User experience and operational feasibility of four point-of-collection oral fluid drug-testing devices according to Brazilian traffic agents.

OBJECTIVE: Traffic fatalities in Brazil still rank among the highest worldwide, with an overall rate of 23.4 deaths/100,000 inhabitants/year. Although alcohol and drug use play an important role in traffic accidents, national data about their relative influence are scarce. Drug screening is not routinely performed by traffic agents because alcohol is the only substance regularly investigated in roadblocks. Therefore, we aimed to describe the initial traffic agent user experience for 4 handheld point-of-collection oral fluid drug testing devices used in routine roadblocks in Brazil, focusing on usage perceptions in hopes of generalizing this approach for other developing countries. METHODS: Four different oral fluid collection devices were evaluated: The DDS2, the DOA MultiScreen, the Dräger DrugTest 5000, and the Multi-Drug Multi-Line Twist Screen Device. Fourteen trained traffic agents obtained oral fluid from 164 drivers and performed 37 qualitative evaluations of the devices. Traffic agents filled out a questionnaire focusing on 9 feasibility criteria: Overall simplicity for roadside operation; operational success; saliva sample collection time; sample analysis time; ease of sample preparation and analysis; agreement with observed clinical signs; overall hygiene and safety; sufficient operating instructions; and hygiene of saliva collection. These were weighted based on an expert panel and yielded an overall composite device experience score that ranged from 1 (poor) to 100 (excellent). RESULTS: Ease of use, operational success, and acceptable collection and analysis time were considered the most important criteria by the expert panel. The results ranged from 27.3 to 88.9% for simplicity of use; 45.5 to 100.0% for operational success; 27.3 to 100% for acceptable collection time; and 36.4 to 100.0% for acceptable analysis time. The final device scores, based on the agents' user experiences, ranked as follows: DOA MultiScreen: 49.3/100; Dräger DrugTest 5000: 82.4/100; Multi-Drug Multi-Line Twist Screen Device: 84.3/100; DDS2: 88.4/100. CONCLUSION: Based on the selected criteria, 3 of the 4 devices were considered useful by traffic agents in routine roadblock operations. The weighted evaluations suggest that their ease of use (handling, sampling analysis, and reliability), as well as their agreement with findings obtained by other means, defined their utility to traffic agents, although such appraisals must be further analyzed in future studies.

Reliability of point-of-collection testing devices for drugs of abuse in oral fluid: A systematic review and meta-analysis.

Point-of-collection testing (POCT) devices for drugs of abuse are used to screen for the presence of psychoactive substances (PAS) in different types of settings and environments. However, these quick and advantageous tools also present disadvantages, including low-reliability measures in comparison to chromatographic assays. Therefore, this article presents a systematic review and meta-analysis of studies evaluating the reliability of measurements of PAS detection in oral fluid using POCT devices. The reliability measures for detection of the five most important drug classes - cocaine, amphetamines, benzodiazepines, cannabinoids and opioids, are reported. The article also presents a subgroup analysis considering the reliability estimates for the different POCT devices that were evaluated by the studies contemplated in the review. A discussion considering the strengths and limitations of POCT techniques was performed in order to guide policymakers, traffic agents and other professionals who also conduct such tests. The use of POCT devices often involves legal and moral aspects of the subjects tested, which demands critical evaluation of these devices before they are implemented in different settings.

Challenges associated with drunk driving measurement: combining police and self-reported data to estimate an accurate prevalence in Brazil.

BACKGROUND: Drunk driving is an important risk factor for road traffic crashes, injuries and deaths. After June 2008, all drivers in Brazil were subject to a "Zero Tolerance Law" with a set breath alcohol concentration of 0.1 mg/L of air. However, a loophole in this law enabled drivers to refuse breath or blood alcohol testing as it may self-incriminate. The reported prevalence of drunk driving is therefore likely a gross underestimate in many cities. OBJECTIVE: To compare the prevalence of drunk driving gathered from police reports to the prevalence gathered from self-reported questionnaires administered at police sobriety roadblocks in two Brazilian capital cities, and to estimate a more accurate prevalence of drunk driving utilizing three correction techniques based upon information from those questionnaires. METHODS: In August 2011 and January-February 2012, researchers from the Centre for Drug and Alcohol Research at the Universidade Federal do Rio Grande do Sul administered a roadside interview on drunk driving practices to 805 voluntary participants in the Brazilian capital cities of Palmas and Teresina. Three techniques which include measures such as the number of persons reporting alcohol consumption in the last six hours but who had refused breath testing were used to estimate the prevalence of drunk driving. RESULTS: The prevalence of persons testing positive for alcohol on their breath was 8.8% and 5.0% in Palmas and Teresina respectively. Utilizing a correction technique we calculated that a more accurate prevalence in these sites may be as high as 28.2% and 28.7%. In both cities, about 60% of drivers who self-reported having drank within six hours of being stopped by the police either refused to perform breathalyser testing; fled the sobriety roadblock; or were not offered the test, compared to about 30% of drivers that said they had not been drinking. DISCUSSION: Despite the reduction of the legal limit for drunk driving stipulated by the "Zero Tolerance Law," loopholes in the legislation permit many drivers under the influence of alcohol to act with impunity. In this context the police/traffic officers are often powerless to enforce the law and thus drunk driving continues to go unchecked. CONCLUSION: Strong legislation and effective enforcement are necessary to reduce the prevalence of this dangerous behaviour. Correction techniques allow calculation of a truer prevalence of drunk driving, which can assist police and policymakers alike to redirect resources and align strategies.

Dependência de álcool, cocaína e crack e transtornos psiquiátricos / Alcohol, cocaine, and crack dependence and psychiatric disorders

Este estudo objetivou verificar a frequência de transtornos psiquiátricos em dois grupos de dependentes químicos, cocaína/crack e álcool/cocaína/crack, por meio do Mini International Neuropsychiatric Interview (M.I.N.I Plus). Foram entrevistados 32 indivíduos do sexo masculino, com idade média de 27,65 (DP=7,38) anos. A maioria tinha Ensino Fundamental incompleto (34,37 por cento), era solteira (81,25 por cento) e relatou história familiar de consumo de álcool (76,5 por cento - grupo cocaína/crack; 53,3 por cento - grupo álcool/cocaína/crack). O período médio de abstinência era de 33,05 (DP=19,52) dias. Os resultados mostraram uma frequência maior de Transtorno do Humor nos dois grupos. Embora a diferença não tenha sido estatisticamente significativa, os dependentes de álcool/cocaína/crack apresentaram, adicionalmente, alta frequência de Transtorno de Personalidade, sugerindo a necessidade de tratamento diferencial para essa população.

This study investigated the frequency of psychiatric disorders in two groups of drug users, cocaine/crack and alcohol/cocaine/crack, by means of the Mini International Neuropsychiatric Interview (M.I.N.I Plus). The participants, 32 men, had an average age of 27.65 (SD=7.38) years. Most of them had not completed Fundamental School (34.37 percent), were single (81.25 percent) and reported a family history of alcohol consumption (76.5 percent - cocaine/crack; 53.3 percent - alcohol/ cocaine/crack). On average, the time of abstinence was 33.05 (SD=19.52) days. The results showed a high frequency of Mood Disorders in both groups. Although the difference was not statistically significant, the alcohol/cocaine/crack group presented, additionally, high frequency of Personality Disorder, suggesting the need of a distinct treatment for that population.

Atenção, ansiedade e raiva em dependentes químicos / La atención, ansiedad y rabia en los adictos químicos / Attention, anxiety and anger in drug-dependents

Este estudo teve como objetivo analisar e comparar a atenção difusa, atenção difusa complexa, atenção concentrada, atenção concentrada complexa, ansiedade e raiva entre três grupos: 1) controle; 2) dependentes de cocaína/crack e 3) dependentes de álcool e cocaína/crack. É uma pesquisa transversal, comparativa do tipo caso-controle, constituída por uma amostra não aleatória. Participaram 49 indivíduos, do sexo masculino com idades entre 18 e 57 anos, avaliados através da Bateria Geral das Funções Mentais 1 e 2; Inventário de Expressão de Raiva como Estado e Traço e Inventário de Ansiedade Beck. O tempo médio de abstinência das drogas foi de 33,05 (DP = 19,52) dias. Os resultados mostraram que na atenção não houve diferenças significativas na comparação entre os grupos. Entretanto, houve diferença nos níveis de ansiedade e raiva entre os dependentes químicos e controles. Conclui-se que não houve prejuízo cognitivo na atenção desses indivíduos, mas alterações emocionais na ansiedade e raiva.

This study had the objective to analyze and compare diffuse attention, complex attention, concentrated attention, anxiety and anger in control subjects and those dependent on alcohol, crack and cocaine. The participants (n = 49) were adult males from 18 to 57 years old, assigned to 3 groups: 1) controls; 2) cocaine/crack dependents; and 3) alcohol and cocaine/crack dependents. They were assessed by Mental Functions General Battery (BGFM 1 and 2); State-Trait Anger Expression Inventory (STAXI) and Beck Anxiety Inventory (BAI). The average time of abstinence was 33.05 (DP = 19.52) days. The results showed no statistically significant difference in cognition among the groups studied. However, there was a statistically significant difference in the anxiety and anger levels when comparing the control group to the group of alcohol, cocaine/crack dependents. It is possible to conclude that there was no cognitive deficit in attention, but emotional changes in anxiety and anger in these drug-dependent individuals.

Este estudio tuvo como objetivo analizar y comparar la atención difusa, atención difusa compleja, atención concentrada, atención concentrada compleja, ansiedad y rabia entre 3 grupos: 1) control, 2) adictos de cocaína/crack (pasta base) y 3) adictos de alcohol y cocaína/crack (pasta base). Es una investigación transversal, comparativa del tipo caso-control, constituida por una muestra no aleatoria. Participaron 49 individuos, del sexo masculino con edades entre 18 y 57 años, evaluados a través de la Batería General de Funciones Mentales 1 y 2; Inventario de Expresión de Rabia como Estado y Trazo e Inventario de Ansiedad Beck. El tiempo promedio de abstinencia de las drogas fue 33.,05 (DP = 19,5) días. Los resultados mostraron que en la atención no hubo diferencias significantes en la comparación entre los grupos. Sin embargo, hubo diferencia en los niveles de ansiedad y rabia entre los adictos químicos y controles. Se concluye que no hubo perjuicio cognitivo en la atención de estos individuos, pero alteraciones emocionales en la ansiedad y rabia.

Álcool e violência em homens e mulheres / Alcohol: gender and implications in the violence

O uso nocivo do álcool configura-se como um problema de saúde pública, associado ao aumento da violência, envolvendo ambos os sexos. Esse artigo tem por objetivo discutir sobre o impacto do uso do álcool em homens e mulheres do ponto de vista neurobiológico, enfatizando a ação psicoativa da substância e sua implicação no comportamento violento. Foi conduzida uma análise baseada em artigos selecionados nas fontes eletrônicas do Scielo, LILACS, MEDLINE, PubMed e Web of Science no período de 1996 a 2008. Do total de 420 artigos selecionados, 90 foram considerados relevantes para a análise. Verificou-se que o uso nocivo do álcool causa mudanças neuroquímicas e alterações nas funções cognitivas, podendo gerar comportamentos violentos em homens e mulheres, entretanto, evidenciou-se importantes diferenças entre os sexos quanto à ação psicoativa do álcool, assim como, no tipo de violência expressa. Estudos sobre a temática proposta ainda são escassos, sugerindo a necessidade de pesquisas futuras que possam contribuir para um melhor entendimento e para ações preventivas eficazes.

The abuse of alcohol can engender serious public health problems in certain people, particularly due to its link to violence involving both men and women. This article has the aim to discuss the impact of alcohol in men and women regarding neurobiological mechanisms, emphasizing its psychoactive effects as well as its implication for violent behavior. An analysis was conduct based on reviews and articles in electronic databases, selected from 1996 to 2008 at Scielo, Lilacs, MEDLINE, Pub Med and Web of Science. From a total of 420 selected articles 90 were considered relevant for this analysis. It was evident that the abuse of alcohol causes changes in neurochemistry and in cognitive functions, and some of those changes lead to violent behavior in men and women. However, there are important differences between both genders and the type of aggressive behavior expressed. Studies on this topic are still rare and more research is necessary in order to develop better diagnostic tools and favor relevant neurobiological mechanisms for more effective treatments.