Driving Under the Influence of Stimulants

On April 22, I published a post on this general topic.  In that article I pointed out that the notion of stimulant prescription drugs improving the driving of people who “have ADHD” was gaining traction.

Since than I have come across two articles on this subject from Australia.  (Thanks to Nanu Grewal for the links.)  Both articles appeared in the Sunshine Coast Daily, and you can see them here and here.

Apparently in 2009, four people, including five-year-old twin girls, died in a two-car accident.  The driver of one of the cars had been prescribed dexamphetamine for the treatment of ADHD by a local psychiatrist, and was found to have had six times the prescribed dosage of dexamphetamine in his system at the time of the crash.

In the first article, dated October 2011, two years after the accident, it was noted that the psychiatrist’s prescribing practices were under investigation.  But the general manager of the psychiatric hospital where the psychiatrist practiced is quoted as saying that none of the allegations had been substantiated.

“Not one shred of evidence against anyone has been unearthed.”

The article also quotes Michael Cleary, Queensland acting chief health officer, as saying

“An analysis of available medical evidence has found that under-medicating is potentially more dangerous than prescribing higher doses, particularly when expert physicians consider a higher dose is appropriate”

So if an “expert physician” (presumably a psychiatrist) says that it’s OK to drive stoked to the gills on speed, then it’s OK!

The second article is dated July 2013, four years after the fatal accident.  Here it is reported that the prescribing psychiatrist whose practices had

“…been the subject of complaints by colleagues and nurses for many years, has had severe restrictions placed on his right to practice.”

 It is also reported that two nurses who were fired after

“…repeatedly raising concerns” about the psychiatrist were planning to sue for reinstatement.

What’s noteworthy about all of this is that, firstly, it took four year and persistent pressure from the dead girls’ father before some kind of action was taken against this psychiatrist.  Secondly, there had evidently been multiple complaints about this psychiatrist, but they were ignored by the hospital

. . . . . . . . . 

The idea of prescribing stimulant drugs to people who drive motor vehicles has always seemed problematic to me.  I worked for five years in the chemical dependency treatment area, and I have heard more horror stories about driving under the influence of stimulants than I care to remember.  Today the notion is gaining credence that stimulant drugs improve driving performance in people who “have ADHD.”  All of the research that supports this notion was industry sponsored , and most was conducted in simulators and under artificial conditions.

In real-life driving, it has to be recognized that stimulants are addictive drugs.  School children sell them to their classmates for recreational use.  Adults buy them illegally on the street.  People who receive them on prescription sometimes save them up for a weekend binge.  How many traffic accidents today are stimulant-induced?  How much of the frenetic, aggressive driving that we see on our highways stems from the use of these products?

There is a movement in most western countries today to combat drunk driving, and this is having considerable success.  In this context, psychiatry’s contention that people who “have ADHD” drive better under the influence of stimulants has to be seen as a major step backwards.

Is there truly no limit to what psychiatry will do to sell drugs and enhance their own perceived importance?

  • Francesca Allan

    Interesting article. I would have guessed that stimulants (not taken in excess) would improve driving performance because many accidents are caused by inattention to the road. The thing is, though, that such improvement (if it exists) would apply to every driver, not just those labeled ADHD.

    It’s similar to my position on antipsychotics and violence. It’s probably true that as APs, being major tranquillizers, reduce your motivation and energy they will also decrease violence. However, that’s true for the entire population. Even “expert physicians” wouldn’t recommend putting Olanzapine in our water supply. Or maybe they would. Who the hell knows?

  • Anonymous

    Wait for a MAADHDDD organization to spring up. (Mothers Against ADHD Drugged Drivers). You’re absolutely right though Hickey, what society improves (drunk driving), society taketh away by putting millions of psych drugged drivers on the roads.

    I’m really seeing a lot of this “expert” word used more and more often.

    Dictionary.com says:

    ex·pert [n., v. ek-spurt; adj. ek-spurt, ik-spurt] noun 1. a person who has special skill or knowledge in some particular field; specialist; authority:

    What’s a psychiatrist an expert in? Slapping pseudoscientific DSM labels on people, and doling out drugs, shoving drugs, into the human brain, after carrying out absolutely no medical examination of said brain. Name-calling, and the drugging of brains never proven diseased in any way.

    That the government spokesman, refers to “expert physicians” in this matter, should terrify all of us, simply because he’s from the government, he believes in this crap, and is “here to help us”.

    We truly do live under a psychiatric theocracy. Just as surely as Iranians live under an Islamic theocracy. Dare not cover up if you’re a woman in Iran, and the religious police will be after you. Dare disagree with the government’s “expert physicans that unilaterally declare by fiat that poor attention span is a disease”, and watch the SWAT team surround your house for not giving ADHD drugs to your kids.

    http://healthimpactnews.com/2012/mom-who-faced-swat-team-over-refusal-to-drug-child-and-went-to-jail-fights-back/

  • Phil_Hickey

    Francesca,

    These are complicated questions. Stimulants do help focus attention, but the
    benefits tend to be short-lived, and are often followed by a crash – which is
    why people tend to keep consuming.

    I agree with what you say about the major tranquilizers. They’re not antipsychotics – they actually reduce all activity. But then as the toxicity progresses, they precipitate horrendous agitation and inner restlessness.

  • T.A. Anderson

    Complex human behavior rarely, if ever, lends itself to valid study by the scientific method. As Dr. Hickey points out in his earlier post, such study often “creates the impression that meaningful or significant correlations/effects have been found, where in fact all that has happened is an elucidation of the terms used.” Put differently, these “scientific” investigators lose their common sense in their use of language and
    nomenclature. The reasons their higher thought processes fail them is simple and very human. Their lizard brains are disrupting their thinking. Self-awareness is key to
    overcoming the influence of their primal instincts resulting relative lack of insight. Ironically, they appear to lack the insight and ability to achieve this on their own and arguably have a behavioral condition (not illness) for which some treatment (not medication) is needed.

    Use of science sometimes without the method and instead with a measure of common sense can enhance our understanding of psychopharmacology and drug efficacy. With that in mind we can arrive at some generally valid conclusions regarding amphetamines usage and alertness vs. impairment. I will sum it up like this:

    Properly dosed intermittent administration of amphetamines enhances attention, concentration, executive function and wakefulness. Improperly dosed and long term administration of amphetamines directly, or indirectly through associated impairments, likely results in reduced attention, concentration, executive function and creation of a
    zombie like state of lessened wakefulness. Hence, when properly administered amphetamines enhance some important human functioning, including that of our military pilots. Unfortunately, amphetamines when improperly administered can and has resulted in severe deficits in human functioning. Truck drivers provide us with ample anecdotal support for both propositions.

    I have not bad experience with psychiatry. I believe the problem with psychiatry today
    exists at its leadership level. The “invisible hand” is running amuck in both the organizational and scientific leadership within psychiatry and putting to the theories of Adam Smith and Milton Friedman. Perhaps we need to be more patient. Milton Friedman believed these problems do resolve themselves through greater awareness, and believe it or not, through litigation. As we proudly and altruistically proclaimed during our first year of law school “sue the bastards.”

  • Phil_Hickey

    T.A.,

    Thanks for your comment. Law suits are certainly having an impact!

  • The Right Hon. Cledwyn B’Stard

    If they put Olanzipine in our water supply, society would be like a scene of “Dawn of the dead”, or perhaps more appropriately, “Dawn of the Fat Dead”.

    One guy I was in hospital with put on 5 stone in six weeks on that stuff.

  • all too easy

    How many drivers with ADHD avoid car crashes due to taking prescribed medication as prescribed? For this article, Dr. Phil says he heard, while working in the substance abuse field, that blah blah blah. Quite scientific.

    I suggest before histrionic haters of medical science shoot off their mouths, they learn something about statistical analysis.