Opioids and the Risk of Motor Vehicle Collision: A Systematic Review

Abstract

Background: Opioid analgesics are among the most commonly prescribed medications, but questions remain regarding their impact on the day-to-day functioning of patients including driving. We set out to perform a systematic review on the risk of motor vehicle collision (MVC) associated with prescription opioid exposure. Method: We searched Medline, PubMed, EMBASE, Scopus, and TRID from January 1990 to August 31, 2021 for primary studies assessing prescribed opioid use and MVCs. Results: We identified 14 observational studies that met inclusion criteria. Among those, 8 studies found an increased risk of MVC among those participants who had a concomitant opioid prescription at the time of the MVC and 3 found no significant increase of culpability of fatal MVC. The 3 studies that evaluated the presence of a dose-response relationship between the dose of opioids taken and the effects on MVC risk reported the existence of a dose-response relationship. Due to the heterogeneity of the different studies, a quantitative meta-analysis to sum evidence was deemed unfeasible. Our review supports increasing evidence on the association between motor vehicle collisions and prescribed opioids. This research would guide policies regarding driving legislation worldwide. Conclusion: Our review indicates that opioid prescriptions are likely associated with an increased risk of MVCs. Further studies are warranted to strengthen this finding, and investigate additional factors such as individual opioid medications, opioid doses and dose adjustments, and opioid tolerance for their effect on MVC risk.

Changes in the burden of medications that may impair driving among older adults before and after a motor vehicle crash

“…First, our results may not generalize to younger adults or to the oldest old (since 12.5% of person‐crashes were ≥ 85 years), those without Medicare fee‐for‐service insurance or who were enrolled in Medicare due to disability, individuals who reside outside of the New Jersey area, crashes that did not result in a police officer responding to and reporting the crash, or to time periods after 2018. Second, we selected medication classes with some prior evidence to support the potential for increased MVC risk 7,21,22,26–32 . However, there is no accepted consensus for PDI medications and there may be other medication classes with adverse effects that could potentially impair driving ability.…”

“…Second, we selected medication classes with some prior evidence to support the potential for increased MVC risk. 7,21,22,[26][27][28][29][30][31][32] However, there is no accepted consensus for PDI medications and there may be other medication classes with adverse effects that could potentially impair driving ability. Nevertheless, we believe that we identified a comprehensive list of medications likely to impair driving ability.…”

Association between prescribed opioid dose and risk of motor vehicle crashes

“…47,75 Many epidemiologic studies show that individuals with opioid prescriptions or opioid-positive toxicology tests are at a greater risk of crash involvement, culpability, injuries, and fatalities than are individuals without prescriptions or with negative toxicology tests. 9,16,25,30,43,65 Although such studies may support the hypothesis of increased crash risk due to prescribed opioids, the threat of confounding from unmeasured factors that differentiate opioid recipients from nonrecipients has thus far precluded clear causal inferences. 16,25,54,61 Critically, confounding by indications for pain management is a possible alternative explanation for these associations.…”

“…46 Finally, we examined opioid dose-related differences, given that fewer observational studies have considered dosage. 31,43 2. Methods…”