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Percent of drivers killed under opioid influence spikes

August 6, 2017

In one of the latest examples of the growing opioid epidemic, researchers found a seven-fold increase in the proportion of drivers killed while under the influence of prescription opioids since 1995.

Researchers at Columbia University examined drug testing results for 36,729 drivers in California, Hawaii, Illinois, New Hampshire, Rhode Island and West Virginia who died within an hour of being in a car crash.

“The opiate epidemic is primarily defined by deaths from overdoses, but its health impact goes beyond those overdose fatalities,” said Guohua Li, the study’s senior author and director of the Center for Injury Epidemiology and Prevention at Columbia University. Li said he expects the increased proportion of fatal crashes involving prescription opioids to apply to this year as well.

In a paper published last month in the American Journal of Public Health, researchers found that the prevalence of drivers with prescription opioids detected in their systems at the time of death surged from 1.0% in 1995 to 7.2% in 2015.

The three most commonly detected opioids were oxycodone, morphine and codeine. Nearly 70% of those who tested positive for prescription opioids also tested positive for other drugs and 30% had elevated blood alcohol concentrations.

“Prescription opiates are so widely prescribed and used,” said Li. “People may think it’s not a big deal and it’s safe to go about routine activities like driving, but we’ve found this is not the case, especially when prescription opiates are used in combination with alcohol or other drugs.”

Mixing alcohol with opioids can increase sedation. It can also increase the risk of an overdose, as both have a depressant effect on the body.

“Our general recommendation is not to drink alcohol when people are on prescription opioids,” said Sarah Wakeman, the medical director of the Substance Use Disorder Initiative and Addiction Consult Team at Massachusetts General Hospital in Boston. She also tells her patients to avoid driving for at least a week after they begin or increase the dosage of an opioid prescription.

“(Opiates) could be a real threat to our driving safety,” he said. “And not just to the drivers themselves, but everyone on the road.”

Henry McCain and Pasco Deputy Ashley Grady were two of those people on the road. McCain was killed and Grady severely injured in 2011 when Brittany Miles drove her truck onto a Florida highway in an attempt to escape arrest for DUI.

During a trial that garnered national media attention , Miles said she was high on oxycodone when she was arrested by law enforcement for a suspected DUI. It was also later found that she had hidden eight or nine Xanax pills in her underwear and swallowed them while she was in the police cruiser.

During the trial, Miles said she became addicted to oxycodone after a car accident in 2009, when a physician prescribed it for her back pain. She was convicted of murder and sentenced to life in prison in 2013.

“She destroyed not just my dad’s life, but she destroyed her own,” said McCain’s daughter, Kellie, who is a victim advocate for Mothers Against Drunk Driving (MADD).

In 2015, MADD expanded its mission statement to include drug-impaired driving.

“MADD is concerned about the rise of opiates across the nation and the effect it has on the safety of our roadways,” said Colleen Sheehey-Church, MADD’s national president, whose own son died in a car crash where the driver was later found to have both alcohol and drugs in her system. “There is absolutely no doubt that drugged driving is a serious problem.”

A study published this month in the Annals of Internal Medicine looked at drug use across the country and reported that an estimated 92 million U.S. adults used prescription opioids in 2015. That’s more than the populations of California, Florida, New York and New Jersey combined.

Nearly 12 million people misused prescription opioids, taking them without a prescription, more often than prescribed or for reasons other than intended by their physicians. Almost 2 million had an opioid use disorder, marked by issues controlling or cutting down use, social problems and failure to fulfill family work or school obligations.

“This epidemic has been going on and getting worse for so many years,” Li said.

Although a recent report by the Centers for Disease Control and Prevention found the overall amount of opioids prescribed in the U.S. dropped between 2010 and 2015, that amount is still three times higher than it was in 1999.

In 2016, the CDC published its CDC Guidelines for Prescribing Opioids for Chronic Pain in an effort to help stymie the epidemic, recommending that physicians in primary care settings prescribe non-opioid therapies such as acetaminophen, NSAIDs, exercise therapy and cognitive behavioral therapy for chronic pain except for during active cancer treatment, palliative care or end-of-life care.

And last month, the president’s commission on the opioid crisis asked President Trump in an interim report to declare the opioid epidemic a national emergency.

The report called for mandating training initiatives for providers, as well as providing legislative language that states can use to increase the availability of naloxone, an overdose-reversing drug. It also recommended waiving a federal rule saying that Medicaid cannot reimburse residential addiction treatment in institutions with more than 16 beds.

“Our citizens are dying,” the commission members wrote. “We must act boldly to stop it.”

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