Tiger Woods' Arrest Brings Attention to the Growing National Problem of Drugged Driving

Interview with Jeffrey Fudin, PharmD, DAIPM, FCCP, FASHP, and Pawan Grover, MD.

Tiger WoodsTiger Woods hits from the fairway during the 2009 Earl Woods Memorial Pro-am at Congressional Country Club in Bethesda, Maryland. Photo by: Chris Wellner/CC by 2.0

Before Tiger Woods was arrested for a "drugged driving" incident on May 29, 2017, driving under the influence of medication was already making headlines. Recent studies reflect a nationwide surge in fatal car crashes involving prescription drugs. In 2015, the Governors Highway Safety Association, released a study showing nearly 43% of fatally-injured drivers had either prescription or illegal drugs in their bodies, compared with 37% of drivers who had consumed alcohol.

Mr. Woods, the youngest pro golfer and first African American to win the US Masters, was found in the early hours asleep at the wheel of his car on the side of the road in Jupiter, Florida. The car was still running and 2 of the tires were flat. Some damage to the tail light and bumpers was also noted by police. According to news reports, Mr. Woods was alone and wearing a seatbelt. When police woke him up he appeared disoriented. His speech was slurred and he failed a field sobriety test. It was later confirmed that 2 breathalyzer tests revealed no evidence of alcohol.

A day after the arrest, the golfer issued a statement taking responsibility for his actions; he blamed his behavior on “an unexpected reaction to prescribed medications” and added that he “didn’t realize the mix of medications had affected me so strongly.”

Practical Pain Management spoke with PPM editorial board member Pharmacist Jeffrey Fudin, PharmD, DAIPM, FCCP, FASHP, and Pawan Grover, MD, a Houston-based interventional pain specialist with Inovospine for insight about the role of prescription medication in the incarceration.

Why So Many Medications?

On April 19, 2017, Mr. Woods had elective surgery to fuse discs in his lower back—his fourth surgery in 3 years—and was still recovering at the time of his arrest (typically, it takes 6 months to recover from this type of procedure).

The police report listed 4 medications Mr. Woods told them he was taking—Vicodin (an opioid pain reliever containing hydrocodone and acetaminophen), Torix (Etoricoxib, a COX-2 specific anti-inflammatory medication not available in the US), Vioxx (a medication similar to Torix that hasn’t been available in the US. since it was pulled from the market in 2004 due to dangerous heart-related side effects), and Soloxex (a drug that doesn’t exist but may have been confused with Zolpimist, a branded form of zolpidem, a sleep agent known to have a high prevalence of sleep walking and sleep driving).

Dr. Fudin explained that multiple medications are often prescribed because each one treats different types of medical problems by unique pharmacological actions.

“Due to his history of back problems, Mr. Woods was likely on opioid therapy to manage his chronic pain so taking an opioid pain reliever such as Vicodin makes sense,” the pharmacist explains. “Since muscle spasms often accompany chronic low back pain, a muscle relaxant was also probably prescribed. For the burning pain radiating from the spine that travels down the leg prior to and following spine surgery, anticonvulsants, such as Lyrica [pregabalin], can alleviate that and antidepressants such as Cymbalta [duloxetine] can help with neuropathic pain.”

Pawan Grover, MD, agrees, explaining that a standard post-surgery cocktail would be a “pain reliever, muscle relaxant, and often a sleep aid as well.”

Regardless of what he was taking, both doctors agree he should not have been driving but Dr. Fudin adds that the ability to drive depends on the drugs taken, the time they were taken, and other important viariables.

“Vicodin has a strong warning on the label not to operate heavy machinery or drive a car. That doesn’t mean that Vicodin is the devil but it means you need to take the medication as directed,” Dr. Fudin explains.

If he was on a sleep aid, Dr Grover says memory loss is an under-reported but well-known side effect of that medication. Both doctors relayed accounts of patients having no recall of their actions after taking insomnia medication such as zolpidem [Ambien]. “I had an overweight patient taking zolpidem who routinely found evidence of late-night snacking that was clearly contributing to his weight problem but he absolutely did not remember any of it,” says Dr. Fudin, adding that “sleep driving, sleep walking, memory loss and motor impairments have all be associated with zolpidem.”

According to Dr. Fudin, "If Mr. Woods was not properly counseled and he took zolpidem, it is not at all far-fetched that he could have gotten into his car without ill-intention and drove away with no recollection of how he ended up on the side of the road hours later."

Still, Dr. Grover warns against vilifying any 1 drug. “The effects of medication can vary widely in individuals. And beyond taking 2 or 3 medications, it’s hard to know how the medications will reaction with each other,” the spine specialist says.

Unexpected Reaction? RX and OTC Meds Can Be Dangerous

Accidental overdoses can be the result of patients not fully understanding the impact of mixing prescription medication with other substances like over-the-counter (OTC) allergy medication, alcohol, and even certain foods.

“The media has it wrong. The story isn’t that the prescribed medications are responsible for the problem,” says Dr. Fudin. “The story is that ALL medications are dangerous if they aren’t taken properly. And certain combination can be lethal when mixed or taken in excess.”

Dr. Fudin notes that opioids taken alone do not cause slurred speech or disoriented behavior. “We don’t have the whole story about Mr. Woods in terms of what he took and their doses, but to be found asleep in a running car and be confused about where you are, suggests something else may have been added to the mix,” he says adding that HIPAA privacy laws may prevent publication of the toxicology screen results and what really happened. "In fact, this is another ding for bad press on opioids when in fact, the opioid alone is probably least likely to be the culprit for Mr. Woods' unfortunate incident."

Given that it’s allergy season, Dr. Fudin speculates that if Mr. Woods had taken an over-the-counter allergy medication, like Benadryl, in combination with the post-surgery prescriptions or a sleep aid, it could have had a significant sedentary affect. “The active ingredient in Benadryl, diphenhydramine, is also used in many OTC sleep medications, Sominex, for example and flu medicines like Tylenol PM,” Dr. Fudin says. In addition, certain kinds of sedatives/muscle relaxants, such as benzodiazepines or carisoprodol (Soma), will cause drowsiness and impair driving, Dr. Grover adds.

All medications, both OTC and prescribed—can be dangerous, the doctors agree. “Extreme care must be taken. When medication isn’t taken as directed it can become poisonous. All medications have risks and you need to be aware of ALL of them,” Dr. Fudin warns.

For tips on how you can help keep our roads safer and protect your loved ones from getting behind the wheel when they are impaired, click here.

Updated on: 06/12/17
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How to Keep Drugged Drivers Off the Road
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