This review is performed as part of The Integrated Project DRUID (Driving under the Influence of Drugs, Alcohol and Medicines). The aim of DRUID is to gain new insights into the degree of impairment caused by psychoactive drugs and their actual impact on road safety. All in all this Integrated Project will try to fill the gaps of knowledge and provide a solid base to generate harmonized, EU-wide regulations for driving under the influence of alcohol, drugs and medicine (1). The task of the Norwegian Institute of Public Health, as part of this project, was to perform a literature review on the results of experimental studies on drugs and driving or tasks related to driving for the following drugs: Opiates/opioids, narcoanal-gesics/atypical opioids and hallucinogens. Initially we were asked to perform a literature review on the effects of single dose administration of these drugs on performance related to driving. In October 2008 we were also asked to broaden the review with data on maintenance use (i.e. methadone and buprenorphine). We also agreed to include chronic use of morphine as it is widely used and the most studied opioid. Studies on chronic use of opioids in general were, however, not meant to be a topic of this review. This review does therefore not include long term use of other drugs than morphine, methadone and buprenorphine. The results for methadone and buprenorphine, and for morphine, will be presented separately in the present review, as these drugs are of particular interest in maintenance treatment of drug dependent subjects and pain treatment, respectively. The literature on the effects of opioids on driving performance has previously been reviewed by a number of researchers. The most recent review, was by Fishbain et al. (2003) (2). He performed a structured evidence-based review of all available studies addressing the issue of whether opioid-dependent/tolerant patients are impaired in driving-related skills. He concluded that the majority of the reviewed studies indicated that opioids appear not to impair driving-related skills in patients on chronic opioid treatment. However, the references reviewed were not categorized according to type of opioid studied or the subjects experience with opioids. Hence, the review by Fishbain is not directly comparable to the present review. The main purpose of the present review is to answer whether use of opiates/opioids, narcoanalgesics and hallucinogens cause impairment in performance tasks related to driving. This literature review will focus on the influence of single dose intake of opiates/opioids, narcoanalgesics and hallucinogens administered to healthy volunteers, and also include studies on administration to opioid maintenance patients, subjects with ongoing use of opioids and to previous opioid (ab)users, and use in patients treated chronically. (Author/publisher) This document is available at https://www.bast.de/Druid/EN/Home/home_node.html
Abstract