Buprenorphine and DUI

For the second time now in a period of several years of prescribing buprenorphine maintenance for opiate dependence a patient has reported a police officer charged them with driving under the influence after discovering that the patient was taking the drug after a minor traffic infraction or accident .

The FDA labels for branded preparations containing buprenorphine include the following warnings:

"SUBOXONE and SUBUTEX may impair the mental or physical abilities required for the performance of potentially dangerous tasks such as driving a car or operating machinery, especially during drug induction and dose adjustment. Patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that buprenorphine therapy does not adversely affect their ability to engage in such activities."

"ZUBSOLV sublingual tablet may impair the mental or physical abilities required for the performance of potentially dangerous tasks such as driving a car or operating machinery, especially during treatment induction and dose adjustment. Patients should be cautioned about driving or operating hazardous machinery until they are reasonably certain that ZUBSOLV sublingual tablet therapy does not adversely affect his or her ability to engage in such activities."

"Butrans may impair the mental and physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery."

By way of comparison another commonly used drug label includes this warning:

"Because Prozac may impair judgment, thinking, or motor skills, patients should be advised to avoid driving a car or operating hazardous machinery until they are reasonably certain that their performance is not affected." 

I can only conclude from the two cases I mentioned that

  • Absent any other evidence of impairment, the law enforcement officer in both cases presumed impairment based only on the infraction or accident.
  • A substantial percentage of Americans drive "under the influence" to a similar degree to those using buprenorphine.
  • Buprenorphine may hold some special status with regard to impairment in the eyes of at least some law enforcement agencies.
  • Ilicit use of drugs produces substantially more impairment of driving than use of buprenorphine by prescription. 

The labels of what must be hundreds of drugs used every day by people while driving probably include warnings similar to those above. However, only buprenorphine and a few other drugs have the potential to reduce crime associated with addiction and thus the need for law enforcement officers. I can only hope that few law enforcement officers and jurisdictions will allow their cynicism to motivate them to obstruct effective treatment of addiction in an attempt to guarantee job security for themselves.

I suggest anyone taking a drug that includes a warning (which should be heeded) like those listed above, but especially any buprenorphine preparation, consult an attorney about whether to provide information to a police officer about their use of any such drug.

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