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Blandino A, Tambuzzi S, Cotroneo R, Di Candia D, Battistini A, Giordano G, Genovese U, Zoja R. Work-related and non-work-related fatal road accidents: Assessment of psychoactive substance use in commuting. MEDICINE, SCIENCE, AND THE LAW 2023; 63:140-150. [PMID: 35929133 DOI: 10.1177/00258024221118415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Commuting road traffic collisions (RTCs) are one of the main causes of occupational death worldwide, including Italy. Among the prominent yet relatively understudied personal risk factors in the subpopulation of workers, there is the use of psychoactive substances. Since the phenomenon of driving under alcohol and drugs effects in the commuter sub-population has so far been poorly studied, we carried out a study by comparing results obtained from the analysis of commuters and non-commuters. The percentage of commuting RTCs victims was 10.4% out of all the RTCs. Commuter victims were mostly men, 51-60 years-old, motorcyclists (32.1%) or car drivers (28.6%), employees, deceased during Fridays and Saturdays, in the afternoon (35.7%) and in the evening (32.1%). It was possible to perform toxicological analyses in 60.7% of commuter cases: approximately 40% tested positive, always and only for ethanol (median Blood Alcohol Concentration, BAC, of about 1.03 g/L). Values above the legal limit were observed in 23.5% of the toxicological samples analyzed from commuter accidents. Our findings contribute to bridging the gap in knowledge in the area of RTCs and commuting and emphasize the importance of carrying out toxicological investigations, with possible repercussions on both insurance issues and public health strategies, which are relevant for analyzing the phenomenon structurally.
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Affiliation(s)
- Alberto Blandino
- Institute of Legal Medicine, Department of Biomedical and Health Sciences, 9304University of Milan, Milan, Italy
| | - Stefano Tambuzzi
- Institute of Legal Medicine, Department of Biomedical and Health Sciences, 9304University of Milan, Milan, Italy
| | - Rosy Cotroneo
- Institute of Legal Medicine, Department of Biomedical and Health Sciences, 9304University of Milan, Milan, Italy
| | - Domenico Di Candia
- Institute of Legal Medicine, Department of Biomedical and Health Sciences, 9304University of Milan, Milan, Italy
| | - Alessio Battistini
- Institute of Legal Medicine, Department of Biomedical and Health Sciences, 9304University of Milan, Milan, Italy
| | - Gaia Giordano
- Institute of Legal Medicine, Department of Biomedical and Health Sciences, 9304University of Milan, Milan, Italy
| | - Umberto Genovese
- Institute of Legal Medicine, Department of Biomedical and Health Sciences, 9304University of Milan, Milan, Italy
- Department of Oncology and OncoEmatology, 9304University of Milan, Milan, Italy
| | - Riccardo Zoja
- Institute of Legal Medicine, Department of Biomedical and Health Sciences, 9304University of Milan, Milan, Italy
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Randomly controlled drivers using minimally invasive sampling: assessment of drug prevalence in Western Switzerland over two time periods. BMC Public Health 2022; 22:2446. [PMID: 36577956 PMCID: PMC9795657 DOI: 10.1186/s12889-022-14883-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND According to the World Health Organization, road traffic injuries lead to 1.3 million deaths each year and represent the leading cause of death for young adults under 30 years old. The use of psychoactive substances, including alcohol, drugs and pharmaceuticals, is a well-known risk factor for road traffic injuries. Our study aims to assess the prevalence of substances consumed by drivers in western Switzerland. Such studies are pivotal to improving prevention and developing public awareness campaigns. METHODS To assess the prevalence of psychoactive substances among drivers, roadside controls were performed in collaboration with local police, using their classical sampling procedures to detect drivers under the influence of drugs or alcohol over two time periods (P1: 2006-2008, P2: 2017-2020). When impaired driving was not suspected by the police, minimally invasive sampling strategies (i.e., oral fluids during P1 and dried blood spots during P2) were performed on volunteer drivers after a road safety survey. A posteriori analyses and statistical interpretation were then performed. RESULTS Among the 1605 drivers included in the study, 1048 volunteers provided an oral fluid sample, while 299 provided a dried blood spot sample. The percentage of drivers testing positive for at least one substance that can impact driving abilities was stable over time, with a rate of 10.5% positivity measured over both periods. Considering the different categories of substances, a slight variation was observed between both periods, with 7.6 and 6.3% of pharmaceuticals and 3.6 and 4.9% of illicit drugs for P1 and P2, respectively. Regarding the consumption of illicit drugs, the highest percentage of positivity was measured in biological fluids of drivers under the age of 35, during nights and week-ends, periods which are considered particularly prone to fatal accidents for this age group. Disturbingly, the road safety survey highlighted that drivers' perception of the risk of getting positively controlled while driving after drug consumption is low (3.3 on a 1-to-10 scale, N = 299). CONCLUSION The number of positive cases measured in voluntary drivers who passed the preliminary police check demonstrates the importance of systematic biofluid sampling strategies regarding driving under the influence of psychoactive substances. Although the number of fatal road accidents globally has decreased over time, the results of this study reveal the need for both better prevention and deterrent processes that could potentially reduce the risk of fatal road accidents associated with drug consumption.
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Gender differences in driving under the influence of psychoactive drugs: Evidence mapping of real case studies and meta-analysis. Forensic Sci Int 2022; 341:111479. [DOI: 10.1016/j.forsciint.2022.111479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/18/2022]
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Jin L, Vermund SH, Zhang Y. Trends in Prescription Opioid Use in Motor Vehicle Crash Injuries in the United States: 2014-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14445. [PMID: 36361324 PMCID: PMC9657604 DOI: 10.3390/ijerph192114445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Motor vehicle crashes (MVC) cause over three million people to be nonfatally injured each year in the United States alone. We investigated trends and patterns in prescription opioid usage among nonfatal MVC injuries in 50 states in the US and the District of Columbia from 2014 to 2018. All emergency department visits for an MVC event (N = 142,204) were identified from the IBM® MarketScan® Databases. Using log-binomial regression models, we investigated whether the prevalence of prescription opioids in MVC injuries varied temporally, spatially, or by enrollees' characteristics. Adjusting for age, relationship to the primary beneficiary, employment status, geographic region, and residence in metropolitan statistical area, the prevalence decreased by 5% (95% CI: 2-8%) in 2015, 18% (95% CI: 15-20%) in 2016, 31% (95% CI: 28-33%) in 2017, and 49% (95% CI: 46-51%) in 2018, compared to 2014. Moreover, the prevalence decreased by 28% (95% CI: 26-29%) after the publication of the CDC Guidelines for Prescribing Opioids for Chronic Pain. Spatial variations were observed in the prevalence and temporal trend of prevalence. The decreasing trend in the prevalence of prescription opioids in MVC is consistent with the decrease in the dispensing rate of opioids and the percentage of high-dosage opioids in the study population.
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Affiliation(s)
- Lan Jin
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT 06510, USA
| | - Yawei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Odoardi S, Biosa G, Mestria S, Valentini V, De Giovanni N, Cittadini F, Strano Rossi S. DRUG-IMPAIRED DRIVING AND TRAFFIC COLLISIONS: STUDY ON A CROSS SECTION OF THE ITALIAN POPULATION. Drug Test Anal 2022; 15:477-483. [PMID: 36082405 DOI: 10.1002/dta.3366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/11/2022]
Abstract
The present study focuses on the association between road accidents and the presence of drugs of abuse markers in the biological fluids of the drivers. Biological fluids collected from 1,236 drivers involved in road accidents (54 fatal and 1,182 non-fatal crashes) in the Rome area were analysed for alcohol and psychotropic drugs, as required by judicial authorities. The substance most frequently detected was alcohol (in 19% of non-fatal and 32% of fatal crashes), followed by cannabinoids (12% of non-fatal crashes) and cocaine (9% of non-fatal and 20% of fatal crashes). The results obtained for cocaine and cannabinoids in blood and urine were compared. We observed the absence or low concentrations of the active drug in blood (cocaine was often below 5 ng/mL and THC below 1 ng/mL), whereas urinary concentrations of metabolites were generally high (benzoylecgonine 250 - above 5000 ng/mL, THCCOOH 15-270 ng/mL). The risk of being involved in a road accident if cocaine or cannabis markers were present in the urine specimens was evaluated compared to a control population. The odds ratios calculated, being 8.13 for cannabis and 5.32 for cocaine, suggest a strong association between the presence of these drugs in the urine of drivers and traffic accidents, regardless of their presence in blood samples. The present data suggest that the chance of being involved in a road accident is higher than in the control population even if the subject is no longer "under the influence" of cannabis or cocaine at the time of the accident.
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Affiliation(s)
- Sara Odoardi
- Department of Healthcare Surveillance and Bioethics, Section of Legal medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario IRCCS A. Gemelli, Rome, Italy
| | - Giulia Biosa
- Department of Healthcare Surveillance and Bioethics, Section of Legal medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario IRCCS A. Gemelli, Rome, Italy
| | - Serena Mestria
- Department of Healthcare Surveillance and Bioethics, Section of Legal medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario IRCCS A. Gemelli, Rome, Italy
| | - Valeria Valentini
- Department of Healthcare Surveillance and Bioethics, Section of Legal medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario IRCCS A. Gemelli, Rome, Italy
| | - Nadia De Giovanni
- Department of Healthcare Surveillance and Bioethics, Section of Legal medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario IRCCS A. Gemelli, Rome, Italy
| | - Francesca Cittadini
- Department of Healthcare Surveillance and Bioethics, Section of Legal medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario IRCCS A. Gemelli, Rome, Italy
| | - Sabina Strano Rossi
- Department of Healthcare Surveillance and Bioethics, Section of Legal medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario IRCCS A. Gemelli, Rome, Italy
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Beaulieu E, Naumann RB, Deveaux G, Wang L, Stringfellow EJ, Hassmiller Lich K, Jalali MS. Impacts of alcohol and opioid polysubstance use on road safety: Systematic review. ACCIDENT; ANALYSIS AND PREVENTION 2022; 173:106713. [PMID: 35640366 DOI: 10.1016/j.aap.2022.106713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/23/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Connections between substance use, impairment, and road safety have been frequently researched. Yet, little is known about how simultaneous use of opioids and alcohol affects road safety outcomes, which is an increasingly critical link within the current landscape of the substance use environment and public health. Lack of this understanding is partly due to testing complications and data limitations. We define polysubstance use here as alcohol and opioids consumed together or within a small-time window such that both are present in the system. This polysubstance use is on the rise and produces greater health risks than when the substances are consumed separately. Given the increasing rate of opioid use, high prevalence of alcohol use, and dangers of polysubstance use, we aim to synthesize literature on the prevalence and impact of this polysubstance on road safety-related outcomes. We performed a systematic review of studies published between 1974 and 2020 that examined opioid and alcohol use exposures and road safety-related outcomes. Out of 644 initial findings, 20 studies were included in this review. Outcomes included motor vehicle crash injuries, deaths, or driver culpability; suspected driving under the influence; and simulated driving performance. Evidence from multiple sources showed a significant rise, approximately 1% to 7%, in the prevalence of opioids among fatally injured drivers in the U.S. from 1995 to 2016. Information published on the simultaneous presence of opioids and alcohol in people involved in crashes was scarce. The limited available findings point toward an overlap where up to 30% of opioid-positive people involved in a crash were also positive for alcohol. Studies also suggest a possibly elevated risk presented by this polysubstance use relative to the substances used alone, though the majority of identified studies did not estimate this association. The synthesized research indicates that alcohol and opioid use is not uncommon and may be increasing among people involved in adverse driving events. More research and better data are needed to improve estimates of association with road traffic-related outcomes, potentially improving substance testing in current surveillance systems or using linked data sets and other novel data sources to improve estimates.
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Affiliation(s)
- Elizabeth Beaulieu
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Rebecca B Naumann
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Genevieve Deveaux
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Lindsay Wang
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Erin J Stringfellow
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA.
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7
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Drug consumption of suspected drug-influenced drivers in Hungary (2016-2018). Forensic Sci Int 2022; 336:111325. [DOI: 10.1016/j.forsciint.2022.111325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
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Zhang Y, Zhao YG, Zhu Y, Shi JW, Cai T, Zhang S. Simultaneous determination of 12 illicit drugs in human plasma by the PRiME clover-shaped nano-titania functionalized covalent organic frameworks pass-through cleanup procedure followed by ultra-performance liquid chromatography-tandem mass spectrometry. J Chromatogr A 2022; 1671:463022. [DOI: 10.1016/j.chroma.2022.463022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/13/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
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9
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Hasan R, Watson B, Haworth N, Oviedo-Trespalacios O. A systematic review of factors associated with illegal drug driving. ACCIDENT; ANALYSIS AND PREVENTION 2022; 168:106574. [PMID: 35152044 DOI: 10.1016/j.aap.2022.106574] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Razi Hasan
- Queensland University of Technology (QUT), Centre for Accident Research and Road Safety- Queensland (CARRS-Q), K Block, 130 Victoria Park Road, Kelvin Grove, QLD 4059, Australia
| | - Barry Watson
- Queensland University of Technology (QUT), Centre for Accident Research and Road Safety- Queensland (CARRS-Q), K Block, 130 Victoria Park Road, Kelvin Grove, QLD 4059, Australia
| | - Narelle Haworth
- Queensland University of Technology (QUT), Centre for Accident Research and Road Safety- Queensland (CARRS-Q), K Block, 130 Victoria Park Road, Kelvin Grove, QLD 4059, Australia
| | - Oscar Oviedo-Trespalacios
- Queensland University of Technology (QUT), Centre for Accident Research and Road Safety- Queensland (CARRS-Q), K Block, 130 Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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Blandino A, Cotroneo R, Tambuzzi S, Di Candia D, Genovese U, Zoja R. Driving under the influence of drugs: Correlation between blood psychoactive drug concentrations and cognitive impairment. A narrative review taking into account forensic issues. Forensic Sci Int Synerg 2022; 4:100224. [PMID: 35330981 PMCID: PMC8938866 DOI: 10.1016/j.fsisyn.2022.100224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022]
Abstract
Driving under the influence of alcohol has been shown to increase the risk of involvement in road traffic collisions (RTCs) however, less is known about the effects of illicit drugs, and a clear correlation between drug concentrations and RTC risk is still debated. The goal of this narrative review is to assess the current literature regarding the most detected psychoactive drugs in RTC (ethanol, amphetamines, cannabis, opioids and cocaine), in relation to driving performance. Evidence on impaired driving due to psychoactive substances, forensic issues relating to the assessment of the impact of drugs, blood cut-off values proposed to date as well as scientific basis for proposed legislative limits are discussed. At present there is no unequivocal evidence demonstrating a clear dose/concentration dependent impairment in many substances. Per se and zero tolerance approaches seem to have negative effect on drugged driving fatalities. However, the weight of these approaches needs further investigation. Driving under the influence of psychotropic substances has become a widespread phenomenon. Only a few substances have been reported to have a clear dose/concentration dependent impairment. Statistically significant differences should not be considered as clinically significant per se There is wide variability in legislative cut-offs. Detection limits seems to be the most public safety-oriented legislative approach.
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11
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The incidence of psychoactive substances and alcohol among impaired drivers in Denmark in 2015–2019. Forensic Sci Int 2022; 333:111207. [DOI: 10.1016/j.forsciint.2022.111207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/11/2022] [Accepted: 01/28/2022] [Indexed: 01/29/2023]
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Anzillotti L, Dagoli S, Calò L, Maglietta G, Cecchi R. Road traffic deaths: A retrospective analysis (2009-2019) in the north of the Italian region Emilia Romagna. TRAFFIC INJURY PREVENTION 2021; 23:29-33. [PMID: 34882488 DOI: 10.1080/15389588.2021.2002853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE International literature and several national studies demonstrate that alcohol and illicit drugs impair driving abilities, diminishing the level of attention, and cause traffic accidents. In Italy, driving under the influence of alcohol or drugs is regulated by Articles 186 and 187 of the National Street Code, which defines penalties and fines for the convicted. The aim of this study was the collection of all available data from 2009 to 2019 focusing on deaths related to road accidents in the Unit of Legal Medicine of Department of Medicine and Surgery at the University of Parma, in order to assess any consumption of alcohol, illicit drugs, and medicinal drugs among drivers. METHODS Data were retrieved from autopsy reports found at the Unit of Legal Medicine of Parma University related to 327 subjects who died following road accidents in the Italian areas of Parma, Reggio-Emilia, and Piacenza. The population was divided into subgroups according to age, gender, crash time, and drug positivity. RESULTS Those in the age group 46 to 65 years old were involved in the most accidents, whereas the category with fewest members included subjects under 26 years old. The majority of road accidents occurred during the daytime and on weekends. Among the toxicological investigations carried out (only for drivers), the highest prevalence was found for alcohol (43.1%), followed by illicit drugs (14.4%) and medicinal drugs (7.8%). The prevalence of alcohol and illicit drugs in combination was 11.8%. Regarding subjects positive for alcohol and illicit drugs in combination, 44.4% had a blood alcohol concentration (BAC) > 1.5 g/L and overall, in 61.1% of the total cases a BAC > 0.81 g/L was detected. CONCLUSIONS Our results are in line with national and international studies highlighting the prevalence of high BAC levels in most of the cases. Confirmation analyses on blood collected from people who died following road accidents showed levels of BAC above 0.8 g/L (threshold for penal sanctions) in the majority of the subjects who tested positive for alcohol. They also revealed cocaine, cannabis, and benzodiazepines as the most common illicit drugs and medicinal drugs used, respectively, as demonstrated in several international studies.
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Affiliation(s)
- L Anzillotti
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - S Dagoli
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L Calò
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G Maglietta
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | - R Cecchi
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Gioldasis C, Christoforou Z, Seidowsky R. Risk-taking behaviors of e-scooter users: A survey in Paris. ACCIDENT; ANALYSIS AND PREVENTION 2021; 163:106427. [PMID: 34628268 DOI: 10.1016/j.aap.2021.106427] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/23/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Abstract
Risk-taking behavior is often held responsible for increased crash involvement. We designed and undertook a face-to-face road survey (N = 459) in order to explore incident involvement history, driving attitudes and perceived risk among e-scooter users is Paris, France. Three risk factors were specifically explored: (i) riding after having consumed alcohol, (ii) riding after having consumed drugs, and (iii) using the smartphone while riding. The relationship between these factors and user attributes (such as age and gender) and travel behavior (such as frequency of e-scooter usage and trip duration) was examined using logit and mixed logit specifications and a structural equation model. Empirical evidence suggests that it is more likely for young and male riders to develop risky behaviors. Longer trip durations seem to be associated with risk-taking behaviors.
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Affiliation(s)
- Christos Gioldasis
- COSYS-GRETTIA, Univ Gustave Eiffel, IFSTTAR, F-77447 Marne-la-Vallée, France; University of Patras, Department of Civil Engineering, Panepistimioupoli Patron 265 04, Patras, Greece.
| | - Zoi Christoforou
- COSYS-GRETTIA, Univ Gustave Eiffel, IFSTTAR, F-77447 Marne-la-Vallée, France; University of Patras, Department of Civil Engineering, Panepistimioupoli Patron 265 04, Patras, Greece
| | - Régine Seidowsky
- COSYS-GRETTIA, Univ Gustave Eiffel, IFSTTAR, F-77447 Marne-la-Vallée, France
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Favretto D, Visentin S, Jones AW. Prevalence and concentrations of sedative-hypnotic drugs in blood of drivers involved in road traffic crashes in the Padova region of Italy - not so easy to interpret. Forensic Sci Int 2021; 330:111097. [PMID: 34814082 DOI: 10.1016/j.forsciint.2021.111097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND & OBJECTIVES This study reports the prevalence and concentrations of sedative-hypnotic drugs as exemplified by benzodiazepines (BZD) and zolpidem (Z-hypnotic) in blood samples from drivers involved in road traffic accidents (RTA) in the Padova region of Italy. Another aim of the study was to estimate the prevalence of these drugs with concentrations in blood above the therapeutic intervals and above specific per se limits. METHODS A total of 4066 blood samples collected from drivers involved in RTA were analysed for the presence of alcohol, drugs of abuse and medicinal drugs with sedative-hypnotic properties. Prevalence of drivers positive for BZDs and zolpidem were reported according to the reporting limit of our laboratory (1 ng/mL) in a sort of zero tolerance approach and compared with the prevalence according to analytical cut-offs used in the "European Union's research project on Driving Under the Influence of Drugs, Alcohol and Medicines" (DRUID). The impairment-based, per se limits adopted in Norway and in England and Wales and the values used to define "therapeutic ranges" in blood and in plasma/serum were also applied to the case study. RESULTS 175 blood samples were positive for sedative-hypnotics above 1 ng/mL, with the following prevalence: diazepam 44%, nordazepam 41.8%, lorazepam 32.6%, zolpidem 28%, oxazepam 25.6%, alprazolam 16%, delorazepam 11,6%, lormetazepam 11,6%, temazepam 11.6%, clonazepam 11.6%, triazolam 6.9%, N-desalkylflurazepam 4.6%, bromazepam 2.3%. When applying DRUID analytical cut-offs, the prevalence of BZDs and zolpidem sharply decreases. Applying the impairing cut-offs used in Norway, 56% of positive samples were above the limits equivalent to a BAC of 0.2 g/L, 39% above the limits corresponding to 0.5 g/L, and 23% above the cut-off corresponding to 1.2 g/L. Only 1% of the drivers had drug concentrations above the per se concentration limits adopted in England and Wales [26]. When comparing blood levels with therapeutic ranges in plasma, bromazepam, lormetazepam and delorazepam were often found above the highest limits. The adjustment of the concentrations with the plasma-to-blood ratios causes a significant increase of cases above the therapeutic ranges in plasma. CONCLUSIONS Sedative-hypnotic drugs are medicinal substances frequently identified in drivers involved in RTA, commonly in concentrations associated with driving impairment. Besides the concentrations of drugs in blood, several factors have to be considered to conclude that a driver was impaired. The frequent association with alcohol, cocaine and other BZDs, confirms the abuse potential of these medications.
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Affiliation(s)
- Donata Favretto
- University Hospital of Padova, Legal Medicine and Toxicology, Via Falloppio 50, Padova, Italy.
| | | | - Alan W Jones
- Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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Beccegato E, Ruggeri A, Montisci M, Terranova C. Driving license regranting in DUI subjects: Road accident variables and predictive factors of substance use disorder. Sci Prog 2021; 104:368504211033702. [PMID: 34289765 PMCID: PMC10364946 DOI: 10.1177/00368504211033702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A comparative case study (2017-2020) was conducted to identify demographic, social, medico-legal, and toxicological variables associated with non-fatal accidents in driving under the influence (DUI) subjects. A second aim was to identify the factors predictive of substance use disorders among subjects. Drivers charged with alcohol DUI (blood alcohol concentration (BAC) > 0.5) and/or psychoactive substance DUI were included; cases included those involved in an accident while intoxicated, and the comparison group included DUI offenders negative for road accident involvement. Significance was determined by chi-square and Mann-Whitney tests. To prevent confounding effects, a multivariate binary logistic regression analysis was performed. Our sample encompassed 882 subjects (381 in the case group and 501 in the comparison group). Parameters such as psychoactive substances and BAC at the time of the road crash/DUI and the day of the week, when subjects were involved in the road accident or found DUI, resulted in significant differences (p < 0.01) between groups. The model's independent variables of BAC > 1.5 g/L (p = 0.013), BAC > 2.5 g/L (p < 0.001), and concurrent alcohol and psychoactive substance use (p < 0.001) were independent risk factors for an accident. Smoking >20 cigarettes/day was an independent risk factor for unfitness to drive (p < 0.01). Unfitness to drive was based primarily on ethyl glucuronide levels >30 pg/mg. Our results suggest a detailed assessment of DUI subjects with variables associated with accidents (BAC > 1.5 g/L and concurrent intake of psychoactive substances). Hair analysis, including ethylglucuronide (EtG) concentration, should be always performed. Based on our results, nicotine use should be investigated in cases of driving license regranting.
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Affiliation(s)
- Elena Beccegato
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Angelo Ruggeri
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Schumann J, Perkins M, Dietze P, Nambiar D, Mitra B, Gerostamoulos D, Drummer OH, Cameron P, Smith K, Beck B. The prevalence of alcohol and other drugs in fatal road crashes in Victoria, Australia. ACCIDENT; ANALYSIS AND PREVENTION 2021; 153:105905. [PMID: 33631704 DOI: 10.1016/j.aap.2020.105905] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Driving under the influence of drugs, including alcohol, is a globally recognised risk factor for road traffic crashes. While the prevalence of alcohol and other drugs in fatal road crashes has been examined in other countries, recent data investigating drug driving in fatal Australian crashes are limited. This study aimed to examine how the presence of alcohol and other drugs in fatal road trauma in Victoria has changed over time in different road users. METHODS A population-based review of road trauma deaths was performed over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System (NCIS) and the Victorian State Trauma Registry (VSTR). Drugs were grouped according to type and analysed accordingly. Poisson regression models were used to determine change in incidence rates over the study period. RESULTS There were 2287 road traffic fatalities with complete toxicology data (97% of all road traffic fatalities). Alcohol (blood alcohol concentration, BAC) was the most commonly detected drug (>0.001 g/100 mL: 21.1%; >0.05 g/100 mL: 18.4%), followed by opioids (17.3%), THC (13.1%), antidepressants (9.7%), benzodiazepines (8.8%), amphetamine-type stimulants (7.1%), ketamine (3.4%), antipsychotics (0.9%) and cocaine (0.2%). Trends demonstrated changing use over time with specific drugs. Alcohol positive road fatalities declined 9% per year in passenger car/4WD drivers (IRR = 0.91, 95% CI: 0.88-0.95). The incidence of strong opioids (oxycodone, fentanyl, morphine, and methadone) increased 6% per year (IRR = 1.06; 95% CI: 1.02-1.10). Methylamphetamine was detected in 6.6% of cases and showed a yearly increase of 7% (IRR = 1.07; 95% CI: 1.01-1.13). The incidence of THC remained unchanged over the period, observed in 13.1% of cases. Stronger opioids were more commonly detected among pedal cyclists (19.0%) and pedestrians (20.9%) while THC was more commonly detected among motorcyclists (19.8%) and other light vehicle drivers (17.6%). CONCLUSIONS A decline in the prevalence of alcohol in fatalities suggests that law enforcement and public health strategies in Australia to address road fatalities and drink-driving may have had a positive effect. However, increases were observed in the incidence of other potentially impairing drugs including opioids and amphetamines, specifically methylamphetamine, indicating a concerning trend in road safety in Victoria that warrants further monitoring.
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Affiliation(s)
- Jennifer Schumann
- Victorian Institute of Forensic Medicine, Victoria, Australia; Department of Forensic Medicine, Australia.
| | - Monica Perkins
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Paul Dietze
- Burnet Institute, Victoria, Australia; National Drug Research Institute, Victoria, Australia
| | - Dhanya Nambiar
- Eastern Clinical School, Monash University, Victoria, Australia
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, Victoria, Australia; Department of Forensic Medicine, Australia
| | - Olaf H Drummer
- Victorian Institute of Forensic Medicine, Victoria, Australia; Department of Forensic Medicine, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Joye T, Rocher K, Déglon J, Sidibé J, Favrat B, Augsburger M, Thomas A. Driving Under the Influence of Drugs: A Single Parallel Monitoring-Based Quantification Approach on Whole Blood. Front Chem 2020; 8:626. [PMID: 33005598 PMCID: PMC7480261 DOI: 10.3389/fchem.2020.00626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022] Open
Abstract
Driving under the influence of psychoactive substances is a major cause of motor vehicle crashes. The identification and quantification of substances most frequently involved in impaired-driving cases in a single analytic procedure could be an important asset in forensic toxicology. In this study, a highly sensitive and selective liquid chromatography (LC) approach hyphenated with Orbitrap high-resolution mass spectrometry (HRMS) was developed for the quantification of the main drugs present in the context of driving under the influence of drugs (DUID) using 100 μL of whole blood. This procedure involves a simple sample preparation and benefit from the selectivity brought by parallel reaction monitoring (PRM) allowing to solve most DUID cases using a single multi-analyte injection. The method was fully validated for the quantification of the major classes of psychoactive substances associated with impaired-driving (cannabinoids, cocaine and its metabolites, amphetamines, opiates and opioids, and the major benzodiazepines and z-drugs). The validation guidelines set by the “Société Française des Sciences et des Techniques Pharmaceutiques” (SFSTP) were respected for 22 psychoactive substances using 15 internal standards. Trueness was measured to be between 95.3 and 107.6% for all the tested concentrations. Precision represented by repeatability and intermediate precision was lower than 12% while recovery (RE) and matrix effect (ME) ranged from 49 to 105% and from −51 to 3%, respectively. The validated procedure provides an efficient approach for the simultaneous and simple quantification of the major drugs associated with impaired driving benefiting from the selectivity of PRM.
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Affiliation(s)
- Timothée Joye
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University Hospitals, Lausanne, Switzerland.,Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Katell Rocher
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University Hospitals, Lausanne, Switzerland
| | - Julien Déglon
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University Hospitals, Lausanne, Switzerland
| | - Jonathan Sidibé
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University Hospitals, Lausanne, Switzerland
| | - Bernard Favrat
- Unit of Medicine and Traffic Psychology, CURML, Lausanne University Hospital, Geneva University Hospitals, Lausanne, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marc Augsburger
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University Hospitals, Lausanne, Switzerland
| | - Aurélien Thomas
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University Hospitals, Lausanne, Switzerland.,Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Lu L, Contrand B, Gadegbeku B, Salmi LR, Lagarde E. Road traffic crash characteristics of drivers who take prescription medicines that carry a risk to driving. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102929. [PMID: 32919299 DOI: 10.1016/j.drugpo.2020.102929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The specific features of crashes involving an alcohol-intoxicated driver have been extensively characterized, but no such data are available for crashes involving a driver who has used a prescription medicine, which could help to plan and target prevention and control initiatives. This study aimed to describe the characteristics of crashes involving drivers under the influence of prescription medicines. METHODS We took advantage of CESIR, a French record linkage study for which data were extracted and matched from three French national databases: police reports, the national police database of injurious crashes and the national health care insurance database (HCI database). The drivers included in the study were those involved in an injurious road crash in France from July 1, 2005 to December 31, 2015, whose national identity number, date of birth and sex allowed matching. Prescription medicines considered were those with the two highest levels of warning. RESULTS Similar crash profiles were found when drivers used alcohol or medicines, particularly with respect to injury severity, type of vehicle, type of collision, type of road and cross-track profile. Alcohol-related crashes were over-represented during weekends and in low-density areas and medicine-related crashes were over-represented during weekdays and in cities of fewer than 300 000 inhabitants. While a much higher strength of association with responsibility was found for alcohol than for medicines, the proportion of crashes with drivers using medicines was twice as high as crashes with drivers using alcohol. CONCLUSION The lower risk carried by medicines is therefore in part compensated by a higher prevalence of use, making medicines one of the hidden factors of road risk. Characterizing these crashes will therefore be useful to better focus road safety intervention on the prevention of driving under the influence of psychotropic medicines.
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Affiliation(s)
- Li Lu
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Benjamin Contrand
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Blandine Gadegbeku
- Université de Lyon, Université Gustave Eiffel, IFSTTAR, UMRESTTE UMR_T9405, F-69675 Lyon, France
| | - Louis-Rachid Salmi
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France; Service d'Information Médicale, Pôle de Santé Publique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Emmanuel Lagarde
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France.
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Barone R, Pelletti G, Garagnani M, Giusti A, Marzi M, Rossi F, Roffi R, Fais P, Pelotti S. Alcohol and illicit drugs in drivers involved in road traffic crashes in Italy. An 8-year retrospective study. Forensic Sci Int 2019; 305:110004. [PMID: 31707239 DOI: 10.1016/j.forsciint.2019.110004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023]
Abstract
This study aims to investigate the prevalence of alcohol and drugs of abuse in Italian drivers involved in road traffic crashes between 2011 and 2018. Toxicological analyses were performed on the whole blood of 7593 injured drivers. Alcohol and illicit drugs, namely tetrahydrocannabinol (THC; cut-off 2ng/ml), cocaine (cut-off 10ng/ml), illicit opiates (cut-off 10ng/ml) and amphetamines (amphetamine, methamphetamine, MDMA, MDA; cut-off 20ng/ml) were investigated. The age and gender of the driver, the time of the crash (weekend/weekday and day/night), the road crash year and Blood Alcohol Concentration (BAC) were also considered. The 16.2% of samples tested positive for alcohol, 2.5% for cocaine, followed by opiates (2.0%), cannabinoids (1.5%), and amphetamines (0.5%). The overall prevalence of alcohol and drugs was lower than those reported in previous epidemiological studies of the DRUID project. The year 2011 showed the highest prevalence of drug-positive cases (24.1%), while the lowest prevalence was found in 2016 (16.8%), after the update of the Road Traffic Law (RTL) that increased punishments for driving under the influence. A progressive increase in the number of alcohol-positive female drivers was observed from 2011 to 2018, and the highest prevalence was found in the 26-35-year-old age range. Illicit drugs showed the highest overall prevalence in drivers <26 years of age but, if considering single drugs, cocaine and opiates were mostly found in subjects older than 36 years of age. A higher percentage of drug-positive drivers was found on weekend nights for alcohol and on both weekend and weekday nights for drugs. The types of drugs used by drivers did not change during the studied period.
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Affiliation(s)
- Rossella Barone
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Alessio Giusti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Mattia Marzi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Francesca Rossi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Raffaella Roffi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
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Ginsburg BC. Strengths and limitations of two cannabis-impaired driving detection methods: a review of the literature. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:610-622. [DOI: 10.1080/00952990.2019.1655568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Brett C. Ginsburg
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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21
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Pelletti G, Verstraete AG, Reyns T, Barone R, Rossi F, Garagnani M, Pelotti S. Prevalence of therapeutic drugs in blood of drivers involved in traffic crashes in the area of Bologna, Italy. Forensic Sci Int 2019; 302:109914. [PMID: 31419592 DOI: 10.1016/j.forsciint.2019.109914] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Psychoactive medicines, such as benzodiazepines and Z-drugs (BdZ), antidepressants and antipsychotics (AA) and medical opioids (MO), have an impairing effect on driving ability. In previous epidemiological studies performed on impaired and/or injured drivers, not all relevant psychoactive substances were included in the toxicological assessment, and their prevalence may be underestimated. This study aims to assess the prevalence of a large set of psychoactive substances (n=53) in Italian drivers involved in a road traffic crash and in predefined population subgroups. MATERIALS AND METHODS The toxicological analyses were performed on the whole blood of 1026 drivers involved in a road traffic crash in the area of Bologna, Italy, from January 2017 to March 2018. Analyses were performed using GC-FID (alcohol), GCMS (illicit drugs) and LC/HRMS (psychoactive drugs). The population was divided into subgroups according to gender, age and crash time. Descriptive statistics were used in order to assess differences among sub-groups. RESULTS The highest prevalence was found for alcohol (17.3%), followed by medicinal drugs (13.6%) and illicit drugs (5.5%). The prevalence of BdZ, AA and MO were 7.3%, 7.2% and 3.1%, respectively. The frequency of BDZ and AA was significantly higher in female drivers and showed higher prevalence at increasing age. The presence of medicinal drugs was significantly higher during the week and in crashes occurring during the day. CONCLUSION Results for alcohol and illicit drugs partially overlap with those reported in previous European and Italian studies, but the prevalence of BdZ was much higher. We also found a high prevalence of AA, which are rarely investigated in epidemiological studies performed on drivers, but may cause impairment of the ability to drive, especially when taken in combination with alcohol or other drugs. The pattern of medication use differs from that involving drugs of abuse, since it is mainly observed in female subjects and older drivers and does not follow the same weekly trend observed for alcohol and other illicit drugs.
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Affiliation(s)
- Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Alain G Verstraete
- Ghent University Hospital, Department of Laboratory Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Diagnostic Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Tim Reyns
- Ghent University Hospital, Department of Laboratory Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Diagnostic Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Rossella Barone
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Francesca Rossi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
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Pascali JP, Vaiano F, Palumbo D, Umani Ronchi F, Mari F, Bertol E. Psychotropic substance abuse and fitness to hold a driving license in Italy. TRAFFIC INJURY PREVENTION 2019; 20:244-248. [PMID: 31013165 DOI: 10.1080/15389588.2019.1579320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
Objective: Driving under the influence (DUI) of psychotropic substances is a serious and widespread problem in road safety. All countries try to reduce the impact with legislative controls over the criteria to regain a driver's license after suspension. In many European countries there are mandatory clinical and toxicological examinations required before a license is regranted. In Italy, individuals convicted of driving under the influence of drugs and/or alcohol must undergo a mandatory medico-legal and forensic toxicological examination prior to regranting of a license. This article reports on the prevalence, trends, and implications of psychotropic substances detected in more than 5,000 subjects submitted to driving license reissuance in the period 2011-2016. Methods: The study involved taking a clinical history, medical examination, and toxicological analysis of both urine and hair samples. Results: There was no change in the prevalence of psychoactive substances in the period 2011-2016. Cocaine was found most often (60%), followed by cannabinoids (15%) and opiates (9%). Methadone and amphetamine stimulants accounted for less than 5% each. Benzodiazepines were present in 15% of samples throughout the period. Conclusion: Cocaine and cannabinoids were the most used substances in the analyzed population, alone and in combination. Benzodiazepines were the most commonly detected prescription medication, raising questions about prescribed medication and driving risk that are not addressed by current legislation.
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Affiliation(s)
- Jennifer P Pascali
- a Forensic Toxicology Division, Department of Health Sciences , University of Florence , Florence , Italy
| | - Fabio Vaiano
- b Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Diego Palumbo
- a Forensic Toxicology Division, Department of Health Sciences , University of Florence , Florence , Italy
| | - Federica Umani Ronchi
- c Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences , Sapienza University of Rome , Rome , Italy
| | - Francesco Mari
- a Forensic Toxicology Division, Department of Health Sciences , University of Florence , Florence , Italy
| | - Elisabetta Bertol
- a Forensic Toxicology Division, Department of Health Sciences , University of Florence , Florence , Italy
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Khojah HM. Do pharmacists counsel customers about the effects of sedating antihistamines on driving skills? A survey of community pharmacies in Saudi Arabia. J Int Med Res 2019; 47:2018-2025. [PMID: 30885078 PMCID: PMC6567744 DOI: 10.1177/0300060519838953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the level of counselling regarding the effects of sedating antihistamines on driving skills provided by private community pharmacies in Madinah, Saudi Arabia. Methods This study randomly selected private community pharmacies. Mystery shoppers following a similar scenario individually visited these pharmacies. These clients asked for a commonly used brand of sedating antihistamine and noted the counselling offered by the pharmacist. If spontaneous counselling was not offered, necessary information regarding the medication’s use was requested. Finally, the content of counselling was documented. Results Of the 100 pharmacies selected, 12 were excluded for various reasons and 88 pharmacies were included in the study. Only 23 pharmacies offered spontaneous counselling. Although 73.9% of pharmacists (65 of 88), spontaneously or upon request, mentioned sedation as a side-effect, only one pharmacist warned the client against driving after taking the medication, and three other pharmacists warned against dealing with hazardous machinery. Other side-effects were almost ignored. Conclusion A life-threatening insufficiency in the quality of counselling at Saudi Arabian private community pharmacies exists. Traffic accidents, secondary to the side-effects of sedating antihistamines, may be avoided if proper counselling is offered. Saudi Arabian authorities should take appropriate actions to ensure optimal practice in community pharmacies.
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Affiliation(s)
- Hani Mj Khojah
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia
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Affiliation(s)
- Maude Marillier
- Department of Continuing Education of the Faculty of Medicine Lille University Lille France
| | - Alain G. Verstraete
- Department of Diagnostic Sciences Ghent University Ghent Belgium
- Department of Laboratory Medicine Ghent University Hospital Ghent Belgium
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A Systematic Review of the Efficacy of Cannabinoid Agonist Replacement Therapy for Cannabis Withdrawal Symptoms. CNS Drugs 2018; 32:1113-1129. [PMID: 30361897 DOI: 10.1007/s40263-018-0577-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND About 30% of regular cannabis users report withdrawal symptoms on cessation of prolonged use, such as irritability, insomnia, decreased appetite, depressed mood, anxiety, and restlessness. However, among highly dependent and/or in-treatment users, the incidence of withdrawal can be even higher, reaching up to 50-95% of individuals. This syndrome was only recognized by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as a diagnosis with specific criteria in 2013. The treatment options are poor, with high rates of relapse and non-responders. In this scenario, agonist replacement therapy with cannabinoids has demonstrated potential as a promising therapeutic intervention, with a series of studies having been carried out in recent years. OBJECTIVE This review sought to summarize trials with cannabinoid agonist replacement therapy for cannabis withdrawal symptoms with the aim of evaluating the efficacy of this pharmacological intervention. DATA SOURCES We entered the following search terms on the PubMed, Web of Science and PsycINFO databases: (marijuana OR marihuana OR cannabis OR THC OR tetrahydrocannabinol OR hashish OR pot) AND (treatment OR medication) AND (withdrawal OR abstinence) AND (dronabinol OR nabilone OR nabiximols OR sativex OR cesamet OR synthetic cannabinoid). The date of the most recent search was September 2017. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Original trials, published in English, performed on humans and dealing with cannabis users who were treated for cannabis withdrawal symptoms using synthetic cannabinoids were all included in the present systematic review. Quality and risk of bias across studies were assessed using a Cochrane tool. STUDY APPRAISAL AND SYNTHESIS METHODS The first, second, and last authors read the abstracts of all studies found in the search (n = 243). The inclusion and exclusion criteria were applied, and 233 articles were excluded. The first and second authors independently developed a data extraction sheet based on the included articles. RESULTS The present review included ten original articles. Despite the limited number of studies and methodological differences, our findings demonstrate that the use of dronabinol, nabilone, or nabiximols, either alone or in combination with other drugs, shows promise in reducing cannabis withdrawal symptoms, probably with a dose-dependent effect. This has also been considered a safe group of medications with good tolerability and few adverse effects. LIMITATIONS No method of handling data and combining results of studies was carried out, representing a limitation of the review. CONCLUSIONS AND IMPLICATION OF THE KEY FINDINGS Cannabinoids appear to be a promising group of drugs for the treatment of cannabis withdrawal symptoms. These medications may help decrease the rate of relapse in the treatment of cannabis dependence due to withdrawal symptoms occurring within the first few weeks of treatment. SYSTEMATIC REVIEW REGISTRATION The protocol for this review has been registered in the PROSPERO International prospective register of systematic reviews (PROSPERO 2014:CRD42014014118).
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