Effects of 3,4-methylenedioxymethamphetamine and methamphetamine on motor vehicle driving performance: A systematic review of experimental and observational studies

Methamphetamine (METH) and 3,4-methylenedioxymethamphetamine (MDMA) are common drugs of abuse and driving under their influence may occur in 1 million people yearly in the United States. This systematic review fills the currently unmet need in understanding the effects of METH and MDMA on motor vehicle driving performance (MVP) and provides insight into the forensic community. A PubMed search on September 24, 2020, for experimental and observational studies, which evaluated the impact of METH and MDMA on MVP was performed. After a review of 208 abstracts, 103 were considered potentially interesting and full texts were obtained. After the exclusion of non-English articles, review articles, single case reports, and articles which did not evaluate METH or MDMA on MVP, a total of nine experimental studies, 10 traditional observational studies, and 35 case series were included. The clinical rigor of experimental studies was evaluated using the Jadad scale. Experimental studies often demonstrated no significant MVP safety signals for METH or MDMA use, which was contrary to the overwhelming MVP safety risks found in observational studies. Common driving behaviors while using METH or MDMA include: errors in judgment, traveling at high speeds, failure to stop, merging inappropriately, lane weaving, and crashes. Limitations of experimental studies that led to dissimilar MVP outcomes from observational studies include: the common use of driving simulators, as opposed to actual driving examinations, and doses of METH or MDMA administered may not be representative of blood concentrations seen in observational studies. This systematic review has no funding source and was not registered.

The prevalence of alcohol and other drugs in fatal road crashes in Victoria, Australia

BACKGROUND

Driving under the influence of drugs, including alcohol, is a globally recognised risk factor for road traffic crashes. While the prevalence of alcohol and other drugs in fatal road crashes has been examined in other countries, recent data investigating drug driving in fatal Australian crashes are limited. This study aimed to examine how the presence of alcohol and other drugs in fatal road trauma in Victoria has changed over time in different road users.

METHODS

A population-based review of road trauma deaths was performed over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System (NCIS) and the Victorian State Trauma Registry (VSTR). Drugs were grouped according to type and analysed accordingly. Poisson regression models were used to determine change in incidence rates over the study period.

RESULTS

There were 2287 road traffic fatalities with complete toxicology data (97% of all road traffic fatalities). Alcohol (blood alcohol concentration, BAC) was the most commonly detected drug (>0.001 g/100 mL: 21.1%; >0.05 g/100 mL: 18.4%), followed by opioids (17.3%), THC (13.1%), antidepressants (9.7%), benzodiazepines (8.8%), amphetamine-type stimulants (7.1%), ketamine (3.4%), antipsychotics (0.9%) and cocaine (0.2%). Trends demonstrated changing use over time with specific drugs. Alcohol positive road fatalities declined 9% per year in passenger car/4WD drivers (IRR = 0.91, 95% CI: 0.88-0.95). The incidence of strong opioids (oxycodone, fentanyl, morphine, and methadone) increased 6% per year (IRR = 1.06; 95% CI: 1.02-1.10). Methylamphetamine was detected in 6.6% of cases and showed a yearly increase of 7% (IRR = 1.07; 95% CI: 1.01-1.13). The incidence of THC remained unchanged over the period, observed in 13.1% of cases. Stronger opioids were more commonly detected among pedal cyclists (19.0%) and pedestrians (20.9%) while THC was more commonly detected among motorcyclists (19.8%) and other light vehicle drivers (17.6%).

CONCLUSIONS

A decline in the prevalence of alcohol in fatalities suggests that law enforcement and public health strategies in Australia to address road fatalities and drink-driving may have had a positive effect. However, increases were observed in the incidence of other potentially impairing drugs including opioids and amphetamines, specifically methylamphetamine, indicating a concerning trend in road safety in Victoria that warrants further monitoring.

Drugs of abuse and ocular effects

Illicit drugs and substances of abuse are increasingly used by adults and teenagers, with novel substances constantly becoming available. Many substances can cause ocular effects or visually threatening conditions. Current literature informing eye-care practitioners on these effects is scant. The present scoping review reports the ocular effects of most commonly used drugs and substances of abuse in the teenage and adult populations of North America. Ovid MEDLINE and Ovid EMBASE databases were searched for publications from 1980 to 2019 regarding ocular effects of drug use. The selected papers regarded human subjects, in either teenage or adult population and included all types of studies, including case reports. Publications in English or in French were included. Exclusion criteria were publications about the use of prescriptions drugs, drug withdrawal, and publications about the use of alcohol, tobacco, or cannabis. Some 241 papers were retained and analysed. The use of various drugs and substances can lead to damage to structures throughout the eye, including but not limited to corneal conditions, glaucoma and other optic neuropathies, maculopathies and endophthalmitis. The data presented in this review may help guide clinicians in their diagnosis and treatment of certain ocular conditions, which could otherwise not be linked to drug use.

Concentrations of drugs determined in blood samples collected from suspected drugged drivers in England and Wales

This communication reports the blood concentrations of alcohol and drugs from 376 cases of alleged driving under the influence of drugs analysed at the Forensic Science Service Chorley and London laboratories between February 2010 and March 2011. The samples were analysed for alcohol, amphetamine, benzodiazepines, cocaine, MDMA, opiates, γ-hydroxybutyrate (GHB), ketamine, methadone and methylmethcathinone (the 4-isomer of which is known as mephedrone). The results were interpreted with respect to the number and type of drugs of abuse detected and the concentrations measured. Alcohol was quantified in 113 cases (30%), and of these a level in excess of the prescribed UK limit for driving of 80 mg% was present in 90 cases. In 80 cases, only the concentration of alcohol was measured, the concentrations of both drugs and alcohol were measured in 33 cases. In the remaining 263 cases, only the concentrations of relevant drugs of abuse were measured. The most common drug of abuse quantified was cocaine which was detected in 92 cases, either as the active drug or as its major metabolite benzoylecgonine, followed by diazepam which was quantified in 76 cases. Concentrations of some new drugs, and drugs rarely reported in driving under the influence cases are also presented.

Risky car following in abstinent users of MDMA

Ecstasy (MDMA) use raises concerns because of its association with risky driving. We evaluated driving performance and risk taking in abstinent recreational MDMA users in a simulated car following task that required continuous attention and vigilance. Drivers were asked to follow two car lengths behind a lead vehicle (LV). Three sinusoids generated unpredictable LV velocity changes. Drivers could mitigate risk by following further behind the erratic LV. From vehicle trajectory data we performed a Fourier analysis to derive measures of coherence, gain, and delay. These measures and headway distance were compared between the different groups. All MDMA drivers met coherence criteria indicating cooperation in the car following task. They matched periodic changes in LV velocity similar to controls (abstinent THC users, abstinent alcohol users, and non-drug users), militating against worse vigilance. While all participants traveled approximately 55 mph (89 kph), the MDMA drivers followed 64 m closer to the LV and demonstrated 1.04 s shorter delays to LV velocity changes than other driver groups. The simulated car following task safely discriminated between driving behavior in abstinent MDMA users and controls. Abstinent MDMA users do not perform worse than controls, but may assume extra risk. The control theory framework used in this study revealed behaviors that might not otherwise be evident.

Patterns of ecstasy use and associated harm: results of a Brazilian online survey

The aim of this study was to gather information about ecstasy users in Brazil, particularly on issues related to risks associated to the use of the drug, so as to offer a basis to prevention projects. A total of 1,140 Brazilian ecstasy users answered an online questionnaire from August 2004 to February 2005. Participants were predominantly young single heterosexual well-educated males from upper economical classes. A categorical regression with optimal scaling (CATREG) was performed to identify the risks associated with ecstasy use. "Pills taken in life" had a significant correlation with every investigated risk, particularly ecstasy dependence, unsafe sex, and polydrug use. "Gender," "sexual orientation," and "socioeconomic class" were not predictive of risk behavior. The Internet proved to be a useful tool for data collection. Given the recent increase in ecstasy availability in Brazil, a first prevention campaign directed toward the drug is urgent. At least in a preliminary Brazilian intervention, the campaign must be conducted at night leisure places, mainly frequented by youngsters from upper socioeconomic classes. The results do not call for information material with specific targets, such as gender or sexual orientation. The study's limitations have been noted.

Negative-Ion Chemical Ionization Gas Chromatography–Mass Spectrometry Assay for Enantioselective Measurement of Amphetamines in Oral Fluid: Application to a Controlled Study with MDMA and Driving Under the Influence Cases

Background: Enantioselective analysis of amphetamine (AM), methamphetamine (MA), 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxyethylamphetamine (MDEA) helps interpret toxicological results. Methods have been described for various matrices, but so far not for oral fluid, a matrix of increasing importance in testing for drugs of abuse, especially in the context of driving under the influence of drugs (DUID).

Methods: After dilution with 200 μL carbonate buffer (pH 9), oral fluid samples (10–50 μL) were derivatized with S-heptafluorobutyrylprolyl chloride. The resulting diastereomers were extracted into 100 μL of cyclohexane, separated by gas chromatography (HP-5MS column), and detected by mass spectrometry in the negative-ion chemical ionization mode (GC-NICI-MS). The method was validated and applied to samples from a controlled study with MDMA and from authentic DUID cases.

Results: The derivatized AM, MA, MDA, MDMA, and MDEA enantiomers were well separated from each other. The method was linear from 5–250 μg/L per enantiomer of MDA and from 25–1250 μg/L per enantiomer of AM, MA, MDMA, and MDEA. With the exception of MDEA, analytical recoveries, repeatability, and intermediate precision were within required limits. The analyte concentrations and enantiomer ratios in the application samples correlated only weakly with corresponding published plasma data.

Conclusions: This sensitive, reliable, and fast GC-NICI-MS assay enantioselectively measures AM, MA, MDA, and MDMA in oral fluid samples. Prediction of plasma concentrations and enantiomer ratios from respective oral fluid data is not possible.

Changing patterns of drug and alcohol use in fatally injured drivers in Washington State

We have previously reported on patterns of drug and alcohol use in fatally injured drivers in Washington State. Here we revisit that population to examine how drug use patterns have changed in the intervening 9 years. Blood and serum specimens from drivers who died within 4 h of a traffic accident between February 1, 2001, and January 31, 2002, were analyzed for illicit and therapeutic drugs and alcohol. Drugs when present were quantitated. Samples suitable for testing were obtained from 370 fatally injured drivers. Alcohol was detected above 0.01 g/100 mL in 41% of cases. The mean alcohol concentration for those cases was 0.17 g/100 mL (range 0.02-0.39 g/100 mL). Central nervous system (CNS) active drugs were detected in 144 (39%) cases. CNS depressants including carisoprodol, diazepam, hydrocodone, diphenhydramine, amitriptyline, and others were detected in 52 cases (14.1%), cannabinoids were detected in 47 cases (12.7%), CNS stimulants (cocaine and amphetamines) were detected in 36 cases (9.7%), and narcotic analgesics (excluding morphine which is often administered iatrogenically in trauma cases) were detected in 12 cases (3.2%). For those cases which tested positive for alcohol c. 40% had other drugs present which have the potential to cause or contribute to the driver's impairment. Our report also considers the blood drug concentrations in the context of their interpretability with respect to driving impairment. The data reveal that over the past decade, while alcohol use has declined, some drug use, notably methamphetamine, has increased significantly (from 1.89% to 4.86% of fatally injured drivers) between 1992 and 2002. Combined drug and alcohol use is a very significant pattern in this population and is probably overlooked in DUI enforcement programs.

Stimulant effects of 3,4-methylenedioxymethamphetamine (MDMA) 75 mg and methylphenidate 20 mg on actual driving during intoxication and withdrawal

BACKGROUND

3,4-methylenedioxymethamphetamine (MDMA) is currently one of the most popular drugs of abuse in Europe. Its increasing use over the last decade has led to concern regarding possible adverse effects on driving. The aims of the present study were to investigate the acute effects of MDMA on actual driving performance during the intoxication and withdrawal phase.

METHODS

Eighteen recreational MDMA-users (nine males, nine females) aged 21-39 years participated in a double-blind, placebo-controlled, three-way cross-over study. MDMA 75 mg, methylphenidate 20 mg and placebo were administered on day 1 of treatment (intoxication phase). Driving tests were conducted between 3 and 5 hours post-drug. Subjects returned the following day for a repetition of the driving tests between 27 and 29 hours post-drug (withdrawal phase). On-the-road driving tests consisted of a road-tracking test and a car-following test. Its main parameters were standard deviation of lateral position (SDLP), time to speed adaptation (TSA), brake reaction time (BRT) and gain.

FINDINGS

MDMA and methylphenidate significantly decreased SDLP in the road-tracking tests by about 2 cm relative to placebo on day 1 (intoxication phase). In addition, MDMA intoxication decreased performance in the car-following test as indicated by a significant rise in the 'overshoot' of the subjects' response to speed decelerations of the leading vehicle. Driving performance was not affected by treatments during withdrawal on day 2.

CONCLUSION

Collectively, these data indicate that MDMA is a stimulant drug that may improve certain aspects of the driving task, such as road-tracking performance, but may reduce performance in other aspects of the driving task, such as accuracy of speed adaptation during car-following performance.

Illicit drug use, alcohol use and problem drinking among infrequent and frequent road ragers

The purpose of this paper is to investigate the relationships between illicit drug and alcohol use, problem drinking, and road rage. Particular attention is devoted to the association between these behaviors and frequent involvement in road rage activities. The data are taken from the 2002 Centre for Addiction and Mental Health (CAMH) Monitor, a representative telephone survey with a sample of 2421 adults aged 18 and older in Ontario. A cluster analysis was performed and analysis of variance procedures were used to test for group differences. The cluster analysis revealed five distinct groups involved in various types of road rage behavior. Frequent road ragers, accounting for 5.3% of the sample, were involved in the most severe forms of road rage behavior and were most likely (24%) to report problem drinking and past year cannabis (23.8%), cocaine (5.4%), and ecstasy (10%) use. These data indicate that illicit drug use and alcohol problems are significantly greater for those involved in the most serious forms of road rage behavior. Further work is needed to identify the mechanisms by which illicit drug use and problem drinking are linked to road rage.

An epidemiological study on alcohol/drugs related fatal traffic crash cases of deceased drivers in Hong Kong between 1996 and 2000

This study is designed to evaluate the correlation between fatal vehicle crashes (FVC) and consumption of alcohol and/or drugs among drivers. Between 1996 and 2000 in Hong Kong, a total of 197 FVC cases of deceased drivers were investigated. The blood and/or urine samples of the victims were examined for the presence of alcohol and drugs. The 197 cases were then classified into two groups: single-vehicle crashes (SVC) and multiple-vehicle crashes (MVC). Out of the 106 cases for the latter group, alcohol and/or drugs were detected in 22 cases (21%) while the remaining 84 cases (79%) were regarded as no significant finding. As for the 91 cases in SVC group, 51 cases (56%) were positive for alcohol and/or drugs. The findings indicate that a driver consuming alcohol and/or drugs has a higher risk of being involved in a FVC. The most frequently detected drugs for SVC group (11 cases) were: 46% central nervous system (CNS) stimulants (including designer drugs like MDMA); 36% cannabis; 18% benzodiazepines and 9% ketamine. The detected drug for the only case in the MVC group was a CNS stimulant. The number of cases with ketamine, methamphetamine and MDMA detected has increased in recent years as these party drugs have gained popularity in Hong Kong.

Drug testing in blood: validated negative-ion chemical ionization gas chromatographic-mass spectrometric assay for enantioselective measurement of the designer drugs MDEA, MDMA, and MDA and its application to samples from a controlled study with MDMA

BACKGROUND

The enantiomers of the designer drugs 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxyethylamphetamine (MDEA) differ in their pharmacologic and toxicologic potency. The aim of this study was to develop an assay for measuring these enantiomers in small plasma volumes and to analyze samples from a controlled study with MDMA.

METHODS

The analytes were extracted from < or = 0.2 mL of plasma by mixed-mode solid-phase extraction. After derivatization with S-(-)-heptafluorobutyrylprolyl chloride, the resulting diastereomers were separated by gas chromatography (HP-5MS) within 17 min and detected by mass spectrometry in the negative-ion chemical ionization mode. The method was fully validated and applied to samples from a controlled study in which a single dose of racemic MDMA (75 mg) was administered.

RESULTS

The derivatized enantiomers were well separated and detected with good sensitivity. The assay was linear (per enantiomer) at 1-50 microg/L for MDA and 5-250 microg/L for MDMA and MDEA. Analytical recovery, accuracy, repeatability, and intermediate precision data were within required limits. Extraction yields were 82.1%-95.3%. In the study samples, concentrations of R-(-)-MDMA significantly exceeded those of S-(+)-MDMA. Their ratios (R vs S) were always >1.0 and increased over time. Concentrations of S-(+)-MDA exceeded those of R-(-)-MDA, their ratios (R vs S) also increasing over time but remaining <1.0.

CONCLUSIONS

This assay enables sensitive, reliable, and fast enantioselective measurement of MDA, MDMA, and MDEA in small volumes of plasma. The controlled study data confirm previous findings of MDMA and MDA enantiomer ratios (R vs S) increasing over time after ingestion of racemic MDMA.

Party drugs: properties, prevalence, patterns, and problems

This review summarizes the latest literature on "party" or "club" drugs, defined as MDMA, GHB, ketamine, and Rohypnol, as published from 2002 to early 2005. Club drugs have been categorized as being used at raves and dance parties. The literature shows that each drug has different properties, users, and settings. Each drug has different adverse effects and requires different acute care protocols. Although these drugs were identified early, scientific information about them, including the toxicological tests to identify them, is still evolving. Increasing numbers of studies on the short- and long-term effects of these drugs on humans are being published, but because of limitations on research using human subjects, they may not always be as rigorous as desired and can be cited by drug users to discredit findings of harm. The lack of research-based information on these drugs has led to the emergence of web sites that may or may not provide accurate data. Evaluated chemical dependency treatment protocols using the latest research for each of these different drugs are needed.

Criminal involvement among young male ecstasy users

Ecstasy (MDMA) use increased rapidly in the U.S. between about 1995 and 2001. Most research on the drug focused on its psychopharmacological and public health contexts. Previous research on drugs-crime linkages suggests that there may have been a concommitant rise in ecstasy-related crimes. We explore this dimension here using data from 7794 arrested men, age 16 to 25, in the 2001 Arrestee Drug Abuse Monitoring (ADAM) sample and 9764 male respondents of similar age in the 2001 National Household Survey on Drug Abuse (NHSDA). Our results using a variety of bivariate and regression methods indicate that ecstasy use is less prevalent among young male arrestees than young men in general and that ecstasy use among arrestees is positively associated with various measures of drug market participation but negatively related to violent and property offenses. We recommend further investigation of ecstasy use in drug-oriented data sets and longitudinal studies to evaluate the link between ecstasy use and overall drug marketing.

Epidemiology of MDMA and associated club drugs in the Seattle area

Club drug use, MDMA in particular, appeared as a growing problem in the Seattle area in the late 1990s. To understand more about the patterns of MDMA use and to evaluate the current state of MDMA use, multiple data sources were examined. The seven data sources utilized included local community-based club drug surveys collected in 2003 at raves, treatment agencies, and gay-oriented bars and sex clubs; school surveys (collected in 2002); mortality data (deaths between 2000 and 2002); data from the sexually transmitted disease clinic (October 2002 to October 2003); focus groups (2003) with men who have sex with men; emergency department drug mentions (1995 to 2002); and drug treatment admissions (1999 to 2003). Taken together, these data indicate moderate levels of MDMA use and relatively low levels of mortality and acute morbidity. However, there are several areas of concern including possible mental health effects and high levels of suspected adulteration of MDMA. Some data point to a relationship between MDMA use and risky behaviors including unprotected sex. Implications for prevention, intervention, and treatment are discussed.

Psychoactive substance use and the risk of motor vehicle accidents

The driving performance is easily impaired as a consequence of the use of alcohol and/or licit and illicit drugs. However, the role of drugs other than alcohol in motor vehicle accidents has not been well established. The objective of this study was to estimate the association between psychoactive drug use and motor vehicle accidents requiring hospitalisation. A prospective observational case-control study was conducted in the Tilburg region of The Netherlands from May 2000 to August 2001. Cases were car or van drivers involved in road crashes needing hospitalisation. Demographic and trauma related data was collected from hospital and ambulance records. Urine and/or blood samples were collected on admission. Controls were drivers recruited at random while driving on public roads. Sampling was conducted by researchers, in close collaboration with the Tilburg police, covering different days of the week and times of the day. Respondents were interviewed and asked for a urine sample. If no urine sample could be collected, a blood sample was requested. All blood and urine samples were tested for alcohol and a number of licit and illicit drugs. The main outcome measures were odds ratios (OR) for injury crash associated with single or multiple use of several drugs by drivers. The risk for road trauma was increased for single use of benzodiazepines (adjusted OR 5.1 (95% Cl: 1.8-14.0)) and alcohol (blood alcohol concentrations of 0.50-0.79 g/l, adjusted OR 5.5 (95% Cl: 1.3-23.2) and >or=0.8 g/l, adjusted OR 15.5 (95% Cl: 7.1-33.9)). High relative risks were estimated for drivers using combinations of drugs (adjusted OR 6.1 (95% Cl: 2.6-14.1)) and those using a combination of drugs and alcohol (OR 112.2 (95% Cl: 14.1-892)). Increased risks, although not statistically significantly, were assessed for drivers using amphetamines, cocaine, or opiates. No increased risk for road trauma was found for drivers exposed to cannabis. The study concludes that drug use, especially alcohol, benzodiazepines and multiple drug use and drug-alcohol combinations, among vehicle drivers increases the risk for a road trauma accident requiring hospitalisation.

Dissociable effects of a single dose of ecstasy (MDMA) on psychomotor skills and attentional performance

Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is a psychoactive recreational drug widely used by young people visiting dance parties, and has been associated with poor cognitive function. The current study assessed the influence of a single dose of MDMA 75 mg and alcohol 0.5 g/kg on cognition, psychomotor performance and driving-related task performance. Twelve healthy recreational ecstasy users participated in an experimental study conducted according to a double-blind, double-dummy, placebo-controlled three-way cross-over design. MDMA improved psychomotor performance, such as movement speed and tracking performance in a single task, as well as in a divided attention task. MDMA impaired the ability to predict object movement under divided attention. However, the inability to accurately predict object movement after MDMA may indicate impairment of particular performance skills relevant to driving. There was no effect of MDMA on visual search, planning or retrieval from semantic memory.