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Pelletti G, Boscolo-Berto R, Anniballi L, Giorgetti A, Pirani F, Cavallaro M, Giorgini L, Fais P, Pascali JP, Pelotti S. Prevalence of alcohol-impaired driving: a systematic review with a gender-driven approach and meta-analysis of gender differences. Int J Legal Med 2024:10.1007/s00414-024-03291-3. [PMID: 39060442 DOI: 10.1007/s00414-024-03291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND A growing number of studies investigated the factors that contribute to driving under the influence (DUI) of alcohol in relation to gender. However, a gendered approach of the scientific evidence is missing in the literature. To fill this gap, a gender-driven systematic review on real case studies of the last two decades was performed. In addition to the gender of the drivers involved, major independent variables such as the period of recruitment, the type of drivers recruited, and the geographical area where the study was conducted, were examined. Afterwards, a meta-analysis was performed comparing alcohol-positive rates (APR) between male and female drivers in three subgroups of drivers: those involved in road traffic accidents, those randomly tested on the road, and volunteers. METHODS Three databases were searched for eligible studies in October 2023. Real-case studies reporting APR in man and women convicted for DUI of alcohol worldwide were included. Univariate analysis by ANOVA with post-hoc tests identified the independent variables with a significant impact on the dependent variable APR, according to a relationship subsequently investigated by standard multiple linear regression. The meta-analysis of random effects estimates was performed to investigate the change in overall effect size (measured by Cohen's d standardized mean difference test) and 95% confidence interval (CI). RESULTS Among papers addressing driver gender, univariate analysis of independent variables revealed a higher Alcohol Positive Rate (APR) in men, particularly in drivers involved in crashes, with a noticeable decrease over time. Analyzing the gender of drivers involved in crashes, the meta-analysis showed that men had a significantly higher APR (30.7%; 95%CI 26.8-35.0) compared to women (13.2%; 95%CI 10.7-16.1). However, in drivers randomly tested, there was no significant difference in APR between genders (2.1% for men and 1.4% for women), while in volunteers, there was a statistically significant difference in APR with 3.4% (95%CI 1.5-7.6) for men and 1.1% (95%CI 0.5-2.7) for women. CONCLUSION Despite a progressive decrease in the epidemiological prevalence of alcohol-related DUI over time, this phenomenon remains at worryingly high levels among drivers involved in road traffic accidents in both genders, with a higher prevalence in men. It's important for policymakers, professionals, and scientists to consider gender when planning research, analysis, interventions, and policies related to psychoactive substances, such as alcohol or other licit drugs. Forensic sciences can play a vital role in this regard, enabling a thorough analysis of gender gaps in different populations.
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Affiliation(s)
- Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Rafael Boscolo-Berto
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Via A. Gabelli 65, Padua, 35127, Italy
| | - Laura Anniballi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Arianna Giorgetti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Filippo Pirani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Mara Cavallaro
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Luca Giorgini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy.
| | - Jennifer Paola Pascali
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
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Paland N, Hamza H, Pechkovsky A, Aswad M, Shagidov D, Louria-Hayon I. Cannabis and Rheumatoid Arthritis: A Scoping Review Evaluating the Benefits, Risks, and Future Research Directions. Rambam Maimonides Med J 2023; 14:RMMJ.10509. [PMID: 37917863 PMCID: PMC10619990 DOI: 10.5041/rmmj.10509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Rheumatoid diseases, including rheumatoid arthritis, osteoarthritis, and fibromyalgia, are characterized by progressive inflammation in the musculoskeletal system, predominantly affecting the joints and leading to cartilage and bone damage. The resulting pain and ongoing degradation of the musculoskeletal system contribute to reduced physical activity, ultimately impacting quality of life and imposing a substantial socioeconomic burden. Unfortunately, current therapeutics have limited efficacy in slowing disease progression and managing pain. Thus, the development of novel and alternative therapies is imperative. Cannabinoids possess beneficial properties as potential treatments for rheumatoid diseases due to their anti-inflammatory and analgesic properties. Preclinical studies have demonstrated promising results in halting disease progression and relieving pain. However, there is a scarcity of patient clinical studies, and the available data show mixed results. Consequently, there are currently no established clinical recommendations regarding the utilization of cannabis for treating rheumatoid diseases. In this review, we aim to explore the concept of cannabis use for rheumatoid diseases, including potential adverse effects. We will provide an overview of the data obtained from preclinical and clinical trials and from retrospective studies on the efficacy and safety of cannabis in the treatment of rheumatoid diseases.
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Affiliation(s)
- Nicole Paland
- Medical Cannabis Research and Innovation Center, Rambam Health Care Campus, Haifa, Israel
| | - Haya Hamza
- Medical Cannabis Research and Innovation Center, Rambam Health Care Campus, Haifa, Israel
| | - Antonina Pechkovsky
- Medical Cannabis Research and Innovation Center, Rambam Health Care Campus, Haifa, Israel
| | - Miran Aswad
- Medical Cannabis Research and Innovation Center, Rambam Health Care Campus, Haifa, Israel
| | - Dayana Shagidov
- Medical Cannabis Research and Innovation Center, Rambam Health Care Campus, Haifa, Israel
| | - Igal Louria-Hayon
- Medical Cannabis Research and Innovation Center, Rambam Health Care Campus, Haifa, Israel
- Clinical Research Institute at Rambam (CRIR), Rambam Health Care Campus, Haifa, Israel
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Cinquetti A, Terranova C, Aprile A, Favretto D. Driving license regranting: Hair EtG, serum CDT, and the role of sociodemographic and medicolegal variables. Drug Test Anal 2023; 15:953-961. [PMID: 36525282 DOI: 10.1002/dta.3426] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
Driving under the influence (DUI) of alcohol is a road safety problem. Driving license regranting is based on the evaluation of medicolegal and toxicological variables that may include serum carbohydrate-deficient transferrin (CDT) and hair ethyl glucuronide (hEtG). The aim of the study was to compare the diagnostic performance of CDT and hEtG in a population of DUI offenders. Other factors potentially associated with heavy alcohol use were explored. The population included DUI offenders examined during the period of January 1, 2019, through June 30, 2022. Sociodemographic, medicolegal, and toxicological variables were collected. CDT in serum and EtG in head hair were determined in all subjects. Excessive alcohol intake (hEtG ≥30 pg/mg) was considered cause for unfitness to drive. Cohen's kappa coefficient was calculated. Descriptive analyses were performed using chi-square and Mann-Whitney tests. Variables significantly different between the groups were included in a multivariate binary logistic regression model. The sample encompassed 838 subjects (case group: 179, comparison group: 689). CDT exhibited poor agreement (κ = 0.053) with hEtG as the reference test. Lower education, age at DUI, heavy smoking, and GGT levels associated with heavy alcohol consumption differentiated the two groups. For DUI offenders, the use of CDT to assess heavy alcohol consumption is limited, possibly due to the time-window assessed, the time required for normalization, and the different amount of ethanol needed to reach higher CDT levels, in comparison to hEtG; thus, hEtG assessment is strongly recommended for this population. Heavy smoking, GGT, education, and age could be related to heavy alcohol consumption and higher risk of DUI.
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Affiliation(s)
- Alessandro Cinquetti
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Anna Aprile
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Donata Favretto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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García-Mingo M, Martín-Fernández M, Gutiérrez-Abejón E, Álvarez FJ. Increase in driving after cocaine use in Spain: a cross-sectional dataset analysis for 2021. Front Public Health 2023; 11:1178300. [PMID: 37228715 PMCID: PMC10203456 DOI: 10.3389/fpubh.2023.1178300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/10/2023] [Indexed: 05/27/2023] Open
Abstract
Objective Driving under the influence of alcohol and/or drugs impairs skills essential for safe driving, increases the risk of being involved in a traffic accident and is particularly prevalent in Spain. The aim is to assess the prevalence of positive substance driving cases, what factors may be associated with driving after substance use, and the evolution of the progress in the prevalence of drug use among drivers in drivers based on the 2008, 2013, 2018, and 2021 studies. Study design and setting The present study was conducted in a representative sample of Spanish drivers in 2021 for alcohol (breath) and psychoactive substances [oral fluid (OF)]. The sample size was 2980 drivers, mostly males (76.5%) with a mean age of 41.35 ± 13.34 years. Results In 2021, 9.3% of drivers tested positive for alcohol and/or drugs. The presence of alcohol alone was observed in 4.2% of drivers, alcohol and another substance in 0.3%, a single drug in 4.4%, and two or drugs other than alcohol in 0.4%. Overall, cocaine cases were the highest registered in 2021 (2.4%), while cannabis (1.9%) and polydrug cases (0.7%) were the lowest, with respect to the 2008/2013/2018 studies. Conclusions According to our research, in 2021, 9 out of 100 drivers were detected to have some substance in their system. This prevalence remains unacceptably high in Spain, with a marked increase in the frequency of driving after cocaine use. Further interventions and measures must be taken to avoid driving under the influence of alcohol and/or drugs.
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Affiliation(s)
- Mercedes García-Mingo
- Institute for Alcohol and Drug Studies, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Pharmacological Big Data Laboratory, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - Marta Martín-Fernández
- Institute for Alcohol and Drug Studies, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Pharmacological Big Data Laboratory, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduardo Gutiérrez-Abejón
- Institute for Alcohol and Drug Studies, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Pharmacological Big Data Laboratory, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Pharmacy Directorate, Castilla y León Health Council, Valladolid, Spain
| | - F. Javier Álvarez
- Institute for Alcohol and Drug Studies, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Pharmacological Big Data Laboratory, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- CEIm, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Association between cannabis use and blood pressure levels according to comorbidities and socioeconomic status. Sci Rep 2023; 13:2069. [PMID: 36740601 PMCID: PMC9899770 DOI: 10.1038/s41598-022-22841-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/19/2022] [Indexed: 02/07/2023] Open
Abstract
The associations between blood pressure and cannabis use remain inconsistent. The purpose of our study was to examine gender stratified associations of cannabis use and blood pressure [systolic, diastolic blood pressure (BP), pulse pressure (PP)] levels among the general UK Biobank population based study. Among 91,161 volunteers of the UK Biobank population, cannabis use status was assessed by questionnaire and range as heavy, moderate, low and never users. Associations between cannabis use and BP were estimated using multiple gender linear regressions. In adjusted covariates models, lifetime heavy cannabis use was associated with decrease in both SBP, DBP and PP in both genders, but with a higher effect among women (for SBP in men, b = - 1.09 (0.27), p < 0.001; in women, b = - 1.85 (0.36), p < 0.001; for DBP in men, b = - 0.50 (0.15), p < 0.001; in women, b = - 0.87 (0.17), p < 0.001; and for PP in men, b = - 0.60 (0.20), p < 0.001; in women, b = - 0.97 (0.27), p < 0.001. Among men, lower SBP and DBP levels were observed with participants without dyslipidemia and lower PP in participants with high income levels. Among women, lower SBP, DBP and PP were observed with current smokers, moderate/low alcohol levels and participants without dyslipidemia. Current cannabis use was associated with lower SBP levels in men (b = - 0.63 (0.25), p = 0.012) and in women (b = - 1.17 (0.31), p < 0.001). Same results were observed for DBP and PP. Negative association between BP in men was found but not in women. The small association in BP differences between heavy users and never users remains too small to adopt cannabis-blood pressure public policy in clinical practice.
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Navarro-Moreno J, Calvo-Poyo F, de Oña J. Investment in roads and traffic safety: linked to economic development? A European comparison. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:6275-6297. [PMID: 35994145 PMCID: PMC9395817 DOI: 10.1007/s11356-022-22567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
This study analyzes how economic resources invested in roads may affect mortality, depending on the level of economic development of a country. To this end, 23 European countries were classified into two groups-high-income countries and low-income countries-according to their average Gross Domestic Product (GDP) per capita over the period 1998-2016. The economic resources are considered through the investment in construction and the maintenance expenditure. Further variables are included to control for several factors related to the infrastructure, socioeconomics, legislation, and meteorology. Fixed-effects panel data models were built separately for the interurban road network of each group of countries. These models also capture the international inequalities within each group and the country-specific national trend for the study period. The main results indicate a reduction effect on the fatality rate of road maintenance expenditure (in both groups), and of the investment in construction (in the low-income countries). Other variables-such as proportion of motorways, motorization rate, unemployment rate, GDP per capita, alcohol consumption, Demerit Point System, and mean annual precipitation-showed statistically significant results as well. Finally, the country-specific fixed effects and the country-specific trend were mapped geographically, to better reflect national conditions for achieving lower fatality rates in the high-income countries, and greater progress in reducing fatalities in the low-income countries. In the end, this study provides evidence to policy-makers that can help to achieve a safer and more sustainable transport system, namely, how to tackle an ongoing major problem-traffic-related deaths-when attending and allocating the economic resources that road infrastructure needs.
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Affiliation(s)
- José Navarro-Moreno
- TRYSE Research Group, Department of Civil Engineering, University of Granada, ETSI Caminos, Canales y Puertos, Campus de Fuentenueva, s/n, 18071 Granada, Spain
| | - Francisco Calvo-Poyo
- TRYSE Research Group, Department of Civil Engineering, University of Granada, ETSI Caminos, Canales y Puertos, Campus de Fuentenueva, s/n, 18071 Granada, Spain
| | - Juan de Oña
- TRYSE Research Group, Department of Civil Engineering, University of Granada, ETSI Caminos, Canales y Puertos, Campus de Fuentenueva, s/n, 18071 Granada, Spain
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Gender differences in driving under the influence of psychoactive drugs: Evidence mapping of real case studies and meta-analysis. Forensic Sci Int 2022; 341:111479. [DOI: 10.1016/j.forsciint.2022.111479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/18/2022]
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Hernández-Becerril Z, Orozco R, Borges G. Road traffic injuries and substance use in Latin America: A systematic review. TRAFFIC INJURY PREVENTION 2022; 23:209-214. [PMID: 35333682 DOI: 10.1080/15389588.2022.2051018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 02/19/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of the study is to identify and report the epidemiological patterns of substance use on fatal and non-fatal road traffic injuries (RTIs) in Latin America. METHODS A systematic review identified all published studies from January 2010 through October 2020. Twenty-eight studies were included from PubMed and SciELO databases. The Newcastle-Ottawa scale was used to assess the methodological quality of the studies. RESULTS The prevalence of alcohol consumption in fatal RTIs in studies where 100% of the target population were tested varies from 15.3% up to 55% in Brazil; with respect to non-fatal RTIs, it varies from 9.1% in car drivers in Brazil to 24.1% in emergency patients in Argentina. The most studied drug other than alcohol was cannabis, present in 6.5% up to 20.8% of non-fatal RTIs cases, but lower rates of testing for drugs was reported. Few studies reported epidemiological association measures. CONCLUSIONS This article shows that scientific production on substance use and RTIs in the region is limited and reports the prevalence of substance use, with few estimates of the relative risk of drug use and RTIs.
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Affiliation(s)
- Zaide Hernández-Becerril
- Nursing Department, Hospital General Regional No. 2 "Mexican Institute of Social Security", Mexico City, Mexico
- Doctorate Program in Medical, Odontology and Health Sciences of the National Autonomous, University of Mexico, Mexico City, Mexico
| | - Ricardo Orozco
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Guilherme Borges
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
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Blandino A, Cotroneo R, Tambuzzi S, Di Candia D, Genovese U, Zoja R. Driving under the influence of drugs: Correlation between blood psychoactive drug concentrations and cognitive impairment. A narrative review taking into account forensic issues. Forensic Sci Int Synerg 2022; 4:100224. [PMID: 35330981 PMCID: PMC8938866 DOI: 10.1016/j.fsisyn.2022.100224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022]
Abstract
Driving under the influence of alcohol has been shown to increase the risk of involvement in road traffic collisions (RTCs) however, less is known about the effects of illicit drugs, and a clear correlation between drug concentrations and RTC risk is still debated. The goal of this narrative review is to assess the current literature regarding the most detected psychoactive drugs in RTC (ethanol, amphetamines, cannabis, opioids and cocaine), in relation to driving performance. Evidence on impaired driving due to psychoactive substances, forensic issues relating to the assessment of the impact of drugs, blood cut-off values proposed to date as well as scientific basis for proposed legislative limits are discussed. At present there is no unequivocal evidence demonstrating a clear dose/concentration dependent impairment in many substances. Per se and zero tolerance approaches seem to have negative effect on drugged driving fatalities. However, the weight of these approaches needs further investigation.
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Affiliation(s)
- Alberto Blandino
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Rosy Cotroneo
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Stefano Tambuzzi
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Domenico Di Candia
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Umberto Genovese
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Riccardo Zoja
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
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Oyono Y, Gjerde H, Kelley-Baker T, Asongalem EA, Kouomogne Nteungue BA, Tayimetha CY, Djouyep Momo O, Biwole Biwole CP, Mekolo Owandja D, Ngono V, Djakari Y, Ramaekers JG, Achidi Akum E. Prevalence of alcohol among drivers, riders and pedestrians injured in road traffic crashes in Cameroon: a cross-sectional study. Int J Inj Contr Saf Promot 2022; 29:340-347. [DOI: 10.1080/17457300.2022.2030365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yannick Oyono
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Favretto D, Visentin S, Jones AW. Prevalence and concentrations of sedative-hypnotic drugs in blood of drivers involved in road traffic crashes in the Padova region of Italy - not so easy to interpret. Forensic Sci Int 2021; 330:111097. [PMID: 34814082 DOI: 10.1016/j.forsciint.2021.111097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND & OBJECTIVES This study reports the prevalence and concentrations of sedative-hypnotic drugs as exemplified by benzodiazepines (BZD) and zolpidem (Z-hypnotic) in blood samples from drivers involved in road traffic accidents (RTA) in the Padova region of Italy. Another aim of the study was to estimate the prevalence of these drugs with concentrations in blood above the therapeutic intervals and above specific per se limits. METHODS A total of 4066 blood samples collected from drivers involved in RTA were analysed for the presence of alcohol, drugs of abuse and medicinal drugs with sedative-hypnotic properties. Prevalence of drivers positive for BZDs and zolpidem were reported according to the reporting limit of our laboratory (1 ng/mL) in a sort of zero tolerance approach and compared with the prevalence according to analytical cut-offs used in the "European Union's research project on Driving Under the Influence of Drugs, Alcohol and Medicines" (DRUID). The impairment-based, per se limits adopted in Norway and in England and Wales and the values used to define "therapeutic ranges" in blood and in plasma/serum were also applied to the case study. RESULTS 175 blood samples were positive for sedative-hypnotics above 1 ng/mL, with the following prevalence: diazepam 44%, nordazepam 41.8%, lorazepam 32.6%, zolpidem 28%, oxazepam 25.6%, alprazolam 16%, delorazepam 11,6%, lormetazepam 11,6%, temazepam 11.6%, clonazepam 11.6%, triazolam 6.9%, N-desalkylflurazepam 4.6%, bromazepam 2.3%. When applying DRUID analytical cut-offs, the prevalence of BZDs and zolpidem sharply decreases. Applying the impairing cut-offs used in Norway, 56% of positive samples were above the limits equivalent to a BAC of 0.2 g/L, 39% above the limits corresponding to 0.5 g/L, and 23% above the cut-off corresponding to 1.2 g/L. Only 1% of the drivers had drug concentrations above the per se concentration limits adopted in England and Wales [26]. When comparing blood levels with therapeutic ranges in plasma, bromazepam, lormetazepam and delorazepam were often found above the highest limits. The adjustment of the concentrations with the plasma-to-blood ratios causes a significant increase of cases above the therapeutic ranges in plasma. CONCLUSIONS Sedative-hypnotic drugs are medicinal substances frequently identified in drivers involved in RTA, commonly in concentrations associated with driving impairment. Besides the concentrations of drugs in blood, several factors have to be considered to conclude that a driver was impaired. The frequent association with alcohol, cocaine and other BZDs, confirms the abuse potential of these medications.
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Affiliation(s)
- Donata Favretto
- University Hospital of Padova, Legal Medicine and Toxicology, Via Falloppio 50, Padova, Italy.
| | | | - Alan W Jones
- Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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Gerbase FE, Tegner M, Krutzmann ME, Muller VV, Alff JDA, da Silva VB, Sagrilo OP, Linden R, Antunes MV. Blood phosphatidyl ethanol levels as a tool to detect alcohol misuse in trauma patients. Clin Toxicol (Phila) 2020; 59:418-425. [PMID: 33021410 DOI: 10.1080/15563650.2020.1822531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION There is a strong need for a reliable marker of harmful alcohol consumption to identify injured patients that can benefit from alcohol interventions, and blood phosphatidyl ethanol (PEth) has not previously been tested on this population. This study aims to compare the performance of blood PEth concentration, blood alcohol concentration (BAC) and the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) for the screening of alcohol misuse in trauma patients. METHODS Prospective cross-sectional study of 238 adult patients presenting in the emergency department with any type of trauma. PEth concentration was determined in whole blood by high-performance liquid chromatography with tandem mass spectrometry. Consent, AUDIT-C score and demographic data were obtained. RESULTS The sample consisted of majority male (67.6%), single (46.2%) and employed (66%) patients. The most common type of trauma was traffic collision (63.9%). The mean age was 41.7 years. We found a significant correlation between PEth levels with AUDIT-C score (Spearman's r = 0.654; p < .0001). PEth had an area under the ROC curve of 0.885 to detect hazardous alcohol consumption (AUDIT-C score ≥ 6) and PEth ≥23.9 ng/mL cutoff point provided 91.2% of sensitivity and 78.4% of specificity. Twelve patients reported alcohol abstinence, but had quantifiable levels of PEth. CONCLUSIONS PEth levels and AUDIT-C score had a moderate correlation in our population. PEth was useful to identify 12 cases of underreporting of alcohol consumption habits. PEth shows promising results, but more research is needed to identify the best screening tool for alcohol misuse in trauma patients.
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Affiliation(s)
- Fernando Engel Gerbase
- Postgraduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil.,Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil.,Emergency Department, Novo Hamburgo Municipal Hospital, Novo Hamburgo, Brazil
| | - Mariane Tegner
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Maria Eduarda Krutzmann
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Victória Vendramini Muller
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Jonatan de Andrade Alff
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Vanessa Becher da Silva
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | | | - Rafael Linden
- Postgraduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil.,Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Marina Venzon Antunes
- Postgraduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil.,Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
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13
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Forson PK, Oduro G, Bonney J, Cobbold S, Sarfo-Frimpong J, Boyd C, Maio R. Emergency department admissions Kumasi, Ghana: Prevalence of alcohol and substance use, and associated trauma. J Addict Dis 2020; 38:520-528. [PMID: 32664825 DOI: 10.1080/10550887.2020.1791378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Alcohol and substance use (ASU) are significant contributors to global morbidity, mortality, and health resource utilization. We sought to describe the frequency of ASU use among adult injured patients presenting to the Komfo Anokye Teaching Hospital Emergency Department (KATH ED) and to describe injury mechanism and site among injured patients. METHODS A cross-sectional study was carried out for six months in 2016 involving all trauma patients and altered mental status patients presenting to the ED in Kumasi, Ghana. Blood alcohol concentration was evaluated with SureScreen Alcometer Breathalyzer, which provided a numeric breath alcohol concentration in mg/L units (BAC). Substance presence was evaluated using saliva strips with Micro-Distribution STATSWAB 6 panel oral fluid devices. Medical charts were reviewed retrospectively for details of history after testing was done at triage. RESULTS The total number of patients tested for substance use was 171 comprising 146 trauma patients and 25 non-trauma patients with altered mental statuses. Twenty-four percent (41) of patients tested positive for drugs. Of these 41, 29 tested positive for marijuana, six tested for opiates, two tested for oxycodone, two tested positive for cocaine, one tested positive for benzodiazepines, and one tested positive for methamphetamines. About a third (29%) of the patients tested positive for alcohol. Eleven patients (6.4%) tested positive for ASU. Road traffic injuries were the commonest mechanism of injury. Lower limb (42.1%), upper limb (29.2%), and head injuries constituted the most common injuries. CONCLUSION ASU may be a preventable cause of injuries among adults presenting to KATH ED.
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Affiliation(s)
- Paa Kobina Forson
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Emergency Medicine Research Office, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - George Oduro
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Emergency Medicine Research Office, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Emergency Medicine Research Office, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sonia Cobbold
- Emergency Medicine Research Office, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Carol Boyd
- Centre for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.,Injury Prevention Centre, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald Maio
- Injury Prevention Centre, University of Michigan, Ann Arbor, Michigan, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Masud M, Chan H, Erdelyi S, Yuan Y, Brubacher JR. Epidemiology of drug driving: protocol from a national Canadian study measuring levels of cannabis, alcohol and other substances in injured drivers. BMC Public Health 2020; 20:1070. [PMID: 32631283 PMCID: PMC7339401 DOI: 10.1186/s12889-020-09176-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 11/11/2022] Open
Abstract
Background Drug driving is an emerging global road safety problem. As the prevalence of alcohol-impaired driving decreases, and as more jurisdictions decriminalize or legalize cannabis, it is increasingly important for policy makers to have accurate information on the prevalence and pattern of drug driving. Unfortunately, this data is not widely available and the World Health Organization identifies lack of accurate data on the prevalence of drug driving as an important knowledge gap. Methods In this paper, we discuss the limitations of current methods of monitoring drug use in drivers. We then present a novel methodology from a multi-centre study that monitors the prevalence and pattern of drug use in injured drivers across Canada. This study uses “left-over” blood taken as part of routine medical care to quantify cannabis and other drugs in non-fatally injured drivers who present to participating emergency departments after a collision. Toxicology testing is done with waiver of consent as we have procedures that prevent results from being linked to any individual. These methods minimize non-response bias and have the advantages of measuring drug concentrations in blood obtained shortly after a collision. Discussion Our methods can be applied in other jurisdictions and provide a consistent approach to collect data on drug driving. Consistent methods allow comparison of drug driving prevalence from different regions. Data from this research can be used to inform policies designed to prevent driving under the influence of cannabis and other impairing drugs.
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Affiliation(s)
- Manal Masud
- Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Herbert Chan
- Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Yue Yuan
- Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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DeGregorio MW, Audino SA, Montoya E, Phong A, Kao CJ, Wurz GT. Development and Validation of a Liquid Chromatography High-Resolution Mass Spectrometry (LC-HRMS) Bioanalytical Method for Quantifying Cannabinoids in Whole Blood: Application for Determining Recent Cannabis Use. J AOAC Int 2020; 103:725-735. [PMID: 33241370 DOI: 10.1093/jaocint/qsz011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cannabis legalization is expanding rapidly throughout the United States, but there is no reliable means of establishing recent use. OBJECTIVE To develop and validate a bioanalytical method for determination of Δ9-tetrahydrocannabinol (Δ9-THC), cannabinol, 11-hydroxy-Δ9-THC, 11-nor-9-carboxy-Δ9-THC, and 8β,11-dihydroxy-Δ9-THC in whole blood microsamples by liquid chromatography high-resolution mass spectrometry (LC-HRMS). METHODS Cannabinoid extraction from whole blood was performed using a mixture of n-hexane/ethyl acetate (90:10, v/v). Chromatographic separation was performed with a C18 column using a binary mobile phase gradient of water and acetonitrile, each with 0.1% formic acid. Detection was performed by positive ion mode heated electrospray ionization with full scan MS on an Orbitrap mass spectrometer. A clinical study was performed in 30 subjects to identify recent cannabis use based on analysis of cannabinoids in blood samples up to 200 min post-smoking. RESULTS Acceptable linearity of all calibration curves was observed (r2>0.99) for all analytes over a 1-100 ng/mL concentration range, with acceptable accuracy. Limit of detection (LOD) was 0.5 ng/mL. Accuracy and precision met acceptance criteria for all analytes. Repeatability (CV) was <5% at low (3 ng/mL) and high (90 ng/mL) concentrations. In the clinical study, the ratios between 11-nor-9-carboxy-Δ9-THC and Δ9-THC fell immediately after smoking and returned to near baseline levels by 200 min post-smoking, which is consistent with recent use. CONCLUSIONS AND HIGHLIGHTS The developed LC-HRMS bioanalytical method is suitable for quantification of five key cannabinoids in whole capillary blood microsamples and can be used in conjunction with a test for determining recent cannabis use.
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Affiliation(s)
| | - Susan A Audino
- RCU Labs, Inc., 408 Sunrise Avenue, Roseville, CA 95661, USA.,S.A. Audino & Associates, LLC, 318 Rockmeade Drive, Wilmington, DE 19810, USA
| | - Edward Montoya
- RCU Labs, Inc., 408 Sunrise Avenue, Roseville, CA 95661, USA
| | - Aron Phong
- RCU Labs, Inc., 408 Sunrise Avenue, Roseville, CA 95661, USA
| | - Chiao-Jung Kao
- RCU Labs, Inc., 408 Sunrise Avenue, Roseville, CA 95661, USA
| | - Gregory T Wurz
- RCU Labs, Inc., 408 Sunrise Avenue, Roseville, CA 95661, USA
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16
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Scherer M, Marques P, Manning AR, Nochajski TH, Romano E, Taylor E, Voas R, King S. Potential for cannabis adaptation among participants in a drunk driving intervention. JOURNAL OF SUBSTANCE USE 2020; 25:605-609. [PMID: 34290567 DOI: 10.1080/14659891.2020.1749950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Some alcohol interventions have been found to have the adverse outcome of increasing non-alcohol-related substance use. It is unknown, however, how changes in alcohol use over the course of alcohol ignition interlocks - a common DUI intervention - may impact other substance use. Methods Alcohol and cannabis use were measured using hair ethylglucuronide and Delta-9-Tetrahydrocannabinol concentrations in blood, respectively. Participants (N = 69) were measured at the interlock installation period and again 6-months later while the interlock was installed. A mixed ANOVA was conducted to examine changes in levels of ethanol and THC over time. Results On measures of marijuana use, there was a significant interaction effect between the group that increased alcohol use and time F(2, 66) = 7.863, p =.001; partial η 2 =.192; as well as a main effect for time F(2, 66) = 21.106, p <.001; partial η 2 =.242. Conclusions Installing interlocks may inadvertently increase cannabis use among those who decrease alcohol use. Crash risk associated with cannabis use is notably less than that of alcohol use, however, continued cannabis use may be problematic when the device is removed and alcohol use is expected to return to the higher pre-interlock levels.
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Affiliation(s)
- Michael Scherer
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA.,Clinical Psychology Department, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Paul Marques
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
| | - Amy R Manning
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA.,University at Buffalo, the State University of New York, Buffalo, NY, USA
| | - Thomas H Nochajski
- University at Buffalo, the State University of New York, Buffalo, NY, USA
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
| | - Eileen Taylor
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
| | - Robert Voas
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
| | - Sagan King
- Clinical Psychology Department, The Chicago School of Professional Psychology, Washington, DC, USA
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Barone R, Pelletti G, Garagnani M, Giusti A, Marzi M, Rossi F, Roffi R, Fais P, Pelotti S. Alcohol and illicit drugs in drivers involved in road traffic crashes in Italy. An 8-year retrospective study. Forensic Sci Int 2019; 305:110004. [PMID: 31707239 DOI: 10.1016/j.forsciint.2019.110004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023]
Abstract
This study aims to investigate the prevalence of alcohol and drugs of abuse in Italian drivers involved in road traffic crashes between 2011 and 2018. Toxicological analyses were performed on the whole blood of 7593 injured drivers. Alcohol and illicit drugs, namely tetrahydrocannabinol (THC; cut-off 2ng/ml), cocaine (cut-off 10ng/ml), illicit opiates (cut-off 10ng/ml) and amphetamines (amphetamine, methamphetamine, MDMA, MDA; cut-off 20ng/ml) were investigated. The age and gender of the driver, the time of the crash (weekend/weekday and day/night), the road crash year and Blood Alcohol Concentration (BAC) were also considered. The 16.2% of samples tested positive for alcohol, 2.5% for cocaine, followed by opiates (2.0%), cannabinoids (1.5%), and amphetamines (0.5%). The overall prevalence of alcohol and drugs was lower than those reported in previous epidemiological studies of the DRUID project. The year 2011 showed the highest prevalence of drug-positive cases (24.1%), while the lowest prevalence was found in 2016 (16.8%), after the update of the Road Traffic Law (RTL) that increased punishments for driving under the influence. A progressive increase in the number of alcohol-positive female drivers was observed from 2011 to 2018, and the highest prevalence was found in the 26-35-year-old age range. Illicit drugs showed the highest overall prevalence in drivers <26 years of age but, if considering single drugs, cocaine and opiates were mostly found in subjects older than 36 years of age. A higher percentage of drug-positive drivers was found on weekend nights for alcohol and on both weekend and weekday nights for drugs. The types of drugs used by drivers did not change during the studied period.
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Affiliation(s)
- Rossella Barone
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Alessio Giusti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Mattia Marzi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Francesca Rossi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Raffaella Roffi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
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Pelletti G, Verstraete AG, Reyns T, Barone R, Rossi F, Garagnani M, Pelotti S. Prevalence of therapeutic drugs in blood of drivers involved in traffic crashes in the area of Bologna, Italy. Forensic Sci Int 2019; 302:109914. [PMID: 31419592 DOI: 10.1016/j.forsciint.2019.109914] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Psychoactive medicines, such as benzodiazepines and Z-drugs (BdZ), antidepressants and antipsychotics (AA) and medical opioids (MO), have an impairing effect on driving ability. In previous epidemiological studies performed on impaired and/or injured drivers, not all relevant psychoactive substances were included in the toxicological assessment, and their prevalence may be underestimated. This study aims to assess the prevalence of a large set of psychoactive substances (n=53) in Italian drivers involved in a road traffic crash and in predefined population subgroups. MATERIALS AND METHODS The toxicological analyses were performed on the whole blood of 1026 drivers involved in a road traffic crash in the area of Bologna, Italy, from January 2017 to March 2018. Analyses were performed using GC-FID (alcohol), GCMS (illicit drugs) and LC/HRMS (psychoactive drugs). The population was divided into subgroups according to gender, age and crash time. Descriptive statistics were used in order to assess differences among sub-groups. RESULTS The highest prevalence was found for alcohol (17.3%), followed by medicinal drugs (13.6%) and illicit drugs (5.5%). The prevalence of BdZ, AA and MO were 7.3%, 7.2% and 3.1%, respectively. The frequency of BDZ and AA was significantly higher in female drivers and showed higher prevalence at increasing age. The presence of medicinal drugs was significantly higher during the week and in crashes occurring during the day. CONCLUSION Results for alcohol and illicit drugs partially overlap with those reported in previous European and Italian studies, but the prevalence of BdZ was much higher. We also found a high prevalence of AA, which are rarely investigated in epidemiological studies performed on drivers, but may cause impairment of the ability to drive, especially when taken in combination with alcohol or other drugs. The pattern of medication use differs from that involving drugs of abuse, since it is mainly observed in female subjects and older drivers and does not follow the same weekly trend observed for alcohol and other illicit drugs.
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Affiliation(s)
- Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Alain G Verstraete
- Ghent University Hospital, Department of Laboratory Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Diagnostic Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Tim Reyns
- Ghent University Hospital, Department of Laboratory Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Diagnostic Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Rossella Barone
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Francesca Rossi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
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Favretto D, Visentin S, Stocchero G, Vogliardi S, Snenghi R, Montisci M. Driving under the influence of drugs: Prevalence in road traffic accidents in Italy and considerations on per se limits legislation. TRAFFIC INJURY PREVENTION 2019; 19:786-793. [PMID: 30024768 DOI: 10.1080/15389588.2018.1500018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The objective of this study was to present the prevalence and concentrations of drugs in blood samples of drivers involved in road traffic accidents (RTAs) and to discuss the effects of adopting different concentration cutoff values proposed or applied in other European countries on the number of driving under the influence of drugs (DUID) offenses. METHODS Blood samples from drivers involved in RTAs in Padova province from 2014 to 2017 were analyzed for the presence of alcohol and drugs. The prevalence of positive subjects was reported for each substance adopting the limits of quantification (LOQs) of our laboratory and the concentration cutoff values proposed and/or used in other European countries. The reduction of cases of driving under the influence of illicit drugs in applying different cutoffs was calculated. RESULTS Four thousand four hundred forty-three blood samples were analyzed: 23.7% were positive for alcohol and 19.9% for psychoactive drugs, with prevalences of polydrug and alcohol-drug abuse of 4.5 and 6%, respectively. The most frequently detected drugs were cannabinoids (9.7%) and cocaine (7.2%), followed by benzodiazepines (4.1%), opiates (1.9%), and other opioids (1.7%). Barbiturates, amphetamines, and ketamine were identified in a much smaller number of cases. The overall decrease in DUID cases when adopting different cutoffs with respect to cases above the LOQs was between 8 and 84%. The adoption of high LOQs such as those used in the European Union's research project on Driving Under the Influence of Drugs, Alcohol and Medicines (DRUID) decreases the hypothetical number of DUID offenses by a quarter, and per se limits proposed as broadly equivalent to a blood alcohol concentration (BAC) between 0.2 and 0.8 g/L dramatically reduce the cases of DUID (cocaine -81%, cannabis -79%, opioids -97%, opiates -96%, and amphetamines -77%); no ketamine-positive samples were above the cutoff. CONCLUSIONS The implementation of high analytical limits or per se limits based on impairing concentrations in the Italian legislation could result in the prosecution of a much lower number of drugged drivers involved in RTAs, with a decrease from 25% to more than 80% depending on the limits.
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Affiliation(s)
- D Favretto
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - S Visentin
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - G Stocchero
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - S Vogliardi
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - R Snenghi
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - M Montisci
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
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20
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Affiliation(s)
- Maude Marillier
- Department of Continuing Education of the Faculty of Medicine Lille University Lille France
| | - Alain G. Verstraete
- Department of Diagnostic Sciences Ghent University Ghent Belgium
- Department of Laboratory Medicine Ghent University Hospital Ghent Belgium
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21
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Carfora A, Campobasso CP, Cassandro P, Petrella R, Borriello R. Alcohol and drugs use among drivers injured in road accidents in Campania (Italy): A 8-years retrospective analysis. Forensic Sci Int 2018; 288:291-296. [DOI: 10.1016/j.forsciint.2018.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/30/2018] [Accepted: 05/02/2018] [Indexed: 11/16/2022]
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22
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Pharmacists' perceptions and communication of risk for alertness impairing medications. Res Social Adm Pharm 2018; 14:31-45. [DOI: 10.1016/j.sapharm.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/19/2016] [Accepted: 12/16/2016] [Indexed: 01/08/2023]
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Tervo T, Michelsson K, Launes J, Hokkanen L. A Prospective 30-Year Follow-Up of ADHD Associated With Perinatal Risks. J Atten Disord 2017; 21:799-810. [PMID: 25163542 DOI: 10.1177/1087054714548036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Longitudinal follow-up of ADHD suggests a poorer outcome in those affected. Studies extending to 30 years however are rare. We investigated the adult outcome of ADHD associated with perinatal risks (PRs), treated non-pharmacologically. METHOD A study group of 122 participants (86 men, 36 women) with PR-associated ADHD was followed-up from birth and compared with a control group also prospectively studied. RESULTS The study group showed more cognitive, motor perception, and learning impairments as well as psychiatric problems at ages 5, 9, and 16. At age 30, the study group reported less education, more involuntary job dismissals and more alcohol abuse. Self-reported ADHD symptoms were still prevalent in adulthood. CONCLUSION ADHD symptoms persist and impair the long-term educational, occupational, and psychiatric outcome. ADHD in participants with PR appears to follow a course seen in studies of unselected ADHD.
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25
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Hartman RL, Richman JE, Hayes CE, Huestis MA. Drug Recognition Expert (DRE) examination characteristics of cannabis impairment. ACCIDENT; ANALYSIS AND PREVENTION 2016; 92:219-229. [PMID: 27107471 DOI: 10.1016/j.aap.2016.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/08/2016] [Accepted: 04/09/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Drug Evaluation and Classification Program (DECP) is commonly utilized in driving under the influence (DUI) cases to help determine category(ies) of impairing drug(s) present in drivers. Cannabis, one of the categories, is associated with approximately doubled crash risk. Our objective was to determine the most reliable DECP metrics for identifying cannabis-driving impairment. METHODS We evaluated 302 toxicologically-confirmed (blood Δ(9)-tetrahydrocannabinol [THC] ≥1μg/L) cannabis-only DECP cases, wherein examiners successfully identified cannabis, compared to normative data (302 non-impaired individuals). Physiological measures, pupil size/light reaction, and performance on psychophysical tests (one leg stand [OLS], walk and turn [WAT], finger to nose [FTN], Modified Romberg Balance [MRB]) were included. RESULTS Cases significantly differed from controls (p<0.05) in pulse (increased), systolic blood pressure (elevated), and pupil size (dilated). Blood collection time after arrest significantly decreased THC concentrations; no significant differences were detected between cases with blood THC <5μg/L versus ≥5μg/L. The FTN best predicted cannabis impairment (sensitivity, specificity, positive/negative predictive value, and efficiency ≥87.1%) utilizing ≥3 misses as the deciding criterion; MRB eyelid tremors produced ≥86.1% for all diagnostic characteristics. Other strong indicators included OLS sway, ≥2 WAT clues, and pupil rebound dilation. Requiring ≥2/4 of: ≥3 FTN misses, MRB eyelid tremors, ≥2 OLS clues, and/or ≥2 WAT clues produced the best results (all characteristics ≥96.7%). CONCLUSIONS Blood specimens should be collected as early as possible. The frequently-debated 5μg/L blood THC per se cutoff showed limited relevance. Combined observations on psychophysical and eye exams produced the best cannabis-impairment indicators.
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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, 251 Bayview Boulevard Ste 200 Rm 05A721, Baltimore, MD, 21224, USA.
| | - Jack E Richman
- Hingham Police Department, 212 Central Street, Hingham, MA 02043, USA.
| | - Charles E Hayes
- International Association of Chiefs of Police, 44 Canal Center Plaza, Suite 200, Alexandria, VA 22314, USA.
| | - Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Boulevard Ste 200 Rm 05A721, Baltimore, MD, 21224, USA.
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Abstract
Alcohol consumption with psychostimulants is very common among drug addicts. There is little known about the possible pharmacological interactions between alcohol and psychostimulants. Among most commonly co-abused psychostimulants with alcohol are methamphetamine, cocaine, 3,4-methylenedioxymethamphetaminen, and nicotine. Co-abuse of alcohol with psychostimulants can lead to several neurophysiological dysfunctions such as decrease in brain antioxidant enzymes, disruption of learning and memory processes, cerebral hypo-perfusion, neurotransmitters depletion as well as potentiation of drug seeking behaviour. Moreover, co-abuse of alcohol and psychostimulants can lead to increase in heart rate, blood pressure, myocardial oxygen consumption and cellular stress, and the risk of developing different types of cancer. Co-abuse of alcohol with psychostimulants during pregnancy can lead to fetal brain abnormalities. Further studies are needed to investigate the pharmacokinetics, pharmacodynamics, and neurochemical changes on co-abuse of alcohol and psychostimulants.
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Affiliation(s)
- Yusuf S Althobaiti
- University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Department of Pharmacology and Experimental Therapeutics, Toledo, OH, USA
| | - Youssef Sari
- University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Department of Pharmacology and Experimental Therapeutics, Toledo, OH, USA
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Hartman RL, Brown TL, Milavetz G, Spurgin A, Gorelick DA, Gaffney GR, Huestis MA. Effect of Blood Collection Time on Measured Δ9-Tetrahydrocannabinol Concentrations: Implications for Driving Interpretation and Drug Policy. Clin Chem 2016; 62:367-77. [PMID: 26823611 DOI: 10.1373/clinchem.2015.248492] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In driving-under-the-influence cases, blood typically is collected approximately 1.5-4 h after an incident, with unknown last intake time. This complicates blood Δ(9)-tetrahydrocannabinol (THC) interpretation, owing to rapidly decreasing concentrations immediately after inhalation. We evaluated how decreases in blood THC concentration before collection may affect interpretation of toxicological results. METHODS Adult cannabis smokers (≥1×/3 months, ≤3 days/week) drank placebo or low-dose alcohol (approximately 0.065% peak breath alcohol concentration) 10 min before inhaling 500 mg placebo, 2.9%, or 6.7% vaporized THC (within-individuals), then took simulated drives 0.5-1.3 h postdose. Blood THC concentrations were determined before and up to 8.3 h postdose (limit of quantification 1 μg/L). RESULTS In 18 participants, observed Cmax (at 0.17 h) for active (2.9 or 6.7% THC) cannabis were [median (range)] 38.2 μg/L (11.4-137) without alcohol and 47.9 μg/L (13.0-210) with alcohol. THC Cmax concentration decreased 73.5% (3.3%-89.5%) without alcohol and 75.1% (11.5%-85.4%) with alcohol in the first half-hour after active cannabis and 90.3% (76.1%-100%) and 91.3% (53.8%-97.0%), respectively, by 1.4 h postdose. When residual THC (from previous self-administration) was present, concentrations rapidly decreased to preinhalation baselines and fluctuated around them. During-drive THC concentrations previously associated with impairment (≥8.2 μg/L) decreased to median <5 μg/L by 3.3 h postdose and <2 μg/L by 4.8 h postdose; only 1 participant had THC ≥5 μg/L after 3.3 h. CONCLUSIONS Forensic blood THC concentrations may be lower than common per se cutoffs despite greatly exceeding them while driving. Concentrations during driving cannot be back-extrapolated because of unknown time after intake and interindividual variability in rates of decrease.
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Affiliation(s)
- Rebecca L Hartman
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
| | - Timothy L Brown
- National Advanced Driving Simulator, University of Iowa, Iowa City, IA
| | - Gary Milavetz
- College of Pharmacy, University of Iowa, Iowa City, IA
| | | | - David A Gorelick
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Gary R Gaffney
- Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD;
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Jones AW. Impact of Trauma, Massive Blood Loss and Administration of Resuscitation Fluids on a Person's Blood-Alcohol Concentration and Rate of Ethanol Metabolism. Acad Forensic Pathol 2016; 6:77-88. [PMID: 31239874 DOI: 10.23907/2016.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/30/2015] [Accepted: 12/05/2015] [Indexed: 11/12/2022]
Abstract
Excessive drinking and drunkenness are tightly linked to many types of intentional and unintentional injuries involving trauma and blood loss, which often necessitate emergency medical intervention. This article considers the impact of trauma, massive blood loss, and the administration of life-saving replacement fluids on a person's blood alcohol concentration (BAC) and rate of ethanol metabolism. Both German and English language journals were reviewed and results from animal experiments, human studies, and actual victims of trauma undergoing life-saving treatment were considered. If trauma-related bleeding occurs when some ingested alcohol remains unabsorbed in the stomach, then under these circumstances continued absorption into portal venous blood is delayed, owing to altered splanchnic circulation. Hemodilution caused by administration of replacement fluids has only minimal effects on a preexisting BAC, because ethanol distributes into the total body water (TBW) compartment, which represents 50-60% of body weight. After hypovolemia there is a transfer of fluids from tissue compartments into the blood, which becomes more like plasma in composition with lower hematocrit and hemoglobin content. Unless the trauma or emergency treatment impedes hepatic blood flow, the rate of ethanol metabolism is not expected to differ from normal values, namely 0.10-0.25 g/L/h (0.01-0.025 g% per h). If ethanol is fully absorbed and distributed in all body fluids and tissues, neither massive blood loss nor administration of resuscitating fluids is expected to have any significant effect on a preexisting BAC or the rate of ethanol metabolism.
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Affiliation(s)
- Alan W Jones
- Department of Clinical Pharmacology, Faculty of Medicine, University of Linköping, Sweden
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Hartman RL, Brown TL, Milavetz G, Spurgin A, Pierce RS, Gorelick DA, Gaffney G, Huestis MA. Cannabis effects on driving longitudinal control with and without alcohol. J Appl Toxicol 2016; 36:1418-29. [DOI: 10.1002/jat.3295] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Rebecca L. Hartman
- Chemistry and Drug Metabolism, Intramural Research Program; National Institute on Drug Abuse, NIH; 251 Bayview Boulevard Street, 200 Rm 05A721 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
- 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 Street, 200 Rm 05A721 Baltimore MD USA
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Kaar SJ, Gao CX, Lloyd B, Smith K, Lubman DI. Trends in cannabis-related ambulance presentations from 2000 to 2013 in Melbourne, Australia. Drug Alcohol Depend 2015; 155:24-30. [PMID: 26361711 DOI: 10.1016/j.drugalcdep.2015.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/28/2015] [Accepted: 08/25/2015] [Indexed: 01/14/2023]
Abstract
AIMS The current burden of cannabis-related presentations to emergency health services is largely unknown. This paper presents data collected over a 13-year period in metropolitan Melbourne, Australia as part of the Ambo Project, a unique surveillance system that analyses and codes paramedic records for drug-related trends and harms. METHODS Cannabis-related ambulance attendances involving 15-59 year olds in metropolitan Melbourne were analysed retrospectively from 2000 to 2013 (n=10,531). Trends and attendance characteristics were compared among cannabis only (CO)-, cannabis and alcohol (CA)- and cannabis with polydrug use (CP)-related attendances. Changes in alcohol and drug involvements in cannabis-related attendances were explored. RESULTS Rates of cannabis-related ambulance attendances increased significantly over the study period. Increasing rate of attendances per 100,000 population per year changed from 0.6 (2000-2010) to 5.5 (2010-2013). This sharp change was driven by CO- and CP-related attendances (rate of CA-related attendance increased steadily). The highest increasing rate (15.6) was for CO-related attendances among 15-29 years old males (2010-2013). Crystal methamphetamine became the most common illicit co-intoxicant amongst cannabis presentations in 2013. CONCLUSIONS Relative to the total drug-related burden on ambulance services, cannabis-related presentations appear to be a small but significant and increasing problem. Significant changes in trends across other drug involvement and demographic subgroups suggest a possible shift in the cannabis using population and/or a change in using behaviours. Public health strategies should raise awareness of the increased risk posed by cannabis polydrug use and high attendance subpopulations should be determined.
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Affiliation(s)
- Stephen J Kaar
- Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; South London and Maudsley NHS Trust, Addictions Clinical Academic Group, Lorraine Hewitt House, 12-14 Brighton Terrace, Brixton, London SW9 8DG, United Kingdom
| | - Caroline X Gao
- Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Vic 3128, Australia
| | - Belinda Lloyd
- Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Vic 3128, Australia
| | - Karen Smith
- Ambulance Victoria, PO Box 2000, Doncaster, Vic 3108, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, Vic 3065, Australia; Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Vic 3128, Australia.
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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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Jones AW, Holmgren A, Ahlner J. High prevalence of previous arrests for illicit drug use and/or impaired driving among drivers killed in motor vehicle crashes in Sweden with amphetamine in blood at autopsy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:790-3. [DOI: 10.1016/j.drugpo.2015.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 01/23/2015] [Accepted: 04/16/2015] [Indexed: 11/29/2022]
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Driving under the influence of alcohol. A 5-year overview in Piedmont, Italy. J Forensic Leg Med 2015; 34:104-8. [PMID: 26165667 DOI: 10.1016/j.jflm.2015.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/25/2015] [Accepted: 05/29/2015] [Indexed: 11/21/2022]
Abstract
Alcohol consumption represents a major health issue worldwide and a crucial factor in road accidences. This study provides information on the prevalence of alcohol in blood testing performed on 2752 subjects involved in vehicle accidents, which occurred in Piedmont (northern Italy) between 2008 and 2013. Blood alcohol concentration (BAC) was determined by an ISO 17025 accredited GC/MS procedure. Fifty-one % of positive samples showed BAC concentrations above 1.5 g/L, with a legal cut-off fixed at 0.5 g/L (and 0 g/L for specified categories such as novice and professional drivers). BAC values proved statistically different regarding the day of sampling (week or weekend days), age and gender, with a prevalence of positive results that reflects different drinking habits of a multifaceted population of alcohol consumers.
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Hartman RL, Brown TL, Milavetz G, Spurgin A, Gorelick DA, Gaffney G, Huestis MA. Controlled Cannabis Vaporizer Administration: Blood and Plasma Cannabinoids with and without Alcohol. Clin Chem 2015; 61:850-69. [PMID: 26019183 DOI: 10.1373/clinchem.2015.238287] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/19/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Increased medical and legal cannabis intake is accompanied by greater use of cannabis vaporization and more cases of driving under the influence of cannabis. Although simultaneous Δ(9)-tetrahydrocannabinol (THC) and alcohol use is frequent, potential pharmacokinetic interactions are poorly understood. Here we studied blood and plasma vaporized cannabinoid disposition, with and without simultaneous oral low-dose alcohol. METHODS Thirty-two adult cannabis smokers (≥1 time/3 months, ≤3 days/week) drank placebo or low-dose alcohol (target approximately 0.065% peak breath-alcohol concentration) 10 min before inhaling 500 mg placebo, low-dose (2.9%) THC, or high-dose (6.7%) THC vaporized cannabis (6 within-individual alcohol-cannabis combinations). Blood and plasma were obtained before and up to 8.3 h after ingestion. RESULTS Nineteen participants completed all sessions. Median (range) maximum blood concentrations (Cmax) for low and high THC doses (no alcohol) were 32.7 (11.4-66.2) and 42.2 (15.2-137) μg/L THC, respectively, and 2.8 (0-9.1) and 5.0 (0-14.2) μg/L 11-OH-THC. With alcohol, low and high dose Cmax values were 35.3 (13.0-71.4) and 67.5 (18.1-210) μg/L THC and 3.7 (1.4-6.0) and 6.0 (0-23.3) μg/L 11-OH-THC, significantly higher than without alcohol. With a THC detection cutoff of ≥1 μg/L, ≥16.7% of participants remained positive 8.3 h postdose, whereas ≤21.1% were positive by 2.3 h with a cutoff of ≥5 μg/L. CONCLUSIONS Vaporization is an effective THC delivery route. The significantly higher blood THC and 11-OH-THC Cmax values with alcohol possibly explain increased performance impairment observed from cannabis-alcohol combinations. Chosen driving-related THC cutoffs should be considered carefully to best reflect performance impairment windows. Our results will help facilitate forensic interpretation and inform the debate on drugged driving legislation.
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Affiliation(s)
- Rebecca L Hartman
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD; Program in Toxicology, University of Maryland, Baltimore, MD
| | - Timothy L Brown
- National Advanced Driving Simulator, University of Iowa, Iowa City, IA
| | - Gary Milavetz
- College of Pharmacy, University of Iowa, Iowa City, IA
| | | | - David A Gorelick
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Gary Gaffney
- Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD;
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Greydanus DE, Kaplan G, Baxter LE, Patel DR, Feucht CL. Cannabis: The never-ending, nefarious nepenthe of the 21st century: What should the clinician know? Dis Mon 2015; 61:118-75. [DOI: 10.1016/j.disamonth.2015.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Van der Linden T, Wille SMR, Ramírez-Fernandez M, Verstraete AG, Samyn N. Roadside drug testing: comparison of two legal approaches in Belgium. Forensic Sci Int 2015; 249:148-55. [PMID: 25700110 DOI: 10.1016/j.forsciint.2015.01.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Internationally, urine on-site testing has been used for detecting drivers under the influence of drugs (DUID) but more and more countries, such as Belgium, are switching to oral fluid screening. OBJECTIVE To compare the previous (published in 1999) and current (published 2009) enforcement procedures of DUID in Belgium. The two evaluated procedures differ in the way the drivers are screened by the police (signs of impairment versus signs of recent drug use), the matrix for screening (urine versus oral fluid) and the analytical cut-off concentrations in plasma. METHODS Data on positive screening and confirmation results were gathered from 1st April 2008 to 30th September 2010, when urine screening (Dipro Druglab panels test) was performed; and from 1st October 2010 to 31st March 2013, when an on-site oral fluid test (Securetec Drugwipe 5(+)) was used. RESULTS Approximately 4100 data sets related to urine screening and 3900 data sets related to oral fluid screening were studied. Eighty-eight percent of positive urine on-site tests yielded positive results in plasma for cannabis, 21% for cocaine, 20% for amphetamines and 7% for opiates. Sixty-six percent of the positive oral fluid on-site tests yielded positive results in plasma for cannabis, 30% for cocaine, 28% for amphetamines and 8% for opiates. For cannabis, opiates and amphetamines more negative results in plasma were observed in the period of urine screening. CONCLUSIONS The percentage of plasma samples of tested drivers, in which none of the positive screened target drugs were present in a concentration above the legal cut-off value, has decreased from 17% to 8% since the introduction of the current legislation involving oral fluid screening.
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Affiliation(s)
- T Van der Linden
- National Institute of Criminalistics and Criminology, Vilvoordsesteenweg 100, 1120 Brussels, Belgium; Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - S M R Wille
- National Institute of Criminalistics and Criminology, Vilvoordsesteenweg 100, 1120 Brussels, Belgium
| | - M Ramírez-Fernandez
- National Institute of Criminalistics and Criminology, Vilvoordsesteenweg 100, 1120 Brussels, Belgium
| | - A G Verstraete
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium; Department of Laboratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - N Samyn
- National Institute of Criminalistics and Criminology, Vilvoordsesteenweg 100, 1120 Brussels, Belgium
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Dépistage de la consommation de substances psychoactives en milieu professionnel : enjeux techniques, éthiques et réglementaires. ARCH MAL PROF ENVIRO 2014. [DOI: 10.1016/j.admp.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fitzcharles MA, Clauw DJ, Ste-Marie PA, Shir Y. The dilemma of medical marijuana use by rheumatology patients. Arthritis Care Res (Hoboken) 2014; 66:797-801. [PMID: 24591442 DOI: 10.1002/acr.22267] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/03/2013] [Indexed: 11/10/2022]
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Espy RD, Teunissen SF, Manicke NE, Ren Y, Ouyang Z, van Asten A, Cooks RG. Paper Spray and Extraction Spray Mass Spectrometry for the Direct and Simultaneous Quantification of Eight Drugs of Abuse in Whole Blood. Anal Chem 2014; 86:7712-8. [DOI: 10.1021/ac5016408] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ryan D. Espy
- Department
of Chemistry and Center for Analytical Instrumentation, Purdue University, West Lafayette, Indiana 47907, United States
| | - Sebastiaan Frans Teunissen
- Netherlands Forensic Institute, Department of Forensic
Chemistry, Toxicology Laboratory, The Hague, The Netherlands
| | - Nicholas E. Manicke
- Department
of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 47907, United States
| | - Yue Ren
- Department
of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | - Zheng Ouyang
- Department
of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | - Arian van Asten
- Netherlands Forensic Institute, Department of Forensic
Chemistry, Toxicology Laboratory, The Hague, The Netherlands
- Van
‘t Hoff Institute for Molecular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - R. Graham Cooks
- Department
of Chemistry and Center for Analytical Instrumentation, Purdue University, West Lafayette, Indiana 47907, United States
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40
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Agius R, Dufaux B, Kahl HG, Nadulski T. Is urine an alternative to cosmetically treated hair for the detection of drugs and alcohol? Drug Test Anal 2014; 6 Suppl 1:120-2. [DOI: 10.1002/dta.1629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/27/2014] [Accepted: 01/27/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Ronald Agius
- Department of Forensic and Clinical Toxicology; Siemensstrasße 40, 32105 Bad Salzuflen Germany
| | - Bertin Dufaux
- Department of Forensic and Clinical Toxicology; Siemensstrasße 40, 32105 Bad Salzuflen Germany
| | - Hans-Gerhard Kahl
- Department of Forensic and Clinical Toxicology; Siemensstrasße 40, 32105 Bad Salzuflen Germany
| | - Thomas Nadulski
- Department of Forensic and Clinical Toxicology; Siemensstrasße 40, 32105 Bad Salzuflen Germany
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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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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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Wiese Simonsen K, Steentoft A, Bernhoft I, Hels T, Rasmussen B, Linnet K. Psychoactive substances in seriously injured drivers in Denmark. Forensic Sci Int 2013; 224:44-50. [DOI: 10.1016/j.forsciint.2012.10.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/12/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
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