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Wei SY, Su CC, Hu HY, Lin SY, Pan CH. Shedding Light on Hidden Methamphetamine Abuse: A Nation-wide 7-year Post-mortem Study in Taiwan. J Epidemiol 2024; 34:477-484. [PMID: 38462530 PMCID: PMC11405366 DOI: 10.2188/jea.je20230263] [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: 09/26/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The number of methamphetamine-related deaths has been increasing in recent decades. However, current data primarily rely on a few large-scale national surveys, highlighting the need for diverse data sources. Post-mortem studies offer advantages that compensate for the limitations of cohort studies. In this study, we aimed to (1) examine mortality rates and years of potential life lost, (2) compare proportionate mortality with previous cohort studies, and (3) quantitatively investigate causes of death as potential risk factors associated with each manner of death. METHODS We analyzed 740 cases from 2013 to 2019 in Taiwan. RESULTS The mean age of cases was 38.4 years, with a notable loss of 30 or more years of potential life, and 79.6% were male. The crude mortality rate was 0.45 per 100,000 person-years. The proportionate mortality indicated that autopsy dataset, compared to cohort studies, provided more accurate estimations for accidental deaths, equivalent suicides, underestimated natural deaths, and overestimated homicides. Accidental deaths were evident in 67% of cases with 80% attributed to drug intoxication. Multiple substances were detected in 61% of cases, with psychiatric medications detected in 43% of cases. Higher methamphetamine concentrations and a greater proportion of multiple substances and benzodiazepines were detected in suicidal deaths. Among accidental deaths, traffic accidents (7.9%) were the second most common cause, particularly motorcycle riders. CONCLUSION Using autopsy dataset as a secondary source, we identified that over half of the cases involved drug intoxication-related accidental deaths. The significant proportion of cases involving multiple substances, psychiatric medications, and drug-impaired driving raises concerns.
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Affiliation(s)
- Shyh-Yuh Wei
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chou Su
- Clinical Innovation and Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsuan-Yun Hu
- Institute of Forensic Medicine, Ministry of Justice, New Taipei City, Taiwan
| | - Szu-Yu Lin
- Institute of Forensic Medicine, Ministry of Justice, New Taipei City, Taiwan
| | - Chih-Hsin Pan
- Institute of Forensic Medicine, Ministry of Justice, New Taipei City, Taiwan
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2
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Bödefeld T, Hartung B. [Reduced mobility in the elderly due to medication, alcohol, and cannabinoids]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:903-909. [PMID: 38913167 PMCID: PMC11282118 DOI: 10.1007/s00103-024-03913-6] [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: 02/07/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024]
Abstract
Many diseases are accompanied by symptoms that can impair the ability to perform complex everyday tasks, such as active participation in road traffic. If a cure is not possible, the aim of drug therapy is to alleviate the symptoms to such an extent that the patient no longer has any restrictions in everyday life. However, around 20% of the approximately 100,000 medicines licensed in Germany have traffic-relevant side effects that can also lead to driving impairment.It is assumed that the effect of a drug is at least partially responsible for one in four traffic accidents and that one in ten victims of fatal road accidents has taken psychotropic drugs before driving. In addition to alcohol and drugs, medications from the benzodiazepine, opioid, and antidepressant groups are suspected of impairing driving safety in particular. The effects of these substances on young people have been described many times, but this review deals specifically with the traffic-relevant (side) effects of various classes of drugs on elderly people (aged 65 and over).Older people in particular often have to take different medications, which are metabolized differently compared to younger people due to underlying diseases and can also interact with each other. It was found that (1) older people often react more sensitively to substances, (2) not all representatives of a drug class have the same effect on driving safety, and (3) a general assessment of a drug's safety is not possible, since the effects also depend on other factors such as underlying diseases, treatment regimen, and the time of day the medication is taken.
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Affiliation(s)
- Theresa Bödefeld
- Institut für Rechtsmedizin, Forensische Toxikologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - Benno Hartung
- Institut für Rechtsmedizin, Universitätsklinikum Essen, Essen, Deutschland
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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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Tassoni G, Cippitelli M, Scendoni R, Froldi R, Buratti E, Cerioni A, Mietti G, Cingolani M. A study into the nature and extent of polydrug use in driving recidivism behavior. TRAFFIC INJURY PREVENTION 2024; 25:110-115. [PMID: 38165201 DOI: 10.1080/15389588.2023.2274273] [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: 07/17/2023] [Accepted: 10/19/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Polydrug use has become a frequent pattern of drug consumption in Europe, and this is considered a particularly dangerous risk factor for impaired driving. In Italy, persons whose license has been revoked or suspended due to the use of psychoactive drugs can reapply for a new driving license, depending on the judgment of the relevant local medical committee (CML). To regain a revoked license, offenders must remain drug free throughout an observation period. An important problem with enforcement of impaired driving is recidivism. The aim of the present study is to analyze the influence of polydrug use on driving recidivism. METHOD We report the findings of several years' experience at the forensic toxicology laboratory of the University of Macerata. Hair samples collected over a 7-year period by the CML from drug users were analyzed for cocaine, opiates, and cannabis using gas chromatography-mass spectrometry. RESULTS Three hundred thirty-five of the tested subjects were recidivists. Recidivism was more frequent among monodrug users (81%) compared with polydrug users (19%), but logistic regression showed that polydrug use is certainly a risk factor for recidivism compared to monodrug use (odds ratio [OR] = 1.99). The sex and age distribution of recidivist subjects showed a strong predominance of males in both groups, but there were no sex differences. There were more recidivist polydrug users than recidivist monodrug users in the younger age groups (OR = 2.012). Cocaine use was most prevalent in the recidivist monodrug group. All drugs analyzed were demonstrated to be a risk factor for recidivism among monodrug users, whereas only the cocaine and cannabis combination was shown to be a risk factor for recidivism among polydrug users (OR = 1.65 versus cocaine; OR = 1.30 versus Δ9-tetrahydrocannabinol). Almost all polydrug users became monodrug users, and cocaine was the most frequently detected drug in the subsequent test during the monitoring phase. CONCLUSIONS Our results show that polydrug use increases the risk of impaired driving recidivism and represents a considerable threat to road safety.
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Affiliation(s)
- Giovanna Tassoni
- Forensic Medicine Laboratory, University of Macerata, Macerata, Italy
| | - Marta Cippitelli
- Forensic Medicine Laboratory, University of Macerata, Macerata, Italy
| | - Roberto Scendoni
- Forensic Medicine Laboratory, University of Macerata, Macerata, Italy
| | - Rino Froldi
- Forensic Medicine Laboratory, University of Macerata, Macerata, Italy
| | - Erika Buratti
- Forensic Medicine Laboratory, University of Macerata, Macerata, Italy
| | - Alice Cerioni
- Forensic Medicine Laboratory, University of Macerata, Macerata, Italy
| | - Gianmario Mietti
- Forensic Medicine Laboratory, University of Macerata, Macerata, Italy
| | - Mariano Cingolani
- Forensic Medicine Laboratory, University of Macerata, Macerata, Italy
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Soyka M, Wild I, Caulet B, Leontiou C, Lugoboni F, Hajak G. Long-term use of benzodiazepines in chronic insomnia: a European perspective. Front Psychiatry 2023; 14:1212028. [PMID: 37599882 PMCID: PMC10433200 DOI: 10.3389/fpsyt.2023.1212028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Chronic insomnia occurs in ~10% of the general population and has numerous negative health effects. The recommended first line treatment of cognitive behavior therapy for insomnia is not widely available for patients in Europe, so pharmacotherapies such as benzodiazepine receptor agonist agents (benzodiazepines and Z-drugs) are commonly used. However, their use is only recommended for ≤4 weeks due to unproven long-term efficacy in treatment of chronic insomnia, and the risk of tolerance, and the potential for dependence and misuse. In Europe, recommendations limiting the use of benzodiazepines (lowest dose and shortest duration) in chronic insomnia are not always followed, likely due to the lack of approved effective alternative therapies. Here we present a recent pilot survey of the pharmacological treatment landscape in chronic insomnia in five European countries (France, Germany, Italy, Spain, and the United Kingdom) and physicians' attitude toward treatment. The results suggest that benzodiazepines and Z-drugs are the most widely used treatments in chronic insomnia and are being used for longer than their recommended duration. Country variations in prescription rates were observed. Due to the known association between long-term benzodiazepine use and potential for developing dependence, further analysis of the literature was performed on the use and misuse of benzodiazepines. The results show that long-term use of benzodiazepines is associated with multiple consequences of treatment, including dependence, but also that previous use of benzodiazepines may increase the risk of opioid use disorder.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Imane Wild
- Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | | | | | - Fabio Lugoboni
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy
| | - Göran Hajak
- University of Regensburg, Regensburg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, Bamberg, Germany
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Voy A. Collisions and cannabis: Measuring the effect of recreational marijuana legalization on traffic crashes in Washington State. TRAFFIC INJURY PREVENTION 2023; 24:527-535. [PMID: 37347154 DOI: 10.1080/15389588.2023.2220853] [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: 03/30/2023] [Revised: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Washington State was among the first states in the US to legalize recreational consumption and retail sales of marijuana. Recreational use of cannabis was legalized December 6, 2012, following the passage of Initiative 502 30 days prior. Roughly 19 months later the first retail cannabis stores opened their doors for public sales ("commercialization"). I measure the impact of cannabis legalization and commercialization on traffic collisions in Washington State. METHODS With county-level vehicle crash data from the Washington State Department of Transportation collected monthly, I utilize an interrupted time-series framework with Poisson estimation to compare traffic collisions with recreational retail cannabis sales revenue from 2011 (three years pre-commercialization) through 2017 (three years post-commercialization). First, I measure the shift in collisions brought about by Washington's 2012 cannabis legalization. Then, I compare retail cannabis sales-a measure of commercialization-to traffic collisions based on severity of injury (fatal, severe injury, minor injury, non-injury, and all). RESULTS After controlling for confounding factors, evidence suggests that recreational cannabis legalization led to fewer fatal and serious injury collisions. Retail cannabis sales generally correlate with more traffic collisions, particularly for less severe (minor injury) crashes. These findings are robust to the inclusion of additional control variables pertaining to county-level cannabis usage and driving behavior while intoxicated. CONCLUSIONS Cannabis legalization led to fewer fatal, serious, and minor injury collisions. Commercialization (cannabis sales) correlated with an increase in less severe crashes. Although cannabis use generally increased in Washington State following legalization/commercialization, survey data suggest that driving behavior while under the influence of cannabis did not change significantly over the post-commercialization period. Future research should focus on measuring the dose-dependent impact of cannabis consumption on traffic collisions. This should include recognition of the importance of cannabis dosing, timing, and route of consumption. Lastly, the dangers of poly-drug driving-particularly cannabis and alcohol-are well established and should be high priority for further research.
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Affiliation(s)
- Annie Voy
- Economics, School of Business Administration, Gonzaga University, Spokane, Washington
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Forma F, Pratiwadi R, El-Moustaid F, Smith N, Thorndike F, Velez F. Network meta-analysis comparing the effectiveness of a prescription digital therapeutic for chronic insomnia to medications and face-to-face cognitive behavioral therapy in adults. Curr Med Res Opin 2022; 38:1727-1738. [PMID: 35938209 DOI: 10.1080/03007995.2022.2108616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effectiveness of the only Food and Drug Administration-authorized prescription digital therapeutic (PDT) Somryst versus face-to-face cognitive behavioral therapy for insomnia (CBT-I), or FDA-approved prescription medications for insomnia. METHODS A systematic literature review was undertaken to identify relevant studies. A Bayesian network meta-analysis (NMA) was conducted to examine (1) mean change in insomnia severity index (ISI); (2) proportional change in ISI remitters; (3) mean change in wake after sleep onset (WASO); and (4) mean change in sleep onset latency (SOL). RESULTS Twenty studies provided data on the PDT, CBT-I, CBT-I in combination with self-help (SH), or two prescription medications (eszopiclone and zolpidem). The PDT was associated with significant mean change in ISI (-5.77, 95% Credible Interval [CrI] - 8.53, -3.07) and ISI remitters (OR 12.33; 95% CrI 2.28, 155.91) compared to placebo, and had the highest probability of being the most effective treatment overall for ISI mean change (56%), and ISI remitters (64%). All evaluated interventions significantly outperformed placebo for WASO but no significant differences were observed for SOL (five interventions). Sensitivity analyses excluding medications and meta-regression (assessing type, duration, delivery method for CBT-I) did not affect NMA results. CONCLUSIONS This network meta-analysis demonstrated that a PDT delivering CBT-I had the highest probability of being most effective compared to face-to-face CBT-I, prescription sleep medications, or placebo, as measured by reductions in mean ISI score from baseline and ISI-determined remittance.
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Beaulieu E, Naumann RB, Deveaux G, Wang L, Stringfellow EJ, Hassmiller Lich K, Jalali MS. Impacts of alcohol and opioid polysubstance use on road safety: Systematic review. ACCIDENT; ANALYSIS AND PREVENTION 2022; 173:106713. [PMID: 35640366 DOI: 10.1016/j.aap.2022.106713] [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: 08/30/2021] [Revised: 04/23/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Connections between substance use, impairment, and road safety have been frequently researched. Yet, little is known about how simultaneous use of opioids and alcohol affects road safety outcomes, which is an increasingly critical link within the current landscape of the substance use environment and public health. Lack of this understanding is partly due to testing complications and data limitations. We define polysubstance use here as alcohol and opioids consumed together or within a small-time window such that both are present in the system. This polysubstance use is on the rise and produces greater health risks than when the substances are consumed separately. Given the increasing rate of opioid use, high prevalence of alcohol use, and dangers of polysubstance use, we aim to synthesize literature on the prevalence and impact of this polysubstance on road safety-related outcomes. We performed a systematic review of studies published between 1974 and 2020 that examined opioid and alcohol use exposures and road safety-related outcomes. Out of 644 initial findings, 20 studies were included in this review. Outcomes included motor vehicle crash injuries, deaths, or driver culpability; suspected driving under the influence; and simulated driving performance. Evidence from multiple sources showed a significant rise, approximately 1% to 7%, in the prevalence of opioids among fatally injured drivers in the U.S. from 1995 to 2016. Information published on the simultaneous presence of opioids and alcohol in people involved in crashes was scarce. The limited available findings point toward an overlap where up to 30% of opioid-positive people involved in a crash were also positive for alcohol. Studies also suggest a possibly elevated risk presented by this polysubstance use relative to the substances used alone, though the majority of identified studies did not estimate this association. The synthesized research indicates that alcohol and opioid use is not uncommon and may be increasing among people involved in adverse driving events. More research and better data are needed to improve estimates of association with road traffic-related outcomes, potentially improving substance testing in current surveillance systems or using linked data sets and other novel data sources to improve estimates.
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Affiliation(s)
- Elizabeth Beaulieu
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Rebecca B Naumann
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Genevieve Deveaux
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Lindsay Wang
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Erin J Stringfellow
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA.
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Betz MR, Jones LE. Do opioid prescriptions lead to fatal car crashes? AMERICAN JOURNAL OF HEALTH ECONOMICS 2022; 8:359-386. [PMID: 36910277 PMCID: PMC9997667 DOI: 10.1086/718511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Widespread opioid misuse suggests a potential for increased fatal car crashes. However, opioid use may not necessarily lead to additional crashes if drivers respond to opioid prevalence by substituting away from more inebriating intoxicants like alcohol. Combining data on local opioid prescription rates and car crashes from the Fatality Analysis and Reporting System, we use two-way fixed effects models to test the direction of the association between prescribing intensity and crash fatalities between 2007 and 2016. We estimate that a 10 percent increase in the local prescription rate is associated with a 1 percent increase in the number of driver deaths in motor vehicle accidents. The association is robust to several model specifications, and isolated to drivers most affected by the opioid crisis: males and 25 to 34 year-olds.
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Affiliation(s)
- Michael R Betz
- Department of Human Sciences, The Ohio State University, 171A Campbell Hall, 1787 Neil Ave., Columbus, Ohio, 43201
| | - Lauren E Jones
- Department of Human Sciences and John Glenn College of Public Affairs, The Ohio State University, 115E Campbell Hall, 1787 Neil Ave., Columbus, Ohio, 43201
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Fukuda Y, Saito M. Factors influencing changes in medication-taking and driving behavior after warnings about prescription medications that prohibit driving: an online survey. BMC Public Health 2022; 22:1020. [PMID: 35596168 PMCID: PMC9122546 DOI: 10.1186/s12889-022-13407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study examined warning messages as a strategy for preventing automobile crashes by drivers on medications. We investigated the degree of awareness regarding the effects of medication on automobile driving and changes in medication-taking and driving behavior. We also assessed associations between socio-environmental factors and the driving and medication-taking behavior adopted by individuals after being warned about driving-related risks. Methods Responses to an online questionnaire from 1200 people with a driving license who were taking prescription medications at the time of inquiry (March 2019) were collected and analyzed. The items surveyed were sex, age, educational history, health literacy, current medications, and medication-taking and driving behavior after being warned. Results Of the total respondents, 30% were taking medicine that prohibited driving. Of those taking prohibited medications, 25.7% did not receive a warning about driving from healthcare professionals. Most respondents taking prohibited medications received euphemistic warnings, such as “practice caution” (30%), “refrain from calling attention” (29.4%), and “avoid driving” (19.8%); 16% of the direct warnings were about not driving. Medication’s effects on driving were recognized by 80% of the total respondents. The degree of awareness was significantly higher among respondents taking medications that prohibit driving than among those taking medications that did not prohibit driving or those taking unknown medications. Awareness of medicine’s influence on driving was associated with health literacy. No association was found between age, gender, health literacy, history of side effects, and driving and medication-taking behavior. Approximately 22% of respondents adjusted their medication use at their discretion and 39% maintained treatment compliance but continued driving. Among respondents taking medications that prohibit driving, whether driving was required for work was a significant factor in their driving and medication-taking behavior after being warned. Conclusions Healthcare professionals do not always fully inform patients about the driving-related risks of medications. To encourage patients who are taking medications that have a significant impact on their driving to either stop driving or consult a healthcare professional, healthcare professionals must first understand the patient’s social environment, such as whether driving is required for work, and then create an environment conducive to advice-seeking.
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Affiliation(s)
- Yasue Fukuda
- Facility of Pharmaceutical Science, Suzuka University of Medical Science, 3500-3 Minami-tamagaki, Suzuka, Mie, 513-8670, Japan.
| | - Moemi Saito
- Faculty of Pharmaceutical Sciences, Tokyo University of Pharmacy and Life Sciences, 192-0392 Horinouti Hachioji city, Tokyo, Japan
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The incidence of psychoactive substances and alcohol among impaired drivers in Denmark in 2015–2019. Forensic Sci Int 2022; 333:111207. [DOI: 10.1016/j.forsciint.2022.111207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/11/2022] [Accepted: 01/28/2022] [Indexed: 01/29/2023]
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Gould F, Jones MT, Harvey PD, Reidy LJ, Hodgins G, Michopoulos V, Maples-Keller J, Rothbaum BO, Rothbaum A, Ressler KJ, Nemeroff CB. The relationship between substance use, prior trauma history, and risk of developing post-traumatic stress disorder in the immediate aftermath of civilian trauma. J Psychiatr Res 2021; 144:345-352. [PMID: 34735838 DOI: 10.1016/j.jpsychires.2021.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
Many reports have documented the relationship between post-traumatic stress disorder (PTSD) and substance use. Substance use is commonly comorbid with PTSD and is a risk factor for trauma exposure. The aim of this study was to prospectively examine how recent substance use, abuse, or dependence influenced the development of PTSD in the context of a prior trauma history, including child abuse, and the severity of initial trauma reactions. Participants (N = 81) were recruited and assessed at the emergency department of a large urban hospital in Miami and serum levels of common drugs of abuse were measured. Although substance use appeared to be a risk factor for trauma exposure, neither self-reported nor blood toxicology influenced the development of PTSD. Positive toxicology screens were more likely to be associated with a diagnosis of substance abuse or dependence, χ2 (1) = 4.11, p = .04. Participants with a history of physical abuse were more likely to have a positive toxicology screen, χ2 (1) = 4.03, p = .05. The majority of our trauma-exposed subjects (66%) were found to be positive for one or more illicit substances at presentation at the ED. The current findings provide support for the "high risk" hypothesis in which substance use is associated with increased trauma exposure.
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Affiliation(s)
- Felicia Gould
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA.
| | - Mackenzie T Jones
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA; Research Service, Bruce W. Carter Miami VA Medical Center, Miami, FL, USA
| | - Lisa J Reidy
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, FL, USA
| | - Gabrielle Hodgins
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA; Yerkes National Primate Research Center, Emory University, USA
| | - Jessica Maples-Keller
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Barbara O Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Alex Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA; Department of Psychological Services, Case Western Reserve University, Cleveland, OH, USA
| | - Kerry J Ressler
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA; Mclean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Charles B Nemeroff
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA; Department of Psychiatry, University of Texas at Austin, Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX,, USA
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Favretto D, Visentin S, Jones AW. Prevalence and concentrations of sedative-hypnotic drugs in blood of drivers involved in road traffic crashes in the Padova region of Italy - not so easy to interpret. Forensic Sci Int 2021; 330:111097. [PMID: 34814082 DOI: 10.1016/j.forsciint.2021.111097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND & OBJECTIVES This study reports the prevalence and concentrations of sedative-hypnotic drugs as exemplified by benzodiazepines (BZD) and zolpidem (Z-hypnotic) in blood samples from drivers involved in road traffic accidents (RTA) in the Padova region of Italy. Another aim of the study was to estimate the prevalence of these drugs with concentrations in blood above the therapeutic intervals and above specific per se limits. METHODS A total of 4066 blood samples collected from drivers involved in RTA were analysed for the presence of alcohol, drugs of abuse and medicinal drugs with sedative-hypnotic properties. Prevalence of drivers positive for BZDs and zolpidem were reported according to the reporting limit of our laboratory (1 ng/mL) in a sort of zero tolerance approach and compared with the prevalence according to analytical cut-offs used in the "European Union's research project on Driving Under the Influence of Drugs, Alcohol and Medicines" (DRUID). The impairment-based, per se limits adopted in Norway and in England and Wales and the values used to define "therapeutic ranges" in blood and in plasma/serum were also applied to the case study. RESULTS 175 blood samples were positive for sedative-hypnotics above 1 ng/mL, with the following prevalence: diazepam 44%, nordazepam 41.8%, lorazepam 32.6%, zolpidem 28%, oxazepam 25.6%, alprazolam 16%, delorazepam 11,6%, lormetazepam 11,6%, temazepam 11.6%, clonazepam 11.6%, triazolam 6.9%, N-desalkylflurazepam 4.6%, bromazepam 2.3%. When applying DRUID analytical cut-offs, the prevalence of BZDs and zolpidem sharply decreases. Applying the impairing cut-offs used in Norway, 56% of positive samples were above the limits equivalent to a BAC of 0.2 g/L, 39% above the limits corresponding to 0.5 g/L, and 23% above the cut-off corresponding to 1.2 g/L. Only 1% of the drivers had drug concentrations above the per se concentration limits adopted in England and Wales [26]. When comparing blood levels with therapeutic ranges in plasma, bromazepam, lormetazepam and delorazepam were often found above the highest limits. The adjustment of the concentrations with the plasma-to-blood ratios causes a significant increase of cases above the therapeutic ranges in plasma. CONCLUSIONS Sedative-hypnotic drugs are medicinal substances frequently identified in drivers involved in RTA, commonly in concentrations associated with driving impairment. Besides the concentrations of drugs in blood, several factors have to be considered to conclude that a driver was impaired. The frequent association with alcohol, cocaine and other BZDs, confirms the abuse potential of these medications.
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Affiliation(s)
- Donata Favretto
- University Hospital of Padova, Legal Medicine and Toxicology, Via Falloppio 50, Padova, Italy.
| | | | - Alan W Jones
- Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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Borst JM, Costantini TW, Reilly L, Smith AM, Stabley R, Steele J, Wintz D, Bansal V, Biffl WL, Godat LN. Driving under the influence: a multi-center evaluation of vehicular crashes in the era of cannabis legalization. Trauma Surg Acute Care Open 2021; 6:e000736. [PMID: 34786487 PMCID: PMC8587622 DOI: 10.1136/tsaco-2021-000736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Eleven states have instituted laws allowing recreational cannabis use leading to growing public health concerns surrounding the effects of cannabis intoxication on driving safety. We hypothesized that after the 2016 legalization of cannabis in California, the use among vehicular injury patients would increase and be associated with increased injury severity. Methods San Diego County’s five adult trauma center registries in were queried from January 2010 to June 2018 for motor vehicle or motorcycle crash patients with completed toxicology screens. Patients were stratified as toxicology negative (TOX−), positive for only THC (THC+), only blood alcohol >0.08% (ETOH+), THC+ETOH, or THC+ with any combination with methamphetamine or cocaine (M/C). County medical examiner data were reviewed to characterize THC use in those with deaths at the scene of injury. Results Of the 11,491 patients identified, there were 61.6% TOX−, 11.7% THC+, 13.7% ETOH+, 5.0% THC+ETOH, and 7.9% M/C. THC+ increased from 7.3% to 14.8% over the study period and peaked at 14.9% post-legalization in 2017. Compared with TOX− patients, THC+ patients were more likely to be male and younger. THC+ patients were also less likely to wear seatbelts (8.5% vs 14.3%, p<0.001) and had increased mean Injury Severity Score (8.4±9.4 vs 9.0±9.9, p<0.001) when compared with TOX− patients. There was no difference in in-hospital mortality between groups. From the medical examiner data of the 777 deaths on scene, 27% were THC+. Discussion THC+ toxicology screens in vehicular injury patients peaked after the 2016 legalization of cannabis. Public education on the risks of driving under the influence of cannabis should be a component of injury prevention initiatives. Level of evidence III, Prognostic
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Affiliation(s)
- Johanna Marie Borst
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California, USA
| | - Todd W Costantini
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California, USA
| | - Lindsay Reilly
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California, USA
| | - Alan M Smith
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California, USA
| | - Robert Stabley
- Examiner's Office, San Diego County Medical Examiner's Office, San Diego, California, USA
| | - John Steele
- Trauma, Palomar Medical Center, Escondido, California, USA
| | - Diane Wintz
- Trauma, Sharp Memorial Medical Center, San Diego, California, USA
| | - Vishal Bansal
- Trauma, Scripps Mercy Hospital, San Diego, California, USA
| | - Walter L Biffl
- Trauma, Scripps Memorial Hospital, La Jolla, California, USA
| | - Laura N Godat
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego School of Medicine, San Diego, California, USA
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Kiwango G, Francis F, Moshiro C, Möller J, Hasselberg M. Association between alcohol consumption, marijuana use and road traffic injuries among commercial motorcycle riders: A population-based, case-control study in Dares Salaam, Tanzania. ACCIDENT; ANALYSIS AND PREVENTION 2021; 160:106325. [PMID: 34390892 DOI: 10.1016/j.aap.2021.106325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/12/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Alcohol consumption and psychoactive drug use are well-recognised risk factors for road traffic injuries (RTIs). Both types of use may impair and affect drivers' performance. Yet, there is limited literature on their contribution to RTIs among commercial motorcycle riders, particularly in low- and middle-income settings. This study aimed to determine the association between alcohol consumption, marijuana use and RTIs among commercial motorcycle riders in the city of Dar es Salaam, Tanzania. METHODS We conducted a case-control study between July 2018 and March 2019. Cases (n = 164) were commercial motorcycle riders who had sustained an RTIs and attended at a hospital. Controls (n = 400) were commercial motorcycle riders who had not experienced an RTIs that led to hospital attendance during the past six months. Alcohol consumption was assessed using the Alcohol Use Disorder Identification (AUDIT) score, which classified participants as a non-drinker, normal drinker(1-7 scores) and risky drinker (scores ≥ 8). Marijuana use was assessed through self-reported use in the past year. We estimated odds ratios (ORs) using logistic regression adjusted for sociodemographic, driver-, and work-related factors. RESULTS Risky drinking was associated with close to six times the odds of RTIs compared to non-drinkers (OR = 5.98, 95% CI: 3.25 - 11.0). The association remained significant even after adjusting for sociodemographic, driving and work-related factors (OR = 2.41, 95% CI: 1.01 - 5.76). The crude odds ratios of RTIs were significantly higher among users of marijuana than non-users (OR = 2.33, 95% CI: 1.38 - 3.95). However, the association did not remain statistically significant after adjusting for confounders (OR = 1.11, 95% CI = 0.49-2.48). CONCLUSION Our findings confirm increased odds of RTIs among commercial motorcycle riders with risky drinking behaviour even after taking sociodemographic, driving and work-related factors into account. Unlike alcohol consumption the relationship between marijuana use and RTIs among commercial motorcycle riders was unclear. Since motorcycle riders are more susceptible to the effect of alcohol due to higher demands of balance and coordination and because commercial motorcyclist riders, in particular, they spend a considerable amount of time on the road, our results underscore the importance of addressing hazardous alcohol consumption and marijuana use in future prevention strategies to enhance road safety.
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Affiliation(s)
- George Kiwango
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Filbert Francis
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; National Institute of Medical Research, Tanga, Tanzania.
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jette Möller
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Marie Hasselberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Garbarino S, Lanteri P, Bragazzi NL, Gualerzi G, Riccò M. Occupational Injuries and Use of Benzodiazepines: A Systematic Review and Metanalysis. Front Hum Neurosci 2021; 15:629719. [PMID: 34054447 PMCID: PMC8155305 DOI: 10.3389/fnhum.2021.629719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Benzodiazepines have been widely used in clinical practice for over four decades and continue to be one of the most consumed and highly prescribed class of drugs available in the treatment of anxiety, depression, and insomnia. The literature indicates that Benzodiazepine users at a significantly increased risk of Motor Vehicle accidents compared to non-users but the impact on injuries at workplace is not well-defined. We aimed to investigate whether use of benzodiazepine is associated with increased risk of occupational injuries (OI). Methods: PubMed, Embase, and Scopus databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) among case controls, cross-sectional studies, either questionnaire or laboratory exams based. Results: A total of 13 studies met inclusion criteria, involving 324,168 OI from seven different countries, with an estimated occurrence of benzodiazepine positivity of 2.71% (95% CI 1.45–4.98). A total of 14 estimates were retrieved. Of them, 10 were based on laboratory analyses, three on institutional databases, while one study was based on questionnaires. Regarding the occupational groups, three estimates focused on commercial drivers (0.73%, 95% CI 0.12–4.30), that exhibited a reduced risk ratio for benzodiazepine positivity compared to other occupational groups (RR 0.109, 95% CI 0.063–0.187). Eventually, no increased risk for benzodiazepine positivity was identified, either from case control studies (OR 1.520, 95% CI 0.801–2.885, I2 76%), or cross sectional studies, when only laboratory based estimates were taken in account (OR 0.590, 95% CI 0.253–1.377, I2 63%). Conclusions: Even though benzodiazepines have the potential to increase injury rates among casual and chronic users, available evidence are insufficient to sustain this hypothesis, particularly when focusing on laboratory-based studies (i.e., studies the characterized the benzodiazepine immediately before the event).
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Affiliation(s)
- Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Paola Lanteri
- UOC Neurophysiopathology, Fondazione IRCCS, Istituto Neurologico "C. Besta," Milan, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Giovanni Gualerzi
- Department of Medicine and Surgery, School of Medicine, University of Parma, Parma, Italy
| | - Matteo Riccò
- AUSL-IRCCS di Reggio Emilia-Department of Public Health, Service for Health and Safety in the Workplace, Reggio Emilia, Italy
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Ciccarelli TM, Leatherdale ST, Perlman C, Thompson K, Ferro MA. Steering clear: Traffic violations among emerging adults who engage in habitual or casual cannabis use. ACCIDENT; ANALYSIS AND PREVENTION 2021; 153:106059. [PMID: 33662695 DOI: 10.1016/j.aap.2021.106059] [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: 06/12/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
While some research has shown that cannabis use can impair driving ability, evidence to the degree and impact of impairment are lacking. This study examined the association between habitual or casual cannabis use and past-year traffic violations among emerging adults (EAs). Data come from the 2012 Canadian Community Health Survey-Mental Health. Respondents (n = 5630) were categorized as: early (15-19 y), middle (20-24 y), and late (25-29 y) EAs. Traffic violations were measured using self-report and cannabis use was measured using the WHO Composite International Diagnostic Interview. The prevalence of traffic violations was higher for males (19.2 %) vs females (9.9 %) and middle (16.2 %) and late (19.4 %) EAs vs early (8.8 %) EAs. The odds of reporting traffic violations were higher for EAs who engaged in habitual [OR = 1.77 (1.17-2.67)] or casual [OR = 1.79 (1.27-2.51)] cannabis use when compared to non-users. Age moderated the association such that higher odds of traffic violations were reported in early EAs who were casual cannabis users and middle EAs who were habitual or casual cannabis users when compared to non-users. Use of other drugs was also a moderator-in the absence vs. presence of other drug use, odds of traffic violations were higher in those who engaged in either habitual or casual use of cannabis. When accounting for the moderating effects of age and drug use, habitual and casual cannabis use resulted in increased odds of a traffic violation. Future research is warranted to explore the robustness of our findings.
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Affiliation(s)
- Tiana M Ciccarelli
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Chris Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Kara Thompson
- Department of Psychology, St. Francis Xavier University, Antigonish, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
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Psychoactive Substance Use and Its Associated Factors among Truck Drivers in Ethiopia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1604245. [PMID: 33628773 PMCID: PMC7889340 DOI: 10.1155/2021/1604245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/08/2021] [Accepted: 02/05/2021] [Indexed: 11/18/2022]
Abstract
Background Road traffic accidents (RTAs) remain an important public health issue worldwide. Psychoactive substance use is one of the main contributors to the occurrence of traffic accidents, and its use by truck drivers is a global problem. Also, psychoactive substance use is a commonly observed behavior among truck drivers. To the best of our knowledge, no evidence shows the prevalence and factors associated with psychoactive substance use among truck drivers in Ethiopia. Therefore, this study was aimed at assessing the prevalence and factors associated with psychoactive substance use among truck drivers in Ethiopia. Methods A cross-sectional study was conducted among 400 systematically selected truck drivers at Modjo dry port in Ethiopia, from February 1 to March 1, 2018. The data were collected through face-to-face individual interviews using a structured questionnaire. The collected data were entered into EpiData version 4.2.0.0 and analyzed using SPSS version 20. Binary logistic regression analysis was computed to determine the association using crude and adjusted odds ratios at 95% confidence intervals. The level of significance was declared at p value < 0.05 in the multivariable binary logistic regression analysis. Results Of the 400 truck drivers interviewed, the overall one-month self-reported prevalence of psychoactive substance use was 70% (n = 280). In the multivariable binary logistic regression analysis, aged 38 years and above (AOR = 0.40, 95% CI [0.23-0.69]), Christianity religion (AOR = 0.52, 95% CI [0.28-0.97]), college and university education (AOR = 3.47, 95% CI [1.27-9.47]), having a family size of 3 or more (AOR = 0.34, 95% CI [0.20-0.60]), having 6 or more hours spent sleeping at night (AOR = 0.46, 95% CI [0.28-0.75]), and rest breaks between driving (AOR = 2.13, 95% CI [1.14-3.97]) were significantly associated with psychoactive substance use. Conclusion The one-month prevalence of psychoactive substance use among truck drivers was remarkably high. We can conclude that psychoactive substance use is a public health problem among truck drivers, which is a major threat to themselves and others on the road. The sociodemographic and occupational factors are the factors associated with drivers' psychoactive substance use. Therefore, devising health education and counseling program for drivers to tackle the problem plays paramount importance.
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Di Sarno M, De Candia V, Rancati F, Madeddu F, Calati R, Di Pierro R. Mental and physical health in family members of substance users: A scoping review. Drug Alcohol Depend 2021; 219:108439. [PMID: 33333362 DOI: 10.1016/j.drugalcdep.2020.108439] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Due to the high pressure they sustain, family members of substance users are thought to experience negative consequences in mental and physical health. This scoping review provided a comprehensive overview on the mental and physical health of adult Affected Family Members (AFMs). METHOD We searched in-journal English articles in PubMed, with no date limit, guided by the concepts of stress, strain, and burden, and including several terms related to substance use. Eligibility criteria included focus on adult AFMs, mental and physical health, and clinical forms of substance use. RESULTS PubMed search identified 3549 articles, with 46 additional papers from other sources. Fifty-six articles were included, quantitative (N = 39), qualitative (N = 15) and both (N = 2). Quantitative findings show that AFMs are subject to increased stress and burden, and impaired mental health. Variable rates of physical problems emerge, with some medical conditions being more common among AFMs of substance users versus controls. Finally, evidence shows increased risk for aggression and reduced quality of life and social adjustment. AFMs report higher stress and strain if they are women, in low socio-economic families, and co-habiting with more severe substance users. Qualitative studies additionally suggest that stigma, self-blame, and social isolation are common. CONCLUSIONS AFMs of substance users represent a population at higher risk for negative health-related outcomes and should be systematically regarded as targets for treatment.
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Affiliation(s)
- Marco Di Sarno
- Department of Psychology, University of Milan-Bicocca, Milan, Italy; Centro per lo studio e la terapia dei disturbi della personalità (C.R.E.S.T), Milan, Italy.
| | | | - Fabio Rancati
- Centro per lo studio e la terapia dei disturbi della personalità (C.R.E.S.T), Milan, Italy
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy; Centro per lo studio e la terapia dei disturbi della personalità (C.R.E.S.T), Milan, Italy; Personality Disorders Lab (PDlab), Parma - Milan, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy; Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France
| | - Rossella Di Pierro
- Department of Psychology, University of Milan-Bicocca, Milan, Italy; Centro per lo studio e la terapia dei disturbi della personalità (C.R.E.S.T), Milan, Italy; Personality Disorders Lab (PDlab), Parma - Milan, Italy
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20
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Cameron-Burr KT, Conicella A, Neavyn MJ. Opioid Use and Driving Performance. J Med Toxicol 2021; 17:289-308. [PMID: 33403571 DOI: 10.1007/s13181-020-00819-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 09/21/2020] [Accepted: 11/09/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The USA is in an opioid epidemic, with an increased number of individuals taking psychoactive drugs while executing the tasks of everyday life, including operating a motor vehicle. The pharmacology of opioids has been widely studied, but the effects of opioids on psychomotor function, driving performance, and the risk of motor vehicle collision remain less clear. Clinicians are faced with the challenge of controlling patient pain while also reconciling conflicting messages from the literature about how safe it is for their patients taking opioids to engage in potentially dangerous routine tasks. DISCUSSION This review assesses the current literature regarding opioids as they relate to neurocognitive function, driving performance, and accident risk. Manuscripts are categorized by study context and subject matter: controlled experimental administration, illicit use, prescription use, retrospective forensic toxicology, and polydrug consumption. CONCLUSION Illicit use, initiation of therapy, and opioid use in combination with other psychoactive medications are contexts most clearly associated with impairment of driving-related functions and/or operation of a motor vehicle. Clinicians should counsel patients on the risk of impairment when initiating therapy, when co-prescribing opioids and other psychoactive drugs, or when a patient is suspected of having an opioid use disorder.
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Affiliation(s)
- Keaton T Cameron-Burr
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Albert Conicella
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Mark J Neavyn
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
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Yamamoto M, Inada K, Enomoto M, Habukawa M, Hirose T, Inoue Y, Ishigooka J, Kamei Y, Kitajima T, Miyamoto M, Shinno H, Nishimura K, Ozone M, Takeshima M, Suzuki M, Yamashita H, Mishima K. Current state of hypnotic use disorders: Results of a survey using the Japanese version of Benzodiazepine Dependence Self-Report Questionnaire. Neuropsychopharmacol Rep 2020; 41:14-25. [PMID: 33259705 PMCID: PMC8182966 DOI: 10.1002/npr2.12149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 12/02/2022] Open
Abstract
Aims Benzodiazepine receptor agonists (BZ‐RAs) are frequently prescribed to treat insomnia; however, their long‐term use is not recommended. To introduce an appropriate pharmaco‐therapy, the current state and background factors of BZ‐RAs' dependence must be elucidated. In this study, we developed a Japanese version of the Benzodiazepine Dependence Self‐Report Questionnaire (Bendep‐SRQ‐J) and conducted a study of BZ‐RAs' use disorder. Methods The Bendep‐SRQ‐J was created with permission from the original developer. Subjects were inpatients and outpatients receiving BZ‐RAs between 2012 and 2013. Clinical data collected were Bendep‐SRQ‐J scores, sleep disorders for which BZ‐RAs were prescribed, physical comorbidities, psychotropic drugs, and lifestyle factors. Logistic analysis was performed to extract factors associated with severe symptoms. Results Of the 707 patients prescribed BZ‐RAs, 324 had voluntarily tapered or discontinued their drugs. Logistic analysis showed that the total number of drugs administered in the last 6 months correlated with both worsening of symptoms or conditions. This was more notable among younger patients, and the proportion of patients with severe symptoms or conditions increased with the increasing number of drugs. Conclusion Using the Bendep‐SRQ‐J, we elucidated the current state of BZ‐RA dependence. Nearly half of the patients were non‐compliant. The proportion of patients with severe symptoms or disease conditions increased with the increase in the number of drugs administered. These findings highlight the need for clinicians to be aware of the likelihood of benzodiazepine dependence, especially in young patients and patients prescribed multiple hypnotics. Using the Bendep‐SRQ‐J, we elucidated the current state of BZ‐RA dependence. Nearly half of the patients were non‐compliant.![]()
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Affiliation(s)
- Mai Yamamoto
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Minori Enomoto
- Department of Sleep-wake disorders, NIMH, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Medical Technology, School of Health Science, Tokyo University of Technology, Tokyo, Japan
| | - Mitsunari Habukawa
- Department of Neuropsychiatry, School of Medicine, Kurume University, Kurume, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University School of Medicine, Tokyo, Japan
| | | | - Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Yuichi Kamei
- Center for Sleep Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tsuyoshi Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Shimotsuga-gun, Japan
| | | | - Hideto Shinno
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Motohiro Ozone
- Department of Medical Technology, School of Health Science, Tokyo University of Technology, Tokyo, Japan.,Department of Psychiatry, Jikei University, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Mayumi Suzuki
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Hidehisa Yamashita
- Department of Psychiatry and Neurosciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Mishima
- Department of Sleep-wake disorders, NIMH, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
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Zou X, Vu HL, Huang H. Fifty Years of Accident Analysis & Prevention: A Bibliometric and Scientometric Overview. ACCIDENT; ANALYSIS AND PREVENTION 2020; 144:105568. [PMID: 32562929 DOI: 10.1016/j.aap.2020.105568] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
Accident Analysis & Prevention (AA&P) is a leading academic journal established in 1969 that serves as an important scientific communication platform for road safety studies. To celebrate its 50th anniversary of publishing outstanding and insightful studies, a multi-dimensional statistical and visualized analysis of the AA&P publications between 1969 and 2018 was performed using the Web of Science (WoS) Core Collection database, bibliometrics and mapping-knowledge-domain (MKD) analytical methods, and scientometric tools. It was shown that the annual number of AA&P's publications has grown exponentially and that over the course of its development, AA&P has been a leader in the field of road safety, both in terms of innovation and dissemination. By determining its key source countries and organizations, core authors, highly co-cited published documents, and high burst-strength publications, we showed that AA&P's areas of focus include the "effects of hazard and risk perception on driving behavior", "crash frequency modeling analysis", "intentional driving violations and aberrant driving behavior", "epidemiology, assessment and prevention of road traffic injuries", and "crash-injury severity modeling analysis". Furthermore, the key burst papers that have played an important role in advancing research and guiding AA&P in new directions - particularly those in the fields of crash frequency and crash-injury severity modeling analyses were identified. Finally, a modified Haddon matrix in the era of intelligent, connected and autonomous transportation systems is proposed to provide new insights into the emerging generation of road safety studies.
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Affiliation(s)
- Xin Zou
- Institute of Transport Studies, Monash University, Clayton, VIC 3800, Australia.
| | - Hai L Vu
- Institute of Transport Studies, Monash University, Clayton, VIC 3800, Australia
| | - Helai Huang
- School of Traffic and Transportation Engineering, Central South University, Changsha 410075, China
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Forest K, Valdenaire G, Lorendeau JP, Sagaspe P, Contrand B, Durand-Teyssier C, Sakr D, Gil-Jardine C, Boutreux S, Lagarde E, Peyrouzet H, Lassalle R, Moore N, Philip P, Girodet PO. Factors associated with serious vehicular accidents: A cross-sectional study in hospital emergency rooms. Br J Clin Pharmacol 2020; 87:612-621. [PMID: 32530532 DOI: 10.1111/bcp.14427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/28/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022] Open
Abstract
AIMS Pictograms on medicine boxes warn of potential drug-related driving hazard; we studied their association with serious accidents. METHODS Prospective study in emergency departments of the hospitals in Bordeaux and Périgueux (France), of drivers with serious (admitted at least 24 hours) or nonserious vehicular accidents. Minors, passengers, pedestrians or subjects incapable of answering an interview were excluded. Interviews ascertained driver and accident characteristics, use of drugs with or without pictograms, use of alcohol and abuse substances, sleepiness, distractions, and mind wandering at the time of the accident, RESULTS: Between 18 October 2016 and 26 December 2018, 1200 of the 6212 drivers admitted to the hospital emergency rooms, 741 nonserious, 459 serious, were interviewed. Serious accidents were associated with male sex (odds ratio 1.89, 95% confidence interval [1.36-2.64]), age above 60 years (3.64 [2.21-6.00]), driving on local roads (3.34 [2.34-4.76]), driving a motorcycle (3.39 [2.29-5.00]), having drunk alcohol within 6 hours (2.89 [1.85-4.51]) and using a drug with a pictogram during the 24 hours previous to the accident (1.57 [1.06-2.32]). From 207 police reports, 101 drivers were not responsible, and 106 were responsible, associated with age below 40 years, driving in overcast or rainy weather (2.62 [1.29-5.33]), on local roads (3.89 [1.90-7.95]), and use of at least 1 pictogram drug in the previous week (3.12 [1.31-7.41]). CONCLUSION The known risks of alcohol and pictogram drugs, of riding motorcycles and using local roads were confirmed. As measured, behavioural sleepiness did not predict accidents.
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Affiliation(s)
- Karelle Forest
- Bordeaux INSERM CIC1401, CHU de Bordeaux - Université de Bordeaux 33076, Bordeaux, France
| | | | | | | | - Benjamin Contrand
- Injury Epidemiology, transport, occupation (University of Bordeaux), Bordeaux, France
| | | | - Dunia Sakr
- Bordeaux INSERM CIC1401, CHU de Bordeaux - Université de Bordeaux 33076, Bordeaux, France
| | | | | | - Emmanuel Lagarde
- Injury Epidemiology, transport, occupation (University of Bordeaux), Bordeaux, France
| | - Hélène Peyrouzet
- Bordeaux INSERM CIC1401, CHU de Bordeaux - Université de Bordeaux 33076, Bordeaux, France
| | - Régis Lassalle
- Bordeaux INSERM CIC1401, CHU de Bordeaux - Université de Bordeaux 33076, Bordeaux, France
| | - Nicholas Moore
- Bordeaux INSERM CIC1401, CHU de Bordeaux - Université de Bordeaux 33076, Bordeaux, France
| | | | - Pierre-Olivier Girodet
- Bordeaux INSERM CIC1401, CHU de Bordeaux - Université de Bordeaux 33076, Bordeaux, France
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24
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Dora-Laskey AD, Goldstick JE, Arterberry BJ, Roberts SJ, Haffajee RL, Bohnert ASB, Cunningham RM, Carter PM. Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample. West J Emerg Med 2020; 21:831-840. [PMID: 32726253 PMCID: PMC7390550 DOI: 10.5811/westjem.2020.3.44844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/08/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment. Methods Participants (aged 25–60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use. Results Among participants completing the screening survey (n = 756; mean age = 42.8 [standard deviation {SD} =10.4]), 37.8% reported past three-month prescription opioid use (30.8% of whom used daily), and 14.7% reported past three-month DAPO. Of screened participants, 22.5% (n = 170) were eligible for the extended study survey. Unadjusted analyses demonstrated that participants reporting DAPO were more likely to use opioids daily (51.1% vs 15.9%) and had higher rates of opioid misuse (mean Current Opioid Misuse Measure score 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]) chronic pain (80.7% vs 42.7%), and driving after marijuana or alcohol use (mean intoxicated driving score 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]) compared to patients not reporting DAPO (all p<0.001). Adjusting for age, gender, employment, and insurance in a logistic regression model, participants reporting DAPO were more likely to report a chronic pain diagnosis (odds ratio [OR] = 3.77, 95% confidence interval [CI], 1.55–9.17), daily opioid use (OR = 3.81, 95% CI, 1.64–8.85), and higher levels of intoxicated driving (OR = 1.62, 95% CI, 1.07–2.45). Alcohol and marijuana use, depression, and opioid misuse were not associated with DAPO in adjusted analyses. Conclusion Nearly one in six adult patients seeking ED care reported DAPO. The ED may be an important site for interventions addressing opioid-related drugged driving.
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Affiliation(s)
- Aaron D Dora-Laskey
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan, Department of Psychiatry, Ann Arbor, Michigan.,University of Michigan Addiction Center, Ann Arbor, Michigan
| | - Jason E Goldstick
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan
| | - Brooke J Arterberry
- University of Michigan Addiction Center, Ann Arbor, Michigan.,Iowa State University, Department of Psychology, Ames, Iowa
| | - Suni Jo Roberts
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
| | - Rebecca L Haffajee
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan.,University of Michigan School of Public Health, Department of Health Management and Policy, Ann Arbor, Michigan and RAND Corporation, Boston, Massachusetts
| | - Amy S B Bohnert
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan, Department of Psychiatry, Ann Arbor, Michigan.,University of Michigan, Department of Anesthesiology, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan.,Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan
| | - Patrick M Carter
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan
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25
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Brubacher JR, Chan H, Staples JA. Cannabis-impaired driving and Canadian youth. Paediatr Child Health 2020; 25:S21-S25. [PMID: 32581627 DOI: 10.1093/pch/pxaa017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
Acute cannabis use results in inattention, delayed information processing, impaired coordination, and slowed reaction time. Driving simulator studies and epidemiologic analyses suggest that cannabis use increases motor vehicle crash risk. How much concern should we have regarding cannabis associated motor vehicle collision risks among younger drivers? This article summarizes why young, inexperienced drivers may be at a particularly high risk of crashing after using cannabis. We describe the epidemiology of cannabis use among younger drivers, why combining cannabis with alcohol causes significant impairment and why cannabis edibles may pose a heightened risk to traffic safety. We provide recommendations for clinicians counselling younger drivers about cannabis use and driving.
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Affiliation(s)
- Jeff R Brubacher
- Faculty of Medicine, Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia
| | - Herbert Chan
- Faculty of Medicine, Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia
| | - John A Staples
- Faculty of Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia
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26
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Association Between Trauma Center Designation Levels and Survival of Patients With Motor Vehicular Transport Injuries in the United States. J Emerg Med 2020; 58:398-406. [DOI: 10.1016/j.jemermed.2019.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/09/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022]
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27
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Drummer OH, Gerostamoulos D, Di Rago M, Woodford NW, Morris C, Frederiksen T, Jachno K, Wolfe R. Odds of culpability associated with use of impairing drugs in injured drivers in Victoria, Australia. ACCIDENT; ANALYSIS AND PREVENTION 2020; 135:105389. [PMID: 31812899 DOI: 10.1016/j.aap.2019.105389] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 06/10/2023]
Abstract
Culpability analysis was conducted on 5000 drivers injured as a result of a vehicular collision and in whom comprehensive toxicology testing in blood was conducted. The sample included 1000 drivers for each of 5 years from approximately 5000-6000 drivers injured and taken to hospital in the State of Victoria. Logistic regression was used to investigate differences in the odds of culpability associated with alcohol and drug use and other selected crash attributes using the drug-free driver as the reference group. Adjusted odds ratios were obtained from multivariable logistic regression models in which other potentially explanatory driver and crash attributes were included. Drivers with alcohol present showed large increases in the odds of culpability similar to that seen in other studies investigating associations between blood alcohol concentration and crash risk. Methylamphetamine also showed a large increase in the odds of culpability (OR 19) compared to the reference group at both below and above 0.1 mg/L, whereas those drivers with Δ9-tetrahydrocannabinol (THC) present showed only modest increase in odds when all concentrations were assessed (OR 1.9, 95 %CI 1.2-3.1). Benzodiazepines in drivers also gave an increase in odds (3.2, 95 %CI 1.6-6.1), but not other medicinal drugs such as antidepressants, antipsychotics and opioids. Drivers that had combinations of impairing drugs generally gave a large increase in odds, particularly combinations of alcohol with THC or benzodiazepines, and those drivers using both THC and methamphetamine.
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Affiliation(s)
- Olaf H Drummer
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Matthew Di Rago
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Noel W Woodford
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Carla Morris
- Road Policing Drug and Alcohol Section, Victoria Police, 20 Dawson St., Brunswick 3056, Victoria, Australia
| | - Tania Frederiksen
- Road Policing Drug and Alcohol Section, Victoria Police, 20 Dawson St., Brunswick 3056, Victoria, Australia
| | - Kim Jachno
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Victoria, Australia
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28
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Vinckenbosch FRJ, Vermeeren A, Verster JC, Ramaekers JG, Vuurman EF. Validating lane drifts as a predictive measure of drug or sleepiness induced driving impairment. Psychopharmacology (Berl) 2020; 237:877-886. [PMID: 31897572 PMCID: PMC7036056 DOI: 10.1007/s00213-019-05424-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/03/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Standard deviation of lateral position (SDLP) has been accepted as a reliable parameter for measuring driving impairment due to lowered vigilance caused by sleepiness or the use of sedating drugs. Recently, lane drifts were proposed as an additional outcome measure quantifying momentary lapses of attention. The purpose of this study was to validate lane drifts as outcome measure of driver impairment in a large data pool from two independent research centers. METHODS Data from 11 placebo-controlled studies that assessed the impact of alcohol, hypnotics, and sleep deprivation on actual driving performance were pooled. In total, 717 on-the-road tests performed by 315 drivers were subjected to an automated algorithm to detect occurrences of lane drifts. Lane drifts were defined as deviations > 100 cm from the mean (LDmlp) and from the absolute lateral position (LDalp) for 8 s. RESULTS The number of LDmlp was low and did not differ between treatments and baseline, i.e., 14 vs. 3 events, respectively. LDalp were frequent and significantly higher during treatment relative to baseline, i.e., 1646 vs. 470 events. The correlation between LDalp and SDLP in the treatment conditions was very high (rs = 0.77). The frequency of the occurrence of treatment-induced lane drifts however depended on baseline SDLP of drivers, whereas treatment-induced changes in SDLP occurred independent of baseline SDLP. CONCLUSION LDmlp is not useful as an outcome measure of driver impairment due to its rare occurrence, even when treatment-induced increments in SDLP are evident. Treatment effects on LDalp and SDLP are closely related.
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Affiliation(s)
- F. R. J. Vinckenbosch
- Department of neuropsychology and psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - A. Vermeeren
- Department of neuropsychology and psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - J. C. Verster
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands ,Division of Pharmacology, Utrecht University, 3584CG, Utrecht, The Netherlands ,Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia
| | - J. G. Ramaekers
- Department of neuropsychology and psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - E. F. Vuurman
- Department of neuropsychology and psychopharmacology, Maastricht University, Maastricht, The Netherlands
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29
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Brubacher JR, Chan H, Erdelyi S, Macdonald S, Asbridge M, Mann RE, Eppler J, Lund A, MacPherson A, Martz W, Schreiber WE, Brant R, Purssell RA. Cannabis use as a risk factor for causing motor vehicle crashes: a prospective study. Addiction 2019; 114:1616-1626. [PMID: 31106494 PMCID: PMC6771478 DOI: 10.1111/add.14663] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/21/2019] [Accepted: 05/10/2019] [Indexed: 11/30/2022]
Abstract
AIM We conducted a responsibility analysis to determine whether drivers injured in motor vehicle collisions who test positive for Δ-9-tetrahydrocannabinol (THC) or other drugs are more likely to have contributed to the crash than those who test negative. DESIGN Prospective case-control study. SETTING Trauma centres in British Columbia, Canada. PARTICIPANTS Injured drivers who required blood tests for clinical purposes following a motor vehicle collision. MEASUREMENTS Excess whole blood remaining after clinical use was obtained and broad-spectrum toxicology testing performed. The analysis quantified alcohol and THC and gave semiquantitative levels of other impairing drugs and medications. Police crash reports were analysed to determine which drivers contributed to the crash (responsible) and which were 'innocently involved' (non-responsible). We used unconditional logistic regression to determine the likelihood (odds ratio: OR) of crash responsibility in drivers with 0 < THC < 2 ng/ml, 2 ng/ml ≤ THC < 5 ng/ml and THC ≥ 5 ng/ml (all versus THC = 0 ng/ml). Risk estimates were adjusted for age, sex and presence of other impairing substances. FINDINGS We obtained toxicology results on 3005 injured drivers and police reports on 2318. Alcohol was detected in 14.4% of drivers, THC in 8.3%, other drugs in 8.9% and sedating medications in 19.8%. There was no increased risk of crash responsibility in drivers with THC < 2 ng/ml or 2 ≤ THC < 5 ng/ml. In drivers with THC ≥ 5 ng/ml, the adjusted OR was 1.74 [95% confidence interval (CI) = 0.59-6.36; P = 0.35]. There was significantly increased risk of crash responsibility in drivers with blood alcohol concentration (BAC) ≥ 0.08% (OR = 6.00;95% CI = 3.87-9.75; P < 0.01), other recreational drugs detected (OR = 1.82;95% CI = 1.21-2.80; P < 0.01) or sedating medications detected (OR = 1.45; 95%CI = 1.11-1.91; P < 0.01). CONCLUSIONS In this sample of non-fatally injured motor vehicle drivers in British Columbia, Canada, there was no evidence of increased crash risk in drivers with Δ-9-tetrahydrocannabinol < 5 ng/ml and a statistically non-significant increased risk of crash responsibility (odds ratio = 1.74) in drivers with Δ-9-tetrahydrocannabinol ≥ 5 ng/ml.
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Affiliation(s)
| | | | | | | | | | - Robert E. Mann
- Centre for Addiction and Mental Health, Toronto and University of TorontoTorontoOntarioCanada
| | - Jeffrey Eppler
- Kelowna General Hospital and University of British ColumbiaKelownaBCCanada
| | - Adam Lund
- Royal Columbian Hospital and University of British ColumbiaNew WestminsterBCCanada
| | - Andrew MacPherson
- Victoria General Hospital and University of British ColumbiaVictoriaBCCanada
| | - Walter Martz
- Institute of Forensic Medicine, Justus Liebig UniversityGiessenGermany
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30
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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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31
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Koellinger PD, de Vlaming R. Mendelian randomization: the challenge of unobserved environmental confounds. Int J Epidemiol 2019; 48:665-671. [PMID: 31263889 PMCID: PMC6659461 DOI: 10.1093/ije/dyz138] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Philipp D Koellinger
- Department of Economics, School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ronald de Vlaming
- Department of Economics, School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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32
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Fleury MJ, Delorme A, Benigeri M, Vanasse A. Utilisation et enjeux des données clinico-administratives dans le domaine de la santé
mentale et de la dépendance. SANTE MENTALE AU QUEBEC 2019. [DOI: 10.7202/1058608ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Les banques de données clinico-administratives sont des outils clés pour la prise
de décision publique en santé. Pour soutenir la gestion des services, plusieurs banques sont
disponibles s’intéressant aux besoins des populations et aux ressources disponibles, tout en
intégrant des indicateurs de performance. Depuis les années 2000, des efforts considérables
ont été menés afin de consolider les données et développer des outils visant à mieux
surveiller l’état de santé des populations ou la performance du système sociosanitaire. Dans
le cadre du congrès annuel de l’Association francophone pour le savoir (ACFAS), qui s’est
tenu à l’Université McGill en 2017, un colloque a été organisé pour débattre de leur
exploitation en santé mentale et en dépendance. Le colloque a intégré une discussion
d’experts qui se sont entretenus afin d’identifier les principales banques
clinico-administratives, l’ampleur de leur utilisation, leurs limites et les solutions à
développer pour les optimiser afin de mieux soutenir la gestion des services. Cet article
vise à résumer le contenu de ces discussions. Bien que les banques comportent des forces
importantes, dont un potentiel élevé de généralisation de l’information, elles présentent
des limites se rapportant surtout à leur capacité à répondre aux besoins, à des enjeux de
qualité et de validation, ainsi que d’accessibilité. Diverses recommandations ont été émises
pour améliorer leur gestion et optimiser leur impact, dont leur conservation et traitement
dans un organisme autonome et hautement accessible, et un changement sociétal de culture
favorisant l’évaluation de la performance afin d’améliorer les pratiques et de mieux
monitorer les résultats de santé.
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Affiliation(s)
- Marie-Josée Fleury
- Département de psychiatrie, Université McGill, QC, Canada
- Institut universitaire en santé mentale Douglas, QC, Canada
| | - André Delorme
- Direction générale des services de santé mentale et de psychiatrie légale,
ministère de la Santé et des Services sociaux (MSSS), QC, Canada
| | - Mike Benigeri
- Organisations publiques, consultations : gestion et exploitation des données
clinico-administratives, QC, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d’urgence, Université de
Sherbrooke, QC, Canada
- Direction scientifique, Unité de soutien à la stratégie de recherche axée sur le
patient (SRAP) du Québec, QC, Canada
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33
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Li G, Chihuri S. Prescription opioids, alcohol and fatal motor vehicle crashes: a population-based case-control study. Inj Epidemiol 2019; 6:11. [PMID: 31245260 PMCID: PMC6582661 DOI: 10.1186/s40621-019-0187-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/19/2019] [Indexed: 11/28/2022] Open
Abstract
Background The prevalence of prescription opioid use among drivers has increased markedly in the past two decades. The purpose of this study is to assess the associations of prescription opioid use and alcohol use with the risk of fatal crash involvement in US drivers. Methods We performed a population-based case-control study using toxicological testing data from two national data systems. Cases (n = 3606) were drivers involved in fatal motor vehicle crashes selected from the Fatality Analysis Reporting System and controls (n = 15,600) were drivers participating in the 2007 and 2013 National Roadside Surveys of Alcohol and Drug Use by Drivers. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) of fatal crash involvement associated with prescription opioid use with and without the presence of alcohol. Results Overall, cases were significantly more likely than controls to test positive for prescription opioids (5.0% vs. 3.7%, p < 0.001), alcohol (56.2% vs. 7.1%, p < 0.0001), and both substances (2.2% vs. 0.2%, p < 0.001). Relative to drivers testing negative for prescription opioids and alcohol, the adjusted ORs of fatal crash involvement were 1.72 (95% CI: 1.37, 2.17) for those testing positive for prescription opioids and negative for alcohol, 17.92 (95% CI: 16.19, 19.84) for those testing positive for alcohol and negative for prescription opioids, and 21.89 (95% CI: 14.38, 33.32) for those testing positive for both substances. The interaction effect on fatal crash risk of prescription opioid use and alcohol use was not statistically significant on either additive or multiplicative scale. Conclusions Prescription opioid use is associated with a significantly increased risk of fatal crash involvement independently of alcohol use. Concurrent use of prescription opioids and alcohol is associated with a 21-fold increased risk of fatal crash involvement.
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Affiliation(s)
- Guohua Li
- 1Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY 10032 USA.,2Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA.,3Department of Epidemiology, Columbia University Mailman School of Public Health, 622 West 168th St, PH5-505, New York, NY 10032 USA
| | - Stanford Chihuri
- 1Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY 10032 USA.,2Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA
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Davis-Stober CP, McCarty KN, McCarthy DM. Decision Making and Alcohol: Health Policy Implications. POLICY INSIGHTS FROM THE BEHAVIORAL AND BRAIN SCIENCES 2019; 6:64-71. [PMID: 34295966 PMCID: PMC8294170 DOI: 10.1177/2372732218818587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many negative outcomes associated with alcohol consumption stem from individual decision making, such as the decision whether or not to drive after drinking. Understanding biases in decision making as they relate to alcohol, and measuring variability in decision strategies across individuals, can be a tool for improving policy. For alcohol-related policy, both addiction and the acute effects of intoxication are potential sources of bias or heterogeneity in decision strategy, and we provide a brief primer on how they can affect decision making. We then discuss two alcohol policy domains, alcohol impaired driving and excessive consumption. We review potential implications of major findings in decision making research for each of these domains, and point out how policy could take account of biases and variability in decision making.
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Favretto D, Visentin S, Stocchero G, Vogliardi S, Snenghi R, Montisci M. Driving under the influence of drugs: Prevalence in road traffic accidents in Italy and considerations on per se limits legislation. TRAFFIC INJURY PREVENTION 2019; 19:786-793. [PMID: 30024768 DOI: 10.1080/15389588.2018.1500018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The objective of this study was to present the prevalence and concentrations of drugs in blood samples of drivers involved in road traffic accidents (RTAs) and to discuss the effects of adopting different concentration cutoff values proposed or applied in other European countries on the number of driving under the influence of drugs (DUID) offenses. METHODS Blood samples from drivers involved in RTAs in Padova province from 2014 to 2017 were analyzed for the presence of alcohol and drugs. The prevalence of positive subjects was reported for each substance adopting the limits of quantification (LOQs) of our laboratory and the concentration cutoff values proposed and/or used in other European countries. The reduction of cases of driving under the influence of illicit drugs in applying different cutoffs was calculated. RESULTS Four thousand four hundred forty-three blood samples were analyzed: 23.7% were positive for alcohol and 19.9% for psychoactive drugs, with prevalences of polydrug and alcohol-drug abuse of 4.5 and 6%, respectively. The most frequently detected drugs were cannabinoids (9.7%) and cocaine (7.2%), followed by benzodiazepines (4.1%), opiates (1.9%), and other opioids (1.7%). Barbiturates, amphetamines, and ketamine were identified in a much smaller number of cases. The overall decrease in DUID cases when adopting different cutoffs with respect to cases above the LOQs was between 8 and 84%. The adoption of high LOQs such as those used in the European Union's research project on Driving Under the Influence of Drugs, Alcohol and Medicines (DRUID) decreases the hypothetical number of DUID offenses by a quarter, and per se limits proposed as broadly equivalent to a blood alcohol concentration (BAC) between 0.2 and 0.8 g/L dramatically reduce the cases of DUID (cocaine -81%, cannabis -79%, opioids -97%, opiates -96%, and amphetamines -77%); no ketamine-positive samples were above the cutoff. CONCLUSIONS The implementation of high analytical limits or per se limits based on impairing concentrations in the Italian legislation could result in the prosecution of a much lower number of drugged drivers involved in RTAs, with a decrease from 25% to more than 80% depending on the limits.
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Affiliation(s)
- D Favretto
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - S Visentin
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - G Stocchero
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - S Vogliardi
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - R Snenghi
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
| | - M Montisci
- a Legal Medicine and Toxicology , University-Hospital of Padova , Padova , Italy
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Gomes MM, Pirdavani A, Brijs T, Souza Pitombo C. Assessing the impacts of enriched information on crash prediction performance. ACCIDENT; ANALYSIS AND PREVENTION 2019; 122:162-171. [PMID: 30384086 DOI: 10.1016/j.aap.2018.10.004] [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: 02/15/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 06/08/2023]
Abstract
While high road safety performing countries base their effective strategies on reliable data, in developing countries the unavailability of essential information makes this task challenging. As a result, this drawback has led researchers and planners to face dilemmas of "doing nothing" or "doing ill", therefore restricting models to data availability, often limited to socio-economic and demographic variables. Taking this into account, this study aims to demonstrate the potential improvements in spatial crash prediction model performance by enhancing the explanatory variables and modelling casualties as a function of a more comprehensive dataset, especially with an appropriate exposure variable. This includes experimental work, where models based on available information from São Paulo, Brazil, and Flanders, the Dutch speaking area of Belgium, are developed and compared with each other. Prediction models are developed within the framework of Geographically Weighted Regression with the Poisson distribution of errors. Moreover, casualties and fatalities as the response variables in the models developed for Flanders and São Paulo, respectively, are divided into two sets based on the transport mode, called active (i.e., pedestrians and cyclists) and motorized transport (i.e., motorized vehicle occupants). In order to assess the impacts of the enriched information on model performance, casualties are firstly associated with all available variables for São Paulo and the corresponding ones for Flanders. In the next step, prediction models are developed only for Flanders considering all the available information in the Flemish dataset. Findings showed that by adding the supplementary data, reductions of 20% and 25% for motorized transport, and 25% and 35% for active transport resulted in AICc and MSPE, respectively. Considering the practical aspects, results could help identify hotspots and relate most influential factors, suggesting sites and data, which should be prioritized in future local investigations. Besides minimizing costs with data collection, it could help policy makers to identify, implement and enforce appropriate countermeasures.
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Affiliation(s)
- Monique Martins Gomes
- UHasselt, Transportation Research Institute (IMOB), Agoralaan, 3590 Diepenbeek, Belgium; São Carlos School of Engineering, Univ. of São Paulo, Av. Trabalhador São Carlense, 400, São Carlos, Brazil.
| | - Ali Pirdavani
- UHasselt, Faculty of Engineering Technology, Agoralaan, 3590 Diepenbeek, Belgium.
| | - Tom Brijs
- UHasselt, Transportation Research Institute, Agoralaan, 3590 Diepenbeek, Belgium.
| | - Cira Souza Pitombo
- São Carlos School of Engineering, Univ. of São Paulo, Av. Trabalhador São Carlense, 400, São Carlos, Brazil.
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Subramaniam S, Holtyn AF, Jarvis BP, Koffarnus MN, Leoutsakos JS, Silverman K. Illicit drug use and work in a model therapeutic workplace. Drug Alcohol Depend 2018; 191:110-116. [PMID: 30098451 DOI: 10.1016/j.drugalcdep.2018.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The link between illicit drug use and impaired employee performance in the workplace has been assumed, but the relation has not been demonstrated clearly in research. This study was an evaluation of the relations between cocaine and opiate use, attendance, and performance in a job skills training program in a population with high rates of drug use. METHODS Out-of-treatment injection drug users (N = 42) attended a model therapeutic workplace where they could earn a maximum pay of around $10 per hour, 4 h every weekday, for 30 weeks. At the workplace, participants could complete practice trials on computer-based typing and keypad training programs. Participants were asked to provide urine samples thrice weekly, which were tested for opiates and cocaine. RESULTS Participants worked for more hours on a program that resulted in a flat hourly wage when their urine was negative for opiates and cocaine than when their urine was opiate and cocaine positive. Attendance was positively associated with opiate-negative samples during the study. When participants attended the workplace, however, their performance was not related to drug use. Participants completed the same number of practice trials, performed at the same accuracy, and typed at the same speed when they were positive and negative for cocaine and opiates. CONCLUSIONS Contrary to common expectations, this study failed to show that the use of opiates or cocaine affected in-training performance, even though opiate and cocaine use predicted reduced attendance under some circumstances.
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Affiliation(s)
- Shrinidhi Subramaniam
- Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA; California State University, Stanislaus, One University Circle, Turlock, CA 95382, USA
| | - August F Holtyn
- Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Brantley P Jarvis
- Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA; NorthTide Group, LLC, 46020 Manekin Plaze, Suite 180, Dulles, VA 20166, USA
| | - Mikhail N Koffarnus
- Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, USA
| | - Jeannie S Leoutsakos
- Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Kenneth Silverman
- Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA.
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Gjerde H, Romeo G, Mørland J. Challenges and common weaknesses in case-control studies on drug use and road traffic injury based on drug testing of biological samples. Ann Epidemiol 2018; 28:812-820. [PMID: 30217677 DOI: 10.1016/j.annepidem.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/01/2018] [Accepted: 08/19/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine and discuss common weaknesses and errors in case-control studies on the association between drug use and road traffic crash injury among drivers and recommend improvements for future studies. METHODS A search for case-control studies published between 2000 and 2016 was performed using PubMed and other databases in addition to manual search. The used methodologies were compared with requirements and recommendations for case-control studies as well as current knowledge on the interpretation of drug concentrations in biological samples. RESULTS Seventeen studies were identified. The major difficulties in the studies were related to likely selection bias, information bias, and confounding. In some studies, the definition of drug exposure was different for controls than for cases, generating potentially serious errors in the odds ratio estimations. Other weaknesses include lacking explanation of the assessment of drug exposure, missing covariates, lacking description of statistical methods, and lack of discussion of bias and confounding. CONCLUSIONS Many of the observed challenges and weaknesses can be overcome or reduced. Recommendations for future studies are presented.
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Affiliation(s)
- Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.
| | - Giovanni Romeo
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jørg Mørland
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Opioid and Benzodiazepine Use Before Injury Among Workers in Washington State, 2012 to 2015. J Occup Environ Med 2018; 60:820-826. [DOI: 10.1097/jom.0000000000001346] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kowalski-McGraw M, Green-McKenzie J, Pandalai SP, Schulte PA. Characterizing the Interrelationships of Prescription Opioid and Benzodiazepine Drugs With Worker Health and Workplace Hazards. J Occup Environ Med 2018; 59:1114-1126. [PMID: 28930799 DOI: 10.1097/jom.0000000000001154] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Prescription opioid and benzodiazepine drug use, which has risen significantly, can affect worker health. Exploration of the scientific literature assessed (1) interrelationships of such drug use, occupational risk factors, and illness and injury, and (2) occupational and personal risk factor combinations that can affect their use. METHODS The scientific literature from 2000 to 2015 was searched to determine any interrelationships. RESULTS Evidence for eight conceptual models emerged based on the search yield of 133 articles. These models summarize interrelationships among prescription opioid and benzodiazepine use with occupational injury and illness. Factors associated with the use of these drugs included fatigue, impaired cognition, falls, motor vehicle crashes, and the use of multiple providers. CONCLUSION Prescription opioid and benzodiazepine drugs may be both a personal risk factor for work-related injury and a consequence of workplace exposures.
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Affiliation(s)
- Michele Kowalski-McGraw
- The Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Drs Kowalski-McGraw, Green-McKenzie); Geisinger Health, Wilkes Barre, Pennsylvania (Dr Kowalski-McGraw); and The Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio (Drs Pandalai, Schulte)
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Simonsen KW, Linnet K, Rasmussen BS. Driving under the influence of alcohol and drugs in the eastern part of Denmark in 2015 and 2016: Abuse patterns and trends. TRAFFIC INJURY PREVENTION 2018; 19:468-475. [PMID: 29370543 DOI: 10.1080/15389588.2018.1428743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/11/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The objective of this study was to examine the frequency of psychoactive drugs and alcohol in drivers under suspicion of driving under the influence of drugs and alcohol in 2015 and 2016 in the eastern part of Denmark. The trends in the number of traffic cases sent for drug analysis since 2000 and alcohol analysis since 2011 are also discussed. METHODS Blood samples from drivers suspected of being under the influence of alcohol and/or medication and/or illicit drugs in 2015 and 2016 were investigated as requested by the police. The blood samples were screened for alcohol and/or tetrahydrocannabinol (THC) alone, for other drugs (covering all drugs, except THC, listed in the Danish list of narcotic drugs), or for THC and other drugs. Age and gender were also recorded. The number of drug traffic cases since 2000 and the number of alcohol cases since 2011 were extracted from our Laboratory Information Management System (LIMS). RESULTS In total, 11,493 traffic cases were investigated. Alcohol and/or drugs exceeded the legal limit in 9,657 (84%) cases. Men constituted 95% of the drivers investigated for drugs and 88% of the alcohol cases. The drivers investigated for drugs consisted primarily of young men, whereas drivers investigated for alcohol were older. The frequency was higher for positive alcohol cases above the legal limit (87%) than for drug cases (76%) above the fixed concentration limit. THC (67-69%) was the most frequently detected drug above the legal limit, followed by cocaine (27-28.5%), amphetamine (17%), and clonazepam (6-7%) in both years. Morphine (5.4%), included among the 5 most frequent drugs in 2015, was replaced by methadone (4.6%) in 2016. Few new psychoactive drugs (NPS) were detected. The number of traffic cases sent for drug analysis has increased more than 30-fold since 2000-2006, and the number of traffic cases submitted in 2016 for drug analysis was higher than the number for alcohol analysis; the latter has decreased since 2011. CONCLUSION Overall, alcohol was the most frequent compound detected above the legal limit in both years, followed by the well-known illicit drugs THC, cocaine, and amphetamine. NPS were seldom seen. One consequence of the increased focus on drugs in traffic has been an immense increase in drug traffic cases sent for analysis since 2006 in the eastern part of Denmark. Although this survey revealed only minimal changes compared to earlier investigations, surveys like this are invaluable for monitoring abuse patterns and trends in drugged and drunken driving.
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Affiliation(s)
- Kirsten Wiese Simonsen
- a Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Kristian Linnet
- a Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Brian Schou Rasmussen
- a Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
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Hostiuc S, Moldoveanu A, Negoi I, Drima E. Corrigendum: The Association of Unfavorable Traffic Events and Cannabis Usage: A Meta-Analysis. Front Pharmacol 2018; 9:564. [PMID: 29882551 PMCID: PMC5989488 DOI: 10.3389/fphar.2018.00564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/11/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alin Moldoveanu
- Faculty of Automatic Control and Computers, Polytechnic University of Bucharest, Bucharest, Romania
| | - Ionuţ Negoi
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eduard Drima
- Clinical-Medical Department, Faculty of Medicine and Pharmacy, University Dunǎrea de Jos, Galați,, Romania.,Galati, Psychiatry Hospital, Galați,, Romania
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Scherer M, Canham S, Voas RB, Furr-Holden CD. Intercorrelation of Alcohol and Other Drug Use Disorders among a National Sample of Drivers. J Psychoactive Drugs 2018; 50:143-150. [PMID: 28846058 PMCID: PMC6117115 DOI: 10.1080/02791072.2017.1366605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.
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Affiliation(s)
- Michael Scherer
- a Associate Research Scientist, Pacific Institute for Research and Evaluation , Calverton , MD , USA
| | - Sarah Canham
- b Research Associate, Department of Gerontology , Simon Fraser University , Vancouver , BC , Canada
| | - Robert B Voas
- c Senior Research Scientist, Pacific Institute for Research and Evaluation , Calverton , MD , USA
| | - C Debra Furr-Holden
- d Endowed Professor, Department of Epidemiology and Biostatics , Michigan State University , Flint , MI , USA
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Coupland C, Hill T, Morriss R, Moore M, Arthur A, Hippisley-Cox J. Antidepressant use and risk of adverse outcomes in people aged 20-64 years: cohort study using a primary care database. BMC Med 2018; 16:36. [PMID: 29514662 PMCID: PMC5842559 DOI: 10.1186/s12916-018-1022-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Antidepressants are one of the most commonly prescribed medications in young and middle-aged adults, but there is relatively little information on their safety across a range of adverse outcomes in this age group. This study aimed to assess associations between antidepressant treatment and several adverse outcomes in people aged 20-64 years diagnosed with depression. METHODS We conducted a cohort study in 238,963 patients aged 20-64 years registered with practices across the UK contributing to the QResearch primary care database. Only patients with a first diagnosis of depression were included. Outcomes were falls, fractures, upper gastrointestinal bleed, road traffic accidents, adverse drug reactions and all-cause mortality recorded during follow-up. Cox proportional hazards models were used to estimate hazard ratios associated with antidepressant exposure adjusting for potential confounding variables. RESULTS During 5 years of follow-up, 4651 patients had experienced a fall, 4796 had fractures, 1066 had upper gastrointestinal bleeds, 3690 had road traffic accidents, 1058 had experienced adverse drug reactions, and 3181 patients died. Fracture rates were significantly increased for selective serotonin reuptake inhibitors (adjusted hazard ratio 1.30, 95% CI 1.21-1.39) and other antidepressants (1.28, 1.11-1.48) compared with periods when antidepressants were not used. All antidepressant drug classes were associated with significantly increased rates of falls. Rates of adverse drug reactions were significantly higher for tricyclic and related antidepressants (1.54, 1.25-1.88) and other antidepressants (1.61, 1.22-2.12) compared with selective serotonin reuptake inhibitors. Trazodone was associated with a significantly increased risk of upper gastrointestinal bleed. All-cause mortality rates were significantly higher for tricyclic and related antidepressants (1.39, 1.22-1.59) and other antidepressants (1.26, 1.08-1.47) than for selective serotonin reuptake inhibitors over 5 years but not 1 year, and were significantly reduced after 85 or more days of treatment with selective serotonin reuptake inhibitors. Mirtazapine was associated with significantly increased mortality rates over 1 and 5 years of follow-up. CONCLUSIONS Selective serotonin reuptake inhibitors had higher rates of fracture than tricyclic and related antidepressants but lower mortality and adverse drug reaction rates than the other antidepressant drug classes. The association between mirtazapine and increased mortality merits further investigation. These risks should be carefully considered and balanced against potential benefits for individual patients when the decision to prescribe an antidepressant is made.
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Affiliation(s)
- Carol Coupland
- Division of Primary Care, University of Nottingham, 13th floor, Tower Building, University Park, Nottingham, NG7 2RD, UK.
| | - Trevor Hill
- Division of Primary Care, University of Nottingham, 13th floor, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Richard Morriss
- Institute of Mental Health, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Michael Moore
- University of Southampton Medical School, Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Antony Arthur
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, Edith Cavell Building, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Julia Hippisley-Cox
- Division of Primary Care, University of Nottingham, 13th floor, Tower Building, University Park, Nottingham, NG7 2RD, UK
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“Positive” urine testing for Cannabis is associated with increased risk of traffic crashes. J Pharm Biomed Anal 2018; 151:71-74. [DOI: 10.1016/j.jpba.2017.12.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 12/30/2017] [Indexed: 11/23/2022]
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Hostiuc S, Moldoveanu A, Negoi I, Drima E. The Association of Unfavorable Traffic Events and Cannabis Usage: A Meta-Analysis. Front Pharmacol 2018; 9:99. [PMID: 29487531 PMCID: PMC5816577 DOI: 10.3389/fphar.2018.00099] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/29/2018] [Indexed: 01/07/2023] Open
Abstract
Background: In the last years were published many epidemiological articles aiming to link driving under the influence of cannabis (DUIC) with the risk of various unfavorable traffic events (UTEs), with sometimes contradictory results. Aim: The primary objective of this study was to analyze whether there is a significant association between DUIC and UTEs. Materials and Methods: We used two meta-analytical methods to assess the statistical significance of the effect size: random-effects model and inverse variance heterogeneity model. Results: Twenty-four studies were included in the meta-analysis. We obtained significant increases in the effect size for DUIC tested through blood analysis, with an odds ratio (OR) of 1.97 and a confidence interval (CI) between 1.35 and 2.87; death as an outcome, with an OR of 1.56 and a CI between 1.16 and 2.09; and case–control as the type of study, with an OR of 1.99 and a CI between 1.05 and 3.80. Publication bias was very high. Conclusion: Our analysis suggests that the overall effect size for DUIC on UTEs is not statistically significant, but there are significant differences obtained through subgroup analysis. This result might be caused by either methodological flaws (which are often encountered in articles on this topic), the indiscriminate employment of the term “cannabis use,” or an actual absence of an adverse effect. When a driver is found, in traffic, with a positive reaction suggesting cannabis use, the result should be corroborated by either objective data regarding marijuana usage (like blood analyses, with clear cut-off values), or a clinical assessment of the impairment, before establishing his/her fitness to drive.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alin Moldoveanu
- Faculty of Automatic Control and Computers, Polytechnic University of Bucharest, Bucharest, Romania
| | - Ionuţ Negoi
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eduard Drima
- Clinical-Medical Department, Faculty of Medicine and Pharmacy, University Dunǎrea de Jos, Galaţi, Romania.,Galai Psychiatry Hospital, Galaţi, Romania
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Chihuri S, Li G. Use of prescription opioids and motor vehicle crashes: A meta analysis. ACCIDENT; ANALYSIS AND PREVENTION 2017; 109:123-131. [PMID: 29059534 DOI: 10.1016/j.aap.2017.10.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/17/2017] [Accepted: 10/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Opioid analgesics are a major driver of the ongoing opioid epidemic in the United Sates, accounting for about two thirds of drug overdose fatalities. There are conflicting reports regarding the effects of prescription opioids on driving safety. A meta-analysis was performed to assess the epidemiologic evidence for the association between use of prescription opioids and the risk of motor vehicle crashes. METHODS Studies examining the association between driver prescription opioid use and motor vehicle crash involvement or crash culpability and published in English were identified through a comprehensive search of 15 bibliographic databases. Eligible articles were fully reviewed and summarized. Study quality was assessed using the Newcastle-Ottawa Scale. Overall summary odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through random effects models. RESULTS Overall, 15 studies were included in the meta-analysis; of them, 10 assessed the association of prescription opioid use with the risk of crash involvement and 5 assessed the association of prescription opioid use with the risk of crash culpability. Reported crude ORs associated with prescription opioid use ranged from 1.15 to 8.19 for the risk of crash involvement and from 0.75 to 2.78 for the risk of crash culpability. Summary ORs based on pooled data were 2.29 (95% CI: 1.51, 3.48) for crash risk and 1.47 (95% CI: 1.01, 2.13) for crash culpability. CONCLUSIONS The existent epidemiologic evidence indicates that use of prescription opioids by drivers is associated with significantly increased risks of crash involvement and crash culpability. Further research is needed to understand the epidemiologic patterns of prescription opioid use in the driver population and the interaction effects between opioids and alcohol on driving safety.
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Affiliation(s)
- Stanford Chihuri
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY, United States; Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Guohua Li
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY, United States; Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
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Marti J, Bachhuber M, Feingold J, Meads D, Richards M, Hennessy S. Financial incentives to discontinue long-term benzodiazepine use: a discrete choice experiment investigating patient preferences and willingness to participate. BMJ Open 2017; 7:e016229. [PMID: 28988167 PMCID: PMC5640034 DOI: 10.1136/bmjopen-2017-016229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Investigate the acceptability of financial incentives for initiating a medically supervised benzodiazepine discontinuation programme among people with long-term benzodiazepine use and to identify programme features that influence willingness to participate. METHODS We conducted a discrete choice experiment in which we presented a variety of incentive-based programs to a sample of older adults with long-term benzodiazepine use identified using the outpatient electronic health record of a university-owned health system. We studied four programme variables: incentive amount for initiating the programme, incentive amount for successful benzodiazepine discontinuation, lottery versus certain payment and whether partial payment was given for dose reduction. Respondents reported their willingness to participate in the programmes and additional information was collected on demographics, history of use and anxiety symptoms. RESULTS The overall response rate was 28.4%. Among the 126 respondents, all four programme variables influenced stated preferences. Respondents strongly preferred guaranteed cash-based incentives as opposed to a lottery, and the dollar amount of both the starting and conditional incentives had a substantial impact on choice. Willingness to participate increased with the amount of conditional incentive. Programme participation also varied by gender, duration of use and income. CONCLUSIONS Participation in an incentive-based benzodiazepine discontinuation programme might be relatively low, but is modifiable by programme variables including incentive amounts. These results will be helpful to inform the design of future trials of benzodiazepine discontinuation programmes. Further research is needed to assess the financial viability and potential cost-effectiveness of such economic incentives.
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Affiliation(s)
- Joachim Marti
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Marcus Bachhuber
- Division of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael Richards
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, USA
| | - Sean Hennessy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
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Née M, Avalos M, Luxcey A, Contrand B, Salmi LR, Fourrier-Réglat A, Gadegbeku B, Lagarde E, Orriols L. Prescription medicine use by pedestrians and the risk of injurious road traffic crashes: A case-crossover study. PLoS Med 2017; 14:e1002347. [PMID: 28719606 PMCID: PMC5515401 DOI: 10.1371/journal.pmed.1002347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND While some medicinal drugs have been found to affect driving ability, no study has investigated whether a relationship exists between these medicines and crashes involving pedestrians. The aim of this study was to explore the association between the use of medicinal drugs and the risk of being involved in a road traffic crash as a pedestrian. METHODS AND FINDINGS Data from 3 French nationwide databases were matched. We used the case-crossover design to control for time-invariant factors by using each case as its own control. To perform multivariable analysis and limit false-positive results, we implemented a bootstrap version of Lasso. To avoid the effect of unmeasured time-varying factors, we varied the length of the washout period from 30 to 119 days before the crash. The matching procedure led to the inclusion of 16,458 pedestrians involved in an injurious road traffic crash from 1 July 2005 to 31 December 2011. We found 48 medicine classes with a positive association with the risk of crash, with median odds ratios ranging from 1.12 to 2.98. Among these, benzodiazepines and benzodiazepine-related drugs, antihistamines, and anti-inflammatory and antirheumatic drugs were among the 10 medicines most consumed by the 16,458 pedestrians. Study limitations included slight overrepresentation of pedestrians injured in more severe crashes, lack of information about self-medication and the use of over-the-counter drugs, and lack of data on amount of walking. CONCLUSIONS Therapeutic classes already identified as impacting the ability to drive, such as benzodiazepines and antihistamines, are also associated with an increased risk of pedestrians being involved in a road traffic crash. This study on pedestrians highlights the necessity of improving awareness of the effect of these medicines on this category of road user.
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Affiliation(s)
- Mélanie Née
- 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
- * E-mail:
| | - Marta Avalos
- Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France
- Team Biostatistique, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université Bordeaux, Bordeaux, France
| | - Audrey Luxcey
- 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
| | - 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
| | - Annie Fourrier-Réglat
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université Bordeaux, Bordeaux, France
- Pharmacologie Medicale, Pôle de Santé Publique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Centre d’Investigation Clinique Bordeaux, INSERM CIC 1401, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Blandine Gadegbeku
- Université de Lyon, Lyon, France
- UMRESTTE, UMR T9405, l’Institut Français des Sciences et Technologies des Transports, de l’Aménagement et des Réseaux (IFSTTAR), Bron, France
- UMRESTTE, Université Lyon 1, Lyon, 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
| | - Ludivine Orriols
- 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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Hser YI, Mooney LJ, Saxon AJ, Miotto K, Bell DS, Huang D. Chronic pain among patients with opioid use disorder: Results from electronic health records data. J Subst Abuse Treat 2017; 77:26-30. [PMID: 28476267 DOI: 10.1016/j.jsat.2017.03.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the prevalence of comorbid chronic pain among patients with opioid use disorder (OUD) and to compare other comorbidities (substance use disorder (SUD), mental health disorders, health/disease conditions) among patients in four categories: no chronic pain (No Pain), OUD prior to pain (OUD First), OUD and pain at the same time (Same Time), or pain condition prior to OUD (Pain First). METHODS Using an electronic health record (EHR) database from 2006-2015, the study assessed 5307 adult patients with OUD in a large healthcare system; 35.6% were No Pain, 9.7% were OUD First, 14.9% were Same Time, and 39.8% were Pain First. RESULTS Most OUD patients (64.4%) had chronic pain conditions, and among them 61.8% had chronic pain before their first OUD diagnosis. Other SUDs occurred more frequently among OUD First patients than among other groups in terms of alcohol (33.4% vs. 25.4% for No Pain, 20.7% for Same Time, and 20.3% for Pain First), cocaine (19.0%, vs. 13.8%, 9.4%, 7.1%), and alcohol or drug-induced disorders. OUD First patients also had the highest rates of HIV (4.7%) and hepatitis C virus (HCV; 28.2%) among the four groups. Pain First patients had the highest rates of mental disorder (81.7%), heart disease (72.0%), respiratory disease (68.4%), sleep disorder (41.8%), cancer (23.4%), and diabetes (19.3%). CONCLUSIONS The alarming high rates of chronic pain conditions occurring before OUD and the associated severe mental health and physical health conditions require better models of assessment and coordinated care plans to address these complex medical conditions.
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Affiliation(s)
- Yih-Ing Hser
- University of California, Los Angeles, United States.
| | | | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, United States
| | - Karen Miotto
- University of California, Los Angeles, United States
| | | | - David Huang
- University of California, Los Angeles, United States
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