Showing papers on "Driving under the influence published in 2022"

Should Per Se Limits Be Imposed For Cannabis? Equating Cannabinoid Blood Concentrations with Actual Driver Impairment: Practical Limitations and Concerns

Abstract: Fourteen US states have amended their longstanding, effect-based DUI drug laws to per se or zero tolerant per se statutes in regard to cannabis. Other states are considering enacting similar legislation. Under these amended traffic safety laws, it is a criminal violation for one to operate a motor vehicle with trace levels of cannabinoids or their metabolites in his or her blood or urine. Opponents of per se cannabinoid limits argue that neither the presence of cannabinoids nor their metabolites are appropriate or consistent predictors of behavioral or psychomotor impairment. They further argue that the imposition of such per se limits may result in the criminal conviction of individuals who may have previously consumed cannabis at some unspecified point in time, but were no longer under its influence. As more states enact statutory changes allowing for the legal use of cannabis under certain circumstances, there is a growing need to re-examine the appropriateness of these proposed per se standards for cannabinoids and their metabolites because the imposition of such limits may, in some instances, inadvertently criminalize behavior that poses no threat to traffic safety, such as the state-sanctioned private consumption of cannabis by adults.

Xylazine: Pharmacology Review and Prevalence and Drug Combinations in Forensic Toxicology Casework.

Abstract: Xylazine, an alpha-2 receptor agonist used in veterinary medicine for its sedative and muscle relaxant effects, has been reported in forensic toxicology casework since the 1980s. It is not approved for human use, but it is used as an adulterant in heroin and illicit fentanyl. The prevalence and concentrations of xylazine in 2.5 years (January 2019-June 2021) of driving-under-the-influence-of-drugs (DUID) and medical-death-investigation (MDI) cases was investigated, including other drugs detected in combination with xylazine. Of over 170,000 cases screened for xylazine, 97% were classified as MDI. Over the course of the study period the prevalence and geographical spread of xylazine increased. Overall, 2.8% of DUID and 2.1% of MDI cases screened positive for xylazine with concentrations of 5.1-450 ng/mL (mean = 36 ng/mL) and 5.0-11,000 ng/mL (mean = 41 ng/mL), respectively. Two MDI cases which had xylazine concentrations of 9,100 and 11,000 ng/mL were drug overdose suicides that did not involve any opioids. Opioids, primarily fentanyl and/or a fentanyl byproduct/metabolite were detected in 100% of DUID and all but two MDI cases. After opioids, stimulants, phyto-cannabinoids and benzodiazepines were the most common drug classes detected in conjunction with xylazine in both DUID and MDI casework. In summary, xylazine exposure continues to increase, mostthrough the adulteration of illicit opioids. There is extensive overlap in the concentrations between living and deceased individuals making it difficult to interpret the role of the drug in MDI or DUID cases without other case information.

A Comparison of High Drug Concentrations in Impaired Driving and Postmortem Casework in Harris County, Texas.

Abstract: Drug-impaired driving is a growing public safety issue. Addressing impairment due to drugs other than ethanol can be challenging for forensic toxicologists as many factors need to be considered including the type of drug(s), drug-drug interaction, the dose(s), and the individual's physiological condition and drug use history. Interpretation of blood drug test results is additionally difficult as drug concentrations in impaired driving cases may overlap levels typically viewed as toxic. This study compares blood concentrations of drugs in impaired driving cases to those in postmortem cases in Houston, Texas from 2014 to 2020. Blood drug concentrations from driving while intoxicated (DWI) or driving under the influence of drugs (DUID) cases submitted to Houston Forensic Science Center (HFSC) and Harris County Institute of Forensic Sciences (HCIFS) were compared to postmortem blood test results from HCIFS. Eight DWI/DUID cases had drugs that exceeded impaired driving concentrations reported in literature. These drugs included fentanyl (220 ng/mL), oxycodone (680 ng/mL), hydrocodone (310 and 490 ng/mL), clonazepam (330 ng/mL), methamphetamine (3500 and 7100 ng/mL), and THC (160 ng/mL). For oxycodone and hydrocodone, the presented DWI/DUID cases exceeded 91% and 96% of postmortem concentrations, respectively. The 7100 ng/mL methamphetamine DWI/DUID result was greater than 98% of postmortem cases. The presented DWI/DUID concentrations were higher than all but one postmortem case for clonazepam and higher than all postmortem cases for THC. This study demonstrates extremely high drug concentrations in DWI/DUID casework blur the line between therapeutic/recreational and toxic concentrations.

Assessing Risk Perception over Recidivist Traffic Offenders from a Multi-group Approach: How Gendered Could It Be?

Abstract: Objective: The core aim of this study was to examine the predictive role of demographic, psychosocial and driving features of Spanish drivers on their risk perception over recidivist traffic offenders, focusing on gender as a key differentiating factor. Method: For this cross-sectional study, it was analyzed the data gathered from a nationwide sample of 1,711 licensed drivers from the 17 regions of Spain (49% females, 51% males) with a mean age of 40.07 years, responding to a telephone-based interview on road safety issues. Demographic, drivingrelated and psychosocial factors were comparatively analyzed through robust tests and a bias-corrected MGSEM (Multi-Group Structural Equation Modeling) approach. Results: The findings of this study indicate that drivers’ age, driving exposure, traffic law knowledge, their assessment of both enforcement and reeducation, and the number of traffic fines they have received, explain the risk perceived in recidivist traffic offenders. Secondly, and in regard to structural differences, three study variables, i.e., driving exposure, need for enforcement and traffic law knowledge, have shown to exert a differential influence on risk perception according to drivers’ gender. Conclusion: The findings of this study suggest that both psychosocial and driving-related features differentially predict drivers’ risk perception over recidivist traffic offenders between male and female drivers. This research supports the need of fostering the emphasis on gender, in order to strengthen driving education, re-education, and training processes aimed at facing and preventing recidivism in the field of traffic and mobility. Evaluación de la percepción del riesgo en infractores de tráfico reincidentes desde un enfoque multigrupo y el efecto moderador del género

Use of psychotropic medication and risk of road traffic crashes: a registry-based case–control study in Denmark, 1996–2018

Abstract: Use of psychotropics is relatively prevalent amongst motor vehicle drivers because mobility is also important for persons suffering from psychiatric illness. However, medication side effects may increase the likelihood of being involved in traffic crashes.This study aimed to assess the association between the use of four types of medication (antipsychotics, benzodiazepines and z-hypnotics, antidepressants and stimulants of ADHD treatment) and the risk of traffic crashes, in general, and single crashes subsequently.We conducted a case-control study of data from 130,000 drivers involved in traffic crashes with personal injury and prescription data from all of Denmark during the period 1996-2018.For antipsychotics, we found odds ratios of 0.86 and 1.29 for traffic crashes and single crashes, respectively; for benzodiazepines and z-hypnotics, 1.29 and 2.49, respectively; for antidepressants, 1.30 and 2.25, respectively; and for stimulants of ADHD treatment, 1.62 and 1.95, respectively. All p values were below 0.001.Based on our results on twofold increased risks of single crashes and moderately increased risks in persons with ADHD, it might seem tempting to ban psychotropic medication in traffic. Conversely, we accept increased risks of traffic crashes in young drivers and in the physically disabled with special aids and, to some extent, with exposure to alcohol. In the end, it is the authorities who must review the evidence and decide whether to prohibit (some types of) psychotropic medication in traffic. Finally, underlying disease and not the drug may increase the risk of being involved in a traffic crash.

Determination of Cross-Reactivity of Contemporary Cannabinoids with THC Direct Immunoassay (ELISA) in Whole Blood.

Abstract: Immunoassay procedures, such as enzyme-linked immunosorbent assay (ELISA), are widely used for screening samples in both driving under the influence of drugs (DUID) and postmortem (PM) investigations. While these are sensitive and widely used techniques, they lack specificity compared to more novel instrumental screening platforms. In this study, the cross-reactivities of several cannabinoid isomers and related compounds were evaluated in whole blood using the Cannabinoids Direct ELISA kit from Immunalysis. The compounds of interest were supplemented individually at three different concentrations, ranging from 10-100 ng/mL or 10-1,000 ng/mL depending on analyte, to determine initial feasibility. Compounds exhibiting cross-reactivity were then tested to create dose-response curves to calculate the percent cross-reactivity. The cross-reactivity was determined to be 200% for delta-8-carboxy-tetrahydrocannabinol (THC) (delta-8-carboxy-THC), 25% for delta-9,11-THC, 13% for delta-10-THC, 7% for delta-6a(10a)-THC, 3% for THC-O-acetate and 0.5% for tetrahydrocannabiphorol (THCP). To determine potential impacts to forensic laboratory casework, a review of DUID and PM casework was also performed. From November 2020 to June 2021, a random sampling of DUID and PM cases was selected monthly and evaluated for the presence of cannabinoid isomer(s) in the absence of a reportable delta-9-carboxy-THC result. While validated techniques for the identification and confirmation of these isomer(s) did not exist at the time of routine testing, delta-8-carboxy-THC was believed to the be the most common isomer finding based on current testing capability. This study demonstrated a noticeable increase in the presence of isomeric cannabinoid compounds in both forensic DUID and PM casework sampled during this period and suggests potential impacts for clinical casework as well.

One-step extraction and determination of 513 psychoactive substances, drugs, and their metabolites from hair by LC–MS/MS

Abstract: The emergence of new psychoactive substances on the market is a significant problem on a global scale. This type of substance in society is associated with many negative consequences, such as traffic accidents, accidents at work, rape, homicide, poisoning, or overdose deaths. The analysis of these substances in biological samples is very important for further legal action and saving lives. Therefore, laboratories face a tremendous challenge in tackling the evolving drug market. The paper describes the optimization of the analytical LC-MS/MS method to identify and determine 513 psychoactive substances in hair samples. A method of chromatographic separation was developed, and the working parameters of the mass spectrometer were selected for each analyte. The method has been validated, and the results are as follows: the limit of quantification of the developed method ranges from 0.025 to 1.25 ng/mg hair. The mean recovery of the tested analytes ranges from 80 to 120%. The achieved coefficient of variation in within-run precision ranged from 1.05 to 19.99%. The results achieved for BIAS are in the range of ± 20%.

Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina

Abstract: To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians. Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina. Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those <30 years old (OR= 7.15, CI 95% 3.49-14.65). This last group also had an increased risk after combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.75). Both drivers (OR= 6.40, CI 95% 3.23-12.69) and passengers (OR= 13.83, CI 95% 2.87-66.42) had an increased risk after alcohol consumption. To our knowledge, these are the first estimates of the risk of having a road traffic injury after alcohol and cannabis consumption in one of the countries of the Southern Cone (Argentina, Chile, and Uruguay). These results highlight the urgent need to implement and enforce comprehensive alcohol control measures. Furthermore, given the global trend towards legalizing cannabis for recreational use, our results could also inform policymakers to enact or amend impaired driving laws.

Understanding Heterogeneity Among Simultaneous Alcohol and Marijuana Users: Latent Classes Derived From Daily Diary Data.

Abstract: OBJECTIVE Simultaneous use of alcohol and marijuana (SAM) is common among U.S. college students, but little research has examined specific substance use behaviors during SAM use episodes. This study identified latent classes of SAM users based on their SAM, alcohol-only, and marijuana-only use episodes. METHOD College student SAM users (N = 284; 50.7% female; M age = 19.8 years) completed up to five surveys each day across two 4-week bursts. Latent class analysis (LCA) was used to characterize SAM users based on seven latent class indicators of use behavior. Sex was examined in relation to latent class membership. RESULTS Five unique classes emerged: Frequent Marijuana-Focused SAM users (21%); Frequent Alcohol-Initiating SAM users (29%); Heavy-Drinking Infrequent SAM users (12%); Moderate SAM users (29%); and Light Infrequent SAM users (9%). These groups were differentiated primarily by their frequency of SAM use, form of marijuana, whether marijuana was used on non-SAM occasions, and whether consequences were experienced. Groups differed significantly by sex. CONCLUSIONS College student SAM users are heterogeneous with respect not only to their degree of SAM use but also in their pattern of drinking, type of marijuana use, relative focus on alcohol versus marijuana, and risk of experiencing acute negative consequences. Describing this heterogeneity is an important step toward developing interventions for different types of users.

Identification of factors associated with various types of impaired driving

Abstract: Abstract Despite significant progress in reducing impaired driving, impaired drivers are still a public threat to themselves and others. Studying all types of drivers’ impairment is especially important as impairment in the literature has been mainly looked at from an angle of the driving under the influence (DUI). In other words, there is a definitional ambiguity regarding the impaired driving in the literature review. Addressing that unclarity is especially important as while many considered impaired driving such as distraction and fatigued driving are similar to DUI, they account for a higher proportion of fatalities on roadway, compared with DUI. Thus, first we highlight links between DUI and other impaired driving based on the literature review, and then this study highlighted factors associated with various impaired driving so drivers’ actions and behaviors could be addressed more efficiently. Here, in addition to DUI, impaired drivers are defined as whether drivers were fatigued, distracted, or under some emotional conditions at the time of crashes. Multinomial logit model (MNL) was extended to a model excluding or equating some coefficients across categories, making parameters’ estimates more robust. The analysis results highlighted, for instance, types of vehicles that the drivers own, drivers’ gender, age, seatbelt use, and various drivers’ actions such as failure to keep the proper lane and following too close are associated with various impaired drivers’ actions. These associations are expected to be related to unseen drivers’ characteristics that were not recorded at the time of crashes. This is one of the earliest comprehensive studies, investigating the association of various factors and different types of impaired driving.

Rapid Extraction and Qualitative Screening of 30 Drugs in Oral Fluid at Concentrations Recommended for the Investigation of DUID Cases.

Abstract: A rapid, simple extraction method followed by qualitative screening using liquid chromatography-tandem mass spectrometry (LC-MS-MS) for drugs in oral fluid is presented. The decision points were selected to be at, or lower, than those recommended as Tier I compounds by the National Safety Council's Alcohol, Drugs, and Impairment Division for toxicological investigation of driving under the influence of drugs cases (DUID) and were also at, or lower, than those recommended by Substance Abuse and Mental Health Service Administration (SAMHSA) and the Department of Transportation (DOT) for Federal workplace drug testing programs. The method included 30 drugs: delta-9-tetrahydrocannabinol (THC), amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), cocaine, benzoylecgonine, carisoprodol, meprobamate, zolpidem, alprazolam, clonazepam, 7-aminoclonazepam, diazepam, nordiazepam, lorazepam, oxazepam, temazepam, codeine, morphine, 6-acetylmorphine, buprenorphine, fentanyl, hydrocodone, hydromorphone, oxycodone, oxymorphone, methadone, tramadol, and phencyclidine. Phencyclidine was included because it is in the Federal workplace program even though it is considered a Tier II drug for DUID cases. A liquid-liquid extraction method using isopropanol, hexane, and ethyl acetate to extract drugs from the oral fluid-buffer mix collected in a Quantisal™ device, followed by LC-MS-MS screening was developed and validated according to ANSI/ASB 2019 Standard Practices for Method Validation in Forensic Toxicology. Interference studies, limit of detection, precision at the decision point, ionization suppression/enhancement and processed sample stability were determined for each drug. The method was successfully applied to proficiency specimens and routine samples received into the laboratory.

Evaluation of RapidSTAT®, DrugWipe® 6S, DrugScreen® 5TK and DrugScreen® 7TR for on-site drug testing in German police roadside traffic patrol.

Abstract: Driving under the influence of drugs (DUID) remains a subject of concern worldwide, and its increasing trend is likely to continue. Therefore, there is a constant need for reliable on-site drug tests to identify drugged drivers during roadside patrols. Performance and reliability of four on-site drug tests were evaluated among a high number of DUID cases in Germany. Results of oral fluid (OF) (RapidSTAT®, DrugWipe® 6S) and urine (DrugScreen® 5TK and 7TR) test devices were compared with corresponding serum/plasma results obtained by confirmation analyses in consideration of recommended analytical limits for substances pertaining the annex of the German Road Traffic Code ('Straßenverkehrsgesetz', StVG) s. 24a (2). Overall, the screening devices performed well for individual drugs; however, none of the test devices assessed in this study fulfilled the ROSITA-1 criteria (sensitivity, specificity ≥ 90%, and accuracy ≥ 95%) for all substances. Our data demonstrated that both urine tests showed high sensitivities for most compounds. DrugWipe® 6S (94%) and RapidSTAT® (93%) revealed high sensitivities, especially for amphetamine screening. Poor specificities (< 90%) and accuracies (< 95%) were observed for all tests except for low-prevalent substances (e.g. opiates). For drug testing in OF, Δ9 -tetrahydrocannabinol (THC) still seems to be a compound of concern due to poor sensitivity (RapidSTAT®, 77%; DrugWipe® 6S, 85%), although the results indicate improvements compared to previously reported data. Although the obtained data indicate reliable detection for some substances, deployment of trained police officers is inevitable to identify DUID suspects by signs of recent use and recognizing impairment.