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Hjelmeland K, Middelkoop G, Mørland J, Høiseth G. The relationship between clinical impairment and blood drug concentration: Comparison between the most prevalent traffic relevant drug groups. Forensic Sci Int 2024; 363:112180. [PMID: 39141931 DOI: 10.1016/j.forsciint.2024.112180] [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: 02/29/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
AIM The aim of the present study was to investigate the relationship between blood concentrations of four different drug classes; ethanol, benzodiazepines, amphetamines and tetrahydrocannabinol (THC) and driver impairment as assessed by a clinical test of impairment (CTI). METHODS Data was retrieved from a national database on CTI assessments and accompanying blood drug concentrations from apprehended drivers. All drug concentrations in blood were quantified using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS), and compared to the results of the CTI which were categorized as either "not impaired", "mildly impaired", "moderately impaired", or "considerably impaired". RESULTS A total number of 15 514 individual mono drug-cases collected over 9 years was included. 89 % were men and the median age was 34 years. In addition, 3 684 individual cases with similar age and gender distribution where no drugs were detected, were included as a reference group. For ethanol and benzodiazepines the percentage of clinically impaired cases increased markedly from lower to higher concentration windows, from 60 % to 97 % for ethanol and from 38 % to 76 % for benzodiazepines. The corresponding increase for amphetamines and THC was modest, from 43 % to 58 % for amphetamines and from 41 % to 55 % for THC. The correlation between drug concentration and degree of impairment was high for ethanol (Spearman´s rho=0.548, p<0.001) and relatively high for benzodiazepines (Spearman´s rho=0.377, p<0.001), but low for amphetamines (Spearman´s rho=0.078, p<0.001) and THC (Spearman´s rho=0.100, p<0.001). CONCLUSION The percentage of impaired drivers increased with increasing blood drug concentration for all four drug classes, most pronounced for ethanol and benzodiazepines and much less for amphetamines and THC. The median blood drug concentration increased with increasing magnitude of impairment for ethanol and benzodiazepines, while this was much less pronounced for amphetamines and THC. The ranges of drug concentrations, however, were wide for all four drug classes in all impairment categories as assessed by individual clinical examination.
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Affiliation(s)
- Knut Hjelmeland
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway.
| | - Gerrit Middelkoop
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway.
| | - Jørg Mørland
- Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo 0213, Norway; Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1039 Blindern, Oslo 0315, Norway.
| | - Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway; Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1039 Blindern, Oslo 0315, Norway; Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 23 Vinderen, Oslo 0319, Norway.
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Strand MC, Gjerde H, Høiseth G. Nystagmus among suspected amphetamine impaired drivers. J Forensic Leg Med 2023; 95:102502. [PMID: 36924680 DOI: 10.1016/j.jflm.2023.102502] [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: 11/23/2022] [Revised: 01/18/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
Clinical signs of drug use can be helpful to identify which drug has been consumed. Amphetamine intake has traditionally not been considered to cause nystagmus. The aim of this study was to explore whether there is a relationship between amphetamine use and nystagmus in a population of apprehended drivers in a naturalistic setting. We evaluated drivers suspected of drug-impaired driving where blood samples were collected and a clinical test of impairment (CTI) was performed. Evaluation of nystagmus is one of the CTI subtests. The samples were analysed for alcohol and psychoactive drugs. Cases with a nystagmus test were recorded and amphetamine-only cases were compared with alcohol-only cases and with cases where alcohol or drugs were not detected, respectively. Samples from 507 amphetamine-only cases were compared to 485 alcohol-only cases and 205 drug-negative cases. The median blood amphetamine concentration was 0.37 mg/L and the median alcohol concentration was 1.57 g/kg. The proportion of cases with nystagmus was similar in amphetamine-only cases (21%) and drug-negative controls (25%), p = 0.273, but higher in alcohol-only cases (53%), p < 0.001. No association was found between the blood amphetamine concentration and degree of nystagmus (Spearman's ρ = 0.008, p = 0.860), whereas an association between blood alcohol concentration and degree of nystagmus was demonstrated (ρ = 0.249, p < 0.001). In conclusion, our study did not find that apprehended drivers using amphetamine had more frequently nystagmus than a control group that tested negative for alcohol and drugs, even at high amphetamine concentrations in blood. Hence, nystagmus should not be considered a tool for identifying amphetamine-induced impairment in drivers.
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Affiliation(s)
| | - Hallvard Gjerde
- Department of Forensic Medicine, Oslo University Hospital, Oslo, Norway
| | - Gudrun Høiseth
- Department of Forensic Medicine, Oslo University Hospital, Oslo, Norway; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Papoutsis I, Nikolaou P, Spiliopoulou C, Athanaselis S. Different aspects of driving under the influence of benzodiazepines. MEDICINE, SCIENCE, AND THE LAW 2016; 56:159-160. [PMID: 27044925 DOI: 10.1177/0025802415594832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ioannis Papoutsis
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece
| | - Panagiota Nikolaou
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece
| | - Sotiris Athanaselis
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece
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Downey LA, Hayley AC, Porath-Waller AJ, Boorman M, Stough C. The Standardized Field Sobriety Tests (SFST) and measures of cognitive functioning. ACCIDENT; ANALYSIS AND PREVENTION 2016; 86:90-98. [PMID: 26528800 DOI: 10.1016/j.aap.2015.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/29/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The Standardized Field Sobriety Tests (SFST) are utilised widely to assess fitness to drive when law enforcement suspects a driver's ability to drive is impaired, whether by drugs or alcohol. The SFST ostensibly achieve this through assessment of the level of drivers' cognitive and psychomotor impairment, although no studies have explicitly assessed the relatedness of cognitive ability and performance on the SFST. The current study aimed to assess the relationship between the three components of the SFST with a well validated computerised cognitive battery. METHOD A sub-set of 61 placebo condition participants comprised the sample, with 33 females and 28 males (mean age 25.45 years). Correlations between the individual SFST subscales 'Horizontal Gaze Nystagmus' (HGN), the 'One Leg Stand' (OLS) and the 'Walk and Turn' test (WAT) and Cognitive Drug Research (CDR) sub-scales of 'Quality of Working Memory', 'Power of Attention' and 'Continuity of Attention' were analysed using point-biserial correlation. RESULTS Sixty participants were included for analyses. A weak-moderate positive (five subscales) and a moderate-strong negative (two subscales) association was noted between seven of the nine individual CDR subscales and the SFST subscale of the WAT test (all p<0.05). Individually, a moderate positive association was noted between the sub-scale 'Nystagmus lack of smooth pursuit' and 'digit vigilance reaction time' and 'choice reaction time; reaction time' (both p<0.05) and 'Nystagmus head move and/or jerk' and 'simple reaction time' (p<0.001). When assessed as a partially composite factor, a comparable association was also noted between the composite score of the SFST subscale 'Nystagmus head move and/or jerk' and both (a) simple and (b) digit vigilance reaction time (both p<0.05). No association was noted between any of the individual cognitive variables and the SFST subscale 'OLS', or between composite cognitive scores 'Quality of Working Memory', 'Power of Attention' and 'Continuity of Attention' and total SFST scores. DISCUSSION Variation in some aspects of cognitive performance was found to be moderately and positively correlated with some individual aspects of the SFST; particularly among tasks which assess reaction time. Impairment of these cognitive processes can also contribute to the completion of complex tasks such as driving or the SFST. Complex behavioural tasks such as driving are often severely impaired due to intoxication, and thus in a practical sense, the SFST can still be considered a useful screening tool to identify drug or alcohol impaired drivers.
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Affiliation(s)
- Luke A Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia; Cambridge Health Alliance, Cambridge, MA, United States.
| | - Amie C Hayley
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
| | | | - Martin Boorman
- Road Policing Command, Victoria Police, Melbourne, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
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Porath-Waller AJ, Beirness DJ. An examination of the validity of the standardized field sobriety test in detecting drug impairment using data from the Drug Evaluation and Classification program. TRAFFIC INJURY PREVENTION 2014; 15:125-131. [PMID: 24345013 DOI: 10.1080/15389588.2013.800638] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The purpose of this study is to assess the validity of the 3 components of the Standardized Field Sobriety Test (SFST), including the Horizontal Gaze Nystagmus (HGN), One Leg Stand (OLS), and Walk and Turn (WAT) tests, in identifying impairment among suspected drug-impaired drivers using data recorded during drug evaluation and classification (DEC) evaluations. METHODS Data from 2142 completed DEC evaluations of central nervous system (CNS) stimulants, CNS depressants, narcotic analgesics, cannabis, or no drugs were analyzed using multinomial logistic regression. RESULTS All drug categories were significantly associated with impaired performance. On the HGN, users of CNS depressants were significantly more likely to experience lack of smooth pursuit and distinct nystagmus at maximum deviation compared to non-drug users. On the OLS, users of all drug classes were significantly more likely to sway while balancing and use their arms to maintain balance but significantly less likely to hop compared to drug-free cases. Users of CNS depressants, CNS stimulants, and narcotic analgesics were significantly more likely to put their raised foot down during the test. On the WAT, users of CNS depressants, CNS stimulants, and narcotic analgesics were significantly less likely to keep their balance while listening to test instructions compared to those who had not used drugs. Users of CNS depressants were less likely to touch heel-to-toe while walking, whereas individuals who had used narcotic analgesics were less likely to take the correct number of steps. CONCLUSIONS These findings provide support for the use of the SFST as a screening tool for law enforcement to identify impairment in persons who have used CNS stimulants, CNS depressants, cannabis, or narcotic analgesics.
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Kane G. The methodological quality of three foundational law enforcement Drug Influence Evaluation validation studies. J Negat Results Biomed 2013; 12:16. [PMID: 24188398 PMCID: PMC3828623 DOI: 10.1186/1477-5751-12-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 10/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A Drug Influence Evaluation (DIE) is a formal assessment of an impaired driving suspect, performed by a trained law enforcement officer who uses circumstantial facts, questioning, searching, and a physical exam to form an unstandardized opinion as to whether a suspect's driving was impaired by drugs. This paper first identifies the scientific studies commonly cited in American criminal trials as evidence of DIE accuracy, and second, uses the QUADAS tool to investigate whether the methodologies used by these studies allow them to correctly quantify the diagnostic accuracy of the DIEs currently administered by US law enforcement. RESULTS Three studies were selected for analysis. For each study, the QUADAS tool identified biases that distorted reported accuracies. The studies were subject to spectrum bias, selection bias, misclassification bias, verification bias, differential verification bias, incorporation bias, and review bias. The studies quantified DIE performance with prevalence-dependent accuracy statistics that are internally but not externally valid. CONCLUSION The accuracies reported by these studies do not quantify the accuracy of the DIE process now used by US law enforcement. These studies do not validate current DIE practice.
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Affiliation(s)
- Greg Kane
- 10785 East Crestline Place, Englewood CO 80111, USA.
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Ip EJ, Bui QV, Barnett MJ, Kazani A, Wright R, Serino MJ, Perry PJ. The effect of trazodone on standardized field sobriety tests. Pharmacotherapy 2013; 33:369-74. [PMID: 23450804 DOI: 10.1002/phar.1210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY OBJECTIVE To evaluate the effects of a single dose of trazodone on the standardized field sobriety test (SFST). DESIGN A randomized, double-blinded, repeated-measures study. PARTICIPANTS Forty-five healthy adult subjects. SETTING University campus. MEASUREMENTS AND MAIN RESULTS The SFST consists of the horizontal gaze nystagmus, walk-and-turn, and one-leg stand tests. Subjects were administered a baseline SFST and at 2 hours after the administration of either trazodone 100 mg (30 subjects) or acetaminophen 650 mg (15 subjects). At 2 hours post drug administration, there were no statistical differences in failure rates between the trazodone and acetaminophen groups (53.3% vs 20.0%, p=0.054). However, the trazodone group exhibited more impairment clues within the individual tests of the SFST than the acetaminophen group. CONCLUSIONS A one-time dose of trazodone 100 mg does not result in an increased SFST failure rate at 2 hours postdosing compared to acetaminophen 650 mg. However, the number of individual impairment clues detected is increased with trazodone. Trazodone 100 mg may cause cognitive driving impairment.
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Affiliation(s)
- Eric J Ip
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA 94592, USA.
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Prevalence and blood concentrations of desoxypipradrol (2-DPMP) in drivers suspected of driving under the influence of drugs and in post-mortem cases. Forensic Sci Int 2013; 226:146-51. [DOI: 10.1016/j.forsciint.2012.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 12/22/2012] [Accepted: 12/28/2012] [Indexed: 11/18/2022]
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Downey LA, King R, Papafotiou K, Swann P, Ogden E, Boorman M, Stough C. Detecting impairment associated with cannabis with and without alcohol on the Standardized Field Sobriety Tests. Psychopharmacology (Berl) 2012; 224:581-9. [PMID: 22763669 DOI: 10.1007/s00213-012-2787-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 06/18/2012] [Indexed: 11/24/2022]
Abstract
RATIONALE Cannabis and alcohol are the most popular drugs amongst recreational users and most prevalent in injured and deceased drivers. The Standardized Field Sobriety Tests (SFST) are commonly used to establish impairment due to drugs and alcohol, but limited empirical evidence exists concerning the combined effects of these drugs on SFST performance. METHODS The sample comprised 80 individuals (31 females; 49 males). Age ranged between 21 and 35 years (M = 26.5, SD = 5). Forty participants (15 females; 25 males) took part in the low alcohol condition (BAC, <0.05 %), and 40 participants (16 females; 24 males), took part in the high alcohol condition (BAC, >0.05 %). For each part of the study, two levels of ∆9-tetrahydrocannabinol (THC) were administered (1.8 and 3 % THC) or a matching placebo cigarette (0 % THC) in combination with alcohol. Performance on the SFST was assessed 30 min post-dosing. RESULTS A number of significant differences in SFST performance were identified with 28 % of the sample failing the test (when the head movement and jerks sign was included) when low alcohol and low THC were administered together. When a higher dose of alcohol was administered with a low dose of THC, 38 % of the sample failed the test, and 35 % also failed when the high dose of alcohol was combined with a higher dose of THC. CONCLUSIONS The current results highlight the limited ability of the SFST to identify drug consumption in the absence of any evidence of driving impairment or physiological indicators.
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Affiliation(s)
- Luke A Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, PO Box 218-H24, Hawthorn, Victoria 3122, Australia
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Downey LA, King R, Papafotiou K, Swann P, Ogden E, Stough C. Examining the effect of dl-3,4-methylenedioxymethamphetamine (MDMA) and methamphetamine on the standardized field sobriety tests. Forensic Sci Int 2012; 220:e33-6. [DOI: 10.1016/j.forsciint.2012.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/17/2011] [Accepted: 02/29/2012] [Indexed: 11/26/2022]
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Abstract
Scientific opinions differ whether the use of stimulants causes deterioration in driving skills. In 1857 of 8709 cases of driving under the influence of drugs, amphetamine-like drugs (amphetamine, methamphetamine, and methylendioxyamphetamine) were present either alone or together with other licit or illicit drugs. In 338 cases, amphetamines were the only psychoactive substance group in plasma at mean, median, and highest concentrations of 0.18, 0.12, and 1.05 mg/L, respectively. A widespread opinion is that after the consumption of amphetamines, centrally stimulating effects with corresponding consequences on safe driving are expected. In contrast, many cases were observed that rather suggested an influence of centrally sedating substances when considering the psycho-physical conditions. Relations between concentration and effect could not be established. The apparent sedation is probably the consequence of sleep deprivation during an amphetamine binge and the after-effects of the drug.
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Stough C, Camfield D, Kure C, Tarasuik J, Downey L, Lloyd J, Zangara A, Scholey A, Reynolds J. Improving general intelligence with a nutrient-based pharmacological intervention. INTELLIGENCE 2011. [DOI: 10.1016/j.intell.2011.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Popova S, Rehm J, Patra J, Baliunas D, Taylor B. Illegal drug-attributable morbidity in Canada 2002. Drug Alcohol Rev 2009; 26:251-63. [PMID: 17454014 DOI: 10.1080/09595230701247673] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Use of illegal drugs is an important behavioral risk factor for burden of morbidity in developed countries. The objective was to estimate the number of diagnoses in acute care hospitals, psychiatric hospitalizations, admissions in specialized treatment, and number of days in treatment attributable to use of illegal drugs for Canada in 2002. The number of diagnoses in acute care hospitals, psychiatric hospitalizations, and hospital days were obtained from the Canadian Institute for Health Information (CIHI). Number of admissions and number of days in specialized inpatient and outpatient treatment of illegal drug dependency were obtained from provincial ministerial officials or drug addiction program coordinators. Except for effects of maternal use of drugs of addiction on the newborn, and suicide, drug-attributable fractions (DAFs) were estimated directly from available statistics in published literature. There were 61,026 illegal drug-related diagnoses in acute care hospitals, 1,517 psychiatric hospitalizations, and 139,773 admissions to specialized treatment attributable to illegal drug use in Canada. The largest contributors were mental and behavioral disorders due to psychoactive substance use in acute care hospitals, and drug psychoses in psychiatric hospitalizations. Length of stay amounted to 352,121 days in acute care hospitals, 31,508 days in psychiatric hospitals, and 2,851,829 days in specialized treatment. Drug use constitutes a major contributor to burden of morbidity in Canada. Compared to 1992, the total number of illegal drug-attributable days in 2002 increased, especially in acute hospitals by a factor of 9.6. A mixture of prevention and harm reduction measures is proposed to reduce the burden of morbidity associated with drug use.
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Affiliation(s)
- Svetlana Popova
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Lia K, Spigset O, Slørdal L. Kjøring under påvirkning av amfetamin og metamfetamin. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:105-8. [DOI: 10.4045/tidsskr.09.34091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Rubenzer SJ. The Standardized Field Sobriety Tests: a review of scientific and legal issues. LAW AND HUMAN BEHAVIOR 2008; 32:293-313. [PMID: 17922178 DOI: 10.1007/s10979-007-9111-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2007] [Accepted: 07/18/2007] [Indexed: 05/25/2023]
Abstract
This article details the history and development of the National Highway and Safety Administration's Standardized Field Sobriety Tests. They are reviewed in terms of relevant scientific, psychometric, and legal issues. It is concluded that the research that supports their use is limited, important confounding variables have not been thoroughly studied, reliability is mediocre, and that their developers and prosecution-oriented publications have oversold the tests. Further, case law since their development has severed the tests from their validation data, so that they are not admissible on the criterion for which they were validated (blood alcohol concentration), and admissible for a criterion for which they were not (mental, physical, or driving impairment). Directions for further research are presented.
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Smink BE, Lusthof KJ, de Gier JJ, Uges DRA, Egberts ACG. The relation between the blood benzodiazepine concentration and performance in suspected impaired drivers. J Forensic Leg Med 2008; 15:483-8. [PMID: 18926498 DOI: 10.1016/j.jflm.2008.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/25/2008] [Accepted: 04/09/2008] [Indexed: 10/21/2022]
Abstract
Several experimental studies have shown a negative influence of benzodiazepines on driving skills. The objective of this study is to study the relationship between the blood concentration of benzodiazepines and the influence on performance in field sobriety tests. A retrospective case file evaluation was conducted to select cases of drivers, tested positive for benzodiazepines only in the period from January 1999 to December 2004. Drivers were grouped into the categories sub therapeutic, therapeutic or elevated concentrations. The outcome of the tests (walking, walking after turn, nystagmus, Romberg's test, behavior, pupils and orientation) was binomial. A Chi square test was used to assess differences in proportions of the categorized cases. In total 171 cases were included. Observations of behavior (n=137; p<0.01), walking (n=109; p<0.01), walking after turn (n=89; p=0.02) and Romberg's test (n=88; p<0.05) were significantly related to the benzodiazepine concentration. There was no significant relation between benzodiazepine concentration and effect on pupil size, nystagmus or orientation. The results of our study indicate a relation between the concentration of benzodiazepines and the results of some performance tests. More effort is needed to standardize the tests and to determine the sensitivity and selectivity of the tests for benzodiazepines.
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Affiliation(s)
- B E Smink
- Department of Toxicology, Netherlands Forensic Institute, The Hague, The Netherlands.
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Aldridge J, Charles V. Researching the intoxicated: informed consent implications for alcohol and drug research. Drug Alcohol Depend 2008; 93:191-6. [PMID: 17945437 DOI: 10.1016/j.drugalcdep.2007.09.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 09/04/2007] [Accepted: 09/05/2007] [Indexed: 11/29/2022]
Abstract
This article considers the informed consent process in relation to carrying out research with intoxicated participants in 'field' research settings. There is little discussion in the literature of the potential problems that the intoxication of research participants may pose to research. Intoxication is a potential problem for all researchers but is heightened in field research that takes place in settings where participants are likely to be intoxicated, such as licensed venues, in drug consumption rooms, or police custody suites. The risks to research participants that intoxication poses should not be resolved by electing not to do research with intoxicated participants; it is argued that these risks can be managed to some extent, and are offset by the benefits of such research. Moreover, intoxication (and the impairment of cognitive functions relevant to valid informed consent) may not always be identifiable through behavioural or biochemical methods of detection. The search for accurate and field-practical methods for identifying intoxication amongst participants is useful, but not the only strategy for researchers who want to ensure the validity of the consent process. Suggestions are provided for devising research protocols that acknowledge and accept intoxication of research participants and attempt to protect them. One solution is to side-step identification of intoxication per se as a strategic objective in the consent process, and turn instead to established methods for ensuring that information has been understood by potential research participants.
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Affiliation(s)
- Judith Aldridge
- School of Law, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom.
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Gustavsen I, Mørland J, Bramness JG. Impairment related to blood amphetamine and/or methamphetamine concentrations in suspected drugged drivers. ACCIDENT; ANALYSIS AND PREVENTION 2006; 38:490-5. [PMID: 16343411 DOI: 10.1016/j.aap.2005.11.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Revised: 10/14/2005] [Accepted: 11/11/2005] [Indexed: 05/05/2023]
Abstract
Experimental studies have investigated effects of low oral doses of amphetamine and methamphetamine on psychomotor functions, while less work has been done on effects of high doses taken by abusers in real-life settings. There are indications that intake of high doses may impair traffic related skills, and that abuse of amphetamines may cause hypersomnolence at the end-of-binge. The present study aimed at investigating the concentration-effect relationship between blood amphetamines concentrations and impairment in a population of real-life users. Eight hundred and seventy-eight cases with amphetamine or methamphetamine as the only drugs present in the blood samples were selected from the impaired driver registry at The Norwegian Institute of Public Health. In each case the police physician had concluded on whether the driver was impaired or not. 27% of the drivers were judged as not impaired, while 73% were judged as impaired. There was a positive relationship between blood amphetamines concentrations and impairment. The relationship reached a ceiling at blood amphetamines concentrations of 0.27-0.53 mg/l. Younger drivers were more often judged impaired than older drivers at similar concentrations. Despite the performance enhancing qualities of amphetamines demonstrated in some low dose laboratory experiments; this study revealed a positive relationship between blood amphetamines concentration and traffic related impairment.
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Affiliation(s)
- Ingebjørg Gustavsen
- Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse, Norway
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