Road traffic crashes and prescribed methadone and buprenorphine: A french registry-based case–control study

Corsenac, Philippe; Lagarde, Emmanuel; Gadegbeku, Blandine; Delorme, Bernard; Tricotel, Aurore; Castot, Anne; Moore, Nicholas; Philip, Pierre; Laumon, Bernard; Orriols, Ludivine · 2012 · Crossref

DOI: 10.1016/j.drugalcdep.2011.10.022

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Summary

This study investigates the association between the use of prescribed methadone and buprenorphine for opioid substitution maintenance therapy and the risk of being responsible for injurious road traffic crashes. While experimental studies suggest that stable doses of these opioids do not significantly impair driving skills in tolerant patients, epidemiological evidence regarding crash risk in this population was previously lacking. The research aimed to determine if drivers under these treatments face an elevated risk of causing accidents compared to non-users. The researchers conducted a registry-based case-control study using data from three French national databases: the national health care insurance database, police reports, and the national police database of injurious crashes. The study period spanned from July 2005 to May 2008. Data were linked using drivers’ national health care numbers, gender, and date of birth. The final cohort included 72,685 drivers involved in injurious crashes, categorized as either responsible (cases) or non-responsible (controls) based on a standardized responsibility scoring method. Exposure to methadone or buprenorphine was defined by pharmacy dispensations within seven days prior to the crash. The analysis adjusted for confounding factors including age, gender, alcohol consumption, and concomitant use of other high-risk medications. The results identified 196 drivers exposed to buprenorphine or methadone on the day of their crash. These individuals were predominantly young males with high rates of co-consumption of alcohol and benzodiazepines. Drivers exposed to these opioids on the crash day had a significantly increased risk of being responsible for the crash, with an odds ratio (OR) of 2.02 (95% confidence interval [CI]: 1.40–2.91). When analyzed separately, buprenorphine use was associated with increased responsibility risk, while methadone showed no significant association, likely due to smaller sample sizes. Drivers who had received a dispensation within the six months preceding the crash also showed an elevated risk (OR=1.70, 95% CI: 1.36–2.14). The authors conclude that patients treated with methadone or buprenorphine are at a doubled risk of being responsible for injurious road traffic crashes. They argue that this risk is likely not solely due to the pharmacological effects of the drugs, as experimental studies show minimal impairment in tolerant patients. Instead, the increased risk is attributed to a combination of risky behaviors inherent to this population, such as high rates of alcohol and benzodiazepine co-consumption, and potential misuse of the medications. The study highlights the need for further research to disentangle the effects of treatment from behavioral factors in opioid-dependent drivers.

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Topics

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• opioids
• illicit drugs
• polydrug
• induced exposure
• incidence prevalence
• prescription meds

Information type

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• Empirical Findings: crash risk outcomes, observational prevalence
• Methodological Resource: dataset resource