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Dr. Natasha
Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11675
Experience:  American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
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GOOD MORNING, LAST WEEK YOU ANSWERED MY QUESTION REGARDING

Customer Question

GOOD MORNING,
LAST WEEK YOU ANSWERED MY QUESTION REGARDING DRIVING AN AUTO. WHILE ON 20- 30 MGS OF VALIUM.
TODAY I WOULD LIKE AN OPINION REGARDING THE SAFETY AND TOLERABILITY OF ANTIDEPRESSANTS FOR THE SAME PATIENT AND THE RISK AND HAZARD ANALYSIS WHEN HE IS ON HIS MEDS,IF HE STOPS HIS MEDS, NOT TAING THE PRESCRIBED DOSES OR MIXING THE ANTIDEPPRESSANTS WHICH HAVE BEEN COMMONLY PRESCRIBED WITH PAIN MEDS,SUCH AS OXYCONTIN
, PERCOSET, VALIUM, ETC.
WHAT ARE THE RISKS OF HIM DRIVING AN AUTOMOBILE WITH A SEVEN YEAR OLD IN THE CAR.
THE PATIENT IS 38,DIAGNOSED WITH EVERY THING FROM BI-POLAR TO MANIC DEPRESSION ,ANXIETY.
MY CONCERNS ARE THAT I WOULD LIKE TO PUT SAFEGUARDS INTO PLACE IN THE EVENT THAT THE PATIENTS JUDGEMENT MAY BE IMPAIRED DUE TO MANIA OR SEVERE DEPRESSION CAUSED BY HIM NOT TAKING HIS MED PROPERLY, NOT TAKING THEM AT ALL, AND THE POSSIBLE MIXING HIS MEDS BY USEING AND ABUSING PAINKILLERS AND OTHER NARCOTICS
AS I EXPLAINED LAST WEEK,THERE IS ALWAYS THE POSSIBILITY THAT THE PATIENTS MAY INTERFERE WITH HIS JUDGEMENT. THE REAL DANGER COMES FROM THE INDIVIDUALS RESPONSIBILITY FOR THE WELFARE, SAFETY AND LIVES OF OTHERS.
THE PATENT WAS INFORMED BY HIS PSYCHIATRIST THAT HE WILL STOP PROVIDING PSYCHIATRIC CARE BECAUSE HE FAILED TO COMPLY WITH TREATMENT RECOMMENDATIONS.
BELLOW IS A LIST OF THE MEDS THAT THE PATIENT WAS ON WHEN HE WAS A PATIENT AT A PSYC. HOSPITAL IN NEW YORK.
PRIMIDONE 50MGS BEDTIME
LAMICTAL 100MGS X2
VIBRYD 20MG
VALIUM 10MG X2
TRAZODONE 100MG BEDTIME
RISPERDAL 2MG BEDTIME
ANBIEN 5MG AT BEDTIME
I DO UNDERSTAND THAT DRUGS AREN'T ILLEGAL BUT THAT DRIVING CAN BE IF ONE CANT CONCENTRATE.MY CONCERN IS FOR MY SEVEN YEAR OLD GRANDSON BEING IN A CAR WITH THE PATIENT.
DR., YOUR OPINION WOULD BE APPRECIATED.
JOEL
Submitted: 9 months ago.
Category: Medical
Expert:  Dr. Natasha replied 9 months ago.
Joel
Can I answer this tonight? Not near computer
Customer: replied 9 months ago.

YES. I APPRECIATE YOUR OPINION.


PATENT AS OF TODAY


VALIUM 20-30 MG A DAY


RESPERDAL 2MG


LAMICTAL100MG


VYBRID 40MGS


LYRICA 300MG X2


WHO KNOWS WHAT ELSE ?


 

Expert:  Dr. Natasha replied 9 months ago.
Hi
Well, as discussed before, medications which can impair your attention and cognition can be called into question
The ones on the list which are scheduled drugs in these classes are valium and ambien. So if he is taking this, it may not be safe for him to drive a car.
The issue is you need to talk to a DUI attorney and find out the law for NY state.
As well, he should be evaluted by a neuropsychiatrist to determine in person whether or not he can safely drive.
Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11675
Experience: American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
Dr. Natasha and 7 other Medical Specialists are ready to help you
Customer: replied 9 months ago.

HI,


ARE YOU GOING TO ANSWER IN MORE DETAIL LATER OR IS THIS IT FOR TODAY?


JOEL

Expert:  Dr. Natasha replied 9 months ago.
I will get to it later in more detail
Expert:  Dr. Natasha replied 9 months ago.
Hi Joel
I am back
Well, I had some more time to look at your question again.
PRIMIDONE 50MGS BEDTIME
LAMICTAL 100MGS X2
VIBRYD 20MG
VALIUM 10MG X2
TRAZODONE 100MG BEDTIME
RISPERDAL 2MG BEDTIME
ANBIEN 5MG AT BEDTIME

Ambien and the valium are restricted drugs as you know. However all of the rest can cause impairment and issues with driving. The question you have is really more of a custody issue. Can the father of the baby be trusted to care for your grandson? If he is caught driving impaired and has these drugs on board, this will be considered to be a DUI. There are no safeguards like with alcohol- in terms of ignition devices. But if you feel that he is not compliant with his medication and is cycling too rapidly with his psych disorder to be safe, you will have to petition the court and see if you can get custody of your grandson or give the mom more custody. But you do need to see a family law attorney for this information. I agree with you, it sounds like he is too unsafe to be driving with a child- but this for the courts to decide, not me or you...

Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11675
Experience: American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
Dr. Natasha and 7 other Medical Specialists are ready to help you
Customer: replied 9 months ago.
Get some rest
Expert:  Dr. Natasha replied 9 months ago.
LOL. thanks :-)
Customer: replied 9 months ago.

GOOD MORNING DR, NATASHA.ONCE AGAIN I WOULD LIKE TO THANK YOU FOR YOU RESPONSE.


I HAVE BEEN CONSULTING WITH A FAMILY LAWYER,CPS, A CHILD CUSTODIAN. AND THE CASE IS BEFORE A FAMILY COURT JUDGE.


IN THE PATIENTS MEDICAL RECORD FROM PSYCHIATRIST#1 ,HE CLAIMS THAT HE HAD BEEN TREATING THE PARTY FOR 5 YEARS AND THAT HE IS BIPOLAR AMONGST HAVING OTHER ISSUES.WHEN HE WAS PAID TO TESTIFY IN COURT HE STATED THAT THE PATIENT IS NOT BIPOLAR.


PSYCHIATRIST # 2 : I REVIEWED HIS MEDICAL RECORDS AND FOUND HIS DIAGNOSIS TO REFLECT THAT THE PATIENT MAY BE BIPOLAR BUT BELIEVES THE PATIENT HAS CLUSTER PERSONALITY B.


THE PSYCHIATRIC HOSPITAL THAT HE CHECKED HIMSELF INTO AND WAS DISCHARGED FROM DIAGNOSED HIM AS BIPOLAR.


BOTH DOCTORS FEEL THAT THE PATIENT IS NOT A THREAT TO HIMSELF OR TO OTHERS, HOWEVER THEY FELT THAT IT WAS NECESSARY FOR HIM TO CHECK INTO A HOSPITAL. NEITHER DOCTOR SAW NOTES INDICATING THAT THE PATIENT WANTED TO HURT OR KILL HIMSELF BECAUSE THE PATIENT DIDN'T REPORT


IT TO THE DOCTORS. AS A MATTER OF FACT HE TOLD THE DOCTORS THAT HE WAS FINE AND NEVER FELT BETTER.



ON JUNE 27, 2013 ,DOCTOR # 2 RECEIVED A DRUG UTILIZATION REPORT FROM THE STATE, FOR A PERIOD OF 6 MONTHS.THE REPORT SHOWED THE FOLLOWING; DOCTOR # 3 PRESCRIBED 140 OXCODONE 5MG OVER A PERIOD OF 90 DAYS.


DOCTOR #1 PRESCRIBED 240 DIAZEPAN FROM JAN. TO JUNE- 30 MG EACH OR 3 A DAY.


DOCTOR # 2 PRESCRIBED 90 /30 MG DIAZEPAN AND


PREGABALIN 150MG 60 PILLS AND75 MG 14 FOR 7 DAYS.


ALL OF THESE ARE RESTRICTED DRUGS ,AS YOU KNOW.THE OTHER DRUGS WHICH I SENT THE LIST ON THE OTHER DAY, CAN CAUSE IMPAIRMENT AND ISSUES WITH DRIVING.


PSYCHIATRIST # 2 DISCHARGED THE PATIENT AND ASKED HIM TO FIND ANOTHER DOCTOR BECAUSE THE PATIENT WASN'T COMPLIANT WITH HIS MEDICATIONS AND WAS CYCLING TOO RAPIDLY WITH HIS PSYCH DISORDER.


THE COURT IS SWAYED BY THE DOCTORS TESTIMONY THAT THE PATIENT IN THEIR OPINION IS OK TO DRIVE.


THE CHILD COURT APPOINTED LAWYER ALSO FEELS THAT THE DOCTOR OPINION WILL DRIVE HIS DISSENSION TO ALLOW THE CHILD TO BE DRIVEN BY HIS FATHER.


CPS SEEMS TO SIDE WITH THE DOCTORS OPINION.


THE JUDGE WANTS ONLY THE DOCTORS REPORTS.


 


THE DUI ATTORNEY INDICATED THAT IN FACT A LAW DOES EXIST IN NEW YORK THAT PREVENTS ANY PERSON FROM OPERATING A VEHICLE WITH A CHILD WHILE THEIR ABILITY IS IMPAIRED BY DRUGS.AS YOU KNOW THERE IS NO DISTINCTION MADE BY THE LAW. DRIVING UNDER PRESCRIBED MEDICATION CAN AND IS STILL ILLEGAL IF YOU ARE DRIVING UNDER THE INFLUENCE IN NEW YORK STATE.WE ALL MAY AGREE THAT THE PRESCRIBED DRUGS AREN'T ILLEGAL BUT THE DRIVING CAN BE IF YOU CANT CONCENTRATE.


YOUR POINT ABOUT CUSTODY IS WELL TAKEN FOR NOW THE CHILD CAN SEE HIS DAD AT ANY TIME WITH SUPERVISION BUT CANT BE A PASSENGER IN A CAR IF HIS DAD IS DRIVING. THESE ARE TEMPORARY COURT ORDERS THAT THE JUDGE WILL BE RULING ON IN THE NEAR FUTURE.


THIS IS WHY I WANT AN OPINION ON THE CHILD'S SAFETY OF HIM BEING IN A VEHICLE WITH HIS DAD ON ALL OF THESE MEDICATIONS.


WAITING FOR YOUR OPINION


JOEL


 

Expert:  Dr. Natasha replied 9 months ago.
Will look at this tonight when I can think
Expert:  Dr. Natasha replied 9 months ago.
Hi Joel
I looked at your case again
The law is the law. So if the law states that he cannot drive with a child while under the influence of pain medication and the benzodiazpines, then he cannot drive. It may be harder to argue the psychotropic (psych meds) because then you are infringing on someone's rights and then all persons who have a mental illness which is being treated with psych meds would not be able to drive in the state of NY and that would not go well with NAMI (national association for mental illness) or the ADA (american disability association).

I think that you may be able to get at this with custody angle- the DUI attorney needs to sway the court that the FOB (father of baby) may have custody of the child with the provision that he is not to drive with the child unless he is clean off the medication (which, as you know, will never happen). As well, it appears that the FOB has been shopping with all of the medication. A good attorney would be able to argue these two criticial points.

I hope that this helped

please leave positive feedback if it did :-)
Customer: replied 9 months ago.

Good morning Dr. Natasha:


Thank you for your reply of last week. I would like to keep you up to date about the patient we were discussing. I just received a confidential Drug Utilization Report from the New York State Monitoring Program and found the patient is on 30 mg. of Diazepam a day and 600 mg. of Pregabalin. As well as these two drugs, he is also having prescriptions filled for Oxycodone 5 mg, 3 x a day. The other drugs he is on that are not monitored are Primidone 50 mg at bedtime, Lamictal 200 mg. a day, Viibryd 20 mg a day, Trazodone 100 mg at bedtime and Risperdal 2mg at bedtime. Naproxen 500 mg was also prescribed.


 


Needless to say, there might be other painkillers involved and I suspect this because he visited the Emergency Room this past week complaining about migraine headaches and I'm sure he received a prescription for some painkillers.


 


What I would really like you to do is seek the opinion of a colleague who is a Neuropsychiatrist to determine what effects these drugs have on the patient and whether or not he can safely drive a car. As I mentioned last week, the real danger comes from whether or not these drugs would interfere with his judgment. Please explain to your colleague that it is against the law to drive in New York State with a blood alcohol concentration level higher than 0.08 and according to the Substance Abuse and Mental Health Services Administration (SAMHSA) just 10 mg. of Valium can cause impairment similar to having a blood alcohol concentration of 0.1%


 


Knowing that the residual effects of sleeping pills and pain relievers can impair drivers, even in the morning, and may cause impairment similar to Codeine and Morphine, I am wondering if the Neuropsychiatrist can put an approximate reading of what the patient's blood alcohol concentration would be if he took the same dose of medications daily.


 


I am looking for a more specific answer that I received last week and know this is a difficult task, but I need it.


 


Respectfully yours,


Joel

Expert:  Dr. Natasha replied 9 months ago.
Joel- if you want you can repost this for a neurologist. I don't have any neuropsych colleagues I can ask...

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