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Scherer JN, Vasconcelos M, Dalanhol CS, Govoni B, Dos Santos BP, Borges GR, de Gouveia GC, Viola PP, Carlson RLR, Martins AF, Costa JL, Huestis MA, Pechansky F. Reliability of roadside oral fluid testing devices for ∆ 9 -tetrahydrocannabinol (∆ 9 -THC) detection. Drug Test Anal 2024. [PMID: 38440942 DOI: 10.1002/dta.3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
Driving under the influence of cannabis (DUIC) is increasing worldwide, and cannabis is the most prevalent drug after alcohol in impaired driving cases, emphasizing the need for a reliable traffic enforcement strategy. ∆9 -tetrahydrocannabinol (THC) detection in oral fluid has great potential for identifying recent cannabis use; however, additional data are needed on the sensitivities, specificities, and efficiencies of different oral fluid devices for detecting cannabinoids at the roadside by police during routine traffic safety enforcement efforts. At the roadside, 8945 oral fluid THC screening tests were performed with four devices: AquilaScan®, Dräger DrugTest®, WipeAlyser Reader®, and Druglizer®. A total of 530 samples screened positive for THC (5.9%) and were analyzed by liquid chromatography-tandem mass spectrometry at multiple cutoff concentrations (2 ng/mL, 10 ng/mL, and manufacturers' recommended device cutoffs) to investigate device performance. Results varied substantially, with sensitivities of 0%-96.8%, specificities of 89.8%-98.5%, and efficiencies of 84.3%-97.8%. The Dräger DrugTest® outperformed the other devices with a 96.8% sensitivity, 97.1% specificity, and 97.0% efficiency at a 5-ng/mL LC-MS/MS confirmation cutoff. The WipeAlyser Reader® had good performance with a 91.4% sensitivity, 97.2% specificity, and 96.4% efficiency. AquilaScan® and Druglizer® had unacceptable performance for cannabinoid detection, highlighted by sensitivity <13%. The choice of roadside oral fluid testing device must offer good analytical performance for cannabinoids because of its high prevalence of use and impact on road safety.
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Affiliation(s)
- Juliana Nichterwitz Scherer
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
| | - Mailton Vasconcelos
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Bruna Govoni
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Bruno Pereira Dos Santos
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Gabriela Ramos Borges
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Patrícia Pacheco Viola
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Aline Franco Martins
- Campinas Poison Control Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Jose Luiz Costa
- Campinas Poison Control Center, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Severna Park, Maryland, USA
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Dutra LM, Gourdet C, Farrelly MC, Bradfield B. Perceived Safety, Not Perceived Legality, Mediates the Relationship Between Cannabis Legalization and Drugged Driving. HEALTH EDUCATION & BEHAVIOR 2023; 50:718-727. [PMID: 35822623 DOI: 10.1177/10901981221109137] [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] [Indexed: 11/16/2022]
Abstract
Cannabis legalization has rapidly spread throughout the United States and is associated with multiple public health outcomes, including driving under the influence of cannabis (DUIC). To improve understanding of the relationship between legalization and DUIC, we tested two potential mediators of this relationship: perceived safety and perceived legality of driving high. We analyzed data from 1,236 current (past 30-day) cannabis users who were recruited from states with recreational, medical only, or no legal cannabis between 2016 and 2017 using address-based and social media samples. Using a generalized linear model and adjusting for cannabis legalization, demographics, living in a state with a cannabis-specific drugged driving law, frequency of cannabis use, and weights, we found that perceived safety (risk ratio [RR] = 2.60, 95% CI [1.88, 3.58]), but not perceived legality (RR = 0.96, 95% CI [0.67, 1.37]), was significantly associated with DUIC. Perceived safety mediated the relationship between legalization and DUIC (Coeff: -0.12, 95% CI [-0.23, -0.01]). Models stratified by frequency of cannabis use yielded results consistent with those of pooled models except that, for frequent users, cannabis-specific driving laws were associated with a significantly lower risk of DUIC (RR = 0.64, 95% CI [0.44, 0.92]). Agencies developing cannabis-focused drugged driving educational campaigns should consider the potential role of perceived safety of driving high in DUIC campaigns.
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Affiliation(s)
- Lauren M Dutra
- RTI International, Research Triangle Park, NC, USA
- RTI International, Berkeley, CA, USA
| | - C Gourdet
- RTI International, Research Triangle Park, NC, USA
| | - M C Farrelly
- RTI International, Research Triangle Park, NC, USA
| | - B Bradfield
- RTI International, Research Triangle Park, NC, USA
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Benedetti MH, Zhang F, Bales R, Rudisill T, Smith GA, Zhu M. Reporting of unknown drug test results in the Fatality Analysis Reporting System and associated factors, 2000-2020. TRAFFIC INJURY PREVENTION 2023; 24:109-113. [PMID: 36648298 DOI: 10.1080/15389588.2022.2155786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To investigate how the percentage of unknown drug test results among drug-tested drivers in the Fatality Analysis Reporting System (FARS) has trended over the past 2 decades and to evaluate factors that may affect a drug-tested driver having unknown test results in FARS. METHODS The percentage of unknown test results among fatally injured drivers who were tested for drugs in FARS was assessed from 2000 to 2020. Trends in annual FARS drug testing data were compared with those for alcohol testing. In addition, the percentage of unknown drug test results was regressed on several factors that have been shown to be associated with higher risk of drug-involved crash fatalities. RESULTS The percentage of unknown drug test results in FARS has decreased drastically over the past 2 decades, and the percentage of unknown drug test data gradually matched that of alcohol data over the study period. Multiple factors such as the fatally injured drivers' age and whether the crash occurred in an urban/rural area were found to be statistically significantly associated with the percentage of unknown drug test results in FARS. CONCLUSIONS The percentage of unknown test results in FARS drug data is decreasing, and the significant associated factors found in this study may help identify additional strategies for reducing unknown drug test results. Future research should focus on continued improvement of FARS data, given the importance of FARS in understanding fatal crashes and informing strategies for prevention of crash-related injuries and fatalities in the United States.
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Affiliation(s)
- Marco H Benedetti
- The Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Fangda Zhang
- The Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Ross Bales
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Toni Rudisill
- School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Gary A Smith
- The Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Motao Zhu
- The Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
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Abstract
As more states in the U.S legalize recreational and medicinal cannabis, rates of driving under the influence of this drug are increasing significantly. Aspects of this emerging public health issue potentially pit science against public policy. The authors believe that the legal cart is currently significantly ahead of the scientific horse. Issues such as detection procedures for cannabis-impaired drivers, and use of blood THC levels to gauge impairment, should rely heavily on current scientific knowledge. However, there are many, often unacknowledged research gaps in these and related areas, that need to be addressed in order provide a more coherent basis for public policies. This review focuses especially on those areas. In this article we review in a focused manner, current information linking cannabis to motor vehicle accidents and examine patterns of cannabis-impairment of driving related behaviors, their time courses, relationship to cannabis dose and THC blood levels, and compare cannabis and alcohol-impaired driving patterns directly. This review also delves into questions of alcohol-cannabis combinations and addresses the basis for of per-se limits in cannabis driving convictions. Finally, we distinguish between areas where research has provided clear answers to the above questions, areas that remain unclear, and make recommendations to fill gaps in current knowledge.
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Affiliation(s)
- Godfrey D. Pearlson
- Department of Psychiatry, Olin Neuropsychiatry Research Center, Institute of Living, Hartford Healthcare Corporation, Hartford, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States
| | - Michael C. Stevens
- Department of Psychiatry, Olin Neuropsychiatry Research Center, Institute of Living, Hartford Healthcare Corporation, Hartford, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Asgarian FS, Namdari M, Soori H. Prevalence of mortality in cannabis consumer motorcyclists: meta-analysis of international studies. Int J Inj Contr Saf Promot 2019; 27:136-143. [DOI: 10.1080/17457300.2019.1669667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Fatemeh Sadat Asgarian
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Namdari
- Department of Community Oral Health, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Soori
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Romano E, Voas RB, Camp B. Cannabis and crash responsibility while driving below the alcohol per se legal limit. ACCIDENT; ANALYSIS AND PREVENTION 2017; 108:37-43. [PMID: 28841409 DOI: 10.1016/j.aap.2017.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
There is a growing interest in how extensively the use of marijuana by drivers relates to crash involvement. While cognitive, lab-based studies are consistent in showing that the use of cannabis impairs driving tasks, epidemiological, field-based studies have been inconclusive regarding whether cannabis use causes an increased risk of accidents. There is ample evidence that the presence of cannabis among drivers with a BAC≥0.08g/dL highly increases the likelihood of a motor vehicle crash. Less clear, however, is the contribution of cannabis to crash risk when drivers have consumed very little or no alcohol. This effort addresses this gap in knowledge. We took advantage of a unique database that merged fatal crashes in the California Statewide Integrated Traffic Records System (SWITRS) and the Fatality Analysis Reporting System (FARS), which allows for a precise identification of crash responsibility. To account for recent increase in lab testing, we restricted our sample to cover only the years 1993-2009. A total of 4294 drivers were included in the analyses. Descriptive analyses and logistic regressions were run to model the contribution of alcohol and drugs to the likelihood of being responsible in a fatal crash. We found evidence that compared with drivers negative for alcohol and cannabis, the presence of cannabis elevates crash responsibility in fatal crashes among drivers at zero BACs (OR=1.89) and with 0<BAC<0.05g/dL (OR=3.42), suggesting that emphasis on curbing impaired driving should not be solely focused on heavy-drinking drivers. Data limitations however caution about the generalizability of study findings. Special efforts to understand the effect of cannabis on fatal crashes, in particular in the absence of alcohol, are needed.
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Affiliation(s)
| | | | - Bayliss Camp
- Research & Development California Department of Motor Vehicles, CA, United States.
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Behnood A, Mannering FL. The effects of drug and alcohol consumption on driver injury severities in single-vehicle crashes. TRAFFIC INJURY PREVENTION 2017; 18:456-462. [PMID: 27893281 DOI: 10.1080/15389588.2016.1262540] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE It is well known that alcohol and drugs influence driving behavior by affecting the central nervous system, awareness, vision, and perception/reaction times, but the resulting effect on driver injuries in car crashes is not fully understood. The purpose of this study was to identify factors affecting the injury severities of unimpaired, alcohol-impaired, and drug-impaired drivers. METHOD The current article applies a random parameters logit model to study the differences in injury severities among unimpaired, alcohol-impaired, and drug-impaired drivers. Using data from single-vehicle crashes in Cook County, Illinois, over a 9-year period from January 1, 2004, to December 31, 2012, separate models for unimpaired, alcohol-impaired, and drug-impaired drivers were estimated. A wide range of variables potentially affecting driver injury severity was considered, including roadway and environmental conditions, driver attributes, time and location of the crash, and crash-specific factors. RESULTS The estimation results show significant differences in the determinants of driver injury severities across groups of unimpaired, alcohol-impaired, and drug-impaired drivers. The findings also show that unimpaired drivers are understandably more responsive to variations in lighting, adverse weather, and road conditions, but these drivers also tend to have much more heterogeneity in their behavioral responses to these conditions, relative to impaired drivers. In addition, age and gender were found to be important determinants of injury severity, but the effects varied significantly across all drivers, particularly among alcohol-impaired drivers. CONCLUSIONS The model estimation results show that statistically significant differences exist in driver injury severities among the unimpaired, alcohol-impaired, and drug-impaired driver groups considered. Specifically, we find that unimpaired drivers tend to have more heterogeneity in their injury outcomes in the presence potentially adverse weather and road surface conditions. This makes sense because one would expect unimpaired drivers to apply their full knowledge/judgment range to deal with these conditions, and the variability of this range across the driver population (with different driving experiences, etc.) should be great. In contrast, we find, for the most part, that alcohol-impaired and drug-impaired drivers have far less heterogeneity in the factors that affect injury severity, suggesting an equalizing effect resulting from the decision-impairing substance.
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Affiliation(s)
- Ali Behnood
- a Lyles School of Civil Engineering, Purdue University , West Lafayette , Indiana
| | - Fred L Mannering
- b Department of Civil and Environmental Engineering , University of South Florida , Tampa , Florida
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Li G, Chihuri S, Brady JE. Role of alcohol and marijuana use in the initiation of fatal two-vehicle crashes. Ann Epidemiol 2017; 27:342-347.e1. [DOI: 10.1016/j.annepidem.2017.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/13/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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Høiseth G, Berg-Hansen GO, Øiestad ÅML, Bachs L, Mørland J. Impairment due to alcohol, tetrahydrocannabinol, and benzodiazepines in impaired drivers compared to experimental studies. TRAFFIC INJURY PREVENTION 2017; 18:244-250. [PMID: 27327554 DOI: 10.1080/15389588.2016.1201205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In some countries, per se laws for other drugs than alcohol are used to judge drunk and drugged drivers. These blood concentration limits are often derived from experimental studies on traffic relevant behavior of healthy volunteers. Knowledge about how results from experimental studies could be transferred to a real-life setting is missing. The aim of this study was to compare impairment seen in experimental studies to the impairment seen at equivalent concentrations in apprehended drunk and drugged drivers. METHODS Results from previously performed meta-analyses of experimental studies regarding impairment from alcohol, tetrahydrocannabinol (THC), and benzodiazepines were compared to impairment in apprehended drunk and drugged drivers as judged by a clinical test of impairment. Both experimental studies and real-life cases were divided into 4 groups according to increasing blood drug concentration intervals. The percentage of impaired test results in experimental studies was compared to the percentage of impaired subjects among drivers within the same blood drug concentration window. RESULTS For ethanol, the percentage of impaired drivers (n = 1,223) increased from 59% in the lowest drug concentration group to 95% in the highest drug concentration group, compared to 7 and 72% in the respective groups in experimental studies. For THC, the percentage of impaired drivers (n = 950) increased from 42 to 58%, the corresponding numbers being 11 and 42% for experimental studies. For benzodiazepines, the percentage of impaired drivers (n = 245) increased from 46 to 76%, the corresponding numbers being 16 and 60% for experimental studies. The increased odds ratio for impairment between 2 concentration groups was comparable for experimental studies and impaired drivers. CONCLUSIONS Fewer test results indicated impairment in experimental studies compared to impaired drivers in real life when influenced by similar blood concentrations of either ethanol, THC, or benzodiazepines. In addition, a comparable relationship between drug concentration and impairment was seen for both experimental studies and real-life cases. We believe that the present study strengthens the background for using experimental studies to establish fixed concentration limits for drunk and drugged drivers, but experimental studies in an impaired driver population could further expand our knowledge.
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Affiliation(s)
- Gudrun Høiseth
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
- b Center for Psychopharmacology, Diakonhjemmet Hospital , Oslo , Norway
| | - Grim Otto Berg-Hansen
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
| | - Åse Marit L Øiestad
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
| | - Liliana Bachs
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
| | - Jørg Mørland
- a Norwegian Institute of Public Health , Division of Forensic Sciences , Oslo , Norway
- c Institute of Clinical Medicine , University of Oslo , Oslo , Norway
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Watson TM, Mann RE. International approaches to driving under the influence of cannabis: A review of evidence on impact. Drug Alcohol Depend 2016; 169:148-155. [PMID: 27810658 DOI: 10.1016/j.drugalcdep.2016.10.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are knowledge gaps regarding the effectiveness of different approaches designed to prevent and deter driving under the influence of cannabis (DUIC). Policymakers are increasingly interested in evidence-based responses to DUIC as numerous jurisdictions worldwide have legally regulated cannabis or are debating such regulation. We contribute a comprehensive review of international literature on countermeasures that address DUIC, and identify where and how such measures have been evaluated. METHODS The following databases were systematically searched from 1995 to present: Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts, and Criminal Justice Abstracts. Hand searching of relevant documents, internet searches for grey literature, and review of ongoing email alerts were conducted to capture any emerging literature and relevant trends. RESULTS Numerous international jurisdictions have introduced a variety of measures designed to deter DUIC. Much interest has been generated regarding non-zero per se laws that set fixed legal limits for tetrahydrocannabinol and/or its metabolites detected in drivers. Other approaches include behavioural impairment laws, zero-tolerance per se laws, roadside drug testing, graduated licensing system restrictions, and remedial programs. However, very few evaluations have appeared in the literature. CONCLUSIONS Although some promising results have been reported (e.g., roadside testing), it is premature to draw firm conclusions regarding the broader impacts of general deterrent approaches to DUIC. This review points to the need for a long-term commitment to rigorously evaluate, using multiple methods, the impact of general and specific deterrent DUIC countermeasures.
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Affiliation(s)
- Tara Marie Watson
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada.
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
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Pelição FS, Peres MD, Pissinate JF, de Paula DML, de Faria MDGC, Nakamura-Palacios EM, De Martinis BS. Predominance of alcohol and illicit drugs among traffic accidents fatalities in an urban area of Brazil. TRAFFIC INJURY PREVENTION 2016; 17:663-667. [PMID: 26891425 DOI: 10.1080/15389588.2016.1146824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence of alcohol and illicit drug use among victims of fatal traffic accidents in the Metropolitan Region of Vitória, Brazil, during the period 2011-2012. METHODS Blood samples were collected and analyzed for the presence of drugs from 391 deceased victims of traffic crashes that occurred in the Metropolitan Region of Vitória, Brazil. The victims included drivers, passengers, and pedestrians. Sociodemographic variables such as age, gender, day of the week, and period of the year in which the accidents occurred were recorded. The analyses were performed by a gas chromatography-flame ionization method for alcohol and by a gas chromatography-mass spectrometry for amphetamines, cocaine, and cannabis. RESULTS The results showed that 44.8% (n = 175) of all cases were positive for alcohol and/or illicit drugs. The detection of alcohol and/or drugs was more frequent in young males, aged 17 to 34, whose samples were positive in 46.8% of cases. Small differences among drivers, passengers, and pedestrians were observed (drivers = 45.9%, passengers = 46.4%, and pedestrians = 45.6%). In general, the most prevalent drug was alcohol, with 141 positive cases (36.1%), followed by cocaine, with 47 positive cases (12%). Amphetamines and cannabis had positivity rates of 4.1 and 4.3%, with 16 and 17 positive cases, respectively. The combined use of alcohol and other drugs was found in 36 cases (9.2%). Crack cocaine use was observed in 27.7% of the positive cases for cocaine. CONCLUSIONS For the effective reduction of traffic accidents related to driving under influence of drugs (DUID), we suggest the intensification of enforcement actions against the use of alcohol by drivers, the definition of which illicit drugs should be surveyed, as well the cutoff values, the promotion of changing legislation to oblige drivers to provide samples for toxicological testing, and the establishment of public information programs and specific actions aimed at young drivers to promote behavioral changes.
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Affiliation(s)
- Fabrício Souza Pelição
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
- b Departamento de Análises Clínicas , Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
| | - Mariana Dadalto Peres
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
- b Departamento de Análises Clínicas , Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
| | - Jauber Fornaciari Pissinate
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
| | | | | | - Ester Miyuki Nakamura-Palacios
- c Departamento de Ciências Fisiológicas , Centro de Ciências da Saúde, Universidade Federal do Espírito Santo , Vitória , Brazil
| | - Bruno Spinosa De Martinis
- d Departamento de Química , Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
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Fischer B, Imtiaz S, Rudzinski K, Rehm J. Crude estimates of cannabis-attributable mortality and morbidity in Canada-implications for public health focused intervention priorities. J Public Health (Oxf) 2016; 38:183-8. [PMID: 25630540 PMCID: PMC4750519 DOI: 10.1093/pubmed/fdv005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cannabis is the most commonly used drug in Canada; while its use is currently controlled by criminal prohibition, debates about potential control reforms are intensifying. There is substantive evidence about cannabis-related risks to health in various key outcome domains; however, little is known about the actual extent of these harms specifically in Canada. METHODS Based on epidemiological data (e.g. prevalence of relevant cannabis use rates and relevant risk behaviors; risk ratios; and annual numbers of morbidity/mortality cases in relevant domains), and applying the methodology of comparative risk assessment, we estimated attributable fractions for cannabis-related morbidity and mortality, specifically for: (i) motor-vehicle accidents (MVAs); (ii) use disorders; (iii) mental health (psychosis) and (iv) lung cancer. RESULTS MVAs and lung cancer are the only domains where cannabis-attributable mortality is estimated to occur. While cannabis use results in morbidity in all domains, MVAs and use disorders by far outweigh the other domains in the number of cases; the popularly debated mental health consequences (e.g., psychosis) translate into relatively small case numbers. CONCLUSIONS The present crude estimates should guide and help prioritize public health-oriented interventions for the cannabis-related health burden in the population in Canada; formal burden of disease calculations should be conducted.
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Affiliation(s)
- Benedikt Fischer
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada V6B 5K3
- Department of Psychiatry, University of Toronto, Toronto, CanadaM5T 1R8
| | - Sameer Imtiaz
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Institute of Medical Science, University of Toronto, Toronto, CanadaM5S 1A8
| | - Katherine Rudzinski
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Dalla Lana School of Public Health, University of Toronto, Toronto, CanadaM5T 3M7
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
- Department of Psychiatry, University of Toronto, Toronto, CanadaM5T 1R8
- Institute of Medical Science, University of Toronto, Toronto, CanadaM5S 1A8
- Dalla Lana School of Public Health, University of Toronto, Toronto, CanadaM5T 3M7
- WHO/PAHO Collaborating Centre for Mental Health and Addiction, Toronto, CanadaM5S 2S1
- Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden 01069, Germany
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Leyton V, Andreuccetti G, de Almeida RM, Muñoz DR, Walls HC, Greve JMD, da Costa Montal JH, Adura FE, Yonamine M. Hair drug testing in the new Brazilian regulation to obtain professional driver's licence: no parallel to any other law enforcement in the world. Addiction 2015; 110:1207-8. [PMID: 25967396 DOI: 10.1111/add.12945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/31/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Vilma Leyton
- Faculty of Medicine, University of São Paulo, Brazil.
| | | | | | | | - H Chip Walls
- Forensic Analytical and Clinical Toxicology Consultant and Training Specialists, Miami, USA
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Karschner EL, Swortwood MJ, Hirvonen J, Goodwin RS, Bosker WM, Ramaekers JG, Huestis MA. Extended plasma cannabinoid excretion in chronic frequent cannabis smokers during sustained abstinence and correlation with psychomotor performance. Drug Test Anal 2015; 8:682-9. [PMID: 26097154 DOI: 10.1002/dta.1825] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/08/2015] [Accepted: 05/19/2015] [Indexed: 11/06/2022]
Abstract
Cannabis smoking increases motor vehicle accident risk. Empirically defined cannabinoid detection windows are important to drugged driving legislation. Our aims were to establish plasma cannabinoid detection windows in frequent cannabis smokers and to determine if residual cannabinoid concentrations were correlated with psychomotor performance. Twenty-eight male chronic frequent cannabis smokers resided on a secure research unit for up to 33 days with daily blood collection. Plasma specimens were analyzed for Δ(9) -tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), and 11-nor-9-carboxy-THC (THCCOOH) by gas chromatography-mass spectrometry. Critical tracking and divided attention tasks were administered at baseline (after overnight stay to ensure lack of acute intoxication) and after 1, 2, and 3 weeks of cannabis abstinence. Twenty-seven of the twenty-eight participants were THC-positive at admission (median 4.2 µg/L). THC concentrations significantly decreased 24 h after admission, but were still ≥2 µg/L in 16 of the 28 participants 48 h after admission. THC was detected in 3 of 5 specimens on day 30. The last positive 11-OH-THC specimen was 15 days after admission. THCCOOH was measureable in 4 of 5 participants after 30 days of abstinence. Years of prior cannabis use significantly correlated with THC concentrations on admission, and days 7 and 14. Tracking error, evaluated by the Divided Attention Task, was the only evaluated psychomotor assessment significantly correlated with cannabinoid concentrations at baseline and day 8 (11-OH-THC only). Median THC was 0.3 µg/L in 5 chronic frequent cannabis smokers' plasma samples after 30 days of sustained abstinence. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Erin L Karschner
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA.,Currently at Armed Forces Medical Examiner System, Division of Forensic Toxicology, 115 Purple Heart Drive, Dover AFB, DE, 19902, USA
| | - Madeleine J Swortwood
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA
| | - Jussi Hirvonen
- Molecular Imaging Branch, IRP, National Institute on Mental Health, NIH, 6001 Executive Blvd., Bethesda, MD, 20892, USA.,Currently at Department of Diagnostic Radiology, University of Turku, 20014, Turun yliopisto, Finland
| | - Robert S Goodwin
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA.,Currently at 7 Church Lane, Suite 15A, Pikesville, MD, 21208, USA
| | - Wendy M Bosker
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA.,Currently at Institute for Neuroscience and Medicine-4, Forschungszentrum Jülich, 52425, Jülich, Germany.,Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, 6211 LK, Maastricht, The Netherlands
| | - Johannes G Ramaekers
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, 6211 LK, Maastricht, The Netherlands
| | - Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA
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Wong K, Brady JE, Li G. Establishing legal limits for driving under the influence of marijuana. Inj Epidemiol 2014; 1:26. [PMID: 27747660 PMCID: PMC5005632 DOI: 10.1186/s40621-014-0026-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/17/2014] [Indexed: 11/27/2022] Open
Abstract
Marijuana has become the most commonly detected non-alcohol substance among drivers in the United States and Europe. Use of marijuana has been shown to impair driving performance and increase crash risk. Due to the lack of standardization in assessing marijuana-induced impairment and limitations of zero tolerance legislation, more jurisdictions are adopting per se laws by specifying a legal limit of Δ9-tetrahydrocannabinol (THC) at or above which drivers are prosecuted for driving under the influence of marijuana. This review examines major considerations when developing these threshold THC concentrations and specifics of legal THC limits for drivers adopted by different jurisdictions in the United States and other countries.
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Affiliation(s)
- Kristin Wong
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, 10032 NY USA
| | - Joanne E Brady
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, 10032 NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, 10032 NY USA
| | - Guohua Li
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, 10032 NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, 10032 NY USA
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 722 West 168th Street, Room 524, New York, 10032 NY USA
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Vindenes V, Boix F, Koksæter P, Strand MC, Bachs L, Mørland J, Gjerde H. Drugged driving arrests in Norway before and after the implementation of per se law. Forensic Sci Int 2014; 245:171-7. [DOI: 10.1016/j.forsciint.2014.10.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/17/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
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Romano E, Torres-Saavedra P, Voas RB, Lacey JH. Drugs and alcohol: their relative crash risk. J Stud Alcohol Drugs 2014; 75:56-64. [PMID: 24411797 DOI: 10.15288/jsad.2014.75.56] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine (a) whether among sober (blood alcohol concentration [BAC] = .00%) drivers, being drug positive increases the drivers' risk of being killed in a fatal crash; (b) whether among drinking (BAC > .00%) drivers, being drug positive increases the drivers' risk of being killed in a fatal crash; and (c) whether alcohol and other drugs interact in increasing crash risk. METHOD We compared BACs for the 2006, 2007, and 2008 crash cases drawn from the U.S. Fatality Analysis Reporting System (FARS) with control drug and blood alcohol data from participants in the 2007 U.S. National Roadside Survey. Only FARS drivers from states with drug information on 80% or more of the drivers who also participated in the 2007 National Roadside Survey were selected. RESULTS For both sober and drinking drivers, being positive for a drug was found to increase the risk of being fatally injured. When the drug-positive variable was separated into marijuana and other drugs, only the latter was found to contribute significantly to crash risk. In all cases, the contribution of drugs other than alcohol to crash risk was significantly lower than that produced by alcohol. CONCLUSIONS Although overall, drugs contribute to crash risk regardless of the presence of alcohol, such a contribution is much lower than that by alcohol. The lower contribution of drugs other than alcohol to crash risk relative to that of alcohol suggests caution in focusing too much on drugged driving, potentially diverting scarce resources from curbing drunk driving.
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Affiliation(s)
- Edurado Romano
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Pedro Torres-Saavedra
- Department of Mathematical Sciences, University of Puerto Rico at Mayagüez, Mayagüez, Puerto Rico
| | - Robert B Voas
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - John H Lacey
- Pacific Institute for Research and Evaluation, Calverton, Maryland
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18
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Salomonsen-Sautel S, Min SJ, Sakai JT, Thurstone C, Hopfer C. Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado. Drug Alcohol Depend 2014; 140:137-44. [PMID: 24831752 PMCID: PMC4068732 DOI: 10.1016/j.drugalcdep.2014.04.008] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Legal medical marijuana has been commercially available on a widespread basis in Colorado since mid-2009; however, there is a dearth of information about the impact of marijuana commercialization on impaired driving. This study examined if the proportions of drivers in a fatal motor vehicle crash who were marijuana-positive and alcohol-impaired, respectively, have changed in Colorado before and after mid-2009 and then compared changes in Colorado with 34 non-medical marijuana states (NMMS). METHODS Thirty-six 6-month intervals (1994-2011) from the Fatality Analysis Reporting System were used to examine temporal changes in the proportions of drivers in a fatal motor vehicle crash who were alcohol-impaired (≥0.08 g/dl) and marijuana-positive, respectively. The pre-commercial marijuana time period in Colorado was defined as 1994-June 2009 while July 2009-2011 represented the post-commercialization period. RESULTS In Colorado, since mid-2009 when medical marijuana became commercially available and prevalent, the trend became positive in the proportion of drivers in a fatal motor vehicle crash who were marijuana-positive (change in trend, 2.16 (0.45), p<0.0001); in contrast, no significant changes were seen in NMMS. For both Colorado and NMMS, no significant changes were seen in the proportion of drivers in a fatal motor vehicle crash who were alcohol-impaired. CONCLUSIONS Prevention efforts and policy changes in Colorado are needed to address this concerning trend in marijuana-positive drivers. In addition, education on the risks of marijuana-positive driving needs to be implemented.
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Affiliation(s)
- Stacy Salomonsen-Sautel
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Sung-Joon Min
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045
| | - Joseph T. Sakai
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045
| | - Christian Thurstone
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045,Denver Health and Hospital Authority, Denver, CO, 80204
| | - Christian Hopfer
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045
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19
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Pacula RL, Kilmer B, Wagenaar AC, Chaloupka FJ, Caulkins JP. Developing public health regulations for marijuana: lessons from alcohol and tobacco. Am J Public Health 2014; 104:1021-8. [PMID: 24825201 PMCID: PMC4062005 DOI: 10.2105/ajph.2013.301766] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2013] [Indexed: 12/12/2022]
Abstract
Until November 2012, no modern jurisdiction had removed the prohibition on the commercial production, distribution, and sale of marijuana for nonmedical purposes-not even the Netherlands. Government agencies in Colorado and Washington are now charged with granting production and processing licenses and developing regulations for legal marijuana, and other states and countries may follow. Our goal is not to address whether marijuana legalization is a good or bad idea but, rather, to help policymakers understand the decisions they face and some lessons learned from research on public health approaches to regulating alcohol and tobacco over the past century.
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Affiliation(s)
- Rosalie Liccardo Pacula
- At the time this work was conducted, Rosalie Liccardo Pacula and Beau Kilmer were with the Drug Policy Research Center, RAND Corporation, Santa Monica, CA. Alexander C. Wagenaar was with the Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville. Frank J. Chaloupka was with the Institute for Health Research and Policy, University of Illinois, Chicago. Jonathan P. Caulkins was with the Heinz School of Public Policy, Carnegie Mellon University, Pittsburgh, PA
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20
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Pelição FS, Peres MD, Pissinate JF, De Martinis BS. A One-Step Extraction Procedure for the Screening of Cocaine, Amphetamines and Cannabinoids in Postmortem Blood Samples. J Anal Toxicol 2014; 38:341-8. [DOI: 10.1093/jat/bku039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Vermeeren A, Vuurman EFPM, Leufkens TRM, Van Leeuwen CJ, Van Oers ACM, Laska E, Rico S, Steinberg F, Roth T. Residual effects of low-dose sublingual zolpidem on highway driving performance the morning after middle-of-the-night use. Sleep 2014; 37:489-96. [PMID: 24587571 DOI: 10.5665/sleep.3482] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE To evaluate next-morning driving performance after middle-of-the-night use of zolpidem 3.5 mg in a buffered sublingual formulation (ZST). DESIGN Single-center, four-period, randomized, double-blind, placebo-controlled, crossover study. SETTING Maastricht University, The Netherlands. PARTICIPANTS Forty healthy volunteers (20 females). INTERVENTIONS Single dose of ZST administered in the middle of the night at 3 and 4 h before driving, zopiclone 7.5 mg at bedtime 9 h before driving, and placebo. MEASUREMENTS Performance in a 100-km standardized highway driving test in normal traffic measuring standard deviation of lateral position (SDLP) - an index of weaving. Drug-placebo changes in SDLP > 2.5 cm were considered to reflect clinically relevant driving impairment. RESULT For ZST, Max McNemar symmetry analyses showed that the proportion of drivers classified as impaired was increased 3 h after dosing (P < 0.012), but not 4 h after dosing. Mean increases in SDLP from placebo, although statistically significant, were small (1.46 cm [P < 0.0001] at 3 h and 0.83 cm [P = 0.0174] at 4 h). The morning after zopiclone, 45% of the drivers were classified as impaired with a mean increase in SDLP of 2.46 cm (P < 0.0001). There were no significant sex differences in effects of ZST and zopiclone. CONCLUSION Zolpidem 3.5 mg in a buffered sublingual formulation has a minimal risk of impairing driving performance in the morning ≥ 4 hours after middle-of-the night use. When taken 3 hours before driving, the drug may have impairing effects so caution should be exercised if medication is taken other than as indicated. CLINICAL TRIAL INFORMATION ClinicalTrials.gov Identifier: NCT01106859; Trial Name: Driving Performance After Middle of the Night Administration of 3.5 mg Zolpidem Tartrate Sublingual Tablet; http://clinicaltrials.gov/ct2/show/NCT01106859.
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Affiliation(s)
- Annemiek Vermeeren
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Eric F P M Vuurman
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tim R M Leufkens
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Cees J Van Leeuwen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Anita C M Van Oers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Eugene Laska
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY and New York University, Langone School of Medicine, New York, NY
| | | | | | - Thomas Roth
- Henry Ford Hospital Sleep Disorders and Research Center, Detroit, MI
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22
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Solomon R, Chamberlain E. Canada's new drug-impaired driving law: the need to consider other approaches. TRAFFIC INJURY PREVENTION 2014; 15:685-693. [PMID: 24380375 DOI: 10.1080/15389588.2013.871004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The objects of this study were: To review the state of drug-impaired driving in Canada, particularly in light of the 2008 amendments to the Criminal Code, which authorized police to demand standardized field sobriety testing and drug recognition evaluations, and to consider whether alternative enforcement models would be more effective in terms of detecting and prosecuting drug-impaired drivers and thereby achieve greater deterrence. METHOD This article provides a review of survey data, roadside screening studies, and postmortem reports that indicate the prevalence of driving after drug use in Canada. It evaluates the Criminal Code's 2008 amendments and their impact on charges and convictions for drug-impaired driving. It then reviews some alternative enforcement models for drug-impaired driving that have been adopted in other jurisdictions, particularly toxicological testing, and evaluates them against Canada's social, political, and constitutional framework. RESULTS Survey data, roadside screening studies, and postmortem reports indicate that driving after drug use is commonplace and is now more prevalent among young people than driving after drinking. Unfortunately, the 2008 Criminal Code amendments have not had their desired effects. The measures have proven to be costly, time-consuming, and cumbersome, and are readily susceptible to challenge in the courts. Accordingly, the charge rates for drug-impaired driving remain extremely low, and the law has had minimal deterrent effects. The review of alternative enforcement models suggests that a system of random roadside saliva screening, somewhat similar to the model used in Victoria, Australia, will be the most effective in terms of detecting and prosecuting drug-impaired drivers and most consistent with Canada's legal and constitutional system. CONCLUSIONS Canada should establish per se limits for the most commonly used drugs, enforceable through a system of screening and evidentiary tests. This will be more efficient and cost-effective and will result in more reliable evidence for criminal trials. Although this system will inevitably be subject to constitutional challenge, existing case law suggests that it should be upheld as a reasonable limit on constitutional rights.
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Affiliation(s)
- Robert Solomon
- a Faculty of Law , Western University , London , Ontario , Canada
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23
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Ahlner J, Holmgren A, Jones AW. Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden. Scand J Public Health 2013; 42:177-83. [PMID: 24265165 DOI: 10.1177/1403494813510792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drunk or drug-impaired drivers represent a major public health and societal problem worldwide. Because over 95% of drivers killed on the roads in Sweden are autopsied, reliable information is available about the use of alcohol and/or other drug before the crash. METHODS This retrospective 4-year study (2008-2011) used a forensic toxicology database (TOXBASE) to evaluate the concentrations of alcohol and other drugs in blood samples from drivers killed in road-traffic crashes. RESULTS The mean age of all victims (N = 895) was 48 ± 20 years, and the majority were male (86%). In 504 drivers (56%), the results of toxicological analysis were negative and these victims were older; mean age (± SD) 47 ± 20 years, than alcohol positive cases (35 ± 14 years) and illicit drug users (34 ± 15 years). In 21% of fatalities, blood-alcohol concentration (BAC) was above the statutory limit for driving (0.2 g/L), although the median BAC was appreciably higher (1.72 g/L). Illicit drugs (mainly amphetamine and cannabis) were identified in ~7% of victims, either alone (2.5%), together with alcohol (1.8%) or a prescription drug (2%). The psychoactive prescription drugs identified were mainly benzodiazepines, z-hypnotics and tramadol, which were found in the blood of 7.6% of crash victims. CONCLUSIONS The high median BAC in fatally-injured drivers speaks strongly towards alcohol-induced impairment as being responsible for the crash. Compared with alcohol, the prevalence of illicit and psychoactive prescription drugs was fairly low despite a dramatic increase in the number of drug-impaired drivers arrested by the police after a zero-tolerance law was introduced in 1999.
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Affiliation(s)
- Johan Ahlner
- 1Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Sweden
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Li G, Brady JE, Chen Q. Drug use and fatal motor vehicle crashes: a case-control study. ACCIDENT; ANALYSIS AND PREVENTION 2013; 60:205-210. [PMID: 24076302 DOI: 10.1016/j.aap.2013.09.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/20/2013] [Accepted: 09/01/2013] [Indexed: 06/02/2023]
Abstract
Drugged driving is a serious safety concern, but its role in motor vehicle crashes has not been adequately studied. Using a case-control design, the authors assessed the association between drug use and fatal crash risk. Cases (n=737) were drivers who were involved in fatal motor vehicle crashes in the continental United States during specific time periods in 2007, and controls (n=7719) were participants of the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers. Overall, 31.9% of the cases and 13.7% of the controls tested positive for at least one non-alcohol drug. The estimated odds ratios of fatal crash involvement associated with specific drug categories were 1.83 [95% confidence interval (CI): 1.39, 2.39] for marijuana, 3.03 (95% CI: 2.00, 4.48) for narcotics, 3.57 (95% CI: 2.63, 4.76) for stimulants, and 4.83 (95% CI: 3.18, 7.21) for depressants. Drivers who tested positive for both alcohol and drugs were at substantially heightened risk relative to those using neither alcohol nor drugs (Odds Ratio=23.24; 95% CI: 17.79, 30.28). These results indicate that drug use is associated with a significantly increased risk of fatal crash involvement, particularly when used in combination with alcohol.
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Affiliation(s)
- Guohua Li
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, USA; Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, New York, NY, USA.
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25
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VOAS ROBERTB. Commentary on Callaghan et al. (2013): Minimum legal drinking age laws protect high school students from both crashes and alcohol abuse. Addiction 2013; 108:1601-2. [PMID: 23947731 PMCID: PMC4448940 DOI: 10.1111/add.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- ROBERT B. VOAS
- Calverton Office Park, Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705-3102, USA.
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Voas RB, Johnson MB, Miller BA. Alcohol and drug use among young adults driving to a drinking location. Drug Alcohol Depend 2013; 132:69-73. [PMID: 23415848 PMCID: PMC3745512 DOI: 10.1016/j.drugalcdep.2013.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 01/07/2013] [Accepted: 01/12/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Clubs that feature electronic music dance events (EMDEs) draw young adults aged 18-34 who are at high-risk for alcohol-related crashes to locations where alcohol sales are the principal source of revenue. Up to 30% of these attendees may also use drugs. This provides an important context in which to study driving arrangements that reflect concern with impaired driving. We explored whether drivers were using less alcohol and fewer drugs at exit than their passengers were and whether a driver for the group ever changed after consuming too much during the evening. METHODS Using biological measures of alcohol consumption (breath tests) and drug use (oral fluid tests), 175 drivers and 272 passengers were surveyed among young adults arriving at and departing from EMDEs in San Francisco. RESULTS Upon exit from the drinking locations, only 20% of the drivers, compared to 47% of the passengers, had a high breath alcohol concentration (defined as a BrAC of .05 g/dL or greater). Further, there was evidence that drivers with high BrACs switched to passenger status on exit and former passengers with lower BrACs replaced those drivers. However, there were no differences in the prevalence of drug use among drivers and passengers. CONCLUSIONS These findings suggest that the effort by young adult drivers to avoid alcohol-impaired driving appears to be reducing the number of drivers with high BrACs returning from drinking locations, such as EMDEs, by about one third. However, there is no similar pattern for drugged driving.
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Affiliation(s)
- Robert B Voas
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705, United States.
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Romano E, Pollini RA. Patterns of drug use in fatal crashes. Addiction 2013; 108:1428-38. [PMID: 23600629 PMCID: PMC3710663 DOI: 10.1111/add.12180] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 11/28/2022]
Abstract
AIMS To characterize drug prevalence among fatally injured drivers, identify significant associations (i.e. day of week, time of day, age, gender), and compare findings with those for alcohol. DESIGN Descriptive and logistic mixed-model regression analyses of Fatality Analysis Reporting System data. SETTING US states with drug test results for >80% of fatally injured drivers, 1998-2010. PARTICIPANTS Drivers killed in single-vehicle crashes on public roads who died at the scene of the crash (n = 16 942). MEASUREMENTS Drug test results, blood alcohol concentration (BAC), gender, age and day and time of crash. FINDINGS Overall, 45.1% of fatally injured drivers tested positive for alcohol (39.9% BAC ≥ 0.08) and 25.9% for drugs. The most common drugs present were stimulants (7.2%) and cannabinols (7.1%), followed by 'other' drugs (4.1%), multiple drugs (4.1%), narcotics (2.1%) and depressants (1.5%). Drug-involved crashes occurred with relative uniformity throughout the day while alcohol-involved crashes were more common at night (P < 0.01). The odds of testing positive for drugs varied depending upon drug class, driver characteristics, time of day and the presence of alcohol. CONCLUSIONS Fatal single-vehicle crashes involving drugs are less common than those involving alcohol and the characteristics of drug-involved crashes differ, depending upon drug class and whether alcohol is present. Concerns about drug-impaired driving should not detract from the current law enforcement focus on alcohol-impaired driving.
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Affiliation(s)
- Eduardo Romano
- Pacific Institute for Research and Evaluation, Impaired Driving Center, 11720 Beltsville Drive, Calverton, MD 20705-3111, USA.
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Brady JE, Li G. Prevalence of alcohol and other drugs in fatally injured drivers. Addiction 2013; 108:104-14. [PMID: 22725100 PMCID: PMC3467360 DOI: 10.1111/j.1360-0443.2012.03993.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/15/2012] [Accepted: 06/15/2012] [Indexed: 11/28/2022]
Abstract
AIM This study aims to examine the prevalence of alcohol and/or other drugs (AOD) in a large sample of fatally injured drivers. DESIGN Using data from the Fatality Analysis Reporting System for 2005-09, the authors examined the prevalence of AOD detected in fatally injured drivers in the United States. SETTING Fatal motor vehicle crashes occurring on public roads. PARTICIPANTS Drivers who died within 1 hour of the crash in 14 states that performed toxicological testing on more than 80% of these drivers. MEASUREMENTS The prevalence of AOD and multivariable-adjusted prevalence ratios (aPR). FINDINGS Of the 20,150 fatally injured drivers studied, 57.3% tested positive for AOD, including 19.9% being positive for two or more substances. Alcohol was the most commonly detected substance, present in 40.2% of the fatally injured drivers, followed by cannabinols (10.5%), stimulants (9.0%), narcotics (5.7%) and depressants (4.0%). Multivariable analysis revealed that AOD was significantly more prevalent among drivers who died in single-vehicle crashes [aPR 1.69, 95% confidence interval (CI): 1.62-1.76] or night-time crashes (aPR 1.43, 95% CI: 1.39-1.47), or who had a driving-while-intoxicated conviction within the past 3 years (aPR 1.41, 95% CI: 1.35-1.47), and less prevalent among drivers who were 65 years or older (aPR 0.45, 95% CI: 0.42-0.49), Asian (aPR 0.47, 95% CI 0.41-0.53) or female (aPR 0.88, 95% CI: 0.85-0.91) or who were operating a motor carrier (aPR 0.41, 95% CI 0.34-0.48). CONCLUSIONS More than half of fatally injured drivers in the United States had been using AOD and approximately 20% had been using polydrugs. The prevalence of AOD use varies significantly with driver and crash characteristics.
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Affiliation(s)
- Joanne E Brady
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Pilkinton MW, Robertson A, McCluskey DL. Drugged driving: increased traffic risks involving licit and illicit substances. JOURNAL OF DRUG EDUCATION 2013; 43:183-201. [PMID: 25068170 DOI: 10.2190/de.43.2.f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Driving under the influence of drugs poses risks for traffic safety. Most research attention has been focused on the most prevalent drugs of abuse, such as alcohol, illegal drugs, and prescription drugs with high abuse potential. The objectives of this study were to determine the types of drugs used by convicted DUI offenders on the day of their arrest, prevalence of poly-substance use, and offender characteristics associated with different drug use patterns. Data were collected from 6,339 individuals enrolled in the court-mandated Mississippi Alcohol Safety Education Program. After alcohol, cannabis was the most frequently used substance, followed by sedative medications and prescription analgesics. Among poly-substance users, 78.4% reported combining alcohol with other drugs. Findings could be used to inform public education campaigns, law enforcement training, and highway safety policies about the prevalence of combining alcohol with other drugs, as well as how poly-substance use further impairs traffic-related risks.
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Voas RB, DuPont RL, Shea CL, Talpins SK. Prescription drugs, drugged driving and per se laws. Inj Prev 2012; 19:218-21. [PMID: 23024170 DOI: 10.1136/injuryprev-2012-040498] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Robert B Voas
- Pacific Institute for Research and Evaluation, Calverton, Maryld 20852, USA
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