Opioid use increased risk for road trauma

Drivers prescribed high doses of opioid analgesics were at a 42% increased odds of experiencing some type of trauma related to vehicular accidents, according to recent study results published in JAMA Internal Medicine. The findings raise certain questions about prescribing high-dose pain killers.

“Road trauma and the toxic effects of prescription drugs represent two leading causes of accidental death in North America, resulting in substantial avoidable public health and economic losses,” the researchers wrote.

The study, conducted in Ontario, Canada, included 5,300 adult cases of road trauma that were equally matched with a control population. All study participants received at least one publically funded prescription for an opioid, which ranged from very low to very high doses (<20 to ≥200 morphine equivalents daily). Road trauma cases included drivers, passengers and pedestrians.

Results indicated a significant association between opioid dose and road trauma. For example, drivers prescribed low doses had a 21% increased odds of road trauma (95% CI, 1.02-1.41) vs. drivers with very low doses. Drivers with moderate doses were at a 29% increased risk (95% CI, 1.06-1.57), and high doses at a 42% increased risk (95% CI, 1.15-1.76).

However, drivers with very high opioid doses were at a 23% increased risk for road trauma (95% CI, 1.02-1.49), a decrease in risk compared with high doses that may be explained by medication diversion or physiologic opioid tolerance among those patients who had underwent long-term treatment. The association between the opioid dose and risk for road trauma was not observed among passengers, pedestrians and others injured in road trauma, nor was there any significant association between escalating opioid dose and risk for road trauma.

“Physicians may want to warn patients about potentially decreased driving ability when escalating to high opioid doses, particularly before acclimation to a fixed dose develops,” the researchers wrote. “Furthermore, policymakers could improve public education surrounding the potential risks of opioid medications and could consider restricted drivers’ licenses for patients treated with high-dose relationships.”

In July, the FDA announced that drugmakers must provide voluntary classes to doctors who prescribe opioids. However, the agency stopped short of requiring physicians to attend special training.

In an accompanying editorial, Mitchell H. Katz, MD, of the Los Angeles County Department of Health Services, said road trauma as a result of impairment from opioid use represents another reason to reconsider the benefits and harms prescribing high-dose opioids.

“As physicians, the relief of pain and suffering is core to our mission,” Katz wrote. “It is so tempting to prescribe and steadily increase the doses of opioids for our patients with chronic pain because we believe that we have no alternative treatments. However, we must accept the limitations of our current chronic pain armamentarium and resist prescribing more opioids just because we believe that we have nothing better to offer. In the case of opioids for chronic pain, for the sake of our patients, less is often more.”

For more information:

Gomes T. JAMA Intern Med. 2013;173:196-201.

Katz MH. JAMA Intern Med. 2013;173:178.

Disclosure: The researchers report no relevant financial disclosures.