Opiates

Single doses of narcotics can have marked effects on performance, such as reaction time. However, most studies of opiates among regular users suggest that they do not present a hazard or exist as a significant factor in driving.

One study compared the effects of alcohol, diazepam, and methadone on clients commencing or stabilized on a methadone program. The battery of tests showed no evidence for an effect of the acute dose of methadone; thus, clients on a methadone program should not be considered impaired in their ability to perform complex tasks, such as driving a motor vehicle. Thus, in the United Kingdom, persons on a stable methadone program who have not abused other drugs for 1 yr and who have clear urine drug screening tests regularly are allowed a driving license subject to annual review. However, it should be remembered that users of heroin are also prone to heavy use of other psycho-active drugs, such as cocaine, alcohol, and tranquilizers, which are all dangerous when it comes to driving.

This problem is illustrated by a more recent study from Germany (73). Thirty-four methadone substitution patients, all of them volunteers, were subjected to a battery of psychological tests. Twenty-one of these patients had to be excluded from the study because the toxicological analysis of repeated blood and urine samples revealed the presence (or possibly chronic use) of substances other than methadone. Of the remaining 13 (age range 26 to 42 years, 8 males and 5 females) 6 were selected who, based on the impression of the physicians, could be described as optimal methadone patients. Although some personality scales and psychopathological findings revealed shortcomings for a few of these patients, they could not be regarded as factors ruling out driver fitness, and the authors concluded that under certain conditions, long-term methadone maintenance patients under strict medical supervision do not suffer significant driving impairment, providing that no other drugs have been taken.

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