The Relationship between Benzodiazepine Use and Traffic Accidents: A Systematic Literature Review

• Published in: CNS drugs 2010-08, Vol.24 (8), p.639-653
• Main Authors: Smink, Beitske E., Egberts, Antoine C. G., Lusthof, Klaas J., Uges, Donald R. A., de Gier, Johan J.
• Format: Article
• Language: English
• Subjects: Accidents, Traffic - statistics & numerical data; Automobile Driving; Benzodiazepine abuse; Benzodiazepines - adverse effects; Benzodiazepines - therapeutic use; Biological and medical sciences; Causes of; Clinical Trials as Topic; Complications and side effects; Dose-Response Relationship, Drug; Drug Prescriptions - statistics & numerical data; Drug toxicity and drugs side effects treatment; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Hypnotics and Sedatives - toxicity; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Neurology; Neuropharmacology; Neurosciences; Pharmacology. Drug treatments; Pharmacotherapy; Psychiatry; Psychopharmacology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Review Article; Risk; Risk Assessment; Systematic review; Toxicity: nervous system and muscle; Traffic accidents
• ISSN: 1172-7047; 1179-1934
• DOI: 10.2165/11533170-000000000-00000

In many countries, benzodiazepines are the most commonly used and misused psychoactive medicinal drugs. Results of epidemiological studies investigating the association between benzodiazepine use and traffic accidents seem to be inconclusive or inconsistent at first sight. However, the outcome of epidemiological studies may be influenced by several methodological factors like study design, study population, exposure measurement, outcome definitions and possible confounders. Our objective was to conduct a systematic literature review of epidemiological studies that investigated the association between benzodiazepine use and traffic accidents, including related outcomes like culpability and injury or accident severity. We searched EMBASE, PubMed and Forensic Science Abstracts 3/0 (FORS®) for references included in these databases at 1 June 2009 using the term ‘benzodiazepines’ in combination with ‘driving performance’ or ‘accident risk’ or ‘traffic accident’. For inclusion in this review, the study design had to be comparative, include road users involved in accidents and provide specific data about benzodiazepines. Sixty-six studies were included in the review. The study populations varied from the general (driving) population, accident-involved road users with or without injury and persons admitted to a hospital to fatally injured accident-involved drivers. Exposure assessment was performed by using toxicological results, prescription data or questionnaires.The divergent study populations and comparison groups and the variety of methods used to express the outcome of interest hampered comparison between results. Evidence is growing that exposure to benzodiazepines is related to increased accident risk. The literature indicates that the greatest accident risk is associated with the use of long half-life benzodiazepines, increasing dosage and the first few weeks of use of benzodiazepines. Clear evidence of increased culpability associated with benzodiazepine use is scarce. More research has to be done to elucidate the relationship between benzodiazepine use and injury severity.