Lemoine P, Ohayon M
Psychiatre des Hôpitaux, chercheur associé au Centre Philippe Pinel de Montréal, Lyon-Bron.
Encephale. 1996 Jan-Feb;22(1):1-6.
The responsibility of psychotropic drugs as a cause of road traffic accidents remains difficult to evaluate with precision. Different studies performed in many countries provide a certain precision in relation to percentage of injured drivers whose blood contained psychotropic substances (8 to 10% according to studies). On the other hand, it is practically impossible to really know either these products were or were not the cause of the accidents because underlying or associated pathologies can equally create problems such as lack of attention and other vigilance deficits. There is also a possibility of suicidal or aggressive tendencies. A certain number of circadian and other chronobiological parameters also complicate the problem since the schedule (hour) as well as the day of the week or even the season can considerably modify vigilance and reaction time. Available medications able to create such problems are numerous and their mechanisms of action varied. They can influence vision, impulsiveness and vigilance. They can act either by direct mechanisms of sedation or, on the contrary, by raising inhibition through secondary mechanisms: delay in drug elimination or provoked insomnia. For the most part, incriminated medications belong to the different classes of sedative medicines: benzodiazepines, antiepileptics, some antihistaminic agents, some antidepressants, some thymo-regulators and some anti-hypertensives. Also included are desinhibitors or stimulant classes: amphetamines and related drugs, caffeine and codeine. Some of them can be used for their psychodysleptic properties: codeine and anticholinergic drugs. Finally, drug and medicinal associations can have unforeseen effects: for example, anticholinergics + alcohol + valpromide, etc. If it appears methodologically impossible that research could ever precisely quantify the share of responsibility of psychotropic drugs in causing road traffic accidents, this relation remains highly probable. It is therefore necessary that in the course of university and post-academic training, potential prescribers might regularly be advised of these risks. Lastly, public needs to be constantly informed.
精神药物作为道路交通事故成因的责任仍难以精确评估。在许多国家开展的不同研究，在涉及血液中含有精神药物的受伤驾驶员百分比方面提供了一定的精确数据（根据研究为8%至10%）。另一方面，实际上不可能真正知晓这些药物是否为事故原因，因为潜在的或相关的病症同样可能引发诸如注意力不集中和其他警觉性缺陷等问题。还存在自杀或攻击倾向的可能性。一些昼夜节律和其他生物钟学参数也使问题变得复杂，因为日程安排（时间）、一周中的日期乃至季节都可能显著改变警觉性和反应时间。能够引发此类问题的现有药物众多，其作用机制各不相同。它们可影响视力、冲动性和警觉性。它们可通过直接的镇静机制起作用，或者相反，通过二级机制提高抑制作用：药物消除延迟或引发失眠。在很大程度上，被归责的药物属于不同类别的镇静药物：苯二氮䓬类、抗癫痫药、一些抗组胺药、一些抗抑郁药、一些情绪调节剂和一些抗高血压药。还包括去抑制药或兴奋药类别：苯丙胺类及相关药物、咖啡因和可待因。其中一些药物因其致幻特性而被使用：可待因和抗胆碱能药物。最后，药物和药物组合可能产生不可预见的效果：例如，抗胆碱能药物 + 酒精 + 丙戊酰胺等。如果从方法论角度看，研究似乎不可能精确量化精神药物在导致道路交通事故中所承担责任的比例，但这种关联很可能存在。因此，有必要在大学和毕业后培训过程中，定期向潜在的开处方者告知这些风险。最后，需要不断向公众宣传。
