Prevalence of psychoactive drug use among drivers in Thailand: a roadside survey

Effects of kratom on driving: Results from a cross-sectional survey, ecological momentary assessment, and pilot simulated driving Study

OBJECTIVES

Despite widespread kratom use, there is a lack of knowledge regarding its effects on driving. We evaluated the self-reported driving behaviors of kratom consumers and assessed their simulated-driving performance after self-administering kratom products.

METHODS

We present results from: 1) a remote, national study of US adults who regularly use kratom, and 2) an in-person substudy from which we re-recruited participants. In the national study (N = 357), participants completed a detailed survey and a 15-day ecological momentary assessment (EMA) that monitored naturalistic kratom use. For the remote study, outcomes were self-reported general and risky driving behaviors, perceived impairment, and driving confidence following kratom administration. For the in-person substudy, 10 adults consumed their typical kratom products and their driving performance on a high-fidelity driving simulator pre- and post-kratom administration was evaluated.

RESULTS

Over 90% of participants surveyed self-reported driving under the influence of kratom. Most reported low rates of risky driving behavior and expressed high confidence in their driving ability after taking kratom. This was consistent with EMA findings: participants reported feeling confident in their driving ability and perceived little impairment within 15-180 min after using kratom. In the in-person substudy, there were no significant changes in simulated driving performance after taking kratom.

CONCLUSIONS

Using kratom before driving appears routine, however, self-reported and simulated driving findings suggest kratom effects at self-selected doses among regular kratom consumers do not produce significant changes in subjective and objective measures of driving impairment. Research is needed to objectively characterize kratom's impact on driving in regular and infrequent consumers.

Endogenous Opioid Activity as the Mechanism of Action for Mitragyna speciosa (Kratom): The Current State of the Evidence

Kratom (Mitragyna speciosa) is a substance derived from botanical compounds native to Southeast Asia. This substance has been cultivated predominantly in Thailand, Malaysia, Vietnam, and Myanmar, where it has historically been used in traditional medicine as a near panacea for several health problems. Such ritualistic use of kratom has been present for centuries; however, recreational use appears to have increased globally, especially in the United States. Pharmacodynamic and pharmacokinetic studies have found that kratom demonstrates a unique parabolic, dose-dependent pattern of effects ranging from stimulation to opioid and analgesic effects. Pharmacological research indicates that kratom is both a mu opioid receptor (μ-OR; MOR) and a kappa opioid receptor (κ-OR; KOR) agonist, which mediates its analgesic effects. Other research suggests that kratom may simultaneously act on dopaminergic and serotonergic receptors, which mediate its stimulant effects. This chapter reviews the literature related to the structural, functional, and cultural characteristics of kratom use. We begin with an overview of current and historical patterns of kratom, followed by a review of data on the pharmacodynamics and pharmacokinetics of kratom thus far.

[Kratom (Mitragyna Speciosa): a Psychoactive Plant with Opportunities and Risks]

Kratom is an evergreen tree that is native to Southeast Asia. Its leafs are traditionally used as a stimulant, a remedy for various health problems and for religious purposes. Especially in the US (in a lesser extent also in Europe) kratom use is significantly prevalent. In Western countries, kratom is used predominantly as an analgesic and stimulant, for the treatment of opioid use disorders, and for improving mental health (e. g., in depression, anxiety disorders). Main molecular constituents of kratom are alkaloids of which mitragynine and 7-hydroxymitragynine appear to be most important. Pharmacodynamics and -kinetics of kratom are complex and insufficiently studied. It is known that mitragynine and 7-hydroxymitragynine are partial agonist at human μ-opioid receptors and antagonists at κ- and δ-opioid receptors with additional effects at other central receptors. Tolerability of kratom is presumably better than that of classical opioids; this is probably due to missing effects of kratom on β-arrestin and discussed as a starting point for the development of opioids with improved tolerability. Some alkaloids of kratom are inhibitors of CYP26 and to a somewhat lesser degree of CYP2C19 and CYP3A4. The addictive potential of kratom appears to be lower than that of classical opioids; however, corresponding data is limited and kratom use disorders appear to occur primarily in Western countries. Several cases of severe health-related problems and deaths are known in the US; in these cases, however, polysubstance use was usually present. Kratom use is likely associated with hepatotoxicity and cardiotoxicity. Kratom-associated mortality and morbidity in Western countries are quantitatively significantly different from Southeast Asia, where kratom use is no public health problem. The reasons for this may be the combined use of substances (which is more prevalent in Western countries), higher dosages of consumed kratom, adulterations and contaminations of commercially available kratom in Western countries, pharmacokinetic interactions, and higher concentrations of 7-hydroxymitragynine in dried kratom leafs (that are typically consumed in Western countries) in comparison to fresh leafs (that are typically consumed in Southeast Asia).

A systematic review of factors associated with illegal drug driving

Drug driving is a serious problem worldwide that can increase the risk of road crashes. This systematic review seeks to identify factors associated with drug driving (i.e., driving after consuming drugs other than alcohol) to highlight gaps in existing knowledge and inform the design of more effective countermeasures. A search of the literature was conducted for the period January 1, 2005 to July 31, 2021 using six different databases. The search protocol followed PRISMA guidelines and was registered in PROSPERO (#CRD42021234616). Studies that met inclusion criteria compared drug drivers with either non-drug drivers, alcohol-only drivers or drug drivers from an earlier time period, to identify factors specifically associated with drug driving, rather than common to all drivers. Two hundred and nineteen publications met the inclusion criteria and were included within the review. Based on the findings, a logic model was developed that presents the factors associated with drug driving. Various sociodemographic, psychosocial and legal factors emerged as the main factors associated with illegal drug driving. At the sociodemographic and psychological levels, drug drivers were more likely to be single, young males who often drive after using cannabis and who score high on sensation-seeking and impulsivity scales. The key social factor found to be associated with drug driving was peer acceptance/disapproval of the behaviour. At the legal level, the review suggested that the effectiveness of current enforcement approaches to drug driving vary among jurisdictions around the world due to differences in the level of perceived certainty of apprehension and the chances of punishment avoidance. Future research into the anticipated and actual rewards for drug driving is needed to inform the development of more effective countermeasures.

The Right to Use Kratom from the Psychiatric and Islamic Perspectives

This paper aimed to summarize kratom's psychological effects on users and the Islamic views on kratom use. A literature survey of published kratom studies, teachings based on the holy Qur'an, the Sunnah, and views of several Islamic scholars based on qualitative methodology through text analysis was conducted. The results demonstrated that despite its beneficial therapeutic effects, the harm induced by kratom outweighs its benefits. We concluded that kratom use for medicinal purposes is only warranted if useful constituent mitragynine can be extracted and used on its own, and if more rigorous human studies demonstrated good safety profile and efficacy of mitragynine for therapeutic purposes.

Psychoactive drug consumption among truck-drivers: a systematic review of the literature with meta-analysis and meta-regression

Few studies have assessed the extent of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern, since psychoactive substance use has a relevant impact on the drivers' health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. A systematic review of the literature and meta-analysis was performed in order to provide Occupational Health Professionals and policy-makers with an updated epidemiological perspective regarding this important issue. The results showed a prevalence of overall drug consumption of 27.6% [95%CI 17.8-40.1], particularly high considering illicit CNS-stimulants (amphetamine consumption of 21.3% [95%CI 15.7-28.1], and cocaine consumption of 2.2% [95%CI 1.2-4.1]). It appears that truck-drivers choose stimulant substances as a form of performance enhancing drug, in order to increase productivity. However, chronic and high dose consumption has been shown to decrease driving skills, placing these professional drivers at risk for health and road safety. Further research is required, particularly in Europe, in order to fill the knowledge gap and improve the strength of evidence.

The prevalence of psychotic symptoms in kratom (Mitragyna speciosa Korth.) Users in Malaysia

BACKGROUND

Kratom is a traditional medicinal herb widely used in Malaysia and Thailand. Despite its widespread use and statements by regulatory agencies on the potential for kratom-associated psychosis, there is little data regarding the prevalence of psychotic symptoms among kratom users. This study investigated the prevalence of psychosis among kratom users, described psychotic symptomatology and severity, while examining associations between kratom use characteristics and the occurrence of psychotic symptoms.

METHODS

This cross-sectional clinical survey recruited 150 regular kratom users. The Mini International Neuropsychiatric Interview (MINI) and Diagnostic and Statistical Manual of Mental Disorders 5^th Edition (DSM-V) diagnostic criteria were used to evaluate psychotic symptomatology among kratom users, and the Brief Psychiatric Rating Scale (BPRS) was used to assess the severity of psychiatric symptoms. Chi-square tests with Yate's correction were performed to determine the association between kratom use characteristics and the occurrence of psychotic symptoms among kratom users in this study.

RESULTS

Six out of 150 kratom users (4%) presented with any psychotic symptoms. The psychotic symptoms reported were positive symptoms and thought alienation, with a mean BPRS score of 33 (i.e., mild severity). Variables related to kratom use (such as intake of kratom with diphenhydramine, duration of kratom use, and quantity and frequency of daily kratom use) were not associated with the occurrence of psychotic symptoms among kratom users.

CONCLUSION

Although psychotic symptoms could occur among regular kratom users, they were rare and not significantly associated with kratom use characteristics. We found no evidence of elevated psychosis among regular users.

Roadside survey of alcohol and drug use among Norwegian drivers in 2016-2017: A follow-up of the 2008-2009 survey

OBJECTIVE

The objective of this study was to study the use of alcohol and drugs among the general driving population in the southeastern part of Norway and to compare the findings with the results from a similar roadside survey in 2008-2009.

METHODS

A roadside survey of drivers of cars, vans, motorcycles, and mopeds was performed from April 2016 to April 2017 in collaboration with the Mobile Police Service. Oral fluid was collected using the Quantisal device and analyzed for alcohol, illicit drugs, and psychoactive medicinal drugs. Age, sex, time, and geographical region were recorded.

RESULTS

Of the 5,556 drivers who were asked to participate in the study, 518 drivers (9.3%) declined to participate, and 4 samples contained insufficient volume of oral fluid to be analyzed; thus, 5,034 drivers were included. Fifteen drivers (0.3%) suspected by the police for driving under the influence of alcohol or drugs refused to participate in the study, so the alcohol and drug findings represent minimum values. The weighted prevalence of alcohol concentrations above the legal limit of 0.2 g/L was 0.2%, which is similar to the finding in the 2008-2009 survey. The weighted prevalences of medicinal drugs and illicit drugs were 3.0 and 1.7%, respectively; those numbers included more drugs than the 2008-2009 survey and are therefore not comparable. The most prevalent illicit and medicinal drugs were tetrahydrocannabinol (1.3%) and zopiclone (1.4%). The prevalences of benzodiazepines and amphetamines were significantly lower than detected in the 2008-2009 survey. Only one sample tested positive for a new psychoactive substance.

CONCLUSIONS

The proportion of samples that tested positive for alcohol had not changed since 2008-2009, and the proportions that tested positive for benzodiazepines and amphetamines were lower. There are several possible reasons for the reduction: Implementation of legal limits for 28 drugs in 2012-2016, increased use of drug recognition tests, implementation of drug screening instruments, and automatic number plate recognition by the police since 2010; more focused enforcement of the driving under the influence (DUI) law; better information provided to drivers; and changes in drug prescriptions.

New psychoactive substances of natural origin: A brief review

Plant-based drugs of abuse are as old as recorded human history. Although traditional addictive substances, such as opium, cannabis and coca, have been controlled by the United Nations anti-drug conventions, many, if not most, natural plants with addictive or abuse liability remain elusive. Therefore, the United Nations Office on Drugs and Crime (UNODC) has warned the emerging threat from new psychoactive substances (NPS), which are mostly derived or modified from the constituents of natural origin. For example, synthetic cannabinoids and synthetic cathinones are derived from the cannabis and khat plant, respectively. In this review, we briefly discussed the chemistry, pharmacology and toxicology of five common NPS of natural origin, i.e., khat, kratom, salvia, magic mushroom and mandrake. Through the review, we hope that professionals and general public alike can pay more attention to the potential problems caused by natural NPS, and suitable control measures will be taken.

Hepatotoxicity Induced by "the 3Ks": Kava, Kratom and Khat

The 3Ks (kava, kratom and khat) are herbals that can potentially induce liver injuries. On the one hand, growing controversial data have been reported about the hepatotoxicity of kratom, while, on the other hand, even though kava and khat hepatotoxicity has been investigated, the hepatotoxic effects are still not clear. Chronic recreational use of kratom has been associated with rare instances of acute liver injury. Several studies and case reports have suggested that khat is hepatotoxic, leading to deranged liver enzymes and also histopathological evidence of acute hepatocellular degeneration. Numerous reports of severe hepatotoxicity potentially induced by kava have also been highlighted, both in the USA and Europe. The aim of this review is to focus on the different patterns and the mechanisms of hepatotoxicity induced by “the 3Ks”, while trying to clarify the numerous aspects that still need to be addressed.

Neurobiology of Kratom and its main alkaloid mitragynine

Kratom or its main alkaloid, mitragynine is derived from the plant Mitragyna speciosa Korth which is indigenous to Southeast Asian countries. This substance has become widely available in other countries like Europe and United States due to its opium- and coca-like effects. In this article, we have reviewed available reports on mitragynine and other M. speciosa extracts. M. speciosa has been proven to have a rewarding effect and is effective in alleviating the morphine and ethanol withdrawal effects. However, studies in human revealed that prolonged consumption of this plant led to dependence and tolerance while cessation caused a series of aversive withdrawal symptoms. Findings also showed that M. speciosa extracts possess antinociceptive, anti-inflammatory, anti-depressant, and muscle relaxant properties. Available evidence further supports the adverse effects of M. speciosa preparations, mitragynine on cognition. Pharmacological activities are mainly mediated via opioid receptors as well as neuronal Ca²⁺ channels, expression of cAMP and CREB protein and via descending monoaminergic system. Physicochemical properties of mitragynine have been documented which may further explain the variation in pharmacological responses. In summary, current researchs on its main indole alkaloid, mitragynine suggest both therapeutic and addictive potential but further research on its molecular effects is needed.

Abuse potential and adverse cognitive effects of mitragynine (kratom)

Mitragynine is the major psychoactive alkaloid of the plant kratom/ketum. Kratom is widely used in Southeast Asia as a recreational drug, and increasingly appears as a pure compound or a component of 'herbal high' preparations in the Western world. While mitragynine/kratom may have analgesic, muscle relaxant and anti-inflammatory effects, its addictive properties and effects on cognitive performance are unknown. We isolated mitragynine from the plant and performed a thorough investigation of its behavioural effects in rats and mice. Here we describe an addictive profile and cognitive impairments of acute and chronic mitragynine administration, which closely resembles that of morphine. Acute mitragynine has complex effects on locomotor activity. Repeated administration induces locomotor sensitization, anxiolysis and conditioned place preference, enhances expression of dopamine transporter- and dopamine receptor-regulating factor mRNA in the mesencephalon. While there was no increase in spontaneous locomotor activity during withdrawal, animals showed hypersensitivity towards small challenging doses for up to 14 days. Severe somatic withdrawal signs developed after 12 hours, and increased level of anxiety became evident after 24 hours of withdrawal. Acute mitragynine independently impaired passive avoidance learning, memory consolidation and retrieval, possibly mediated by a disruption of cortical oscillatory activity, including the suppression of low-frequency rhythms (delta and theta) in the electrocorticogram. Chronic mitragynine administration led to impaired passive avoidance and object recognition learning. Altogether, these findings provide evidence for an addiction potential with cognitive impairments for mitragynine, which suggest its classification as a harmful drug.

Following "the Roots" of Kratom (Mitragyna speciosa): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries

The use of substances to enhance human abilities is a constant and cross-cultural feature in the evolution of humanity. Although much has changed over time, the availability on the Internet, often supported by misleading marketing strategies, has made their use even more likely and risky. This paper will explore the case of Mitragyna speciosa Korth. (kratom), a tropical tree used traditionally to combat fatigue and improve work productivity among farm populations in Southeast Asia, which has recently become popular as novel psychoactive substance in Western countries. Specifically, it (i) reviews the state of the art on kratom pharmacology and identification; (ii) provides a comprehensive overview of kratom use cross-culturally; (iii) explores the subjective experiences of users; (iv) identifies potential risks and side-effects related to its consumption. Finally, it concludes that the use of kratom is not negligible, especially for self-medication, and more clinical, pharmacological, and socioanthropological studies as well as a better international collaboration are needed to tackle this marginally explored phenomenon.

The pharmacology and toxicology of kratom: from traditional herb to drug of abuse

Mitragyna speciosa (Rubiaceae), commonly known as kratom, is a tropical tree with a long history of traditional use in parts of Africa and Southeast Asia. In recent years, kratom has gained popularity for use as a recreational drug across the globe. Relatively new to the illicit market and used in a manner different from its traditional applications, preparations of kratom are touted by many as a safe and legal psychoactive product that improves mood, relieves pain, and may provide benefits in opiate addiction. Available literature was reviewed for M. speciosa via PubMed, Google Scholar, CINAHL, and EBSCO to summarize its traditional uses, phytochemical composition, pharmacology and toxicology of proposed active constituents, and potential for misuse and abuse. Research has demonstrated that both stimulant and sedative dose-dependent effects do exist, but a growing concern for the drug's effects and safety of use has resulted in national and international attention primarily due to an increase in hospital visits and deaths in several countries that are said to have been caused by extracts of the plant. The main active alkaloid substances in kratom, mitragynine and 7-hydroxymitragynine, present with a range of CNS stimulant and depressant effects mediated primarily through monoaminergic and opioid receptors. Recently, Palm Beach County, located in the southeastern corridor of Florida, has considered regulating kratom due to public safety concerns following the death of a young adult. At the local, state, and even federal levels, governments are now being confronted with the task of determining the safety and the possible regulation of kratom extracts. There are currently no standard analytical screening techniques for mitragynine and its metabolites following ingestion limiting its detection to more sophisticated techniques like liquid chromatography-mass spectrometry to determine kratom use. The growing concern of the abuse potential of kratom requires careful evaluation of its benefits and potential toxicities.

Driving under the influence of alcohol in the Netherlands by time of day and day of the week

The purpose of this study is to provide an overview of the variation in the prevalence of alcohol in everyday traffic in the Netherlands during all days of the week and all times of day. Breath tests were taken from randomly selected car drivers and drivers of small vans in six police regions in the Netherlands between January 2007 and August 2009. A total of 28,057 drivers were included in the study. The prevalence of driving under the influence of alcohol was highest during night-time hours of weekend days. Large proportions of sampled drivers under the influence of alcohol were also found during day-time hours on weekend days, especially early in the morning and early in the evening. Furthermore, a small proportion of sampled drivers under the influence of alcohol was found during morning traffic on Monday and Friday mornings. The results of this study indicate that drink driving is not only limited to night-time hours and that prevalence of drink driving is also high during evening hours from Wednesday to Sunday. In addition to these time periods, breath testing activities may also be effective from a police enforcement perspective on Monday, Friday, and Saturday mornings between 06.00h and 08.00h and on Sunday mornings until 10.00h.

The culpability of drivers killed in New Zealand road crashes and their use of alcohol and other drugs

Over a period of five years, blood samples were taken from 1046 drivers killed as a result of a motor vehicle crash on New Zealand roads. These were analysed for the presence of alcohol and a range of both illicit drugs and psychoactive medicinal drugs. Driver culpability was determined for all crashes. The control group of drug- and alcohol-free drivers comprised 52.2% of the study population. Drivers positive for psychoactive drugs were more likely to be culpable (odds ratio (OR) 3.5, confidence interval (CI) 95% 2.4-5.2) than the control group. Driver culpability exhibited the expected positive association with alcohol use (OR 13.7, 95% CI 4.3-44) and with combined alcohol and cannabis use (OR 6.9, 95% CI 3.0-16). There was only a weak positive association between cannabis use (with no other drug) and culpability (OR 1.3, CI 95% 0.8-2.3). Furthermore, the OR for drivers with blood tetrahydrocannabinol (THC) concentrations greater than 5 ng/mL was lower (OR 1.0, CI 95% 0.4-2.4) than drivers with blood THC concentrations less than 2 ng/mL (OR 3.1, CI 95% 0.9-10). This is inconsistent with results reported by other studies where a significant increase in crash risk was found with blood THC levels greater than 5 ng/mL. In this study, there were very few drivers who had used a single drug, other than cannabis or alcohol. Therefore, from this study, it is not possible to comment on any relationship between opioid, stimulant or sedative drug use and an increased risk of being killed in a crash for the drivers using these drugs. The results from a multivariate analysis indicate that driver gender, age group and licence status, (P=0.022, P=0.016, P=0.026, respectively), the type of vehicle being driven (P=0.013), the number of vehicles in the crash (P<0.001), the blood alcohol concentration of the driver (P<0.001) and the use of any drug other than alcohol and cannabis (P=0.044), are all independently associated with culpability.

Seizure-related vehicular crashes and falls with injuries for people with epilepsy (PWE) in northeastern Thailand

This cross-sectional study aimed to determine the number and types of falls and vehicular crashes with injuries , as well as some specific behavioral associations in people with epilepsy (PWE) in northeastern Thailand. Two hundred and three patients with epilepsy were randomly recruited from the university epilepsy clinic in Khon Kaen, who then completed an interview and a questionnaire. It was found that 84.5% of the patients were operating a vehicle on a regular basis (more than 3days a week), and 21.6% of those had been in a vehicle crash. Additionally, 25.6% of the patients had been involved in falls with injuries. Forty-three percent of the respondents had been involved in either a vehicular crash or a fall with an injury, with 39.7% of the accidents resulting in moderate to severe injuries. Medication compliance was estimated at 66%, while 59.1% said that they had little or no control over their seizures, and more than half the patients did not feel confident about their ability to take care of themselves or to take their antiepileptic drugs (AEDs) properly. In a multivariate model, the following factors significantly increased the risk of being in either a vehicular crash or a fall with an injury: being single, attaining a secondary or higher education, exercising at least three times a week, napping every day or more frequently, and having poor seizure control. The results of this study suggest that patients' poor medication adherence and lack of confidence in managing their seizures may contribute to accidents. Patients with epilepsy should be counseled to seek less risky behaviors and try to attend classes that provide education on AED management.

Spatial-temporal analysis of drink-driving patterns in Hong Kong

Normally, bars and restaurants are the preferred locations for drinking. Therefore, there is concern that the roads in bar and restaurant areas could have a higher probability of drink-drivers and alcohol-related road crashes. Many studies have been conducted to model the association between drinking locations and the prevalence of drink-driving, so that cost-effective enforcement strategies can be developed to combat drink-driving. In this study, a cluster analysis approach was applied to model the spatial-temporal variation of drink-driving distribution in Hong Kong. Six spatial-temporal clusters of drink-driving distribution emerged from the data: (i) bar and restaurant area, weekend-overnight; (ii) bar and restaurant area, other timespan; (iii) urban area, weekend-overnight; (iv) urban area, other timespans; (v) rural area, weekend-overnight; and (vi) rural area, other timespans. Next, separate zero-inflated regression models were established to identify the factors contributing to the prevalence of drink-driving for each of the six recognized clusters. The results indicated that drivers in rural areas tend to consume more alcohol than those in urban areas, regardless of the time period. In addition, both seasonal variation and vehicle class were found to determine the breath alcohol concentration (BrAC) levels among drivers.

Safety riding program and motorcycle-related injuries in Thailand

A retrospective cohort study was conducted in Thailand from 2007 to 2009 to evaluate the efficacy of a safety riding program in preventing motorcycle-related injuries. A training group of motorcyclists were certified by the Asia-Pacific Honda Safety Riding Program in either 30-h instruction (teaching skills, riding demonstration) or 15-h license (knowledge, skills, and hazard perception) courses. The control group consisted of untrained motorcyclists matched on an approximately 1:1 ratio with the training group by region and date of licensure. In total, there were 3250 subjects in the training group and 2963 in the control group. Demographic data and factors associated with motorcycle-related injuries were collected. Motorcycle-related injuries were identified using the Road Injuries Victims Protection for injuries claims and inpatient diagnosis-related group datasets from the National Health Security Office. The capture-recapture technique was used to estimate the prevalence of injuries. Multivariate analysis was used to identify factors related to motorcycle-related injuries. The prevalence of motorcycle-related injuries was estimated to be 586 out of 6213 riders (9.4%) with a 95% confidence interval (CI): 460-790. The license course and the instruction course were significantly associated with a 30% and 29% reduction of motorcycle-related injuries, respectively (relative risk 0.70, 95% CI: 0.53-0.92 and 0.71, 95% CI: 0.42-1.18, respectively). Other factors associated with the injuries were male gender and young age. Safety riding training was effective in reducing injuries. These training programs differ from those in other developed countries but display comparable effects. Hazard perception skills might be a key for success. This strategy should be expanded to a national scale.

Regional differences associated with drinking and driving in Brazil

OBJECTIVE

To evaluate regional differences and similarities associated with drinking and driving (DUI) in the five Brazilian macro-regions.

METHOD

A roadside survey was conducted in the 27 Brazilian state capitals. A total of 3,398 drivers were randomly selected and given a structured interview and a breathalyzer test. To determine the predictors of positive blood alcohol concentration (BAC) in each region, a MANOVA was performed, and 3 groups were used as follows: 1) North and Northeast, 2) South and Midwest, and 3) Southeast. A Poisson robust regression model was performed to assess the variables associated with positive BAC in each group.

RESULTS

Of all surveyed drivers, 2,410 had consumed alcohol in the previous 12 months. Most were male, with a median age of 36. Leisure as the reason for travel was associated with positive BAC in all 3 groups. Low schooling, being older than 30, driving cars or motorcycles and having been given a breathalyzer test at least once in their lives predicted DUI in at least two different groups.

CONCLUSIONS

Factors , especially low schooling and leisure as a reason for travel, associated with drinking and driving were similar among regions, although certain region-specific features were observed. This information is important for aiming to reduce DUI in the country.

Norwegian roadside survey of alcohol and drug use by drivers (2008-2009)

OBJECTIVE

To examine alcohol and drug use among random drivers in different regions of Norway by analyzing oral fluid, compare drivers in urban and rural areas, compare with results from the roadside survey in southeastern Norway in 2005-2006, and roughly estimate the prevalence of driving with blood drug concentrations above the new Norwegian legislative limits among random drivers. This roadside survey was part of the European DRUID (Driving Under the Influence of Drugs, Alcohol and Medicines) Project.

METHODS

Drivers were selected for a voluntary and anonymous study using a stratified multistage cluster sampling procedure in collaboration with the Mobile Police Service. Samples of oral fluid were taken using the Statsure Saliva Sample (Statsure Diagnostic Systems, Framingham, MA), and the drivers' gender, age, and nationality were recorded. Samples of oral fluid were analyzed for alcohol or drugs, for a total 28 psychoactive substances.

RESULTS

One hundred eighty-four roadside survey sessions were conducted and 10,004 drivers were asked to participate. The refusal rate was 5.8 percent. Psychoactive substances were found in 4.8 percent of the 9410 oral fluid samples analyzed. Alcohol was detected in 0.3 percent, medicinal drugs in 3.2 percent, and illegal drugs in 1.5 percent of the samples. Illegal drugs were significantly more frequently detected in samples from southeastern Norway including the capital Oslo, whereas medicinal drugs were more frequently detected in samples from southeastern Norway excluding Oslo. Illegal drugs were significantly more frequently detected in samples from drivers in urban areas than in rural areas, though there were no significant differences for alcohol and medicinal drugs. Medicinal drugs were most commonly found in samples collected during the daytime on weekdays (3.8%), and illegal drugs were most commonly found in samples collected during late night on weekdays or weekends (2.8%-3.2%). The most commonly found substances were the sleeping agent zopiclone (1.4%), the main active substance in cannabis tetrahydrocannabinol (1.1%), and the sedative drug diazepam (0.7%). The prevalence of driving with drug concentrations above the Norwegian legislative limits for blood was estimated to be about 0.2 percent for alcohol, 0.6 percent for illegal drugs, and about 1.3 percent for medicinal drugs.

CONCLUSIONS

The incidence of drink driving was very low, though driving after using psychoactive illegal or medicinal drugs was more frequent.

Drinking and driving in southeastern Brazil: results from a roadside survey study

OBJECTIVE

The objective of this study is to present data from a roadside survey study on drinking and driving and alcohol consumption in southeastern Brazil.

METHODS

A cross-sectional roadside survey study using a questionnaire and breathalyzer data is the method used to determine the prevalence of drinking and driving and to examine whether socio-demographic characteristics and drivers' behavior, attitude and alcohol consumption predicted positive blood alcohol content (BAC). The data were gathered from 2005 to 2007 through roadside surveys conducted on high volume public roads in four cities in southeastern Brazil. A total of 4182 randomly selected drivers took part in the research. Of these drivers, 3488 (83.4%) completed the questionnaire and agreed to take a breath test.

RESULTS

Overall, 24.6% of drivers had a detectable blood alcohol concentration (BAC) and 15.9% had a BAC above the legal limit (0.6g/l) at the time of the study. Logistic regression controlling for locale (city), sex, age and marital status was used to predict whether each driver would present a positive breath test. Socio-demographic characteristics, driving behaviors and attitudes, and alcohol consumption patterns were included as predictors. These analyses indicated that those who believed drinking and driving was a serious offense were about two-thirds as likely to have a positive breath test, and that drivers reporting a pattern of regular alcohol use were three times as likely to have a positive breath test.

CONCLUSIONS

These findings indicate that drinking and driving is relatively common in Brazil, and that it occurs considerably more frequently than similar surveys suggest, is the case in other countries.

From Kratom to mitragynine and its derivatives: physiological and behavioural effects related to use, abuse, and addiction

Kratom (or Ketum) is a psychoactive plant preparation used in Southeast Asia. It is derived from the plant Mitragyna speciosa Korth. Kratom as well as its main alkaloid, mitragynine, currently spreads around the world. Thus, addiction potential and adverse health consequences are becoming an important issue for health authorities. Here we reviewed the available evidence and identified future research needs. It was found that mitragynine and M. speciosa preparations are systematically consumed with rather well defined instrumentalization goals, e.g. to enhance tolerance for hard work or as a substitute in the self-treatment of opiate addiction. There is also evidence from experimental animal models supporting analgesic, muscle relaxant, anti-inflammatory as well as strong anorectic effects. In humans, regular consumption may escalate, lead to tolerance and may yield aversive withdrawal effects. Mitragynine and its derivatives actions in the central nervous system involve μ-opioid receptors, neuronal Ca²⁺ channels and descending monoaminergic projections. Altogether, available data currently suggest both, a therapeutic as well as an abuse potential.

The incidence of alcohol and other drugs in drivers killed in New Zealand road crashes 2004-2009

Alcohol is a drug known to impair the ability to drive safely and is acknowledged as a major factor in New Zealand road crashes. However, the use of other impairing drugs by New Zealand drivers is largely unknown. This paper reports the prevalence of drug use by drivers killed on New Zealand roads. As this is a biased population sample the results can only indicate possible drug use in the wider driving population. Blood samples taken from 1046 deceased drivers were analysed for the presence of alcohol and a range of both illicit drugs and psychoactive medicinal drugs. Five hundred and forty-six (52%) of these drivers had not used alcohol or other potentially impairing drugs. Five hundred (48%) had alcohol and/or other drugs in their blood that may have impaired their ability to drive safely. Of these 500 drivers, 135 had used alcohol alone, 96 had used cannabis alone and 142 had used a combination of alcohol and cannabis, but no other drug. Alcohol concentrations in 351 drivers who had drunk alcohol ranged from 5 to 354 mg per 100 mL (mean 152 mg/100 mL). Levels of tetrahydrocannabinol (THC) in the blood of the 314 drivers who had used cannabis ranged from approximately 0.1 ng/mL to 44 ng/mL (mean 5.6 ng/mL). There were 127 drivers who had used some other combination of drugs, many still including alcohol and/or cannabis. Only 29 of the 500 drivers who had used a drug, had not used either cannabis or alcohol and 240 (48%) of the 500 drivers had used more than one potentially impairing drug.

Commercial vehicles and road safety in Pakistan: exploring high-risk attributes among drivers and vehicles

Road traffic injuries are on the rise in developing countries with a disproportionately high number of crashes involving commercial vehicles. Baseline information on risk factors is necessary to develop targeted prevention programmes. A survey of commercial drivers was conducted at the largest bus and truck station in Rawalpindi, Pakistan. Structured interviews elicited information from 857 drivers on their socio-demographics, high-risk driving behaviours, fatigue, use of drugs while driving, vehicle maintenance and health conditions, as well as crash involvement. A binary logistic regression analysis was used to investigate the factors associated with crash involvement in the last five years. Overall, 92 (11.2%) drivers reported having had a road crash in the last 5 years. Factors independently associated with the occurrence of crashes were alcohol use (OR 2.2, 95% CI 1.1-4.4), poor vehicle maintenance (OR 3.4, 95% CI 1.7-7.01) and lack of seat belt use (OR 2.7, 95% CI 1.3-5.6). The high prevalence of high-risk attributes in the study population indicates a great need for targeted risk prevention.

Helmet use and associated factors among Thai motorcyclists during Songkran festival

The aim of this study was to assess helmet use and associated factors among motorcycle riders during Songkran festival in Thailand. A cross-sectional survey was conducted to determine the prevalence of helmet use among Thai motorcycle riders (sample size = 18,998) during four days of the Songkran festival. For this sample, the population of motorcycle riders was consecutively selected using quota sampling from 12 petrol stations in four provinces from each of the four main geographical regions of Thailand. The study was conducted at petrol stations at roads in town, outside town and highway at different time intervals when trained field staff administered a structured questionnaire and performed an observation checklist. Results indicate that 44.2% of the motorcycle riders and 72.5% of the motorcycle passengers had not been using a helmet. In multivariable analysis demographics, environmental factors, helmet use experiences and attitudes and recalling a lower exposure to road safety awareness (RSA) campaign were associated with non-helmet use among motorcyclists. It appears that the RSA campaign may have some positive effect on reducing non-helmet use among motorcycle riders during the Songkran festival.

Non-seatbelt use and associated factors among Thai drivers during Songkran festival

Background

Road traffic accidents are the second largest cause of burden of disease in Thailand, largely attributable to behavioural risk factors including drinking and driving, speeding, substance abuse and failure to use seatbelts. The aim of this study was to assess the prevalence and associated factors of non-seatbelt use among drivers during Songkran festival in Thailand.

Methods

A cross-sectional survey has been performed to determine the prevalence of seatbelt use among Thai drivers (N=13722) during four days of the Songkran festival. For this sample the population of drivers was consecutively selected from 12 petrol stations in four provinces from each of the four main geographical regions of Thailand. The study was conducted at petrol stations at roads in town, outside town and highway at different time intervals when trained field staff administered a structured questionnaire and performed an observation checklist on seat belt use.

Results

An overall prevalence of 28.4% of non-seatbelt use among drivers was found. In multivariable analysis demographics (being male, younger age, coming from the Northern or Southern region in Thailand), environmental factors (earlier during the Songkran festival, in the morning and late evening and on main roads in town), seatbelt use experiences and attitudes (having been in an accident before, never having used a seatbelt, no intention to use a seatbelt, lack of awareness of danger of non-seatbelt use and lower perceived risk of being caught with non-seatbelt use) and lower exposure to road safety awareness (RSA) campaign (less frequent exposure to RSA campaign, less frequent following of RTI statistics and not talking with others about the RSA campaign) were associated with non-seatbelt use.

Conclusion

Rates of non-seatbelt use by Thai drivers during Songkran festival was 28.4%. Lower exposure to the RSA campaign was found to be associated with non-seatbelt use among drivers during the Songkran festival.

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

Background

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

Methods

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

Results

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

Conclusion

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

The prevalence of drugs in motor vehicle accidents and traffic violations in Shanghai and neighboring cities

The objective of this study was to determine the prevalence of psychoactive drug use among motor vehicle drivers in Shanghai and its neighboring cities. We selected 10,002 drivers involved in a traffic accident or violation between 2007 and 2008 in Shanghai, Suzhou and Wuxi. We checked for the presence of psychoactive drugs from blood samples using liquid chromatography tandem mass spectrometry (LC-MS-MS). Of the 10,002 drivers, 10.5% tested positive for drugs (excluding alcohol). Cold medicines were the most frequently detected drugs including chlorpheniramine (4.78%), pseudoephedrine (2.15%) and paracetamol (1.32%). The use of multiple cold medicines was common. Illegal drugs such as methamphetamine (0.15%), ketamine (0.03%) and MDMA (0.01%) were also detected. The prevalence of psychoactive drugs among drivers involved in traffic accidents or violations in Shanghai and its neighboring cities was lower compared to previous reports in Europe. Furthermore, cannabis--which has been reported to be the most widely used psychoactive drug after alcohol--was not commonly encountered among Shanghai drivers.