Issues of transport, driving safety & intoxication for opioid agonist treatment clients in New South Wales, Australia
Background: Opioid agonist treatment (OAT) is a well-established treatment for opioid dependence, but driving safety concerns exist due to their sedative nature and potential poly-substance use among OAT clients. Evidence supports that OAT clients can drive if on a stable dose and are not using other substances. However, transportation and distance to services can be a barrier to treatment. We examined OAT client driving and transport behaviours, driving histories and concerns, and staff perspectives around client intoxication, driving safety and clinical guidance.
Methods: Cross-sectional survey of 482 OAT clients and 79 staff at 15 public OAT clinics in New South Wales, Australia. Client survey examined transport habits, recent substance use, driving histories and driving offences, including substance use whilst driving. Staff survey examined substances of concern for OAT clients, staff confidence and training in intoxication detection/management and reported barriers or experiences from client intoxication assessments. Clients and staff were asked about their knowledge of driving-related OAT clinical guidance, client driving rights, and restrictions whilst receiving OAT. Data was analysed using descriptive statistics, binary logistic regression, and thematic analysis.
Results: Past month client use of sedating substances was high (87%), although most relied on public transport (42%) over driving (28%). Regionality differences were noted. Fifty-seven clients reported driving under the influence of a substance in the past month. Clients who drove regularly were less likely to report illicit drug use (OR=0.48, 95%CI=0.32-0.71). Clients with recent driving offences were more likely male (aOR=1.81, 95%CI=1.08-3.05), report injecting drug use (aOR=1.81, 95%CI=1.10-3.12), and had prior licence suspensions (aOR=9.05, 95%CI=5.42-15.13).
Two-thirds of staff sampled indicated confidence identifying client intoxication; 56% reported at least one intoxication presentation in the past year. Reported barriers to addressing suspected client intoxication were concerns of aggression (72%), upsetting the client (44%), incorrect assessments (38%) and time-pressures (37%). Most clients (80%) and staff (73%) agreed that clients should have equity of access to a driving licence, but should not drive if using an impairing substance (82% clients, 86% staff). Clients were less agreeable that they should only drive when their OAT dose is stable (80%, staff 92%).
Conclusions: While client use of sedating medications/substances is high, which could impact on driving safety, most do not regularly drive, nor report driving under impairment. Staff reported a high level of confidence in identifying intoxication, but concerns remained around intoxication assessments and client driving safety. It is important that clients and staff are aware of driving and intoxication issues to ensure the safety of clients, the general public and ensure confidence in opioid treatment programs.
