Alcohol and drugs in seriously injured drivers in six European countries
TL;DR: The high prevalence of high BACs and combinations (compared to roadside surveys) suggest that those drivers are most at risk and that preventive actions should target them preferentially.
Abstract: The objective of this study was to determine the presence of alcohol and drugs in drivers severely injured in traffic crashes in six European countries. Data were collected from 2492 seriously injured drivers of cars and vans in Belgium, Denmark, Finland, Italy, Lithuania, and the Netherlands, between 2007 and 2010. Toxicological analysis was performed with chromatographic techniques on whole blood for 23 substances. The percentage of drivers positive for at least one psychoactive substance ranged between 28% (Lithuania) and 53% (Belgium). Alcohol (≥0.1 g/L) was the most common finding with the highest percentage in Belgium (42.5%). Among the alcohol-positive drivers, 90.5% had a blood alcohol count (BAC) ≥0.5 g/L and 65.7% had a BAC ≥1.3 g/L. Benzodiazepines (0.0-10.2%) and medicinal opioids (0.5-7.8%) were the most prevailing medicinal drugs, but half of the concentrations were lower than therapeutic. Cannabis (0.5-7.6%) was the most prevailing illicit drug. Alcohol was found in combination with drugs in 2.3-13.2% of the drivers. Drug combinations were found in 0.5-4.3% of the drivers. This study confirms the high prevalence of psychoactive substances in injured drivers, but we observed large differences between the participating countries. Alcohol was the most common finding, followed by cannabis and benzodiazepines. Notable are the many drivers having a BAC ≥ 1.3 g/L. The majority of the substances were found in combination with another psychoactive substance, mostly alcohol. The high prevalence of high BACs and combinations (compared to roadside surveys) suggest that those drivers are most at risk and that preventive actions should target them preferentially.
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TL;DR: SDLP was a sensitive cannabis-related lateral control impairment measure similar to notably-impairing alcohol concentrations, and despite OF's screening value, OF variability poses challenges in concentration-based effects interpretation.
172 citations
TL;DR: Determination of eight drugs of abuse in blood has been performed using paper spray or extraction spray mass spectrometry in under 2 min with minimal sample preparation and exhibit the potential for performing rapid and high-throughput assays for selective on-site multicompound quantitative screening of illicit drugs.
Abstract: Determination of eight drugs of abuse in blood has been performed using paper spray or extraction spray mass spectrometry in under 2 min with minimal sample preparation. A method has been optimized for quantification of amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxy-N-methylamphetamine (MDMA), 3,4-methylenedioxy-N-ethylamphetamine (MDEA), morphine, cocaine, and Δ9-tetrahydrocannabinol (THC) from a single blood spot. Sample to sample variations of 1–5% relative standard deviation were achieved using stable isotope-labeled internal standards and tandem mass spectrometry. Limits of detection for all drugs were below typical physiological and toxicological levels. Paper spray and extraction spray each used less than 10 μL of whole blood. These methods exhibit the potential for performing rapid and high-throughput assays for selective on-site multicompound quantitative screening of illicit drugs.
162 citations
TL;DR: The results indicate that drug use is associated with a significantly increased risk of fatal crash involvement, particularly when used in combination with alcohol.
140 citations
Cites background from "Alcohol and drugs in seriously inju..."
...Drugged driving has become a safety issue of increasing public concern in the United States and many other countries (Brady and Li, 2013; Dupont et al., 2012; Legrand et al., 2013)....
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TL;DR: The significantly higher blood THC and 11-OH-THC Cmax values with alcohol possibly explain increased performance impairment observed from cannabis-alcohol combinations.
Abstract: BACKGROUND: Increased medical and legal cannabis intake is accompanied by greater use of cannabis vaporization and more cases of driving under the influence of cannabis. Although simultaneous Δ9-tetrahydrocannabinol (THC) and alcohol use is frequent, potential pharmacokinetic interactions are poorly understood. Here we studied blood and plasma vaporized cannabinoid disposition, with and without simultaneous oral low-dose alcohol.
METHODS: Thirty-two adult cannabis smokers (≥1 time/3 months, ≤3 days/week) drank placebo or low-dose alcohol (target approximately 0.065% peak breath-alcohol concentration) 10 min before inhaling 500 mg placebo, low-dose (2.9%) THC, or high-dose (6.7%) THC vaporized cannabis (6 within-individual alcohol-cannabis combinations). Blood and plasma were obtained before and up to 8.3 h after ingestion.
RESULTS: Nineteen participants completed all sessions. Median (range) maximum blood concentrations ( C max) for low and high THC doses (no alcohol) were 32.7 (11.4–66.2) and 42.2 (15.2–137) μg/L THC, respectively, and 2.8 (0–9.1) and 5.0 (0–14.2) μg/L 11-OH-THC. With alcohol, low and high dose C max values were 35.3 (13.0–71.4) and 67.5 (18.1–210) μg/L THC and 3.7 (1.4–6.0) and 6.0 (0–23.3) μg/L 11-OH-THC, significantly higher than without alcohol. With a THC detection cutoff of ≥1 μg/L, ≥16.7% of participants remained positive 8.3 h postdose, whereas ≤21.1% were positive by 2.3 h with a cutoff of ≥5 μg/L.
CONCLUSIONS: Vaporization is an effective THC delivery route. The significantly higher blood THC and 11-OH-THC C max values with alcohol possibly explain increased performance impairment observed from cannabis-alcohol combinations. Chosen driving-related THC cutoffs should be considered carefully to best reflect performance impairment windows. Our results will help facilitate forensic interpretation and inform the debate on drugged driving legislation.
104 citations
IBM1
TL;DR: Mango et al. as discussed by the authors compared five anatomic severity systems and two impairment systems in terms of purpose, code structure, and use and discussed the reasons for the differences between these systems.
Abstract: Background: The Abbreviated Injury Scale (AIS), developed by the Association for the Advancement of Automotive Medicine is the most widely used anatomic injury severity scale in the world (Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale; 1985 and 1990 revisions. Des Plaines, IL: Association for the Advancement of Automotive Medicine). However, different user groups have modified the AIS system to fit their needs, and these modifications prevent ready comparison and trending of data collected in these systems in the United States and throughout the world. The United States currently has five AIS-based severity systems and two AIS-based impairment systems in use, with additional revisions forthcoming. Other modified AIS systems are known to be in use in the United Kingdom and Japan. The data collected in these systems cannot be accurately combined or compared without re-coding or the use of complex mapping methodologies. Furthermore, the expanding use of data linked from multiple databases to answer complex medical, engineering, or policy issues emphasizes the need for coordination between severity and other injury systems. Linkage of state-wide motor vehicle crash data with data from hospital injury classification systems, mortality files, trauma registry, and national crash databases brings into immediate focus the lack of well defined relationships between the severity coding systems and these other widely used injury systems (Mango N, Garthe E. SAE Congress, February, 1998; Johnson, S, Walker, J. NHTSA Technical Report. DOT HS 808 338, Washington, DC: NHTSA; January, 1996). With the expanding use of linked data in state and national policy decisions, it is vital that consistent standards for injury descriptions, severities, and impairments be available for clinical, engineering, and policy users. Methods: This paper compares five anatomic severity systems and two impairment systems in terms of purpose, code structure, and use and discusses the reasons for the differences between these systems. With global harmonization encouraging greater sharing of international data, the paper also presents the relationship of the severity and impairment systems to US morbidity and reimbursement and worldwide mortality classification systems. Results: To resolve compatibility issues resulting from multiple injury systems, the authors propose that a unified system for global use be developed, configured by inputs from major data owners, users, and analysts. The proposed unified system has six key attributes: backward compatibility with historical data through maps so no data are lost; scalability to allow a simple level of use for developing countries, a more complex level for crash research and a detailed level for clinical hospital use, all with data compatibility; the ability to satisfy the needs of the engineering community for injury location information and aspect, and also the clinical requirement for precise injury description; inherent integration with whole body severity scores to permit easy computation; compatibility with other injury data systems such as mortality, morbidity, and reimbursement systems; and a mechanism and process to maintain and upgrade the system into the 21st century. Conclusion: The authors believe that a unified injury system is a necessary and crucial advance from the currently fragmented injury system situation.
88 citations
References
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TL;DR: In this article, Probable Inference, the Law of Succession, and Statistical Inference are discussed, with a focus on the law of succession in probabilistic inference.
Abstract: (1927). Probable Inference, the Law of Succession, and Statistical Inference. Journal of the American Statistical Association: Vol. 22, No. 158, pp. 209-212.
3,253 citations
"Alcohol and drugs in seriously inju..." refers methods in this paper
...Confidence intervals were calculated with the Wilson method.([32]) Multiple regression was used to correct for age and gender....
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TL;DR: Combined use of THC and alcohol produced severe impairment of cognitive, psychomotor, and actual driving performance in experimental studies and sharply increased the crash risk in epidemiological analyses, suggesting that recent use of cannabis may increase crash risk, whereas past use of Cannabis does not.
539 citations
"Alcohol and drugs in seriously inju..." refers background in this paper
...9% among non-fatally injured drivers,([39]) and 4–14% among injured or fatally injured drivers.([40]) In the present study, the prevalence of cannabis ranged from 0....
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TL;DR: It is concluded that drug driving is a significant problem, both in terms of a general public health issue and as a specific concern for drug users.
Abstract: The existing literature on the prevalence of drug driving, the effects of drugs on driving performance, risk factors and risk perceptions associated with drug driving was reviewed. The 12-month pre...
425 citations
"Alcohol and drugs in seriously inju..." refers background in this paper
...Driving under the influence of drugs other than alcohol is a significant problem all over the world.([1]) Both illicit and licit drugs that affect the central nervous system have a high potential to increase crash risk....
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...The high prevalence of drug combinations among injured drivers confirms that the risk increases exponentially when substances are combined.([1,38,42,53,56,57]) In the DRUID roadside survey, the weighted average percentage was only 0....
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TL;DR: Brief or extended periods of exposure to long-half-life benzodiazepines are associated with an increased risk of motor vehicle crash involvement in the elderly population, and there is no such elevated risk for short- half-life Benzodiazepine use.
Abstract: Context. —Benzodiazepines, used by a sizable number of the elderly population, may affect the ability to drive and thus increase the risk of a motor vehicle crash. Epidemiologic studies of this question have produced inconsistent results that may be due to the different effects of long—and short—half-life benzodiazepines and variations in their duration of use. Objective. —To determine whether the use of benzodiazepines of either long- or short-elimination half-life is associated with the risk of injurious motor vehicle crash in the elderly. Design and Setting. —Nested case-control design within a cohort of 224 734 drivers from the Canadian province of Quebec, aged 67 to 84 years, followed up from 1990 to 1993. Computerized data for the study were obtained from provincial driver's license files, police reports of injurious crashes, and health insurance records. Patients. —We identified all 5579 drivers involved in an injurious crash (cases) and a random sample of 10 controls per case selected from a subcohort of 13 256 subjects. Main Outcome. —Involvement of a cohort member as a driver in a motor vehicle crash in which at least 1 person (not necessarily the driver) sustained bodily injury. Results. —The adjusted rate ratio of crash involvement within the first week of long—half-life benzodiazepine use was 1.45 (95% confidence interval [CI], 1.04-2.03). The rate ratio for continuous use of longer duration up to 1 year was slightly lower but remained significant (rate ratio, 1.26; 95% CI, 1.09-1.45). In contrast, there was no increased risk after the initiation of treatment with short-half-life benzodiazepines (rate ratio, 1.04; 95% CI, 0.81-1.34) or with their continued use (rate ratio, 0.91; 95% CI, 0.82-1.01). Conclusions. —Brief or extended periods of exposure to long—half-life benzodiazepines are associated with an increased risk of motor vehicle crash involvement in the elderly population. There is no such elevated risk for short—half-life benzodiazepines.
412 citations
TL;DR: Driving under the influence of cannabis increases the risk of involvement in a crash in France, however, in France its share in fatal crashes is significantly lower than that associated with positive blood alcohol concentration.
Abstract: Objectives To evaluate the relative risk of being responsible for a fatal crash while driving under the influence of cannabis, the prevalence of such drivers within the driving population, and the corresponding share of fatal crashes. Design Population based case-control study. Participants 10 748 drivers, with known drug and alcohol concentrations, who were involved in fatal crashes in France from October 2001 to September 2003. Main outcome measures The cases were the 6766 drivers considered at fault in their crash; the controls were 3006 drivers selected from the 3982 other drivers. Positive detection of cannabis was defined as a blood concentration of Δ 9 tetrahydrocannabinol of over 1 ng/ml. The prevalence of positive drivers in the driving population was estimated by standardising controls on drivers not at fault who were involved in crashes resulting in slight injuries. Results 681 drivers were positive for cannabis (cases 8.8%, controls 2.8%), including 285 with an illegal blood alcohol concentration (0.5 g/l). Positive cannabis detection was associated with increased risk of responsibility (odds ratio 3.32, 95% confidence interval 2.63 to 4.18). A significant dose effect was identified; the odds ratio increased from 2.18 (1.22 to 3.89) if 0 9 tetrahydrocannabinol 9 tetrahydrocannabinol 5 ng/ml. The effect of cannabis remains significant after adjustment for different cofactors, including alcohol, with which no statistical interaction was observed. The prevalence of cannabis (2.9%) estimated for the driving population is similar to that for alcohol (2.7%). At least 2.5% (1.5% to 3.5%) of fatal crashes were estimated as being attributable to cannabis, compared with 28.6% for alcohol (26.8% to 30.5%). Conclusions Driving under the influence of cannabis increases the risk of involvement in a crash. However, in France its share in fatal crashes is significantly lower than that associated with positive blood alcohol concentration.
324 citations