Department of Toxicology, Netherlands Forensic Institute, The Hague, the Netherlands.
CNS Drugs. 2010 Aug;24(8):639-53. doi: 10.2165/11533170-000000000-00000.
In many countries, benzodiazepines are the most commonly used and misused psychoactive medicinal drugs. Results of epidemiological studies investigating the association between benzodiazepine use and traffic accidents seem to be inconclusive or inconsistent at first sight. However, the outcome of epidemiological studies may be influenced by several methodological factors like study design, study population, exposure measurement, outcome definitions and possible confounders. Our objective was to conduct a systematic literature review of epidemiological studies that investigated the association between benzodiazepine use and traffic accidents, including related outcomes like culpability and injury or accident severity. We searched EMBASE, PubMed and Forensic Science Abstracts 3/0 (FORS) for references included in these databases at 1 June 2009 using the term 'benzodiazepines' in combination with 'driving performance' or 'accident risk' or 'traffic accident'. For inclusion in this review, the study design had to be comparative, include road users involved in accidents and provide specific data about benzodiazepines. Sixty-six studies were included in the review. The study populations varied from the general (driving) population, accident-involved road users with or without injury and persons admitted to a hospital to fatally injured accident-involved drivers. Exposure assessment was performed by using toxicological results, prescription data or questionnaires. The divergent study populations and comparison groups and the variety of methods used to express the outcome of interest hampered comparison between results. Evidence is growing that exposure to benzodiazepines is related to increased accident risk. The literature indicates that the greatest accident risk is associated with the use of long half-life benzodiazepines, increasing dosage and the first few weeks of use of benzodiazepines. Clear evidence of increased culpability associated with benzodiazepine use is scarce. More research has to be done to elucidate the relationship between benzodiazepine use and injury severity.
在许多国家，苯二氮䓬类药物是最常用和滥用最多的精神活性药物。对调查苯二氮䓬类药物使用与交通事故之间关联的流行病学研究结果乍一看似乎没有定论或不一致。然而，流行病学研究的结果可能受到几个方法学因素的影响，如研究设计、研究人群、暴露测量、结局定义和可能的混杂因素。我们的目的是对调查苯二氮䓬类药物使用与交通事故之间关联的流行病学研究进行系统综述，包括相关结局，如肇事责任和损伤或事故严重程度。我们在 2009 年 6 月 1 日使用术语“苯二氮䓬类药物”与“驾驶表现”或“事故风险”或“交通事故”相结合，在 EMBASE、PubMed 和法医学摘要 3/0（FORS）数据库中搜索这些数据库中包含的参考文献。为了纳入本综述，研究设计必须是比较性的，包括涉及事故的道路使用者，并提供有关苯二氮䓬类药物的具体数据。共有 66 项研究纳入本综述。研究人群从一般（驾驶）人群、有或无损伤的涉及事故的道路使用者以及因事故受伤而住院的人员到致命损伤的涉及事故的驾驶员不等。通过使用毒理学结果、处方数据或问卷来进行暴露评估。不同的研究人群和对照组以及表达感兴趣结局的方法多样性阻碍了结果之间的比较。越来越多的证据表明，接触苯二氮䓬类药物与增加事故风险有关。文献表明，最大的事故风险与使用半衰期长的苯二氮䓬类药物、增加剂量和使用苯二氮䓬类药物的最初几周有关。与苯二氮䓬类药物使用相关的肇事责任增加的明确证据很少。需要进一步研究以阐明苯二氮䓬类药物使用与损伤严重程度之间的关系。
