Driving under the influence, public policy, and pharmacy practice

Professional Drivers’ Knowledge About the Influence of Medicines that May Impair Driving

More knowledge about the impact of medication on driving are indicative of a lower likelihood of having a motor vehicle crash. The aim of this study was to investigate knowledge of professional drivers about the influence of driving impairing medicines in Serbia and Bosnia and Herzegovina.

This multicenter cross-sectional study was conducted in 6 cities in Serbia and Bosnia and Herzegovina, during first trimester of 2017, with 221 professional drivers, using questionnaire with 35 statements, where participants expressed their agreement according to Likert scale, from completely disagree to completely agree.

The average score related to the drivers’ knowledge was 131,58 (range from 49 to 175), 22,6% were unaware that some medicines may influence psychophysical abilities and ability to drive. A high percentage of participants in the study don’t know that a negative impact on the driving ability can be the result of the use of medicines from groups for which it is unexpected to have such effects, medicines that are dispensed without a medical prescription, herbal remedies, dietary supplements and medicines that affects eyesight or hearing. More than half didn’t know that medicines labeled with warning symbols Δ, ▲ and § are not allowed to be used immediately before or during driving.

Professional drivers’ knowledge about driving impairing medicines is not satisfactory. Labeling system of these medicines is inadequate. These findings could help to identify drivers, who are at increased risk for using potentially impairing medicines, to inform and educate them, and to prevent driving under the influence of medicines.

Development and validation of questionnaires on professional drivers’ knowledge and attitudes about various medications’ influence on driving ability

Introduction

Professional drivers’ knowledge about driving-impairing medications is not satisfactory. The aim of this study was to develop and test the reliability and validity of the questionnaires designed to measure the knowledge and attitude of professional drivers about the influence of various medications on driving ability.

Methods

The questionnaires for assessing professional driver’s knowledge (performance-based) and attitudes about influence of various medications on driving abilities were developed by creating the item pool, testing reliability and validity, and factor analysis. The study was conducted as a multicenter, cross-sectional study in Serbia and Bosnia and Herzegovina. The study population consisted of professional drivers, who filled out both questionnaires in three time intervals.

Results

Both questionnaires showed great internal consistency and temporal stability. Cronbach’s Alpha for the first questionnaire was 0.984 and for the second it was 0.944. The Kaiser–Meyer–Olkin test for the first questionnaire confirmed sampling adequacy with its value of 0.964 and for the second questionnaire it was 0.933. Exploratory factor analysis of the questionnaire showed that three factors were revealed after rotation for the first questionnaire and they explained 78.0% of variance. Both questionnaires showed high degree of correlation between scores after the first and repeated administration, Spearman’s rho coefficient of correlation for was 0.962 and 0.980.

Conclusion

Based on the results of this study, we believe that both questionnaires are useful tools for testing professional drivers’ knowledge and attitudes about the influence of medications on driving ability.

Drugs, pesticides and metabolites in forensic post-mortem blood samples

Forensic post-mortem toxicological data provide valuable information for the elucidation of cause of death. However, this is still not routine practice in Brazilian laboratories. This study investigated the presence of illicit and prescription drugs, pesticides and metabolites in 111 post-mortem blood samples from cases investigated by the Forensic Medical Institute of the Federal District, Brazil. Quantitative analysis was performed for 14 analytes using a validated programmed temperature vaporisation-large volume injection-gas chromatography-mass spectrometry method, which was also used as screening (qualitative analysis) for an additional 19 substances of forensic interest. At least one analyte was found in 61.2% of the samples, of which 34 were related to homicide, 15 to accidental death and 10 to suicide cases. The victims were 14-72 years old. The benzodiazepines diazepam, midazolam and 7-aminoflunitrazepan were detected in 46% of the positive samples (0.02-1.12 µg/mL; midazolam only qualitative). Cocaine was found in 34% (0.02-4.07 µg/mL), associated with substances commonly used as cocaine adulterants (e.g. caffeine, lidocaine and phenacetin). Three suicide cases involved the illegal rodenticide chumbinho, residues of which were found in the gastric content, and blood samples showed the presence of terbufos (0.03 and 0.04 µg/mL) and carbofuran (27.3 µg/mL). These results are discussed, along with autopsy and crime-scene information.

Risk awareness, medication adherence, and driving behavior as determined by the provision of drug information to patients

OBJECTIVE

The study identifies appropriate risk expressions by healthcare professionals in communicating the risks of driving-impairing medicine to patients, gauging changed patient behavior, preventing traffic accidents due to drugs, and improving drug adherence.

METHODS

An online questionnaire survey was conducted on participants' perception of driving-related risks, and risk awareness, as well as reports of healthcare professionals' expressions and warning messages regarding driving-impairing drugs.

RESULTS

Approximately 80 % of participants were aware of the effects of pharmaceutical drugs on driving ability, and 50 % responded that they had received an explanation from their respective health professionals. As reported by participants, although healthcare professionals typically used more indirect expressions, direct warning messages were associated with high-risk awareness.

CONCLUSION

The content of the explanatory sentences and debriefing influenced risk perception among participants. Direct expressions were more desirable for appropriate risk perception by participants. Providing information from healthcare professional about the degree of risks and patients' determining their influence on driving behavior based on risk perception was necessary to clarify the predictors of driving behavior.

PRACTICE IMPLICATIONS

Health professionals should be aware that their warning messages could have a significant impact on patients' risk perception and driving behavior.

Population-Based Registry Analysis of Antidiabetics Dispensations: Trend Use in Spain between 2015 and 2018 with Reference to Driving

Insulins and some oral antidiabetics are considered to be driving-impairing medicines (DIM) and they belong to the Driving under the Influence of Drugs, alcohol, and medicines (DRUID) category I (minor influence on fitness to drive). The trend of antidiabetics use in Castilla y León from 2015 to 2018 is presented through a population-based registry study. Treatment duration with these medicines and the concomitant use of other DIMs were observed. An adjustment method was used with information from the drivers' license census. For all calculations, age and gender were taken into account. 3.98% of the general population used at least one antidiabetic, as well as 2.92% of drivers. The consumption of antidiabetics in men was higher than in women (4.35% vs. 3.61%, p = 0.001), and the use increases with age, especially from 35-39 years to 75-79 years in men and 85-89 years in women. Antidiabetics were consumed chronically, specifically 100% in the case of insulins and 95% in the case of oral antidiabetics. In addition to antidiabetics, 2.5 ± 1.86 DIMs were consumed, mainly anxiolytics (25.53%), opioids (23.03%), other analgesics and antipiretics (19.13%), and antidepressants (17.73%). Collaboration between pharmacists and physicians is a priority to clearly transmitting risks to patients. It is necessary that the health authorities include information on DIMs, such as the DRUID classification, in the prescription and dispensing software.

Do pharmacists counsel customers about the effects of sedating antihistamines on driving skills? A survey of community pharmacies in Saudi Arabia

Objective

To investigate the level of counselling regarding the effects of sedating antihistamines on driving skills provided by private community pharmacies in Madinah, Saudi Arabia.

Methods

This study randomly selected private community pharmacies. Mystery shoppers following a similar scenario individually visited these pharmacies. These clients asked for a commonly used brand of sedating antihistamine and noted the counselling offered by the pharmacist. If spontaneous counselling was not offered, necessary information regarding the medication’s use was requested. Finally, the content of counselling was documented.

Results

Of the 100 pharmacies selected, 12 were excluded for various reasons and 88 pharmacies were included in the study. Only 23 pharmacies offered spontaneous counselling. Although 73.9% of pharmacists (65 of 88), spontaneously or upon request, mentioned sedation as a side-effect, only one pharmacist warned the client against driving after taking the medication, and three other pharmacists warned against dealing with hazardous machinery. Other side-effects were almost ignored.

Conclusion

A life-threatening insufficiency in the quality of counselling at Saudi Arabian private community pharmacies exists. Traffic accidents, secondary to the side-effects of sedating antihistamines, may be avoided if proper counselling is offered. Saudi Arabian authorities should take appropriate actions to ensure optimal practice in community pharmacies.

Receipt of Warnings Regarding Potentially Impairing Prescription Medications and Associated Risk Perceptions in a National Sample of U.S. Drivers

OBJECTIVE

Reducing drug-involved driving is a national policy priority, but little is known about the extent to which drivers receive warnings about the impairment potential of their prescribed medications. We used data from the 2013-2014 National Roadside Survey (NRS) to quantify the proportion of drivers who received warnings regarding potentially impairing medications and the association with driving-related risk perceptions.

METHOD

Drivers randomly selected at 60 sites completed the self-administered survey, which contained questions on their use of prescription medications.

RESULTS

Overall, 7,405 drivers completed the prescription drug portion of the NRS. Of these, 19.7% reported recent use (within the past 2 days) of a potentially impairing prescription drug, and 78.2% said the drug had been prescribed for their use. Users of prescribed sedatives (85.8%) and narcotics (85.1%) were most likely to report receiving information about potential impairment, compared with only 57.7% and 62.6% of users of prescribed stimulant and antidepressant medications, respectively. Receipt of warnings varied by sex, race/ethnicity, income, geographic region, and time of day. For a majority of drug categories, drivers who reported receiving warnings had significantly higher odds of perceived risk of impaired driving/crash and criminal justice involvement.

CONCLUSIONS

Most users of prescription medications reported that the drug was prescribed for their use, but not all reported receiving warnings about driving impairment. Our study provides evidence of missed opportunities for information provision on impaired driving, identifies subgroups that may warrant enhanced interventions, and provides preliminary evidence that receipt of impairment warnings is associated with increased perceptions of driving-related risk.