Opioid Use and Fatal Two-Vehicle Crash Initiation | Peoria

Last Updated: November 8, 2026

In a study of fatal two-vehicle crashes, drivers who tested positive for prescription opioids had more than twice the odds of crash initiation. The adjusted odds ratio was 2.18. The most common driving error was failure to keep in lane.

Chihuri and Li report more than 214 million total annual opioid prescriptions in the background of their 2019 article in JAMA Network Open. Their study then measured crash initiation.

Stanford Chihuri and Guohua Li studied 18,321 fatal two-vehicle crashes on public roads from January 1, 1993, through December 31, 2016, using the Fatality Analysis Reporting System (JAMA Network Open, 2019). With adjustment for age, sex, and driving history, the odds of crash initiation for drivers who tested positive for prescription opioids were more than twice the odds for drivers who tested negative. The adjusted odds ratio was 2.18, with a 95% confidence interval of 1.91 to 2.48. From 1993 to 2016, detection among crash initiators rose from 2.0% to 7.1%. The study compared initiators with the other driver in the same crash.

The most common driving error in those crashes was failure to keep in lane, 7,535 of 18,321 crashes. Among crash initiators who tested positive for prescription opioids, failure to keep in lane accounted for 502 of the errors, 54.7%. The article reports no significant interaction between prescription opioid use and blood alcohol concentration on crash initiation.

The study authors reported that drug-testing data were available for only 47% of drivers involved in fatal car accidents, with testing protocols varying across states. They also cautioned that a positive prescription-opioid test does not necessarily indicate acute impairment. When police reports lack toxicology, counsel may pursue other discovery. Under 735 ILCS 5/8-802, treatment records can be protected by the physician-patient privilege. In Palm v. Holocker, 2018 IL 123152, the Illinois Supreme Court held that civil allegations of impairment or comparative negligence alone do not waive a defendant’s privilege. Some non-treatment records disclosed in discovery, such as a driver-license renewal medical report, may be obtainable through court order. Subpoenas and motions to compel do not guarantee access to every record. The Chihuri and Li study measures population-level associations with fatal crash initiation; proving impairment or causation in a particular crash requires case-specific evidence.

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