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Psychotropic drugs and driving: Prevalence and types

Article in Annals of General Psychiatry · May 2014

DOI: 10.1186/1744-859X-13-14 · Source: PubMed

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Alonso et al. Annals of General Psychiatry 2014, 13:14
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PRIMARY RESEARCH Open Access

Psychotropic drugs and driving: prevalence and

types
Francisco Alonso1*, Cristina Esteban1, Luis Montoro2 and Francisco Tortosa3

Abstract
Background: Some psychotropic medications (e.g., benzodiazepines, sedative antidepressants, etc.) may impair
cognitive and psychomotor functions and, therefore, endanger traffic safety (Ravera, Br J Clin Pharmacol,
72(3):505–513, 2011). They affect detection, registration, and information processing, problem solving, and
decision-making processes, and they also affect emotional and social aspects. The objective of this research
was to clarify three closely related issues that are significant for traffic safety: the prevalence of psychotropic
drugs on driving, the most frequently used psychotropic drugs to treat depression, anxiety, insomnia, or any
tranquilizers (whether it is a medical prescription or self-medication), and finally, provide a further understanding of the
socio-demographic and psycho-social characteristics of drivers related to the psychotropic drugs consumption in Spain.
Methods: A sample of 1,200 Spanish drivers ranging from 18 to 64 years was used, 666 men and 534 women were
asked to answer a questionnaire composed by a set of questions structured in different sections. The only selection
criteria were to be in possession of any type of driving license for vehicles other than motorcycles and drive frequently.
Results: The results showed that 15% of the participants were consuming psychotropic drugs to treat depressive
disorders, anxiety disorders, insomnia, or tranquilizers; 13.5% were using drugs to treat one of these disorders; while
1.5% used them for several of these disorders. A 2.5% of drivers were using medicines to treat depression, 2.6% to treat
anxiety, and 3.7% to treat insomnia. The 8.3% of those drivers who were not using any drugs to treat these three
disorders were occasionally using some type of tranquilizers. Benzodiazepines and selective serotonin reuptake
inhibitors (SSRIs) were the most used type of medicines among drivers. Benzodiazepines were the most used
medicines to treat anxiety, while SSRIs were the most used to treat depression, 56.5% and 43.5%, respectively.
Conclusions: Measures can be developed to reduce traffic accidents caused by the effects of these drugs; however,
this will only be possible once the drivers and the use of these drugs are understood. Health care professionals and
patients should be properly informed about the potential effects of some psychotropic medications on driving abilities
considering individual and group differences.
Keywords: Drivers, Road safety, Medicines, Psychotropic drugs, Epidemiology, Public health

Introduction a study [4], the majority of the psychiatric patients studied

Many psychiatric disorders may present problems with had a driving license and were driving on a daily basis,
driving [1,2]. However, decisions regarding fitness to and 79.5% of them failed to pass the required tests (gen-
drive on psychiatric grounds may be difficult because of eral driving license tests obligatory to obtain the license
the subjective nature of the symptoms and difficulty in according to the Spanish Medical and Psychotechnical
prediction of disturbed behavior. Exam Model). The most worrying finding was that ten
Most mental illnesses tend to reduce activity and inter- participants out of those who were driving were profes-
est and therefore possibly the use of a car [3]. However, in sional drivers (and only two of them passed the tests).
Moreover, psychiatric drug treatments may cause changes
* Correspondence: [email protected] in perception, information processing and integration, and
1
DATS (Development and Advising in Traffic Safety) Research Group, INTRAS psychomotor activity that may disturb and/or interfere
(Research Institute on Traffic and Road Safety), University of Valencia, Serpis
29, Valencia 46022, Spain with the ability to drive safely [5,6].
Full list of author information is available at the end of the article

© 2014 Alonso et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Alonso et al. Annals of General Psychiatry 2014, 13:14 Page 2 of 10
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When it comes to traffic, drugs are one of the many Specifically, using antidepressants, benzodiazepines, and
factors that may affect the ability to drive safely, even sleeping pills known as Z-drugs are all associated with a
though they are not the main cause of traffic accidents significantly increased risk of car accidents, according to a
[7]. Because of that, the high number of drivers who are study about psychotropic drugs linked to increased car ac-
under treatment is an aspect of great relevance that af- cidents. It was concluded that participants should be
fects road safety. In this sense, research has shown that properly informed of the potential risks associated with
taking psychotropic drugs can cause a higher risk of get- the use of these medicines [1,18].
ting involved in a traffic accident [8]. The Driving under the Influence of Drugs, Alcohol
The responsibility of psychotropic drugs as a cause of and Medicines (DRUID) project was an integrative effort
road traffic accidents remains difficult to evaluate with to reduce the danger of alcohol, illicit drugs, and medi-
precision. Different studies performed in many countries cines in traffic. Regarding prevalence of medicinal drugs
have provided a certain precision in relation to the per- in European countries, the study conclusions were as
centage of injured drivers whose blood contained psy- follows:
chotropic substances (8% to 10% according to studies).
On the other hand, it is practically impossible to really ! Illicit drugs are most prevalent among the
know either these substances were or were not the cause population in the Southern European countries
of the accidents because underlying or associated path- whereas medicines are most prevalent in the Nordic
ologies may equally create problems such as lack of at- countries (Denmark, Norway, Sweden, Finland).
tention and other vigilance deficits. There is also a ! EU mean, all psychoactive medicines: 1.4%; range
possibility of suicidal or aggressive tendencies [9]. across countries: 0.17%–2.99%).
A certain number of circadian and other chronobio- ! The prevalence rate for medicines in Spain was
logical parameters also complicate the problem since the 1.6%.
schedule (hour) as well as the day of the week or even ! Benzodiazepines were the most prevalent medicinal
the season can considerably modify vigilance and reac- drug in traffic. Z-drugs were less prevalent. However,
tion time. Available medications able to create such considerable differences between countries were
problems are numerous, and their mechanisms of action present.
are varied. They may affect vision, impulsiveness, and vigi- ! The medicinal drugs in general mainly detected
lance. They can act either by direct mechanisms of sed- among older female drivers during daytime hours.
ation or, on the contrary, by raising inhibition through ! More prevalence in men, in 35–49 years old, roads
secondary mechanisms: delay in drug elimination or caus- (not urban), weekend and holiday in daytime
ing insomnia. For the most part, incriminated medica- (working day in dark).
tions belong to the different classes of sedative medicines:
benzodiazepines, antiepileptics, some antihistaminic The epidemiology reveals a low risk for injury (1.5–3)
agents, some antidepressants, some thymoregulators and and a higher fatality risk (5–7) for the group of ‘benzodi-
some antihypertensives. If it appears methodologically azepines and Z-drugs’. The risk of medicinal opioids is
impossible that research could ever precisely quantify high for injury (5–8) but lower for a fatality (5) [19,20].
the share of responsibility of psychotropic drugs in caus- Usually, multiple administration of a psychoactive sub-
ing road traffic accidents, this relation remains highly stance to naïve subjects leads to adaptation after some
probable [9]. time of use. This means that after some days of use of a
It has been known for many years that the use of psy- psychoactive substance, the degree of performance impair-
chotropic substances, such as alcohol, sedatives, anxio- ment decreases. The degree of adaption depends on many
lytics, antidepressants, or illicit drugs, has a negative effect factors, especially the dose and the frequency of use.
on the ability to drive [10]. The condition in patients is by far even more complex
Several classes of drugs, including amphetamines, anti- than the situation during adaption of healthy subjects
histamines, cannabis, hypnotics, tranquilizers, and tricyclic because the disease itself might have impairing effects
antidepressants, have been shown to impair driving skills on performance that might be decreased by the medic-
in laboratory tests and driver-simulation studies [11-13]. ament itself. Thus, the impairing effects are determined
It is also apparent that drugs in combination with al- by an interaction of these factors. For further discussion
cohol, and multiple drugs, present an even greater risk. of this problem, see [21].
Drug driving is a significant problem, both in terms of a
general public health issue and as a specific concern for Study framework
drug users [14]. In fact, either alone or in combination, Connections between traffic and illnesses are strong and
alcohol and psychoactive substances increase the risk of complex, and they are beyond the existing relation of
having a traffic accident [10,15-17]. the ability to drive and the probability of being involved
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in a traffic crash. Health, beyond the absence of any ill- Method

ness, entails the full self-perceived biopsychosocial state Participants
of well-being [22]. From this approach, road health has Participants were part of a wide-ranging research on dif-
to be treated from a comprehensive perspective, i.e., tak- ferent aspects of health that affect driving. The sample
ing into account the biological, psychological, and social used was composed of 1,200 Spanish drivers ranging from
aspects [23,24]. Moreover, it is important to understand 18 to 64 years, 666 men (56%) and 534 women (44%). The
the health-related causes of drivers that may impair driv- starting sample size was proportional by quota to the
ing in order to prevent motor vehicle collisions and, also Spanish population segments of age and gender. The num-
important, for drivers to be aware of this risk. So, this is ber of participants represents an error margin for the gen-
why the framework of this article was a large-scale pro- eral data of ±2.9 with a 95% confidence interval in the
ject on ‘road safety and health’ to raise people's aware- most unfavorable case of p = q = 50%.
ness regarding this matter [23-25]. Drivers completed a telephone-based survey. Interviews
This global research on health and driving used a ques- were completed for 1,200 drivers, and the response rate
tionnaire made up of a set of items in different sections. was 92.8%; as it was a survey dealing with social matters,
First of all, the questionnaire was used to collect socio- the vast majority of people wanted to collaborate. There
demographic and psychosocial data of drivers. were 93 (7.2%) people who did not want to participate in
There were also subsections to collect information re- the interview.
lated to four areas: ‘subjective incidence of health in
driving’, ‘drivers' psychological state (condition)’ (includ- Procedure and design
ing symptom scales for depression, fatigue, anxiety, and The survey was conducted by telephone. A national tele-
daily and work stress), ‘medication and driving’, and ‘the phone household sample was constructed using random
system of selection of drivers’ (view and proposal). digit dialing. Each household was screened to determine the
The study described in this article is based on the data number of adult (age 18 or older) drivers in the household.
found in the section ‘medication and driving’. In the sec- The only selection criteria were to be in possession of any
tion of the questionnaire, participants were asked whether type of driving license for vehicles other than motorcycles
they were under pharmacological treatment for anxiety, and drive frequently. One eligible driver was systematically
depression, or insomnia. If not, they were asked whether selected in each eligible household by the interviewers.
they were using tranquilizers occasionally. If so, they were The survey was conducted using the computer-assisted
asked to state the type of medicine used and whether it telephone interviewing (CATI) system to reduce interview
had been prescribed by a doctor. In addition, in order to length and minimize recording errors, guaranteeing at all
understand the perception of drivers about how medicines times the anonymity of the participants, and stressing on
treat depression, anxiety, insomnia, or tranquilizers affect the fact that the data would only be used for statistical
driving, they were asked whether they thought that these and research purposes. The importance of answering hon-
medicines could affect their driving. It was also interesting estly to all the arisen questions was emphasized, as well as
to learn about their perception regarding the amount of the non-existence of wrong or right answers.
information they had about medicine use and how did In this article, the data obtained was analyzed in the
they learn about the influence of medicines on driving. questions as follows: ‘Are you currently under pharmaco-
The relationship between different treatments, type of logical treatment for any of these ailments? Anxiety, de-
medicine, and medical prescription was also analyzed in pression or insomnia’. The participants answered ‘yes’ or
the global research [25]. ‘no’ for each disorder. If their answer was ‘no’ for all of
them, they were asked: ‘Do you occasionally use any drug
Objective or pill to relax?’. If their answer was ‘yes’, in anyone, they
The specific objectives of this survey were as follows: were asked to say the type of medicine they used.
First of all, the questionnaire was used to collect data to
1. To know the prevalence of psychotropic drugs establish a profile of the interviewed as a driver, with the
(drugs to treat depression, anxiety, insomnia, or aim of detecting the distinguishing characteristics that de-
other tranquilizers) in drivers. fine their inclusion into a certain group(s). These variables
2. To identify the most used type of drug mainly focused on socio-demographic and psychosocial
3. Provide a further understanding of the socio- characteristics grouped in the following subsections.
demographic and psychosocial characteristics of drivers
related to the psychotropic drugs consumption. Demographic variables
The following are the demographic variables:
In general terms, these aspects will be used to design
interventions and to increase road safety. ! Sex (man or woman)
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! Age (grouped in 18–25, 26–35, 36–45, 46–55, Experience/risk

56–65, over 65) The following are the experiences/risks:
! Population size where they live (strata considered
are as follows: in less than 10,000; from 10,001 to ! Years of driving experience. Experience has been
20,000; 20,001 to 100,000; 100,001 to 500,000; and defined as the time that the respondent has been
more than 500,000) driving on a regular basis. This variable is
! Work activity (grouped in active, not active, complementary to the risk exposure, since both
housework) variables are an indicator of learning situations (both
! Profession (grouped in self-employed, management, positive and negative) that the respondent has been
other employees employed) able to experience in their driving history. (Grouped
! Working time (day, night, and shifts) in less than 1 year, 1–2 years, 3–10 years, 11–20,
21–30, over 30 years).
Driving habits ! Risky behavior. The risky taking is calculated by five
The following are the driving habits: items. The objective of this set of items is to rate
drivers for certain risk behaviors (exceeding speed
! Day/night driving (by day, by night, either). limits and not keep a safe distance, making a rushed
! Continuous driving by journey (grouped in less than or improper pass, driving after drinking alcohol,
1 h; for 1 to 2 h; 2 or more hours). using a mobile while driving without using a
! Type of road more frequently used for driving hands-free device). For each behavior considered
(grouped in urban zones; conventional roads; have applied the classification criteria of risk-no risk
highway). used in the study SARTRE 3 [26], depending on
! Type of vehicle used (grouped in utilitarian vehicles— how often they engaged in these behaviors. Taking
conventional cars, sports cars, and family—and these criteria into account, drivers have been
commercial or transportation vehicles such as vans, classified into three groups:
trucks, buses, etc. ‘No Risk’ group: drivers that have not been
! Risk exposure. To determine the level of risk classified in any of the risk behaviors considered.
exposure of the driver interviewed, both the average ‘Medium risk’ group: drivers who have been
miles driven per year as well as the frequency driven classified in one or two risk behaviors considered.
were taken into account. The combination of both ‘High risk’ group: drivers of risk are classified in
variables have led to a classification of drivers in five more than one of the considered behaviors.
groups: ! Traffic violations. Number of penalties received in
Exposure to very low risk: includes mainly the last 3 years, excluding parking offenses (none,
sporadic drivers (low frequency and/or few one, more than one penalty).
km/year). ! Crash history. Number of accidents occurring
Exposure to low risk: includes drivers who made throughout a driver's life, focusing primarily on
sporadic but long trips (e.g., vacation) or even accidents suffered as a conductor (none, one, more
those who drive frequently but made very few than one accident).
kilometers per year.
Average risk exposure: includes regular drivers Once the data was obtained, the relevant statistical
who do not average many kilometers per year analyses were carried out with the Statistical Package for
as their movements are not excessively long the Social Sciences (SPSS).
(e.g., urban trips or weekend outings).
Exposure to high risk: includes the usual Results
drivers averaging significant kilometers The results showed that 15% of the participants were con-
per year because their movements are suming psychotropic drugs, to treat depressive disorders,
relatively long (i.e., their commute to anxiety disorders, insomnia disorders, or tranquilizers;
and from work). 13.5% were using drugs to treat one of these disorders;
Exposure to very high risk, including those who while 1.5% used them for several of these disorders.
drive frequently and that in turn make many A 2.5% of drivers were using medicines to treat depres-
kilometers per year (e.g., professional drivers, sion, 2.6% to treat anxiety, and 3.7% to treat insomnia.
commercial, delivery, etc.). The 8.3% of those drivers who were not using any drugs
! Reason for driving. Grouped in itinere (on the to treat these three disorders were occasionally using
way to or from work), during work, leisure, some type of tranquilizers (7.7% of the total drivers inter-
and/or personal, regardless labor or leisure). viewed) (Figure 1).
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Percentage of drivers using drugs to treat different

disorders
% 97.5 97.4
100 96.3
91.7
90
80
70
60
50 Yes
40 No
30
20
8.3
10 2.5 2.6 3.7
0
Depression Anxiety Sleep disorders Tranquilizers (without
any other treatment)
Figure 1 Percentage distribution of drivers using drugs to treat depression, anxiety, stress, or tranquilizers.

There were statistically significant differences for gender that were being treated for this disorder was small (2.6%).
(x2 = 8.101, p ≤ 0.005), and age (x2 = 13.666, p ≤ 0.05) However, it was not possible to establish a significant rela-
among the 2.5% of drivers that were being treated for tionship between gender and drug use to treat this dis-
depression; women (70% of the interviewed drivers under order. Table 2 shows the frequency and percentage of
treatment for depression) and adults (46–55) used drugs people with or without anxiety medication classified ac-
more often than any other age group. Table 1 shows the cording to their gender or age.
frequency and percentage of people with or without By contrast, adults ranging from 56–65 years took
depression medication classified according to their gen- more drugs to treat insomnia, even though the differ-
der or age. ences in these groups did not reach the level of import-
Regarding anxiety, adults ranging from 36 to 45 years ance required (x2 = 10.229, p ≤ 0.07). In this case, it was
(x2 = 13.306, p ≤ 0.05) were the group that most used anx- not possible to establish a significant relationship be-
iety medication, even though the percentage of drivers tween gender and drug use to treat this disorder. Table 3

Table 1 Frequency and percentage of people with or Table 2 Frequency and percentage of people with or
without depression medication classified according to without anxiety medication classified according to their
their gender or age gender or age
With depression Without depression With anxiety Without anxiety
medication medication medication medication
Frequency Percentage Frequency Percentage Frequency Percentage Frequency Percentage
(n = 30) (n = 1170) (n = 31) (n = 1169)
Gender Women 21 3.9 513 96.1 Gender Women 19 3.6 515 96.4
Men 9 1.4 657 98.6 Men 12 1.8 654 98.2
Age 18–25 0 0 125 100 Age 18–25 2 1.6 123 98.4
26–35 4 1.5 261 98.5 26–35 3 1.1 262 98.9
36–45 11 3.2 335 96.8 36–45 17 4.9 329 95.1
46–55 12 5.2 220 94.8 46–55 7 3.0 225 97.0
56–65 3 1.7 169 98.3 56–65 2 1.2 170 98.8
> 65 0 0 60 100 > 65 0 0 60 100
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Table 3 Frequency and percentage of each gender and drive in daylight (98%, n = 887) are the groups in which
each age group with or without insomnia medication there are high percentages of drivers who are not under
With insomnia Without insomnia treatment for depression. It was not possible to establish a
medication medication significant relationship between size of town, risk expos-
Frequency Percentage Frequency Percentage ure, type of vehicle, hours of non-stop driving in usual
(n = 44) (n = 1156)
commutes, most frequently used type of road, crashes,
Gender Women 22 4.1 512 95.9 sanctions over the last 3 years (except parking tickets), risk
Men 22 3.3 644 96.7 assumed, working status, profession, or work schedule.
Age 18–25 2 1.6 123 98.4 Regarding anxiety, drivers who live in towns with more
26–35 5 1.9 260 98.1 than 500,000 people (6.1%, n = 12), and adults ranging
36–45 11 3.2 335 96.8
from 36–45 years (4.9%, n = 17) are the groups with a big-
ger number of people under treatment for this disorder,
46–55 13 5.6 219 94.4
even though the total percentage of drivers for it is small
56–65 11 6.4 161 93.6 (2.5%). In contrast, active workers (98.1%, n = 819), and
> 65 2 3,3 58 96.7 people living in towns with no more than 10,000 people
stated (99.3%, n = 217) they were using medicines for this
disorder less frequently.
shows the frequency and percentage of each gender and It was not possible to establish a significant relation-
each age group with or without insomnia medication. ship between age, type of vehicle, risk exposure, driving
Likewise, tranquilizers are used by 8.3% of the drivers experience, reasons for the journey, daylight/night driving,
who were not using drugs to treat depression, anxiety, or hours of non-stop driving in daily commutes, most fre-
insomnia; adults ranging from 56–65 used these drugs quently type of road, crashes, sanctions over the last 3 years
more often. In this case, it was not possible to establish a (except parking tickets), risk assumed, and profession.
significant relationship between gender and drug use. On the other hand, the percentage of people using
Therefore, information in Table 4 shows the frequency medicines to treat insomnia is slightly higher (3.7%). The
and percentage of different gender and age groups with or number of people ranging from 36–45 years (3.2%, n = 11),
without tranquilizers. 46–55 years (5.6%, n = 13), 56–65 years (6.4%, n = 11) are
Regarding the significative relationship between vari- the groups with a bigger number of people under treat-
ables related to driving, experienced drivers, 11–20 years ment for this disorder. The percentage of active workers
of experience (4%, n = 12) and 21–30 years of experience using medicines to treat insomnia is 2.4%, n = 20, while this
(4.2%, n = 12), and drivers who drive ‘regardless labor or percentage increases until 6.6%, n = 18, for the group of
leisure’ (4.3%, n = 16) have a higher percentage of drivers unemployed people (Figure 2).
under treatment for depression. On the other hand, men It was not possible to establish a significant relation-
(98.6%, n = 657), young people, 18–25 years old (100%, ship between size of town, gender, risk exposure, type of
n = 125), drivers with 3–10 years of experience (99.3%, vehicle, driving experience, reasons for the journey, day-
n = 275), or with more than 30 years (99.5%, n = 214), those light/night driving, hours of non-stop driving in daily
who use their vehicle for ‘personal and/or leisure’ (98.6%, commutes, most frequent type of road, crashes, sanc-
n = 419) and during work (98.7%, n = 220), and those who tions over the last 3 years (except parking tickets), risk
assumed, profession, and work schedule.
Finally, it is important to remember that 8.3% of drivers
Table 4 Frequency and percentage of different gender
and age groups with or without tranquilizers (only taking into account those who do not use medicines
to treat depression, anxiety or insomnia) stated they were
With tranquilizers Without tranquilizers
sometimes using tranquilizers. The use of these medicines
Frequency Percentage Frequency Percentage
(n = 92) (n = 1021) is more frequent in drivers living in towns of 10,000–
Gender Women 41 8.5 444 91.5
20,000 people (12.8%, n = 16) and in drivers ranging from
56–65 years (12.7%, n = 20).
Men 51 8.1 577 91.9
Regarding the variables related to driving, drivers with
Age 18–25 6 5.0 115 95.0 an average risk exposure (12.1%, n = 29), those drivers
26–35 21 8.3 233 91.7 with more than 30 years of driving experience (13.9%,
36–45 23 7.3 294 92.7 n = 28), and those who drive non-stop for 1 or 2 h (14.1%,
46–55 17 8.3 189 91.7 n = 23, of drivers in this last group used tranquilizers)
56–65 20 12.7 137 87.3
were the groups that used tranquilizers more frequently
(Figure 3). In addition, they were drivers who were sanc-
> 65 5 8.6 53 91.4
tioned over the last 3 years (except parking tickets)
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Drivers using drugs to treat insomnia or not according to their

working status
% 97.6 96.3
100 93.4 93.5
90
80
70
60
50 Yes
40 No
30
20
10 6.6 6.5 3.7
2.4
0
Active worker Unemployed Housework Total
Figure 2 Drivers with insomnia according to their working status, and comparison with the general distribution.

(13.3%, n = 21), who were unemployed (13.2%, n = 32), or serotonin reuptake inhibitors (SSRIs) were used to treat
who worked on their own (10.7%, n = 17). depression (43.5%), anxiety (26.1%), insomnia (3.6%), and
However, the probability of using tranquilizers was as tranquilizers (1.5%) (Figure 4). The table below shows
smaller for those drivers who were active workers (93.1%, the most frequently used medicines classified according to
n = 733), less than 1 h in the continuous driving by jour- their specification (Table 5).
ney (92.6%, n = 793).
It was not possible to establish a relationship between Discussion
the use of tranquilizers and gender, type of vehicle, rea- The fact that a high percentage of people (15%) use
sons for the journey, type of road, daylight/night driving, drugs to treat depression, anxiety, insomnia, and tran-
crashes, risk assumed, or work schedule. quilizers shows that this group of drivers is a risk for
Regarding the type of medicines, these are the most fre- road safety since these psychotropic drugs.
quently used among drivers interviewed: benzodiazepines These prevalence data are more important if possible, as
to treat anxiety (56.5%), to treat insomnia (35.7%), and de- they are higher than the results of the DRUID project (re-
pression (26.1%), as tranquilizers (42.6%). The selective member that according to this project, prevalence rate for

Drivers using tranquilizers or not according to

hours of non-stop driving
%
100 92.6 92.2 91.6
90 85.9
80

70

60

50 Yes
40 No
30

20 14.1
7.4 7.8 8.4
10

0
Less than 1 hour 1 to 2 hours 2 or more hours Total
Figure 3 Drivers using tranquilizers or not according ‘hours non-stop driving’ comparing with the general distribution.
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% Most frequently used antidepressant drugs

50
43.5
45
40
35
30 26.1
25
20
15 Depression
7.1 8.7 8.7
10 3.61.5 4.3 4.3 Anxiety
5 1.4
0 Sleep disorders
Relaxing/sleeping

Figure 4 Most frequently used antidepressant drugs to treat the different disorders in this research.

medicines in Spain was 1.6%. These data would place among the drivers interviewed and corresponds with data
Spain closest to the group of countries with higher obtained in the DRUID project and other studies.
risk as happens in the case of illicit drugs and alcohol. However, in our study, the results are also very im-
The distinct methodology used to obtain them is the portant on the consumption of different drugs at the
cause of the differences between the data of the studies same time.
(for this section, we use the results of the DRUID project The combined used of drugs for the three conditions
which relate to the prevalence determined by ‘roadside studied (depression, anxiety, and insomnia) must also be
surveys (RSS)’ on drivers and in drivers who have been taken into account since these conditions are usually re-
injured/killed in traffic accidents (hospital studies (HS)). lated to one another thus leading drivers to use medicines
The fact that 8.3% of those drivers who were not using for more than one condition (insomnia and anxiety, 29%
any drugs to treat these three disorders were occasion- of the drivers; depression and anxiety, 20%; insomnia and
ally using some type of tranquilizers (7.7% of the total depression, 17%).
drivers interviewed), may involve a more difficult adap-
tation (recall that according Berghaus says in a report Conclusions
of the DRUID project, the degree of adaption depends In order to prevent traffic crashes, it is necessary to in-
on many factors, especially the dose and the frequency form drivers using drugs about the effects they may have
of use). on driving and more much control (both the health sys-
The fact that more women than men use more drugs tem and the police).
to treat depression is also a coinciding data with those We propose creating and implementing a wide range
determined in the DRUID project on a general level. In of formal intervention strategies. This can be achieved
the case of the anxiety and tranquilizers in our study, it by using general communication campaigns and adver-
was not possible to establish a significant relationship tising in order to inform and teach drivers about the in-
between these variables. fluence of several psychotropic drugs on driving.
It also seems clear that, regarding the age, people be- It is a fact that there are many campaigns on other sub-
tween 36–45 use more drugs to treat anxiety and 46–55 stances such as alcohol and illicit drugs but much less on
use more drugs to depression. Aged 56–65 use drugs to psychotropic medications.
treat insomnia and tranquilizers. The data obtained in this study according to socio-
Given the different nature of other studies, it is diffi- demographic and psychosocial characteristics are very
cult to make comparisons in the case of age as well as important for the design and dissemination of such cam-
the type of road (roads/cities) and the time of displace- paigns. And it is for both determining the target audi-
ment (workday, weekend, holiday, daytime). ence to the communication of certain risk behaviors in
Furthermore, other socio-demographic and psycho- Spain.
social characteristics cannot be contrasted because those Standardized warning labels on medicine boxes and
have not been contemplated by previous studies. package inserts sold in all countries should be imple-
The fact is that drugs containing benzodiazepine are the mented as an important countermeasure (have already
most used drugs to treat all the disorders in the study been implemented in Spain).
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Table 5 Percentage distribution of medicines used by Likewise, it is necessary that health professionals (pri-
drivers who were under treatment for different disorders mary health care doctors, health care specialists, phar-
Medicines used by drivers who were under Percentage macists, psychiatrics, and psychologists) get involved in
treatment for different disorders informing drivers about the side effects (cognitive and
Drugs to treat depression psychomotor deterioration) of using psychotropic drugs,
Antidepressant 60.9% as well as the serious consequences of self-medication.
Selective serotonin reuptake inhibitors (SSRI) (43.5%) In order to minimize side effects affecting daily activ-
Antidepressant tretracyclics (8.7%)
ities, it is necessary that health professionals prescribe
drugs (specific components, route of administration,
Serotonin and noradrenaline reuptake inhibitors (4.3%)
avoiding certain associations, and establishing the dose)
Other antidepressants (4.3%) according to the vital and professional needs of the pa-
Anxiolytics 30.4% tient. Some of these demands are related to driving vehi-
Benzodiazepines (26.1%) cles, specifically when it comes to professional drivers
Other anxiolytics (4.3%) and drivers making daily commutes.
Hypnotic-sedatives 4.3%
In this sense, the results of this study for Spanish
health professionals are very important because socio-
Drugs to treat anxiety
demographic and psychosocial characteristics can help
Anxiolytics 60.9% identify high risk group. It is also important for police
Benzodiazepines (56.5%) supervision as it can decide better the controls to be
Other anxiolytics (4.3%) made on this behavior both temporally and spatially.
Antidepressants 34.8% Likewise, it is also necessary to regulate the fact that
Selective serotonin reuptake inhibitors (SSRI) (26.1%)
driving should not be allowed while certain drugs are be-
ing used. It would be interesting to authorize doctors to
Serotonin and noradrenaline reuptake inhibitors (8.7%)
determine, if necessary, those drivers who may be im-
Hypnotic-sedatives 4.3% paired due to the treatment with certain drugs thus low-
Other hypnotic-sedatives (4.3%) ering road safety.
Drugs to treat insomnia In this sense, it is very important to establish better
Anxiolytics 35.7% communication and collaboration between the health
Benzodiazepines (35.7%)
system (hospitals, health centers, etc.) and recognition
center conductors (regulated in Spanish Medical and
Hypnotic-sedatives (35.7%)
Psychotechnical Exam Model), as the seconds, given the
Benzodiazepines (2.9%) time between recognitions (which only occur in obtain-
Melatonin receptor agonists (3.6%) ing and renewing the license) cannot detect transient
Imidazopyridines (5.9%) risks such as those that can be derived from the use of
Other hypnotic-sedatives (17.9%) these substances.
Antidepressants 10.7%
Competing interests
Selective serotonin reuptake inhibitors (SSRI) (3.6%) The authors declare that they have no competing interests.
Tricyclic antidepressants (TCAs) (7.1%)
Authors’ contributions
Drugs to relax and calm down (tranquilizers) FA elaborated the design of the study with the help of CE; the rest of the
Anxiolytics 42.6% authors also contributed. FT and LM were in charge of the data revision.
CE also drafted the manuscript. FA performed the statistical analysis.
Benzodiazepines (42.6%) All authors read and approved the final manuscript.
Hypnotic-sedative 35.7%
Benzodiazepines (2.9%) Acknowledgements
The authors wish to thank the Audi's program of Corporate Social
Imidazopyridines (5.9%) Responsibility, Attitudes for the patrimony of the basic research. Also thanks
to Mayte Duce for the revisions and to Catalina Pardo and Jose Colomer for
Other hypnotic-sedatives (17.6%)
the revision of the English text.
Anti-inflammatory and analgesic drugs 20.6%
Author details
Antidepressants 2.9% 1
DATS (Development and Advising in Traffic Safety) Research Group, INTRAS
Selective serotonin reuptake inhibitors (SSRI) (1.5%) (Research Institute on Traffic and Road Safety), University of Valencia, Serpis
29, Valencia 46022, Spain. 2FACTHUM.lab (Human Factor and Road Safety),
Serotonin and noradrenaline reuptake inhibitors (1.4%) INTRAS (University Research Institute on Traffic and Road Safety), University
Distribution of different active principles based on their specific action. of Valencia, Serpis 29, Valencia 46022, Spain. 3PRECOVIR (Prevention of Risk
Behavior on the Road), INTRAS (Research Institute on Traffic and Road
Safety), University of Valencia, Serpis 29, Valencia 46022, Spain.
 Alonso et al. Annals of General Psychiatry 2014, 13:14 Page 10 of 10
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Received: 12 December 2013 Accepted: 23 April 2014 25. Alonso F, Esteban C, Calatayud C, Alamar B, Fernández C, Medina JE:
Published: 8 May 2014 Conclusiones de las 7as jornadas de reflexión Attitudes: Salud vial ¿el
conductor a terapia? Cuadernos de Reflexión Attitudes. Valencia, Spain:
Intras; 2008.
References 26. Sánchez F: Actitudes frente al riesgo vial. Intervención Psicosocial 2008,
1. Ravera S, van Rein N, de Gier JJ, de Jong-van den Berg LT: Road traffic 17(1):45–59.
accidents and psychotropic medication use in the Netherlands:
a case–control study. Br J Clin Pharmacol 2011, 72(3):505–513. doi:10.1186/1744-859X-13-14
2. Metzner JL, Dentino AN, Godard SL, Hay DP, Hay L, Linnoila M: Impairment Cite this article as: Alonso et al.: Psychotropic drugs and driving:
in driving and psychiatric illness. J Neuropsychiatry Clin Neurosci 1993, prevalence and types. Annals of General Psychiatry 2014 13:14.
5(2):211–220.
3. Gibbons TCN: Mental illness, personality and behaviour disorders.
In Medical Aspects of Fitness to Drive. 3rd edition. Edited by Raffle PAB.
London, England: Medical Commission on Accident Prevention;
1976:30–33.
4. De las Cuevas C, Sanz EJ: Fitness to drive of psychiatric patients. Prim Care
Comanion J Clin Psychiatry 2008, 10(5):384–390.
5. Harris MC: Psychotropic medication and driving. Psychiatry Pract 1997,
16:5–7.
6. Odell M: Assessing fitness to drive, part 2. Aust Fam Physician 2005,
34(6):475–477.
7. Montoro L, Alonso F, Esteban C, Toledo F: Manual de seguridad vial: El factor
humano. Barcelona. Spain: Ariel; 2000.
8. Wang CC, Kosinski CJ, Schwartzberg JG, Shanklin AV: Medical conditions
and medications that may impair driving. In Physician’s Guide to Assessing
and Counseling Older Drivers. Washington, DC: National Highway Traffic
Safety Administration; 2003.
9. Lemoine P, Ohayon M: Abuse of psychotropic drugs during driving.
L'Encéphale 1996, 22(1):1–6.
10. Orriols L, Salmi LR, Philip P, Moore N, Delorme B, Castot A, Lagarde E:
The impact of medicinal drugs on traffic safety: a systematic review
of epidemiological studies. Pharmacoepidemiol Drug Saf 2009,
18(8):647–658.
11. O’Hanlon JF, Volkerts ER: Hypnotics and actual driving performance.
Acta Psychiatr Scand 1986, 74(332):95–104.
12. Smiley A: Effects of minor tranquilizers and antidepressants on
psychomotor performance. J Clin Psychiatry 1987, 48:22–28.
13. Robbe H: Marijuana’s impairing effects on driving are moderate when
taken alone but severe when combined with alcohol. Hum Psychopharm
Clin 1998, 13(2):70–78.
14. Kelly E, Darke S, Ross J: A review of drug use and driving: epidemiology,
impairment, risk factors and risk perceptions. Drug Alcohol Rev 2004,
23:319–344.
15. Engeland A, Skurtveit S, Morland J: Risk of road traffic accidents
associated with the prescription of drugs: a registry-based cohort
study. Ann Epidemiol 2007, 17(8):597–602.
16. Movig KL, Mathijssen MP, Nagel PH, van Egmond T, de Gier JJ, Leufkens HG,
Egberts AC: Psychoactive substance use and the risk of motor vehicle
accidents. Accid Anal Prev 2004, 36(4):631–636.
17. Verster JC, Mets MA: Psychoactive medication and traffic safety. Int J
Environ Res Public Health 2009, 6(3):1041–1054.
18. Smink BE, Egberts AC, Lusthof KJ, Uges DR, de Gier JJ: The relationship
between benzodiazepine use and traffic accidents: a systematic
literature review. CNS Drugs 2010, 24(8):639–653.
19. Schulze H, Schumacher M, Urmeew R, Auerbach K: DRUID Final Report: Work
Performed, Main Results and Recommendations. http://www.druid-project.eu.
20. Hargutt V, Krüger H-P, Knoche A: Driving Under the Influence of Alcohol, Illicit
Drugs and Medicines. Risk Estimations from Different Methodological Submit your next manuscript to BioMed Central
Approaches, DRUID deliverable 1.3.1. 2011. http://www.druid-project.eu. and take full advantage of:
21. Berghaus G, Sticht G, Grellner W, Lenz D, Naumann T, Wiesenmüller S:
Meta-Analysis of Empirical Studies Concerning the Effects of Medicines and
• Convenient online submission
Illegal Drugs Including Pharmacokinetics on Safe Driving. 2010. EU Project
DRUID, WP 1, Deliverable 1.1.2b. • Thorough peer review
22. Gee GC, Takeuchi DT: Traffic stress, vehicular burden and wellbeing: • No space constraints or color figure charges
a multilevel analysis. Soc Sci Med 2004, 59:405–414.
• Immediate publication on acceptance
23. Alonso F, Esteban C, Calatayud C, Alamar B, Egido A: Salud Vial. Teoría y
prácticas de los trastornos físicos y psíquicos en la conducción. Cuadernos de • Inclusion in PubMed, CAS, Scopus and Google Scholar
Reflexión Attitudes. Valencia, Spain: Intras; 2008. • Research which is freely available for redistribution
24. Alonso F, Sanmartín J, Esteban C, Calatayud C, Alamar B, López E: Salud Vial.
Diagnóstico de los conductores españoles. Cuadernos de Reflexión Attitudes.
Valencia, Spain: Intras; 2008. Submit your manuscript at
www.biomedcentral.com/submit

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