Drugs and medicines in traffic : literature study. Among drivers, cannabis and opiates are the most common illicit drugs, while benzodiazepines are the most common medicinal drugs. Drivers regularly combine illicit and medicinal drugs, and drugs with alcohol. Cannabis, benzodiazepines and alcohol are found in combination most often. Based on current knowledge, cannabis use is considered to be dangerous for traffic safety, at least during the first hours after use. Cocaine, heroin and hallucinogens are incompatible with safe driving. Not all studies find increased risks among drivers using amphetamines and ecstasy. This could be partly explained by the use of lower doses in experimental studies. The prescription medicines most associated with their influence on driving performance and traffic accidents are benzodiazepines (especially those with long halflife), cyclic antidepressants and opioid analgesics. Hypnotics, sedatives and anxiolytics (including benzodiazepines) impair driving performance and are associated with increased accident risk. Most beta-blockers and central stimulants have no or only a limited detrimental effect on driving performance. There is a serious lack of information concerning the effects of neuroleptics on driving performance, but based on the general effects of neuroleptics, it can be assumed that there is an effect on driving performance. Especially the first and second generation antihistamines have a significant detrimental effect on driving performance. Concerning the effects of analgesics and antitussives on driving performance and accident risk, the results of the different studies are inconsistent. Effects may be expected, but administration of stable doses would cause few effects on driving performance. Problems during driving are mainly to be expected at onset of the treatment, when changing the dose and when other substances are co-ingested. Antidepressants have the ability to influence driving performance negatively, especially at onset of the treatment, and are associated with higher accident risk. This potential is highest among sedative antidepressants. Epilepsy and diabetes patients should be allowed to drive only under strict conditions, taking into account the important detrimental effects on driving performance. Combination of drugs with alcohol should be avoided, as well as combinations of illicit and medicinal drugs, as they are associated with increased traffic accident risks and with increased responsibility in responsibility analysis studies. Moreover, the risks seem to increase with polydrug use. Benzodiazepines and cannabis in combination with alcohol deserve special attention at policy level, due to their high risk and prevalence. (Author/publisher) The report is available at: http://www.steunpuntverkeersveiligheid.be/en/node/287
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