Drugs and chronic alcohol abuse in drivers

Blood specimens from 210 drivers (179 male and 31 female) apprehended in Luxembourg from autumn 2001 to spring 2002 and requested for the determination of their blood alcohol concentration (BAC) were tested for medicinal drugs, illicit drugs, and chronic alcohol abuse (by quantification of the carbohydrate-deficient transferrin: CDT). These additional analyses were performed anonymously and with permission of state prosecutor. The 22.8% had consumed medicinal drugs, with benzodiazepines and antidepressants (10.9 and 7.6%, respectively) as main psychoactive classes. Cannabis was the most detected illicit drug (9.5%) but only one in three had THC detectable in their blood. Association of two or more psychoactive substances (poly-drug use) was observed in 27.6% of drivers (90.6% of drug consumers). On the basis of CDT values, 29.5% of drivers investigated were assumed to be chronic alcohol abusers. Statistical analysis revealed that chronic alcohol abuse and medicinal psychoactive drugs were associated with significantly higher BAC. Medicinal psychoactive drugs were clearly associated with poly-drug use, and were furthermore detected at supra-therapeutic levels in 34.9%.     

Driving under the influence in Greece: a 7-year survey (1998-2004)

Alcohol is one of the main causes of traffic accidents worldwide. Its use decreases significantly the driving ability of an individual increasing in this way the possibilities of their involvement in motor-vehicle accidents. The above possibilities are increased when a psychoactive substance has been taken in combination with alcohol due to their synergistic effect. The Laboratory of Forensic Medicine and Toxicology of the University of Athens is authorized to perform the toxicological investigation of traffic accidents that happen in the southern part of Greece. The objective of the present study was to identify the prevalence of alcohol and other psychoactive substances among drivers involved in road traffic accidents in Greece during the period 1998-2004. Alcohol was detected in the blood of about 37% of the drivers involved in traffic accident during the years 1998-2000. The detection of alcohol was lower (29%) in the years 2001-2004. Cannabis, benzodiazepines, opiates, and cocaine were found in 4%, 4%, 4% and 1% of the total number of cases, respectively. The above values were compared with those of a previous study concerning the period 1995-1997 and the reasons for the reduction of the number of alcohol-related traffic accidents during the last years are discussed.     

Comparison of the prevalence of alcohol,cannabis and other drugs between 900 injured drivers and 900 control subjects: results of a French collaborative study

A collaborative case-control study was conducted in France in order to determine the prevalence of alcohol, cannabinoids, opiates, cocaine metabolites, amphetamines and therapeutic psychoactive drugs in blood samples from drivers injured in road accidents and to compare these values with those of a control population. Recruitment was performed in emergency departments of six university or general hospitals and comprised 900 drivers involved in a non-fatal accident and 900 patients (controls) who attended the same emergency units for a non-traumatic reason. Drivers and controls were matched by sex and age. Alcohol was determined by flame ionization-gas chromatography, drugs of abuse (DOA) by gas chromatography-mass spectrometry with the same analytical procedures in the six laboratories, and medicines by high performance liquid chromatography with diode array detection. Blood alcohol concentration exceeding 0.5 g/l (i.e. the legal French threshold) was found in 26% of drivers and 9% of controls. In the 18-27 years age range, alcohol was the only toxic found in blood samples of 17% drivers and 5% controls, leading to an odds-ratio (OR) of 3.8. A significant relationship was found between alcohol blood concentrations and OR values. All age groups confounded, the main active substance of cannabis, Delta(9) tetrahydrocannabinol (THC), was found in 10% of drivers and 5% of controls. In the less than 27 years old, THC (>1 ng/ml) was detected alone in the blood of 15.3% drivers and of 6.7% controls, giving OR=2.5, whereas there was no link between THC blood concentrations and OR value. THC was found alone in 60% of cases and associated with alcohol in 32%, with OR=4.6 between drivers and controls for this association. The difference in morphine prevalence between drivers (2.7%) and controls (0.03%) was highly significant (P<0.001), with OR=8.2. The number of positive cases for amphetamines and cocaine metabolites was too low for reaching any interpretation. The most frequently observed psychoactive therapeutic drugs were by far benzodiazepines, that were found alone in 9.4% of drivers and 5.8% of controls, which led to OR=1.7 (P<0.01).This study demonstrates a higher prevalence of opiates, alcohol, cannabinoids and the combination of these last two compounds in blood samples from drivers involved in road accidents than in those from controls, which suggests a causal role for these compounds in road crashes.     

Psychoactive substances in seriously injured drivers in Denmark

This study assesses the presence of a number of psychoactive substances, including alcohol, based on blood samples from 840 seriously injured drivers admitted to five selected hospitals located in five different regions of Denmark. The study was a part of the EU 6th framework program DRUID (Driving Under the Influence of Drugs, Alcohol and Medicines). Blood samples were screened for 30 illegal and legal psychoactive substances and metabolites as well as ethanol. Danish legal limits were used to evaluate the frequency of drivers violating the Danish legislation while limit of quantification (LOQ) was used for monitoring positive drivers. Tramadol is not included in the Danish legislation therefore the general cut off, as decided in the DRUID project was used. Overall, ethanol (18%) was the most frequently identified compound (alone or in combination with other drugs) exceeding the legal limit, which is 0.53 g/l in Denmark. The percentage of seriously injured drivers testing positive for medicinal drugs at levels above the Danish legal limit was 6.8%. Benzodiazepines and Z-drugs (6.4%) comprised the majority of this group. One or more illegal drugs (primarily amphetamines and cannabis) were found to be above the Danish legal limit in 4.9% of injured drivers. Young men (median age 31 years) were over-represented among injured drivers who violated Danish law for alcohol and drugs.Diazepam (4.4%), tramadol (3.2%), and clonazepam (3.0%) were the medicinal drugs most frequently detected at levels above LOQ, whereas amphetamines (5.4%) (amphetamine [5.2%] and methamphetamine [1.5%]), tetrahydrocannabinol (3.7%), and cocaine (3.3%), including the metabolite benzoylecgonine, were the most frequently detected illegal drugs. A driver could be positive for more than one substance; therefore, percentages are not mutually exclusive. Poly-drug use was observed in 112 (13%) seriously injured drivers. Tramadol was detected above DRUID cutoffs in 2.1% of seriously injured drivers. This is 3.5 times that observed in a Danish survey of randomly selected drivers. Moreover, illegal and medicinal drug levels above the Danish legal limit were present more than 10 times as frequently as in injured drivers, whereas ethanol was present more than 30 times as frequently than in randomly selected drivers. The results indicate that there is an increased risk in traffic when driving under the influence of psychoactive drugs, especially alcohol in young male drivers.     

Occurrence of barbiturate, benzodiazepine, meprobamate, methaqualone and phenothiazine in car occupants killed in traffic accidents in the south of Sweden

An investigation of the following psychoactive drugs: barbiturate, benzodiazepine, meprobamate, methaqualone and phenothiazine, was performed on all automobile occupants killed in accidents in southern Sweden during 1977 and 1978. Of 122 drivers and 55 passengers analysed, low concentrations of these drugs were found in nine drivers and in five passengers. Thus, 7.3% of the drivers were driving under the influence of drugs and, of these, two drivers (1.6% of all analysed drivers) were also inebriated. Twenty-three per cent of the drivers were inebriated only. According to the circumstances in the accidents and the number of drivers whose analyses proved positive, drug influence seldom seems to be the cause of fatal traffic accidents.     

Occupational workplace and traffic fatalities in Alsace, France (2000–2005): Results of toxicological investigations

France ranks as leader country in Europe for the consumption of cannabis as well as of psychoactive medications. Whereas the relationship between psychotropics and road accidents is now well-established, few data are still available on the influence of drugs on occupational accidents. The purpose of the present study was to measure the prevalence of psychoactive drug intake (alcohol excepted) among victims of occupational fatalities (including workplace accidents + traffic accidents, i.e. on the way to and from work) occurred in the region Alsace over the period 2000–2005. Data were collected by compiling files on occupational accidents from two different public agencies (CRAM, Regional Sickness Fund Alsace-Moselle; DRTEFP, Regional Department of Work, Employment and Professional Training) together with those from the Medico-Legal Institute of Strasbourg over the period tested. Data analysis showed that 3% of the victims of workplace fatalities were under the influence of drugs (alcohol excluded) at the time of accident, as well as 5% of the victims of occupational traffic accidents. Our results also highlight a low rate of toxicological analyses, since these investigations were requested by the authorities in 41% of traffic victims and only 15% of workplace victims. In France, the relevance of psychoactive drug intake in occupational deaths is much better targeted in the case of traffic fatalities (due to the existence of specific regulations, e.g. compulsory urinalysis for drugs of abuse in drivers involved in a road accident) than in those occurred at workplace (no specific regulations).     

Detection of polybrominated biphenyl ethers (PBDEs) in pediatric hair as a tool for determining in utero exposure

This study presents the prevalence of ethanol and illicit drugs in fatal road traffic accident victims in the Centre of Portugal between January 1990 and December 2007. Among the violent deaths, road traffic accidents presented the highest percentage (around 35%; n=3095), but decreasing throughout the years. Accidents were preponderant in males (about 80%; n=2402), between 21 and 30 years-old. Accidents involving drivers (55%; n=1310) were of the most common, being the car the main vehicle (45%), followed by the motorcycle (40%). An alcohol analysis request was present in 50% of the cases (n=1687), but increasing each year. Ethanol concentrations >1.2g/L, the legal limit in Portugal, were found in 55% (n=283) of the cases. Concerning drugs of abuse requests, only 4.4% (n=137) and 17.3% (58 cases) of the cases included the analysis at the Forensic Pathology Department (FPD) and at the Medico-Legal Office (MLO), respectively. Among the road accident cases analysed, 18 were positive, mainly in men (84%), between 21 and 30 years-old; opiates (47.1%; n=8) and cannabinoids (50%; n=4) were the most found, at the FPD and at the MLO, respectively. In conclusion, ethanol was identified as a key factor to traffic accidents, which explains the definition of specific legislation and methods of enforcement to prohibit this form of impairing. Nevertheless, ethanol still remains the psychoactive substance most frequently identified in the blood of divers killed in road-traffic crashes, recommending additional actions of supervision and control.     

Alcohol use among fatally injured drivers in Spain

Blood from 285 fatally injured drivers in Northern Spain was collected and tested for the presence of alcohol and drugs. Alcohol was detected in 50.5% of all fatalities. Alcohol alone was detected in 44.2% of all samples and in the remaining 6.3% another substance was found together with alcohol. Blood alcohol concentration was classified in different levels. It has been observed that in 35.4% of the cases the blood alcohol level was > or = 0.8 g/l, the legal limit in Spain for car drivers. Alcohol together with other substances was encountered in 18 cases, with medication in 22.2% (4 out of 18), alcohol with illegal drugs in 66.6% of the cases (12 out of 18), and alcohol with medicines and illegal drugs in 11.1% (2 out of 18). Cocaine was the most commonly detected drug. The study shows how widespread the incidence of a high level of alcohol concentration among drivers involved in fatal accidents in Spain.     

Alcohol and drugs in drivers fatally injured in traffic accidents in Sweden during the years 2000-2002

During the years 2000-2002, alcohol, pharmaceuticals and illicit drugs were analysed in blood samples from fatally injured drivers in Sweden. The total number of drivers was 920 and in 855 of these, corresponding to 93%, a toxicological investigation was performed. About 85% of the drivers were men and 15% were women. All but three women (96%) were car drivers while the corresponding figure for men was about 78% and about 13% were motorcyclists. The number of positive cases increased from 38.9% in year 2000 to 45.9% in year 2002 and alcohol was the most common drug with frequencies of 19.8%, 25.0% and 21.8% for the studied years 2000, 2001 and 2002, respectively. The median blood alcohol concentration ranged from 1.6 to 2.0mg/mL for men and from 1.2 to 1.8 mg/mL for women. There was a decrease in cases where alcohol was the only drug detected, from 52 out of 58 cases (90%) in year 2000 to 41 out of 61 cases (67%) in 2002. At the same time there was an increase, from 5.4% to 10.0% of illicit drugs, mainly amphetamine, and the cases with multiple drug intake increased from 10% to 26%. The prevalence of pharmaceuticals as the only drug or drugs detected decreased from 14.0% to 10.4% and in the majority of these cases the drug concentrations were within the therapeutic range.     

Alcohol and drugs (medical and illicit) in fatal road accidents in a city of 300 000 inhabitants

During a 1-year period all fatal road accidents in the police district of Aarhus, Denmark, were investigated regarding the presence of alcohol, medical drugs or narcotic substances, and the nature of the accident. Out of a total of 30 accidents 24 were investigated. Two thirds had been caused by the victim him- or herself. In one third of the accidents alcohol was present and considered an important contributory factor. Medical drugs and narcotic substances played a lesser role.     

The prevalence of drugs and alcohol found in road traffic fatalities: A comparative study of victims

Researchers have studied the involvement of drugs and alcohol in fatal road traffic incidents, but with particular emphasis on the possible impairment of the driver. This paper describes a comparative study of drug and alcohol findings in various victim groups (drivers of cars, vans or lorries, car passengers, motorcyclists, motorcycle passengers, cyclists and pedestrians) between 2000 and 2006. Post-mortem blood and urine specimens submitted were analysed by immunoassay, GC–NPD, GC–FID, GC–MS and HPLC–DAD. The results of 1047 cases indicated 54% of all victims were positive for drugs and/or alcohol, with the highest percentage of positive findings occurring in pedestrians (63%). Males between the ages of 17–24 were most likely to be involved in a road traffic accident, whether being in control of a vehicle (driver) or involved indirectly (car passenger, pedestrian, motorcycle passenger). A wide range of drugs were detected (e.g. drugs of abuse, anti-convulsants, anti-histamines, anti-inflammatories, anti-psychotics, cardiac drugs and over-the-counter products), but alcohol and cannabinoids were the most frequent substances across the victim groups. When detected, alcohol was commonly above the legal driving limit in blood and urine (> 63% in those in control and > 60% not in control). Overall, the presence of drugs and/or alcohol was of similar frequency in those victims in control (55% of driver, 48% of motorcyclists, 33% of cyclists) and not in control of a vehicle (52% of car passengers, 63% of pedestrians). This degree of frequency strongly implicates the involvement of drugs and alcohol in road traffic incidents and infers an effect on driving ability and individual impairment.     

Psychoactive drugs in the road traffic in the legal and consultative aspects—Experience gained by the Forensic Medicine Department, Silesian University of Medicine, Katowice

Introduction

In the years 1997–2007 in the Forensic Medicine Department, Silesian University of Medicine, Katowice a total of 785 blood samples collected from drivers being the perpetrators of road accidents was tested for the presence of psychoactive drugs.

Methods

The studies took advantage of FPIA (Abbott), ELISA (Neogen), LC–MS and GC FID.

Results

21% of tested samples were positive. In the blood of the driver cannabinoids, amphetamine and its derivatives were most frequently found. Moreover, individual opium alkaloids, their combinations with barbiturates, benzodiazepines or amphetamine, benzodiazepine derivatives (isolated cases), drugs of benzodiazepine group in combination with barbiturates, tramadol or tricyclic anti-depressants (isolated cases), carbamazepine, phenotiazine, cocaine, dibenzepine, benzene, toluene and acetone were determined.

Conclusion

The obtained results showed cannabinoids and amphetamine derivatives to be the most frequent whereas opium alkaloids, barbiturates and benzodiazepines rather rare psychoactive drugs found in the tested blood samples of the drivers involved in the road accidents. The authors suggest screening psychoactive drugs not only in drivers involved in road accidents but also those put through the routine road check procedures. While giving opinions on the influence of the above mentioned drugs on the psychophysical efficiency of road traffic users, drugs and compounds which are not subject to legal control but have an effect on the human psychomotor efficiency and thus, enhance the risk of the road accident should be also taken into account.     

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.     

Driving and the combined use of drugs and alcohol in The Netherlands

The extent and nature of the use of medicinal drugs by drivers who had undergone a blood test on suspicion of driving under the influence of alcohol was ascertained by analysing some 40,000 case records in which the suspect had been questioned about the use of drugs. No chemical analyses were performed. 9.7% of the road users indicated that they used drugs in combination with alcohol, and more than 50% of the drugs used must be considered to have a negative impact on driving performance. The influence of the combined use of benzodiazepines and alcohol on behaviour was also investigated. The finding here was that drivers using these drugs should be warned against the consumption of alcohol.     

The prevalence of drugs in injured drivers

In mid 2009 Victoria introduced compulsory drug testing of blood taken from all injured drivers taken to hospital. Δ(9)-Tetrahydrocannabinol (THC), methylamphetamine (MA) and 3,4-methylenedioxy-methylamphetamine (MDMA) are prohibited and if drivers are positive to any amount an automatic penalty is enforced. Laboratory screens were conducted on preserved blood using ELISA testing for cannabis metabolite and methylamphetamines and a fully validated LC-MS/MS method for 105 drugs including THC, amphetamines, opioids, benzodiazepines, antidepressants and antipsychotics and a number of other psychoactive substances using a minimum of two transitions per drug. Conventional GC-testing for ethanol was used to screen and quantify the presence of alcohol. 1714 drivers were tested and showed alcohol in 29% (≥ 0.01 g/100mL) and drugs in 35%. The positive rate for the three drugs prohibited by legislation was 12.5%. The prevalence of THC, MA and MDMA was 9.8%, 3.1%, and 0.8%, respectively. The range of THC concentrations in blood was 2-42 ng/mL (median 7) of which 70% had a concentration of 10 ng/mL or higher. The range of concentrations for MA and MDMA was 0.02-0.4 and 0.03-0.3mg/L (median for both drugs was 0.05 mg/L). Drugs of any type were detected in 35% of cases. The other drugs were largely prescribed drugs such as the antidepressants (9.3%) and benzodiazepines (8.9%). Neither 6-acetylmorphine nor cocaine (or benzoylecgonine) was detected in these cases.     

The use of alcohol and other psychoactive substances by victims of traffic accidents in Greece.

Alcohol is one of the main causes of traffic accidents worldwide. Its use decreases significantly the driving ability of an individual as well as the reflexes of a pedestrian increasing in this way the possibilities of their involvement in motor-vehicle accidents. The above possibilities are increased when a psychoactive substance has been taken in combination with alcohol due to their synergistic effect. The Laboratory of Forensic Medicine and Toxicology of the University of Athens is authorized to perform the toxicological investigation of traffic accidents that happen in the major part of Greece. The findings of the toxicological analyses that were performed in our laboratory during the years 1995 to 1997 are classified according to the alcohol concentration and the kind of psychoactive substance detected as well as to the gender and the age of the victims, drivers or pedestrians. The results of the above classification are evaluated and the conclusions regarding alcohol, drugs and traffic accidents in Greece are discussed thoroughly.     

The frequency of alcohol,illicit and licit drug consumption in the general driving population in South-East Hungary

In the framework of the DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) EU-6 project, a roadside survey was performed in South-East Hungary to determine the incidence of alcohol and the most frequent illicit and licit drug consumption (amphetamines, THC, illicit and medical opiates, cocaine, ketamine, benzodiazepines, zopiclone and zolpidem) in the general driving population. All 3110 drivers stopped between 01 January 2008 and 31 December 2009 were checked for alcohol, and among them 2738 persons (87.7%) participated in the further examinations, on a voluntary basis. Licit and illicit drugs were determined from their oral fluid samples by GC–MS analysis.Illicit drugs were detected in 27 cases (0.99%), licit drugs in 85 cases (3.14%), and alcohol (cut off: 0.1 g/l) was found in 4 (0.13%) cases. Illicit drug consumption was the highest among men of the ages 18–34, during the spring, and on the week-end nights. With respect to licit drugs, the highest incidence was found among women over the age of 50, during the summer, and on the week-days. All alcohol positive cases were men over the age of 35. In comparison to international European averages, the alcohol and illicit drug consumption was low, but the licit drug consumption was over the European average.     

Toxicology and Circumstances of Completed Suicide by Means Other than Overdose*

Abstract: To determine the prevalence and circumstances of psychoactive substances amongst nonoverdose completed suicide, 1436 consecutive cases autopsied at the NSW Department of Forensic Medicine over the period 1/1/1997–12/31/2006 were analyzed. Substances were detected in 67.2% of cases, and illicit drugs in 20.1%. Alcohol was present in 40.6% of cases. Males were more likely to be positive for alcohol, cannabis, and psychostimulants, and females for pharmaceuticals. Illicits were associated with younger age. Alcohol was most prominent amongst toxicity cases, as were opioids, psychostimulants amongst gunshot cases, and pharmaceuticals amongst drownings. Cases in which drug and alcohol histories were noted were more likely to have a substance detected. Alcohol was more common where a suicide note was left and where relationship problems were involved. Pharmaceuticals were more common where a previous attempt was noted. Licit and illicit substances are strongly associated with suicide, even when the method does not involve drug overdose.     

Toxicology and circumstances of death of homicide victims in New South Wales, Australia 1996-2005.

To determine the prevalence and circumstances of psychoactive substances amongst homicide victims, 485 consecutive cases autopsied at the NSW Department of Forensic Medicine (1/1/1996-12/31/2005) were analyzed. Substances were detected in 62.6% of cases, and illicit drugs in 32.8%. Alcohol, cannabis, opioids, and psychostimulants were most commonly detected. Alcohol and cannabis were both more prevalent amongst males. Mean ages were significantly younger for decedents who tested positive for a substance and for an illicit drug. Cases where death resulted from a physical altercation were more likely to have had alcohol and cannabis present. Illicit drugs were prominent amongst firearms deaths. The proportion of alcohol positive cases increased from 25.0% on Monday to 49.4% for Saturdays/Sundays. Alcohol was more common in incidents in the 0001-0600 h and 1800-2400 h periods. Psychoactive substances appear to substantially increase the risk of homicide, although there are important differences between drug classes in the circumstances of such incidents.     

Role of drugs and alcohol in impaired drivers and fatally injured drivers in the Strathclyde police region of Scotland, 1995–1998

During the 4-year study period, 1995–1998, the Department of Forensic Medicine and Science, University of Glasgow received a total of 752 biological samples from drivers suspected of driving under the influence of drink and/or drugs in the Strathclyde region of Scotland. The majority of samples were blood and had been primarily obtained from males. Drugs were detected in 68 and 90% of blood and urine samples, respectively. Toxicological analyses revealed that cannabis was the most frequently encountered illegal drug which was detected in 39% of all drug positive blood samples. Benzodiazepines were detected in the majority of drug positive samples with 82% containing at least one member of this group. Polydrug use was prevalent, with the average number of drugs detected per sample increasing from 2.0 in 1995 to 3.1 in 1998. For comparison, the results of toxicological analyses from 151 fatally injured drivers are described. Although the majority of samples tested negative for the presence of drugs and alcohol, drugs were found to be present in 19% and alcohol was detected in 33%. As the majority of drugs had been prescribed or administered post-accident, this study shows that alcohol was the main causative factor conducive to fatal road traffic accidents.