A retrospective study of traffic offenses associated with driving under the influence of drugs in China

OBJECTIVE

This study aimed to investigate the prevalence and pattern of traffic offenses associated with driving under the influence of drugs (DUID) in 31 provinces of mainland China.

METHODS

Traffic offenses were extracted from the nationally representative court file disclosure website. Drivers convicted of traffic offenses associated with DUID were included. The monthly percentage change (MPC) in rates was estimated by fitting negative binomial regression models to assess the time trends. Moran's I was used to determine the correlations of DUID-related rates among surrounding provinces.

RESULTS

In total, 896 individuals convicted of DUID offenses were identified (April 2007 to March 2022). Of these, 769 individuals were involved in traffic crashes, and they killed 629 people. Regarding the types of drugs, 638 used amphetamine-type stimulants (ATS; methamphetamine, 3,4-methylenedioxymethamphetamine, amphetamine, and tenamfetamine), 104 used ketamine, 104 used opioids (heroin, morphine, methadone, codeine, and tramadol), 20 used caffeine, 4 used tetrahydrocannabinol, and 1 used gamma-hydroxybutyric acid. The offense trends among overall drug users (MPC, -1.1; p < .001) declined from 2014 to 2020. The trends also decreased for DUID-related traffic crashes (-1.5; p < .001) and deaths (-1.7; p < .001) during the same period. Except in three provinces, ATS-related offense rates were higher than opioid-related offense rates. Ketamine-related offense rates showed a significant positive correlation among the surrounding provinces (Moran's I, 0.22; p < .01), and South China had the highest ketamine-related offense rates.

CONCLUSIONS

In the sample, the case fatality rate was 70.7%, which was a strong indicator of underreporting, and most minor DUID-related offenses could not be captured by Chinese court files. The frequency of drug screening tests for people should be increased. The traffic police in Qinghai, Tibet, and Xinjiang should always be equipped with fast screening test kits for drugs, which could increase the possibility of identifying DUID offenders.

Randomly controlled drivers using minimally invasive sampling: assessment of drug prevalence in Western Switzerland over two time periods

BACKGROUND

According to the World Health Organization, road traffic injuries lead to 1.3 million deaths each year and represent the leading cause of death for young adults under 30 years old. The use of psychoactive substances, including alcohol, drugs and pharmaceuticals, is a well-known risk factor for road traffic injuries. Our study aims to assess the prevalence of substances consumed by drivers in western Switzerland. Such studies are pivotal to improving prevention and developing public awareness campaigns.

METHODS

To assess the prevalence of psychoactive substances among drivers, roadside controls were performed in collaboration with local police, using their classical sampling procedures to detect drivers under the influence of drugs or alcohol over two time periods (P1: 2006-2008, P2: 2017-2020). When impaired driving was not suspected by the police, minimally invasive sampling strategies (i.e., oral fluids during P1 and dried blood spots during P2) were performed on volunteer drivers after a road safety survey. A posteriori analyses and statistical interpretation were then performed.

RESULTS

Among the 1605 drivers included in the study, 1048 volunteers provided an oral fluid sample, while 299 provided a dried blood spot sample. The percentage of drivers testing positive for at least one substance that can impact driving abilities was stable over time, with a rate of 10.5% positivity measured over both periods. Considering the different categories of substances, a slight variation was observed between both periods, with 7.6 and 6.3% of pharmaceuticals and 3.6 and 4.9% of illicit drugs for P1 and P2, respectively. Regarding the consumption of illicit drugs, the highest percentage of positivity was measured in biological fluids of drivers under the age of 35, during nights and week-ends, periods which are considered particularly prone to fatal accidents for this age group. Disturbingly, the road safety survey highlighted that drivers' perception of the risk of getting positively controlled while driving after drug consumption is low (3.3 on a 1-to-10 scale, N = 299).

CONCLUSION

The number of positive cases measured in voluntary drivers who passed the preliminary police check demonstrates the importance of systematic biofluid sampling strategies regarding driving under the influence of psychoactive substances. Although the number of fatal road accidents globally has decreased over time, the results of this study reveal the need for both better prevention and deterrent processes that could potentially reduce the risk of fatal road accidents associated with drug consumption.

The Prevention of Drugged Driving: Needs, Barriers, and Self-Efficacy of Prevention Professionals

Driving under the influence of drugs (e.g., marijuana, prescription medications) is a major public health and safety concern. As a relatively understudied and growing problem, prevention strategies that address it are not as clear, well-tested, or evidence-based as those developed for preventing other risky behaviors such as drunk driving. Key components of a successful prevention of this harmful behavior are the efforts of practitioners working in the areas of substance abuse prevention and highway safety for whom drugged driving is likely a part, but not the sole focus, of their job. We surveyed 238 prevention professionals working in substance abuse prevention and highway safety from 46 states to understand their needs, barriers, and self-efficacy to prevent drugged driving in their communities. Most respondents reported needing training and resources to implement strategies related to drugged driving, particularly with regard to engaging youth and parents, if they are to address this problem effectively. The majority of respondents also reported low levels of self-efficacy for implementing a wide range of drugged driving prevention strategies. Our findings reveal that the professionals we need to feel prepared and efficacious to prevent drugged driving have generally low feelings of confidence in their ability to do so.

A review of drug abuse in recently reported cases of driving under the influence of drugs (DUID) in Asia, USA, and Europe

Driving Under the Influence of Drugs (DUID) is considered a serious issue related to the abuse of illegal drugs. DUID cases, including deaths, are being continuously reported in Asia, USA, and Europe. This literature review focuses on illegal drug abuse in recent DUID cases reported in Asia, USA, and Europe. To determine illegal drug abuse in DUID suspects, previous studies collected and analyzed biological samples, such as blood, urine, oral fluids, and hair. In addition, there were forensic autopsies and surveys for investigation of illegal drugs in DUID cases and drivers. In previous studies, ketamine, morphine, methamphetamine (MA), and khat were mainly reported in Asia, whereas amphetamine, benzodiazepines (BZDs), and cannabinoids were mainly reported in USA, and synthetic cannabinoids (SCs), opiates, and cocaine were mainly reported in Europe. Since DUID suspects related to illegal drugs have been frequently reported in Asia, USA, and Europe, there is a need to plan for national monitoring for drivers or motor vehicles to regulate and prevent drug abuse and relevant DUID cases.

Driving under the influence of drugs: Prevalence in road traffic accidents in Italy and considerations on per se limits legislation

OBJECTIVE

The objective of this study was to present the prevalence and concentrations of drugs in blood samples of drivers involved in road traffic accidents (RTAs) and to discuss the effects of adopting different concentration cutoff values proposed or applied in other European countries on the number of driving under the influence of drugs (DUID) offenses.

METHODS

Blood samples from drivers involved in RTAs in Padova province from 2014 to 2017 were analyzed for the presence of alcohol and drugs. The prevalence of positive subjects was reported for each substance adopting the limits of quantification (LOQs) of our laboratory and the concentration cutoff values proposed and/or used in other European countries. The reduction of cases of driving under the influence of illicit drugs in applying different cutoffs was calculated.

RESULTS

Four thousand four hundred forty-three blood samples were analyzed: 23.7% were positive for alcohol and 19.9% for psychoactive drugs, with prevalences of polydrug and alcohol-drug abuse of 4.5 and 6%, respectively. The most frequently detected drugs were cannabinoids (9.7%) and cocaine (7.2%), followed by benzodiazepines (4.1%), opiates (1.9%), and other opioids (1.7%). Barbiturates, amphetamines, and ketamine were identified in a much smaller number of cases. The overall decrease in DUID cases when adopting different cutoffs with respect to cases above the LOQs was between 8 and 84%. The adoption of high LOQs such as those used in the European Union's research project on Driving Under the Influence of Drugs, Alcohol and Medicines (DRUID) decreases the hypothetical number of DUID offenses by a quarter, and per se limits proposed as broadly equivalent to a blood alcohol concentration (BAC) between 0.2 and 0.8 g/L dramatically reduce the cases of DUID (cocaine -81%, cannabis -79%, opioids -97%, opiates -96%, and amphetamines -77%); no ketamine-positive samples were above the cutoff.

CONCLUSIONS

The implementation of high analytical limits or per se limits based on impairing concentrations in the Italian legislation could result in the prosecution of a much lower number of drugged drivers involved in RTAs, with a decrease from 25% to more than 80% depending on the limits.

Ability to monitor driving under the influence of marijuana among non-fatal motor-vehicle crashes: An evaluation of the Colorado electronic accident reporting system

INTRODUCTION

As more states legalize medical/recreational marijuana use, it is important to determine if state motor-vehicle surveillance systems can effectively monitor and track driving under the influence (DUI) of marijuana. This study assessed Colorado's Department of Revenue motor-vehicle crash data system, Electronic Accident Reporting System (EARS), to monitor non-fatal crashes involving driving under the influence (DUI) of marijuana.

METHODS

Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to assess EARS' usefulness, flexibility, timeliness, simplicity, acceptability, and data quality. We assessed system components, interviewed key stakeholders, and analyzed completeness of Colorado statewide 2014 motor-vehicle crash records.

RESULTS

EARS contains timely and complete data, but does not effectively monitor non-fatal motor-vehicle crashes related to DUI of marijuana. Information on biological sample type collected from drivers and toxicology results were not recorded into EARS; however, EARS is a flexible system that can incorporate new data without increasing surveillance system burden.

CONCLUSIONS

States, including Colorado, could consider standardization of drug testing and mandatory reporting policies for drivers involved in motor-vehicle crashes and proactively address the narrow window of time for sample collection to improve DUI of marijuana surveillance. Practical applications: The evaluation of state motor-vehicle crash systems' ability to capture crashes involving drug impaired driving (DUID) is a critical first step for identifying frequency and risk factors for crashes related to DUID.

Blood concentrations of new designer benzodiazepines in forensic cases

INTRODUCTION

A number of new designer benzodiazepines have reached the illegal drug market over the past years. Toxicological interpretation of concentrations of these drugs in blood is quite challenging as very limited human data have previously been published. The aim of this study was to report blood concentrations of new designer benzodiazepines in a population of drugged drivers as well as some other criminal offenders, and to relate this to clinical impairment.

METHODS

The present material represents cases involving new designer benzodiazepines (clonazolam, diclazepam, flubromazepam, flubromazolam and pyrazolam) and etizolam, submitted for analyses during the period July 1, 2013-May 31, 2016. Analyses were performed using an ultra-performance liquid chromatography-tandem mass spectrometry method. Blood concentrations and results from the clinical test of impairment are reported.

RESULTS

New designer benzodiazepines were detected in 77 cases during the study period. The median (range) concentrations were 0.012mg/L (0.00048-0.10) for flubromazolam (n=25), 0.055mg/L (0.0047-1.2) for flubromazepam (n=24), 0.013mg/L (0.0021-0.057) for diclazepam (n=15), 0.050mg/L (0.019-0.17) for etizolam (n=14), 0.0053mg/L (0.0019-0.011) for clonazolam (n=7) and 0.074mg/L for pyrazolam (n=1). In six cases, designer benzodiazepines were the only drugs detected in blood, and in two of those cases, the physician had given the conclusion of "considerably impaired" upon performing the clinical test for impairment.

CONCLUSION

Given the lack of previously published data on human concentrations, results presented in this study could be helpful in interpretation of blood concentrations of new designer benzodiazepines. This is crucial for the assessment of the importance of toxicological results in suspected drugged drivers, rape victims, etc.