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Heydari ST, Vossoughi M, Akbarzadeh A, Lankarani KB, Sarikhani Y, Javanmardi K, Akbary A, Akbari M, Mahmoodi M, Shirazi MK, Tabrizi R. Prevalence and risk factors of alcohol and substance abuse among motorcycle drivers in Fars province, Iran. Chin J Traumatol 2016; 19:79-84. [PMID: 27140214 PMCID: PMC4897829 DOI: 10.1016/j.cjtee.2015.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this present study is to investigate the prevalence of alcohol and substance abuse (ASA) and its relationship with other risky driving behaviors among motorcycle drivers. METHODS This is a cross sectional study which is performed at Shiraz city of Iran. Data from motorcycle drivers were collected using a standard questionnaire in eight major streets at different times of the day. The data includes consumption of alcohol and other substances two hours before driving and some of the risky behaviors during driving. RESULTS A total of 414 drivers with a mean ± SD age of (27.0 ± 9.3) years participated in the study. Alcohol or substance consumptions two hours before driving was significantly associated with risky driving behaviors such as using mobile phone during driving, poor maneuvering, and driving over the speed limit (both p < 0.001). It was also associated with carelessness about safety such as driving with technical defects (p < 0.001) and not wearing a crash helmet (p=0.008). CONCLUSION Screening for alcohol and substance consumption among motorcycle drivers is an efficient way to identify drivers that are at a greater risk for road traffic accidents.
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Affiliation(s)
- Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Vossoughi
- Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Akbarzadeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran B. Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Kazem Javanmardi
- Fars Province Police Headquarter Applied Research & Studies Office, Shiraz, Iran
| | - Ali Akbary
- Department of Psychiatry, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Maryam Akbari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author. Tel.: +98 711 2309615.
| | - Mojtaba Mahmoodi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Tabrizi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Karjalainen K, Haukka J, Lintonen T, Joukamaa M, Lillsunde P. The use of psychoactive prescription drugs among DUI suspects. Drug Alcohol Depend 2015; 155:215-21. [PMID: 26282109 DOI: 10.1016/j.drugalcdep.2015.07.1195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/06/2015] [Accepted: 07/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The study seeks to increase understanding of the use of psychoactive prescription drugs among persons suspected of driving under the influence (DUI). We studied whether the use of prescribed psychoactive medication was associated with DUI, and examined the difference in the use of prescription drugs between DUI recidivists and those arrested only once. METHODS In this register-based study, persons suspected of DUI (n=29470) were drawn from the Register of DUI suspects, and an age- and gender-matched reference population (n=30043) was drawn from the Finnish general population. Data on prescription drug use was obtained by linkage to the National Prescription Register. The associations of DUI arrest and use of psychoactive prescription drugs in different DUI groups (findings for alcohol only, prescription drugs, prescription drugs and alcohol, illicit drugs) were estimated by using mixed-effect logistic regression. RESULTS The use of psychoactive prescription drugs and DUI appeared to be strongly associated, with DUI suspects significantly more likely to use psychoactive prescription drugs compared to the reference population. Gender differences existed, with the use of benzodiazepines being more common among female DUI suspects. Moreover, DUI recidivists were more likely to use psychoactive prescription drugs compared to those arrested only once. CONCLUSIONS In addition to alcohol and/or illicit drug use, a significant proportion of DUI suspects were using psychoactive prescription drugs. When prescribing psychoactive medication, especially benzodiazepines, physicians are challenged to screen for possible substance use problems and also to monitor for patients' alcohol or illicit drug use while being medicated.
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Affiliation(s)
| | - Jari Haukka
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Hjelt-Institute, Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014 Helsinki, Finland
| | - Tomi Lintonen
- The Finnish Foundation for Alcohol Studies, P.O. Box 30, FI-00271 Helsinki, Finland; School of Health Sciences, University of Tampere, FI-33014 Tampere, Finland
| | - Matti Joukamaa
- School of Health Sciences, University of Tampere, FI-33014 Tampere, Finland
| | - Pirjo Lillsunde
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
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Hartman RL, Brown TL, Milavetz G, Spurgin A, Pierce RS, Gorelick DA, Gaffney G, Huestis MA. Cannabis effects on driving lateral control with and without alcohol. Drug Alcohol Depend 2015; 154:25-37. [PMID: 26144593 PMCID: PMC4536116 DOI: 10.1016/j.drugalcdep.2015.06.015] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effects of cannabis, the most commonly encountered non-alcohol drug in driving under the influence cases, are heavily debated. We aim to determine how blood Δ(9)-tetrahydrocannabinol (THC) concentrations relate to driving impairment, with and without alcohol. METHODS Current occasional (≥1×/last 3 months, ≤3days/week) cannabis smokers drank placebo or low-dose alcohol, and inhaled 500mg placebo, low (2.9%)-THC, or high (6.7%)-THC vaporized cannabis over 10min ad libitum in separate sessions (within-subject design, 6 conditions). Participants drove (National Advanced Driving Simulator, University of Iowa) simulated drives (∼0.8h duration). Blood, oral fluid (OF), and breath alcohol samples were collected before (0.17h, 0.42h) and after (1.4h, 2.3h) driving that occurred 0.5-1.3h after inhalation. We evaluated standard deviations of lateral position (lane weave, SDLP) and steering angle, lane departures/min, and maximum lateral acceleration. RESULTS In N=18 completers (13 men, ages 21-37years), cannabis and alcohol increased SDLP. Blood THC concentrations of 8.2 and 13.1μg/L during driving increased SDLP similar to 0.05 and 0.08g/210L breath alcohol concentrations, the most common legal alcohol limits. Cannabis-alcohol SDLP effects were additive rather than synergistic, with 5μg/L THC+0.05g/210L alcohol showing similar SDLP to 0.08g/210L alcohol alone. Only alcohol increased lateral acceleration and the less-sensitive lane departures/min parameters. OF effectively documented cannabis exposure, although with greater THC concentration variability than paired blood samples. CONCLUSIONS SDLP was a sensitive cannabis-related lateral control impairment measure. During drive blood THC ≥8.2μg/L increased SDLP similar to notably-impairing alcohol concentrations. Despite OF's screening value, OF variability poses challenges in concentration-based effects interpretation.
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Affiliation(s)
- Rebecca L. Hartman
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, 251 Bayview Boulevard Ste 200 Rm 05A721, Baltimore, MD, USA,Program in Toxicology, University of Maryland Baltimore, 660 West Redwood Street, Baltimore, MD, USA
| | - Timothy L. Brown
- National Advanced Driving Simulator, University of Iowa, 2401 Oakdale Boulevard, Iowa City, IA, USA
| | - Gary Milavetz
- College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Andrew Spurgin
- College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | | | - David A. Gorelick
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, 251 Bayview Boulevard Ste 200 Rm 05A721, Baltimore, MD, USA,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gary Gaffney
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, 251 Bayview Boulevard Ste 200 Rm 05A721, Baltimore, MD, USA
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Christophersen AS, Gjerde H. Prevalence of alcohol and drugs among motorcycle riders killed in road crashes in Norway during 2001-2010. ACCIDENT; ANALYSIS AND PREVENTION 2015; 80:236-242. [PMID: 25932788 DOI: 10.1016/j.aap.2015.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/30/2015] [Accepted: 04/16/2015] [Indexed: 06/04/2023]
Abstract
The aim of the study was to examine the prevalence of alcohol and drugs in blood samples from motorcycle riders who died in road crashes in Norway from 2001 to 2010. An additional aim was to compare the prevalence of alcohol and drugs in blood samples from fatally injured motorcycle riders and car drivers who died during the same time period. Blood samples from motorcycle riders who died within 24h after the accident (n=207, 63% of all killed riders), were analysed for alcohol, psychoactive drugs (medicinal and illicit drugs). The cut-off concentrations for alcohol and drugs findings in blood samples (i.e., the drug concentrations above which a finding was regarded as positive) were set according to the legislative limits under the Norwegian Road Traffic Act. Results were assessed in relation to age, sex, time of the day and week, and single versus multiple-vehicle accidents. Alcohol or drugs were found in 27.1 percent of all investigated riders. For riders killed in single or multiple-vehicle accidents, alcohol or drugs were found in 44.6 and 15.3 percent, respectively. Alcohol was the most frequently found substance for all age groups and most prevalent in samples from riders below 25 years who died in single-vehicle accidents (45.8 percent). Drugs were most often found among riders between 25 and 34 years (19.6 percent in total and 25.9% for those killed in single-vehicle crashes). The prevalence of alcohol or drugs was highest among riders killed in single-vehicle accidents during weekend days and nights (60.9 and 65.2 percent). Alcohol and drugs were less often found in samples from killed motorcycles riders than in samples from car and van drivers (40.2 percent). For single-vehicle accidents, the total prevalence of alcohol or drugs among killed motorcycles riders and car drivers was 44.6 percent and 63.8 percent, respectively. The same pattern of alcohol and drugs was found among the two groups, except that the prevalence among motorcycle riders was lower compared to car drivers in all age groups and time periods, which may be related to the fact that they are more vulnerable for fatal injury compared to car drivers in similar accidents.
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Affiliation(s)
- Asbjørg S Christophersen
- Norwegian Institute of Public Health, Division of Forensic Sciences, P.O. Box 4404, Nydalen 0443 Oslo, Norway.
| | - Hallvard Gjerde
- Norwegian Institute of Public Health, Division of Forensic Sciences, P.O. Box 4404, Nydalen 0443 Oslo, Norway.
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Can a simple clinical test detect impairment of zopiclone and alcohol? – A randomized controlled trial. Forensic Sci Int 2015; 248:129-33. [DOI: 10.1016/j.forsciint.2014.12.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/22/2014] [Accepted: 12/31/2014] [Indexed: 11/21/2022]
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Baldock MRJ, Lindsay VL. Examination of the role of the combination of alcohol and cannabis in South Australian road crashes. TRAFFIC INJURY PREVENTION 2015; 16:443-449. [PMID: 25287700 DOI: 10.1080/15389588.2014.969804] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of the present study was to examine the role of cannabis in road crashes in South Australia, with a particular focus on the extent to which crashes involving cannabis also involve alcohol. METHODS Hospital data, police-reported crash data, and the results of forensic tests of blood samples for drugs and alcohol were collected for 1,074 crash participants (drivers or motorcyclists) admitted to hospital. A sample of 135 coroners' reports was also examined to determine the role of alcohol and cannabis in fatal crashes. RESULTS The 3 years of linked data for hospital admission cases revealed that alcohol played a greater role in road crashes than other drugs. Approximately 1 in 5 drivers or motorcyclists had a blood alcohol concentration (BAC) above the legal limit of 0.05. Routine testing for cannabis, methamphetamine, and MDMA revealed a drug-positive rate of approximately 1 in 10 of those tested, with over half of these positive to cannabis. More than a third of cannabis cases also involved alcohol. The majority of those who were positive for alcohol had a BAC above 0.15 g/100 mL. BACs were similarly high among drivers positive for both alcohol and cannabis. CONCLUSIONS The findings of the hospital data and the coroners' reports were consistent with each other in terms of providing confirmation that alcohol is still the drug associated with the greatest level of road trauma on South Australian roads. Furthermore, alcohol was also present in around half of the cannabis cases and, when present, tended to be present at very high levels. The results of this study emphasize that, although drug driving is clearly a problem, the most important form of impaired driving that needs to be the target of enforcement is drink driving. Roadside drug testing is important but should not be conducted in such a way that reduces the deterrent value of random breath testing.
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Affiliation(s)
- M R J Baldock
- a Centre for Automotive Safety Research , University of Adelaide , South Australia , Australia
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Høiseth G, Middelkoop G, Mørland J, Gjerde H. Has Previous Abuse of Flunitrazepam Been Replaced by Clonazepam? Eur Addict Res 2015; 21:217-21. [PMID: 25895512 DOI: 10.1159/000377628] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS For many years, flunitrazepam was the benzodiazepine of choice among users of illegal drugs. The aim of this study was to investigate to which extent clonazepam use has increased in this population, and whether this was related to increased prescription or because of illegal availability. METHODS We used data from three sources to study the changes in the use of clonazepam: (1) Presence and concentrations of clonazepam and flunitrazepam in blood samples collected from Norwegian drugged drivers; (2) Sales numbers (legal market) for clonazepam, extracted from the Norwegian prescription database (NorPD), and (3) Specific seizures (illegal market) for clonazepam in Norway. RESULTS In 2004, 13.0% of the analysed blood samples from drugged drivers contained clonazepam, whereas this proportion had increased to 27.7% in 2013. In the same period, the frequency of flunitrazepam in drugged drivers decreased from 16.6% in 2004 to 3.2% in 2013. The number of clonazepam prescriptions decreased, while the number of seized tablets containing clonazepam increased considerably from 2004 to 2013. CONCLUSIONS For the last 10 years, a significant increase in the illegal use of clonazepam has been seen, now replacing flunitrazepam as the most used illegal benzodiazepine in Norway.
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Affiliation(s)
- Gudrun Høiseth
- Norwegian Institute of Public Health, Division of Forensic Sciences, Diakonhjemmet Hospital, Oslo, Norway
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Wong K, Brady JE, Li G. Establishing legal limits for driving under the influence of marijuana. Inj Epidemiol 2014; 1:26. [PMID: 27747660 PMCID: PMC5005632 DOI: 10.1186/s40621-014-0026-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/17/2014] [Indexed: 11/27/2022] Open
Abstract
Marijuana has become the most commonly detected non-alcohol substance among drivers in the United States and Europe. Use of marijuana has been shown to impair driving performance and increase crash risk. Due to the lack of standardization in assessing marijuana-induced impairment and limitations of zero tolerance legislation, more jurisdictions are adopting per se laws by specifying a legal limit of Δ9-tetrahydrocannabinol (THC) at or above which drivers are prosecuted for driving under the influence of marijuana. This review examines major considerations when developing these threshold THC concentrations and specifics of legal THC limits for drivers adopted by different jurisdictions in the United States and other countries.
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Affiliation(s)
- Kristin Wong
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, 10032 NY USA
| | - Joanne E Brady
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, 10032 NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, 10032 NY USA
| | - Guohua Li
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, 10032 NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, 10032 NY USA
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 722 West 168th Street, Room 524, New York, 10032 NY USA
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Høiseth G, Andås H, Bachs L, Mørland J. Impairment due to amphetamines and benzodiazepines, alone and in combination. Drug Alcohol Depend 2014; 145:174-9. [PMID: 25456327 DOI: 10.1016/j.drugalcdep.2014.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/08/2014] [Accepted: 10/15/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The impairing effects of combined use of amphetamines and benzodiazepines among recreational drug users are not well described, but knowledge about this is important in the risk assessment of such combined drug use. The aim of this study was to compare the impairment, among apprehended drivers, as judged by a clinical test of impairment (CTI), in cases where a combination of amphetamines and benzodiazepines was detected, in blood, with cases where only one of the two drug groups was detected. METHODS The results of CTI judgments were compared to toxicological drug tests of blood samples that were obtained at the time of CTI screening in cases containing amphetamines only, cases containing different benzodiazepines only, and cases containing a combination of amphetamines and benzodiazepines. RESULTS There were significantly more drivers being judged as impaired in the combined group (n = 777), compared both with amphetamines alone (n = 267, χ(2) = 47.8, p < 0.001) and benzodiazepines alone (n = 153, χ(2) = 7.0, p = 0.008). This was also seen when only including the lowest concentrations of benzodiazepines (χ(2) = 4.3, p = 0.038). The concentrations of the drugs were higher in the single drug groups, compared with the combined group. CONCLUSION This study indicates that during real-life driving, those influenced by both amphetamines and benzodiazepines are more impaired, as judged by the CTI, compared with those influenced by either drug alone, although the combined group showed lower drug concentrations.
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Affiliation(s)
- Gudrun Høiseth
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
| | - Hilde Andås
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway
| | - Liliana Bachs
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway
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Aguilera SLVU, Sripad P, Lunnen JC, Moyses ST, Chandran A, Moysés SJ. Alcohol consumption among drivers in Curitiba, Brazil. TRAFFIC INJURY PREVENTION 2014; 16:219-224. [PMID: 24983644 DOI: 10.1080/15389588.2014.935939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/13/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The combination of drinking and driving is globally understood as a risk factor for road traffic crashes and disastrous outcomes such as injury and disability or death. However, the magnitude of the problem may not always be known in many countries, particularly where there are legislative loopholes. In Brazil, until December 2012, verification by breathalyzer of drinking and driving was dependent on drivers' acceptance of the tests after being stopped by the police. OBJECTIVE To describe the epidemiological profile of drinking and driving behaviors of a sample of drivers from Curitiba, Brazil, and explore the sociodemographic characteristics of those interviewed at police sobriety checkpoints. METHODS Drivers were selected and interviewed at police checkpoints on public roads in Curitiba. The local police, after informed consent, applied breathalyzer tests to check the drivers' blood alcohol content and the results were compared with data previously collected through interviews containing self-reports of drinking and driving. Data were collected between March and November 2012. RESULTS Of the 511 drivers asked to participate in the study, 398 (77.9%) agreed to give a roadside interview. Most respondents were single men between the ages of 18 and 29 years, with 8.3% of interviewed drivers self-reporting alcohol consumption in the last 6 h before driving. On the other hand, only 46.2% of the whole sample accepted the breathalyzer testing. Among those breathalyzed by the police, 2.7% tested positive for alcohol. DISCUSSION This study, conducted on public roads in Curitiba, shows a noticeable proportion of drivers voluntarily self-reporting drinking and driving. However, a smaller percentage was confirmed to have positive blood alcohol content, likely due to the high breathalyzer refusal rate.
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Wilson FA, Stimpson JP, Pagán JA. Fatal crashes from drivers testing positive for drugs in the U.S., 1993-2010. Public Health Rep 2014; 129:342-50. [PMID: 24982537 DOI: 10.1177/003335491412900409] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Illegal drug use is a persistent problem, prescription drug abuse is on the rise, and there is clinical evidence that drug use reduces driving performance. This study describes trends in characteristics of drivers involved in fatal motor vehicle crashes who test positive for drugs. METHODS We used the Fatality Analysis Reporting System-a census of motor vehicle crashes resulting in at least one fatality on U.S. public roads-to investigate suspected drug use for the period 1993-2010. RESULTS Drugged drivers who were tested for drug use accounted for 11.4% of all drivers involved in fatal motor vehicle crashes in 2010. Drugged drivers are increasingly likely to be older drivers, and the percentage using multiple drugs increased from 32.6% in 1993 to 45.8% in 2010. About half (52.4%) of all drugged drivers used alcohol, but nearly three-quarters of drivers testing positive for cocaine also used alcohol. Prescription drugs accounted for the highest fraction of drugs used by drugged drivers in fatal crashes in 2010 (46.5%), with much of the increase in prevalence occurring since the mid-2000s. CONCLUSIONS The profile of a drugged driver has changed substantially over time. An increasing share of these drivers is now testing positive for prescription drugs, cannabis, and multiple drugs. These findings have implications for developing interventions to address the changing nature of drug use among drivers in the U.S.
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Affiliation(s)
- Fernando A Wilson
- University of Nebraska Medical Center, Department of Health Services Research and Administration, Omaha, NE
| | - Jim P Stimpson
- University of Nebraska Medical Center, Department of Health Services Research and Administration, Omaha, NE
| | - José A Pagán
- New York Academy of Medicine, Center for Health Innovation, New York, NY
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Mehmandar M, Soori H, Amiri M, Norouzirad R, Khabzkhoob M. Risk factors for fatal and nonfatal road crashes in iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e10016. [PMID: 25389468 PMCID: PMC4221994 DOI: 10.5812/ircmj.10016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 10/21/2013] [Accepted: 07/15/2014] [Indexed: 11/16/2022]
Abstract
Background: Road traffic injuries are among the leading causes of death in the world and Iran. Objectives: The aim of this study was to assess the role of age, sex, education, and time of accident on human casualties and mortalities of road crashes in Iran. Materials and Methods: This study was based on data gathered by Iranian Police Department from the records of road crashes from April 4, 2008 through April 4, 2009. Road crashes are categorized into three types: with no human casualties, with injuries, and with human mortalities. Results: The largest rate of human causalities was observed in people aged between 25 to 34 years (P < 0.001). Illiterate people had 81% smaller odds of causality in road crashes (P < 0.001) in comparison with those with a kind of academic education. Overall, 73.4% of crashes had happened during the last ten days of a month were with human casualties (P < 0.001) and human casualties rate was slightly higher in crashes happened between 1 AM to 5 AM Fatality rate was slightly higher in the females (OR = 2.6, P = 0.068). The smallest odds of fatality were found in the people aged between 18 to 24 years and the highest odds were seen in people ≥ 55 years of age (P < 0.001). In people with a university education, 61.9% of crashes were with fatality (P = 0.026). In addition, 82.8% of crashes during winter, 60.2% of crashes during autumn, and 35.8% of crashes during summer were with mortalities. Overall, 78.3% of crashes with human casualties that had happened during 1 AM to 5 AM led to mortalities. There was also a significant association between injury and its intensity with fastening seatbelts. Conclusions: Older age, university degrees, female sex, wintertime, and the time of accident seem to be the most important risk factors in road crashes that lead to fatalities in Iran. Drivers in Iran should be informed and trained regarding these risk factors, which have direct effect on casualties and mortalities in road crashes.
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Affiliation(s)
| | - Hamid Soori
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University, Tehran, IR Iran
| | - Mosa Amiri
- NAJA Research Center of Traffic Police of Iran, Tehran, IR Iran
| | - Reza Norouzirad
- Biochemistry Department, Faculty of Medicine, Dezful University of Medical Sciences, Dezful, IR Iran
| | - Mehdi Khabzkhoob
- Department of Epidemiology, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Mehdi Khabzkhoob, Department of Epidemiology, Faculty of health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2182401615, E-mail:
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Poulsen H, Moar R, Pirie R. The culpability of drivers killed in New Zealand road crashes and their use of alcohol and other drugs. ACCIDENT; ANALYSIS AND PREVENTION 2014; 67:119-128. [PMID: 24636874 DOI: 10.1016/j.aap.2014.02.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/23/2014] [Accepted: 02/24/2014] [Indexed: 06/03/2023]
Abstract
Over a period of five years, blood samples were taken from 1046 drivers killed as a result of a motor vehicle crash on New Zealand roads. These were analysed for the presence of alcohol and a range of both illicit drugs and psychoactive medicinal drugs. Driver culpability was determined for all crashes. The control group of drug- and alcohol-free drivers comprised 52.2% of the study population. Drivers positive for psychoactive drugs were more likely to be culpable (odds ratio (OR) 3.5, confidence interval (CI) 95% 2.4-5.2) than the control group. Driver culpability exhibited the expected positive association with alcohol use (OR 13.7, 95% CI 4.3-44) and with combined alcohol and cannabis use (OR 6.9, 95% CI 3.0-16). There was only a weak positive association between cannabis use (with no other drug) and culpability (OR 1.3, CI 95% 0.8-2.3). Furthermore, the OR for drivers with blood tetrahydrocannabinol (THC) concentrations greater than 5 ng/mL was lower (OR 1.0, CI 95% 0.4-2.4) than drivers with blood THC concentrations less than 2 ng/mL (OR 3.1, CI 95% 0.9-10). This is inconsistent with results reported by other studies where a significant increase in crash risk was found with blood THC levels greater than 5 ng/mL. In this study, there were very few drivers who had used a single drug, other than cannabis or alcohol. Therefore, from this study, it is not possible to comment on any relationship between opioid, stimulant or sedative drug use and an increased risk of being killed in a crash for the drivers using these drugs. The results from a multivariate analysis indicate that driver gender, age group and licence status, (P=0.022, P=0.016, P=0.026, respectively), the type of vehicle being driven (P=0.013), the number of vehicles in the crash (P<0.001), the blood alcohol concentration of the driver (P<0.001) and the use of any drug other than alcohol and cannabis (P=0.044), are all independently associated with culpability.
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Affiliation(s)
- Helen Poulsen
- Environmental Science and Research, Porirua, New Zealand.
| | - Rosemary Moar
- Environmental Science and Research, Porirua, New Zealand
| | - Ruth Pirie
- Environmental Science and Research, Porirua, New Zealand
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Brady JE, Li G. Trends in alcohol and other drugs detected in fatally injured drivers in the United States, 1999-2010. Am J Epidemiol 2014; 179:692-9. [PMID: 24477748 PMCID: PMC3939850 DOI: 10.1093/aje/kwt327] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 12/04/2013] [Indexed: 11/14/2022] Open
Abstract
Drugged driving is a safety issue of increasing public concern. Using data from the Fatality Analysis Reporting System for 1999-2010, we assessed trends in alcohol and other drugs detected in drivers who were killed within 1 hour of a motor vehicle crash in 6 US states (California, Hawaii, Illinois, New Hampshire, Rhode Island, and West Virginia) that routinely performed toxicological testing on drivers involved in such crashes. Of the 23,591 drivers studied, 39.7% tested positive for alcohol and 24.8% for other drugs. During the study period, the prevalence of positive results for nonalcohol drugs rose from 16.6% in 1999 to 28.3% in 2010 (Z = -10.19, P < 0.0001), whereas the prevalence of positive results for alcohol remained stable. The most commonly detected nonalcohol drug was cannabinol, the prevalence of which increased from 4.2% in 1999 to 12.2% in 2010 (Z = -13.63, P < 0.0001). The increase in the prevalence of nonalcohol drugs was observed in all age groups and both sexes. These results indicate that nonalcohol drugs, particularly marijuana, are increasingly detected in fatally injured drivers.
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Affiliation(s)
| | - Guohua Li
- Correspondence to Dr. Guohua Li, Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 722 West 168th Street, Room 524, New York, NY 10032 (e-mail: )
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Møller M, Haustein S. Peer influence on speeding behaviour among male drivers aged 18 and 28. ACCIDENT; ANALYSIS AND PREVENTION 2014; 64:92-99. [PMID: 24355559 DOI: 10.1016/j.aap.2013.11.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/14/2013] [Accepted: 11/18/2013] [Indexed: 06/03/2023]
Abstract
Despite extensive research, preventive efforts and general improvements in road safety levels, the accident risk of young male drivers remains increased. Based on a standardized survey of a random sample of 2018 male drivers at the age of 18 and 28, this study looked into attitudes and behaviours related to traffic violations of male drivers. More specifically, the role of peer influence on speeding was examined in both age groups. In regression analyses it could be shown that the descriptive subjective norm, i.e., the perception of friends' speeding, was the most important predictor of speeding in both age groups. Other significant factors were: negative attitude towards speed limits, injunctive subjective norm, and the perceived risk of having an accident when speeding. In the older age group it was more common to drive faster than allowed and their speeding was largely in line with the perceived level of their friends' speeding. In the younger age group a higher discrepancy between own and friends' speeding was found indicating that young male drivers are socialized into increased speeding behaviour based on peer pressure. By contrast for the 28-year-olds peer pressure mainly seems to maintain or justify individual speeding behaviour. It is suggested that preventive measures should take these different influences of peer pressure into account by using a peer-based approach for the 18-year-olds and a more individual approach for the 28-year-olds.
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Affiliation(s)
- Mette Møller
- Technical University of Denmark (DTU), Department of Transport, Bygningstorvet 116B, DK-2800 Kgs. Lyngby, Denmark.
| | - Sonja Haustein
- Technical University of Denmark (DTU), Department of Transport, Bygningstorvet 116B, DK-2800 Kgs. Lyngby, Denmark
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De Boni RB, Bastos FI, de Vasconcellos M, Oliveira F, Limberger RP, Pechansky F. Drug use among drivers who drank on alcohol outlets from Porto Alegre, Brazil. ACCIDENT; ANALYSIS AND PREVENTION 2014; 62:137-142. [PMID: 24148905 DOI: 10.1016/j.aap.2013.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 08/31/2013] [Accepted: 09/23/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Driving under the influence of multiple substances is a public health concern, but there is little epidemiological data about their combined use and putative impact on driving in low and middle-income countries where traffic crashes have been clustering in recent years. The aim of this study is to estimate the prevalence of alcohol and drug use - as well as their associated factors - among drivers in the context of alcohol outlets (AOs). METHODS A probability three-stage sample survey was conducted in Porto Alegre, Brazil. Individuals who were leaving AO were screened, with the selection of 683 drivers who met the inclusion criteria. Drivers answered a structured interview, were breathalyzed, and had their saliva collected for drug screening. Prevalences were assessed using domain estimation and logistic regression models assessed covariates associated with substance use. FINDINGS Benzodiazepines 3.9% (SE 2.13) and cocaine 3.8% (SE 1.3) were the most frequently detected drugs in saliva. Among drivers who were going to drive, 11% had at least one drug identified by the saliva drug screening, 0.4% two, and 0.1% three drugs in addition to alcohol. In multivariable analyses, having a blood alcohol concentration (BAC)>0.06% was found to be associated with a 3.64 times (CI 95% 1.79-7.39) higher chance of drug detection, compared with interviewees with lower BACs. CONCLUSIONS To drive under the influence of multiple substances is likely to be found in this setting, highlighting an association between harmful patterns of consume of alcohol and the misuse of other substances.
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Affiliation(s)
- Raquel B De Boni
- Department of Health Information, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Gjerde H, Bogstrand ST, Lillsunde P. Commentary: why is the odds ratio for involvement in serious road traffic accident among drunk drivers in Norway and Finland higher than in other countries? TRAFFIC INJURY PREVENTION 2014; 15:1-5. [PMID: 24279959 DOI: 10.1080/15389588.2013.780651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Recent Norwegian and Finnish studies have found high odds ratios for serious or fatal injury in road traffic accidents among drivers after drinking alcohol. In this report we have compared the odds ratios with results from studies in other countries. METHODS A literature review was conducted. RESULTS The odds ratios were significantly higher than in countries where drunk driving is more common. CONCLUSION The calculated odds ratios are not only related to alcohol use or blood alcohol concentration per se but also related to the study design-for example, the inclusion of nonculpable drivers among cases-and confounding factors not included in statistical analysis; for example, risk-taking behavior. Those two issues may contribute to explaining why the reported odds ratios are higher for Norway and Finland.
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Christophersen AS, Gjerde H. Prevalence of alcohol and drugs among car and van drivers killed in road accidents in Norway: an overview from 2001 to 2010. TRAFFIC INJURY PREVENTION 2014; 15:523-531. [PMID: 24867563 DOI: 10.1080/15389588.2013.848981] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To examine the prevalence of alcohol and drugs in blood samples collected from car and van drivers killed in traffic accidents in Norway during the time period from 2001 to 2010. METHODS Blood samples (n = 676, 63% of all killed drivers) were analyzed for alcohol, psychoactive medications, and illicit drugs. The cutoff limits for positive results were set according to the new legislative limits under the Norwegian Road Traffic Act. The results were assessed in relation to sex and age, time of day and day of week, and single- versus multiple-vehicle and all investigated vehicle accidents. RESULTS Alcohol or one or more drugs was detected in samples from 40.2 percent of all investigated drivers, with 28.7 percent showing blood concentrations of at least 5 times the legislative limits. For the investigated female drivers, the total prevalence was 24.0 percent. Among the single-vehicle accidents, alcohol or drugs was found in 63.8 percent of the cases, with 49.1 percent showing blood concentrations of at least 5 times the legislative limits. Alcohol was detected in 25.3 and 49.1 percent of samples from all investigated drivers and among drivers killed in single-vehicle accidents, respectively. Psychoactive medications were found in 14.4 and 17.7 percent and illicit drugs in 14.1 and 19.2 percent, respectively. The most commonly detected group of medications was benzodiazepines, and amphetamines and tetrahydrocannabinol were the most commonly detected illicit drugs. The prevalence of alcohol alone was highest among drivers under the age of 25, and the combination of alcohol with other drugs was highest among drivers under the age of 35. Drivers between the ages of 25 and 54 showed the highest prevalence of medications and/or illicit drugs without the presence of alcohol. The highest prevalence of alcohol or drugs was found among drivers killed in single-vehicle accidents on weeknights (83.8%) and on weekend nights (89.3%). CONCLUSIONS The findings confirm that a large number of fatally injured drivers, in particular among drivers involved in single-vehicle accidents, had concentrations of alcohol or drugs above the new legislative limits introduced in 2012. In many cases, concentrations of at least 5 times the limits were found. The proportion of drivers killed who tested positive for alcohol or other drugs did not change during the study period; however, the total number of drivers killed per year decreased by about 20 percent. Some changes were also observed with regard to the types of benzodiazepines and amphetamines detected during the 10-year period.
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Ahlner J, Holmgren A, Jones AW. Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden. Scand J Public Health 2013; 42:177-83. [PMID: 24265165 DOI: 10.1177/1403494813510792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drunk or drug-impaired drivers represent a major public health and societal problem worldwide. Because over 95% of drivers killed on the roads in Sweden are autopsied, reliable information is available about the use of alcohol and/or other drug before the crash. METHODS This retrospective 4-year study (2008-2011) used a forensic toxicology database (TOXBASE) to evaluate the concentrations of alcohol and other drugs in blood samples from drivers killed in road-traffic crashes. RESULTS The mean age of all victims (N = 895) was 48 ± 20 years, and the majority were male (86%). In 504 drivers (56%), the results of toxicological analysis were negative and these victims were older; mean age (± SD) 47 ± 20 years, than alcohol positive cases (35 ± 14 years) and illicit drug users (34 ± 15 years). In 21% of fatalities, blood-alcohol concentration (BAC) was above the statutory limit for driving (0.2 g/L), although the median BAC was appreciably higher (1.72 g/L). Illicit drugs (mainly amphetamine and cannabis) were identified in ~7% of victims, either alone (2.5%), together with alcohol (1.8%) or a prescription drug (2%). The psychoactive prescription drugs identified were mainly benzodiazepines, z-hypnotics and tramadol, which were found in the blood of 7.6% of crash victims. CONCLUSIONS The high median BAC in fatally-injured drivers speaks strongly towards alcohol-induced impairment as being responsible for the crash. Compared with alcohol, the prevalence of illicit and psychoactive prescription drugs was fairly low despite a dramatic increase in the number of drug-impaired drivers arrested by the police after a zero-tolerance law was introduced in 1999.
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Affiliation(s)
- Johan Ahlner
- 1Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Sweden
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Li G, Brady JE, Chen Q. Drug use and fatal motor vehicle crashes: a case-control study. ACCIDENT; ANALYSIS AND PREVENTION 2013; 60:205-210. [PMID: 24076302 DOI: 10.1016/j.aap.2013.09.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/20/2013] [Accepted: 09/01/2013] [Indexed: 06/02/2023]
Abstract
Drugged driving is a serious safety concern, but its role in motor vehicle crashes has not been adequately studied. Using a case-control design, the authors assessed the association between drug use and fatal crash risk. Cases (n=737) were drivers who were involved in fatal motor vehicle crashes in the continental United States during specific time periods in 2007, and controls (n=7719) were participants of the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers. Overall, 31.9% of the cases and 13.7% of the controls tested positive for at least one non-alcohol drug. The estimated odds ratios of fatal crash involvement associated with specific drug categories were 1.83 [95% confidence interval (CI): 1.39, 2.39] for marijuana, 3.03 (95% CI: 2.00, 4.48) for narcotics, 3.57 (95% CI: 2.63, 4.76) for stimulants, and 4.83 (95% CI: 3.18, 7.21) for depressants. Drivers who tested positive for both alcohol and drugs were at substantially heightened risk relative to those using neither alcohol nor drugs (Odds Ratio=23.24; 95% CI: 17.79, 30.28). These results indicate that drug use is associated with a significantly increased risk of fatal crash involvement, particularly when used in combination with alcohol.
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Affiliation(s)
- Guohua Li
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, USA; Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, New York, NY, USA.
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Elvik R. Risk of road accident associated with the use of drugs: a systematic review and meta-analysis of evidence from epidemiological studies. ACCIDENT; ANALYSIS AND PREVENTION 2013; 60:254-267. [PMID: 22785089 DOI: 10.1016/j.aap.2012.06.017] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 06/03/2012] [Accepted: 06/15/2012] [Indexed: 06/01/2023]
Abstract
This paper is a corrigendum to a previously published paper where errors were detected. The errors have been corrected in this paper. The paper is otherwise identical to the previously published paper. A systematic review and meta-analysis of studies that have assessed the risk of accident associated with the use of drugs when driving is presented. The meta-analysis included 66 studies containing a total of 264 estimates of the effects on accident risk of using illicit or prescribed drugs when driving. Summary estimates of the odds ratio of accident involvement are presented for amphetamines, analgesics, anti-asthmatics, anti-depressives, anti-histamines, benzodiazepines, cannabis, cocaine, opiates, penicillin and zopiclone (a sleeping pill). For most of the drugs, small or moderate increases in accident risk associated with the use of the drugs were found. Information about whether the drugs were actually used while driving and about the doses used was often imprecise. Most studies that have evaluated the presence of a dose-response relationship between the dose of drugs taken and the effects on accident risk confirm the existence of a dose-response relationship. Use of drugs while driving tends to have a larger effect on the risk of fatal and serious injury accidents than on the risk of less serious accidents (usually property-damage-only accidents). The quality of the studies that have assessed risk varied greatly. There was a tendency for the estimated effects of drug use on accident risk to be smaller in well-controlled studies than in poorly controlled studies. Evidence of publication bias was found for some drugs. The associations found cannot be interpreted as causal relationships, principally because most studies do not control very well for potentially confounding factors.
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Affiliation(s)
- Rune Elvik
- Institute of Transport Economics, Gaustadalléen 21, NO-0349 Oslo, Norway; Aalborg University, Department of Development and Planning, Fibigerstræde 13, DK-9220 Aalborg Ø, Denmark.
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Bukten A, Herskedal A, Skurtveit S, Bramness JG, Clausen T. Driving under the influence (DUI) among patients in opioid maintenance treatment (OMT): a registry-based national cohort study. Addiction 2013; 108:1954-61. [PMID: 23773400 DOI: 10.1111/add.12275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/16/2013] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
AIMS To investigate convictions for driving under the influence (DUI) before, during and after opioid maintenance treatment (OMT) and to examine factors associated with convictions for DUI during treatment. DESIGN, SETTING AND PARTICIPANTS Treatment data on all patients who started OMT in Norway between 1997 and 2003 (n = 3221) were cross-linked with national criminal records using unique person identifiers. Patients were followed over a 9-year period, before, during and in periods out of opioid maintenance treatment. MEASUREMENTS Data were formal charges leading to convictions recorded during four different time-periods: 3 years prior to application, waiting-list, in-treatment and in periods out of treatment. FINDINGS During OMT, convictions for DUI were reduced by almost 40% compared with pre-application levels. The conviction rate for DUI for males in the pre-application period was 9.59 per 100 person-years (PY) and for females, 3.44 per 100 PY. During OMT, rates of DUI convictions were reduced to 5.97 per 100 PY among men and to 1.09 per 100 PY among women. However, when estimating the effect of OMT on convictions for DUI, the interaction between gender and exposure to OMT was not statistically significant. Patients who remained in continuous treatment had fewer convictions for DUI during treatment compared with patients in discontinuous treatment. Compared with patients having no road traffic convictions during the pre-application period, patients with two or more pre-application convictions for DUI had higher odds [odds ratio (OR) = 3.69 (2.30-5.93)] for further convictions for DUI during OMT. CONCLUSION In Norway, patients receiving opioid maintenance treatment (OMT) have reduced convictions for driving under the influence (DUI) compared with their pre-treatment levels. Being male and having a previous history of several convictions for DUI were found to be important risk factors for convictions for DUI during OMT.
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Affiliation(s)
- Anne Bukten
- SERAF-Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
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Acar F, Asirdizer M, Aker RG, Kucukibrahimoglu EE, Ates I, Erol Y, Sahin A. A review of suspected cases of driving under the influence of drugs (DUID) involved in traffic accidents in Istanbul (Turkey). J Forensic Leg Med 2013; 20:626-31. [DOI: 10.1016/j.jflm.2013.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/09/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
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Monárrez-Espino J, Möller J, Berg HY, Kalani M, Laflamme L. Analgesics and road traffic crashes in senior drivers: an epidemiological review and explorative meta-analysis on opioids. ACCIDENT; ANALYSIS AND PREVENTION 2013; 57:157-164. [PMID: 23685567 DOI: 10.1016/j.aap.2013.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/03/2013] [Accepted: 04/10/2013] [Indexed: 06/02/2023]
Abstract
AIM To assess the epidemiological evidence associating the use of analgesics with the occurrence of road traffic crashes in senior drivers including a meta-analysis with specific focus on opioids. METHODS Systematic literature review of articles published between 1991 and 2012 retrieved from major databases using relevant key words. Eligible articles were fully reviewed and the main characteristics and results summarized. The methodological quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity tests and forest and funnel plots were used as part of the meta-analysis on opioids. RESULTS From the potentially eligible articles, nine were selected (4 case-control, 1 case-crossover, and 4 cohort studies) of which four were of medium and five of high quality; seven investigated opioids and four non-steroidal anti-inflammatory drugs. Crash involvement (n=7) rather than responsibility (n=2) was investigated. Age and sex were the most common covariates adjusted for. Both opioids and non-steroidal anti-inflammatory drugs showed mixed results including differences across estimates between and within studies. A marginal positive effect was observed in the pooled analyses on opioids (n=6, OR 1.20; 95% CI 1.08-1.32). CONCLUSIONS The evidence is unconvincing in terms of number of studies, control of major confounders, and consistency of the results. The effect seen for opioids can be attributed to the lack of adjustment of key confounders such as concomitant illness or the consumption of alcohol or other psychoactive medications. There is a need for more efficient designs like larger population-based retrospective cohorts and nested case-control or case-crossover studies based on registers of high quality allowing adjustment for these factors and for the selection of unequivocal outcomes (e.g. drivers' responsibility) to produce more persuasive empirical evidence.
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Affiliation(s)
- Joel Monárrez-Espino
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Widerströmska huset, 17177 Stockholm, Sweden.
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Zolpidem Use and the Risk of Injury: A Population-Based Follow-Up Study. PLoS One 2013; 8:e67459. [PMID: 23826304 PMCID: PMC3694900 DOI: 10.1371/journal.pone.0067459] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/17/2013] [Indexed: 11/20/2022] Open
Abstract
Background While an association between zolpidem use and fracture and road accident was previously proposed, this study aimed to further explore the frequency and risk of a wide spectrum of injuries in subjects prescribed with zolpidem in Taiwan. Methods We identified 77,036 subjects who received Zolpidem treatment between 2005 and 2007. We randomly selected 77,036 comparison subjects who were frequency-matched based-on their demographic profiles. We individually tracked each subject for a 90-day period to identify those who subsequently suffered an injury. Cox proportional hazards regressions were performed to calculate the hazard ratio of injury between the two groups. Results The incidence rate of injury during the 90-day follow-up period for the total subjects was 18.11 (95% CI = 17.69–18.54) per 100 person-years; this was 24.35 (95% CI = 23.66–25.05) and 11.86 (95% CI = 11.39–12.36) for the study and comparison cohort, respectively. After adjusting for demographic variables, the hazard ratio (HR) of injury during the 90-day follow-up period for study subjects was 1.83 (95% CI = 1.73–1.94) that of comparison subjects. Additionally, compared to comparison subjects, the adjusted HR of injury during the 90-day follow-up period for study subjects who were prescribed Zolpidem for >30 days was as high as 2.17 (95% CI = 2.05–2.32). The adjusted HR of injury to blood vessels for study subjects was particularly high when compared to comparison subjects (HR = 6.34; 95% CI = 1.37–29.38). Conclusions We found that patients prescribed with Zolpidem were at a higher risk for a wide range of injuries.
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Callaghan RC, Gatley JM, Veldhuizen S, Lev-Ran S, Mann R, Asbridge M. Alcohol- or drug-use disorders and motor vehicle accident mortality: a retrospective cohort study. ACCIDENT; ANALYSIS AND PREVENTION 2013; 53:149-155. [PMID: 23434842 DOI: 10.1016/j.aap.2013.01.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/03/2012] [Accepted: 01/17/2013] [Indexed: 06/01/2023]
Abstract
A large body of research has linked alcohol consumption and motor vehicle accidents (MVAs), but far fewer studies have estimated the risk of MVA fatality among drug users. Our study addresses this gap. We identified cohorts of individuals hospitalized in California from 1990 to 2005 with ICD-9 diagnoses of methamphetamine- (n=74,170), alcohol- (n=592,406), opioids- (n=68,066), cannabis- (n=47,048), cocaine- (n=48,949), or polydrug-related disorders (n=411,175), and these groups were followed for up to 16 years. Age-, sex-, and race-adjusted standardized mortality rates (SMRs) for deaths due to MVAs were generated in relation to the California general population. Standardized MVA mortality ratios were elevated across all drug cohorts: alcohol (4.5, 95% CI, 4.1-4.9), cocaine (3.8, 95% CI, 2.3-5.3), opioids (2.8, 95% CI, 2.1-3.5), methamphetamine (2.6, 95% CI, 2-3.1), cannabis (2.3, 95% CI, 1.5-3.2) and polydrug (2.6, 95% CI, 2.4-2.9). Males and females had similar MVA SMRs. Our large, population-based study found elevated risk of MVA mortality across all cohorts of individuals with alcohol- or drug-use disorders. Given that illicit drug users are often unaware of or misperceive the impacts of drug use on safe driving, it may be important for health-service or public-health interventions to address such biases and improve road safety.
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Affiliation(s)
- Russell C Callaghan
- Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, Canada.
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Abstract
BACKGROUND Cannabis is the most prevalent illicit drug identified in impaired drivers. The effects of cannabis on driving continue to be debated, making prosecution and legislation difficult. Historically, delays in sample collection, evaluating the inactive Δ(9)-tetrahydrocannabinol (THC) metabolite 11-nor-9-carboxy-THC, and polydrug use have complicated epidemiologic evaluations of driver impairment after cannabis use. CONTENT We review and evaluate the current literature on cannabis' effects on driving, highlighting the epidemiologic and experimental data. Epidemiologic data show that the risk of involvement in a motor vehicle accident (MVA) increases approximately 2-fold after cannabis smoking. The adjusted risk of driver culpability also increases substantially, particularly with increased blood THC concentrations. Studies that have used urine as the biological matrix have not shown an association between cannabis and crash risk. Experimental data show that drivers attempt to compensate by driving more slowly after smoking cannabis, but control deteriorates with increasing task complexity. Cannabis smoking increases lane weaving and impaired cognitive function. Critical-tracking tests, reaction times, divided-attention tasks, and lane-position variability all show cannabis-induced impairment. Despite purported tolerance in frequent smokers, complex tasks still show impairment. Combining cannabis with alcohol enhances impairment, especially lane weaving. SUMMARY Differences in study designs frequently account for inconsistencies in results between studies. Participant-selection bias and confounding factors attenuate ostensible cannabis effects, but the association with MVA often retains significance. Evidence suggests recent smoking and/or blood THC concentrations 2-5 ng/mL are associated with substantial driving impairment, particularly in occasional smokers. Future cannabis-and-driving research should emphasize challenging tasks, such as divided attention, and include occasional and chronic daily cannabis smokers.
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Affiliation(s)
- Rebecca L. Hartman
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
- Program in Toxicology, Graduate Program in Life Sciences, University of Maryland Baltimore, Baltimore, MD
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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78
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Legrand SA, Gjerde H, Isalberti C, Van der Linden T, Lillsunde P, Dias MJ, Gustafsson S, Ceder G, Verstraete AG. Prevalence of alcohol, illicit drugs and psychoactive medicines in killed drivers in four European countries. Int J Inj Contr Saf Promot 2013; 21:17-28. [DOI: 10.1080/17457300.2012.748809] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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79
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El-Bakary AAES. Oral Fluids and Teeth in Toxicology. EVIDENCE-BASED FORENSIC DENTISTRY 2013:189-199. [DOI: 10.1007/978-3-642-28994-1_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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80
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Institóris L, Tóth AR, Molnár A, Árok Z, Kereszty É, Varga T. The frequency of alcohol, illicit and licit drug consumption in the general driving population in South-East Hungary. Forensic Sci Int 2013; 224:37-43. [DOI: 10.1016/j.forsciint.2012.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 10/08/2012] [Accepted: 10/11/2012] [Indexed: 11/27/2022]
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81
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Gjerde H, Christophersen AS, Normann PT, Assum T, Oiestad EL, Mørland J. Norwegian roadside survey of alcohol and drug use by drivers (2008-2009). TRAFFIC INJURY PREVENTION 2013; 14:443-452. [PMID: 23697895 DOI: 10.1080/15389588.2012.728016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine alcohol and drug use among random drivers in different regions of Norway by analyzing oral fluid, compare drivers in urban and rural areas, compare with results from the roadside survey in southeastern Norway in 2005-2006, and roughly estimate the prevalence of driving with blood drug concentrations above the new Norwegian legislative limits among random drivers. This roadside survey was part of the European DRUID (Driving Under the Influence of Drugs, Alcohol and Medicines) Project. METHODS Drivers were selected for a voluntary and anonymous study using a stratified multistage cluster sampling procedure in collaboration with the Mobile Police Service. Samples of oral fluid were taken using the Statsure Saliva Sample (Statsure Diagnostic Systems, Framingham, MA), and the drivers' gender, age, and nationality were recorded. Samples of oral fluid were analyzed for alcohol or drugs, for a total 28 psychoactive substances. RESULTS One hundred eighty-four roadside survey sessions were conducted and 10,004 drivers were asked to participate. The refusal rate was 5.8 percent. Psychoactive substances were found in 4.8 percent of the 9410 oral fluid samples analyzed. Alcohol was detected in 0.3 percent, medicinal drugs in 3.2 percent, and illegal drugs in 1.5 percent of the samples. Illegal drugs were significantly more frequently detected in samples from southeastern Norway including the capital Oslo, whereas medicinal drugs were more frequently detected in samples from southeastern Norway excluding Oslo. Illegal drugs were significantly more frequently detected in samples from drivers in urban areas than in rural areas, though there were no significant differences for alcohol and medicinal drugs. Medicinal drugs were most commonly found in samples collected during the daytime on weekdays (3.8%), and illegal drugs were most commonly found in samples collected during late night on weekdays or weekends (2.8%-3.2%). The most commonly found substances were the sleeping agent zopiclone (1.4%), the main active substance in cannabis tetrahydrocannabinol (1.1%), and the sedative drug diazepam (0.7%). The prevalence of driving with drug concentrations above the Norwegian legislative limits for blood was estimated to be about 0.2 percent for alcohol, 0.6 percent for illegal drugs, and about 1.3 percent for medicinal drugs. CONCLUSIONS The incidence of drink driving was very low, though driving after using psychoactive illegal or medicinal drugs was more frequent.
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82
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Zancanaro I, Limberger RP, Bohel PO, dos Santos MK, De Boni RB, Pechansky F, Caldas ED. Prescription and illicit psychoactive drugs in oral fluid—LC–MS/MS method development and analysis of samples from Brazilian drivers. Forensic Sci Int 2012; 223:208-16. [DOI: 10.1016/j.forsciint.2012.08.048] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 08/24/2012] [Accepted: 08/28/2012] [Indexed: 11/29/2022]
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83
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Bogstrand ST, Gjerde H, Normann PT, Rossow I, Ekeberg Ø. Alcohol, psychoactive substances and non-fatal road traffic accidents--a case-control study. BMC Public Health 2012; 12:734. [PMID: 22943663 PMCID: PMC3489595 DOI: 10.1186/1471-2458-12-734] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 08/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background The prevalence of alcohol and other psychoactive substances is high in biological specimens from injured drivers, while the prevalence of these psychoactive substances in samples from drivers in normal traffic is low. The aim of this study was to compare the prevalence of alcohol and psychoactive substances in drivers admitted to hospital for treatment of injuries after road traffic accidents with that in drivers in normal traffic, and calculate risk estimates for the substances, and combinations of substances found in both groups. Methods Injured drivers were recruited in the hospital emergency department and drivers in normal conditions were taken from the hospital catchment area in roadside tests of moving traffic. Substances found in blood samples from injured drivers and oral fluid samples from drivers in moving traffic were compared using equivalent cut off concentrations, and risk estimates were calculated using logistic regression analyses. Results In 21.9% of the injured drivers, substances were found: most commonly alcohol (11.5%) and stimulants eg. cocaine or amphetamines (9.4%). This compares to 3.2% of drivers in normal traffic where the most commonly found substances were z-hypnotics (0.9%) and benzodiazepines (0.8%). The greatest increase in risk of being injured was for alcohol combined with any other substance (OR: 231.9, 95% CI: 33.3- 1615.4, p < 0.001), for more than three psychoactive substances (OR: 38.9, 95% CI: 8.2- 185.0, p < 0.001) and for alcohol alone (OR: 36.1, 95% CI: 13.2- 98.6, p < 0.001). Single use of non-alcohol substances was not associated with increased accident risk. Conclusion The prevalence of psychoactive substances was higher among injured drivers than drivers in normal moving traffic. The risk of accident is greatly increased among drivers who tested positive for alcohol, in particular, those who had also ingested one or more psychoactive substances. Various preventive measures should be considered to curb the prevalence of driving under the influence of psychoactive substances as these drivers constitute a significant risk for other road users as well as themselves.
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Affiliation(s)
- Stig Tore Bogstrand
- Emergency Department, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Oslo N-0407, Norway.
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84
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A case-control study estimating accident risk for alcohol, medicines and illegal drugs. PLoS One 2012; 7:e43496. [PMID: 22952694 PMCID: PMC3429508 DOI: 10.1371/journal.pone.0043496] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/24/2012] [Indexed: 11/21/2022] Open
Abstract
Background The aim of the present study was to assess the risk of having a traffic accident after using alcohol, single drugs, or a combination, and to determine the concentrations at which this risk is significantly increased. Methods A population-based case-control study was carried out, collecting whole blood samples of both cases and controls, in which a number of drugs were detected. The risk of having an accident when under the influence of drugs was estimated using logistic regression adjusting for gender, age and time period of accident (cases)/sampling (controls). The main outcome measures were odds ratio (OR) for accident risk associated with single and multiple drug use. In total, 337 cases (negative: 176; positive: 161) and 2726 controls (negative: 2425; positive: 301) were included in the study. Results Main findings were that 1) alcohol in general (all the concentrations together) caused an elevated crash risk; 2) cannabis in general also caused an increase in accident risk; at a cut-off of 2 ng/mL THC the risk of having an accident was four times the risk associated with the lowest THC concentrations; 3) when ranking the adjusted OR from lowest to highest risk, alcohol alone or in combination with other drugs was related to a very elevated crash risk, with the highest risk for stimulants combined with sedatives. Conclusion The study demonstrated a concentration-dependent crash risk for THC positive drivers. Alcohol and alcohol-drug combinations are by far the most prevalent substances in drivers and subsequently pose the largest risk in traffic, both in terms of risk and scope.
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85
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Impairment based legislative limits for driving under the influence of non-alcohol drugs in Norway. Forensic Sci Int 2012; 219:1-11. [DOI: 10.1016/j.forsciint.2011.11.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/28/2011] [Accepted: 11/01/2011] [Indexed: 11/18/2022]
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Karjalainen K, Blencowe T, Lillsunde P. Substance use and social, health and safety-related factors among fatally injured drivers. ACCIDENT; ANALYSIS AND PREVENTION 2012; 45:731-736. [PMID: 22269564 DOI: 10.1016/j.aap.2011.09.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 09/25/2011] [Accepted: 09/29/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The aim of this study was to examine different socio-demographic, health and safety-related factors, and psychoactive substance use among fatally injured drivers in road traffic accidents in Finland during 2006-2008. METHODS An accident information register maintained by the Traffic Safety Committee of Insurance Companies (VALT) of the Finnish Motor Insurers' Centre was used as basic data, and the basic data were complemented with further toxicological analytical information retrieved from autopsy reports from the Department of Forensic Medicine, Helsinki University. The data included all the drivers (n=556) who were driving a motor vehicle and who died in a road traffic accident in Finland during 2006-2008. RESULTS Of all the 556 fatally injured drivers 43% (n=238) had psychoactive substance findings. 51% (n=121) of substance positive drivers had a finding for alcohol only, the rest had a finding for one or more illicit/medicinal drugs impairing driving ability, and possibly also alcohol. Fatally injured drivers with alcohol findings were significantly younger (mean age 34 years) than sober drivers (mean age 44 years) or drivers with findings for drugs (mean age 45 years). Socio-demographic background did not differ substantially among drunken/drugged and sober drivers, although drivers with alcohol findings had a slightly lower education and socioeconomic position. Previous substance abuse problems were highly prevalent among drivers with substance findings and mental or both mental and physical health problems were more common among drivers with drug findings. The non-use of safety equipment and driving at a high speed were more common among fatally injured drivers with substance findings. CONCLUSIONS Substance abuse and mental health problems, as well as reckless driving behavior were more pronounced among fatally injured drivers with substance findings when compared to sober drivers. Thus, prevention and early intervention concerning substance abuse, mental health problems and DUI are essential. Improved traffic safety cannot be achieved by means of traffic policy only, but integration with other policies, such as health and social policy should be strengthened.
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Das A, Gjerde H, Gopalan SS, Normann PT. Alcohol, drugs, and road traffic crashes in India: a systematic review. TRAFFIC INJURY PREVENTION 2012; 13:544-553. [PMID: 23137084 DOI: 10.1080/15389588.2012.663518] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE India reported the highest number of road traffic crashes, related injuries, and deaths among all countries in the world, with 105,725 road traffic fatalities and 452,922 nonfatal road traffic injuries in 2007. In this report we present a systematic review of available literature on the use of psychoactive substances (alcohol and drugs) among road users, particularly those involved in road traffic crashes (RTCs). METHODS MEDLINE, EMBASE, Ind Medica, and several other databases were searched for reports published between 1980 and 2011 that present data on the prevalence or extent of substance use among road users in India. RESULTS Among the 23 studies eligible for the review, alcohol was reported by all, but only 2 mentioned the use of drugs. Most of the studies were hospital based, included injured or killed road users, and belonged to southern parts of India. Seven studies did not report any method for detecting alcohol use, whereas 7 used analytical testing, 7 used self-reporting, and 2 used observation. Utilizing the various means of verification, the studies reported that 2 to 33 percent of injured and 6 to 48 percent of killed RTC victims had consumed alcohol or drugs; only 2 mentioned drugs without specifying which types. Most studies did not distinguish between drivers, passengers, bicyclists, and pedestrians, and none investigated alcohol or drug use among those responsible for the accident. CONCLUSION A significant proportion of injured or killed road users in India had used alcohol before the accident. However, the existing studies cannot be used to estimate the risk of accident involvement among drunk drivers. There is a need for more rigorous research and capacity building on substance use vis-à-vis road traffic crashes.
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Affiliation(s)
- Ashis Das
- The World Bank, Washington, DC 20433, USA.
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A preliminary investigation on the distribution of cannabinoids in man. Forensic Sci Int 2011; 210:e7-e11. [DOI: 10.1016/j.forsciint.2011.04.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 04/04/2011] [Accepted: 04/09/2011] [Indexed: 11/19/2022]
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