Tiger Woods' Drug Misadventure: Recklessness or an Honest Mistake?

One morning in May while I was on the way into the office, I was listening to the Dan Le Batard Show on ESPN Radio shortly after Tiger Woods was arrested on suspicion of driving under the influence (DUI). Halfway into the conversation, the radio hosts dove into a back-and-forth discussion about whether Woods should have been seen in a less negative light because alcohol was not involved:

“One [story] gives off irresponsibility and recklessness, and debauchery—and the other feels more like a genuine mistake … 0.0 [alcohol] changes this discussion for me … If he blew a 0.0, isn’t that enough evidence for you to say ‘Look, this was an honest mistake with pain medications’ … One of them is being intentionally irresponsible … Pain changes it for me because when you think it’s a DUI, the place you go is ‘Come on, man, get a car. How wealthy are you? Why are you driving? What are you doing?’ And then all of a sudden—oh wait, he’s disoriented; he’s not himself; he’s altered by the medications …”—Dan Le Batard Show, ESPN Radio, May 30, 2017¹

On another ESPN show, Highly Questionable, Bomani Jones took a harder line on the perils of central nervous system (CNS)-active medication use while driving. He felt that there should be no distinction between alcohol and prescription drugs when we judge a person’s character with respect to inappropriate use:

“I reacted like Tiger Woods got busted for DUI. Where this gets interesting is the way that most people react to DUI, which is a whole lot of finger wagging at how you need to be responsible when you drink. And then you find out that the dude wasn’t drinking; it was just pain pills. And then all of a sudden, everyone had to remember, ‘Wait, what’s the morality play that we make on this one? Because my thinking on this one was, it is about being in a car and driving when you should not be in a car driving. He shouldn’t have done that. But the way that people have vacillated on how mad they want to be actually points out a lot about the way we receive these crimes, and that says a lot more about us than it does about Tiger Woods.”—Bomani Jones, Highly Questionable, ESPN Radio, May 30, 2017²

Interestingly, Le Batard shifted his position ever so subtly on that show, taking a more unforgiving stance, perhaps because he had more time to consider the earlier back-and-forth discussion:

“The way that people judge the recklessness of getting into a car while drunk was different than the statement that came out, and the way that [people] reacted, [which was,] ‘Well, wait a minute. Maybe this was a more innocent mistake that involved [prescription] opiates, which, if we are [actually] thinking clearly, is probably a little more dangerous than even drinking.”—Dan Le Batard, Highly Questionable, ESPN Radio, May 30, 2017²

SHOULD A PERSON WHO IS NOT EXPOSED TO EDUCATION ABOUT THE DANGERS OF CNS-ACTIVE MEDICATIONS AND DRIVING BE THOUGHT OF AS IRRESPONSIBLE?

As a pharmacist, my reaction to the dialogue was one of wonder about how many patients I see every day who may go out and drive or engage in other unsafe activities after taking drugs I have dispensed to them. It would be difficult to defend oneself with a claim of, “I didn’t know that drinking and driving wasn’t safe,” but should a person who is not exposed to education about the dangers of CNS-active medications and driving be thought of as irresponsible? And should a pharmacist who hasn’t made an extra effort to educate be considered the same?

EVERY DAY, MILLIONS OF AMERICANS PICK UP FROM PHARMACIES MEDICATIONS THAT COMPROMISE COGNITION AND ALERTNESS.

The No. 1 selling prescription medication in the United States in 2012 was hydrocodone, at more than 135 million prescriptions filled.³ Alprazolam (#13), zolpidem (#15), tramadol (#21), and oxycodone (#22) also made the top 25, generating about 160 million prescription fills. That is a lot of patients with a lot of prescriptions to assume that nobody is driving cars or operating heavy machinery while on these medications.

THE OTHER 90%—NOT JUST DRUG ABUSERS— ARE AT RISK.

We often think of those at risk for DUI and accidents due to intoxication as drug misusers or abusers. Yet, there are ample circumstances within which your average everyday person, without an addiction or predilection for risky behavior, finds himself or herself at risk behind the wheel. About 10% of prescription drug users who consume drugs from classes that are commonly abused end up abusing them. The other 90% do not abuse drugs but still drive cars, for the most part.⁴

THE DANGERS OF DRIVING WHILE MEDICATED WITH CNS-ACTIVE MEDICATIONS SHOULD NOT BE UNDERESTIMATED.

Among drivers killed in automobile accidents, 18% test positive for at least 1 drug.⁵ Pharmacists and pharmacy technicians are well aware of these dangers and are conversant in which drugs, and why they are risky, to use in any activity requiring cognition. But we should not assume that the average Joe knows the difference or has the level of awareness needed to appreciate the risk. And this lack of appreciation goes beyond prescription medications. Unfortunately, the public still considers OTC products to be less powerful and dangerous than prescription drugs. Yet, diphenhydramine use has been shown to have a more deleterious effect on driving than does alcohol intoxication.⁶

IT IS NOT JUST KIDS AND MIDDLE-AGE INDIVIDUALS, EITHER.

Among car accidents that result in death from drug use, more than one-fourth of individuals who die are older than 50.⁷ We should remember that drugs can have different and often more pronounced effects on older people, putting them at greater risk of low cognition, drowsiness, syncope, and other adverse effects from medications that we do not consider medications of abuse.

EDUCATIONAL EFFORTS ARE FALLING SHORT.

In a AAA-sponsored survey of men and women older than 55, 70% of whom drove 6 or 7 times a week, more than two-thirds answered that they regularly took medications known to potentially impair driving. Yet just 17% recalled receiving a warning from a health care professional about the dangers of driving while using these medications.⁸

Pharmacists are the first line and perhaps the last line of defense for patients engaging in risky behavior related to medication use. If we do not properly counsel or educate our patients, we fall short of our duty and capabilities. How Woods is judged by the legal system, sports radio, and the public may ultimately depend on the question of receipt of education and knowledge of risk. I am not judging his behavior without more information to determine his awareness level, but I do judge pharmacists if we don’t do a better job of educating patients and the public about this problem.

Troy Trygstad, PharmD, PhD, MBA, is vice president of pharmacy programs for Community Care of North Carolina, which works collaboratively with more than 1800 medical practicesto serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD inpharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors for the American Pharmacists Association Foundation and thePharmacy Quality Alliance.

References

• Le Batard, Stugotz and Greg Cote discuss Tiger Woods getting a DUI and Tim Kurkjian joins the show to settle a disagreement we're having/The Dan Le Batard Show. Player FM website. player.fm/series/the-dan-le-batard-show-with-stugotz-1203957/hour-1-tim-kurkjian-53017. Recorded May 30, 2017. Accessed June 23, 2017.
• Dan Le Batard, Bomani Jones and Papi talk about Tiger Wood's DUI arrest, Mike Trout's injury, if Bryce Harper should be suspended and more/Highly Questionable. ESPN website. espn.com/espnradio/podcast/archive/_/id/6962629. Accessed June 23, 2017.
• https://www.imshealth.com/files/web/Corporate/News/TopLine%20Market%20Data/US_Top_25_Medicines_Dispensed_Prescriptions.pdf. IMS Health website. Updated March 22, 2013. Accessed June 30, 2017.
• Prescription drug use and misuse in the United States: results from the 2015 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services website. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm#tabb-4. Accessed June 23, 2017.
• Drug involvement of fatally injured drivers. Washington, DC: National Highway Traffic Safety Administration; 2010. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/811415
• Weiler JM, Bloomfield JR, Woodworth GG, et al. Effects of fexofenadine, diphenhydramine, and alcohol on driving performance: a randomized, placebo-controlled trial in the Iowa driving simulator. Ann Intern Med. 2000;132(5):354-363.
• Brady JE, Li G. Trends in alcohol and other drugs detected in fatally injured drivers in the United States, 1999-2010. Am J Epidemiol. 2014;179(6):692-699. doi: 10.1093/aje/kwt327.
• MacLennan PA, Owsley C, Rue LW, McGwin Jr G; AAA Foundation for Safety. 2009 older adults’ knowledge about medications that can impact driving. Stop Drugged Driving website. stopdruggeddriving.org/pdfs/KnowledgeAboutMedicationsAndDrivingReport.pdf. Published August 2009. Accessed June 23, 2017.