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Boonyayothin W, Kobtrakul K, Khositanon P, Vimolmangkang S, Phoolcharoen W. Development of a plant-produced recombinant monoclonal antibody against Δ-9-tetrahydrocannabinol (Δ9-THC) for immunoassay application. BIOTECHNOLOGY REPORTS (AMSTERDAM, NETHERLANDS) 2022; 34:e00725. [PMID: 35686006 PMCID: PMC9171438 DOI: 10.1016/j.btre.2022.e00725] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022]
Abstract
Δ-9-tetrahydrocannabinol (Δ9-THC) is mainly a psychoactive compound in the cannabis plant. The immunoassay, an alternative method to HPLC and GC, can be used to analyze and measure Δ9-THC. This method provides high sensitivity and specificity by using antibodies specific to the desired substances. Currently, plants provide several benefits over traditional expression platforms to produce recombinant antibodies, such as lower production costs and scalability. Therefore, this study aims to produce a recombinant anti-Δ9-THC monoclonal antibody (mAb) with transient expression using N. benthamiana. The highest expression level of the plant-produced mAb was estimated to be 0.33 ug/g leaf fresh weight. Our results demonstrate that the antibody provided in vitro affinity binding related to Δ9-THC and the metabolites of Δ9-THC, such as cannabinol (CBN). Moreover, the antibody also showed binding efficiency with Δ9-THC in cannabis extract. Moreover, plant-produced mAbs provide efficiency against Δ9-THC and can be applied for further immunoassay applications.
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Affiliation(s)
- Wanuttha Boonyayothin
- Center of Excellence in Plant-Produced Pharmaceuticals, Chulalongkorn University, Bangkok, Thailand
- Pharmaceutical Sciences and Technology Program, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Khwanlada Kobtrakul
- Pharmaceutical Sciences and Technology Program, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Petlada Khositanon
- Research Cluster for Cannabis and its Natural Substances, Chulalongkorn University, Bangkok, Thailand
| | - Sornkanok Vimolmangkang
- Center of Excellence in Plant-Produced Pharmaceuticals, Chulalongkorn University, Bangkok, Thailand
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
- Research Cluster for Cannabis and its Natural Substances, Chulalongkorn University, Bangkok, Thailand
| | - Waranyoo Phoolcharoen
- Center of Excellence in Plant-Produced Pharmaceuticals, Chulalongkorn University, Bangkok, Thailand
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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Renaud-Young M, Mayall RM, Salehi V, Goledzinowski M, Comeau FJ, MacCallum JL, Birss VI. Development of an ultra-sensitive electrochemical sensor for Δ9-tetrahydrocannabinol (THC) and its metabolites using carbon paper electrodes. Electrochim Acta 2019. [DOI: 10.1016/j.electacta.2019.02.117] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Courchesne NS, Muth CM, Barker M, Woodruff SI. Correlates of Breath Alcohol Concentration Among Driving Under the Influence Program Clients in Southern California. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618815688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Understanding factors correlated with breath alcohol concentration (BrAC) at time of arrest for driving under the influence (DUI) may lead to informed rehabilitation programs. This study describes correlations between BrAC at time of arrest and sociodemographic, mental, and physical health, and alcohol-related characteristics among clients in a large California DUI Program. Client reported data ( n = 17,282) were collected at an intake from 2009 to 2014. BrACs ranged from 0.083% to 0.390%, with an average of 0.159% ( SD = 0.051), almost twice the legal limit in the state. Approximately 10.6% of the variance in BrAC was explained by 11 significant correlates. Two sociodemographic factors (age and race/ethnicity) as well as several alcohol-related characteristics were related to higher BrAC levels, whereas comorbid mental and physical health factors played less of a role. Factors associated with BrAC are complex and warrant further investigation to identify causality and inform future interventions.
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Gibson S, Woodford M, Czeizinger TJ. Avoiding the Last Ride: Can DUI Programming Address Multiple Risk Factors to Reduce Recidivism? JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2018. [DOI: 10.1002/jaoc.12047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sandy Gibson
- Department of Counselor Education, The College of New Jersey
| | - Mark Woodford
- Department of Counselor Education, The College of New Jersey
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Smart R, Osilla KC, Jonsson L, Paddock SM. Differences in alcohol cognitions, consumption, and consequences among first-time DUI offenders who co-use alcohol and marijuana. Drug Alcohol Depend 2018; 191:187-194. [PMID: 30130715 PMCID: PMC6309328 DOI: 10.1016/j.drugalcdep.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/04/2018] [Accepted: 07/09/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND A significant portion of alcohol-related DUI offenders engage in co-use of alcohol and marijuana (AM). Given expanding marijuana legalization and the impaired driving risks associated with co-use, it is of increased importance to understand how characteristics of AM co-users compare to those who use alcohol only (AO) in order to inform DUI interventions and prevent recidivism. METHODS Participants were 277 first-time DUI offenders enrolled in a first-time DUI offender program across three locations. Using well-established measures, we evaluated differences in alcohol-related cognitions (positive expectancies and self-efficacy), frequency and quantity of alcohol consumption, and alcohol-related consequences between AO users and AM co-users by running a series of multivariate generalized linear models. RESULTS Compared to AO users, AM co-users reported lower self-efficacy to achieve abstinence and avoid DUI. Differences in abstinence self-efficacy largely explain higher relative rates of average and peak drinking quantity and higher odds of binge drinking among AM co-user. Despite lower self-efficacy and higher drinking quantity, there were no significant differences between AM and AO-users on alcohol-related consequences and past month reports of drinking and driving. CONCLUSIONS Our results provide preliminary evidence that DUI offenders who co-use alcohol and marijuana have higher alcohol use and lower self-efficacy than AO-users, and long-term consequences for this group should be monitored in future research. DUI programs may screen and identify co-users and consider tailoring their interventions to build self-efficacy to address the risks associated with AM co-use uniquely.
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Affiliation(s)
- Rosanna Smart
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States.
| | - Karen Chan Osilla
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States
| | - Lisa Jonsson
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States
| | - Susan M Paddock
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States
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Webster JM, Dickson MF, Mannan F, Staton M. Characteristics of Prescription-Opioid-Impaired and Other Substance-Impaired Drivers in Rural Appalachian Kentucky. J Psychoactive Drugs 2018; 50:373-381. [PMID: 30204565 DOI: 10.1080/02791072.2018.1514477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Previous studies have highlighted the prescription opioid epidemic in rural Appalachia and its associated risk behaviors; however, no studies have examined prescription-opioid-impaired driving as a consequence of this epidemic. The purpose of the present study was to describe prescription-opioid-impaired drivers in rural Appalachian Kentucky and examine how they are similar to and different from other substance-impaired drivers from the region. A sample of convicted DUI offenders from rural Appalachian Kentucky completed a confidential research interview focused on their substance use, mental health, and criminal activity. Prescription-opioid-impaired drivers (n = 33) were compared to other drug-impaired drivers (n = 29) and to alcohol-only-impaired drivers (n = 44). Overall, prescription-opioid-impaired drivers had a similar prevalence of illicit substance use and criminal activity, including impaired driving frequency, to other drug-impaired drivers, but had a higher prevalence of illicit substance use and more frequent impaired driving when compared to alcohol-only-impaired drivers. Study implications include the importance of comprehensive substance abuse assessment and treatment for DUI offenders and the need for tailored interventions for prescription-opioid-impaired and other drug-impaired drivers.
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Affiliation(s)
- J Matthew Webster
- a Department of Behavioral Science and Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
| | - Megan F Dickson
- b Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
| | - Faiyad Mannan
- c College of Medicine , University of Kentucky , Lexington , KY , USA
| | - Michele Staton
- a Department of Behavioral Science and Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
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Walton MA, Epstein-Ngo Q, Carter PM, Zimmerman MA, Blow FC, Buu A, Goldstick J, Cunningham RM. Marijuana use trajectories among drug-using youth presenting to an urban emergency department: Violence and social influences. Drug Alcohol Depend 2017; 173:117-125. [PMID: 28219802 PMCID: PMC5366264 DOI: 10.1016/j.drugalcdep.2016.11.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 01/14/2023]
Abstract
AIMS This paper examined longitudinal marijuana use trajectories among drug-using youth presenting to the ED to inform intervention development. METHODS Given interest in substance use and violence, this study oversampled those presenting with assault injuries. Assault-injured youth (ages 14-24) endorsing past 6-month drug use (n=349), and a sex and age proportionally-sampled comparison group (n=250) endorsing drug use, completed a baseline assessment and follow-ups at 6, 12, 18, and 24 months. Latent class trajectory analyses examined days of marijuana use over 2 years. Multinomial regression analyses examined baseline, 12-month and 24-month factors associated with substance use trajectory groups. RESULTS Trajectory analyses identified 5 groups: Low (Low; 28.2%; n=169); Intermittent (INT; 16.2%; n=97); Moderate Decline (MD; 12.0%; n=72); High decline (HD, 13.2%; n=79) and Chronic (C; 30.4%; n=182). At baseline, as compared to the Low group, the other trajectory groups were more likely to be male and have greater levels of physical aggression. At 12- and 24-months, negative and positive peer influences, incarceration and community violence were additional characteristics associated with the greater marijuana use trajectories (as compared to the Low group). CONCLUSIONS Interventions for drug-using youth presenting to the urban ED should address peer influences, physical aggression and community violence exposure, given the association between these characteristics and greater marijuana use trajectories.
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Affiliation(s)
- Maureen A Walton
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Quyen Epstein-Ngo
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Institute on Women and Gender Studies, University of Michigan, 500 South State St., Ann Arbor, MI 48109, USA
| | - Patrick M Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA; Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA
| | - Marc A Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, USA
| | - Frederic C Blow
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Anne Buu
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls, Room 4346, Ann Arbor, MI 48109, USA
| | - Jason Goldstick
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA; Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA
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Andersen SH. Drinking Alone? The Effect of an Alcohol Treatment Program on Relationship Stability for Convicted Drunk Drivers in Denmark. THE ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE 2016; 665:46-62. [PMID: 27471323 PMCID: PMC4941095 DOI: 10.1177/0002716216632456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article tests whether an alcohol treatment program for drunk drivers in Denmark increased the stability of their relationships with spouses or cohabiting partners. The treatment program, implemented in 1990, allowed a group of offenders to avoid prison and participate in a rehabilitation program. I use it here as a natural experiment, exploiting a rich administrative dataset to show that the program marginally increases offenders' relationship stability. I also test whether increased relationship stability observed among the treated offenders results from their pardon from prison or from their participation in the rehabilitation program. Results suggest that the rehabilitation program drives the effect. These findings contribute to the literature on what alternative sanctions could be offered to offenders to improve their long-term social outcomes.
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Brown TG, Ouimet MC, Eldeb M, Tremblay J, Vingilis E, Nadeau L, Pruessner J, Bechara A. Personality, Executive Control, and Neurobiological Characteristics Associated with Different Forms of Risky Driving. PLoS One 2016; 11:e0150227. [PMID: 26910345 PMCID: PMC4766103 DOI: 10.1371/journal.pone.0150227] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/10/2016] [Indexed: 11/27/2022] Open
Abstract
Background Road crashes represent a huge burden on global health. Some drivers are prone to repeated episodes of risky driving (RD) and are over-represented in crashes and related morbidity. However, their characteristics are heterogeneous, hampering development of targeted intervention strategies. This study hypothesized that distinct personality, cognitive, and neurobiological processes are associated with the type of RD behaviours these drivers predominantly engage in. Methods Four age-matched groups of adult (19–39 years) males were recruited: 1) driving while impaired recidivists (DWI, n = 36); 2) non-alcohol reckless drivers (SPEED, n = 28); 3) drivers with a mixed RD profile (MIXED, n = 27); and 4) low-risk control drivers (CTL, n = 47). Their sociodemographic, criminal history, driving behaviour (by questionnaire and simulation performance), personality (Big Five traits, impulsivity, reward sensitivity), cognitive (disinhibition, decision making, behavioural risk taking), and neurobiological (cortisol stress response) characteristics were gathered and contrasted. Results Compared to controls, group SPEED showed greater sensation seeking, disinhibition, disadvantageous decision making, and risk taking. Group MIXED exhibited more substance misuse, and antisocial, sensation seeking and reward sensitive personality features. Group DWI showed greater disinhibition and more severe alcohol misuse, and compared to the other RD groups, the lowest level of risk taking when sober. All RD groups exhibited less cortisol increase in response to stress compared to controls. Discussion Each RD group exhibited a distinct personality and cognitive profile, which was consistent with stimulation seeking in group SPEED, fearlessness in group MIXED, and poor behavioural regulation associated with alcohol in group DWI. As these group differences were uniformly accompanied by blunted cortisol stress responses, they may reflect the disparate behavioural consequences of dysregulation of the stress system. In sum, RD preference appears to be a useful marker for clarifying explanatory pathways to risky driving, and for research into developing more personalized prevention efforts.
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Affiliation(s)
- Thomas G. Brown
- Research Centre of the Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Foster Addiction Rehabilitation Centre, St. Philippe de Laprairie, Quebec, Canada
- * E-mail:
| | - Marie Claude Ouimet
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Manal Eldeb
- Research Centre of the Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jacques Tremblay
- Research Centre of the Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Evelyn Vingilis
- Department of Family Medicine and Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Louise Nadeau
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Jens Pruessner
- Research Centre of the Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Antoine Bechara
- Department of Psychology, University of Southern California, Los Angeles, California, United States of America
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Choi NG, DiNitto DM, Marti CN. Risk Factors for Self-reported Driving Under the Influence of Alcohol and/or Illicit Drugs Among Older Adults. THE GERONTOLOGIST 2014; 56:282-91. [DOI: 10.1093/geront/gnu070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/29/2014] [Indexed: 11/14/2022] Open
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De Boni RB, Bastos FI, de Vasconcellos M, Oliveira F, Limberger RP, Pechansky F. Drug use among drivers who drank on alcohol outlets from Porto Alegre, Brazil. ACCIDENT; ANALYSIS AND PREVENTION 2014; 62:137-142. [PMID: 24148905 DOI: 10.1016/j.aap.2013.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 08/31/2013] [Accepted: 09/23/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Driving under the influence of multiple substances is a public health concern, but there is little epidemiological data about their combined use and putative impact on driving in low and middle-income countries where traffic crashes have been clustering in recent years. The aim of this study is to estimate the prevalence of alcohol and drug use - as well as their associated factors - among drivers in the context of alcohol outlets (AOs). METHODS A probability three-stage sample survey was conducted in Porto Alegre, Brazil. Individuals who were leaving AO were screened, with the selection of 683 drivers who met the inclusion criteria. Drivers answered a structured interview, were breathalyzed, and had their saliva collected for drug screening. Prevalences were assessed using domain estimation and logistic regression models assessed covariates associated with substance use. FINDINGS Benzodiazepines 3.9% (SE 2.13) and cocaine 3.8% (SE 1.3) were the most frequently detected drugs in saliva. Among drivers who were going to drive, 11% had at least one drug identified by the saliva drug screening, 0.4% two, and 0.1% three drugs in addition to alcohol. In multivariable analyses, having a blood alcohol concentration (BAC)>0.06% was found to be associated with a 3.64 times (CI 95% 1.79-7.39) higher chance of drug detection, compared with interviewees with lower BACs. CONCLUSIONS To drive under the influence of multiple substances is likely to be found in this setting, highlighting an association between harmful patterns of consume of alcohol and the misuse of other substances.
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Affiliation(s)
- Raquel B De Boni
- Department of Health Information, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Pilkinton MW, Robertson A, McCluskey DL. Drugged driving: increased traffic risks involving licit and illicit substances. JOURNAL OF DRUG EDUCATION 2013; 43:183-201. [PMID: 25068170 DOI: 10.2190/de.43.2.f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Driving under the influence of drugs poses risks for traffic safety. Most research attention has been focused on the most prevalent drugs of abuse, such as alcohol, illegal drugs, and prescription drugs with high abuse potential. The objectives of this study were to determine the types of drugs used by convicted DUI offenders on the day of their arrest, prevalence of poly-substance use, and offender characteristics associated with different drug use patterns. Data were collected from 6,339 individuals enrolled in the court-mandated Mississippi Alcohol Safety Education Program. After alcohol, cannabis was the most frequently used substance, followed by sedative medications and prescription analgesics. Among poly-substance users, 78.4% reported combining alcohol with other drugs. Findings could be used to inform public education campaigns, law enforcement training, and highway safety policies about the prevalence of combining alcohol with other drugs, as well as how poly-substance use further impairs traffic-related risks.
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