There's no need to apologize. I made a poor choice that afternoon. Additionally, I understand this sentiment - especially coming from an outside perspective in a forum that largely focuses on recreational usage. I certainly won't take a dose on my drive home again after a break in dosing like that, or possibly ever again as I'm generally well medicated before leaving for my appointments anyway and this rarely require additional doses before returning home. This was simply something I didn't expect.
When I was first placed on oxycodone, I didn't drive for about a week while I learned how it impacted me; when they switched me to Dilaudid, I took similar action, and then again when I went from Dilaudid to Dilaudid HP and then to Levorphanol and other synthetics. The big issue here was my failure to recognize what a huge impact that forced taper would have on me. It was stupid and it didn't occur to me in the slightest that what only 10 days prior constituted wholly regular dosing would do that to me.
Now that my dose has been reduced and re-adjusted, though, I do drive on it. There are copious studies supporting the fact that, when specifically talking about chronic pain patients on therapeutic doses of opioids in the long term, driving improves at best and has no adverse impact at worst when the patient is medicated at their usually level. Within one study that claimed otherwise, the study related all participants who had drugs in their system in the same way, including those with multi-drug toxicity, recreational drugs, and mixed medications which were not prescribed and monitored. Even the studies and guidelines that seem to not support allowing opioid tolerant pain patients to drive, the closing guidelines repeatedly refer to discouraging patients from driving "for 7-14 days or until dosing is appropriately adjusted to provide relief without sedation". This isn't like the anecdotes of people who claim they drive better after drinking or smoking pot, it's based on the long term study of opioid dependent pain patients. We are more dangerous on the road when our pain is not well managed than when it is. That is why my anesthetist let me drive out of his clinic less than an hour after having 2-3mg IV Dilaudid. He's not an irresponsible or rash doctor - he's following a protocol supported by the available evidence.
Being that I expected that to be my "normal" dose - which I had been stable on for over a year - I did not expect it to hit me like that. I failed to achieve appropriate relief without sedation. That doesn't make it okay and it doesn't mean I didn't royally fuck up that day. That is all on me. In the future, especially after changes in dosage or brand or after tapering like I did, I'll wait to take my first dose until I'm at home for the day to avoid a similar issue because it was scary, I really didn't like it, and I recognized as soon as I pulled into my driveway that this was an aberrant event that I don't wish to repeat. However, to suggest that I shouldn't drive at all if I've taken a medication I take about every 4 hours every day of my life and with literature supporting the fact that most long-term, opioid-dependent pain patients are as safe or safer on the road when taking regular doses of medication doesn't make sense. Outside of this one event, which I won't repeat, there's truly no reason for me (and other opioid dependent patients with chronic and severe pain) not to drive on my regular doses of opioids.
TL;DR: I agree that I messed up by not anticipating the impact of the medication change (which rendered me above a herapuetic dose), but also like to share the available information which is generally supportive of pain patients driving on our long-term medications at therapeutic doses.
