Drugs in oral fluid in randomly selected drivers

Presence of psychoactive substances in oral fluid from randomly selected drivers in Denmark

This roadside study is the Danish part of the EU-project DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) and included three representative regions in Denmark. Oral fluid samples (n=3002) were collected randomly from drivers using a sampling scheme stratified by time, season, and road type. The oral fluid samples were screened for 29 illegal and legal psychoactive substances and metabolites as well as ethanol. Fourteen (0.5%) drivers were positive for ethanol (alone or in combination with drugs) at concentrations above 0.53g/l, which is the Danish legal limit. The percentage of drivers positive for medicinal drugs above the Danish legal concentration limit was 0.4%; while, 0.3% of the drivers tested positive for one or more illicit drug at concentrations exceeding the Danish legal limit. Tetrahydrocannabinol, cocaine, and amphetamine were the most frequent illicit drugs detected above the limit of quantitation (LOQ); while, codeine, tramadol, zopiclone, and benzodiazepines were the most frequent legal drugs. Middle aged men (median age 47.5 years) dominated the drunk driving group, while the drivers positive for illegal drugs consisted mainly of young men (median age 26 years). Middle aged women (median age 44.5 years) often tested positive for benzodiazepines at concentrations exceeding the legal limits. Interestingly, 0.6% of drivers tested positive for tramadol, at concentrations above the DRUID cut off; although, tramadol is not included in the Danish list of narcotic drugs. It can be concluded that driving under the influence of drugs is as serious a road safety problem as drunk driving.

The acute effects of 3,4-methylenedioxymethamphetamine and methamphetamine on driving: a simulator study

OBJECTIVES

Illicit drugs such as MDMA and methamphetamine are commonly abused drugs that have also been observed to be prevalent in drivers injured in road accidents. Their exact effect on driving and driving behavior has yet to be thoroughly investigated.

METHODS

Sixty-one abstinent recreational users of illicit drugs comprised the participant sample, with 33 females and 28 males, mean age 25.45 years. The three testing sessions involved oral consumption of 100 mg MDMA, 0.42 mg/kg methamphetamine, or a matching placebo. The drug administration was counter-balanced, double-blind, and medically supervised. At each session driving performance was assessed 3 h and 24 h post drug administration on a computerized driving simulator.

RESULTS

At peak concentration overall impairment scores for driving (F(2,118)=9.042, p<0.001) and signaling (F(2,118)=4.060, p=0.020) were significantly different for the daytime simulations. Performance in the MDMA condition was worse than both the methamphetamine (p=0.023) and placebo (p<0.001) conditions and the methamphetamine condition was also observed to be worse in comparison to the placebo (p=0.055). For signaling adherence, poorer signaling adherence occurred in both the methamphetamine (p=0.006) and MDMA (p=0.017) conditions in comparison to placebo in the daytime simulations.

CONCLUSIONS

The findings of this study have for the first time illustrated how both MDMA and methamphetamine effect driving performance, and provide support for legislation regarding testing for the presence of illicit drugs in impaired or injured drivers as deterrents for driving under the influence of illicit drugs.

The effect of d-methamphetamine on simulated driving performance

OBJECTIVES

Methamphetamine is considered to be one of the most popularly abused drugs by drivers; however, its exact effect on driving and driving behaviour has yet to be thoroughly investigated. This being despite methamphetamine's increased prevalence in injured and deceased drivers.

METHODS

Twenty healthy recreational illicit stimulant users (10 male and 10 female), aged between 21 and 32 years (mean = 25.4 years, SD = 3.3 years) attended two testing sessions involving oral consumption of 0.42 mg/kg d-methamphetamine or a matching placebo. The drug administration was counter-balanced, double-blind, and medically supervised. At each session driving, performance was assessed 2.5 h post drug administration.

RESULTS

d-methamphetamine (0.42 mg/kg) did not significantly impair overall simulated driving performance 2.5 h post drug administration. At the individual driving variable level, participants in the d-methamphetamine condition were observed to be driving slower when an emergency situation occurred (T = 44, p < 0.05), but interestingly, participants in both conditions recorded average speeds in excess of the speed limit (100 km/h) when the emergency situations occurred. The d-methamphetamine condition did also produce four times more infringements where participants did not stop at red traffic light in comparison to the placebo, but this effect was only evident at a trend level (T = 7, p = 0.11).

CONCLUSIONS

The findings presented herein suggest that d-methamphetamine administered at the levels supplied did not impair driving performance in a manner consistent with epidemiological evidence. Further research is certainly required to elucidate the effects of various doses of methamphetamine, alone and in combination with other legal and illicit substances.

Alcohol and marijuana use while driving--an unexpected crash risk in Pakistani commercial drivers: a cross-sectional survey

Background

A significant proportion of road traffic crashes are attributable to alcohol and marijuana use while driving globally. Sale and use of both substances is illegal in Pakistan and is not considered a threat for road traffic injuries. However literature hints that this may not be the case. We did this study to assess usage of alcohol and marijuana in Pakistani commercial drivers.

Methods

A sample of 857 commercial bus and truck drivers was interviewed in October 2008 at the largest commercial vehicle station in Rawalpindi and Islamabad, Pakistan. Time location cluster sampling was used to select the subjects and a structured questionnaire was used to assess the basic demographic profile, substance abuse habits of the drivers while on the road, and reasons for usage of illicit substances while driving were recorded. Self reported information was collected after obtaining informed consent. Chi square and fisher exact tests were used to assess differences between groups and logistic regression was used to identify significant associations between driver characteristics and alcohol and marijuana use.

Results

Almost 10% of truck drivers use alcohol while driving on Pakistani roads. Marijuana use is almost 30% in some groups. Statistically different patterns of usage are seen between population subgroups based on age, ethnicity, education, and marital status. Regression analysis shows association of alcohol and marijuana use with road rage and error behaviours, and also with an increased risk of being involved in road crashes. The reported reasons for using alcohol or marijuana show a general lack of awareness of the hazardous nature of this practice among the commercial driver population.

Conclusion

Alcohol and marijuana use is highly prevalent in Pakistani commercial drivers. The issue needs to be recognized by concerned authorities and methods such as random breath tests and sobriety check points need to be employed for proper law enforcement.

The effect of d,l-methamphetamine on simulated driving performance

RATIONALE

Illicit drugs such as methamphetamine are commonly abused drugs that have also been observed to be prevalent in drivers injured in road accidents. The exact effect of methamphetamine or its specific isomers on driving and driving behaviour have yet to be thoroughly investigated.

METHODS

Twenty healthy recreational illicit stimulant users (ten males, ten females), aged between 21 and 34 years (mean = 24.3 years, SD = 3.4 years), attended two testing sessions involving oral consumption of 0.42 mg/kg d,l-methamphetamine or a matching placebo. The drug administration was counterbalanced, double-blind, and medically supervised. At each session, driving performance was assessed 2.5 h post-drug administration.

RESULTS

Mean blood and saliva d,l-methamphetamine concentrations of approximately 90 and 400 ng/ml, respectively, at 2 h and 95 and 475 ng/ml at 3 h were observed. These levels of d,l-methamphetamine were found not to significantly impair, or improve, driving performance at the 2.5-h post-drug administration time point.

CONCLUSIONS

The findings of this study illustrate that d,l-methamphetamine has no significant effect on simulated driving performance.

Analysis of alcohol and drugs in oral fluid from truck drivers in Norway

OBJECTIVE

To examine alcohol and drug use among truck drivers compared to car or van drivers in Norway by analyzing samples of oral fluid.

METHODS

Drivers were selected for a voluntary and anonymous study using a stratified multistage cluster sampling procedure. Drivers of trucks were recruited at two control stations for heavy vehicles in southeastern Norway in collaboration with the Norwegian Roads Administration, and drivers of cars and vans were recruited in a roadside survey in collaboration with the mobile police service. Samples of oral fluid were taken by using the Statsure Saliva Sampler (Statsure Diagnostic Systems, Framingham, MA), and the drivers' gender, age, and nationality were recorded. Samples of oral fluid were analyzed for alcohol or drugs, in total 28 psychoactive substances.

RESULTS

About 97 percent of the truck drivers and 94 percent of the car or van drivers agreed to participate in the study. Of the 882 studied truck drivers studied, 1.4 percent were female and 29.1 percent were Norwegian; of the 5305 car or van drivers, 27.6 percent were female and 90.9 percent were Norwegian. Alcohol or drugs were found in 1.9 and 6.6 percent of the samples from truck drivers and car/van drivers, respectively. The adjusted odds ratio (OR) for the detection of a psychoactive substance in a sample from a truck driver compared to car or van driver was 0.29; the 95 percent confidence interval (95% CI) was 0.17 to 0.53. The adjusted OR for the detection of an illegal drug was 0.42 (95% CI: 0.18-0.82), the adjusted OR for the detection of a psychoactive medicinal drug was 0.29 (95% CI: 0.13-0.68), and the adjusted OR for the detection of alcohol was 0.13 (95% CI: 0.02-1.10).

CONCLUSIONS

The proportion of oral fluid samples containing psychoactive substances was lower for truck drivers than for car or van drivers.

Determination of amphetamine-type stimulants in oral fluid by solid-phase microextraction and gas chromatography-mass spectrometry

A method for the simultaneous identification and quantification of amphetamine (AMP), methamphetamine (MET), fenproporex (FEN), diethylpropion (DIE) and methylphenidate (MPH) in oral fluid collected with Quantisal™ device has been developed and validated. Thereunto, in-matrix propylchloroformate derivatization followed by direct immersion solid-phase microextraction and gas chromatography-mass spectrometry were employed. Deuterium labeled AMP was used as internal standard for all the stimulants and analysis was performed using the selected ion monitoring mode. The detector response was linear for the studied drugs in the concentration range of 2-256 ng mL(-1) (neat oral fluid), except for FEN, whereas the linear range was 4-256 ng mL(-1). The detection limits were 0.5 ng mL(-1) (MET), 1 ng mL(-1) (MPH) and 2 ng mL(-1) (DIE, AMP, FEN), respectively. Accuracy of quality control samples remained within 98.2-111.9% of the target concentrations, while precision has not exceeded 15% of the relative standard deviation. Recoveries with Quantisal™ device ranged from 77.2% to 112.1%. Also, the goodness-of-fit concerning the ordinary least squares model in the statistical inference of data has been tested through residual plotting and ANOVA. The validated method can be easily automated and then used for screening and confirmation of amphetamine-type stimulants in drivers' oral fluid.

Bioanalytical procedures and recent developments in the determination of opiates/opioids in human biological samples

The use and abuse of illegal drugs affects all modern societies, and therefore the assessment of drug exposure is an important task that needs to be accomplished. For this reason, the reliable determination of these drugs and their metabolites in biological specimens is an issue of utmost relevance for both clinical and forensic toxicology laboratories in their fields of expertise, including in utero drug exposure, driving under the influence of drugs and drug use in workplace scenarios. Most of the confirmatory analyses for abused drugs in biological samples are performed by gas chromatographic-mass spectrometric methods, but use of the more recent and sensitive liquid chromatography-(tandem) mass spectrometry technology is increasing dramatically. This article reviews recently published articles that describe procedures for the detection of opiates in the most commonly used human biological matrices, blood and urine, and also in unconventional ones, e.g. oral fluid, hair, and meconium. Special attention will be paid to sample preparation and chromatographic analysis.

An analytical evaluation of eight on-site oral fluid drug screening devices using laboratory confirmation results from oral fluid

The performance of eight on-site oral fluid drug screening devices was studied in Belgium, Finland and the Netherlands as a part of the EU-project DRUID. The main objective of the study was to evaluate the reliability of the devices for testing drivers suspected of driving under the influence of drugs (DUID). The performance of the devices was assessed by their ability to detect substances using cut-offs which were set at sufficiently low levels to allow optimal detection of positive DUID cases. The devices were evaluated for the detection of amphetamine(s), cannabis, cocaine, opiates and benzodiazepines when the relevant test was incorporated. Methamphetamine, MDMA and PCP tests that were included in some devices were not evaluated since there were too few positive samples. The device results were compared with confirmation analysis results in oral fluid. The opiates tests appeared to perform relatively well with sensitivity results between 69 and 90%. Amphetamines and benzodiazepines tests had lower sensitivity, although the DrugWipe test evaluated was promising for amphetamine. In particular, it is evident that the cannabis and cocaine tests of the devices still lack sensitivity, although further testing of the cocaine tests is desirable due to the low prevalence and low concentrations encountered in this study.

Pharmacokinetics of cocaine and metabolites in human oral fluid and correlation with plasma concentrations after controlled administration

Oral fluid is an attractive alternative matrix for drug testing with a noninvasive and directly observed collection, but there are few controlled cocaine administration studies to guide interpretation.

MATERIALS AND METHODS

While residing on a closed research unit for up to 10 weeks under constant medical supervision, 19 participants were administered 75 mg/70 kg subcutaneous cocaine and 14 received 150 mg/70 kg. The disposition of cocaine, benzoylecgonine (BE), and ecgonine methyl ester (EME) into oral fluid was determined by gas chromatography-mass spectrometry for 0.08 to 48 hours after administration.

RESULTS

In oral fluid collected by citric acid candy-stimulated expectoration, cocaine first appeared in oral fluid 0.08 to 0.32 hours after dosing and was rapidly eliminated with half-lives of 1.1 to 3.8 hours. BE and EME were first detected 0.08 to 1.0 hours after dosing with longer half-lives of 3.4 to 13.8 (BE) and 2.4 to 15.5 hours (EME) (P < 0.05). Oral fluid and plasma concentrations were significantly correlated for cocaine, BE, and EME (P < 0.0001). There were no significant differences (P > 0.05) in first and last detection times with the 8-μg/L cutoff proposed by the Substance Abuse and Mental Health Services Administration or the 10-μg/L cutoff from the European initiative, Driving Under the Influence of Drugs, Alcohol and Medicines. Metabolite:cocaine ratios increased after cocaine administration, potentially helpful for interpreting time of last use. Comparison of oral fluid collection through citric acid candy-stimulated expectoration, citric acid-treated Salivette, and neutral cotton Salivette devices did not reveal significant differences between devices for areas under the curve for cocaine, BE, or EME (P > 0.05).

DISCUSSION AND CONCLUSION

These results provide additional evidence for interpreting cocaine and metabolite concentrations in oral fluid and oral fluid's usefulness as an alternative matrix for drug testing.

The effects of cannabis and alcohol on simulated arterial driving: Influences of driving experience and task demand

This study compared the effects of three doses of cannabis and alcohol (placebo, low and high doses), both alone and in combination, on the driving performance of young, novice drivers and more experienced drivers. Alcohol was administered as ethanol (95%) mixed with orange juice in doses of approximately 0, 0.4 and 0.6g/kg. Cannabis was administered by inhalation of smoke from pre-rolled cannabis cigarettes (supplied by the National Institute of Drug Abuse, USA). Active cigarettes contained 19 mg delta-9-THC. Using a counterbalanced design, the simulated driving performance of 25 experienced and 22 inexperienced drivers was tested under the nine different drug conditions in an arterial driving environment during which workload was varied through the drive characteristics as well as through the inclusion of a secondary task. High levels of cannabis generally induced greater impairment than lower levels, while alcohol at the doses used had few effects and did not produce synergistic effects when combined with cannabis. Both cannabis and alcohol were associated with increases in speed and lateral position variability, high dose cannabis was associated with decreased mean speed, increased mean and variability in headways, and longer reaction time, while in contrast alcohol was associated with a slight increase in mean speed. Given the limitations of the study, it is of great interest to further explore the qualitative impairments in driving performance associated with cannabis and alcohol separately and how these impairments may manifest in terms of crash characteristics.

Forensic toxicology

Forensic toxicology has developed as a forensic science in recent years and is now widely used to assist in death investigations, in civil and criminal matters involving drug use, in drugs of abuse testing in correctional settings and custodial medicine, in road and workplace safety, in matters involving environmental pollution, as well as in sports doping. Drugs most commonly targeted include amphetamines, benzodiazepines, cannabis, cocaine and the opiates, but can be any other illicit substance or almost any over-the-counter or prescribed drug, as well as poisons available to the community. The discipline requires high level skills in analytical techniques with a solid knowledge of pharmacology and pharmacokinetics. Modern techniques rely heavily on immunoassay screening analyses and mass spectrometry (MS) for confirmatory analyses using either high-performance liquid chromatography or gas chromatography as the separation technique. Tandem MS has become more and more popular compared to single-stage MS. It is essential that analytical systems are fully validated and fit for the purpose and the assay batches are monitored with quality controls. External proficiency programs monitor both the assay and the personnel performing the work. For a laboratory to perform optimally, it is vital that the circumstances and context of the case are known and the laboratory understands the limitations of the analytical systems used, including drug stability. Drugs and poisons can change concentration postmortem due to poor or unequal quality of blood and other specimens, anaerobic metabolism and redistribution. The latter provides the largest handicap in the interpretation of postmortem results.

Conventional and alternative matrices for driving under the influence of cannabis: recent progress and remaining challenges

In the past decade much research concerning the impact of cannabis use on road safety has been conducted. More specifically, studies on effects of cannabis smoking on driving performance, as well as epidemiological studies and cannabis-detection techniques have been published. As a result, several countries have adopted driving under the influence of drugs (DUID) legislations, with varying approaches worldwide. A wide variety of bodily fluids have been utilized to determine the presence of cannabis. Urine and blood are the most widely used matrices for DUID legislations. However, more and more publications focus on the usability of oral fluid testing for this purpose. Each matrix provides different information about time and extent of use and likelihood of impairment. This review will focus on the practical aspects of implying a DUID legislation. The pros and cons of the different biological matrices used for Δ9-tetrahydrocannabinol screening and quantification will be discussed. In addition, a literature overview concerning (roadside) cannabinoid detection, as well as laboratory confirmation techniques is given. Finally, we will discuss important issues influencing interpretation of these data, such as oral fluid collection, choice of cut-offs, stability and proficiency testing.

First nationwide study on driving under the influence of drugs in Switzerland

In Switzerland, a two-tier system based on impairment by any psychoactive substances which affect the capacity to drive safely and zero tolerance for certain illicit drugs came into force on 1 January 2005. According to the new legislation, the offender is sanctioned if Delta(9)-tetrahydrocannabinol THC is >or=1.5ng/ml or amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyethylamphetamine (MDEA), cocaine, free morphine are >or=15ng/ml in whole blood (confidence interval+/-30%). For all other psychoactive substances, impairment must be proven in applying the so-called "three pillars expertise". At the same time the legal blood alcohol concentration (BAC) limit for driving was lowered from 0.80 to 0.50g/kg. The purpose of this study was to analyze the prevalence of drugs in the first year after the introduction of the revision of the Swiss Traffic Law in the population of drivers suspected of driving under the influence of drugs (DUID). A database was developed to collect the data from all DUID cases submitted by the police or the Justice to the eight Swiss authorized laboratories between January and December 2005. Data collected were anonymous and included the age, gender, date and time of the event, the type of vehicle, the circumstances, the sampling time and the results of all the performed toxicological analyses. The focus was explicitly on DUID; cases of drivers who were suspected to be under the influence of ethanol only were not considered. The final study population included 4794 DUID offenders (4243 males, 543 females). The mean age of all drivers was 31+/-12 years (range 14-92 years). One or more psychoactive drugs were detected in 89% of all analyzed blood samples. In 11% (N=530) of the samples, neither alcohol nor drugs were present. The most frequently encountered drugs in whole blood were cannabinoids (48% of total number of cases), ethanol (35%), cocaine (25%), opiates (10%), amphetamines (7%), benzodiazepines (6%) and methadone (5%). Other medicinal drugs such as antidepressants and benzodiazepine-like were detected less frequently. Poly-drug use was prevalent but it may be underestimated because the laboratories do not always analyze all drugs in a blood sample. This first Swiss study points out that DUID is a serious problem on the roads in Switzerland. Further investigations will show if this situation has changed in the following years.

Oral fluid testing for drugs of abuse

BACKGROUND

Oral fluid (OF) is an exciting alternative matrix for monitoring drugs of abuse in workplace, clinical toxicology, criminal justice, and driving under the influence of drugs (DUID) programs. During the last 5 years, scientific and technological advances in OF collection, point-of-collection testing devices, and screening and confirmation methods were achieved. Guidelines were proposed for workplace OF testing by the Substance Abuse and Mental Health Services Administration, DUID testing by the European Union's Driving under the Influence of Drugs, Alcohol and Medicines (DRUID) program, and standardization of DUID research. Although OF testing is now commonplace in many monitoring programs, the greatest current limitation is the scarcity of controlled drug administration studies available to guide interpretation.

CONTENT

This review outlines OF testing advantages and limitations, and the progress in OF that has occurred during the last 5 years in collection, screening, confirmation, and interpretation of cannabinoids, opioids, amphetamines, cocaine, and benzodiazepines. We examine controlled drug administration studies, immunoassay and chromatographic methods, collection devices, point-of-collection testing device performance, and recent applications of OF testing.

SUMMARY

Substance Abuse and Mental Health Services Administration approval of OF testing was delayed because questions about drug OF disposition were not yet resolved, and collection device performance and testing assays required improvement. Here, we document the many advances achieved in the use of OF. Additional research is needed to identify new biomarkers, determine drug detection windows, characterize OF adulteration techniques, and evaluate analyte stability. Nevertheless, there is no doubt that OF offers multiple advantages as an alternative matrix for drug monitoring and has an important role in DUID, treatment, workplace, and criminal justice programs.

Rapid drug detection in oral samples by porous silicon assisted laser desorption/ionization mass spectrometry

The demand for analysis of oral fluid for illicit drugs has arisen with the increased adoption of roadside testing, particularly in countries where changes in legislation allow random roadside testing of drivers for the presence of a palette of illicit drugs such as methamphetamine (MA), 3,4-methylenedioxymethamphetamine (MDMA) and Delta9-tetrahydrocannabinol (THC). Oral samples are currently tested for such drugs at the roadside using an immunoassay-based commercial test kit. Positive roadside tests are sent for confirmatory laboratory analysis, traditionally by means of gas chromatography/mass spectrometry (GC/MS). We present here an alternative rapid analysis technique, porous silicon assisted laser desorption/ionization time-of-flight mass spectrometry (pSi LDI-MS), for the high-throughput analysis of oral fluids. This technique alleviates the need for sample derivatization, requires only sub-microliter sample volumes and allows fast analysis (of the order of seconds). In this study, the application of the technique is demonstrated with real samples from actual roadside testing. The analysis of oral samples resulted in detection of MA and MDMA with no extraction and analysis of THC after ethyl acetate extraction. We propose that, subject to miniaturization of a suitable mass spectrometer, this technique is well suited to underpin the deployment of oral fluid testing in the clinic, workplace and on the roadside.

Current technologies and considerations for drug bioanalysis in oral fluid

Drug oral fluid analysis was first used almost 30 years ago for the purpose of therapeutic drug monitoring. Since then, oral fluid bioanalysis has become more popular, mainly in the fields of pharmacokinetics, workplace drug testing, criminal justice, driving under the influence testing and therapeutic drug monitoring. In fact, oral fluid can provide a readily available and noninvasive medium, without any privacy loss by the examinee, which occurs, for instance, during the collection of urine samples. It is believed that drug concentrations in oral fluid may parallel those measured in blood. This feature makes oral fluid an alternative analytical specimen to blood, which assumes particular importance in roadside testing, the most published application of this sample. Great improvements in the development of accurate and reliable methods for sample collection, in situ detection devices (on-site drug detection kits), and highly sensitive and specific analytical methods for oral fluid testing of drugs have been observed in the last few years. However, without mass spectrometry-based analytical methods, such as liquid chromatography coupled to mass spectrometry (LC–MS) or tandem mass spectrometry (LC–MS/MS), the desired sensitivity would not be met, due to the low amounts of sample usually available for analysis. This review will discuss a series of published papers on the applicability of oral fluid in the field of analytical, clinical and forensic toxicology, with a special focus on its advantages and drawbacks over the normally used biological specimens and the main technological advances over the last decade, which have made oral fluid analysis of drugs possible.

Screening for drugs in oral fluid: drug driving and illicit drug use in a sample of Queensland motorists

OBJECTIVE

Random roadside oral fluid testing is becoming increasingly popular as an apprehension and deterrence-based countermeasure to reduce drug driving. This article outlines research conducted to provide an estimate of the extent of drug driving in a sample of drivers in Brisbane, Queensland.

METHODS

Oral fluid samples were collected from 1587 drivers who volunteered to participate at random breath testing (RBT) sites. Illicit substances tested for included cannabis (delta 9 tetrahydrocannibinol [THC]), meth/amphetamines, and cocaine. Drivers also completed a self-report questionnaire regarding their drug-related driving behaviors.

RESULTS

Oral fluid samples from 58 participants (3.7%) were confirmed positive for at least one illicit substance. The most common drugs detected in oral fluid were ecstasy (n = 35) followed by cannabis (n = 20). Similarly, cannabis was confirmed as the most common self-reported drug combined with driving. Nevertheless, individuals who tested positive to any drug through oral fluid analysis were also more likely to report the highest frequency of drug driving.

CONCLUSIONS

This research provides evidence that drug driving is relatively prevalent on some Queensland roads, and thus the behavior presents as a serious road safety threat. This article will further outline the study findings and present possible directions for future drug driving research.

Prevalence of alcohol and drugs among Norwegian motor vehicle drivers: a roadside survey

The objective of the study was to determine the prevalence of alcohol, psychoactive medicinal drugs and illegal drugs among drivers in Norwegian road traffic. Drivers of motor vehicles were selected from April 2005 to April 2006 in the south-eastern part of Norway, surrounding, but not including the capital, Oslo. A stratified two-stage cluster sampling procedure was used. In the first stage, random road sites and time intervals were selected, and in the second stage, drivers were stopped by random at those sites and time intervals. Altogether about 12,000 drivers were asked to provide a sample of oral fluid (saliva) and answer a few questions. Samples of oral fluid were obtained from 88% of the drivers, of whom 30% were females and 70% males. The prevalence of each drug was estimated by a weighted average using weights adjusted for under- or over-sampling compared to traffic statistics. Alcohol or drugs were found in oral fluid samples of 4.5% of the drivers; alcohol in 0.4%, psychoactive medicinal drugs in 3.4%, and illegal drugs in 1.0%. Illegal drugs were found more frequently in samples from younger drivers, while psychoactive medicinal drugs were more frequently found in samples from older drivers. Psychoactive medicinal drugs were more prevalent among females than males, among drivers stopped on working days rather than weekends, and among those who reported annual driving distances less than 16,000 km. The drugs found most frequently were zopiclone (1.4%), benzodiazepines (1.4%), codeine (0.8%), tetrahydrocannabinol (0.6%) and amphetamines (0.3%). Two or more drugs were found in 0.6% of the samples, corresponding to 15% of the drug-positive drivers.

Current developments in drug testing in oral fluid

In the last few years, significant developments have occurred on the key issues involved in oral fluid drug testing. New pharmacokinetic studies have been conducted, optimal cutoffs have been proposed, and new studies have examined the correlation between oral fluid drug concentrations and impairment. Recent studies (eg, the discovery of the presence of THC-COOH in oral fluid) can contribute to solve the issue of false-positive results caused by passive exposure to marijuana. Reliable point-of-care drug testing is still problematic, especially for cannabinoids and benzodiazepines. To date, there is no device that allows both reliable and practical point-of-care testing. The importance of liquid chromatography- tandem mass spectrometry in confirmation analysis has increased over the last several years. It can be expected that this trend will continue because the low sample volumes make simultaneous detection of different drug classes with limited sample preparation necessary. Literature on proficiency testing to ensure reliability and comparability of results is limited. Oral fluid has become an important sample type in driving under the influence research, and the first legal random drug testing program in oral fluid since 2004 has been organized in Victoria. It can be expected that the role of oral fluid as an alternative matrix will keep increasing in the future.

Experience of road and other trauma by the opiate dependent patient: a survey report

Background

Trauma plays an important role in the experience of many patients with substance use disorder, but is relatively under-studied particularly in Australia. The present survey examined the lifetime prevalence of various forms of trauma including driving careers in the context of relevant medical conditions.

Methods

A survey was undertaken in a family medicine practice with a special interest in addiction medicine in Brisbane, Australia.

Results

Of 350 patients surveyed, 220 were substance dependent, and 130 were general medical patients. Addicted patients were younger (mean ± S.D. 33.72 ± 8.14 vs. 44.24 ± 16.91 years, P < 0.0001) and had shorter driving histories (15.96 ± 8.50 vs. 25.54 ± 15.03 years, P < 0.0001). They had less driving related medical problems (vision, spectacle use, diabetes) but more fractures, surgical operations, dental trauma and assaults. Addicted patients also had significantly worse driving histories on most parameters measured including percent with driving suspensions (O.R. = 7.70, C.I. 4.38–13.63), duration of suspensions (1.71 ± 3.60 vs. 0.11 ± 0.31 years, P < 0.0001), number of motor vehicle collisions (2.00 ± 3.30 vs. 1.10 ± 1.32, P = 0.01), numbers of cars repaired (1.73 ± 3.59 vs. 1.08 ± 1.60, P = 0.042), rear end collisions (O.R. = 1.90, CI 1.13–3.25), running away after car crashes (O.R. = 26.37, CI 4.31–1077.48), other people hospitalized (O.R. = 2.00, C.I. 0.93–4.37, P = 0.037) and people killed (17 vs. 0 P = 0.0005). Upon multivariate analysis group membership was shown to be a significant determinant of both cars repaired and cars hit when controlled for length of driving history. Hence use of all types of drugs (O.R. = 10.07, C.I. 8.80–14.72) was more common in addicted patients as were general (O.R. = 3.64, C.I. 2.99–4.80) and road (O.R.= 2.73, C.I. 2.36–3.15) trauma.

Conclusion

This study shows that despite shorter driving histories, addicted patients have worse driving careers and general trauma experience than the comparison group which is not explained by associated medical conditions. Trauma is relevant to addiction management at both the patient and policy levels. Substance dependence policies which focus largely on prevention of virus transmission likely have too narrow a public health focus, and tend to engender an unrealistically simplistic and trivialized view of the addiction syndrome. Reduction of drug driving and drug related trauma likely require policies which reduce drug use per se, and are not limited to harm reduction measures alone.