Prescription Opioids and Driving Risk: A Comparison by Dose and Medical Use and Misuse

driver holding steering wheel fuzzy mind

The purpose of the pilot study is to compare the patterns of prescription opioid use, individual characteristics, driving behavior, and driving outcomes of three groups: high-dose (>50mg morphine equivalent per day [MME]) medical users, high-dose prescription opioid misusers, and low-dose (<50MME) opioid users. Non-medical opioid users will not be included due to the small scope of the study and extra resources required to recruit this group; and because a primary intention of the proposed study is to identify opportunities to intervene in conjunction with opioid prescribing. Participants will be recruited at pain clinics and asked to complete an online survey and to provide permission to obtain their Michigan driver history and electronic medical records.

The specific study objectives will be to characterize: 1) Driving risk behavior and driver history outcomes; 2) Patterns of prescription opioid use/misuse and Alcohol and other drug (AOD) use/misuse/abuse; 3) Interactions between driving and opioid use/misuse that represent elevated risk; and 4) Individual beliefs, attitudes and psychological characteristics related to prescription opioid use and driving risk. These will be examined overall and in comparison across groups. Sex differences will also be examined. Hypotheses are: 1) participants in the high-dose misuse group will report more driving risk behavior and have driver histories records that include a greater number of crashes and moving violations compared to the other two groups; 2) patients who misuse prescription opiates will also have greater AOD compared to the other two groups, which will not differ from each other; 3) the two high-dose groups will report more interactions of opioid use and driving that reflect high risk compared to the low-dose group, and that patients who misuse prescription opioids will have the greatest driving risk; 4) greater risk-taking, sensation seeking, and involvement in other injury-risk behaviors will predict higher odds of misusing prescription opiates in this sample of patients receiving treatment for pain. Sex differences will also be examined.

This pilot study examined the individual characteristics, driving behavior, and driving outcomes among adult emergency department (25-60 years old) seeking care who report medical use and misuse of prescription opioid medications. Study aims include identifying: 1) Patterns of prescription opioid use/misuse, as well as alcohol and other drug (AOD) use/misuse/abuse among adult patients seeking ED treatment; 2) Interactions between opioid use/misuse and driving behaviors, including risky driving behaviors such as driving under the influence of opioids (DUIO); 3) Individual beliefs, attitudes and psychological characteristics related to prescription opioid use. Results will have implications for understanding how to design behavioral interventions to address prescription opioid misuse and associated consequences, such as driving under the influence of opioid medications. Among participants endorsing opioid use (n=240), 52% of participants reported a recent history of driving under the influence of opioid medications – defined as: 1) any driving after opioids in the past 3-months; 2) any crash within 4 hours of taking opioids; 3) any driving under the effects of opioids in past 30 days. Within the bivariate analysis, those reporting driving under the influence of opioids were less likely employed (either full or part-time) – 20.9% vs. 31.8% (p<0.01) and more likely on Medicaid insurance (20.9% vs. 13.4%, p<0.01). No differences were noted between those endorsing DUIO and those not DUIO with regards to age, gender, race, and income. Patients endorsing DUIO were more likely to endorse medical misuse (30.9% vs. 19.6%, p<0.001) or non-medical opioid use (3.0% vs. 1.7%, p<0.001) than those without DUIO. Further, those with DUIO were less likely to report appropriate medical use of opioids (14.4% vs. 30.4%, p<0.001). Those with DUIO were also more likely to endorse risky driving (42.7% vs. 38.9%, p<0.01) and higher levels of sensation seeking (10.2 vs. 9.0, p<0.05). No differences were noted in recent crash history (i.e., past 3 months) or traffic tickets. Findings seem to suggest that driving under the influence of opioids is more likely associated with patients who use opioids inappropriately, either through misuse of prescribed opioids or for non-medical use of prescription opioids. Final data analysis and models are pending.