Testing reckless drivers for cocaine and marijuana

Drugs of abuse and alcohol in weekend drivers involved in car crashes in Belgium

STUDY OBJECTIVE

To determine levels of alcohol and drugs of abuse in weekend drivers injured in car crashes.

METHODS

This study was the first systematic drug and alcohol testing of blood and urine samples of drivers injured in weekend car crashes in Belgium. Five collaborating hospital in Flanders participated. All injured weekend drivers admitted to the emergency units from July 1, 1994, to June 30, 1995, were included in the study sample. Sampling times were from Friday at 8 PM to Monday at 8 AM.

RESULTS

Of the 211 injured drivers, 47.9% had positive test results for screenings for drugs or alcohol; 35.5% only for alcohol, 6.6% only for drugs, and 5.7% had positive results for both alcohol and drugs. Of the 87 weekend drivers with positive alcohol test results, 8% had a blood alcohol concentration (BAC) level below 80 mg/dL, 25.3% had a concentration between 150 and 190 mg/dL, and 39% had a BAC of 200 mg/dL or greater. There seems to be a consistent association between the consequences of the weekend crashes and the use of alcohol, drugs, or both. More than 50% of those who had negative results for drugs and alcohol could leave the hospital within 24 hours after their car crash. For the majority of those with positive findings for alcohol only or for drugs and alcohol (respectively, 72% and 78%), hospitalization in a general hospital unit or ICU was necessary.

CONCLUSION

The results suggest that testing drivers for use of alcohol alone is insufficient.

Comparative effects of alcohol and marijuana on mood, memory, and performance

This study compared subjective and behavioral effect profiles of alcohol and smoked marijuana using technology that controlled puffing and inhalation parameters. Male volunteers (n = 5) with histories of moderate alcohol and marijuana use were administered three doses of alcohol (0.25, 0.5, or 1.0 g/kg), three doses of marijuana [4.8, or 16 puffs of 3.55% delta 9-tetrahydrocannabinol (THC)], and placebo in random order under double blind conditions in seven separate sessions. Blood alcohol concentration (10-90 mg/dl) and THC levels (63-188 ng/ml) indicated that active drug was delivered to subjects dose dependently. Alcohol and marijuana produced dose-related changes in subjective measures of drug effect. Ratings of perceived impairment were identical for the high doses of alcohol and marijuana. Both drugs produced comparable impairment in digit-symbol substitution and word recall tests, but had no effect in time perception and reaction time tests. Alcohol, but not marijuana, slightly impaired performance in a number recognition test. These data are useful for understanding the relative performance impairment produced by alcohol and marijuana at the delivered doses and the relationship between their subjective and behavioral effects.

Screening for drugs of abuse (II): Cannabinoids, lysergic acid diethylamide, buprenorphine, methadone, barbiturates, benzodiazepines and other drugs

Requirements for the provision of an efficient and reliable service for drugs of abuse screening in urine have been summarized in Part I of this review. The requirements included rapid turn-around times, good communications between requesting clinicians and the laboratory, and participation in quality assessment schemes. In addition, the need for checking/confirmation of positive results obtained for preliminary screening methods was stressed. This aspect of the service has assumed even greater importance with widespread use of dip-stick technology and the increasing number of reasons for which drug screening is performed. Many of these additional uses of drug screening have possible serious legal implications, for example, screening school pupils, professional footballers, parents involved in child custody cases, persons applying for renewal of a driving licence after disqualification for a drug-related offence, doctors seeking re-registration after removal for drug abuse, and checking for compliance with terms of probation orders; as well as pre-employment screening and work-place testing. In many cases these requests will be received from a general practitioner or drug clinic with no indication of the reason for which testing has been requested. This also raises the serious problems of a chain of custody, provision of two samples, stability of samples, and secure and lengthy storage of samples in the laboratory-samples may be requested by legal authorities several months after the initial testing. The need for confirmation of positive results is now widely accepted but it may be equally important to confirm unexpected negative results. Failure to detect the presence of maintenance drugs may lead to the patient being discharged from a drug treatment clinic and, if attendance at the clinic is one of the terms of continued employment, to dismissal. It seems likely that increasing abuse of drugs and the efforts of regulatory authorities to control this, will lead to the manufacture of more designer drugs. Production of substituted phenethylamines was facilitated by the drug makers' cook book, 'PIHKAL' (Phenethylamines I Have Known And Loved) by Dr Alexander Shulgin and Ann Shulgin, and production of substituted tryptamines is promised in their next book, TIHKAL. Looking to the future, laboratories will need to ensure that they can detect and quantitate an ever-increasing number of drugs and related substances. The question of confidence in results of drugs of abuse testing raised in 1993 by Watson has assumed even greater importance as a result of attention focused on the OJ Simpson trial in Los Angeles. Toxicological investigations are likely to be challenged more frequently in the future. Even if analyses have been performed by GC-MS, there is a need to establish the level of match between the spectrum of the unknown substance and a library spectrum which is considered acceptable for legal purposes. It will also be essential to ensure that computer libraries contain spectra for all substances likely to be encountered in drugs of abuse screening.

Marijuana Use: Current Issues and New Research Directions

Due to recent evidence of the increasing frequency of marijuana use among adolescents and young adults, and due to the many remaining research issues regarding this drug, it is appropriate to summarize some of the important data about marijuana and to suggest some directions for research and service. This article first provides a review of the history, botany, active ingredients, effects, and negative consequences of marijuana use. Next, prevention and cessation of marijuana use are discussed. Finally, this paper provides a selective examination of current issues in marijuana research. Several salient issues are highlighted including its preference among certain subgroups (high risk youth and ethnic differences), its relations with illegal behavior (marijuana use and driving, current marijuana-related legislation, and marijuana use and violence), and its recent portrayal in the media.

Alcohol and drugs (medical and illicit) in fatal road accidents in a city of 300,000 inhabitants

During a 1-year period all fatal road accidents in the police district of Aarhus, Denmark, were investigated regarding the presence of alcohol, medical drugs or narcotic substances, and the nature of the accident. Out of a total of 30 accidents 24 were investigated. Two thirds had been caused by the victim him- or herself. In one third of the accidents alcohol was present and considered an important contributory factor. Medical drugs and narcotic substances played a lesser role.

Non-fatal injuries and the use of psychoactive drugs among young adults in Spain

We compared the prevalence of injuries requiring medical treatment in the general population, in cocaine users and in heroin users, and we studied the factors associated with the occurrence of injuries in these groups, using data from two interview surveys carried out in 1993 in Spain: the National Health Interview Survey, a national representative sample of the non-institutionalized general population, and a survey of a non-probability sample of heroin or cocaine users selected from the community. The subjects included in the study were persons 16-40 years of age in urban areas: 4261 persons from the general population, 369 cocaine users and 215 heroin users. The annual prevalence of injuries requiring medical treatment was 7.9 percent in the general population, 10.8 percent in cocaine users and 35.2 percent in heroin users. There was a statistically significant positive association of injury occurrence (1) among the general population: with male sex, alcohol use, use of tranquillizers/sleeping pills, and the use of antidepressants or stimulants; (2) in cocaine users: with the use of opiates other than heroin; and (3) in heroin users: with alcohol use, the use of tranquillizers/sleeping pills, and the injected route. The only statistically significant negative association was with the amount of cocaine consumed among heroin users. The results suggest that other psychoactive substances besides alcohol are positively associated with injury occurrence, and that cocaine use may contribute to a reduced risk of injuries associated with the use of depressants (alcohol, tranquillizers, heroin).

Urine toxicology screens in drivers suspected of driving while impaired from drugs

OBJECTIVE

Police departments, in conjunction with the National Highway Traffic Safety Administration, have developed a standardized evaluation aimed at identifying drivers impaired by drugs other than ethanol. These evaluations are performed by specially trained police officers known as Drug Recognition Experts.

METHODS

We retrospectively reviewed the evaluations of 242 drivers detained for driving while impaired in the City and County of Denver from January 1, 1988 to June 30, 1990.

RESULTS

All drivers had urine toxicology screens performed, which were positive for a mean 1.2 +/- 0.9 SD (range zero to four) for drugs having the potential for causing driving impairment. The 193/242 urine screens (79.8%) testing positive showed the following drugs: cannabis 162 (66.9%), stimulants (including cocaine metabolites) 80 (33.1%), depressants (benzodiazepines and barbiturates) 24 (9.9%), narcotics 12 (5.0%), inhalants (toluene) 1 (0.4%), hallucinogens (LSD) 1 (0.4%), and other 3 (1.2%). Drug Recognition Experts, based on their initial evaluation, were able to predict correctly some or all of the drugs found on the urine screens in 178/242 (73.6%) of cases. Overall agreement between the Drug Recognition Experts opinions and urine screen results had a kappa value (p < 0.05) of 0.41.

CONCLUSIONS

There was a high rate (79.8%) of positive urine toxicology screens in drivers suspected of nonethanol drug impairment. In most cases, Drug Recognition Experts were able to reliably predict the results of these screens.