Acute administration of oxycodone, alcohol, and their combination on simulated driving-preliminary outcomes in healthy adults

Abstract

Rationale: Epidemiological data indicate that drivers testing positive for an opioid drug are twice as likely to cause a fatal car crash; however, there are limited controlled data available.

Objectives: The primary aim of this study was to assess the effects of a therapeutic dose range of oxycodone alone and in combination with alcohol on simulated driving performance.

Methods: Healthy participants (n = 10) completed this within-subject, double-blind, placebo-controlled, randomized outpatient study. Six 7-h sessions were completed during which oxycodone (0, 5, 10 mg, p.o.) was administered 30 min before alcohol (0, 0.8 g/kg (15% less for women), p.o.) for a total of 6 test conditions. Driving assessments and participant-, observer-rated, psychomotor and physiological measures were collected in regular intervals before and after drug administration.

Results: Oxycodone alone (5, 10 mg) did not produce any changes in driving outcomes or psychomotor task performance, relative to placebo (p > 0.05); however, 10 mg oxycodone produced increases in an array of subjective ratings, including sedation and impairment (p < 0.05). Alcohol alone produced driving impairment (e.g., decreased lateral control) (p < 0.05); however, oxycodone did not potentiate alcohol-related driving or subjective effects.

Conclusions: These preliminary data suggest that acute doses of oxycodone (5, 10 mg) do not significantly impair acuity on laboratory-based simulated driving models; however, 10 mg oxycodone produced increases in self-reported outcomes that are not compatible with safe driving behavior (e.g., sedation, impairment). Additional controlled research is needed to determine how opioid misuse (higher doses; parenteral routes of administration) impacts driving risk.

Keywords: Alcohol; Driving simulator; Drugged driving; Ethanol; Human; Impairment; Opioid; Oxycodone.

FIGURE 1.

Mean peak change from baseline outcomes are displayed for standard deviation of lane position (SDLP) as a function of oxycodone dose (0, 5, 10 mg, p.o.) (x-axis) and alcohol dose (placebo; 0.8 g/kg, 15% less for women, p.o.) (line functions on graph). Filled symbols indicate the dose condition is significantly different from placebo (0 alcohol, 0 OXY) (p < 0.05, Tukey post-hoc).

FIGURE 2.

Mean ratings are displayed for VAS trough ratings of “Could you safely drive a car right now?” (rating scale anchors: 0= not at all to 100 = definitely) (Panel A), peak ratings of Sedated from the bi-phasic alcohol questionnaire (likert-type scale from 0-10) (Panel B), and peak VAS ratings of “How impaired do you feel?” (rating scale anchors: 0= not at all to 100 = extremely) (Panel C). Values are displayed as a function of dose condition (n=10; ±1 SEM); oxycodone doses (mg) are displayed on the x-axis and the doses of alcohol are displayed as the two-line functions: circle = placebo alcohol, square = active alcohol (0.8 g/kg, 15% less for women, p.o.). The filled symbols indicate a significant difference from the placebo condition (Tukey post-hoc, p<0.05). Time course analyses detected a significant dose x time interaction for ratings of driving safely (F (20, 180) = 3.2, p<.05); a main effect of dose for ratings of sedated F (5, 45) = 2.5, p<.05); and a dose x time interaction for ratings of impaired (F (75,671) = 4.3, p<.05).

FIGURE 3.

Mean time course effects are displayed for VAS ratings of “Do you feel any drug of alcohol effects right now?” (rating scale anchors: 0= not at all to 100 = extremely) The data are displayed as a function of dose: 0 mg oxycodone in Panel A, 5 mg oxycodone in Panel B, and 10 mg oxycodone in Panel C; the doses of alcohol are displayed as the two line functions: circle = placebo alcohol, square = active alcohol 0.8 g/kg, 15% less for women, p.o.). The filled symbols indicate a significant difference from the placebo condition at a given timepoint (Tukey post-hoc, p<0.05). Triangle symbols on the x-axis denote the time of each of the driving assessments (baseline and 1, 2, 3 and 5 hr post oxycodone dose). Time course analyses detected a significant dose x time interaction: (F (75, 671) = 6.2, p<.0001).