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Chronic non-cancer pain (CNCP) is a major health problem. Patients are increasingly treated with chronic opioid therapy (COT). Several laboratory studies have demonstrated that long-term use of opioids does not generally impair driving related skills. But there is still a lack of studies investigating on-the-road driving performance in actual traffic. The present study assessed the impact of COT on road-tracking and car-following performance in CNCP patients. Twenty CNCP patients, long-term treated with stable doses of opioid analgesics, and 19 healthy controls conducted standardized on-the-road driving tests in normal traffic. Performance of controls with a blood alcohol concentration (BAC) of 0.5 g/L was used as a reference to define clinically relevant changes in driving performance. Standard Deviation of Lateral Position (SDLP), a measure of road-tracking control, was 2.57 cm greater in CNCP patients than in sober controls. This difference failed to reach statistical significance in a superiority test. Equivalence testing indicated that the 95% CI around the mean SDLP change was equivalent to the SDLP change seen in controls with a BAC of 0.5 g/L and did not include zero. When corrected for age differences between groups the 95% CI widened to include both the alcohol reference criterion and zero. No difference was found in car-following performance. Driving performance of CNCP patients did not significantly differ from that of controls due to large inter-individual variations. Hence in clinical practice determination of fitness to drive of CNCP patients who receive opioid treatments should be based on an individual assessment.
The DRUID expert consensus established recommendations on how to define limits for psychoactive substance use in traffic. The European DRUID project established a group of experts who are members of national working groups for defining analytical and/or risk thresholds. This group evaluated the results of DRUID, scientific literature and the experience of representatives of several EU Member States and Norway in determining cut-off levels. 1. Cut-offs should be defined for the most frequently used psychoactive substances; 2. In order to achieve compliance of the population towards cut-off regulations, they should be clear and comprehensible, pointing out the risks when used in traffic; 3. Thus, the definition of cut-offs should be based on current scientific knowledge; 4. The lowest substance concentration exerting an effect on driving should be preferred instead of the lowest limit of quantification/ detection; 5. For all psychoactive substances including alcohol, the same risk should be accepted. When a country intends to determine per se cut-off levels, several considerations have to be taken into account. From a scientific point of view, the same risk should be anticipated for all psychoactive substances including alcohol. Nevertheless, every cut-off discussion should address the question if the DRUID approach, to determine risk thresholds equivalent to alcohol limits, is feasible for the respective case.
The 6th RFP project DRUID aimed at supporting European transport policy makers by suggesting scientifically based recommendations to combat impaired driving. The main DRUID objectives were: 1. In-depth analysis of the problem situation with regard to DUI/DUID in Europe; 2. Assessment of prevalence and accident risks of DUI/DUID on the basis of epidemiological and experimental studies; 3. Evaluation of oral fluid screening devices and cost-benefit analysis of a strengthened drug driving enforcement; 4. Development of a classification system for medicines; 5. Evaluation of driver rehabilitation schemes and strategies of licence revocation; 6. Assessment of the effectiveness of new prescribing and dispensing guidelines for medicines; 7. Ddevelopment of policy recommendations on the basis of DRUID results. All in all, the DRUID results revealed that prevalence of psychoactive substance consumption, DUI/DUID, enforcement levels and legal strategies are very heterogeneous in European countries. Nonetheless, DRUID derives general recommendations as base for national solutions.