Poly-drug findings in drugged driving cases during 1977–2007

A study into the nature and extent of polydrug use in driving recidivism behavior

OBJECTIVE

Polydrug use has become a frequent pattern of drug consumption in Europe, and this is considered a particularly dangerous risk factor for impaired driving. In Italy, persons whose license has been revoked or suspended due to the use of psychoactive drugs can reapply for a new driving license, depending on the judgment of the relevant local medical committee (CML). To regain a revoked license, offenders must remain drug free throughout an observation period. An important problem with enforcement of impaired driving is recidivism. The aim of the present study is to analyze the influence of polydrug use on driving recidivism.

METHOD

We report the findings of several years' experience at the forensic toxicology laboratory of the University of Macerata. Hair samples collected over a 7-year period by the CML from drug users were analyzed for cocaine, opiates, and cannabis using gas chromatography-mass spectrometry.

RESULTS

Three hundred thirty-five of the tested subjects were recidivists. Recidivism was more frequent among monodrug users (81%) compared with polydrug users (19%), but logistic regression showed that polydrug use is certainly a risk factor for recidivism compared to monodrug use (odds ratio [OR] = 1.99). The sex and age distribution of recidivist subjects showed a strong predominance of males in both groups, but there were no sex differences. There were more recidivist polydrug users than recidivist monodrug users in the younger age groups (OR = 2.012). Cocaine use was most prevalent in the recidivist monodrug group. All drugs analyzed were demonstrated to be a risk factor for recidivism among monodrug users, whereas only the cocaine and cannabis combination was shown to be a risk factor for recidivism among polydrug users (OR = 1.65 versus cocaine; OR = 1.30 versus Δ9-tetrahydrocannabinol). Almost all polydrug users became monodrug users, and cocaine was the most frequently detected drug in the subsequent test during the monitoring phase.

CONCLUSIONS

Our results show that polydrug use increases the risk of impaired driving recidivism and represents a considerable threat to road safety.

The prevalence of alcohol use and risky driving practises among individuals who consume sedatives nonmedically: findings from the NESARC-III

Background: Worldwide, 1.3 million people die because of a road traffic collision each year, with over half (57.7%) of such deaths in the United States involving a psychoactive substance. The prevalence of drink-drivers is slowly declining; however, the number of drivers under the influence of other drugs, such as sedatives, continues to rise.Objectives: This study aimed to examine alcohol use and risky driving practices among individuals who consume sedatives nonmedically.Methods: A total of 36,309 US adults (48.1% male) who participated in wave 3 (2012) of the National Epidemiologic Survey on Alcohol and Related Conditions were included for analysis.Results: Overall, 827 respondents reported past-year nonmedical sedative use. Almost two-third (64.9%) of these individuals exceeded recommended drinking guidelines and 42.5% met the criteria for a past-year DSM-5 alcohol use disorder. When controlling for demographic, lifestyle, and health factors, they were 1.84 times as likely to drink-drive (95% confidence interval = 1.46-2.33, p < .001) compared to those not using sedatives or using them as prescribed. Among those who reported both drink-driving and driving under the influence of sedatives in the last 12 months, 68.1% met the criteria for a past-year DSM-5 sedative use disorder.Conclusion: Several driving outcomes relevant to road safety, such as driving under the influence of alcohol or sedatives, are impacted by sedative consumption. Given that individuals who consume sedatives nonmedically may be unaware or misperceive the impacts of substance use on safe driving, interventions to reduce such behavior should be targeted among this high-risk group.

Hair Analysis to Evaluate Polydrug Use

Polydrug use is a frequent pattern of consumption in Europe. This behavior has mainly been analyzed within restricted groups; more rarely in large populations. Current polydrug use is less studied than simultaneous use. This study focused on the concurrent assumption of polydrug among drivers using hair matrix. Hair matrix, for its biological characteristics, allows to identify illicit drug use more often than other matrices, i.e., urine, and it provides information on the long-term use of them. Hair samples of subjects positive for opiates, cocaine and delta-9-tetrahydrocannabinol (Δ⁹-THC) collected by the forensic toxicology laboratory of the University of Macerata in the period 2010–2020, were analyzed using a gas chromatography-mass spectrometry method. Our results evidenced that a significant part of the examined population (12.15%) used polydrug. A strong predominance of males over females was evident. Polydrug users were more frequently young people. The abuse of two substances was predominant. Cocaine and Δ⁹-THC was the most common combination, followed by cocaine and morphine, and morphine and Δ⁹-THC. The timeframe of polydrug use was also analyzed. Our study shows that polydrug use is a very frequent behavior, and that hair analysis may be a powerful tool to obtain objective biological information of this complex phenomenon.

Illicit drug use is increasing among non-medical users of prescription drugs-Results from population-based surveys 2002-2014

BACKGROUND

Non-medical use of prescription drugs (NMUPD) is known to be associated with illicit drug use, but less is known about how illicit drug use has changed in NMUPD. We examined (1) the changes in illicit drug use among Finnish non-medical users of prescription drugs during the 2000s and (2) whether the trends of illicit drug use differ by non-medical use of prescription drugs in the general population.

METHODS

Data were derived from population-based (aged 15-69) Drug Surveys conducted in Finland in 2002, 2006, 2010 and 2014. The response rates varied between 63% and 48%. NMUPD during the last year was measured (n=252). Past-year illicit drug use among non-medical users of prescription drugs and the reference population not reporting NMUPD (n=10,967) was compared. Logistic regression was used to estimate the p-values for trends.

RESULTS

Illicit drug use has increased notably among Finnish non-medical users of prescription drugs (from 21% to 70%, p for trend<0.001). This was not explained by the respondents' gender, age, employment status or alcohol use. Among the reference population, illicit drug use also increased statistically significantly, but much more moderately (from 2.5% to 5.4%). The difference between the trends was confirmed by an interaction test (p=0.022).

CONCLUSIONS

NMUPD seems to be increasingly merging with illicit drug use. This indicates an increasing prevalence of polydrug use among non-medical users of prescription drugs, which may bring about more severe harms and worse health outcomes for users and more challenges in regard to treatment.

Sedative-hypnotics are widely abused by drivers apprehended for driving under the influence of drugs

BACKGROUND

Sedative-hypnotics are commonly encountered in drivers apprehended for driving under the influence of drugs (DUID). Previous research has mainly concentrated on the residual effects of the drugs.

METHODS

In this study, the extent of sleep medication use and abuse among drivers apprehended on suspicion of DUID was assessed. Additionally, the prevalence and concentrations of the drugs, concomitant use of other drugs of abuse, and the age and sex of the drivers positive for the most commonly prescribed sedative-hypnotics (temazepam, midazolam, nitrazepam, zopiclone, and zolpidem) in DUID cases in Finland in 2009 to 2011 were examined.

RESULTS

Sedative-hypnotics were found in 3155 samples of the 13,248 that were analyzed. Temazepam was present in over half of the cases (57.9%), along with other benzodiazepines such as midazolam (13.1%) and nitrazepam (7.0%) and the non-benzodiazepine hypnotics zopiclone (12.2%) and zolpidem (9.8%). The mean age of the drivers using the studied sedative-hypnotics was 33.5 years. Many of the drivers were polydrug users; concomitant stimulant use was found in nearly half of the cases. Cannabis and alcohol were also very common co-findings. In nearly 20% of the cases, the driver had taken more than 1 of the studied sedative-hypnotics; only 2.5% had no findings other than a single sedative-hypnotic in their blood. The drug use pattern of those positive for zopiclone and zolpidem was somewhat different from that of users of benzodiazepine sedative-hypnotics; their age was higher and the concomitant use of illegal stimulants was markedly less prevalent than among the users of temazepam, midazolam, and nitrazepam.

CONCLUSIONS

There were very few cases in our study population where the positive sedative-hypnotic finding could have been due to appropriate medical use. The extremely prevalent concomitant use of other psychoactive drugs and the high median serum concentrations of the studied sedative-hypnotics suggest their widespread abuse among apprehended drivers.

[Alcohol use alone and in combination with other drugs among truck drivers on highways in São Paulo State, Brazil: a cross-sectional study]

Traffic accidents cause more than a million deaths per year worldwide. Brazil is one of the leading countries in traffic accidents. Since alcohol is a known etiological factor for traffic accidents, the pattern of alcohol use alone and in combination with other drugs was assessed in a convenience sample of 684 truck drivers in São Paulo State, Brazil. 67.3% of participants reported alcohol use in the previous 30 days, 34.6% reported heavy drinking, 26% binge drinking, and 9.2% were at risk of developing alcohol addiction. Furthermore, 54.6% reported multiple drug use, mostly alcohol with tobacco and energy drinks. Truck drivers that reported multiple drug use showed heavier alcohol use than those who consumed only alcohol. Drinking and driving is problematic and can be aggravated by multiple drug use. The authors thus suggest monitoring the issue, which creates serious problems for users and society as a whole.

The use of psychoactive prescription drugs among DUI suspects

BACKGROUND

The study seeks to increase understanding of the use of psychoactive prescription drugs among persons suspected of driving under the influence (DUI). We studied whether the use of prescribed psychoactive medication was associated with DUI, and examined the difference in the use of prescription drugs between DUI recidivists and those arrested only once.

METHODS

In this register-based study, persons suspected of DUI (n=29470) were drawn from the Register of DUI suspects, and an age- and gender-matched reference population (n=30043) was drawn from the Finnish general population. Data on prescription drug use was obtained by linkage to the National Prescription Register. The associations of DUI arrest and use of psychoactive prescription drugs in different DUI groups (findings for alcohol only, prescription drugs, prescription drugs and alcohol, illicit drugs) were estimated by using mixed-effect logistic regression.

RESULTS

The use of psychoactive prescription drugs and DUI appeared to be strongly associated, with DUI suspects significantly more likely to use psychoactive prescription drugs compared to the reference population. Gender differences existed, with the use of benzodiazepines being more common among female DUI suspects. Moreover, DUI recidivists were more likely to use psychoactive prescription drugs compared to those arrested only once.

CONCLUSIONS

In addition to alcohol and/or illicit drug use, a significant proportion of DUI suspects were using psychoactive prescription drugs. When prescribing psychoactive medication, especially benzodiazepines, physicians are challenged to screen for possible substance use problems and also to monitor for patients' alcohol or illicit drug use while being medicated.

Occupational conditions and the risk of the use of amphetamines by truck drivers

OBJECTIVE To test whether the occupational conditions of professional truck drivers are associated with amphetamine use after demographic characteristics and ones regarding mental health and drug use are controlled for.METHODS Cross-sectional study, with a non-probabilistic sample of 684 male truck drivers, which was collected in three highways in Sao Paulo between years 2012 and 2013. Demographic and occupational information was collected, as well as data on drug use and mental health (sleep quality, emotional stress, and psychiatric disorders). A logistic regression model was developed to identify factors associated with amphetamine use. Odds ratio (OR; 95%CI) was defined as the measure for association. The significance level was established as p < 0.05.RESULTS The studied sample was found to have an average age of 36.7 (SD = 7.8) years, as well as low education (8.6 [SD = 2.3] years); 29.0% of drivers reported having used amphetamines within the twelve months prior to their interviews. After demographic and occupational variables had been controlled for, the factors which indicated amphetamine use among truck drivers were the following: being younger than 38 years (OR = 3.69), having spent less than nine years at school (OR = 1.76), being autonomous (OR = 1.65), working night shifts or irregular schedules (OR = 2.05), working over 12 hours daily (OR = 2.14), and drinking alcohol (OR = 1.74).CONCLUSIONS Occupational aspects are closely related to amphetamine use among truck drivers, which reinforces the importance of closely following the application of law (Resting Act ("Lei do Descanso"); Law 12,619/2012) which regulates the workload and hours of those professionals. Our results show the need for increased strictness on the trade and prescription of amphetamines in Brazil.

Benzodiazepine use among mothers of small children: a register-based cohort study

AIMS

To compare benzodiazepine (BZD) purchases in different groups of mothers of small children.

DESIGN

Prospective population-based cohort study based on the Finnish social and health care registers.

SETTING

Finnish women of child-bearing age.

PARTICIPANTS

All women who gave birth in 2002 in Finland (n = 54 519).

MEASUREMENTS

Latent class analysis (LCA) was used to create a typology of mothers according to their substance abuse status, psychiatric disorders and socio-demographic characteristics. The mothers were followed-up yearly for purchases of benzodiazepines, starting 4 years before the child's birth and continuing up to the child's 7th birthday. BZD purchases in different mother groups were compared using negative binomial hurdle models.

FINDINGS

The five mother types identified by LCA were mothers with substance abuse (1%), mothers with psychiatric disorders (1%), mothers with a risk of social marginalization (11%), mothers with minor social problems (18%) and mothers with no identified problems (69%; the comparison group). Mothers with substance abuse problems had the highest odds of purchasing BZDs [odds ratio OR = 27.5, 95%CI = 22.9-33.0; RR = 20.2, 95%CI = 14.9-27.3. The change in time was similar in all groups: the probability of purchasing and the number of purchases were lowest during pregnancy and the year of the child's birth.

CONCLUSIONS

In Finland, among mothers of young children, prevalence of benzodiazepine use is reduced during pregnancy and the child's first year, and then increases as the child grows older. Mothers with substance abuse and psychiatric disorders are at particularly high risk of benzodiazepine use.

Driving under the influence as a turning point? A register-based study on financial and social consequences among first-time male offenders

AIMS

To examine gradual change in debt problems, divorce and income among men in Finland before and after a first conviction for driving under the influence (DUI).

DESIGN AND SETTING

A register-based longitudinal study conducted in Finland between 1999 and 2013.

PARTICIPANTS

A nationally representative sample of 70,659 Finnish males born between 1918 and 1983, and a subsample of males (n = 1782) who had their first DUI conviction during 2005-2012.

MEASUREMENTS

Descriptive statistics showing the socio-demographic and economic determinants of DUI. The main analysis was based on a longitudinal, within-individual setting. The impact of DUI on debt problems, divorce and income was analysed using random effects regression models.

FINDINGS

DUI offenders were more likely to be younger and to have lower education and income than the non-DUI group. Criminal convictions were also more common among DUI offenders. Debt problems, divorce and loss of income were more likely after the DUI incident than before. The already increasing level of debt problems accelerated after the incident and divorce rates increased after the DUI incident, whereas the decrease in income was gradual over the whole observation period.

CONCLUSIONS

Among men in Finland, DUI offences are more common among vulnerable social groups. The first drunk-driving conviction among men in Finland constitutes a significant life event that appears to increase the likelihood of financial problems and divorce.

Prevalence of alcohol and other drugs in fatally injured drivers

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.

Phenazepam abuse in Finland: findings from apprehended drivers, post-mortem cases and police confiscations

Phenazepam is a long-acting benzodiazepine that, unlike other benzodiazepines, is currently not scheduled as a narcotic in Finland, most other European countries or the USA. It is used as an anxiolytic, sedative-hypnotic and anti-epileptic, mainly in Russia. In Finland, as well as in some other countries, an increase in the unauthorized use of phenazepam has been observed in recent years. In the one year period between July 1, 2010 and June 30, 2011 the prevalence of phenazepam in Finland was assessed among drivers apprehended for driving under the influence of drugs (DUID), in medico-legal autopsy cases and in police confiscations of illicit drugs. In DUID cases an LC-MS/MS method preceded by solid phase extraction was used for the determination of phenazepam. In the post-mortem investigations the sample preparation consisted of liquid-liquid extraction followed by derivatization and the determination was carried out by GC-MS. The police confiscations were analysed by GC-MS. There were 141 positive phenazepam cases among apprehended drivers, representing approximately 3.5% of all confirmed drug cases (n=4007) in this time period. The median (range) phenazepam blood concentration in DUID cases was 0.061 mg/L (0.004-3.600 mg/L). The median phenazepam concentration in cases with no concomitant stimulant use was significantly higher than the overall median concentration. Phenazepam was found in 17 medico-legal autopsy cases and the median (range) blood concentration was 0.048 mg/L (0.007-1.600 mg/L). Phenazepam was not considered by the medico-legal team to be the sole cause of death in any of the cases, the majority of them being accidental opiod overdoses. There were 26 seizures of phenazepam by the Police in the time period studied, some of the batches consisted of a mixture of phenazepam and stimulant designer drugs. The data show that phenazepam abuse is a widespread phenomenon in Finland. A typical user was a male multi-drug user in his 30s. The concentration range of phenazepam among apprehended drivers and medico-legal autopsy cases was wide and the drug was usually found along with other psychoactive drugs. Therefore, although it seems likely that phenazepam contributed to impairment of driving in some DUID cases, the extent of its effect remains unclear and further studies are needed to define the concentrations causing impairment and toxicity.

Substance use and social, health and safety-related factors among fatally injured drivers

OBJECTIVE

The aim of this study was to examine different socio-demographic, health and safety-related factors, and psychoactive substance use among fatally injured drivers in road traffic accidents in Finland during 2006-2008.

METHODS

An accident information register maintained by the Traffic Safety Committee of Insurance Companies (VALT) of the Finnish Motor Insurers' Centre was used as basic data, and the basic data were complemented with further toxicological analytical information retrieved from autopsy reports from the Department of Forensic Medicine, Helsinki University. The data included all the drivers (n=556) who were driving a motor vehicle and who died in a road traffic accident in Finland during 2006-2008.

RESULTS

Of all the 556 fatally injured drivers 43% (n=238) had psychoactive substance findings. 51% (n=121) of substance positive drivers had a finding for alcohol only, the rest had a finding for one or more illicit/medicinal drugs impairing driving ability, and possibly also alcohol. Fatally injured drivers with alcohol findings were significantly younger (mean age 34 years) than sober drivers (mean age 44 years) or drivers with findings for drugs (mean age 45 years). Socio-demographic background did not differ substantially among drunken/drugged and sober drivers, although drivers with alcohol findings had a slightly lower education and socioeconomic position. Previous substance abuse problems were highly prevalent among drivers with substance findings and mental or both mental and physical health problems were more common among drivers with drug findings. The non-use of safety equipment and driving at a high speed were more common among fatally injured drivers with substance findings.

CONCLUSIONS

Substance abuse and mental health problems, as well as reckless driving behavior were more pronounced among fatally injured drivers with substance findings when compared to sober drivers. Thus, prevention and early intervention concerning substance abuse, mental health problems and DUI are essential. Improved traffic safety cannot be achieved by means of traffic policy only, but integration with other policies, such as health and social policy should be strengthened.

The acute effects of 3,4-methylenedioxymethamphetamine and methamphetamine on driving: a simulator study

OBJECTIVES

Illicit drugs such as MDMA and methamphetamine are commonly abused drugs that have also been observed to be prevalent in drivers injured in road accidents. Their exact effect on driving and driving behavior has yet to be thoroughly investigated.

METHODS

Sixty-one abstinent recreational users of illicit drugs comprised the participant sample, with 33 females and 28 males, mean age 25.45 years. The three testing sessions involved oral consumption of 100 mg MDMA, 0.42 mg/kg methamphetamine, or a matching placebo. The drug administration was counter-balanced, double-blind, and medically supervised. At each session driving performance was assessed 3 h and 24 h post drug administration on a computerized driving simulator.

RESULTS

At peak concentration overall impairment scores for driving (F(2,118)=9.042, p<0.001) and signaling (F(2,118)=4.060, p=0.020) were significantly different for the daytime simulations. Performance in the MDMA condition was worse than both the methamphetamine (p=0.023) and placebo (p<0.001) conditions and the methamphetamine condition was also observed to be worse in comparison to the placebo (p=0.055). For signaling adherence, poorer signaling adherence occurred in both the methamphetamine (p=0.006) and MDMA (p=0.017) conditions in comparison to placebo in the daytime simulations.

CONCLUSIONS

The findings of this study have for the first time illustrated how both MDMA and methamphetamine effect driving performance, and provide support for legislation regarding testing for the presence of illicit drugs in impaired or injured drivers as deterrents for driving under the influence of illicit drugs.

Socio-economic determinants of drugged driving--a register-based study

AIMS

To examine the associations between socio-economic characteristics and driving under the influence of drugs (DUID), and to elaborate determinants of drugged driving.

DESIGN

A register-based case-control study.

SETTING

Finland.

PARTICIPANTS

Cases (n = 5859) apprehended by the police and suspected of DUID during 1993-2006 and controls (n = 74 809) drawn from the general Finnish population.

MEASUREMENTS

The effects of parents' and own education, urbanization of municipality, socio-economic position (SEP), main activity, income, marital status and living arrangements on DUID were estimated using logistic regression analysis. The analyses were conducted separately for men and women, age groups of under 45 years and aged 45 or over, and for substance groups of benzodiazepines only, benzodiazepines with alcohol, amphetamines and cannabinoids.

FINDINGS

Low education, unemployment, disability pension, being divorced and living alone were the strongest individual predictors of DUID in all substance groups. Illicit drug users were more disadvantaged compared to those in the benzodiazepines groups. Contrary to other substance and age groups, higher educational level and higher SEP were associated with DUID among benzodiazepine users aged 45 or over.

CONCLUSIONS

A disadvantaged social background is a significant predictor of driving while under the influence of drugs for all substance use groups in Finland. The gradient is greater for amphetamines and cannabinoids than benzodiazepines.