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Affiliation
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Norwegian Institute of Public Health , Division of Health Data and Digitalization , PO Box 4404 Nydalen , 0403 Oslo , Norway. |
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Abstract
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OBJECTIVE: To look for dose- and concentration-effect relationships in experimental studies on single-dose administration of morphine on traffic relevant behavioral tests by a systematic literature review, and possibly to see if a dose/concentration could be defined, below which few or no tests would be affected.
METHODS: Searches for corresponding literature were conducted using MEDLINE, EMBASE, and PsycINFO, throughout March of 2016. The search strategy consisted of words colligated to cognitive- and psychomotor functions of relevance to driving, in relation to morphine administration. The tests were arranged into main groups, and tests showing impairment were categorized by doses as well as calculated plasma concentrations.
RESULTS: In total, 15 studies were included in the review. Impairment, after the administration of a single intravenously dose of morphine, was found in some of the tests on reaction time, attention and visual functions. No impairment was observed in tests on psychomotor skills and en-/decoding. Tests on reaction time appeared to be less sensitive to the morphine administration, while tests on visual functions and attention appeared to be the most sensitive to the morphine administration. Single-dose administration of morphine with dosages up to 5 mg appeared to cause very few effects on traffic-relevant performance tasks. At higher dosages, impairment was found on various tasks but with no clear dose-effect relationship. Plasma morphine concentrations less than 50 nmol/L are most probably accompanied by few effects on traffic-relevant performance tasks.
CONCLUSIONS: A plasma morphine concentration of 50 nmol/L (approximately 14.3 ng/mL) could represent an upper level, under which there is little accompanying road traffic risk. A single-dose of 5 mg morphine IV and analgetic equivalence doses of fentanyl, hydromorphone, oxycodone and oxymorphone are presented with the suggestion that few traffic-relevant effects will appear after such doses.
Language: en |