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Abstract
Background Opioids increase the risk of traffic crash by limiting coordination, slowing reflexes, impairing concentration and producing drowsiness. The epidemiology of prescription opioid use among drivers remains uncertain. We aimed to examine population-based trends and geographical variation in drivers’ prescription opioid consumption.
Methods We linked 20 years of province-wide driving records to comprehensive population-based prescription data for all drivers in British Columbia (Canada). We calculated age- and sex-standardised rates of prescription opioid consumption. We assessed temporal trends using segmented linear regression and examined regional variation in prescription opioid use using maps and graphical techniques.
Results A total of 46 million opioid prescriptions were filled by 3.0 million licensed drivers between 1997 and 2016. In 2016 alone, 14.7% of all drivers filled at least one opioid prescription. Prescription opioid use increased from 238 morphine milligram equivalents per driver year (MMEs/DY) in 1997 to a peak of 834 MMEs/DY in 2011. Increases in MMEs/DY were greatest for higher potency and long-acting prescription opioids. The interquartile range of prescription opioid dispensation by geographical region increased from 97 (Q1=220, Q3=317) to 416 (Q1=591, Q3=1007) MMEs/DY over the study interval.
Implications Patterns of prescription opioid consumption among drivers demonstrate substantial temporal and geographical variation, suggesting they may be modified by clinical and policy interventions. Interventions to curtail use of potentially impairing prescription medications might prevent impaired driving.
- public health
- descriptive epidemiology
- driver
- drugs
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Footnotes
Contributors JAS, HC, SE and JRB were responsible for study concept. All authors contributed to study design. JAS and SE designed analytic strategy. JRB, HC and SE were responsible for acquisition of the data. SE had full access to all study data, was responsible for the integrity of the data and the accuracy of the data analysis. JAS was responsible for drafting the manuscript. All authors were responsible for critical revision of the manuscript. All inferences, opinions and conclusions drawn in this manuscript are those of the authors and do not reflect the opinions or policies of the Data Stewards.
Funding This study was supported by the Canadian Institutes of Health Research (grant numbers 162089 and 126059), the Heart and Stroke Foundation of Canada (grant number G-19-0026232) and the UBC Division of General Internal Medicine (no award/grant number). JAS was supported by the Vancouver Coastal Health Research Institute, the UBC Division of General Internal Medicine and the Michael Smith Foundation for Health Research. JRB is supported by the Michael Smith Foundation for Health Research and the British Columbia Emergency Medicine Network.
Disclaimer Funding organisations were not involved in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review and approval of this manuscript.
Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The University of British Columbia Clinical Research Ethics Board approved the study and waived the requirement for individual consent.
Data availability statement Data may be obtained from a third party and are not publicly available. Data stewards including the British Columbia Ministry of Health and the Insurance Corporation of British Columbia provided the de-identified administrative health and driver data used in this study. Linked data were accessed through Population Data BC. All inferences, opinions and conclusions drawn in this manuscript are those of the authors and do not reflect the opinions or policies of the Data Stewards.
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