The impact of therapeutic opioid agonists on driving-related psychomotor skills assessed by a driving simulator or an on-road driving task: A systematic review

Abstract

Background:

Driving cessation is associated with poor health-related outcomes. People with chronic diseases are often prescribed long-term opioid agonists that have the potential to impair driving. Studies evaluating the impact of opioids on driving-related psychomotor skills report contradictory results likely due to heterogeneous designs, assessment tools and study populations. A better understanding of the effects of regular therapeutic opioid agonists on driving can help to inform the balance between individual’s independence and community safety.

Aim:

To identify the literature assessing the impact of regular therapeutic opioid agonists on driving-related psychomotor skills for people with chronic pain or chronic breathlessness.

Design:

Systematic review reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement; PROSPERO Registration CRD42017055909.

Data sources:

Six electronic databases and grey literature were systematically searched up to January, 2017. Inclusion criteria were as follows: (1) empirical studies reporting data on driving simulation, on-the-road driving tasks or driving outcomes; (2) people with chronic pain or chronic breathlessness; and (3) taking regular therapeutic opioid agonists. Critical appraisal used the National Institutes of Health’s quality assessment tools.

Results:

From 3809 records screened, three studies matched the inclusion criteria. All reported data on people with chronic non-malignant pain. No significant impact of regular therapeutic opioid agonists on people’s driving-related psychomotor skills was reported. One study reported more intense pain significantly worsened driving performance.

Conclusion:

This systematic review does not identify impaired simulated driving performance when people take regular therapeutic opioid agonists for symptom control, although more prospective studies are needed.

Keywords

Opioids opioid agonists chronic pain chronic breathlessness driving simulator driving performance driving outcomes

Get full access to this article

View all access options for this article.

References

King

Meuser

Berg-Weger

et al . Decoding the Miss Daisy Syndrome: an examination of subjective responses to mobility change. J Gerontol Soc Work 2011; 54(1): 29–52.

Gilhooly

Hamilton

O’Neill

et al . Transport and ageing: extending quality of life for older people via public and private transport. End of Award Report, ESRC L480254025, 31 May 2002. Swindon: Economic and Social Research Council.

Mezuk

Rebok

. Social integration and social support among older adults following driving cessation. J Gerontol B Psychol Sci Soc Sci 2008; 63(5): S298–S303.

Marottoli

de Leon

CFM

Glass

et al . Consequences of driving cessation decreased out-of-home activity levels. J Gerontol B Psychol Sci Soc Sci 2000; 55(6): S334–S340.

Choi

Lohman

Mezuk

. Trajectories of cognitive decline by driving mobility: evidence from the health and retirement study. Int J Geriatr Psychiatry 2014; 29(5): 447–453.

Chihuri

Mielenz

Dimaggio

et al . Driving cessation and health outcomes in older adults. J Am Geriatr Soc 2016; 64(2): 332–341.

Ragland

Satariano

MacLeod

. Driving cessation and increased depressive symptoms. J Gerontol A Biol Sci Med Sci 2005; 60(3): 399–403.

Windsor

Anstey

Butterworth

et al . The role of perceived control in explaining depressive symptoms associated with driving cessation in a longitudinal study. Gerontologist 2007; 47(2): 215–223.

Widman

Bergstrom

. Driving for patients in palliative care-a reality? Springerplus 2014; 3: 79.

10.

Portenoy

Lesage

. Management of cancer pain. Lancet 1999; 353: 1695–1700.

11.

Stewart

Wild

. World cancer report 2014. Geneva: World Health Organization, 2016.

12.

World Health Organization. Cancer pain relief: with a guide to opioid availability. Geneva: World Health Organization, 1996.

13.

Coluzzi

Pappagallo

. Opioid therapy for chronic noncancer pain: practice guidelines for initiation and maintenance of therapy. Minerva Anestesiol 2005; 71(7–8): 425–433.

14.

Abernethy

Currow

Frith

et al . Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ 2003; 327(7414): 523–528.

15.

Currow

McDonald

Oaten

et al . Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study. J Pain Symptom Manage 2011; 42(3): 388–399.

16.

Devulder

Richarz

Nataraja

. Impact of long-term use of opioids on quality of life in patients with chronic, non-malignant pain. Curr Med Res Opin 2005; 21(10): 1555–1568.

17.

Vainio

Tigerstedt

. Opioid treatment for radiating cancer pain: oral administration vs. epidural techniques. Acta Anaesthesiol Scand 1988; 32(3): 179–185.

18.

Bruera

Macmillan

Hanson

et al . The cognitive effects of the administration of narcotic analgesics in patients with cancer pain. Pain 1989; 39(1): 13–16.

19.

Banning

Sjogren

. Cerebral effects of long-term oral opioids in cancer patients measured by continuous reaction time. Clin J Pain 1990; 6(2): 91–95.

20.

Sjøgren

Thomsen

Olsen

. Impaired neuropsychological performance in chronic nonmalignant pain patients receiving long-term oral opioid therapy. J Pain Symptom Manage 2000; 19(2): 100–108.

21.

Vainio

Ollila

Matikainen

et al . Driving ability in cancer patients receiving long-term morphine analgesia. Lancet 1995; 346(8976): 667–670.

22.

Haythornthwaite

Menefee

Quatrano-Piacentini

et al . Outcome of chronic opioid therapy for non-cancer pain. J Pain Symptom Manage 1998; 15(3): 185–194.

23.

Byas-Smith

Chapman

Reed

et al . The effect of opioids on driving and psychomotor performance in patients with chronic pain. Clin J Pain 2005; 21(4): 345–352.

24.

Mailis-Gagnon

Lakha

Furlan

et al . Systematic review of the quality and generalizability of studies on the effects of opioids on driving and cognitive/psychomotor performance. Clin J Pain 2012; 28(6): 542–555.

25.

Cherny

Fallon

Kaasa

et al . Oxford textbook of palliative medicine. Oxford: Oxford University Press, 2015.

26.

Pathan

Williams

. Basic opioid pharmacology: an update. Br J Pain 2012; 6(1): 11–16.

27.

Trescot

Datta

Lee

et al . Opioid pharmacology. Pain Physician 2008; 11(Suppl. 2): S133–S153.

28.

Brown

Kraus

Fleming

et al . Methadone: applied pharmacology and use as adjunctive treatment in chronic pain. Postgrad Med J 2004; 80(949): 654–659.

29.

Newcomer

Farber

Olney

. NMDA receptor function, memory, and brain aging. Dialogues Clin Neurosci 2000; 2(3): 219–232.

30.

Argoff

Silvershein

. A comparison of long-and short-acting opioids for the treatment of chronic noncancer pain: tailoring therapy to meet patient needs. Mayo Clinic Proc 2009; 84: 602–612.

31.

Nicholson

. Responsible prescribing of opioids for the management of chronic pain. Drugs 2003; 63(1): 17–32.

32.

Hariharan

Lamb

Neuner

. Long-term opioid contract use for chronic pain management in primary care practice. A five year experience. J Gen Intern Med 2007; 22(4): 485–490.

33.

Gourlay

Cherry

Onley

et al . Pharmacokinetics and pharmacodynamics of twenty-four-hourly Kapanol compared to twelve-hourly MS Contin in the treatment of severe cancer pain. Pain 1997; 69(3): 295–302.

34.

Gourlay

. Sustained relief of chronic pain. Clin Pharmacokinet 1998; 35(3): 173–190.

35.

Portenoy

Southam

Gupta

et al . Transdermal fentanyl for cancer pain. Repeated dose pharmacokinetics. Anesthesiology 1993; 78(1): 36–43.

36.

Stevens

Ghazi

. Routes of opioid analgesic therapy in the management of cancer pain. Cancer Control 2000; 7(2): 132–141.

37.

Bachs

Engeland

Mørland

et al . The risk of motor vehicle accidents involving drivers with prescriptions for codeine or tramadol. Clin Pharmacol Ther 2009; 85(6): 596–599.

38.

Fine

. Ethical and practical issues with opioids in life-limiting illness. Proc (Bayl Univ Med Cent) 2007; 20(1): 5–12.

39.

Dumas

Pollack

. Opioid tolerance development: a pharmacokinetic/ pharmacodynamic perspective. AAPS J 2008; 10(4): 537.

40.

Puehler

Zöllner

Brack

et al . Rapid upregulation of μ opioid receptor mRNA in dorsal root ganglia in response to peripheral inflammation depends on neuronal conduction. Neuroscience 2004; 129(2): 473–479.

41.

Al-Hasani

Bruchas

. Molecular mechanisms of opioid receptor-dependent signaling and behavior. Anesthesiology 2011; 115(6): 1363–1381.

42.

Zacny

Lichtor

. Within-subject comparison of the psychopharmacological profiles of oral oxycodone and oral morphine in non-drug-abusing volunteers. Psychopharmacology 2008; 196(1): 105–116.

43.

Zacny

Paice

Coalson

. Separate and combined psychopharmacological effects of alprazolam and oxycodone in healthy volunteers. Drug Alcohol Depend 2012; 124(3): 274–282.

44.

Benyamin

Trescot

Datta

et al . Opioid complications and side effects. Pain Physician 2008; 11(2): S105–S120.

45.

Fishbain

Cutler

Rosomoff

et al . Are opioid-dependent/tolerant patients impaired in driving-related skills? A structured evidence-based review. J Pain Symptom Manage 2003; 25(6): 559–577.

46.

Ekström

Bornefalk-Hermansson

Abernethy

et al . Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ 2014; 348: g445.

47.

Dellinger

Sehgal

Sleet

et al . Driving cessation: what older former drivers tell us. J Am Geriatr Soc 2001; 49(4): 431–435.

48.

Naughton

Bennett

Feely

. Prevalence of chronic disease in the elderly based on a national pharmacy claims database. Age Ageing 2006; 35(6): 633–636.

49.

Milton

Hill-Smith

Jackson

. Prescribing for older people. BMJ 2008; 336: 606.

50.

Reuben

Mor

. Dyspnea in terminally ill cancer patients. Chest 1986; 89(2): 234–236.

51.

Johannes

Zhou

et al . The prevalence of chronic pain in United States adults: results of an internet-based survey. J Pain 2010; 11(11): 1230–1239.

52.

Wilkie

Ezenwa

. Pain and symptom management in palliative care and at end of life. Nurs Outlook 2012; 60(6): 357–364.

53.

Loeser

Treede

. The Kyoto protocol of IASP basic pain terminology. Pain 2008; 137(3): 473–477.

54.

Johnson

Yorke

Hansen-Flaschen

et al . Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness. Eur Respir J 2017; 49(5): 1602277.

55.

Lipnicki

Sachdev

Crawford

et al . Risk factors for late-life cognitive decline and variation with age and sex in the Sydney memory and ageing study. PLoS ONE 2013; 8(6): e65841.

56.

Maher

Hanlon

Hajjar

. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014; 13(1): 57–65.

57.

Verster

Joris

. The on-the-road driving test. In: Verster

Pandi-Perumal

Ramaekers

et al . (eds) Drugs, driving and traffic safety. Berlin: Springer, 2009, pp. 83–91.

58.

Verster

Roth

. Predicting psychopharmacological drug effects on actual driving performance (SDLP) from psychometric tests measuring driving-related skills. Psychopharmacology 2012; 220(2): 293–301.

59.

Waller

. Functional impairment in driving. New York State J Med 1980; 80(13): 1987–1991.

60.

Yale

Hansotia

Knapp

et al . Neurologic conditions: assessing medical fitness to drive. Clin Med Res 2003; 1(3): 177–188.

61.

Weaver

Bédard

. Assessing fitness to drive: practical tips on choosing the right screening tools for your practice. C Geriatr Soc J CME 2012; 2(3): 5–9.

62.

Helland

Jenssen

Lervåg

L-E

et al . Evaluation of measures of impairment in real and simulated driving: results from a randomized, placebo-controlled study. Traffic Inj Prev 2016; 17(3): 245–250.

63.

Jongen

Perrier

Vuurman

et al . Sensitivity and validity of psychometric tests for assessing driving impairment: effects of sleep deprivation. PLoS ONE 2015; 10(2): e0117045.

64.

Jongen

Vuurman

Ramaekers

et al . The sensitivity of laboratory tests assessing driving related skills to dose-related impairment of alcohol: a literature review. Accid Anal Prev 2016; 89: 31–48.

65.

Kay

Logan

. Drugged driving expert panel report: a consensus protocol for assessing the potential of drugs to impair driving. Washington, DC: National Highway Traffic Safety Administration, 2011.

66.

Desai

Wilsmore

Bartlett

et al . The utility of the AusEd driving simulator in the clinical assessment of driver fatigue. Behav Res Methods 2007; 39(3): 673–681.

67.

Vakulin

Baulk

Catcheside

et al . Effects of alcohol and sleep restriction on simulated driving performance in untreated patients with obstructive sleep apnea. Ann Intern Med 2009; 151(7): 447–455.

68.

Galski

Bruno

Ehle

. Driving after cerebral damage: a model with implications for evaluation. Am J Occup Ther 1992; 46(4): 324–332.

69.

Helland

Jenssen

Lervag

et al . Comparison of driving simulator performance with real driving after alcohol intake: a randomised, single blind, placebo-controlled, cross-over trial. Accid Anal Prev 2013; 53: 9–16.

70.

Moher

Liberati

Tetzlaff

et al . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6(7): e1000097.

71.

Dijkstra

Houx

Jolles

. Cognition after major surgery in the elderly: test performance and complaints. Br J Anaesth 1999; 82(6): 867–874.

72.

Smith

. Opioid metabolism. Mayo Clin Proc 2009; 84(7): 613–624.

73.

Popay

Roberts

Sowden

et al . Guidance on the conduct of narrative synthesis in systematic reviews. London: Institute for Health Research, 2006.

74.

Nilsen

Landrøl

Kaasal

et al . Driving functions in a video simulator in chronic non malignant pain patients using and not using codeine. Eur J Pain 2011; 15(4): 409–415.

75.

Menefee

Frank

Crerand

et al . The effects of transdermal fentanyl on driving, cognitive performance, and balance in patients with chronic nonmalignant pain conditions. Pain Med 2004; 5(1): 42–49.

76.

Galski

Williams

Ehle

. Effects of opioids on driving ability. J Pain Symptom Manage 2000; 19(3): 200–208.

77.

Opioid conversion ratios: guide to palliative care practice 2016, Eastern Metropolitan Region Palliative Care Consortium, 2016, http://www.emrpcc.org.au/wp-content/uploads/2016/05/Opioid-Conversions-May-3-2016-final.pdf (accessed 18 October 2017)

78.

Klepstad

Kaasa

Jystad

. Immediate-or sustained-release morphine for dose finding during start of morphine to cancer patients: a randomized, double-blind trial. Pain 2003; 101(1): 193–198.

79.

Gomes

Redelmeier

Juurlink

et al . Opioid dose and risk of road trauma in Canada: a population-based study. JAMA Intern Med 2013; 173(3): 196–201.

80.

Clark

Fan

Slatore

et al . Dyspnea and pain frequently co-occur among Medicare managed care recipients. Ann Am Thorac Soc 2014; 11(6): 890–897.

81.

Von Leupoldt

Dahme

. Experimental comparison of dyspnea and pain. Behav Res Methods 2007; 39(1): 137–143.

82.

Sjøgren

Olsen

Thomsen

et al . Neuropsychological performance in cancer patients: the role of oral opioids, pain and performance status. Pain 2000; 86(3): 237–245.

83.

Veldhuijzen

Van Wijck

Wille

et al . Effect of chronic nonmalignant pain on highway driving performance. Pain 2006; 122(1): 28–35.

84.

Farrar

Young

LaMoreaux

et al . Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001; 94(2): 149–158.

85.

Karakontaki

Gennimata

S-A

Palamidas

et al . Driving-related neuropsychological performance in stable COPD patients. Pulm Med 2013; 2013: 279371.

86.

Traue

Ross

. Palliative care in non-malignant diseases. J R Soc Med 2005; 98(11): 503–506.

87.

Rocker

Young

Donahue

et al . Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease. CMAJ 2012; 184(9): E497–E504.

88.

Hadjiphilippou

Odogwu

Dand

. Doctors’ attitudes towards prescribing opioids for refractory dyspnoea: a single-centred study. BMJ Support Palliat Care 2014; 4(2): 190–192.

89.

Martin

Williams

Haskard

et al . The challenge of patient adherence. Ther Clin Risk Manag 2005; 1(3): 189–199.

90.

Jin

Sklar

Min Sen Oh

et al . Factors affecting therapeutic compliance: a review from the patient’s perspective. Ther Clin Risk Manag 2008; 4(1): 269–286.