title: Influence of peak and trough levels of opioid maintenance therapy on driving aptitude.
abstract: To evaluate driving aptitude and traffic-relevant performance at peak and trough medication levels in opioid-dependent patients receiving maintenance therapy with either buprenorphine (mean: 13.4 mg) or methadone (52.7 mg) and a medication-free control group, the Addiction Clinic at Medical University Vienna conducted a prospective, open-label trial where 40 opioid-dependent patients maintained either on buprenorphine or methadone were assessed regarding their traffic-relevant performance. Using the standardized Act and React Testsystem (ART) 2020 Standard test battery, traffic-relevant performance was analysed 1.5 h (peak level) and 20 h (trough level) after administration of opioid maintenance therapy. Results showed that patients at trough level had a significantly higher percentage of incorrect reactions (p = 0.03) and more simple errors (p = 0.02) than patients at peak level as well as methadone-maintained patients at peak level tended to perform less well than buprenorphine-maintained patients in some of the test items, e.g. methadone-maintained patients at trough level had a higher number of delayed reactions in the RST3 phase 2 test (p = 0.09) and answered fewer questions correctly in the visual structuring ability test (p = 0.04). This investigation indicates that opioid-maintained patients did not differ significantly at peak vs.trough level in the majority of the investigated items and that both substances do not appear to affect traffic-relevant performance dimensions when given as a maintenance therapy in a population where concomitant consumption would be excluded.
authors.affiliation: Department of Psychiatry, Medical University Vienna, Vienna, Austria.
authors.forename: Andjela
authors.initials: A
authors.lastname: Baewert
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gombas
authors.forename: Shird-Dieter
authors.initials: SD
authors.lastname: Schindler
authors.forename: Alexandra
authors.initials: A
authors.lastname: Peternell-Moelzer
authors.forename: Harald
authors.initials: H
authors.lastname: Eder
authors.forename: Reinhold
authors.initials: R
authors.lastname: Jagsch
authors.forename: Gabriele
authors.initials: G
authors.lastname: Fischer
mesh_terms: D000328:Adult; D001288:Attention / Q000187:drug effects; D001317:Austria; D001334:Automobile Driving / Q000523:psychology*; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D003657:Decision Making / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D009294:Narcotics / Q000008:administration & dosage* / Q000493:pharmacokinetics; D009483:Neuropsychological Tests; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011446:Prospective Studies; D011930:Reaction Time / Q000187:drug effects
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone