Do Drowsy Driver Drugs Differ?

This research paper explores how different drug mechanisms within a single class of drugs can produces different profiles of driving impairment. Prior research has failed to consider these mechanistic differences and often utilizes less controlled study methodologies. The potential impact of differing mechanistic effects is important for practitioners but remains unclear for most drugs. Twentynine licensed drivers in good general health completed one of two miniSim™ studies using a validated, standardized, driving impairment scenario. Both drugs caused degradation in lateral control measures of standard deviation of lane position (SDLP) and number of lane departures, however only diphenhydramine was found to cause a significant change in steering bandwidth. The studied drugs differed in their effects on all longitudinal driving measures with diphenhydramine effecting speed and alprazolam effecting the standard deviation of speed. Difference in therapeutic mechanism of action results in differing pharmacodynamic driving performance outcomes. This analysis reinforces the importance of careful consideration of a drug’s specific mechanism of action when considering a sedating drug’s impact on a patient’s ability to safely operate a motor vehicle

Evaluating drugged driving: Effects of exemplar pain and anxiety medications

<p><b>Objective</b>: Distracted and drug-influenced driving presents a major risk for traffic safety morbidity and mortality. As part of an ongoing research program, we examined the effects of a commonly prescribed combination of medications for pain relief: alprazolam, a benzodiazepine, and a hydrocodone preparation, a combination opiate and acetaminophen, on a simulated driving protocol.</p> <p><b>Methods</b>: Utilizing a within-subjects design, we recruited 8 healthy experienced drivers without major physical and psychological histories. Using a double-blind, placebo-controlled crossover design, we administered placebo, alprazolam alone, hydrocodone/acetaminophen, and the combination of the 2 drugs in a standardized simulated driving protocol. Measures of lateral and longitudinal control were collected and the data were reduced and statically analyzed.</p> <p><b>Results</b>: The study observed clear detrimental effects of alprazolam on driving measures of lateral control and longitudinal control. Driving appeared to more aberrant at higher speeds and in rural scenarios. There were no statistical differences between hydrocodone and placebo. A measure of sedation showed that subjects rated alprazolam as more sedating than both hydrocodone and placebo.</p> <p><b>Conclusions</b>: The findings suggest that impairing effects of this commonly prescribed combination of pharmacologic agents impact simulated driving performance. Negative changes in driving performance included measures of lateral and longitudinal control, although the deleterious effects on lateral control measures such as standard deviation of lane position (SDLP) were larger and more robust. Although the number of subjects was small, thus making it more difficult to draw conclusions on the narcotic effects, these results suggest that in this combination of central nervous system (CNS)-active drugs the benzodiazepine alprazolam accounted for the majority of impairing drug effects. The effect sizes associated with the hydrocodone preparation ranged from very small to medium. These results have potential implications for prescribing physicians and dispensing pharmacists, traffic safety experts, law enforcement officers, and patients themselves.</p

Patterns of Marijuana Use and Health Impact: A Survey Among Older Coloradans

Access to recreational and medical marijuana is common in the United States, particularly in states with legalized use. Here, we describe patterns of recreational and medical marijuana use and self-reported health among older persons using a geographically sampled survey in Colorado. The in-person or online survey was offered to community-dwelling older persons aged above 60 years. We assessed past-year marijuana use including recreational, medical, or both; methods of use; marijuana source; reasons for use; sociodemographic and health factors; and self-reported health. Of 274 respondents (mean age = 72.5 years, 65% women), 45% reported past-year marijuana use. Of these, 54% reported using marijuana both medically and recreationally. Using more than one marijuana method or preparation was common. Reasons for use included arthritis, chronic back pain, anxiety, and depression. Past-year marijuana users reported improved overall health, quality of life, day-to-day functioning, and improvement in pain. Odds of past-year marijuana use decreased with each additional year of age. The odds were lower among women and those with higher self-reported health status; odds of use were higher with past-year opioid use. Older persons with access to recreational and medical marijuana described concurrent use of medical and recreational marijuana, use of multiple preparations, and overall positive health impacts