Trends in benzodiazepine anxiolytics and z-hypnotics use among French drivers involved in road traffic crashes from 2005 to 2015: a responsibility case-control study

Orriols, Ludivine; Gbaguidi, Gwladys Nadia; Contrand, Benjamin; Gadegbeku, Blandine; Lagarde, Emmanuel · 2019 · Crossref

DOI: 10.1186/s40621-019-0209-8

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Summary

This study investigates the trends in the use of benzodiazepine anxiolytics and z-hypnotics among French drivers involved in road traffic crashes between 2005 and 2015, specifically assessing the impact of a color-graded pictogram warning system implemented in 2003. Benzodiazepines and z-hypnotics represent the largest share of crash risk attributable to prescription drugs in France. The research aimed to determine whether the introduction of standardized warning labels on drug packaging reduced exposure levels or altered the association between drug use and crash responsibility. The researchers conducted a responsibility case-control study using linked data from three national databases: police reports, the national police database of injurious crashes, and the national health care insurance database. The study included 201,458 drivers involved in injurious crashes from July 2005 to December 2015, categorized as either responsible (97,936) or non-responsible (103,522) for the crash based on a standardized scoring method. A control group of 105,909 individuals from the general population was matched by age and gender for the period 2008–2015. Exposure to benzodiazepines and z-hypnotics was estimated using prescription reimbursement records, with exposure periods defined by median prescription durations. The analysis compared exposure frequencies and crash risk odds ratios across six time periods, adjusting for confounders such as age, gender, alcohol use, and other medications. The results indicated that the proportion of drivers exposed to benzodiazepine anxiolytics or z-hypnotics remained stable among both responsible and non-responsible drivers throughout the study period. In contrast, exposure in the general population control group increased significantly from 2008 onwards. The association between benzodiazepine use and crash responsibility remained nearly constant, with adjusted odds ratios ranging from 1.42 in the initial period to 1.27 in the final period. A transient decrease in the association was observed immediately following the pictogram's introduction but disappeared in subsequent years. No significant interactions were found between drug exposure and demographic or clinical variables. The authors conclude that while the stability of exposure among crash-involved drivers relative to the increasing exposure in the general population suggests a relative effectiveness of the pictogram in limiting driver exposure, the persistent association with crash risk indicates that drivers did not significantly adapt their behavior or consumption patterns as intended. The findings imply that the warning labels alone were insufficient to modify driving behaviors or reduce the intrinsic risk associated with these medications.

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• prescription meds
• polydrug

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• Empirical Findings: observational prevalence, crash risk outcomes