Driving under the influence of prescribed opioids: a qualitative study of the pharmacist's contribution to road safety

Background

Australia's 20-year consistent fall in road crash fatalities has stalled. Concerning is the marked increase of prescribed potentially driving-impairing medications (PDIMs), led by opioids, in driver autopsies. Drivers prescribed opioids are often not well advised on cognitive impairment. Pharmacists have a potential role to provide such advice, but their experiences and opinions are generally unreported.

Aim

To investigate the experiences, perceptions, and opinions of pharmacists dispensing prescribed opioids to patients, particularly what specific advice is given regarding driving safety, and to explore pharmacists' potential future role.

Method

Ten pharmacists in the regional city of Toowoomba, Queensland, consented to semi-structured interviews, conducted between November 2019–November 2021. Interviews were then transcribed and subjected to reflexive thematic analysis to identify themes from the pharmacists' responses. This study is part of a broader project: How do doctors and pharmacists perceive their roles in ensuring safety in driving for both the patient and the general community? Ethical approval was granted by the Queensland University of Technology Research Ethics Committee (Reference no: 1900000374) and the study conforms to Australian National statement on ethical conduct in human research. Informed consent was obtained from all participants via completion of a written consent form after detailed project information was provided. This occurred at least 5 days after participants were first approached.

Results

Three main themes emerged: road safety versus freedom and independence, team approach and communication with general practitioners (GPs), and varying scope of advice on opioid impairment and tolerance. Pharmacists are aware of potential impacts on road safety, yet they are sympathetic towards the independence driving affords. GP communication and a team approach with GPs were the strongest subthemes. Pharmacists gave good information about cognitive impairment without specifically referencing driving. Pharmacists' learning about medications and driving occurred only “on the job.”

Conclusion

Pharmacists' current advice to opioid-medicated drivers (OMDs) would benefit from focused opioid upskilling empowering OMDs to make rational driving decisions. A more team-oriented interaction, marked by better communication between pharmacists and GPs, should result in improved road safety among OMDs.