The benefit of stimulants in reducing driving risk in adult drivers with ADHD

Redelmeier and Tien1 have provided an excellent update on the medical interventions to reduce driving risk. A recent article by Chang and colleagues2 from Sweden may be of interest to CMAJ readers. The authors reported on an epidemiologic study between 2006 and 2009 of over 17 000 drivers with attention-deficit/hyperactivity disorder (ADHD). The hazard ratio for serious motor vehicle collisions for drivers with ADHD was 1.47, for males and 1.45, for females. The authors observed a 58% risk reduction in motor vehicle collisions involving male drivers with ADHD who took stimulants over the three years of the study. However there was no apparent benefit for female drivers with ADHD. The association between ADHD and increased driving risk, and the protective benefits of stimulants when driving has been documented.3 The CMA Driver’s Guide: Determining Medical Fitness to Operate Motor Vehicles. 8th Edition includes ADHD as a reportable condition if there is demonstrated problem driving.4 Physicians are encouraged to consider a trial of long-acting stimulants in reducing driving risk. The article by Chang and colleagues2 provides more support for this medical intervention in drivers with ADHD and problem driving.