Influence of Peak and Trough Levels of Opioid Maintenance Therapy on Driving Aptitude

Abstract

To evaluate driving aptitude and traffic-relevant performance at peak and trough medication levels in opioid-dependent patients receiving maintenance therapy with either buprenorphine (mean: 13.4 mg) or methadone (52.7 mg) and a medication-free control group, the Addiction Clinic at Medical University Vienna conducted a prospective, open-label trial where 40 opioid-dependent patients maintained either on buprenorphine or methadone were assessed regarding their traffic-relevant performance. Using the standardized Act and React Testsystem (ART) 2020 Standard test battery, traffic-relevant performance was analysed 1.5 h (peak level) and 20 h (trough level) after administration of opioid maintenance therapy. Results showed that patients at trough level had a significantly higher percentage of incorrect reactions (p = 0.03) and more simple errors (p = 0.02) than patients at peak level as well as methadone-maintained patients at peak level tended to perform less well than buprenorphine-maintained patients in some of the test items, e.g. methadone-maintained patients at trough level had a higher number of delayed reactions in the RST3 phase 2 test (p = 0.09) and answered fewer questions correctly in the visual structuring ability test (p = 0.04). This investigation indicates that opioid-maintained patients did not differ significantly at peak vs.trough level in the majority of the investigated items and that both substances do not appear to affect traffic-relevant performance dimensions when given as a maintenance therapy in a population where concomitant consumption would be excluded.

Psychiatric comorbidities in opioid-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study

“…The effects of OAT on patient´s driving ability are controversial (Baewert et al, 2007;Fishbain et al, 2003;Loeber et al, 2012;Schindler et al, 2004). Although OAT might impair driving ability, it does so to a less degree than other psychotropic agents or drugs of abuse (Soyka, 2014).…”

Can Patients Receiving Opioid Maintenance Therapy Safely Drive? A Systematic Review of Epidemiological and Experimental Studies on Driving Ability With a Focus on Concomitant Methadone or Buprenorphine Administration

“…The number of tests performed per study ranged from 1 to 52. Finally, 5 separate studies, including a total of 10 tests, reported some improvement (Baewert et al 2007;Gordon 1970;Mintzer et al 2005;Prosser et al 2009;Specka et al 2000).…”

“…A total of 28 studies, focusing on performance among MMPs compared to various control groups, were included (Appel 1982;Appel and Gordon 1976;Baewert et al 2007;Darke et al 2000;Davis et al 2002;Dittert et al 1999;Ersche et al 2006;Gordon 1970;Grevert et al 1977;Gritz et al 1975;HauriBionda et al 1998;Hornung et al 1995;Kubitzki 1997;Lenne et al 2003;Mintzer et al 2005;Mintzer and Stitzer 2002;Moskowitz and Robinson 1985;Pirastu et al 2006;Prosser et al 2006Prosser et al , 2009Rapeli et al 2007 2015 2005), and the most relevant information is summarized in Table 3. Patient group sizes studied were between 9 and 54 subjects, with doses ranging between 2 and 150 mg.…”

“…Only 7 studies dealt with the performance among BMPs compared to various control groups (Baewert et al 2007;Lenne et al 2003;Messinis et al 2009;Pirastu et al 2006;Rapeli et al 2007;Schindler et al 2004;Soyka et al 2008), where 6 studies found impairment. The total number of tests revealing impairment was 22 out of a total of 83 (n = 15-22, daily doses ranging from 6.78 to 15.8 mg/day).…”

“…The total number of tests revealing impairment was 22 out of a total of 83 (n = 15-22, daily doses ranging from 6.78 to 15.8 mg/day). Improvement was seen in one single test (n = 20, 13.4 mg of buprenorphine/day; Baewert et al 2007). …”