DRUGS AND ROAD SAFETY

Megha Jain, Dr. Alok Khunteta,  S K Swarnkar, Kishnendra Jain

LBS College of Pharmacy, Tilak Nagar, Jaipur, Rajasthan

There is growing concern around the world about drug use and road safety. Drinking alcohol and driving is a well studied risk factor for road traffic crashes, injuries and deaths but drug-induced impairment of driving is causing increasing concern in many countries around the world. For many years there have been several gaps in our knowledge, particularly about the global extent of the problem, the relationship between drug concentrations and crash risk, appropriate threshold limits in blood, legislation and enforcement of effective measures to prevent drug-driving. However, these knowledge gaps are progressively being filled by a growing body of evidence on drug use and road safety, including effective ways to reduce drug-induced road traffic crashes and injuries. This document focuses on drug-driving and not on drink-driving.

Drugs can interfere with factors that are essential for safe driving, such as:

• Coordination – needed for steering, braking, accelerating, and manipulating the vehicle;
• Reaction time – needed to respond in time and appropriately deal with certain situations;
• Judgment – helps with risk assessment, avoidance of hazards, and emergency decision-making;
• Tracking – helps to stay in the lane and maintain the correct distance from other cars and obstacles;
• Attention – ability to handle the high demand for information-processing ;
• Perception – needed for glare resistance, dark and light adaptation, and dynamic visual acuity.

The reactions caused by certain types of medication may include nausea, drowsiness, blurred vision, inability to think clearly, reduced coordination and diminished motor or judgment skills and can therefore impair your ability to drive.  These medications include over-the-counter medication as well as scheduled medication, prescribed by the doctor.

Care should be taken with medication developed to treat:

• Sleeping difficulties
• Anxiety, depression and stress
• Pain (medication with codeine or opiates)
• Allergies
• Colds and flu
• Arthritis
• Blood pressure
• Epilepsy
• Heart conditions
• Fluid retention
• Nausea and motion sickness
• Stomach problems
• Diabetes
• Some types of infections

Three categories of psychoactive drug are relevant to the risk of road traffic injury.

Illicit drugs (e.g. cocaine, heroin, methamphetamine, cannabis) are under international control and are largely produced and consumed for nonmedical purposes.

Prescription drugs (e.g. antidepressants, benzodiazepines, opioid analgesics) can be bought legally or prescribed by a doctor for the management of acute or chronic medical conditions.

New psychoactive substances (e.g. synthetic cannabinoids, synthetic cathinones) are synthesized and consumed for nonmedical purposes with expectation of effects of well-known illicit drugs.

Table 1: Ways in which different drugs affect brain functioning

DRUG CLASS	DRUG	IMPAIRMENT
		Drowsiness	Congestive function	Motor function	Mood	Lateral vehicle control	Time estimation	Balance
ILLICT DRUGS	CANNABIS	YES	YES	YES	YES	YES	YES	YES
	COCAINE	–	YES	YES	YES	–	–	YES
	AMPHETAMINES	–	YES	YES	YES	–	YES	YES
	MDMA	–	YES	–	YES	–	–	YES
	HALLUCINOGENS	–	YES	YES	YES	–	YES	YES
PRECRIPTION DRUGS	BENZODIAZEPINES	YES	YES	YES	–	YES	–	YES
	OPIOIDS	YES	YES	YES	YES	YES	–	YES
	OTHER DEPRESSANTS	YES	YES	YES	YES	YES	–	YES
NEW PSYCHOACTIVE SUBSTANCE	SYNTHETIC CANABINOIDS	YES	YES	YES	YES	YES	YES	YES
	SYNTHETIC CATHINONES	–	YES	YES	YES	–	–	–

       Yes  : the drug has an impairment effect;  – :the drug has no impairment effect.

 

Many medications – particularly those that affect the central nervous system – can impair your ability to drive, for example:  muscle relaxants, sedatives and tranquilizers, anticonvulsants, older generation antidepressants, such as tricyclics and central nervous stimulants.  It remains in the body for several hours and will probably affect driving skills even on the next morning.

Over-the-counter medications containing diphenhydramine, brompheniramine, or chlorpheniramine, such as those for allergies (antihistamines) are especially known to cause drowsiness.  One study in the Annals of Internal Medicine suggested that a standard dose of the antihistamine had a greater negative effect on driving “coherence” than alcohol.  Driving coherence is the ability to match the speed of the vehicle ahead to avoid accidents.

This study also suggested that antihistamines and alcohol had similar effects on steering ability and the likelihood of crossing into another lane.  Herbal remedies that interact with prescription or over-the-counter medications as well as medications administered to the eye, which can produce heightened light sensitivity, should also be avoided when driving.

Epidemiology of drug use and road traffic injuries

Surveys and laboratory tests from various countries show that psychoactive drug use is reported frequently by drivers or detected in the biological fluids of injured or killed drivers. For instance:

• Roadside surveys show that the prevalence of any psychoactive drug among drivers ranges from 3.9% to 20.0%.
• Population surveys show that self-reported driving after using psychoactive drugs (mostly cannabis) varies in different countries between 3.8% and 29.9%.
• Prevalence of drug use (such as amphetamines, benzodiazepines, cannabis and cocaine) among fatally injured persons in a road traffic crash ranges from 8.8% to 33.5%.

 

In 2013, illicit drug use was estimated to be responsible for just over 39 600 road traffic deaths worldwide. Amphetamine use was estimated to cause around half of these deaths while cannabis was estimated to cause one fifth of them (Figure 2). Although there were more deaths due to drink-driving worldwide in the same year (just over 188 000), the risk of death from drug-driving remains high.

Figure 2: Analysis of Road traffic deaths due to drugs

Prevention and early interventions

Measures that need to be in place and implemented in a comprehensive manner cover five essential areas: legislation, testing, enforcement, awareness-raising, and counselling and treatment.

• Establishing drug-driving laws and regulations

The type of legal framework varies according to the social, legal and economic characteristics of a particular jurisdiction, as well as the historical context of the development of laws designed to improve road user safety.

1. Zero tolerance laws make it unlawful to drive with any amount of specified drugs in the body.
2. Impairment laws make it unlawful to drive when the ability to drive has become impaired following drug use, often described as being “under the influence” or in similar terms.
3. Per se laws make it unlawful to drive with amounts of specified drugs that exceed the maximum set concentration. The specific link between drug concentration, impairment and the risk of a crash still needs more research. To date, a few countries, including the United Kingdom, have adopted per se laws (Box 1).

A total of 159 countries around the world have national legislation prohibiting drug-driving but most of these laws do not define what is considered to be a “drug”, nor do they specify a threshold. It will be difficult to enforce drug-driving laws in countries that have neither defined what is considered to be a “drug” nor specified a threshold.

Box 1: Drug-driving legislation in the United Kingdom In 2012, the government of the United Kingdom announced a new offence in relation to driving with specific controlled drugs in the body above the limit specified in regulations. The Crime and Courts Act inserted a new section 5A in the Road Traffic Act 1988. Thus, on 2 March 2015, new regulations came into force in England and Wales, addressing eight general prescription drugs and eight illicit drugs. Regulations on amphetamines came into force on 14 April 2015. Department for Transport, United Kingdom.

 

 

Box 2 Teen drugged driving: an activity guide for parents, coalitions and community groups The Teen drugged driving toolkit, released in 2011 in the USA, was created to provide coalitions, prevention groups and parent organizations with: • facts on the danger and extent of teen and young adult drug-driving; • activities for effective prevention; and • resources to further assist in prevention activities. Evidence shows that, because teens are the least experienced drivers as a group, they have a higher risk of being involved in a road traffic crash compared with more experienced drivers. When this lack of experience is combined with the use of marijuana or other substances – which alter perception, cognition, reaction time and other faculties – the results can be tragic. The included activities were designed to raise awareness about drug-driving, to give parents and community leaders tips and advice on identifying the risks of drug-driving, to encourage local media to raise awareness of the dangers of drug-driving, and to educate parents and teens about the issue. The first activity consisted of a programme guide to host a drug-driving prevention night (including discussion guide and media pitch materials). The second activity was the development of guidelines for a drug-driving poster contest (including promotional language, discussion guide and sample teen posters). This toolkit has been distributed to more than 600 Drug-Free Community programmes in all 50 states of the USA, and has been utilized by youth-serving non-profit organizations – including Students Against Destructive Decisions (SADD) and National Organizations for Youth Safety (NOYS).

 

• Testing for drug use

Testing and/or detecting drugs can be done at the roadside and in hospital emergency rooms or other settings to determine the extent of drug use among drivers and other road users. It is important to detect and monitor the trend in the use of drugs among drivers and other road users continuously to determine the scale of the problem and to develop appropriate measures. Where a threshold concentration has been specified in legislation, in order for the legislation to work, enforcement officers must be trained to collect samples of bodily fluid for testing. For drugs that as yet have no set threshold, enforcement officers must be trained to recognize clinical signs and symptoms of drug use, assess impairment, and take samples to determine the type and concentration of substance present. The type and concentration of substance present can also be tested on injured persons attending hospitals or emergency rooms.

• Enforcing drug-driving laws

It is critical that a drug-driving law is visibly and regularly enforced. In addition,            appropriate penalties should be imposed to support compliance with the requirements of the law. Without visible enforcement and swift penalties, a drug-driving law has   little chance of changing behaviour.

• Raising awareness of drug-driving

Raising awareness of drug-driving and its impact on road safety – including deaths, injuries, property damage and harm to other road users – among the general public and policy-makers can reduce drug-driving and create a climate in which legislation and enforcement will be supported

Drug use and

• Counselling and treatment

It is important not only to enforce drug-driving laws but also to counsel and, when appropriate, treat drivers found to be impaired by drugs – especially those who are repeat offenders or those with drug-use disorders

Box 3: Public health sector role • Support and provide preventive interventions, counselling and, when appropriate, treatment for drivers found to be impaired by drugs – especially those who are repeat offenders or who have drug-use disorders. Applied programmes should be evaluated regularly for their effectiveness on traffic safety. • In close cooperation with the road safety sector, participate in activities to raise awareness about drug-driving injury and other health risks, as well as evidence-based preventive interventions on drug use and road safety addressing the general public, policy-makers, drivers (especially young drivers), people using drugs, patients and health-care professionals. • Conduct research and disseminate information on, for instance, the prevalence of drug use among drivers and the effectiveness of implemented measures. • Provide guidance on the use and effects of prescription drugs on fitness to drive. For instance, risk communication can be based on a graded warning system with pictograms for medicines that impair driving. Key actors to provide this information to the patients are prescribing physicians and dispensing pharmacists.  • Ensure multisectoral collaboration with involvement of law enforcement officers and legislators. Recommendations for national activities regarding enforcement, education or campaigns should take into account country-specific characteristics of the problem.

 

Conclusion:

Finally this article clarifies that drugs and driving can’t be intermixed. Drugs that are safe to take during driving have no issue; but drugs having some lethal side effects leading to accidents and deaths are to be taken with major care or driving should be avoided during medication. In particular, Hallucinogenic and psychoactive drugs during driving should be avoided. Safe driving is everyone’s duty and road safety is on prime importance with drugs.