Opioids and the Risk of Motor Vehicle Collision: A Systematic Review

Aim and Background: Opioid analgesics are amongst the most commonly prescribed medications, but questions remain regarding their impact on the day-to-day functioning of patients including driving. Previous studies of the effects of opioids on the risk of motor vehicle collisions (MVCs) have shown inconsistent findings. We set out to perform a systematic review on the risk of MVC associated with prescription opioid exposure. Methods: We searched Medline, PubMed, EMBASE, Scopus and TRID from January 1990 to January 31, 2020 for primary studies assessing prescribed opioid use and MVCs. Studies that used surrogate driving capability tests were excluded. The Newcastle-Ottawa scale was used to assess quality of included studies. Findings: We identified 12 observational studies that met inclusion criteria. Among those, 7 studies found an increased risk of MVC among those participants who had a concomitant opioid prescription at the time of the MVC and 2 found no significant increase of culpability of fatal MVC. The three studies that evaluated the presence of a dose-response relationship between the dose of opioids taken and the effects on MVC risk reported the existence of a dose-response relationship. Due to the heterogeneity of the different studies, a quantitative meta-analysis to sum evidence was deemed unfeasible. Interpretation: Our review indicates that opioid prescriptions are likely associated with an increased risk of MVCs. Further studies are warranted to strengthen this finding, and investigate additional factors such as individual opioid medications, opioid doses and dose adjustments, and opioid tolerance for their effect on MVC risk. Funding: This project was supported by the Rady Faculty of Health Sciences, University of Manitoba and the Chronic Disease Innovation Centre, Seven Oaks Hospital. Declaration of Interest: None to declare.