The toll of road traffic accidents

While I wholeheartedly support the conclusion of the editorial by Rodger Charlton and Gary Smith (October 2003 JRSM¹) I am surprised that the authors make no mention of the reduction in road traffic accidents (RTAs) that the appropriate prescription of certain medications to car driving patients would produce. I realize there are few data investigating the role of prescription medicines in RTAs, but those that exist (e.g. Barbone et al., Association of road traffic accidents with benzodiazepine use, Lancet 1998, 352, 1331–6, or Currie et al., The use of antidepressants and benzodiazepines in the perpetrators and victims of accidents, Occup Med 1995, 45, 323–5) clearly indicate that certain prescription-only medications are implicated as causative agents in RTAs.

An easy way to help reduce the toll of such drugs is that they be clearly labelled as incompatible with vehicle operating and should therefore be avoided by road users. Such a mechanism, an unambiguous red warning triangle on the dispensing pack, is employed in several European countries. The UK use of a label on the lines of ‘if you feel affected, do not drive’ is not a straightforward indication to that patient not to operate a motor vehicle. The ‘red triangle’ alerts physicians, pharmacists and patient, and the good news is that for every red-triangle medicine there exist several clinically equipotent compounds with no measurable effect on car driving skills.