Alcohol and drugs in seriously injured drivers in six European countries.

The objective of this study was to determine the presence of alcohol and drugs in drivers severely injured in traffic crashes in six European countries. Data were collected from 2492 seriously injured drivers of cars and vans in Belgium, Denmark, Finland, Italy, Lithuania, and the Netherlands, between 2007 and 2010. Toxicological analysis was performed with chromatographic techniques on whole blood for 23 substances. The percentage of drivers positive for at least one psychoactive substance ranged between 28% (Lithuania) and 53% (Belgium). Alcohol (≥0.1 g/L) was the most common finding with the highest percentage in Belgium (42.5%). Among the alcohol-positive drivers, 90.5% had a blood alcohol count (BAC) ≥0.5 g/L and 65.7% had a BAC ≥1.3 g/L. Benzodiazepines (0.0-10.2%) and medicinal opioids (0.5-7.8%) were the most prevailing medicinal drugs, but half of the concentrations were lower than therapeutic. Cannabis (0.5-7.6%) was the most prevailing illicit drug. Alcohol was found in combination with drugs in 2.3-13.2% of the drivers. Drug combinations were found in 0.5-4.3% of the drivers. This study confirms the high prevalence of psychoactive substances in injured drivers, but we observed large differences between the participating countries. Alcohol was the most common finding, followed by cannabis and benzodiazepines. Notable are the many drivers having a BAC ≥ 1.3 g/L. The majority of the substances were found in combination with another psychoactive substance, mostly alcohol. The high prevalence of high BACs and combinations (compared to roadside surveys) suggest that those drivers are most at risk and that preventive actions should target them preferentially.

[Psychoactive drugs and accident risk in road traffic]. / Psykoaktiiviset aineet ja onnettomuusriski tieliikenteessä.

In the DRUID (Driving under the influence of drugs, alcohol and medicines) study, the risk of injury and death was calculated for different psychoactive substances on the basis of samples collected from drivers in road traffic and in various accident situations. The number of persons having used alcohol or drugs with negative effects on the ability to drive was lower in Finland than in Europe on the average. Aggravated drunk drivers and mixed substance abusers pose an accident risk that can be several hundredfold higher compared with sober drivers. More attention should be focused on traffic risks due to mixed use of drugs and alcohol.

Substance use and social, health and safety-related factors among fatally injured drivers.

OBJECTIVE: The aim of this study was to examine different socio-demographic, health and safety-related factors, and psychoactive substance use among fatally injured drivers in road traffic accidents in Finland during 2006-2008. METHODS: An accident information register maintained by the Traffic Safety Committee of Insurance Companies (VALT) of the Finnish Motor Insurers' Centre was used as basic data, and the basic data were complemented with further toxicological analytical information retrieved from autopsy reports from the Department of Forensic Medicine, Helsinki University. The data included all the drivers (n=556) who were driving a motor vehicle and who died in a road traffic accident in Finland during 2006-2008. RESULTS: Of all the 556 fatally injured drivers 43% (n=238) had psychoactive substance findings. 51% (n=121) of substance positive drivers had a finding for alcohol only, the rest had a finding for one or more illicit/medicinal drugs impairing driving ability, and possibly also alcohol. Fatally injured drivers with alcohol findings were significantly younger (mean age 34 years) than sober drivers (mean age 44 years) or drivers with findings for drugs (mean age 45 years). Socio-demographic background did not differ substantially among drunken/drugged and sober drivers, although drivers with alcohol findings had a slightly lower education and socioeconomic position. Previous substance abuse problems were highly prevalent among drivers with substance findings and mental or both mental and physical health problems were more common among drivers with drug findings. The non-use of safety equipment and driving at a high speed were more common among fatally injured drivers with substance findings. CONCLUSIONS: Substance abuse and mental health problems, as well as reckless driving behavior were more pronounced among fatally injured drivers with substance findings when compared to sober drivers. Thus, prevention and early intervention concerning substance abuse, mental health problems and DUI are essential. Improved traffic safety cannot be achieved by means of traffic policy only, but integration with other policies, such as health and social policy should be strengthened.

Cannabis findings in drivers suspected of driving under the influence of drugs in Finland from 2006 to 2008.

The authors examined driving under the influence of drugs (DUID) cases which were found to be positive in whole blood for cannabis in Finland from 2006 to 2008. Factors studied were the number of cases positive for any combination of Δ(9)-tetrahydrocannabinol (THC) and the metabolites 11-hydroxy-Δ(9)-tetrahydrocannabinol (THC-OH) and 11-nor-9-carboxy-Δ(9)-tetrahydrocannabinol (THC-COOH). Concurrent use of amphetamines, benzodiazepines and/or alcohol was also recorded, as well as the drivers' age and gender. Altogether 2957 cannabis positive cases were retrieved from the database of the Alcohol and Drug Analytics Unit, National Institute for Health and Welfare. Drug findings were examined in relation to the zero-tolerance policy operated towards DUID in Finland. The number of cannabis positive cases in each year was approximately 1000 and the main demographic of cases was males aged 20-30 years. In the majority of cases (51.6%) the inactive metabolite THC-COOH was the only indication of cannabis use, however, associated use of amphetamines (58.8% of all cases) and/or benzodiazepines (63.9%) in cannabis positive drivers was very common. Detections for amphetamines and/or benzodiazepines were especially common in drivers with THC-COOH only (92.8% of these cases). Combined use of alcohol (25.7%) was also prevalent. Suspect DUID cases generally arise from suspicion on behalf of the police and the zero-tolerance policy offers an expedient means to deal with the challenges presented in DUID, particularly in view of the high incidence of multiple drug use - the legislation is not unduly punitive when enforced in this manner.

Benzodiazepine whole blood concentrations in cases with positive oral fluid on-site screening test results using the DrugWipe(®) single for benzodiazepines.

Reliable on-site oral fluid screening devices are a useful and convenient means of policing traffic. In Finland, benzodiazepines represent a particular challenge to traffic safety. This study presents a retrospective examination of toxicological analysis results from whole blood in cases which gave a positive screening result for benzodiazepines in oral fluid using the DrugWipe Single device (Securetec). Use of oral fluid on-site screening tests and blood confirmation analyses reflects the real situation in many countries. The data were compiled from the databases of Alcohol and Drug Analytics Unit at the National Institute for Health and Welfare. Confirmation analysis results in whole blood were obtained using gas chromatography-mass spectrometry. Data were from 224 real cases in which the Finnish police had conducted a DrugWipe Single benzodiazepines test on drivers suspected of driving under the influence of drugs (DUID). The benzodiazepine concentrations encountered in positive oral fluid screening cases in this study indicate that the device is able to detect these substances even at relatively low levels. However, the DrugWipe device does not enable any distinction between therapeutic use and harmful use of benzodiazepines at higher doses.

An evaluation of on-site oral fluid drug screening devices DrugWipe 5+ and Rapid STAT using oral fluid for confirmation analysis.

In this study, the performance of two on-site oral fluid drug-testing devices, DrugWipe 5(+) (Securetec) and Rapid STAT (Mavand), was assessed. The results obtained by the devices were compared with gas chromatography-mass spectrometry confirmation analysis results in oral fluid. Sensitivity, specificity, and accuracy of the tests, as well as positive and negative predictive values, were calculated based on the classified results of the comparison. Both of the devices were evaluated for their ability to meet toxicological cutoffs as set in the DRUID project (www.druid-project.eu) as well as those reported by the manufacturers. The evaluation was performed for relevant drug groups of both devices: amphetamines, cannabis, cocaine, and opiates. Additionally, Rapid STAT has a test for benzodiazepines included in the same device. Both tests seemed to perform quite well for amphetamines although they also gave negative results for cases with high concentrations. Also, the benzodiazepine test of Rapid STAT was at a relatively good level although only half of the positive test results were true positives using the test cutoffs. The same phenomenon was detected for the cannabis tests of both devices. The proper evaluation of cocaine and opiates tests was not applicable because of the very low number of positive cases.

Performance evaluation of the DrugWipe® 5/5+ on-site oral fluid screening device.

This study presents a retrospective performance evaluation of an on-site oral fluid drug screening device DrugWipe® 5/5+ (Securetec). The results obtained by the device were compared with gas chromatography-mass spectrometry confirmation analysis results in whole blood. Data used in the comparison were based on 1,807 real cases in which the Finnish police had conducted an on-site drug test on persons suspected of driving under the influence of drugs. The present data cover only cases wherein the DrugWipe device has shown a positive result for at least one substance. The data were compiled from the databases of Alcohol and Drug Analytics Unit at the National Institute for Health and Welfare. The performance of the DrugWipe was evaluated for its relevant drug groups: amphetamines, cannabis, opiates, and cocaine. The evaluation was carried out by calculating the sensitivity, specificity, and accuracy as well as the positive and negative predictive values. These calculations were based on the classification of the results as true positives, false positives, true negatives, and false negatives. Additionally, the demographics of the cases and analytical findings in whole blood are discussed. According to this study, the DrugWipe device performed quite well in detecting amphetamines, the most frequently encountered group of illicit drugs in Finnish traffic. The performance of the cannabis, opiate, and cocaine tests was not at the same level.

An analytical evaluation of eight on-site oral fluid drug screening devices using laboratory confirmation results from oral fluid.

The performance of eight on-site oral fluid drug screening devices was studied in Belgium, Finland and the Netherlands as a part of the EU-project DRUID. The main objective of the study was to evaluate the reliability of the devices for testing drivers suspected of driving under the influence of drugs (DUID). The performance of the devices was assessed by their ability to detect substances using cut-offs which were set at sufficiently low levels to allow optimal detection of positive DUID cases. The devices were evaluated for the detection of amphetamine(s), cannabis, cocaine, opiates and benzodiazepines when the relevant test was incorporated. Methamphetamine, MDMA and PCP tests that were included in some devices were not evaluated since there were too few positive samples. The device results were compared with confirmation analysis results in oral fluid. The opiates tests appeared to perform relatively well with sensitivity results between 69 and 90%. Amphetamines and benzodiazepines tests had lower sensitivity, although the DrugWipe test evaluated was promising for amphetamine. In particular, it is evident that the cannabis and cocaine tests of the devices still lack sensitivity, although further testing of the cocaine tests is desirable due to the low prevalence and low concentrations encountered in this study.

Benzodiazepines and sedative-hypnotics in blood of drivers under the influence and their association with other common illegal drug use and national sales figures.

The authors examined benzodiazepine and sedative-hypnotic positive cases of drivers under the influence (DUI) in Finland from 1997 to 2008. Factors studied were the number of cases positive for the most commonly encountered of these pharmaceuticals, simultaneous use of amphetamine and/or cannabis, and the relationship between the number of DUI cases and overall sales in Finland for the individual pharmaceuticals. Data for 20037 cases positive for the relevant drugs were retrieved from the laboratory database of the Alcohol and Drug Analytics Unit, National Institute for Health and Welfare. Toxicological results were from blood analysis. Drug sales figures for each pharmaceutical were obtained from the Finnish Medicines Agency. An increase in DUI cases that were positive for the drugs studied was evident, which reflected the overall increase in positive DUI cases detected annually. The proportion of relevant cases was typically 75% or higher of all positive DUI cases up to 2003, the year that the Finnish zero tolerance law was introduced, and then decreased to 66.2% in 2008. Diazepam was consistently the most commonly detected nonmetabolite drug. The prevalence of clonazepam and alprazolam increased sharply from 2004 onward. Metabolites of diazepam, nordiazepam, temazepam, and oxazepam, were other common findings. Associated use of amphetamine and/or cannabis was also common in these DUI cases, typically between 56% and 66% of cases. An increase in the number of DUI cases showing combined use of benzodiazepines and sedative-hypnotics with amphetamines in particular was apparent after zero tolerance legislation and the introduction in 2005 of an effective on-site screening device for the stimulant. Ratios of DUI cases to sales figures showed an increase in detection of clonazepam-positive DUI cases from 2003. Diazepam, midazolam, and alprazolam also exhibited relatively high ratios, which increased from 1997 to 2008.