Effects of stimulant drugs on actual and simulated driving: perspectives from four experimental studies conducted as part of the DRUID research consortium

Ramaekers, Johannes G.; Kuypers, Kim P. C.; Bosker, Wendy M.; Brookhuis, Karel; Veldstra, Janna; Simons, Ries; Martens, Marieke; Hjälmdahl, Magnus; Forsman, Åsa; Knoche, Anja · 2012 · OpenAlex-citations

DOI: 10.1007/s00213-012-2766-1

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Summary

This commentary synthesizes findings from four experimental studies conducted under the European DRUID (Driving under the Influence of Drugs, Alcohol and Medicines) consortium to evaluate the impact of stimulant drugs on driving performance. The research aimed to provide a scientific basis for harmonized pan-European regulations regarding driving under the influence of stimulants. The studies utilized standardized, placebo-controlled designs involving actual and simulated driving scenarios. Key metrics included road tracking (measured by standard deviation of lateral position, or SDLP), car-following ability, and risk-taking behaviors. Clinical relevance was assessed using equivalence testing, comparing drug effects against a blood alcohol concentration (BAC) criterion of 0.5 mg/mL. The studies examined MDMA and dexamphetamine in isolation, combined with alcohol, and in the context of sleep deprivation. When taken alone at therapeutic or recreational doses, both stimulants generally produced neutral or slightly improving effects on driving measures, such as reduced SDLP and decreased subjective sleepiness. However, these stimulatory effects were insufficient to counteract impairments caused by other factors. In combination with alcohol, neither MDMA nor dexamphetamine mitigated the significant impairment in road tracking and increased risk-taking behaviors (e.g., shorter gap acceptance, more crashes) induced by alcohol. Equivalence testing for combined use yielded ambiguous results, indicating high individual variability where some subjects remained impaired while others did not. Sleep deprivation caused severe driving impairment, with SDLP increases equivalent to a BAC of approximately 0.8 mg/mL, exceeding the impairment levels of moderate alcohol intoxication. Neither MDMA nor dexamphetamine compensated for the deficits caused by sleep loss; driving performance remained significantly impaired regardless of stimulant dose. Furthermore, the studies found no dose-related effects on driving performance for either drug within the tested ranges. The authors note that experimental doses were lower than those often found in real-world driving under the influence (DUI) cases, where concentrations can be tenfold higher. The significance of these findings lies in the distinction between medicinal use and recreational abuse. While stimulants alone at regular doses may not impair driving, they pose significant risks when combined with sleep deprivation or alcohol, common in recreational settings. Crucially, stimulants increase subjective feelings of arousal and energy, which may lead users to underestimate their objective impairment. Consequently, the authors advise that regulatory frameworks should distinguish between therapeutic use and abuse, and drivers should be warned that stimulants do not mitigate the dangers of driving while fatigued or intoxicated.

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Topics

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• illicit drugs
• polydrug
• prescription meds
• sleep deprivation