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The Relationship between Benzodiazepine Use and Traffic Accidents

A Systematic Literature Review

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Abstract

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.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Toxicology, Netherlands Forensic Institute, P.O. Box 24044, 2490 AA, The Hague, the Netherlands

    Beitske E. Smink & Klaas J. Lusthof

  2. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, the Netherlands

    Antoine C. G. Egberts

  3. Department of Clinical Pharmacy, University Medical Centre, Utrecht, the Netherlands

    Antoine C. G. Egberts

  4. Department of Pharmacy, Toxicology and Forensic Medicine, University Medical Center Groningen, Groningen, the Netherlands

    Donald R. A. Uges

  5. Department of Analytical Biochemistry, Groningen Research Institute for Pharmacy, University of Groningen, Groningen, the Netherlands

    Donald R. A. Uges

  6. Department of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute for Pharmacy, University of Groningen, Groningen

    Johan J. de Gier

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  1. Beitske E. Smink
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  2. Antoine C. G. Egberts
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Correspondence to Beitske E. Smink.

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Smink, B.E., Egberts, A.C.G., Lusthof, K.J. et al. The Relationship between Benzodiazepine Use and Traffic Accidents. CNS Drugs 24, 639–653 (2010). https://doi.org/10.2165/11533170-000000000-00000

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