Education Regarding Medications
In addition to cannabis and illicit drugs, there are also numerous prescription medications that may have impairing effects (see Drug-Impaired Driving – Understanding the Problem). As part of the 2013-2014 National Roadside Survey of Alcohol and Drug Use, 20% of drivers self-reported use of a potentially impairing prescription medication within the last 2 days, with the most common reported categories of medications being CNS depressants (8%), antidepressants (8%), and narcotic analgesics (8%). Among drivers reporting recent prescription medication use, 78% responded that they had a prescription for the medication. Most drivers reported receiving warning of the potentially impairing effects of their prescribed medication from a health care provider or pharmacist, but there was variability by drug category, with more than 85% of drivers prescribed CNS depressants or narcotic analgesics reporting being warned, as compared to less than 65% of drivers being prescribed antidepressants or stimulants (Pollini et al., 2017). Due to the prevalence of driver use of potentially impairing prescription medications and the lack of reported education given to drivers regarding the medications’ potentially impairing effects, there is an opportunity for intervention. Therefore, this countermeasure involves providing education to healthcare providers, pharmacists, and patients about the potential risk of motor vehicle crashes associated with certain prescription medications. For example, healthcare providers and pharmacists can receive instruction relating to potentially driver-impairing prescription drugs, laws relating to medication use and DWI, and how to convey this information to patients to whom they are prescribing medications. Medical providers are also encouraged to select non-impairing alternative medication (if possible) and to consider the patients’ medication regime (e.g., other drugs, substances) to avoid drug-additive driving-impairment effects (American Geriatric Society & Pomidor, 2019). More generally, education can also include use of clear warning labels on drug packaging or State PSAs.
Programs that provide education about the side-effects of medication exist, but there is currently no information about how widespread they are.
As an example of an application of this countermeasure, NHTSA worked with Walgreens, the country’s largest drugstore chain, to develop a curriculum for pharmacists on medication-impaired driving. The curriculum modules covered potentially driver-impairing prescription drugs, laws relating to medication use and DWI, and the role of pharmacists in counseling patients regarding medications and driving risk. A pilot test with 640 pharmacists showed the curriculum was effective in increasing pharmacists’ knowledge of medication-related impaired driving (Lococo & Tyree, 2007). However, this program was not formally evaluated.
A more recent application of the countermeasure was tested in Belgium in 2012. In this example Legrand et al. (2012) tested several methods of training pharmacists about dispensing guidelines for potentially impairing medications, the risks associated with these medications, and methods for communicating these risks to patients. Following training, more pharmacists reported being aware of the effects of medications on driving, and more pharmacists talked with their patients about driving-related risks.
Studies with patients have been less encouraging. Smyth, Sheehan, and Siskind (2013) conducted interviews with patients who were using medications that could influence their driving. Half (49%) did not recall seeing the warning label on the medication. Instead, there was a high level of confidence among patients that they could determine themselves whether it was safe to drive. Monteiro et al. (2013) investigated the effectiveness of pictograms in communicating the degree of driving risk associated with certain medications. Many patients could not understand the pictograms, and often misjudged how risky it would be to drive while taking the medication. Smith et al. (2018) also arrived at similar findings from expert interviews, including the insight that many Americans do not associate the warning to “not operate heavy machinery” to driving their vehicle. The experts in their study suggested adding visual indicators such as changes to the color of the driving-specific warning label, color of the prescription bottle, and increasing the minimum font size to accommodate older drivers. Similarly, a survey a Japanese drivers taking prescription medications found that only 5% of respondents were aware of a pictogram created by the Council of Appropriate Drug Use in Japan to alert drivers of medications with potentially impairing effects. After viewing the pictogram, the results were mixed regarding the efficacy of the pictogram to convey the intended message (Fukuda et al., 2020).
Therefore, there is insufficient evidence to conclude that this countermeasure is currently effective at reducing drug-impaired driving and improving safety.
Costs will depend on the program elements and could include printed material, staff time, and administrative costs. Costs will also depend on the target audience: healthcare providers and pharmacists versus drivers, with the former group likely being more costly than the latter (especially if personalized training is involved).
Time to implement:
Educational and communication programs could require a year or more to plan, produce, and implement. Programs that include individualized feedback and training will be more time intensive to implement.