driving while impaired

Monday, March 17, 2014

The arrest of the owner of the Indianapolis Colts conjures up too many emotions for most people who work in the ER. Irsay who was charged with DUI, driving under the influence, plus possession of controlled substances, presumably painkillers, has had his demons when it comes to drug and alcohol abuse. But most EMTs, paramedics, doctors and nurses battle their own demons when looking after the victims of those who drink while impaired. Some are innocent bystanders, some are the drinker, but 10,000 people a year are killed in the US.

Irsay has publicly admitted his struggles and presumed victory over alcohol addiction by saying that he had been sober for more than 15 years. He had also undergone treatment for narcotic addiction that was the result of perhaps a less than vigilant plastic surgeon who prescribed the drugs. That doctor surrendered his DEA number and the privilege to prescribe pain medications. But there are lessons to be learned about the presumption of safety, just because a doctor writes a prescription does not make that medication safe.

Narcotic or opioid pain killers attached themselves to chemical receptors in the brain, blocking pain signals. If there is prolonged use of the narcotic, the body becomes physiologically addicted and tolerance occurs. The body and pain receptors require an increased amount of drug at the receptor site to gain the same effect. Dependence describes the symptoms of withdrawal that occur when drug levels drop. They can be intense and include increased pain, shaking, sweating, vomiting and diarrhea. The withdrawal symptoms may last for days depending upon the type of narcotic used and its half life, how quickly it is metabolized by the body. Even after the acute withdrawal, the person coming off the drug may have months of depression and insomnia as brain chemistry normalizes. Addiction describes the physical and psychologic craving for the drug and the fear of withdrawal such that an otherwise reasonable person seeks the drug, though the negative consequences of use are intellectually understood.

The patient often does not begin down the road of pain killer addiction knowingly. The course may like that of Brent Favre. After taking a few pain pills to help ease the rough patches that go along with playing pro quarterback, he found himself requiring more and more of the drug. The initial prescriptions were provided by team doctors but soon after, he began getting his “fix” from teammates who would share their supply.

Legitimate use of pain medications requires close scrutiny so that the amount of drug prescribed is the minimum required to meet the patient need. Many states require a physician to obtain a special prescribing license, in addition to the federal DEA certificate. Other states have set up prescription monitoring websites where care providers and police can review individual patient prescriptions to look for those who doctor shop for their drugs.

Regardless of the legitimacy of the use of medications like Vicodin, Oxycontin, muscle relaxants or over the counter Benadryl, operating a motor vehicle while impaired turns a car into a potential killer. As it turns out, it may be just as dangerous to walk when impaired, increasing the risk of walking into traffic and being the person hit by a car.

Mr. Irsay is fortunate that didn’t run into a school bus. His actions are not defensible and frustrate those who care for the carnage that happens routinely on the streets. He would not allow one of his players onto the field when they were incapacitated and yet his decision to venture out into the street is a reminder that driving while impaired is a premeditated act. The person knows that they are going to drink, then drive. They know that they are going to take a pill, then drive.

It is hubris to suggest that one is above physiology and brain chemistry. In football a flagrant foul is penalized with ejection form the game. Criminal penalties are much softer, though considering the potential damage, being removed from the streets by suspending a driver’s license and placing the perpetrator in jail might not be a bad way to go.



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