Incidence of drug and alcohol intake in road traffic accident victims

Benzodiazepine drugs in Australia: associated mortality and morbidity

The use of benzodiazepine drugs in Australia results not only in widespread therapeutic benefits but also in harmful outcomes at both an individual and societal level. Accurate measurement of the level of harm has been precluded by a lack of robust data relating to the use of these drugs and to the resulting adverse consequences. This paper examines existing mortality and morbidity data, comments upon the available data sources and recommends areas where research is needed in order to clarify the relationship between the use of benzodiazepines and associated adverse effects.

Alcohol use and abuse in training conscripts of the Hellenic navy

OBJECTIVES

Alcohol abuse and addiction are big current problems of the developed world having multivariate causality and multiple effects. Alcohol abuse in young people is a matter of central importance due to its wide range long lasting effects, especially so in Greece where the problem has only recently started growing. The Hellenic Navy is interested in the complications of alcohol abuse in training conscripts. Because young conscripts will be placed in demanding positions, but also because in Greece the military service is obligatory and represents an important period for the socialization of young men.

METHODS

In the present study, levels of alcohol use and abuse were measured in a sample of 650 male training conscripts of the Hellenic Navy. The tools used are: (a) two questionnaires measuring frequency and quantity of alcohol consumption and psychosocial variables, (b) the CAGE test, which is a questionnaire measuring hidden alcoholism.

RESULTS

38,1% conscripts were characterized problematic drinkers according the adolescents criteria. Additional psychological complications were related to alcohol use. Using the stricter criterion for adults (plus psychological complications) 8.9% were found to be problematic drinkers. The use of CAGE questionnaire which is measuring hidden alcoholism, identified 16% of the total sample as hidden alcoholics.

DISCUSSION

The findings regarding unregular levels of alcohol use and abuse are presented as well as their relation to psychosocial complications and to demographic characteristics. The results are discussed in the light of Creek and international bibliography.

A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions

The existing literature on the prevalence of drug driving, the effects of drugs on driving performance, risk factors and risk perceptions associated with drug driving was reviewed. The 12-month prevalence of drug driving among the general population is approximately 4%. Drugs are detected commonly among those involved in motor vehicle accidents, with studies reporting up to 25% of accident-involved drivers positive for drugs. Cannabis is generally the most common drug detected in accident-involved drivers, followed by benzodiazepines, cocaine, amphetamines and opioids. Polydrug use is common among accident-involved drivers. Studies of impairment indicate an undeniable association between alcohol and driving impairment. There is also evidence that cannabis and benzodiazepines increase accident risk. The most equivocal evidence surrounds opioids and stimulants. It is apparent that drugs in combination with alcohol, and multiple drugs, present an even greater risk. Demographically, young males are over-represented among drug drivers. Although there is an association between alcohol use problems and drink driving, it is unclear whether such an association exists between drug use problems and drug driving. Evidence surrounding psychosocial factors and driving behaviour is also equivocal at this stage. While most drivers perceive drug driving to be dangerous and unacceptable, there is less concern about impaired driving among drug drivers and drink drivers than from those who have not engaged in impaired driving. Risk perceptions differ according to drug type, with certain drugs (e.g. cannabis) seen as producing less impairment than others (e.g. alcohol). It is concluded that drug driving is a significant problem, both in terms of a general public health issue and as a specific concern for drug users.

Drug and alcohol use among injured motor vehicle drivers in Sweden: prevalence, driver, crash, and injury characteristics

Injured motor vehicle drivers who were hospitalized (Umeå: n = 130) and fatally injured drivers who were autopsied (Umeå, Northern Sweden: n = 111; Gothenburg, Western Sweden: n = 136) from May 1991 through December 1993 were tested for alcohol and for both licit and illicit drugs. Nineteen percent of the Umeå-hospitalized drivers (UHDs), 26% of the Umeå fatally injured drivers (UFDs), and 21% of the Gothenburg fatally injured drivers (GFDs) tested positive for drugs and/or alcohol. Ten percent of the UHDs, 8% of the UFDs, and 6% of the GFDs tested positive for drugs. Almost 5% of the UHDs, had illicit drugs, and 6% had licit drugs. Only 3% of the GFDs and none of the UFDs had illicit drugs. Benzodiazepines, followed by opiates, tetrahydrocannabinol, and amphetamine were the most common drugs detected. Twelve percent of the UHDs, 24% of the UFDs, and 17% of the GFDs tested positive for alcohol. Two percent of the UHDs, 6% of the UFDs, and 2% of the GFDs had a combination of drugs and alcohol.

Low blood alcohol concentrations and driving impairment. A review of experimental studies and international legislation

While noting that there is no international scientific or legislative uniformity in blood alcohol concentration (BAC) levels admissible for driving motor vehicles, the authors analyse problems concerning the effects of low levels of ethyl alcohol on driving ability. A summary of the international literature on this subject reveals: the existence of contrasting assumptions, with scientific evidence clearly demonstrating altered psychomotor functions; the need to adopt sufficiently complex psychometric tests to reveal the effects of low BACs; the need to improve standardization of experimental studies on man-machine interaction; the need to investigate the following areas: tolerance to alcohol; low BACs with inexperienced, infrequent drinkers and chronic, heavy drinkers; hangover effects; alcohol-gender-age interactions, and specific effects on young drivers; alcohol-drug combinations. The analysis of legislation and enforcement policies also reveals the need for: re-evaluation of the international legal BAC threshold and standardization of procedures for ascertaining the degree of driving disability; further scientific research to compare and evaluate selected legislative initiatives currently in place in most states; to identify the best strategies and procedures to detect and arrest impaired drivers; to determine the optimum random testing rate to maximize deterrent effects in the workplace at minimal cost; to design innovative and comprehensive approaches to rehabilitation programs needed for subgroups of offenders and of workers; to study the effectiveness of new legislations and policies.

Automated screening procedure using gas chromatography-mass spectrometry for identification of drugs after their extraction from biological samples

A novel analytical screening procedure has been developed, using computer-controlled gas chromatography-mass spectrometry (GC-MS), to detect 120 drugs of interest to road safety. This paper describes GC-MS methodology suitable for use on extracts of biological origin, while extraction procedures will be the subject of a future communication. The method was devised to identify drugs in extracts of blood samples, as part of an investigation into the involvement of drugs, other than alcohol, in road accidents. The method could be adapted to screen for other substances. The method depends on a "macro" program which was written to automate the search of GC-MS data for target drugs. The strategy used was to initially search for each drug in the database by monitoring for a single characteristic ion at the expected retention time. If a peak is found in this first mass chromatogram, a peak for a second characteristic ion is sought within 0.02 min of the first and, if found, the ratio of peak areas calculated. Probable drug identification is based on the simultaneous appearance of peaks for both characteristic ions at the expected retention time and in the correct ratio. If the ratio is outside acceptable limits, a suspected drug (requiring further investigation) is reported. The search macro can use either full mass spectra or, for enhanced sensitivity, data from selected ion monitoring (which requires switching between groups of ions during data acquisition). Quantitative data can be obtained in the usual way by the addition of internal standards.

Drugs, alcohol and road accidents in Tasmania

Drug analyses were performed on 200 blood samples that were taken for alcohol analysis from road users in Tasmania. Alcohol at a concentration of above 0.5 g was found in 75% of the samples, and other drugs were found in 17% of the samples. Cannabis was the most prevalent of these other drugs: it was detected in 6% of road users; benzodiazepine drugs were detected in 5% of road users; and barbiturate drugs were detected in 2% of road users. Alcohol was found in 50% and other drugs were found in 25%, of drivers, riders and pedestrians who were involved in road accidents that were serious enough to cause death or injury. In addition to alcohol, other drugs may be making a significant contribution to road accidents because all the drugs that were identified are capable of impairing psychomotor performance. Of particular concern is the prevalence of cannabis, which is an illegal drug, and barbiturate drugs, which are now prescribed rarely. A well-controlled study is required to quantitate the contribution of drugs other than alcohol to road accidents. In the meantime, drivers should be warned that drugs that depress the central nervous system can be expected to impair driving ability and to increase the risk of an accident.

Factors affecting the drinking driver

Although the relationship between alcohol and traffic safety has been the subject of numerous studies, much remains unknown about the mechanisms by which alcohol contributes to traffic accidents. A number of other factors, which are reviewed in this paper, also can contribute to car accidents. They may also interact with alcohol, perhaps in a complex manner. Therefore, multiple factors rather than one single factor may contribute to automobile accidents for those who drink and drive.

Drugs and the impaired driver in Northern Ireland: an analytical survey

The techniques used to analyse 212 "under-the-limit" drink-driving blood and urine specimens for drugs during a 3-year period (1982-85) in Northern Ireland are described. In all of these specimens (representing 15% of all below-limit cases) either the police surgeon who carried out the clinical examination, or the police, strongly suspected that drugs may have been a contributory factor in driving impairment, considering the lower than expected alcohol concentration. Thirty-eight (18%) samples were found to contain significant drug(s). Benzodiazepines were the most frequently encountered group of drugs (87% of all positive cases) with diazepam being that most frequently encountered (18 cases). The analytical procedures were radioimmunoassay, gas chromatography using nitrogen selective and electron capture detection along with high performance liquid chromatography (HPLC) using ultra-violet detection. Drugs and their metabolites were identified using a mixture of these techniques along with GC/MS where possible. The usefulness of HPLC coupled with a rapid-scanning diode-array spectrophotometer is also demonstrated, the technique being particularly useful in the analysis of some of the more "difficult" benzodiazepines (e.g. lorazepam, temazepam, nitrazepam) not directly amenable to gas chromatography without derivatisation.

Biological markers of alcohol intake among 4796 subjects injured in accidents

An epidemiological survey was carried out in France in 1982-3 to study the proportions of occasional and chronic drinkers among people injured in accidents of all kinds. The characteristics of 4796 victims recruited in the emergency units of 21 hospitals were recorded. Systematic blood sampling was performed to determine the blood alcohol concentration and two markers of chronic alcohol consumption--gamma-glutamyltransferase activity and mean corpuscular volume. Alcohol was present in the blood of 35% of the injured people, with concentrations exceeding 17.4 mmol/l (0.8 g/l) in one man out of four and in one woman out of 10. gamma-Glutamyltransferase values and mean corpuscular volume were also much higher than in a reference population of healthy subjects, indicating that most of the intoxicated subjects were probably chronic drinkers. This was confirmed by a discriminant analysis which showed an overall proportion of 30% of chronic drinkers among casualties. In France, therefore, the policy for preventing accidents should focus on chronic as much as on occasional drinking.

Effects of combined alcohol and benzodiazepine: a review

Both human and animal studies relating to the combined effects of alcohol and benzodiazepine (BZD) are reviewed. Although the combination of alcohol and BZD is sometimes associated with drug-induced deaths, drug overdoses and traffic accidents or fatalities, epidemiological information is lacking on the true extent of the combined abuse and on the patterns and prevalence of use of these two drugs. Since BZD are widely used for the short- and long-term treatment of alcoholics, these patients are deemed more at risk of developing BZD or alcohol/BZD dependence than the general population. There is a dire need for large-scale controlled studies concerning the efficacy of BZD in the long-term treatment of alcoholics. Compared to men, women are at a higher risk as far as the potential for BZD addiction is concerned, since they tend to use BZD more often. Epidemiologic studies on the patterns of use of BZD, alcohol or alcohol/BZD in pregnant women are called for. Animal models are also needed to ascertain whether prenatal exposure to both alcohol and BZD can impart long-lasting behavioral changes in the progeny. It is possible that BZD can exacerbate the damaging prenatal effects of alcohol.