Bernard Delorme

The impact of medicinal drugs on traffic safety: a systematic review of epidemiological studies

To evaluate the quality of epidemiological research into effects of medicinal drugs on traffic safety and the current knowledge in this area.

Benzodiazepine-like hypnotics and the associated risk of road traffic accidents.

The aim of the study was to investigate the association between the use of benzodiazepine or benzodiazepine‐like hypnotics and the risk of road traffic accidents. Data from three French national databases were matched: the health‐care insurance database, police reports, and the police database of injury‐related traffic accidents. A total of 72,685 drivers involved in injury‐related road traffic accidents in France, from 2005 to 2008, were included in the study. The risk of being responsible for a traffic accident was higher in users of benzodiazepine hypnotics (odds ratio (OR) = 1.39 (1.08–1.79)) and in the 155 drivers to whom a dosage of more than one pill of zolpidem a day had been dispensed during the 5 months before the collision (OR = 2.46 (1.70–3.56)). No association was found between the use of zopiclone and risk of traffic accidents. Although this study did not find any association between the use of zolpidem as recommended and causation of traffic accidents, the potential risk related to possible abuse of the drug and risky driving behaviors should be further investigated. The results related to benzodiazepine hypnotics are consistent with those of previous studies.

Prescription Medicines and the Risk of Road Traffic Crashes: A French Registry-Based Study

Using three nationwide databases in France, Ludivine Orriols, Emmanuel Lagarde, and colleagues provide evidence that prescribed medicines contribute to the risk of experiencing a road traffic crash.

Road traffic crashes and prescribed methadone and buprenorphine: A french registry-based case–control study

BACKGROUND Opioids have been shown to impair psychomotor and cognitive functioning in healthy volunteers with no history of opioid abuse. Few or no significant effects have been found in opioid-dependant patients in experimental or driving simulation studies. The risk of road traffic crash among patients under buprenorphine or methadone has not been subject to epidemiological investigation so far. The objective was to investigate the association between the risk of being responsible for a road traffic crash and the use of buprenorphine and methadone. METHODS Data from three French national databases were extracted and matched: the national health care insurance database, police reports, and the national police database of injurious crashes. Case-control analysis comparing responsible versus non responsible drivers was conducted. RESULTS 72,685 drivers involved in an injurious crash in France over the July 2005-May 2008 period, were identified by their national health care number. The 196 drivers exposed to buprenorphine or methadone on the day of crash were young, essentially males, with an important co-consumption of other substances (alcohol and benzodiazepines). Injured drivers exposed to buprenorphine or methadone on the day of crash, had an increased risk of being responsible for the crash (odds ratio (OR)=2.02, 95% confidence interval (CI): 1.40 and 2.91). CONCLUSIONS Users of methadone and buprenorphine were at increased risk of being responsible for injurious road traffic crashes. The increased risk could be explained by the combined effect of risky behaviors and treatments.

Prescription of Antiepileptics and the Risk of Road Traffic Crash

Studies assessing the impact of epilepsy and its medication on the risk of road traffic crashes have shown inconsistent results. The aim in this study was to assess this risk using French databases. Data from three French national databases were extracted and matched: the national health care insurance database, police reports, and the national police database of injurious crashes. Only antiepileptics prescribed predominantly in epilepsy were studied (phenobarbital, phenytoin, ethosuximide, valproic acid, vigabatrin, tiagabin, levitiracetam, zonisamide, and lacosamide). A case–control analysis comparing responsible and non‐responsible drivers and a case–crossover analysis were performed. Drivers (72 685) involved in an injurious crash in France between July 2005 and May 2008, were included. Drivers exposed to prescribed antiepileptic medicines (n = 251) had an increased risk of being responsible for a crash (OR 1.74 [1.29–2.34]). The association was also significant for the most severe epileptic patients (n = 99; OR = 2.20 [1.31–3.69]). Case–crossover analysis found no association between crash risk and treatment prescription. Patients with prescription of antiepileptic drugs should be cautioned about their potential risk of road traffic crash. This risk is however more likely to be related to seizures than to the effect of antiepileptic medicines.

298 Impact of colour-graded pictogram on medicine packages to caution against the risk of traffic crash

Background In France, a colour-graded pictogram is printed on the outer packaging of medicines according to their effect on driving performance, from level 1 (low risk) to level 3 (high risk). The aim of this study was to assess the impact of labelling benzodiazepines and z-hypnotics with level 2 or 3 pictograms on the risk of road traffic crash. Methods Data from three French national databases were extracted and matched: the healthcare insurance database, police reports, and the police database of injurious crashes. Drivers involved in an injury crash in France, from July 2005 to December 2011, and identified by their national identifier were included. The study period was divided into 4 periods. The first period corresponded to a period before the colour-graded three-level pictogram was set up. The immediately subsequent period was used to estimate the impact of the introduction of the three-level pictogram. The two following time-periods were defined to assess any relapse in the potential impact of the pictogram. A case-control analysis comparing responsible versus non-responsible drivers was conducted. Results 142,763 drivers were included. Exposure to benzodiazepine anxiolytics (level 2 or 3) was associated with an increased risk of being responsible for a road traffic crash during the first period of the study (OR = 1.42 [1.24–1.62]). The association disappeared in the second period and became significant again during the third and the fourth period. The risk of being responsible for a crash increased in users of z-hypnotics (level 3) across the four periods (OR from 0.97 [0.81–1.17] to 1.32 [1.10–1.60]). Conclusions Our results suggest that there has been a change in driving behaviour in benzodiazepine anxiolytic users after the implementation of the graded pictogram. However, there was a relapse immediately after. The increased risk associated with z-hypnotic use despite the presence of the higher level of pictogram calls for further preventive interventions.

Risk of injurious road traffic crash after prescription of antidepressants

Background Antidepressants are commonly used worldwide. Experimental studies have suggested that antidepressants may impair driving abilities. Aims/Objectives/Purpose The study aims to estimate the risk of road traffic crash associated with prescription of antidepressants. Methods Data from three French national databases were extracted and matched: the national health care insurance database, police reports, and the national police database of injurious crashes. A case-control analysis comparing 34 896 responsible versus 37 789 non-responsible drivers was conducted. Case-crossover analysis was performed to investigate the acute effect of medicine exposure. Results/Outcomes 72 685 drivers identified by their national healthcare number, involved in an injurious crash in France over the July 2005 to May 2008 period, were included. 2936 drivers (4.0%) were exposed to at least one antidepressant on the day of the crash. The results showed a significant association between the risk of being responsible for a crash and prescription of antidepressants (OR=1.34 (1.22 to 1.47)). The case-crossover analysis showed no association with treatment prescription but the risk of road traffic crash increased after an initiation of an antidepressant treatment (OR=1.49 (1.24 to 1.79)) and after a change in antidepressant treatment (OR=1.32 (1.09 to 1.60)). Significance/Contribution to the Field Patients and prescribers should be warned about the risk of crash during periods of antidepressant medication and particularly high vulnerability periods such as those when a treatment is initiated or modified.

Prescribed medicines and the risk of road traffic crashes: results of a French registry-based study

Background There is a growing concern over the impact of medicines on the risk of road traffic crashes. The French Health Products Safety Agency established a classification of medicines affecting driving abilities, using a labelling system with 4 levels of risk. Objective To investigate the association between prescribed medicine use and the risk of road traffic crashes, providing risk and attributable fraction estimates, with particular focus on the French labelling system. Methods We matched data from three exhaustive nation-wide databases: the database on medicine reimbursing, police reports and the database of injurious crashes. Drivers involved in an injurious crash in France, from July 2005 to May 2008, and identified by their national healthcare number were included. We studied prescribed medicines grouped according to the four levels of the French classification (level 0 to level 3). We performed a responsibility and a case-crossover analysis. Results 72 685 drivers were included. The results showed an increased risk of being responsible for a crash for users of medicines of level 2 (OR=1.31 [1.24 to 1.40]) and level 3 (OR=1.25 [1.12 to 1.40]). The fractions of road traffic crashes attributable to levels 2 and 3 medicine use were 2.9% (2.3–3.4%) and 0.6% (0.3–0.8%) respectively. Conclusion Users of level 2 and 3 medicines are at increased risk of experiencing a road traffic crash. Further studies are needed to evaluate the impact of the French labelling system.