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Kureshi N, Clarke DB, Audas L, Magee K, Nassar B, Chan H, Yuan Y, Erdelyi S, Brubacher JR. Off-road vehicle crashes: dangers of alcohol and drug impairment. CAN J EMERG MED 2024; 26:321-326. [PMID: 38416393 DOI: 10.1007/s43678-024-00656-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/24/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Impaired driving is a public health issue, yet little is known concerning the prevalence of substance use in drivers involved in off-road vehicle crashes. The goal of the present study was to describe the demographics and prevalence of alcohol and drug use in drivers of off-road vehicle crashes. METHODS In this observational substudy, we collected clinical and toxicological data on all moderately or severely injured off-road vehicle drivers who had blood samples obtained within 6 h of the crash. Clinical data were extracted from patients' medical charts and toxicology analyses were performed for blood alcohol, cannabinoids, recreational drugs, and impairing medications. RESULTS Thirty-three injured drivers met the inclusion criteria. The mean age was 37.6 ± 13.4 years and 79% were male. Blood alcohol was detected in 58% of drivers and 42% of these were above the legal limit. Tetrahydrocannabinol was positive in 12% of drivers, and 18% were positive for recreational drugs. Opiates were detected in 21% of drivers. Overall, 85% were positive for at least one substance and 39% tested positive for multiple substances. CONCLUSION This study presents the first evidence of alcohol and drug use in off-road vehicle drivers after cannabis legalization in Canada. Our results show that over half of drivers in off-road vehicle crashes test positive for alcohol and 30% tested positive for THC, cocaine, or amphetamines. Opiates are also commonly detected in off-road vehicle drivers. Emergency department (ED) visits resulting from drug driving of off-road vehicles serve as an opportunity for screening, initiating treatment, and connecting patients to interventions for substance use disorders.
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Affiliation(s)
- Nelofar Kureshi
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
| | - David B Clarke
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada.
| | - Lorelei Audas
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
| | - Kirk Magee
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Bassam Nassar
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yue Yuan
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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Wrathall M, Cristiano N, Walters D, Cullen G, Hathaway A. Examining the impact of legalization on the prevalence of driving after using cannabis: A comparison of rural and non-rural parts of Canada. TRAFFIC INJURY PREVENTION 2024; 25:571-578. [PMID: 38572920 DOI: 10.1080/15389588.2024.2333908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The purpose of this study was to examine the likelihood of driving after using cannabis, and of being a passenger with someone who is driving after using cannabis, in rural areas and non-rural areas before and after legalization. METHODS A multi-wave analysis of Canada's National Cannabis Survey was conducted using logistic regression with interactions to predict the prevalence of driving after using cannabis, and of being a passenger with someone who is driving after using cannabis, in relation to place of residence (rural or non-rural) and in the weeks and months before and after legalization. Three time points were compared: pre-legalization, two months following legalization and 1 year after legalization. RESULTS At the national level, there are no significant differences between the predicted estimates of driving after using cannabis for those who live in rural and non-rural areas. However, when examining the impact of legalization, we found a significant increase in driving after using cannabis among rural residents directly following legalization. Furthermore, it was observed that this increase in driving after using cannabis returns to pre-legalization rates one year after legalization. By contrast, in the weeks and months following legalization, driving after using cannabis decreased among those living in non-rural areas, and slowly increased soon thereafter. No significant differences were observed, in either time period or group, in the prevalence of being a passenger with someone who is driving after using cannabis. CONCLUSIONS The finding of significantly higher risk of driving after use of cannabis soon after legalization in rural areas suggests a need for more attention to address immediate concerns for public safety. The increased potential for traffic injuries and deaths in other jurisdictions contemplating legalization supports the call for more and better targeted prevention efforts in rural communities that have far too often been overlooked and under-served.
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Affiliation(s)
- Meghan Wrathall
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
| | - Nick Cristiano
- Department of Policing and Community Well-Being, Trent University Durham, Oshawa, Ontario, Canada
| | - David Walters
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
| | - Greggory Cullen
- Department of Economics, Justice, and Policy Studies, Mount Royal University, Calgary, Alberta, Canada
| | - Andrew Hathaway
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
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Alexandrescu L, Poulsen H, Mason R, van Lamoen N. Do crashed drivers need more drug testing? A retrospective analysis of blood samples from hospitalised post-crash drivers in New Zealand. ACCIDENT; ANALYSIS AND PREVENTION 2024; 195:107413. [PMID: 38043214 DOI: 10.1016/j.aap.2023.107413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
Driving under the influence of alcohol and other drugs is a prominent safety concern in New Zealand and across the world. While alcohol testing is routinely performed for drivers involved in hospitalisation crashes, testing for other drugs is often not undertaken. The present study refers to 530 traffic crashes that occurred from October 2019 to January 2020 on New Zealand roads. The blood samples from 550 drivers who were injured in a crash and were admitted to a hospital (66% of all drivers involved in these crashes), previously tested for drugs and/or alcohol, were retested for a wider range of drugs. Alcohol above the applicable limit was found to be present in 38% of hospitalised drivers, while other drugs of interest were found in 47% of hospitalised drivers. Binary logistic regression was used to predict the presence of drugs of interest for a crashed driver using previous offence data. A driver having at least one prior drink and drug driving offence is 61% more likely to be positive for a drug of interest when involved in a crash. Similarly, a driver having at least one prior non-traffic drug offence is 4.7 times more likely to be positive for at least a drug of interest when involved in a crash. While the presence of a drug or drugs cannot be presumed to have played a role in the occurrence of the crash, this study has provided a unique and comprehensive picture of the presence of various drugs present in New Zealand drivers' blood. It is recommended to consider standardising drug testing on all blood specimens taken in relation to a serious injury or fatal crash. This procedure is not only of interest for information purposes but may importantly inform appropriate charging decisions.
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Affiliation(s)
| | - Helen Poulsen
- Environmental Science and Research, Porirua, New Zealand
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Brubacher JR, Chan H, Erdelyi S, Yuan Y, Daoust R, Vaillancourt C, Rowe B, Lee J, Mercier E, Atkinson P, Davis P, Clarke D, Taylor J, Macpherson A, Emond M, Al-Hakim D, Horwood C, Wishart I, Magee K, Rao J, Eppler J. High-'n'-dry? A comparison of cannabis and alcohol use in drivers presenting to hospital after a vehicular collision. Addiction 2023; 118:1507-1516. [PMID: 36898848 DOI: 10.1111/add.16186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
DESIGN This was a prospective observational study. BACKGROUND AND AIMS The characteristics of cannabis-involved motor vehicle collisions are poorly understood. This study of injured drivers identifies demographic and collision characteristics associated with high tetrahydrocannabinol (THC) concentrations. SETTING The study was conducted in 15 Canadian trauma centres between January 2018 and December 2021. CASES The cases (n = 6956) comprised injured drivers who required blood testing as part of routine trauma care. MEASUREMENTS We quantified whole blood THC and blood alcohol concentration (BAC) and recorded driver sex, age and postal code, time of crash, crash type and injury severity. We defined three driver groups: high THC (THC ≥ 5 ng/ml and BAC = 0), high alcohol (BAC ≥ 0.08% and THC = 0) and THC/BAC-negative (THC = 0 = BAC). We used logistic regression techniques to identify factors associated with group membership. FINDINGS Most injured drivers (70.2%) were THC/BAC-negative; 1274 (18.3%) had THC > 0, including 186 (2.7%) in the high THC group; 1161 (16.7%) had BAC > 0, including 606 (8.7%) in the high BAC group. Males and drivers aged less than 45 years had higher adjusted odds of being in the high THC group (versus the THC/BAC-negative group). Importantly, 4.6% of drivers aged less than 19 years had THC ≥ 5 ng/ml, and drivers aged less than 19 years had higher unadjusted odds of being in the high THC group than drivers aged 45-54 years. Males, drivers aged 19-44 years, rural drivers, seriously injured drivers and drivers injured in single-vehicle, night-time or weekend collisions had higher adjusted odds ratios (aORs) for being in the high alcohol group (versus THC/BAC-negative). Drivers aged less than 35 or more than 65 years and drivers involved in multi-vehicle, daytime or weekday collisions had higher adjusted odds for being in the high THC group (versus the high BAC group). CONCLUSIONS In Canada, risk factors for cannabis-related motor vehicle collisions appear to differ from those for alcohol-related motor vehicle collisions. The collision factors associated with alcohol (single-vehicle, night-time, weekend, rural, serious injury) are not associated with cannabis-related collisions. Demographic factors (young drivers, male drivers) are associated with both alcohol and cannabis-related collisions, but are more strongly associated with cannabis-related collisions.
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Affiliation(s)
- J R Brubacher
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - H Chan
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - S Erdelyi
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - Y Yuan
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - R Daoust
- Department of Emergency Medicine, University of Montréal, Montréal, QC, Canada
| | - C Vaillancourt
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - B Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - J Lee
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - E Mercier
- Department of Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - P Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, St John, NB, Canada
| | - P Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Clarke
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
| | - J Taylor
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - A Macpherson
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - M Emond
- Department of Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - D Al-Hakim
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - C Horwood
- Department of Emergency Medicine, Memorial University, St John, NB, Canada
| | - I Wishart
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - K Magee
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - J Rao
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - J Eppler
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
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The sentinel role of forensic toxicology laboratories to identify and act upon diverse drug threats by addressing toxicology and economic demands. Forensic Sci Int Synerg 2022; 5:100292. [PMID: 36419757 PMCID: PMC9677077 DOI: 10.1016/j.fsisyn.2022.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
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Robertson MB, Li A, Yuan Y, Jiang A, Gjerde H, Staples JA, Brubacher JR. Correlation between oral fluid and blood THC concentration: A systematic review and discussion of policy implications. ACCIDENT; ANALYSIS AND PREVENTION 2022; 173:106694. [PMID: 35640367 DOI: 10.1016/j.aap.2022.106694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/25/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
Cannabis is the second most commonly used impairing substance by drivers, after alcohol. As more countries legalize cannabis, there is concern that cannabis-impaired driving will increase. In many countries, police use roadside devices to test for oral fluid THC (the primary psychotropic component in cannabis) to identify drivers who used cannabis; including in countries with non-zero per se limits for THC in blood. This practice is questioned as previous research demonstrates a poor correlation between oral fluid and blood THC concentrations at the individual level. We conducted a meta-analysis to identify all research that compared oral fluid with blood THC levels. We obtained individual-level data from study authors and analyzed pooled individual-level data to calculate sensitivity and specificity of oral fluid THC (at various cut-off values) to detect blood THC above different concentration limits. Finally, we explored practical implications of using oral fluid THC in an enforcement context. Our review found THC concentrations measured in over 18,000 paired samples of oral fluid and blood. We found a good correlation between the presence of THC in oral fluid and presence of THC in blood (sensitivity = 71.2%, specificity = 97.7%). However oral fluid THC, at commonly used cut-off values, is less sensitive and less specific when used as a biomarker to detect people with blood THC concentrations above commonly used per se limits (such as 5 ng/mL). As such, there will be a large number of "false positive" tests if oral fluid THC testing were used as a biomarker for "illegal" THC concentrations in randomly selected drivers. We argue that the adverse implications of false positive oral fluid THC tests in this context outweigh the possible road safety benefits and we recommend against oral fluid THC screening in randomly selected drivers in countries with non-zero per se limits for blood THC. In contrast, oral fluid THC tests appear to be useful for investigating "high-risk" drivers who come to police attention because of evidence of impairment.
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Affiliation(s)
| | - A Li
- University of Ottawa, Canada
| | - Y Yuan
- University of British Columbia, Canada
| | - A Jiang
- University of British Columbia, Canada
| | - H Gjerde
- Oslo University Hospital, Norway
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Brubacher JR, Chan H, Erdelyi S, Staples JA, Asbridge M, Mann RE. Cannabis Legalization and Detection of Tetrahydrocannabinol in Injured Drivers. N Engl J Med 2022; 386:148-156. [PMID: 35020985 DOI: 10.1056/nejmsa2109371] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effect of cannabis legalization in Canada (in October 2018) on the prevalence of injured drivers testing positive for tetrahydrocannabinol (THC) is unclear. METHODS We studied drivers treated after a motor vehicle collision in four British Columbia trauma centers, with data from January 2013 through March 2020. We included moderately injured drivers (those whose condition warranted blood tests as part of clinical assessment) for whom excess blood remained after clinical testing was complete. Blood was analyzed at the provincial toxicology center. The primary outcomes were a THC level greater than 0, a THC level of at least 2 ng per milliliter (Canadian legal limit), and a THC level of at least 5 ng per milliliter. The secondary outcomes were a THC level of at least 2.5 ng per milliliter plus a blood alcohol level of at least 0.05%; a blood alcohol level greater than 0; and a blood alcohol level of at least 0.08%. We calculated the prevalence of all outcomes before and after legalization. We obtained adjusted prevalence ratios using log-binomial regression to model the association between substance prevalence and legalization after adjustment for relevant covariates. RESULTS During the study period, 4339 drivers (3550 before legalization and 789 after legalization) met the inclusion criteria. Before legalization, a THC level greater than 0 was detected in 9.2% of drivers, a THC level of at least 2 ng per milliliter in 3.8%, and a THC level of at least 5 ng per milliliter in 1.1%. After legalization, the values were 17.9%, 8.6%, and 3.5%, respectively. After legalization, there was an increased prevalence of drivers with a THC level greater than 0 (adjusted prevalence ratio, 1.33; 95% confidence interval [CI], 1.05 to 1.68), a THC level of at least 2 ng per milliliter (adjusted prevalence ratio, 2.29; 95% CI, 1.52 to 3.45), and a THC level of at least 5 ng per milliliter (adjusted prevalence ratio, 2.05; 95% CI, 1.00 to 4.18). The largest increases in a THC level of at least 2 ng per milliliter were among drivers 50 years of age or older (adjusted prevalence ratio, 5.18; 95% CI, 2.49 to 10.78) and among male drivers (adjusted prevalence ratio, 2.44; 95% CI, 1.60 to 3.74). There were no significant changes in the prevalence of drivers testing positive for alcohol. CONCLUSIONS After cannabis legalization, the prevalence of moderately injured drivers with a THC level of at least 2 ng per milliliter in participating British Columbia trauma centers more than doubled. The increase was largest among older drivers and male drivers. (Funded by the Canadian Institutes of Health Research.).
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Affiliation(s)
- Jeffrey R Brubacher
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - Herbert Chan
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - Shannon Erdelyi
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - John A Staples
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - Mark Asbridge
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
| | - Robert E Mann
- From the University of British Columbia, Vancouver (J.R.B., H.C., S.E., J.A.S.), Dalhousie University, Halifax, NS (M.A.), and the Centre for Addiction and Mental Health (R.E.M.) and the University of Toronto (R.E.M.), Toronto - all in Canada
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8
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Pitt TM, Howard A, HubkaRao T, Hagel B. Identifying modifiable factors related to novice adolescent driver fault in motor vehicle collisions. TRAFFIC INJURY PREVENTION 2021; 22:437-442. [PMID: 34097541 DOI: 10.1080/15389588.2021.1923700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Novice adolescent drivers have a higher propensity to engage in risky driving and are at higher odds of being involved in collisions. Graduated driver licensing programs have been instituted to help novice drivers gain experience while avoiding higher risk driving circumstances. This study examines modifiable risk factors contributing to novice adolescent driver fault in collisions. METHODS Police traffic collision report data from municipalities in Alberta for the years 2010-2016, inclusive, were used. Fault in collision was assigned using an automated and previously validated tool for assigning culpability. Factors contributing to novice adolescent (16-19 years of age) fault in collision were examined using multivariable logistic regression. RESULTS Novice adolescent drivers had higher adjusted odds ratios (aOR) of being at-fault in collision when driving from 01:00-05:00 (aOR = 1.38; 95% Confidence Interval [CI]: 1.26-1.50). Novice adolescent drivers had lower odds of fault when driving with an adult (aOR= 0.62; 95% CI: 0.57-0.68) or a single peer (aOR= 0.87; 95% CI: 0.80-0.94), but higher odds of causing a severe collision with a single peer present (aOR= 2.23; 95% CI: 1.21-4.11). Impairment of the teen driver was reported in 25% of all fatal collisions, and 40% of late-night fatal collisions. CONCLUSIONS The findings support policies that allow driving with a single adult or peer passenger during daytime hours. Driving during late-night hours should be restricted for novice adolescent drivers.
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Affiliation(s)
- Tona M Pitt
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - Andrew Howard
- Department of Surgery & Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Tate HubkaRao
- Department of Paediatrics, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Brent Hagel
- Department of Paediatrics, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Faculty of Kinesiology, Sports Injury Prevention Research Centre, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
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9
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Peng YW, Desapriya E, Chan H, R Brubacher J. "Residual blood THC levels in frequent cannabis users after over four hours of abstinence: A systematic review.". Drug Alcohol Depend 2020; 216:108177. [PMID: 32841811 DOI: 10.1016/j.drugalcdep.2020.108177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, causes psychomotor impairment and puts drivers at increased risk of motor vehicle collisions. Many jurisdictions have per se limits for THC, often 2 or 5 ng/mL, that make it illegal to drive with THC above the "legal limit". People who use cannabis regularly develop partial tolerance to some of its impairing effects. Regular cannabis users may also have persistent elevation of THC even after a period of abstinence. Some stakeholders worry that current per se limits may criminalize unimpaired drivers simply because they use cannabis. We conducted a systematic review of published literature to investigate residual blood THC concentrations in frequent cannabis users after a period of abstinence. METHODS We identified relevant articles by combining terms for "cannabis" and "blood" and "concentration" and "abstinence" and searching MEDLINE, EMBASE, PsycINFO, and Web of Science. We included studies that reported THC levels in frequent cannabis users after more than 4 h of abstinence. RESULTS Our search identified 1612 articles of which 8 met our inclusion criteria. After accounting for duplicate publications, we had identified 6 independent studies. These studies show that blood THC over 2 ng/mL does do not necessarily indicate recent cannabis use in frequent cannabis users. Five studies reported blood THC >2 ng/mL (or plasma THC >3 ng/mL) in some participants after six days of abstinence and two reported participants with blood THC >5 ng/mL (or plasma THC > 7.5 ng/mL) after a day of abstinence. CONCLUSIONS Blood THC >2 ng/mL, and possibly even THC >5 ng/mL, does not necessarily represent recent use of cannabis in frequent cannabis users.
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Affiliation(s)
- Yuan Wei Peng
- The University of British Columbia, Faculty of Pharmaceutical Sciences, (Student), 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | - Ediriweera Desapriya
- The University of British Columbia, Faculty of Medicine, Department of Emergency Medicine, VGH Research Pavilion, Room 281 - 828 W 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Herbert Chan
- The University of British Columbia, Faculty of Medicine, Department of Emergency Medicine, VGH Research Pavilion, Room 281 - 828 W 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Jeffrey R Brubacher
- The University of British Columbia, Faculty of Medicine, Department of Emergency Medicine, VGH Research Pavilion, Room 281 - 828 W 10th Ave, Vancouver, BC V5Z 1M9, Canada.
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Piccioni A, Cicchinelli S, Saviano L, Gilardi E, Zanza C, Brigida M, Tullo G, Volonnino G, Covino M, Franceschi F, La Russa R. Risk Management in First Aid for Acute Drug Intoxication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218021. [PMID: 33143348 PMCID: PMC7663746 DOI: 10.3390/ijerph17218021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Drug abuse (cannabis, cocaine, opiates, and synthetic drugs) is an increasing phenomenon, especially in the younger population, thus leading to more cases of intoxication requiring evaluation in the emergency department and subsequent hospitalization. In 2017, 34.2% of students reported having used an illegal psychoactive substance in their lifetime, while 26% reported having done so over the past year. We made a review about the effectiveness of the role of the temporary observation unit in the emergency department to improve management of acute drugs intoxication. We checked medical literature from the last 10 years (2009-2019). The following electronic databases were systematically searched: MEDLINE-PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Then, a systematic review was carried out according to the Preferred Reporting Items for Systematic Review standards. Intoxicated patients usually display a favorable medical course, few diagnostic and therapeutic interventions, a short stay in the hospital, and, when hospitalization is needed, semi-intensive therapy is a feasible solution; therefore, intoxicated patients are ideal candidates for a temporary observation unit. The emergency department is very important to manage intoxicated patients; however, the hospitalization of these patients is often not necessary.
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Affiliation(s)
- Andrea Piccioni
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Sara Cicchinelli
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Luisa Saviano
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Emanuele Gilardi
- Emergency-Admission Department, Biomedical Campus, 00128 Rome, Italy;
| | - Christian Zanza
- Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, 12051 Verduno, Italy;
| | - Mattia Brigida
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Gianluca Tullo
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Gianpietro Volonnino
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00161 Rome, Italy;
| | - Marcello Covino
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | | | - Raffaele La Russa
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00161 Rome, Italy;
- Correspondence:
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Lu L, Contrand B, Gadegbeku B, Salmi LR, Lagarde E. Road traffic crash characteristics of drivers who take prescription medicines that carry a risk to driving. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102929. [PMID: 32919299 DOI: 10.1016/j.drugpo.2020.102929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The specific features of crashes involving an alcohol-intoxicated driver have been extensively characterized, but no such data are available for crashes involving a driver who has used a prescription medicine, which could help to plan and target prevention and control initiatives. This study aimed to describe the characteristics of crashes involving drivers under the influence of prescription medicines. METHODS We took advantage of CESIR, a French record linkage study for which data were extracted and matched from three French national databases: police reports, the national police database of injurious crashes and the national health care insurance database (HCI database). The drivers included in the study were those involved in an injurious road crash in France from July 1, 2005 to December 31, 2015, whose national identity number, date of birth and sex allowed matching. Prescription medicines considered were those with the two highest levels of warning. RESULTS Similar crash profiles were found when drivers used alcohol or medicines, particularly with respect to injury severity, type of vehicle, type of collision, type of road and cross-track profile. Alcohol-related crashes were over-represented during weekends and in low-density areas and medicine-related crashes were over-represented during weekdays and in cities of fewer than 300 000 inhabitants. While a much higher strength of association with responsibility was found for alcohol than for medicines, the proportion of crashes with drivers using medicines was twice as high as crashes with drivers using alcohol. CONCLUSION The lower risk carried by medicines is therefore in part compensated by a higher prevalence of use, making medicines one of the hidden factors of road risk. Characterizing these crashes will therefore be useful to better focus road safety intervention on the prevention of driving under the influence of psychotropic medicines.
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Affiliation(s)
- Li Lu
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Benjamin Contrand
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Blandine Gadegbeku
- Université de Lyon, Université Gustave Eiffel, IFSTTAR, UMRESTTE UMR_T9405, F-69675 Lyon, France
| | - Louis-Rachid Salmi
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France; Service d'Information Médicale, Pôle de Santé Publique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Emmanuel Lagarde
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France.
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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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Watling CN. Young drivers who continue to drive while sleepy: What are the associated sleep- and driving-related factors? J Sleep Res 2019; 29:e12900. [PMID: 31347230 DOI: 10.1111/jsr.12900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/12/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022]
Abstract
Crashes due to sleepiness account for a substantial proportion of road crash incidents. The purpose of the current study was to examine several sleep-related factors and driving-related factors for their association with self-reports of continuing to drive while sleepy. In total 257 young drivers aged 18-25 years completed an online survey that assessed factors such as sleep quality, sleep duration and consistency, excessive daytime sleepiness, experiences with sleepiness and their driving-related behaviours. The results demonstrate that being older, having a perceived ability to overcome sleepiness, committing more highway code violations and having experienced a sleep-related close call were positively associated with an increased likelihood of continuing to drive while sleepy. The obtained results highlight the acceptance of risky driving behaviours among some younger drivers. Younger drivers' risky driving behaviour is certainly a road safety concern given the impairment associated with sleepiness and their over-representation in road crash incidents.
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Affiliation(s)
- Christopher N Watling
- Centre for Accident Research and Road Safety - Queensland (CARRS-Q), Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Division Sleep and Alertness, Stress Research Institute, Stockholm University, Stockholm, Sweden
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Vandoros S, Kawachi I. The relative risk of motor vehicle collision on cannabis celebration day in Great Britain. ACCIDENT; ANALYSIS AND PREVENTION 2019; 128:248-252. [PMID: 30902341 DOI: 10.1016/j.aap.2019.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/30/2018] [Accepted: 02/10/2019] [Indexed: 06/09/2023]
Abstract
Cannabis celebration day, also known as "420 day", takes place at 4:20pm on April 20 every year. The objective of this paper is to study whether there is an increase in road traffic collisions in Great Britain on that day. We used daily car crash data resulting in death or injury from all 51 local police forces covering Great Britain over the period 2011-2015. We compared crashes from 4:20pm onwards on April 20 to control days on the same day of the week in the preceding and succeeding two weeks, using panel data econometric models. On the average cannabis celebration day in Britain, there were an additional 23 police-reported collisions compared to control days, corresponding to a 17.9% increase in the relative risk of collision.
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Affiliation(s)
- Sotiris Vandoros
- King's College London, 30 Aldwych, London WC2B 4BG, United Kingdom; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
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Spotlight on Neurotrauma Research in Canada's Leading Academic Centers. J Neurotrauma 2018; 35:1986-2004. [PMID: 30074875 DOI: 10.1089/neu.2018.29017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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