Update: An illuminating toxicology report for Tiger Woods

Tiger Woods mug shot driving drowsy impaired DUI Ambien Dilaudid THC Xanax VicodinSleepApnea.org previously blogged about the DUI charge leveled against Tiger Woods last spring after he was found asleep behind the wheel of his vehicle, engine running and brake lights on, with right turn signal flashing.

He failed a sobriety test, and the police report observed flat tires and rim damage on the driver’s side tires.

The initial concern was whether he had been drinking. Days later, the world found Woods admitting to using both Vicodin—an opiate pain medication— and Xanax—a prescription antidepressant used as a sleep aid—prior to driving.

This week, we learned more about Tiger Woods’ drug use related to painsomnia: insomnia caused by chronic pain.

The Tiger Woods DUI timeline: What’s new since June

Toxicology results

The recent release of the incident’s toxicology report for Tiger Woods reveals a few more details. Woods tested positive for the presence of five medications in his bloodstream at the time of his arrest:

  • 2 opioid pain medications: hydrocodone (Vicodin) and hydromorphone (Dilaudid)
  • Alprazolam, an anti-anxiety medication often used as a sleep aid (Xanax), plus its *metabolites
  • Zolpidem (better known as the prescription sleep aid, Ambien)
  • Delta-9 carboxy tetrahydrocannabinol, a marijuana *metabolite
*Metabolites remain in the body after a substance has been metabolized (broken down), into a different substance. They are a reliable marker of previous consumption of substances after normal metabolism of them has taken place.

In our June 22 post, we discussed the dangers of driving while under the influence of both Vicodin and Xanax. But this was before the latest toxicology report for Tiger Woods shed new light on these dangers.

According to more recent reporting by CNN, “The US National Library of Medicine warns against mixing alprazolam with either hydrocodone or hydromorphone, suggesting that the combination might lead to dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. In particular, hydrocodone plus alprazolam may increase the risk of ‘breathing problems, sedation, coma, or other serious, life-threatening side effects.’ ”

This explains the dangers of consuming a “cocktail” of substances that includes Dilaudid, Vicodin, and Xanax, as referenced in the toxicology report for Tiger Woods. However, let’s consider how Ambien and marijuana can also impact driving, by themselves or in combination with these other medications.

Ambien (zolpidem)

Ambien (zolpidem) is a well-known and frequently prescribed medication for insomnia. More sleep physicians have started to steer clear of this medication based on recent research. It suggests cognitive behavioral therapy for insomnia (CBT-i) is a more effective therapy for treating chronic sleeplessness than most sleep aids. Ambien also brings a host of side effects that make it dangerous to use long term.

“Sleep driving”—in which users operate a vehicle in a trance-like state—is just one of many automatic behaviors that can occur while using Ambien.

Even when automatic behaviors don’t take place, Ambien can lead to a host of other problems even when the user is awake, including:

  • Hallucinations
  • Memory loss (amnesia or dementia)
  • Impaired alertness
  • Ambien “hangover” (in which users face a higher risk for accidents and falls in the morning after its use)

In addition, many people who take Ambien become habituated to it in the long term. This itself is problematic, as Ambien is intended for use “as needed”—not in a nightly, open-ended fashion. Many users don’t realize it’s not to be used nightly or for longer than four weeks.

Dependency to Ambien is a problem for many as a result. They find it extremely difficult to wean from after months—even years—of use. But Ambien withdrawal is no joke: It can lead to seizures, rebound insomnia, muscle cramping, nausea and vomiting, anxiety and confusion, and emotional distress. Users who wish to taper off of this medication should seek the guidance of a physician to be safe.

Noteworthy: Just last week, a Minnesota nurse, who struck a pedestrian with her car after taking Ambien last April, was sentenced to four years in prison. The charge? Criminal vehicular homicide. She had a perfect driving record and was considered a model citizen, otherwise.

Considering the consequences of using Ambien alone (without using any other drugs), it’s fairly clear that combining it with Xanax, Vicodin, and Dilaudid can only lead to a much more dangerous outcome—especially when one gets behind the wheel of a car.


Legal doesn’t necessarily mean safe

It’s worth noting that medicinal use of marijuana is legal in the state of Florida, where Woods was arrested.

Legality of marijuana doesn’t erase its known impact on driving, however. A recent article in the Boston Globe shared that “One 2016 study found that even drivers with a relatively small amount of THC in their systems can be just as impaired as if they were highly intoxicated.”

Research is slow in providing evidence that legalizing the use of marijuana is positively associated with higher crash rates and vehicular fatalities.

However, the NIH National Institute of Drug Abuse reports that “Marijuana significantly impairs judgment, motor coordination, and reaction time, and studies have found a direct relationship between blood THC concentration and impaired driving ability.” (Check out their comprehensive research links here.)

Said research also points to two large studies in Europe. Both found that drivers using marijuana prior to driving were almost twice as likely to cause a fatal crash than those who did not use any substances.

This fact sheet from the CDC provides additional information about the risks of driving while under the influence of marijuana.

Noteworthy: The state of Massachusetts recently generated a new awareness campaign, “Drive High: The crash is on you.” This happened in response to concerns about unsafe roads following the state’s recent legalization of marijuana. The campaign follows efforts that have coalesced in both the state of Washington and Colorado. Increases in traffic fatalities due to marijuana impairment may be on the uptick in both states.

Concerns about combining marijuana with alcohol are a rising concern as well. It appears that alcohol use increases marijuana concentration in the bloodstream.

While Woods wasn’t drinking when he was arrested, it’s not a stretch to say that combining marijuana with medications like Xanax, Vicodin, and/or Dilaudid would be ill-advised prior to driving.

What about using marijuana as a pain reliever?

Marijuana use to treat pain is nothing new. A recent report from Business Insider suggests pain relief is the most common reason why people seek medical marijuana. Research shared at the beginning of 2017 conclusively supports marijuana’s pain management properties.

On the flip side, new research out this month seems to contradict these findings, suggesting more studies are needed.

With such emphasis on opioid addiction in the news, it shouldn’t be surprising that people are trading pills for “herb.” And many will do so without a prescription, wherever pot is legal (recreationally or medicinally).

Woods represents a large population of people dealing with chronic pain. Many will try alternatives when relief doesn’t come fast enough.

He admitted in his Monday statement that he was self-treating for his back pain. “Recently, I had been trying on my own to treat my back pain and a sleep disorder, including insomnia,” he said. “I realize now it was a mistake to do this without medical assistance.”

Not guilty plea to DUI

Woods’ attorney, Douglas Duncan, entered Woods’ plea of “not guilty” to his DUI charge last Wednesday. In July, Woods announced completion of treatment at a prescription medication abuse clinic. He’s now expected to enter a local program for first-time DUI offenders.

Meanwhile, Woods has also agreed to enter a diversion program that could erase the DUI charge later this year. The four-year-old diversion program requires Woods to:

  • spend one year on probation
  • pay a $250 fine and court costs
  • attend DUI school
  • perform 50 hours of community service, and
  • attend a victim-centered workshop highlighting how impaired drivers have negatively affected people’s lives

Meanwhile, a conviction of DUI, moving forward, would leave Woods with a fine between $500 and $1,000 and up to six months of possible (though unlikely) jail time. He could lose his license for a period of six months to a year, and his car would be impounded. Woods also plans to plead guilty to reckless driving (a lesser charge) when he returns to court in October, according to news reports from NBC.

What’s next?

We’ll be waiting to see how Woods’ drug use and DUI charges pan out. What happens next may very well shape the way drowsy driving in its various forms—driving while drowsy, drugged driving, driving while impaired, driving under the influence—will be prosecuted in the future.

Review our previous timeline on the Tiger Woods DUI arrest