MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA.
Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Accid Anal Prev. 2022 Aug;173:106713. doi: 10.1016/j.aap.2022.106713. Epub 2022 May 28.
Connections between substance use, impairment, and road safety have been frequently researched. Yet, little is known about how simultaneous use of opioids and alcohol affects road safety outcomes, which is an increasingly critical link within the current landscape of the substance use environment and public health. Lack of this understanding is partly due to testing complications and data limitations. We define polysubstance use here as alcohol and opioids consumed together or within a small-time window such that both are present in the system. This polysubstance use is on the rise and produces greater health risks than when the substances are consumed separately. Given the increasing rate of opioid use, high prevalence of alcohol use, and dangers of polysubstance use, we aim to synthesize literature on the prevalence and impact of this polysubstance on road safety-related outcomes. We performed a systematic review of studies published between 1974 and 2020 that examined opioid and alcohol use exposures and road safety-related outcomes. Out of 644 initial findings, 20 studies were included in this review. Outcomes included motor vehicle crash injuries, deaths, or driver culpability; suspected driving under the influence; and simulated driving performance. Evidence from multiple sources showed a significant rise, approximately 1% to 7%, in the prevalence of opioids among fatally injured drivers in the U.S. from 1995 to 2016. Information published on the simultaneous presence of opioids and alcohol in people involved in crashes was scarce. The limited available findings point toward an overlap where up to 30% of opioid-positive people involved in a crash were also positive for alcohol. Studies also suggest a possibly elevated risk presented by this polysubstance use relative to the substances used alone, though the majority of identified studies did not estimate this association. The synthesized research indicates that alcohol and opioid use is not uncommon and may be increasing among people involved in adverse driving events. More research and better data are needed to improve estimates of association with road traffic-related outcomes, potentially improving substance testing in current surveillance systems or using linked data sets and other novel data sources to improve estimates.
物质使用、损伤和道路安全之间的联系已经被频繁研究。然而，对于阿片类药物和酒精同时使用如何影响道路安全结果知之甚少，这是当前物质使用环境和公共卫生领域中一个日益重要的环节。这种理解的缺乏部分是由于测试的复杂性和数据的局限性。在这里，我们将同时或在短时间内摄入酒精和阿片类药物定义为同时使用两种物质，即两种物质都存在于体内。这种同时使用物质的情况正在增加，并且比单独使用这些物质产生更大的健康风险。鉴于阿片类药物使用的增加、酒精使用的高患病率以及同时使用多种物质的危险，我们旨在综合文献，研究这种同时使用物质对与道路安全相关结果的影响。我们对 1974 年至 2020 年间发表的研究进行了系统综述，这些研究考察了阿片类药物和酒精使用暴露与道路安全相关结果之间的关系。在 644 项初步研究结果中，有 20 项研究纳入了本次综述。研究结果包括机动车事故伤害、死亡或驾驶员责任；疑似酒后驾车；以及模拟驾驶表现。来自多个来源的证据表明，1995 年至 2016 年，美国致命性车祸中阿片类药物的流行率显著上升，约为 1%至 7%。关于同时发生在车祸参与者中的阿片类药物和酒精的信息很少。有限的现有研究结果表明，在涉及车祸的阿片类药物阳性人群中，有高达 30%的人同时也呈酒精阳性。研究还表明，与单独使用这些物质相比，这种同时使用两种物质可能存在更高的风险，但大多数已确定的研究都没有估计这种关联。综合研究表明，酒精和阿片类药物的使用并不罕见，并且可能在涉及不良驾驶事件的人群中增加。需要更多的研究和更好的数据来提高与道路交通相关结果的关联估计，这可能需要改善当前监测系统中的物质检测，或利用关联数据集和其他新的数据源来提高估计值。
