Prevalence of driving under the influence of psychoactive substances and road traffic crashes among Brazilian crack-using drivers

Prevalence and factors associated with driving under the influence of alcohol in Brazil

OBJECTIVES

To estimate the prevalence and factors associated with Driving Under the Influence of Alcohol (DUIA) among car drivers and motorcyclists in Brazil and to evaluate the association between DUIA and self-reported Road Traffic Injuries (RTIs) in these groups.

METHODS

A cross-sectional study was conducted using data from adults aged 18 or older who participated in the 2019 National Health Survey. Probability sampling was used to recruit participants, and data collection was carried out through home visits. Data from 31,246 car drivers and 21,896 motorcyclists were analyzed. Key indicators included the proportion (%) of car drivers who consumed alcohol and then drove in the past 12 months and the proportion (%) of motorcyclists who consumed alcohol and then drove in the past 12 months. Multiple Poisson regression was used to determine factors associated with DUIA and the association of this variable with RTIs in both groups.

RESULTS

DUIA prevalence was 9.4% (95% Confidence Interval [95% CI] = 8.8-10.0) among car drivers and 11.2% (95% CI = 10.4-12.1) among motorcyclists. Among car drivers, DUIA prevalence was higher in men, young adults, those without a spouse/partner, and lower in individuals with lower income and education level. Among motorcyclists, DUIA prevalence was higher in men, young adults, those living outside the capitals and metropolitan regions, and lower in individuals with lower income. DUIA increased the prevalence of self-reported RTIs in the previous 12 months among car drivers and motorcyclists.

CONCLUSIONS

A high prevalence of DUIA was evident among drivers, particularly motorcyclists. The DUIA was more prevalent among men and young adults. The DUIA was associated with an increased magnitude of self-reported RTIs among car drivers and motorcyclists. Despite the extensive legislation for zero tolerance toward DUIA in the country, actions need stricter enforcement.

High-dose benzodiazepine use and QTc interval prolongation, a latent class analysis study

Benzodiazepine (BDZ) addiction is a widespread and multifaceted phenomenon. For many patients, especially females, the concomitant use of other drugs also increases their risk of QTc prolongation, possibly leading to complications such as seizures and even sudden death. However, the relationship between BDZ use and QTc prolongation is currently unclear. The present study aims to examine patterns of polysubstance use among a sample of Italian adults with BDZ dependence in relation with their QTc prolongation risk. We used Latent Class Analysis (LCA) on data collected from 251 inpatients of the Addiction Medicine Unit in Verona to group patients into three classes according to their substance use and their QTc prolongation risk. Results showed no significant relationship between QTc prolongation and BDZ use in any of the classes considered. We conclude that BDZs, even if used long-term and at high dosages, can be considered safe in terms of cardiovascular complications for patients.

A systematic review of factors associated with illegal drug driving

Drug driving is a serious problem worldwide that can increase the risk of road crashes. This systematic review seeks to identify factors associated with drug driving (i.e., driving after consuming drugs other than alcohol) to highlight gaps in existing knowledge and inform the design of more effective countermeasures. A search of the literature was conducted for the period January 1, 2005 to July 31, 2021 using six different databases. The search protocol followed PRISMA guidelines and was registered in PROSPERO (#CRD42021234616). Studies that met inclusion criteria compared drug drivers with either non-drug drivers, alcohol-only drivers or drug drivers from an earlier time period, to identify factors specifically associated with drug driving, rather than common to all drivers. Two hundred and nineteen publications met the inclusion criteria and were included within the review. Based on the findings, a logic model was developed that presents the factors associated with drug driving. Various sociodemographic, psychosocial and legal factors emerged as the main factors associated with illegal drug driving. At the sociodemographic and psychological levels, drug drivers were more likely to be single, young males who often drive after using cannabis and who score high on sensation-seeking and impulsivity scales. The key social factor found to be associated with drug driving was peer acceptance/disapproval of the behaviour. At the legal level, the review suggested that the effectiveness of current enforcement approaches to drug driving vary among jurisdictions around the world due to differences in the level of perceived certainty of apprehension and the chances of punishment avoidance. Future research into the anticipated and actual rewards for drug driving is needed to inform the development of more effective countermeasures.

Polysubstance Use Patterns Among High Dose Benzodiazepine Users: A Latent Class Analysis and Differences Between Male and Female Use

Benzodiazepines (BZDs) represent one of the most widely used groups of pharmaceuticals, but if used for long periods of time they are associated with dependence and an increased risk of harmful effects. High-dose (HD) BZD dependence is a specific substance use disorder associated with a poor quality of life. It is especially important to pinpoint differences in HD BZD addict subgroups in order to tailor treatment to the individual's specific needs, also considering possible comorbidities with other substance use disorders. We conducted a study to evaluate HD BZD dependence (converted doses to diazepam equivalents, mg) in an Italian sample of 1,354 participants. We also investigated if and to which extent participants co-used other substances (alcohol, tobacco, cannabis/cannabinoids, cocaine, and heroin). We then performed latent class analysis (LCA) to identify the use patterns of these substances, finding three classes: participants in Class 1 (4.3% of the sample) had the highest probability of also using cocaine and alcohol (Polysubstance BZD users); Class 2 comprised subjects with the highest probability of being former heroin, cocaine, THC, and alcohol users (Former polysubstance BZD users); Class 3 represented mono-dependence BZD users (78.5% of the sample) and was the most prevalent among women, while young men were most prevalent in Class 1. The present study underlines different characteristics in HD BZD users both concerning other addictions and sex, and also highlights the need for a stricter control of BZD use, ranging from prescriptions to sales.

Social support networks of users of crack cocaine and the role of a Brazilian health program for people living on the street: A qualitative study

This cross-sectional qualitative study analyzed characteristics of social support for users of crack cocaine and the role of "Consultório na Rua" (CR), or "Office in the Street," a Brazilian program for people living on the street. Data were collected using 1) ethnographic field observations during the delivery of services from this program, 2) in-depth interviews with 17 users of crack cocaine, and 3) a focus group with professionals from CR. To analyze data, we used content analysis and analytical categories based on Social Network Analysis (SNA) theoretical statements. Results showed that family, peers, community members, and professionals from CR were the main social support providers. Participants mentioned receiving material, informational, and emotional support from CR members. It was observed that CR had a welcoming and inclusive approach, but CR team members identified challenges related to stigma directed toward people who use substances and live on the street. CR assumed a central role in the health and social assistance of users of crack cocaine living on the street, providing an important link to healthcare and social services. However, initiatives related to motivation to receive mental health services, treatment, or social reintegration were not observed in conjunction with this program.

Predictive factors associated with driving under the influence among Brazilian drug-using drivers

The incidence of driving under the influence of psychoactive substances (DUI) and its recidivism can be curtailed by the proper identification of specific and predictive characteristics among drug users. In this sense, interpersonal violence (IV), psychiatric comorbidity and impulsivity seem to play an important role in DUI engagement according to previous studies. There are, however, limited data originated from low and middle income countries. In the present study, drug-using Brazilian drivers reporting DUI (n = 75) presented a higher prevalence of bipolar disorders (BD; DUI: 8% vs. non-DUI: 0%, p < 0.001), lower prevalence of obsessive-compulsive disorder (OCD; DUI: 0% vs. non-DUI: 12.6%, p < 0.001), and higher prevalence of childhood trauma (DUI: 65.3% vs. non-DUI: 46.8%, p = 0.022) than those not reporting DUI (n = 79). The evaluation of impulsivity though the Barratt Impulsivity Scale, which give impulsivity scores ranging from 30 to 120, showed higher impulsivity scores in the DUI group (80.4 ± 8) than in the non-DUI group (77.2 ± 10, p = 0.045). In general, subjects were young adults (mean age of 36 ± 9 years), Caucasians (58.4%), not married (61.0%), and with elementary schooling (40.3%) with no significant differences in demographic characteristics between drivers with and without DUI behavior. A multiple Poisson regression model showed that individuals reporting IV as perpetrators and history of childhood trauma were more likely to report DUI (PR: 1.66, 95%CI 1.22-2.7; PR: 1.57, 95%CI 1.02-2.42, respectively). The overlapping of violent situations (childhood trauma, IV and DUI) in some individuals presented here corroborates literature data suggesting that DUI can be an externalizing expression of a range of risky behavior, such as impulsiveness and aggressiveness. Moreover, while BD and higher impulsivity scores seem to act as risk factors for DUI, OCD was shown as a protective factor. These results corroborate the hypothesis that individuals with high risk for DUI could probably be identified by multidimensional assessment of cognitive, risky taking, and personality traits, which perhaps could facilitate the development of focused interventions.

Clinical characteristics of poly-drug abuse among heroin dependents and association with other psychopathology in compulsory isolation treatment settings in China

OBJECTIVE

To investigate clinical characteristics and associations of polydrug abuse among heroin-dependent patients in compulsory isolation settings in China.

METHODS

Structured interviews were conducted in 882 heroin-dependent patients in two compulsory isolation settings in Changsha, China. Descriptive statistics were employed to report prevalence and general information of polydrug abuse among the participants. Bivariate associations were examined between polydrug abuse and variables regarding demographics, heroin use profile and psychopathology. Multivariate logistic regressions were conducted to determine independent factors associated with polydrug abuse.

RESULTS

Of all the participants, 40.6% reported abuse of/dependence on at least one other type of drug/alcohol than heroin/opioids during the month preceding admission, with benzodiazepines and alcohol being the most common type of drugs abused apart from heroin. Antisocial and depressive personality disorders, as well as more severe heroin use patterns, including younger age at initiate use and larger amount used per day, were found to be independently associated with polydrug abuse.

CONCLUSIONS

The prevalence of polydrug abuse and its associated severe heroin use patterns and personality disorders suggests an urgent need of promoting treatment policies and strategies for heroin patients in China to address these issues.