Opioids and Driving: The epidemic nobody is talking about and what we can do about it

Dahianna Lopez, PhD, MSN, MPH
Assistant Professor
University of Rhode Island College of Nursing

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Opioid overdoses and car crashes are the leading causes of death for Americans between the ages of 15 and 45. In 2018 and 2016, 76% of Americans drove alone to work daily, and nearly 13 million of them drove under the influence of drugs other than alcohol. In 2016, 20% of drivers who experienced a fatal car crash tested positive for opioids.

We must study the overlap of opioid overdoses and car crashes—especially since both rates have accelerated during the pandemic. Among various groups of people who use drugs, cars are often perceived as safer locations for injection drug use than public settings. Moreover, for some people cars are not just a form of transportation; they are places where they essentially live and work. How can we target cars for intervention?

Media coverage of people found overdosed in their cars commonly includes photographs of the vehicle occupants and language that suggests they are irresponsible criminals. This type of news coverage perpetuates the pervasive public stigma against people who use drugs, rendering individuals with opioid use disorder less likely to seek treatment and request assistance. This type of coverage must stop.   

Detention and imprisonment of people with substance use disorders do not prevent or minimize crime or opioid use. However, law enforcement initiatives on impaired driving encourage arrests. Shouldn’t we focus more on offering treatment so that fewer people drive under the influence of drugs?  Why not provide immunity from “constrictive” drug possession charges to designated drivers who take opioid-using individuals home? Why not offer alternative transportation options to people using opioids? Would employers or health insurance companies be willing to pay?  

We must continue developing autonomous vehicles that recognize and adapt to road environments and execute critical activities without human input. This would allow a person under the influence of any drug (prescription or not) to avoid the need to drive; impaired driving would become obsolete. For added safety, we must continue developing technology that allows cars (autonomous or not) to detect an overdose and call for help. Short-range active sonar appears promising for detecting respiratory depression associated with opioid overdoses.

Historically, impaired driving has been viewed as an issue of personal responsibility. But it’s time to ask: How can we ensure that people who use opioids have access to safe transportation? What if we stopped seeing them as criminals?

To save lives, we must recognize that impaired driving is a symptom of a much larger set of issues that we should attempt to solve through a safe systems approach. This means designing a transportation system that is human-centric and expects a shared responsibility for road safety (Federal Highway Safety Administration, 2021).