Physician Focus: Medical Aspects of Impaired Driving

MMS Physician Focus: January 2011
By Janet Jankowiak, M.D.

When reports surface on the dangers of impaired driving, headlines usually include alcohol, age, and the multi-purpose category of "distracted driving."  Those rightfully belong at the top of the list.
  
Alcohol abuse is the greatest risk factor for motor-vehicle collisions, deaths, and injury. For the five years 2005-2009, one-third of the motor-vehicle related fatalities in the U.S. every year were alcohol related, according to the National Highway Transportation Safety Administration. The same holds true for Massachusetts, which has averaged 400 alcohol-related fatalities over the same period.

Age has also taken center stage with driving ability, as the older driver has become a growing national public health concern. Federal data show that drivers 75 year and older have higher rates of fatal motor vehicle crashes than any other group, except teens. Every elderly person, either by physical or mental impairment, will reach a point where it will be unsafe to drive, though the rate of decline will vary from person to person.

"Distracted driving" - especially talking and "texting" with cell phones - has also captured the spotlight, after several tragic accidents. Such events have led the state legislature to enact a new law, banning texting as well as the use of cell phones and other electronic devices by those under 18. Although the law targets young drivers, multitasking while driving is risky at any age.  The same law also requires drivers over 75 years of age to renew their licenses in person at a Registry office. Many other states are doing the same.

While alcohol, age, and distracted driving catch the attention, it's important to remember that sleep deprivation and many medical conditions also have the potential to cause impaired driving.

  • A driver's visual acuity must be at a level where he or she has time to detect and react to pedestrians, obstacles, signs, and other vehicles in daylight and darkness. State motor vehicle departments have set minimum standards on vision requirements, including color and peripheral vision standards.

  • Prescription drugs and other medications can affect sensory, mental or physical functions, particularly for those who may be taking several medicines at the same time. Sedatives, antidepressants, muscle relaxants, codeine, and pain control medicines are just some medications that can impair driving. People taking prescription drugs or over-the-counter medicines should read the instructions carefully and question their physician and pharmacist about possible side effects, how a medicine might interact with others they may be taking, and how driving ability might be affected. Drinking alcohol when taking certain drugs can add to the side effects of the medication.

  • Diseases of the nervous system can impair muscle control, alertness, and consciousness. Patients with such conditions as dementia, seizures, severe pain, head injuries, Parkinson's disease, multiple sclerosis, or stroke should be evaluated carefully by their physicians. This is especially important if the condition is progressive.

  • Patients with sleep disorders, such as obstructive sleep apnea or narcolepsy, as well as diabetes, cardiovascular disease, respiratory disease, psychiatric disorders, and musculoskeletal disabilities should also be cautious.  These conditions may impact cognitive, visual, and muscular abilities needed for safe operation of motor vehicles.

The Massachusetts Registry of Motor Vehicles has established policies on such medical conditions as visual or cognitive impairment, seizures and loss of consciousness, arthritis and musculo-skeletal disease, cardiovascular and respiratory disease. Its Medical Affairs Branch may issue restrictions - or deny a license - related to these and other medical conditions. Licensees with a medical condition that makes them ineligible to drive have the responsibility to report their medical condition to the Registry's Medical Affairs Branch.

Motor vehicle operators should know that the new law adopted by the legislature in 2010 allows physicians and other health care providers to report in good faith any patient whom they have reasonable cause to believe is not physically or mentally capable of safely operating a motor vehicle., However, such reports cannot be based solely upon age or a diagnosis, and must be made on observations of the "actual effect" of the condition on a person's ability to drive - a provision to prevent routine filings and discrimination in denial of licenses. The Registry will then determine whether that person is competent to drive.

As safe operation of motor vehicles is a shared responsibility and a critical public health and safety concern, individuals with medical conditions should become familiar with applicable laws and regulations. For information on state laws, visit www.mass.gov/rmv. The Massachusetts Medical Society's Medical Perspectives on Impaired Driving, while developed for physicians, can be useful for others in describing medical conditions and how they affect driving. Download a free copy at www.massmed.org/impaireddriving
 
Janet L. Jankowiak, M.D., is a geriatric neurologist and was a member of the Massachusetts Medical Society's Working Group on Impaired Drivers. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment and check with local and state officials for the latest laws regarding medical aspects of driving.  Send comments to
PhysicianFocus@mms.org

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