Barbone F, McMahon A D, Davey P G, Morris A D, Reid I C, McDevitt D G, MacDonald T M
Department of Clinical Pharmacology and Therapeutics, University of Dundee, Ninewells Hospital and Medical School, UK.
Lancet. 1998 Oct 24;352(9137):1331-6. doi: 10.1016/s0140-6736(98)04087-2.
Psychomotor studies suggest that commonly prescribed psychoactive drugs impair driving skills. We have examined the association between the use of psychoactive drugs and road-traffic accidents.
We used dispensed prescribing as a measure of exposure in a within-person case-crossover study of drivers aged 18 years and over, resident in Tayside, UK, who experienced a first road-traffic accident between Aug 1, 1992, and June 30, 1995, and had used a psychoactive drug (tricyclic antidepressant, benzodiazepine, selective serotonin-reuptake inhibitor, or other psychoactive drug [mainly major tranquillisers]) between Aug 1, 1992, and the date of the accident. For each driver, the risks of having a road-traffic accident while exposed and not exposed to a drug were compared.
19386 drivers were involved in a first road-traffic accident during the study period. 1731 were users of any study drug. On the day of the accident, 189 individuals were taking tricyclic antidepressants (within-patient exposure odds ratio for an accident 0.93 [95% CI 0.72-1.21]), 84 selective serotonin-reuptake inhibitors (0.85 [0.55-1.33]), 235 benzodiazepines (1.62 [1.24-2.12]), and 47 other psychoactive drugs (0.88 [0.62-1.25]). The risk associated with benzodiazepine use decreased with increasing driver's age and was greater when the breath test for alcohol was positive. A dose-response relation was evident with benzodiazepines. The increased risk with benzodiazepines was significant for long-half-life drugs, used as anxiolytics, and for short-half-life hypnotics (all zopiclone).
Users of anxiolytic benzodiazepines and zopiclone were at increased risk of experiencing a road-traffic accident. Users of anxiolytic benzodiazepines and zopiclone should be advised not to drive.
精神运动研究表明，常用的精神活性药物会损害驾驶技能。我们研究了精神活性药物的使用与道路交通事故之间的关联。
在一项自身对照病例交叉研究中，我们将药物配给量作为暴露指标，研究对象为居住在英国泰赛德地区、年龄在18岁及以上的驾驶员，这些驾驶员在1992年8月1日至1995年6月30日期间首次发生道路交通事故，且在1992年8月1日至事故发生日期之间使用过精神活性药物（三环类抗抑郁药、苯二氮䓬类药物、选择性5-羟色胺再摄取抑制剂或其他精神活性药物[主要是强效镇静剂]）。对每位驾驶员，比较其在暴露于药物和未暴露于药物时发生道路交通事故的风险。
在研究期间，19386名驾驶员首次发生道路交通事故。其中1731人使用过任何一种研究药物。在事故发生当天，189人服用三环类抗抑郁药（事故的患者内暴露比值比为0.93[95%可信区间0.72 - 1.21]），84人服用选择性5-羟色胺再摄取抑制剂（0.85[0.55 - 1.33]），235人服用苯二氮䓬类药物（1.62[1.24 - 2.12]），47人服用其他精神活性药物（0.88[0.62 - 1.25]）。与使用苯二氮䓬类药物相关的风险随驾驶员年龄增加而降低，且在酒精呼气测试呈阳性时风险更高。苯二氮䓬类药物存在剂量反应关系。长效苯二氮䓬类药物（用作抗焦虑药）和短效催眠药（所有佐匹克隆）使用后风险增加显著。
使用抗焦虑苯二氮䓬类药物和佐匹克隆的人发生道路交通事故的风险增加。应建议使用抗焦虑苯二氮䓬类药物和佐匹克隆的人不要开车。
