APRI Highlights - Spring 2003

John Bobo

Director of the National Traffic Law Center

Impaired Driving Incidents Expected With New Heroin Treatment

Anyone in law enforcement or treatment can tell you that if a drug can be abused it will be abused. That’s why people are concerned about the U.S. Food and Drug Administration’s approval in October 2002 for doctors to prescribe buprenorphine for the treatment of drug addiction –especially in the area of impaired driving.

For the first time outside a methadone clinic, doctors will be able to prescribe a narcotic drug for the treatment of opiate dependence. What attracted the treatment community is that buprenorphine induces far less respiratory depression than methadone and is thought to be safer in an overdose. Yet, the drug is potent. The Drug Enforcement Administration (DEA) describes buprenorphine as having 30 to 50 times the analgesic potency of morphine. Ultimately, what that means for the highways is more impaired drivers and a need to educate police officers and prosecutors about the drug.

The FDA has initiated a risk management program of “active and passive surveillance” to see if the drugs are being abused. According to the FDA, “[t]he surveillance will include interviews with substance abusers, monitoring local drug markets, data collection, and the monitoring of adverse event reports.” These reports will enable the FDA to “take appropriate actions to protect the public health.”

In the meantime, law enforcement officers and prosecutors will serve as the front line in protection against abuses. With access to buprenorphine, there will likely be an exponential increase in the abuse the law enforcement community has long witnessed surrounding methadone clinics, such as impaired driving, sale of narcotics and other substance abuse crimes. These risks are recognized in other countries where buprenorphine was legalized for heroin dependence years earlier.

Symptoms can include slurred speech, unsteady walking and poor balance, drowsiness, slowed movement, confusion and sleeping for prolonged periods. In later stages of an overdose, buprenorphine may cause a person to have floppy limbs, blue lips and an inability to regain consciousness, leading to a coma.

Law enforcement officers and prosecutors will also need to make a special testing request to their drug toxicology laboratories. No one should assume that a screen of blood or urine for opiates will detect methadone or buprenorphine. A special test for buprenorphine not only assists prosecutors in securing a conviction and treatment for the offender, but the evidence of abuse also allows the driver’s physician and other treatment professionals to better treat and monitor the driver.

Everyone wants addicts to receive the treatment they need, but in periods of relapse and abuse, people on the road should be safe from the addicts’ drug impairment. Enforcement, prosecution and court-monitored treatment are the most effective ways to keep that abuse in check on and off the roads. For more information, visit SAMHSA’s Web site www. buprenorphine.samhsa.gov, or contact APRI’s National Traffic Law Center.