Drugs and Driving: Steer Clear of Deadly Drowsiness
Over-the-counter and prescription drugs can drive you to distraction, or worse.
Nov. 27, 2011— -- I Fell Asleep!
That's what the dazed woman exclaimed after Chuck Hayes found her slumped over the steering wheel of her crashed car.
Hayes had been patrolling a rural stretch of Interstate 5 north of Salem, OR, just after midnight on New Year's Eve, when he glimpsed a flash of red in the hedge along the median strip. It took a moment for the veteran state police officer to register what he'd seen: taillights shining out from the shrubbery. He doubled back and found a subcompact embedded in the bushes. In the driver's seat sat a woman in her 40s, conscious and apparently uninjured.
When Hayes approached and called out to her, her eyelids fluttered, and she looked surprised by her surroundings. From her slurred speech and abysmal performance on the field sobriety test (which included the time-tested "touch your finger to your nose" and so forth), Hayes guessed she'd been hitting the champagne, but there was no hint of alcohol on her breath. When she opened her purse to get her driver's license, he spotted the cause of her intoxication: a handful of small prescription bottles.
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She was carrying three common medications: a sleeping pill, a tranquilizer, and an antidepressant. Leaning against her car, too impaired to stand for more than a few minutes, the woman explained that her doctor had recently prescribed the drugs to help her through a rough patch--just the ordinary woes of a middle-aged waitress. That night she'd been working, not celebrating, and had planned to go to bed as soon as she got home. Her doctor had told her that the sleep med would kick in half an hour after she swallowed it. Her commute took 15 minutes, so she'd popped the pill just before getting in the car, thinking her timing was perfect. But she'd blacked out and drifted off the road.
As it happened, for the past 17 years, Hayes had been serving (as he still does) as a drug-recognition expert (DRE), one of more than 6,500 officers nationwide who are specially trained to evaluate drivers affected by substances other than alcohol. He knew that sleeping pills, like any other medication, don't always behave as expected, especially when taken in conjunction with other drugs, such as those he'd seen in the waitress's purse. He also knew she was lucky not to have been injured--or to have hurt someone else. Hayes booked her for driving under the influence, a crime that increasingly covers impairment caused by prescription medications, not just alcohol and illegal drugs, and she was duly convicted. She pleaded guilty and, as a first offender, was sentenced to a year's probation instead of jail.
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The hard-working waitress hadn't knowingly abused drugs, but she was just as great a menace on the road as any five-margarita happy-hour guzzler. And her dangerous mistake is hardly unique.
"Law enforcement officers commonly see people who have no idea how unsafe prescribed drugs have made their driving," says Hayes, now a regional DRE coordinator for the International Association of Chiefs of Police. "They don't realize that they shouldn't be behind the wheel of a car until it's brought to their attention--often dramatically."
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Over the past two decades or so, drunk-driving deaths in the United States have fallen by nearly half, from more than 21,000 in 1982 to fewer than 11,000 in 2009. But according to Hayes, there's been an upswing in vehicle crashes involving drugs that are potentially driver impairing (PDI). Substances such as marijuana and methamphetamine are included in that uptick, but many "drugged driving" accidents are caused by ordinary motorists who misjudge their ability to drive safely while taking legitimate medications.
Precise figures on such accidents are hard to come by for several reasons: Few states keep separate records for incidents or DUIs involving drugs, there's no standard measure of drug-induced intoxication, and laws about culpability vary greatly. However, the Office of National Drug Control Policy calls drugged driving a "growing problem" and warns that the pills in many Americans' medicine cabinets play a significant role--a judgment echoed by police officials, emergency room workers, and traffic safety researchers across the country.
The results of such unintentional impairment can be tragic. One afternoon last summer, in Provo, UT, 58-year-old Diane Mott lost control of her car, swerving across several lanes and killing an elderly man in another vehicle, police charge. Allegedly, she told an officer she was taking a narcotic painkiller, which had been prescribed after back surgery. Mott was uninjured, but after her field sobriety test indicated impairment, she was charged with DUI and automobile homicide. The case is still pending.
And in Newport Beach, CA, Janene Johns, 53, struck and killed a 31-year-old third-grade teacher when she ran her Lexus onto a sidewalk. Johns's husband had died a month earlier, and she'd been prescribed a sleeping pill and an anti-anxiety med to help her cope. According to the district attorney's office, she had taken several prescription drugs on the day of the accident, including the anti-anxiety and sleeping pills, as well as a decongestant. Her local paper reported that the defense argued that when she got in her car at 6:30 PM, she might have been too addled even to know she was driving. Regardless, she was convicted of DUI and gross vehicular manslaughter while intoxicated. She was sentenced to 6 years in prison.
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Drivers may not always fully realize the risks that such commonplace medicines present. "The responsibility for making patients aware that drugs may impair their driving is shared," says Jennifer A. Reinhold, PharmD, an assistant professor of clinical pharmacy at the University of the Sciences in Philadelphia and a Prevention Advisory Board member.
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"Physicians should be warning patients, and though leaflets are dispensed with every drug, the effects and their strengths can vary, depending on the individual and the medication, so pharmacists offer counseling too. But it's the patients' responsibility to use the information."
Although not all patients read labels and brochures as carefully as they should, it's also true that the warnings may not be equally accurate for both sexes. "Women may have longer-lasting effects from drugs you swallow, such as sleeping pills or sedatives, because their stomachs have slower emptying times," says Marianne Legato, MD, director of the Partnership for Gender-Specific Medicine at Columbia University and a Prevention Advisory Board member. And because hormonal fluctuations can affect drug metabolism, the effects on women can be more unpredictable too.
In a 2007 roadside survey by the National Highway Traffic Safety Administration, nearly 4% of weekend nighttime drivers tested positive for PDI medications, including prescription and OTC drugs. By comparison, 2.2% had a blood alcohol level of 0.08 grams per deciliter or more (legally impaired). But motorists who've been drinking are likely to know--at least theoretically--that alcohol can make driving dangerous. Although older drivers are more apt to be taking one or more prescription drugs, only 28% of them indicated "some" awareness of the trouble such meds could cause, according to a 2009 AAA Foundation for Traffic Safety survey.
R. Gil Kerlikowske, the White House drug czar, aims to dispel such ignorance with a nationwide campaign to gather and disseminate data on the topic. For its part, the AAA foundation is developing an online program called Roadwise Rx, which will allow people to research the driving-related effects of various drugs and learn how the substances may interact. The launch date for the free service had yet to be determined at press time.
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Until these projects are completed, however, some motorists will end up learning the hard way about the dangers of drugged driving. For people who, to the best of their knowledge, haven't done anything illegal or wrong, finding themselves behind the wheel while impaired can be a terrifying lesson.
Last summer, Diane H., a 33-year-old Southern California administrative assistant and the mother of a 2-year-old boy, hurt her back when a car in which she was a passenger was rear-ended. Her doctor put her on a narcotic painkiller. For the first few weeks, Diane took the pills each evening after dinner, kept to her usual 9:30 PM bedtime, and didn't feel abnormally drowsy.
Then one afternoon, her back pain flared up while she was at work. She took her painkiller--on an empty stomach--and left the office around 4 PM, getting behind the wheel of her Toyota SUV to drive straight home.
She had almost made it back safely when she started feeling a little groggy; by the time she had reached her block, her vision was blurred, and she could barely steer straight. She took a wide turn as she pulled into her driveway, veered onto the path beside it, and heard a sickening crunch. Her reflexes had slowed down so much that she almost ran into the garage door before she managed to bring the car to a stop. Stumbling from the SUV, she found she'd run over a tricycle belonging to the 3-year-old who lived next door.
"It freaked me out beyond belief," she says now. "My neighbor's son could have been on that trike--or my son."
Highway To Health
There are Rx rules of the road you can use to keep from becoming a proverbial statistic. For starters, educate yourself. "A lot of the information you need is on either the medication label or the attached information sheet," says Dennis Bryan, past president of the Illinois Pharmacists Association. Many accidents could be avoided if drivers paid closer attention to the details, like the list of potential side effects, the recommended amount to take and frequency of dosage, and advice on whether the medication should be ingested on a full or empty stomach, as well as what steps to take if you accidentally miss a dose.
You also need to know your body so you can take into account just how quickly or slowly you personally tend to metabolize drugs. And always pay close attention to how you feel whenever you begin taking any given medication for the first time.
One thing most warning labels won't tell you is exactly when it's safe to get behind the wheel of your car.
"A good rule of thumb is to avoid driving for the first week after starting a new medication or changing the dose," says Richard Marottoli, MD, an associate professor at Yale University School of Medicine who consults for the US Department of Transportation. "It takes time to know how your body will respond." That goes for your mind as well: Stimulants that are used to treat attention deficit disorders, for example, may cloud a patient's judgment at first, even though they can improve focus once the proper dose has been established.
Another factor affecting driving safety is how your prescription medication interacts with other drugs.
Avoid These Dangerous Interactions
Warnings about taking alcohol with prescription drugs are especially crucial: Even a small amount of beer, wine, or hard liquor in combination with certain meds can cause unexpectedly severe intoxication. "Many of our prescription-drug cases involve middle-aged women, usually well-to-do, with no criminal histories," says Dana Grimes, a San Diego criminal defense attorney.
"They'll wash down a pain pill with a glass or two of wine and end up flipping their SUV on a road with no other traffic."
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It's also important to watch out for potentially dangerous interactions among otherwise benign meds. Some drugs can intensify the effects of others in ways you may not anticipate if you're not on your guard: Antihistamines, for instance, increase the sedating power of anti-anxiety drugs and codeine-based analgesics.
"Review potential interactions and side effects with your doctor or pharmacist whenever you're prescribed a medication," Dr. Marottoli advises. "And it's also helpful if one person knows everything you're taking." He recommends buying all your medications at the same place and requesting that the pharmacist flag any potentially problematic combinations she sees: "She'll know what you really need to worry about."
Sobbing, Diane called a friend, who recommended a physician who specializes in prescription-painkiller and pain-management issues. With his help, she's weaning herself off the medication and now uses mainly physical therapy to ease her pain. In retrospect, she realizes that her original doctor had advised her to take the pills at night because they might make her woozy; she'd also glanced at the warning label, which had the usual cautions about driving. But because "almost all medications have these stickers," she says, she'd ignored it. "I just thank God I didn't have to hurt anybody to get my wake-up call."
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