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Abstract
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Each year over 1·3 million people are killed, and between 20 and 50 million more sustain life-changing injuries due to road traffic collisions. Road trauma accounts for a considerable proportion of global macroeconomic and health burden; much of which is unequally distributed, and disproportionally borne by low-income and middle-income regions. With many contributors to collision causality being potentially modifiable through changes to infrastructure, policy, car manufacturing, and driver behaviour, the responsibility for crash avoidance should be a shared proposition for the global community of road users.
Impaired driving due to psychoactive substance usage remains one of the largest preventable contributing factors to road trauma statistics worldwide. Enactment and enforcement of best-practice legislative policies to reduce road traffic deaths due to drink-driving (eg, legal blood alcohol concentration) have successfully reduced alcohol-related harm in the past few decades. However, the proportion of drivers involved in traffic collisions that are intoxicated by psychoactive drugs continues to increase.
Enforcement strategies designed to mitigate drug-affected driving primarily concern the detection of illicit substances as determined by region-specific legal frameworks of zero-tolerance, impairment-based, or per se approaches (eg, checking in body substance concentration against legal thresholds, regardless of impairment, through oral fluid tests or sobriety checkpoints). Despite a comparable rise, to illicit drug use, in the proportion of drivers using prescription pharmaceutical medications that have the potential to negatively affect driving ability, methods used to manage and mitigate collision risk among people who use potentially impairing--but legal--prescription medications remain underdeveloped.
Jeffrey Brubacher and colleagues' robust pharmacoepidemiological study6 published in The Lancet Public Health estimates that 119 370 (2·84%) of 4 200 000 British Columbian drivers, Canada, involved in incident collisions have an active prescription for a potentially-impairing medication. Drivers who were currently using certain prescription medications were at moderately higher odds of being at-fault for a collision compared with those without an active prescription and also with people who had previously been prescribed these medication; these higher odds persisted among long-term users. Perhaps unsurprisingly, this coincides with consumption patterns of medications identified as the most prevalent and impairing. In the same cohort, a previous study found that 3 million drivers filled approximately 46 million prescriptions for opioids reflecting a three-fold increase in consumption among active drivers over the 20-year period from 1997-2016; corresponding with a proportional increase in opioid-positive drivers involved in traffic collisions...
Language: en |