Zeitschrift für Alkoholismus und Drogenabhängigkeit
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Driving, Opioid-maintenance, and Co-medications: A Comprehensive Assessment of 22 Cases

Pekka Rapeli, Pekka Kuikka, Hanna Sillanpää, Carola Fabritius, Kaarlo Simojoki, Hely Kalska, Pirjo Lillsunde and Hannu Alho

Introduction: Patients in stable Opioid Maintenance Treatment (OMT) for opioid-dependence are, as a rule, considered fit to drive a car. Polypharmacotherapy, however, is common in opioid-dependent patients, and its association with driving fitness is not well known. Therefore, we examined driving fitness of 22 OMT patients of whom the majority were multidrug-treated patients.

Material and methods: The assessment included a standard on-road driving test, clinical neurological examination, and cognitive driving-related tests. The OMT patients were grouped on the basis of their psychoactive medications into two groups. The first group was considered to have a low probability for drug-related driving impairment (n=10). This group included patients treated with opioid agonist alone or along with the second generation antidepressant or lithium. The second group included patients with probable drug-related driving impairment (n=12). All patients in this group were given at least one benzodiazepine (BZD) drug,

Results: In neurological evaluation all OMT patients met the basic requirements for driving. In the driving test, all patients in the group with ‘improbable drug-related driving impairment’ and all except one in the group with ‘probable drug-related driving impairment’ were found fit to drive. However, in the driving test total score and two driving-related cognitive tests, the group with ‘probable drug-related driving impairment’ scored significantly lower than the improbable group (p=0.021, 0.001, and 0.028, respectively). Two cases with ‘probable drug-related driving impairment’ are described in detail.

Conclusions: The results of this case series give support for the notion that OMT patients in stable treatment, in general, are fit to drive. When assessing the driving fitness of individual OMT patients with polypharmacy, combining pharmacological and non-pharmacological information is essential, as shown by two case descriptions.