National Drunk, Drugged Driving Prevention Month: A Pharmacist’s Role in Helping Patients Arrive Home Safely

December is celebrated around the world as a month full of holiday laughter and cultural traditions; however, December is also nationally recognized as Drunk and Drugged Driving Prevention month in the United States. In 2018, the National Highway Traffic Safety Administration reported 839 fatal alcohol-related vehicular accidents in December. Specifically, the multiple crashes on December 24 and December 31 increased impaired driving accidents to account for approximately 50% of all traffic fatalities that year.¹

Between the months of March and July in 2020, nearly two-thirds of drivers involved in vehicular wrecks tested positive for at least 1 active drug including alcohol, marijuana, and opioids.² All 50 states have laws claiming impaired driving to be illegal; yet, many people do not understand that driving under the influence (DUI) not only includes intoxication from alcohol or illicit substance use but also impairment from legal prescription medications.³ As medication experts, pharmacists can serve a life-saving role as educators of the public and their patients on the facts and hazards of driving while impaired under legal prescription medications.⁴

The primary concerning medications are drugs that cause excessive drowsiness such as opioids, benzodiazepines, and even some anticonvulsants and antipsychotics.⁴ Excessive drowsiness impairs cognitive function by decreasing alertness, impairing judgment, and slowing reaction time—all of which negatively impact a person’s driving capability.⁵

While there is limited data concerning impaired driving with legal prescriptions, a meta-analysis of 15 studies involving prescription opioid use while driving reported an increased odds ratios of 2.29 (95% CI: 1.51, 3.48) for crash risk and 1.47 (95% CI: 1.01, 2.13) for crash culpability.⁵ Additionally, 2 other meta analyses regarding driving while influenced under benzodiazepines concluded an associated 60% (for case-control studies: pooled odds ratio [OR] 1.59; 95% CI 1.10, 2.31) to 80% (for cohort studies: pooled incidence rate ratio 1.81; 95% CI 1.35, 2.43) increase in the risk of traffic accidents and a 40% (pooled OR 1.41; 95% CI 1.03, 1.94) increase in 'accident responsibility.'⁷

Furthermore, the odds ratio in the accident risk pool increased by 7.7-fold with co-ingestion of benzodiazepines and alcohol (pooled OR 7.69; 95% CI 4.33, 13.65).6 These increased hazard risks directly impact pharmacists because 27 out of 100 annual physician visits result in a benzodiazepine prescription, with one-third of these visits involving an overlapping opioid prescription, according to the National Health Statistics Report.⁷ Thus, pharmacists should be aware of strategies that can easily be adopted to prevent public harm through DUIs that are due to intoxication from legal prescription medications.⁸

One strategy emphasizes the importance of acknowledging a patient’s health literacy and providing comprehendible patient education. Pharmacists can help decrease DUI events through proper patient counseling at every CNS depressant prescription pick-up.⁸

‘May cause drowsiness’ prescription labels can help warn patients; however, many patients do not know how to properly comprehend prescription labels. Specifically, studies have shown that the use of certain terminology in particular can negatively impact a patient’s ability to understand prescription labels.⁸ For example, the safety label that warns patients to not drive or operate heavy machinery while taking opioids does not specify that automobiles are considered heavy machinery. If a pharmacist does not explain this terminology to the patient, then the patient may operate a vehicle while under the influence of narcotics simply because they were not counseled effectively.⁶

Another strategy that pharmacists can employ to prevent DUIs is to be mindful of older patients who are prescribed medications on the Beers Criteria List—especially those with anticholinergic or sedative effects. A meta-analysis found an increase in vehicular accident risk among 65 years and older patients who were taking tricyclic antidepressants when compared to younger patients.⁶

While some medications on the Beers List are very common and safe to use, pharmacists must still be proactive and cautious to prevent impaired driving in every patient population. Additionally, despite many DUI cases occurring in the month of December, everyday pharmacists should serve the life-saving, preemptive role of comprehensive patient counseling and thorough medication assessment to prevent DUIs, decrease vehicular fatalities, and help patients arrive safely to their destinations.

This December, as people are coming together once more to celebrate the holiday season and the end of another year, pharmacist should remain vigilant for opportunities to intervene and reduce impaired driving. While this is an area many people may not assume is related to pharmacy, the fact is that many of the medications our patients take on a day-to-day basis can be implicated. Our involvement and awareness will not only benefit our individual patients, but our entire community. By helping raise awareness regarding what could contribute to DUIs and impaired driving, we can help reduce the tragic results that a DUI can cause.

REFERENCES

1. Media MADD. December is National Impaired Driving Prevention Month [Internet]. MADD. 2020 [cited 2021Nov3]. Available from: https://www.madd.org/december-is-national-impaired-driving-prevention-month
2. United States Department of Transportation National Highway Traffic Safety Administration, Office of Behavioral Safety Research. Update to special reports on traffic safety during the COVID-19 public health emergency: Fourth quarter data [traffic safety facts] [Internet]. National Transportation Library. United States. National Highway Traffic Safety Administration. Office of Behavioral Safety Research; 2021 [cited 2021Nov3]. Available from: https://rosap.ntl.bts.gov/view/dot/56125
3. National Center for Injury Prevention and Control. Impaired driving [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2021Nov3]. Available from: https://www.cdc.gov/transportationsafety/impaired_driving/index.html#:~:text=Impaired%20Driving%20%7C%20Motor%20Vehicle%20Safety%20%7C%20CDC%20Injury%20Center
4. Sigona N, Williams KG. Driving under the influence, public policy, and pharmacy practice. J Pharm Pract. 2015 Feb;28(1):119-23. doi: 10.1177/0897190014549839. Epub 2014 Oct 13. PMID: 25312259.
5. Chihuri S, Li G. Use of prescription opioids and motor vehicle crashes: A meta analysis. Accid Anal Prev. 2017 Dec;109:123-131. doi: 10.1016/j.aap.2017.10.004. Epub 2017 Oct 20. PMID: 29059534.
6. Dassanayake T, Michie P, Carter G, Jones A. Effects of benzodiazepines, antidepressants and opioids on driving: a systematic review and meta-analysis of epidemiological and experimental evidence. Drug Saf. 2011 Feb 1;34(2):125-56. doi: 10.2165/11539050-000000000-00000. PMID: 21247221.
7. Santo L, Rui P, Ashman J. Physician Office Visits at Which Benzodiazepines Were Prescribed: Findings From 2014–2016 National Ambulatory Medical Care Survey [Internet]. National Health Statistics Reports; 2020 [cited 2021Nov3]. Available from: https://www.cdc.gov/nchs/data/nhsr/nhsr137-508.pdf
8. Jeetu G, Girish T. Prescription drug labeling medication errors: a big deal for pharmacists. J Young Pharm. 2010 Jan;2(1):107-11. doi: 10.4103/0975-1483.62218. PMID: 21331202; PMCID: PMC3035877.