• Brian G Wilhelmi and Steven P Cohen.
• Johns Hopkins School of Medicine, Anesthesiology and Critical Care Medicine, 600 N. Wolfe St., Blalock 1412, Baltimore, MD 21287, USA. bwilhel5@jhmi.edu
• Pain Physician. 2012 Jul 1;15(3 Suppl):ES215-30.

BackgroundDriving under the influence of drugs (DUID) is a term used to designate the action of driving an automobile after the consumption of drugs or medications other than alcohol that interfere with the capacity to operate a vehicle safely. Unlike recreational drugs, prescription medications pose a unique challenge to those attempting to harness their benefits yet protect the driving public. As studies demonstrate a steady increase in opioid use and abuse in the United States, these same constituencies must regulate a significant percentage of drivers who are under the influence of opioids.ObjectiveThis article examines current DUID policy and attempts to present unified suggestions for improvement based on best scientific evidence of opioid-induced psychomotor impairment.Study DesignLiterature ReviewMethodsA literature search was conducted regarding the epidemiology of opioid use and abuse, psychomotor effects of opioids, DUID, and state policy concerning DUID. A total of 23 epidemiological studies, 3 studies on acute psychomotor effects, 32 on chronic psychomotor effects, and selected pertinent law and policy were reviewed.ResultsCurrent state law concerning DUID is variable and often relies on prosecutorial discretion to provide protection of the driving public and prosecution of the truly impaired.LimitationsThe design of various studies included in this review imposes limitations on the epidemiological data extracted. Relationships between opioids and automobile accidents are commonly reviewed in retrospect. The data on opioid-induced psychomotor impairment and its effects on driving an automobile require further direct study to examine current inferences.ConclusionsA sizable percentage of the driving public has detectable levels of opioids within their bodies. The best available evidence demonstrates psychomotor impairment following acute administration of opioids or an increase in opioid dosage, but impairment diminishes with chronic, stable opioid usage. Policy makers must account for this evidence when balancing the benefit of pain relief against the need for public roadway protection when drafting DUID legislation.

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