized drug, and demographical data

“…Consistent with other reports on the increase in overdose deaths due to fentanyl, rising concentrations in drivers, and increase in seized drug evidence identified as fentanyl, the Toxicology and Drug Laboratories at SWIFS also observed an increase in fentanyl positive cases each year from 2015 to 2020 [4,14,15]. The number of heroin/6-MAM positive cases remained stable over the six-year period, underscoring concurrent use of heroin and fentanyl as users began to supplement or substitute fentanyl for heroin [16,17].…”

Trends in Prescription Opioid Use in Motor Vehicle Crash Injuries in the United States: 2014–2018

“…To the best of our knowledge, this is the first study reporting a decreasing trend in opioid-involved MVC injuries. A study on blood fentanyl concentrations in impaired drivers from 2014–2019 found that their prevalence increased from 4% to 22% in New Hampshire and from 7% to 40% in Florida; however, the illicit use of drugs was apparent in 60% of the fentanyl-involved cases [ 5 ]. In our study, we observed a 39% decrease in the prevalence of prescription fentanyl after the CDC guidelines in 2016, suggesting that policy measures may have been effective in reducing the involvement of prescription fentanyl in MVC injuries.…”

“…In our study, we observed a 39% decrease in the prevalence of prescription fentanyl after the CDC guidelines in 2016, suggesting that policy measures may have been effective in reducing the involvement of prescription fentanyl in MVC injuries. The illicit use of opioids is hard to ascertain in fatally injured drivers and fentanyl concentrations in blood are hard to interpret [ 5 ]; therefore, the illicit use of opioids, including fentanyl, was seldomly reported in previous studies. As the illicit use of opioids is an important risk factor for impaired driving, future studies are needed to investigate the impact of the illicit use of opioids on driving safety.…”

“…MVC-related injuries cause substantial economic burdens to society due to medical costs and productivity losses [ 3 ]. Exposure to opioids can cause drowsiness, confusion, nausea, impaired driving performance, and poor psychomotor outcomes (e.g., reaction time) [ 4 , 5 , 6 ]. A meta-analysis showed that people taking prescription opioids were more than twice as likely to be involved in MVC as those not taking them [ 7 ].…”

Quantification of fentanyl analogs in oral fluid using LC‐QTOF‐MS

“…More recently, Rohrig et al report a drastic increase in the percentage of fentanyl‐related DUIDs reported in various geographical locations (north‐ and southeast, midwest) in the United States. Twenty case studies of individuals driving under the influence of fentanyl are also reported with concentrations in blood ranging from 2.0 to 16 ng/mL (5). Increasing reports of fentanyl and fentanyl analog reports in DUID cases presents a major public safety issue that requires the need for routine, advanced forensic toxicological analyses.…”