Abstract
Objectives
To examine the relationship between the combination of alcohol and benzodiazepines and the risk of committing an unsafe driver action.
Methods
We used data from the Fatality Analysis Reporting System (1993-2006) on drivers aged 20 or older who were tested for both alcohol and drugs. Using a case-control design, we compared drivers who had at least one unsafe driver action (UDA; e.g., weaving) recorded in relation to the crash (cases) to drivers who did not (controls).
Results
Drivers who tested positive for intermediate- and long-acting benzodiazepines in combination with alcohol had significantly greater odds of a UDA compared to those under the influence of alcohol alone, up to blood alcohol concentrations (BACs) of 0.08 and 0.05 g/100 ml, respectively. The odds of a UDA with short-acting benzodiazepines combined with alcohol were no different than for alcohol alone.
Conclusions
This study demonstrates that the combination of alcohol and benzodiazepines can have detrimental effects on driving beyond those of alcohol alone. By describing these combined effects in terms of BAC equivalencies, this study also allows for the extrapolation of simple, concrete concepts that communicate risk to the average benzodiazepine user.
Key words: Automobile driving, benzodiazepines, alcohol drinking, drug interactions, case control studies
Résumé
Objectif
Examiner la relation entre la combinaison d’alcool et les benzodiazépines et le risque de commettre un action de conducteur dangereux.
Méthodes
Nous avons utilisé les données du Fatality Analysis Reporting System (1993-2006) sur les conducteurs âgés de 20 ans ou plus qui ont été testés pour l’alcool et les drogues. En utilisant un devis cas-témoin, nous avons comparé les conducteurs ayant au moins une action de conduite dangereuse (par exemple, changements de voie fréquent) enregistré par rapport envers les accidents (cas) aux conducteurs qui n’ont pas (contrôles).
Résultats
Les conducteurs qui ont testés positifs pour les benzodiazépines à durée d’action intermédiaire et à longue durée d’action en combinaison avec l’alcool avaient une probabilité significativement plus élevée de commettre une action de conduite dangereuse par rapport à l’alcool seul, jusqu’à un taux d’alcool de 0,08 et 0,05 g/100mL, respectivement. Les benzodiazépines à effet de courte durée en combinaison avec l’alcool n’étaient pas différents de l’alcool seul.
Conclusions
Cette étude démontre que la combinaison d’alcool et de benzodiazépines peut avoir des effets néfastes sur la conduite au-delà de celles de l’alcool. En décrivant ces effets combinés sur le plan d’un taux d’alcoolémie équivalent, cette étude permet également l’extrapolation de concepts simples qui communiquent les risques aux utilisateurs de benzodiazépines.
Mots clés: conduite automobile, benzodiazépines, interactions de drogues, études cas-témoins
Footnotes
Acknowledgements: Funding for this research was provided through research grants from AUTO21, Network of Centres of Excellence, the Ontario Neurotrauma Foundation, and the Thunder Bay Foundation. Michel Bédard is a member of CanDRIVE, a team funded by the Canadian Institutes of Health Research, Institute of Aging. Michel Bédard is also a Canada Research Chair in Aging and Health (https://doi.org/www.chairs.gc.ca); he acknowledges the support of both programs.
Conflict of Interest: None to declare.
References
- 1.Tu K, Mamdani MM, Hux JE, Tu JB. Progressive trends in the prevalence of benzodiazepine prescribing in older people in Ontario, Canada. J Am Geriatr Soc. 2001;49:1341–45. doi: 10.1046/j.1532-5415.2001.49262.x. [DOI] [PubMed] [Google Scholar]
- 2.Vanakoski J, Mattila MJ, Seppala T. Driving under light and dark conditions: Effects of alcohol and diazepam in young and older subjects. J Clin Psychopharmacol. 2000;56:453–58. doi: 10.1007/s002280000167. [DOI] [PubMed] [Google Scholar]
- 3.Willumeit HP, Ott H, Neubert W, Hemmerling KG, Schratzer M, Fichte K. Alcohol interaction of lormetazepam, mepindolol sulphate and diazepam measured by performance on the driving simulator. Pharmacopsychiatry. 1984;17(2):36–43. doi: 10.1055/s-2007-1017405. [DOI] [PubMed] [Google Scholar]
- 4.Brookhuis KA, Volkerts ER, O’Hanlon JF. Repeated dose effects of lormetazepam and flurazepam upon driving performance. Eur J Clin Pharmacol. 1990;39(1):83–87. doi: 10.1007/BF02657065. [DOI] [PubMed] [Google Scholar]
- 5.O’ Hanlon JF, Volkerts ER. Hypnotics and actual driving performance. Acta Psychiatr Scand Suppl. 1986;332:95–104. doi: 10.1111/j.1600-0447.1986.tb08985.x. [DOI] [PubMed] [Google Scholar]
- 6.van Laar MW, Volkerts E, Verbaten M. Subchronic effects of the GABA-agonist lorazepam and the 5-HT2A/2C antagonist ritanserin on driving performance, slow wave sleep and daytime sleepiness in healthy volunteers. Psychopharmacology. 2001;154(2):189–97. doi: 10.1007/s002130000633. [DOI] [PubMed] [Google Scholar]
- 7.Staner L, Ertle S, Boeijinga P, Rinaudo G, Arnal MA, Muzet A, Luthringer R. Next-day residual effects of hypnotics in DSM-IV primary insomnia: A driving simulator study with simultaneous electroencephalogram monitoring. Psychopharmacology. 2005;181:790–98. doi: 10.1007/s00213-005-0082-8. [DOI] [PubMed] [Google Scholar]
- 8.van Laar MW, Volkerts ER, van Willigenburg AP. Therapeutic effects and effects on actual driving performance of chronically administered buspirone and diazepam in anxious outpatients. J Clin Psychopharmacol. 1992;12(2):86–95. [PubMed] [Google Scholar]
- 9.Berthelon C, Bocca ML, Denise P, Pottier A. Do zopiclone, zolpidem and flu-nitrazepam have residual effects on simulated task of collision anticipation? J Psychopharmacol. 2003;17:324–31. doi: 10.1177/02698811030173015. [DOI] [PubMed] [Google Scholar]
- 10.Verster JC, Volkerts ER. Verbaten MN. Effects of alprazolam on driving ability, memory functioning and psychomotor performance: A randomized, placebo-controlled study. Neuropsychopharmacology. 2002;27:260–69. doi: 10.1016/S0893-133X(02)00310-X. [DOI] [PubMed] [Google Scholar]
- 11.Verster JC, Veldhuijzen DS, Volkerts ER. Residual effects of sleep medication on driving ability. Sleep Med Rev. 2004;8:309–25. doi: 10.1016/j.smrv.2004.02.001. [DOI] [PubMed] [Google Scholar]
- 12.Dubois S, Bedard M, Weaver B. The impact of benzodiazepines on safe driving. Traffic Inj Prev. 2008;9(5):404–13. doi: 10.1080/15389580802161943. [DOI] [PubMed] [Google Scholar]
- 13.Barbone F, McMahon AD, Davey PG, Morris AD, Reid IC, McDevitt DG, MacDonald TM. Association of road-traffic accidents with benzodiazepine use. Lancet. 1998;352:1331–36. doi: 10.1016/S0140-6736(98)04087-2. [DOI] [PubMed] [Google Scholar]
- 14.Neutel CI. Risk of traffic accident injury after a prescription for a benzo-diazepine. Ann Epidemiol. 1995;5:239–44. doi: 10.1016/1047-2797(94)00112-7. [DOI] [PubMed] [Google Scholar]
- 15.Drummer OH, Gerostamoulos J, Batziris H, Chu M, Caplehorn JR, Robertson MD, Swann P. The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes. Accid Anal Prev. 2004;36(2):239–48. doi: 10.1016/S0001-4575(02)00153-7. [DOI] [PubMed] [Google Scholar]
- 16.Appenzeller BM, Schneider S, Yegles M, Maul A, Wennig R. Drugs and chronic alcohol abuse in drivers. Forensic Sci Int. 2005;155(2-3):83–90. doi: 10.1016/j.forsciint.2004.07.023. [DOI] [PubMed] [Google Scholar]
- 17.Linnoila M, Stapleton JM, Lister R, Moss H, Lane E, Granger A, Eckardt MJ. Effects of single doses of alprazolam and diazepam, alone and in combination with ethanol, on psychomotor and cognitive performance and on autonom-ic nervous system reactivity in healthy volunteers. Eur J Clin Pharmacol. 1990;39(1):21–28. doi: 10.1007/BF02657051. [DOI] [PubMed] [Google Scholar]
- 18.Longo MC, Hunter CE, Lokan RJ, White JM, White MA. The role of alcohol, benzodiazepines and stimulants in road crashes. Stockholm, Sweden, 15th International Conference on Alcohol. 2000;2000:22. [Google Scholar]
- 19.Longo MC, Hunter CE, Lokan RJ, White JM, White MA. The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability: Part II: The relationship between drug prevalence and drug concentration, and driver culpability. Accid Anal Prev. 2000;32:623–32. doi: 10.1016/S0001-4575(99)00110-4. [DOI] [PubMed] [Google Scholar]
- 20.Baldock MRJ, McLean AJ. Older drivers: Crash involvements rates and causes. Adelaide, Australia: Centre for Automotive Safety Research; 2005. [Google Scholar]
- 21.Oehlert GW. A note on the delta method. Am Stat. 1992;46(1):27–29. [Google Scholar]
- 22.Engeland A, Skurtveit S, Morland J. Risk of road traffic accidents associated with the prescription of drugs: A registry-based cohort study. Ann Epidemiol. 2007;17:597–602. doi: 10.1016/j.annepidem.2007.03.009. [DOI] [PubMed] [Google Scholar]
- 23.Oster G, Russell MW, Huse DM, Adams SF, Imbimbo J. Accident- and injury-related health-care utilization among benzodiazepine users and nonusers. J Clin Psychiatry. 1987;48(Suppl):17–21. [PubMed] [Google Scholar]
- 24.Hemmelgarn B, Suissa S, Huang A, Boivin JF, Pinard G. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA. 1997;278(1):27–31. doi: 10.1001/jama.1997.03550010041037. [DOI] [PubMed] [Google Scholar]
- 25.O’ Hanlon JF, Vermeeren A, Uiterwijk MM, van Veggel LM, Swijgman HF. Anxiolytics’ effects on the actual driving performance of patients and healthy volunteers in a standardized test. An integration of three studies. Neuro-psychobiology. 1995;31(2):81–88. doi: 10.1159/000119177. [DOI] [PubMed] [Google Scholar]