The incidence of drugs in drivers killed in Australian road traffic crashes

The incidence of alcohol and drugs in fatally injured drivers were determined in three Australian states; Victoria (VIC), New South Wales (NSW) and Western Australia (WA) for the period of 1990-1999. A total of 3398 driver fatalities were investigated which included 2609 car drivers, 650 motorcyclists and 139 truck drivers. Alcohol at or over 0.05 g/100ml (%) was present in 29.1% of all drivers. The highest prevalence was in car drivers (30.3%) and the lowest in truckers (8.6%). WA had the highest rate of alcohol presence of the three states (35.8%). Almost 10% of the cases involved both alcohol and drugs. Drugs (other than alcohol) were present in 26.7% of cases and psychotropic drugs in 23.5%. These drugs comprised cannabis (13.5%), opioids (4.9%), stimulants (4.1%), benzodiazepines (4.1%) and other psychotropic drugs (2.7%). 8.5% of all drivers tested positive for Delta(9)-tetrahydrocannabinol (THC) and the balance of cannabis positive drivers were positive to only the 11-nor-Delta(9)-tetrahydrocannabinol-9-carboxylic acid (carboxy-THC) metabolite. The range of THC blood concentrations in drivers was 0.1-228 ng/ml, with a median of 9 ng/ml. Opioids consisted mainly of morphine (n=84), codeine (n=89) and methadone (n=33), while stimulants consisted mainly of methamphetamine (n=51), MDMA (n=6), cocaine (n=5), and the ephedrines (n=61). The prevalence of drugs increased over the decade, particularly cannabis and opioids, while alcohol decreased. Cannabis had a larger prevalence in motorcyclists (22.2%), whereas stimulants had a much larger presence in truckers (23%).     

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.     

Analysis of fatalities in road accidents

This paper is based on the analysis of 524 autopsies carried out on the victims of road accidents at the Office of the Judicial Medical Officer, Colombo for a 2-year period ending December 1985. 51.4% of the fatalities were among pedestrians. The highest number of fatalities were in the age group 20-29 years. Cranio-cerebral injury was the commonest cause of death in all groups of victims.     

Diffuse vascular injury in fatal road traffic accident victims: its relationship to diffuse axonal injury

The authors have reported a macro- and microscopic study of brain lesions in 120 victims of fatal road traffic accidents, independent of the survival time. Diffuse vascular injury (DVI) was found in 14 patients (11.7%). All patients with DVI died within 24 h after the accident. The 14 patients with DVI also showed severe (Grade 2 or 3) diffuse axonal injury (DAI). Since DVI is restricted to road traffic accidents and incompatible with life, the high frequency observed in our series could be explained by the fact that all 120 patients were victims of road traffic accidents, and 69.2% had died within 24 h after the accident. The association between DVI and severe DAI (Grades 2 and 3) suggests that both lesions depend on the same mechanism, with the degree of axonal and vascular damage being determined by the intensity of the head acceleration. Our results show a relationship between DVI and DAI that suggest there may be a spectrum or at least a continuum between these entities as distinct from DVI being a separate entity.     

Detection of cannabinoids in homicide victims and motor vehicle fatalities

A gas chromatographic/mass spectrometric (GC/MS) procedure is described for the detection and measurement of delta 9-tetrahydrocannabinol, 11-hydroxy-delta 9-tetrahydrocannabinol, and 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid in blood, or 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid in urine. About 50% of all homicide victims and motor vehicle drivers killed in Bexar County in 1985 were tested for the presence of cannabinoids. Of 130 homicides and 69 drivers tested, blood was analyzed primarily in all but 15 and 3 cases, respectively. In these latter cases, blood analyzed after urine was found to be positive. Of the homicide victims, 44 (34%), and of all drivers, 19 (28%), tested were positive for one or more of the cannabinoids. As a separate group, 16 motorcycle drivers tested had 38% positive as compared with 25% of the other vehicle drivers. Ethyl alcohol was present in 55% of the drivers, and in 63% of the homicide victims. Drugs other than alcohol or cannabinoids were found in 10% of the drivers, and in 12% of the homicide victims.     

Neck injuries: I. Occipitoatlantal dislocation--a pathologic study of twelve traffic fatalities.

Twelve of 155 persons killed in traffic crashes had occipitoatlantal dislocations. Nine were vehicular occupants, 2 were cyclists, and one was a pedestrian. The dislocations involved various combinations of lacerations of the alar ligaments, the occipitoatlantal joint capsules, the dura mater, the tectorial membrane, the rectus capitis muscles, and the suboccipital muscles. In 2 instances, an occipital condyle failed instead of the corresponding alar ligament, producing condyle fractures. Atlas ring fractures occurred in 3 instances. Axial and subaxial cervical trauma were uncommon. Facial or mandibular fractures occurred in a majority of cases, vault skull fractures were uncommon, and basilar fractures were absent. Pontomedullary brainstem lacerations occurred in 9 of the 12, and 4 had midbrain lacerations. The majority of the victims succumbed to acute neurogenic shock as the sole or the major mechanism of death. The biomechanical basis for occipitoatlantal dislocation is discussed, and the author suggests that distraction, in concert with variable combinations of extension, rotation, and posterior translation is responsible for occipitoatlantal dislocations.     

Neck injuries: II. Atlantoaxial dislocation--a pathologic study of 14 traffic fatalities.

C1-C2 vertebral dislocations have not been commonly recognized at autopsy. Among 66 subjects with neck injuries, drawn from a series of 155 traffic fatalities, were 14 with injuries at the level of the atlantoaxial motion segment, ranging in age from 8 months to 93 years. Thirteen had sprains or lacerations of the atlantoaxial facet joints, and one had a healed C1 fracture. Six of the 14 had odontoid fractures. None had transverse ligament lacerations. Injuries of the alar ligaments and the tectorial membrane were frequent. Only 3 subjects had subaxial cervical injury. All 14 had evidence of impact to the head or neck. Four had fractures of the mandible or facial bones, and 5 had skull fractures. Subdural and subarachnoid hemorrhages were found in 7 and 6, respectively. Brainstem lacerations were not uncommon, but only one had a pontomedullary laceration. Spinomedullary cord injuries occurred in 5. Acute neurogenic shock was the major mechanism of death in 9 of the 14, including 5 with major cardiovascular lacerations. Delayed effects of craniocerebral trauma accounted for the majority of the remainder. The biomechanical mechanisms are discussed.     

The impact of fentanyl on DUIDs and traffic fatalities: Blood and oral fluid data

Fentanyl has emerged as the most prolific drug in the ongoing opioid epidemic and has greatly impacted traffic safety in recent years. This study aimed to evaluate fentanyl prevalence and concentrations in blood and oral fluid in driving under the influence of drugs (DUID) cases in three different regions (i.e., Alabama, Orange County, CA, and Houston, TX) from 2017 to 2022. Furthermore, traffic fatalities were evaluated for Alabama and Orange County, CA. Fentanyl positivity in DUID and traffic fatalities increased for most years in this study. In Alabama, the prevalence of fentanyl DUID cases increased 4-fold in 2022 compared to 2017. Orange County's increase from 2017 to 2022 was 14-fold. In Houston, the increase was approximately 2-fold from 2019 to 2022. The greatest increase for all laboratories coincided with the start of the COVID-19 pandemic. In 2022, the median fentanyl DUID blood concentrations were 4.7, 11, and 4.7 ng/mL in Alabama, Orange County, and Houston, respectively. Most fentanyl cases were polydrug cases (≥90%). Methamphetamine, THC, and alprazolam were the most frequently detected drugs in combination with fentanyl. Alabama has collected oral fluid and blood in DUID cases since 2018. The detection of fentanyl in oral fluid was comparable to blood. However, 59% and 8.7% of fentanyl-positive cases had concentrations of >20 ng/mL in oral fluid and blood, respectively. Therefore, oral fluid as an alternative or supplemental specimen to blood is an attractive approach for fentanyl in DUID cases. This study contributes to understanding recent fentanyl trends and their impact on traffic safety.     

Presence of alcohol in suicide victims

A number of studies have established a strong connection between acute inebriation, alcohol addiction and suicides, as the last act of alcoholism or an act of desperation in an alcoholic's family, an act of escape from restraints in state of depression or as a way of self-destruction.In recent years in average 600 people per year committed suicide. Slovenia is a country with extremely high and variable suicide tendencies and harmful alcohol use levels, as well as a high level of alcohol-related troubles.The aim of our research was to ascertain some typical features, especially those connected to the inebriation of suicide victims from a wider Ljubljana region. Autopsies were carried out on the victims in the period between 1995 and 1999.There were 508 (31.2%) suicides among all the analyzed violent deaths; 73.2% of them were men. The average age of the victims was 46.5 years. Most suicides were committed at home (50.0%). 25.4% were completely sober in the moment of the act, while in all other cases inebriation was established, the average value being 9.57 g/kg. Men were drunk in 87.1% of cases, women only in 12.9% and the given alcohol levels were substantially higher with men (0.65:0.26 g/kg). The share of inebriated persons decreases with age—reaching its peak in the 35–54 age group. Regarding the method, the predominant ones are intoxication and the use of firearms, which is a typical way of committing suicide among men, while women rather choose jumping from great heights and drowning.Alcohol was present in as many as 55.7% of suicides with intoxication and in 68.8% of all suicides committed by using firearms, while the highest alcohol levels were found in those who died from cutting their veins (2.01 g/kg).Based on this and on other research, more effort should be focused on alcohol abuse prevention, making all people aware of the consequences of alcohol abuse, the possibilities of treatment and their availability as well as possible co-morbid depressions. Simultaneously, due to an established link, the national alcohol policy and strategy for prevention of suicides should be professionally harmonized.     

Post-mortem blood alcohol concentration of the traffic accident victims and changes in DUI legislation in Slovenia 1980–2006

This study aims to contribute to the analysis of the impact of alcohol consumption on road traffic safety in Slovenia and to evaluate the effectiveness of the changes in road traffic safety legislation concerning this issue within the period 1980–2006. For this purpose we have performed a retrospective analysis of 1913 autopsy reports on traffic casualties, with an emphasis on their blood alcohol concentration (BAC), mode of participation in traffic (drivers, pedestrians, etc.) and the impact of legislation changes. In addition, we have analysed the relations between BAC, the time and day of death and the gender of victims. Changes in the legislation were made in 1981, 1985, 1988, 1989, 1990, 1998 and 2005, yet only those made in 1981, 1990 and 1998 resulted in the increase of the actual fines. Within the observed period there was a substantial reduction in the average BAC in almost all of the categories of traffic participants (pedestrians: from 1.20 to 0.73; passengers: from 1.08 to 0.56; cyclists: from 1.11 to 0.56; motorcyclists: from 0.68 to 0.33) except in the category of drivers (negligible reduction from 0.81 to 0.76). Insufficient improvement in the latter category is extremely important, because many sober vulnerable traffic participants become victims of drunk drivers. Further concern arises from the finding that heavily drinking drivers are not responsive to penalty increases. We came to the conclusion that, in addition to raising fines and expanding penalty points, the introduction and effective enforcement of complex legislative measures together with wide community action are necessary to resolve DUI problems in Slovenia.     

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 social willingness to comply with the law: The effect of social attitudes on traffic fatalities

This paper investigates the effect of the social willingness to comply with the law on driver behavior and traffic fatalities. We analyze a panel of 15 European Union states for 1996–2002, a period for which consistent attitudinal data are available. Using corruption indices, we find that the social willingness to comply with the law has significant positive effects on traffic fatalities with an elasticity estimated between −0.207 and −0.217. Other significant factors are traffic exposure, economic growth, speed, and alcohol consumption. We also find that, whatever benefits laws produce, differences in national traffic rules do not explain divergences in road safety. This result seems to indicate that willingness to comply matters more than legal specificity.     

道路交通事故损伤中的损伤部位与伤残关系

研究道路交通事故中活体损伤案例 ,损伤部位、伤残率、伤残程度之间关系。收集 1997年～ 1999年间武汉地区道路交通事故中活体损伤案例 35 47例 ,对其进行统计和分析。 1792例损伤被评残 ( 5 0 5 2 % ) ,伤残评定率最高的部位为周围神经损伤和耳外伤 ,分别为 90 0 0 % ,83 30 %。最低为躯干及四肢软组织损伤 ( 17 5 2 % )。伤残程度评定中Ⅸ～Ⅹ级和Ⅰ～Ⅴ级伤残评定率分别为 78 74%和 4 41%。伤残评定率与损伤部位的发生并不一致 ,伤后治疗效果直接影响伤残评定。伤残程度以Ⅸ～Ⅹ级最多 ,各部位损伤均可见 ,Ⅰ～Ⅴ级伤残较少 ,Ⅰ级伤残仅见于颅脑和脊髓损伤     

Time of death of victims found in cold water environment

Limited data is available on the application of post-mortem temperature methods to non-standard conditions, especially in problematic real life cases in which the body of the victim is found in cold water environment. Here we present our experience on two cases with known post-mortem times. A 14-year-old girl (rectal temperature 15.5 degrees C) was found assaulted and drowned after a rainy cold night (+5 degrees C) in wet clothing (four layers) at the bottom of a shallow ditch, lying in non-flowing water. The post-mortem time turned out to be 15-16 h. Four days later, at the same time in the morning, after a cold (+/- 0 degrees C) night, a young man (rectal temperature 10.8 degrees C) was found drowned in a shallow cold drain (+4 degrees C) wearing similar clothing (four layers) and being exposed to almost similar environmental and weather conditions, except of flow (7.7 l/s or 0.3 m/s) in the drain. The post-mortem time was deduced to be 10-12 h. We tested the applicability of five practical methods to estimate time of death. Henssge's temperature-time of death nomogram method with correction factors was the most versatile and gave also most accurate results, although there is limited data on choosing of correction factors. In the first case, the right correction factor was close to 1.0 (recommended 1.1-1.2), suggesting that wet clothing acted like dry clothing in slowing down body cooling. In the second case, the right correction factor was between 0.3 and 0.5, similar to the recommended 0.35 for naked bodies in flowing water.     

Role of drugs in traffic accidents. A pilot study of traffic accident offenders in Switzerland (Bern region)

Toxicological analyses of blood and/or urine specimens collected between 1980 and 1981 revealed that 34.7% of all traffic accident victims (n = 144) had measurable concentrations of drugs. Analyses of blood samples taken from traffic offenders (n = 250) in 1979, on the other hand, showed 22.4% to have consumed drugs with or without alcohol. This percentage is comparable with values reported in other studies. Our results indicate that the widespread use of drugs represents a hazard for traffic safety in Switzerland. Road safety is additionally jeopardized by the often concomitant consumption of alcohol.     

The prevalence of drugs in carbon monoxide-related deaths: a retrospective study, 2000-2003

The objective of this study was to review demographic characteristics and drugs detected in carbon monoxide (CO)-related deaths from cases received by the Office of the Cuyahoga County Coroner in Cleveland, Ohio, from 2000-2003. Postmortem reports were reviewed, and decedents for which CO was listed as the cause of death were included. The data were compiled into 3 groups according to the official coroner's verdict as to the manner of death: accident, suicide, and homicide. Included in this study were 122 cases: 84 (69%) accidental, 31 (25%) suicide, and 7 (6%) homicide. Accident decedents were typically white males, aged 40-59 years, residing in Cleveland. Suicide decedents were also middle-aged, white males but residing in the suburbs. Homicide decedents under the age of 6 were characteristically black (N=2), while decedents over the age of 39 were predominately white (N=3). Carboxyhemoglobin (COHb) levels in suicide cases were higher than concentrations measured in accidental deaths. The highest percentage of suicide decedents (36%) had a COHb level>70% saturation, accident decedents (36%) between 50% and 69% saturation, and homicide decedents (71%) below 50% saturation. Ethanol (N=34) was detected in 28% of deaths, and therapeutic and/or abused drugs (N=50) were detected in 41% of deaths. Illicit drugs were detected in 11% of cases (cocaine/metabolites; THC/metabolites), other drug positives were therapeutic medications. The most common drugs detected were antidepressants and antihistamines in suicides and pain medications and antihistamines in accidents.     

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.     

Some mathematical problems in the DNA identification of victims in the 2004 tsunami and similar mass fatalities

DNA is a major and essential identification tool for mass fatality incidents including the hundreds of thousands of victims of the 2004 Indian Ocean tsunami. Mathematical complications characteristic of this sort of mass fatality include prevalence of related victims, the many races represented among the victims, and various identification modalities in tandem with DNA. Four mathematical problems of interest are discussed in this paper. (1) Other quantifiable factors (i.e. geography) can be formally accounted for by including a likelihood ratio that can be thought of as reducing the "effective number of victims." (2) When a victim is found and tentatively identified as V, but then it comes to light that the victim has a relative W who is also missing, confidence in the identity is depressed. To account for the existence of W, increment the effective number of victims by the likelihood ratio supporting W as the identity of the victim. (3) When several apparently related victims are found, their mutual identities should be calculated simultaneously. Compared to one-at-a-time, serial identifications, this is both logical and may lead to much more confidence in the identities. (4) Although there may be many different population groups represented among the missing, it is generally sufficient to consider population statistics for only a few of them in deciding whether to declare an identification.