Waking up to side effects

Heart Beat: I was recently approached by a patient for a second opinion, who asked me to help her reduce her medication.

Heart Beat: I was recently approached by a patient for a second opinion, who asked me to help her reduce her medication.

She had fallen asleep while driving and caused a minor accident. Ironically it proved to be her "wake-up call". She produced a plastic bag containing boxes of antidepressants, tranquillisers, hypnotics, anticonvulsants, lithium salts and thyroid replacement hormones. She was ingesting eight different psychoactive medications daily.

This patient is not atypical. Many such individuals find it difficult to attend an appointment before lunchtime, so hungover and sedated are they early in the day.

Contrast this with pilots who are instantly grounded when taking psychoactive medication. Their lowered reaction times and diminished responsibility are obviously taken seriously.

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There are thousands driving under the influence of medications that cause dizziness, sleepiness, poor concentration, slow reaction time and other deficits in intellectual functioning.

Many pain-relieving medication cocktails are made from opium derivatives which can cause serious dysfunction when taken in combination with other drugs, including alcohol.

Warnings of such effects are contained on the prescription bottle and in the patient information leaflet, but are often ignored by consumers of these drugs.

Perhaps this is because the "warnings" hardly qualify as such, as they have a purely advisory tone. Compared to the fearsome warnings of death and serious illness on tobacco products, they constitute little warning at all.

As with a cigarette package, the box is the place for a serious warning against potentially fatal consequences, and the warning should not mince words.

It should state, bluntly and clearly: DO NOT DRIVE WHILE TAKING THIS MEDICATION. THIS PRODUCT COULD BE RESPONSIBLE FOR A FATAL ACCIDENT OR SERIOUS INJURY IF YOU DRIVE WHILE TAKING IT.

One case heard before the well-known Judge John Neilan - he who threatened to jail all drink/drive offenders without exception - involved a motorist who caused an accident.

He put up as a defence the fact that he had an illness and had been taking prescribed drugs at the time. His medicines bore an advisory notice to the effect that they could cause drowsiness and that the user should "not drive or operate machinery".

Far from accepting this defence, the judge saw it as aggravating the offence, saying that the defendant should not have driven at all in light of the advice, and the consequence was his sole responsibility.

It seems clear that one vital piece of statistical information we are currently lacking is the contribution made by prescription medication to road-traffic accidents.

Reliable statistics accumulated through comprehensive blood analysis, as is presently done for alcohol and recreational drugs, need to be compiled before a clear perspective on the issue is possible.

The question of responsibility also arises. Since doctors are the gatekeepers to prescription medication, should more responsibility be allocated to them in this matter?

Should they be obliged by their professional bodies or by legislation, when prescribing "drowsy" medications, to issue such prescriptions on forms which contain a preprinted, serious warning to the patient not to drive, with the dangers fully spelt out?

And should they be required to have taken cognisance of the possibility of interactions with other medications their patient may be ingesting, including those prescribed by other specialists?

Clearly the patient also has some responsibility in this matter, but in such cases of polypharmacy they would obviously lack the knowledge to be discerning.

What is the role of the licensing authorities, car insurance companies, pharmacists and the pharmaceutical industry regarding the matter of responsibility? One thing is clear - urgent legislation is required.

•Dr Michael Corry is a consultant psychiatrist and the co-author of Depression: An Emotion not a Disease (Mercier) with Dr Áine Tubridy. Their website is www.depressiondialogues.ie