Experience of road and other trauma by the opiate dependent patient: a survey report

Abstract

Background: Trauma plays an important role in the experience of many patients with substance use disorder, but is relatively under-studied particularly in Australia. The present survey examined the lifetime prevalence of various forms of trauma including driving careers in the context of relevant medical conditions.

Methods: A survey was undertaken in a family medicine practice with a special interest in addiction medicine in Brisbane, Australia.

Results: Of 350 patients surveyed, 220 were substance dependent, and 130 were general medical patients. Addicted patients were younger (mean +/- S.D. 33.72 +/- 8.14 vs. 44.24 +/- 16.91 years, P < 0.0001) and had shorter driving histories (15.96 +/- 8.50 vs. 25.54 +/- 15.03 years, P < 0.0001). They had less driving related medical problems (vision, spectacle use, diabetes) but more fractures, surgical operations, dental trauma and assaults. Addicted patients also had significantly worse driving histories on most parameters measured including percent with driving suspensions (O.R. = 7.70, C.I. 4.38-13.63), duration of suspensions (1.71 +/- 3.60 vs. 0.11 +/- 0.31 years, P < 0.0001), number of motor vehicle collisions (2.00 +/- 3.30 vs. 1.10 +/- 1.32, P = 0.01), numbers of cars repaired (1.73 +/- 3.59 vs. 1.08 +/- 1.60, P = 0.042), rear end collisions (O.R. = 1.90, CI 1.13-3.25), running away after car crashes (O.R. = 26.37, CI 4.31-1077.48), other people hospitalized (O.R. = 2.00, C.I. 0.93-4.37, P = 0.037) and people killed (17 vs. 0 P = 0.0005). Upon multivariate analysis group membership was shown to be a significant determinant of both cars repaired and cars hit when controlled for length of driving history. Hence use of all types of drugs (O.R. = 10.07, C.I. 8.80-14.72) was more common in addicted patients as were general (O.R. = 3.64, C.I. 2.99-4.80) and road (O.R.= 2.73, C.I. 2.36-3.15) trauma.

Conclusion: This study shows that despite shorter driving histories, addicted patients have worse driving careers and general trauma experience than the comparison group which is not explained by associated medical conditions. Trauma is relevant to addiction management at both the patient and policy levels. Substance dependence policies which focus largely on prevention of virus transmission likely have too narrow a public health focus, and tend to engender an unrealistically simplistic and trivialized view of the addiction syndrome. Reduction of drug driving and drug related trauma likely require policies which reduce drug use per se, and are not limited to harm reduction measures alone.

Figure 1

Frequency histograms of A: Age profile and B: Driving history durations.

Figure 2

Odds ratios of various driving related events – categorical variables. Abbreviations: MBA – motor bike accident; MVA – motor vehicle accident; BZD – benzodiazepines; FX – effects. Note that the numerators for ran away from crash and anybody killed have been adjusted as described to allow calculation of an odds ratio, as the numbers identified in the N-SUD group were zero. Note the scale break. * – P < 0.05. ** – P < 0.01. *** – P < 0.001. **** – P < 0.0001.

Figure 3

Relative crude rates of various continuous variables. # = Number. * – P < 0.05. ** – P < 0.01. *** – P < 0.001. **** – P < 0.0001.

Figure 4

Scatterplots of A.: Number of cars hit and B.: Number of cars repaired by length of driving experience.