In Golf, the Wood is the Driver

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Tiger Woods’ Arrest Brings Attention to the Growing National Problem of Drugged Driving (Posted on PPM June 5, 2017).

Some snippets of the Practical Pain Management article include the following:

Regardless of what he was taking, both doctors agree he should not have been driving but Dr. Fudin adds that the ability to drive depends on the drugs taken, the time they were taken, and other important variables.

“Vicodin has a strong warning on the label not to operate heavy machinery or drive a car. That doesn’t mean that Vicodin is the devil but it means you need to take the medication as directed,” Dr. Fudin explains. In addition, “data supports that had Mr. Woods used Vicodin on a regular basis—as a single agent without the other drugs listed—it may have actually improved response time in a motor vehicle, not hindered it. To read the whole story, click here.

Since his accident, news coverage has speculated about what caused Woods to drive under the influence of drugs, with blame and attention towards Vicodin, specifically the opioid hydrocodone, as the cause.  This of course just adds to the rhetoric of the terribleness that has been overstated with opioids.

As PPM points out in their interview, Mr. Woods admitted to taking several medications.  But, we don’t know the doses or times they were taking, what they actually were, or the tolerance level Mr. Woods may or may not have had to opioid therapy.

While we never recommend driving with any sedating medications, there is precedent for driving when on continuous long-term opioid therapy at regular doses.1-7 This is not something clinicians generally advocate, but there may be unique circumstances that must be determined between the prescribing clinician, the patient,and with adherence to state and federal regulation. Notwithstanding, when combining opioids with other sedating medications, this can be problematic. Another issue is that certain OTC (and prescribed drugs) could actually inhibit the metabolism of hydrocodone if taken within 48 hours.  Lansoprazole used for stomach upset and gastrointestinal ulcers for example could vastly increase the levels of hydrocodone. If this were the case, Mr. Woods would have had no idea that he was doing anything wrong. If he had taken zolpidem, the same argument could be made in terms of culpability, as he may have had no clue if he was “sleep-driving”.

What We Do Know

  • Tiger Woods was found in a vehicle with motor running on the side of the road.
  • Opioids are generally safe if taken as prescribed with appropriate warnings including NOT driving.

What We Don’t Know

  • Drug interactions from the unknown drugs above
  • What prescribed medications were taken by Woods, what time they were taken, and the doses
  • Drug interactions from over-the-counter medications that may have been taken
  • How did Mr. Woods come upon two anti-inflammatories that are not available in the US? Perhaps they were legitimately prescribed outside the US, but why did he take what is likely to be expired Vioxx, if he even really took that.
  • Reporters are not privy to the toxicology reports due to HIPAA laws

Let’s not place blame without having the facts!
Last I checked, in this country we are presumed innocent until proven guilty?

This one is especially for those that asked to comment, so please read the entire article on PPM and chime in here!

References

1. Byas-Smith MG, Chapman SL, Reed B, Cotsonis G. The Effect of Opioids on Driving and
Psychomotor Performance in Patients With Chronic Pain. Clin J Pain. 2005;21:345–352.
2. Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff S. Are Opioid-Dependent/Tolerant Patients.
Impaired in Driving-Related Skills? A Structured Evidence-Based Review. (Journal of Pain & Palliative Care. Pharmacotherapy. 2003;16(1) 2002;9-28. Journal of Pain and Symptom Management. June 2003; 25(6):559-576.)
3. Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff S. Can Patients Taking Opioids Drive Safely?
A Structured Evidence-Based Review. Journal of Pain & Palliative Care Pharmacotherapy
2002;16(1);9-28.
4. Gaertner J. Radbruch L, Giesecke T, Gerbershagen H, Petzke F, Ostgathe C, Elsner F, Sabatowski R. Assessing cognition and psychomotor function under long-term treatment with
controlled release oxycodone in non-cancer pain patients. Acta Anaesthesiol Scand 2006; 50:
664–672.
5. Galski T, Williams JB, Ehle HT. Effects of Opioids on Driving Ability. J Pain Symptom Manage
2000;19:200–208.
6. Menefee LA, Frank ED, Crerand C, Jalali S, Park J, Sanschagrin K, Besser M. The Effects of Transdermal Fentanyl on Driving, Cognitive Performance, and Balance in Patients with Chronic Nonmalignant Pain Conditions. Pain Medicine. 2004;5(1):42-49.
7. Sabatowski R, Schwalen S, Rettig K, Herberg KW, Kasper SM, Radbruch L. Driving Ability
Under Long-Term Treatment with Transdermal Fentanyl. J Pain Symptom Manage 2003;25:38–
47.

1 thought on “In Golf, the Wood is the Driver

  1. Thank you for honest and fair-minded assessment of the facts as we know them to date. Once again, those who are ready to vilify that which they do not understand will have poor Tiger crucified in the drive-by media. Having had 4 spine surgeries, I sympathize with what he’s struggled with for years. But also agree that it appears on the surface as though he had no business behind the wheel of a car. However, we do not know the circumstances and may never know. Great commentary both here and in Practical Pain Managemnt.

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