University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.
University of Michigan, Department of Psychiatry, Ann Arbor, Michigan.
West J Emerg Med. 2020 Jun 19;21(4):831-840. doi: 10.5811/westjem.2020.3.44844.
Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment.
Participants (aged 25-60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use.
Among participants completing the screening survey (n = 756; mean age = 42.8 [standard deviation {SD} =10.4]), 37.8% reported past three-month prescription opioid use (30.8% of whom used daily), and 14.7% reported past three-month DAPO. Of screened participants, 22.5% (n = 170) were eligible for the extended study survey. Unadjusted analyses demonstrated that participants reporting DAPO were more likely to use opioids daily (51.1% vs 15.9%) and had higher rates of opioid misuse (mean Current Opioid Misuse Measure score 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]) chronic pain (80.7% vs 42.7%), and driving after marijuana or alcohol use (mean intoxicated driving score 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]) compared to patients not reporting DAPO (all p<0.001). Adjusting for age, gender, employment, and insurance in a logistic regression model, participants reporting DAPO were more likely to report a chronic pain diagnosis (odds ratio [OR] = 3.77, 95% confidence interval [CI], 1.55-9.17), daily opioid use (OR = 3.81, 95% CI, 1.64-8.85), and higher levels of intoxicated driving (OR = 1.62, 95% CI, 1.07-2.45). Alcohol and marijuana use, depression, and opioid misuse were not associated with DAPO in adjusted analyses.
Nearly one in six adult patients seeking ED care reported DAPO. The ED may be an important site for interventions addressing opioid-related drugged driving.
鉴于与吸毒驾驶相关的风险，处方类阿片类药物的使用和驾驶是一个公共卫生问题，但该问题仍研究不足。我们研究了在寻求急诊（ED）治疗的成年人中，服用处方类阿片类药物（DAPO）后驾驶的流行率和相关因素。
在一级创伤中心接受 ED 护理的参与者（年龄 25-60 岁）完成了一项计算机化调查。经验证的工具用于测量处方类阿片类药物的使用、驾驶行为和危险驾驶。报告过去三个月内使用过处方类阿片类药物且每周至少驾驶两次的患者接受了一项扩展研究调查，该调查测量了 DAPO、抑郁、疼痛和药物使用情况。
在完成筛选调查的参与者中（n = 756；平均年龄为 42.8 [标准差 {SD} = 10.4]），37.8%报告过去三个月内使用过处方类阿片类药物（其中 30.8%的人每天使用），14.7%报告过去三个月内有过 DAPO。在筛选出的参与者中，22.5%（n = 170）符合参加扩展研究调查的条件。未经调整的分析表明，报告 DAPO 的参与者更有可能每天使用阿片类药物（51.1% vs 15.9%），并且更有可能出现阿片类药物滥用（平均当前阿片类药物滥用量表得分 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]）、慢性疼痛（80.7% vs 42.7%）以及在吸食大麻或酒精后驾驶（平均醉酒驾驶量表得分 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]），与未报告 DAPO 的患者相比（均 p<0.001）。在逻辑回归模型中，调整年龄、性别、就业和保险因素后，报告 DAPO 的参与者更有可能报告慢性疼痛诊断（优势比 [OR] = 3.77，95%置信区间 [CI]，1.55-9.17）、每日阿片类药物使用（OR = 3.81，95% CI，1.64-8.85）和更高水平的醉酒驾驶（OR = 1.62，95% CI，1.07-2.45）。在调整后的分析中，酒精和大麻使用、抑郁和阿片类药物滥用与 DAPO 无关。
近六分之一的寻求 ED 护理的成年患者报告有 DAPO。ED 可能是解决与阿片类药物相关的吸毒驾驶问题的重要场所。
