Search

Important events in the history of driving under the influence of alcohol (DUI) and/or other drugs (DUID) are reviewed covering a period of approximately 100 years. This coincides with major developments in the pharmaceutical industry and the exponential growth in motor transportation worldwide. DUID constitutes an interaction between the driver, the motor-driven vehicle, and one or more psychoactive (mind-altering) substances. In this connection, it is important to differentiate between drugs intended and used for medical purposes (prescription or licit drugs) and recreational drugs of abuse (illicit drugs). All chemicals with a mechanism of action in the central nervous system (brain and spinal cord) are potentially dangerous to use when skilled tasks, such as driving, are performed. The evidence necessary to charge a person with drug-impaired driving has evolved over many years and initially rested on a driver's own admissions and observations made about the driving by police officers or eyewitnesses. Somewhat later, all suspects were examined by a physician, whose task was to ask questions about any recent ingestion of alcohol and/or other drugs and to administer various clinical tests of impairment. By the 1940s-1950s, the driver was asked to provide samples of blood, breath, or urine for toxicological analysis, although the test results served only to verify the type of drug causing impairment of the driver. The current trend in DUID legislation is toward zero-tolerance or concentration per se statutes, which are much more pragmatic, because behavioral evidence of impairment is no longer a lynchpin in the prosecution case. This legal framework puts considerable emphasis on the results of toxicological analysis; therefore, the methods used must be accurate, precise, and fit for forensic purposes. Many traffic delinquents charged with DUI or DUID suffer from a substance use and/or personality disorder, with high recidivism rates. In addition to conventional penalties and sanctions for drug-related traffic crimes, many offenders would probably benefit from a medical intervention, such as counseling, rehabilitation, and treatment for substance use disorder, which often coexists with a mental health problem. [ABSTRACT FROM AUTHOR]

Experimental, epidemiological, and real-case studies have different advantages and limitations when used to study the effect of substance use on the risk for involvement in a road traffic crash. It is easier to perform well-controlled experimental studies than well-controlled epidemiological studies due to difficulties related to selection bias, information bias, and confounding. On the other hand, it is difficult or impossible to perform experimental studies using single and repeated substance doses similar to those used by drivers and problematic drugs users. Real-case studies indicate which substances may cause observed impairment and involvement in road traffic crashes and at which concentrations; however, those studies cannot be used to quantify crash risks or determine causality. All three types of studies are needed to obtain a broad and complete picture as they may complement each other when assessing the effects of substance use on road traffic safety. [ABSTRACT FROM AUTHOR]

Trends in the use of alcohol and drugs among motor vehicle drivers in Australia, Brazil, Norway, Spain, and the United States have been reviewed. Laws, regulations, enforcement, and studies on alcohol and drugs in biological samples from motor vehicle drivers in general road traffic and fatal road traffic crashes (RTCs) are discussed. Roadside surveys showed a reduction of drunk driving over time in the studied countries; however, the pattern varied within and between different countries. The reduction of alcohol use may be related to changes in road traffic laws, public information campaigns, and enforcement, including implementation of random breath testing or sobriety checkpoints. For non-alcohol drugs, the trend in general road traffic is an increase in use. However, drugs were not included in older studies; it is therefore impossible to assess the trends over longer time periods. Data from the studied countries, except Brazil, have shown a significant decrease in fatal RTCs per 100,000 inhabitants over the last decades; from 18.6 to 4.9 in Australia, 14.5 to 2.9 in Norway, 11.1 to 3.6 in Spain, and 19.3 to 10.3 in the United States. The number of alcohol-related fatal RTCs also decreased during the same time period. The proportion of fatal RTCs related to non-alcohol drugs increased, particularly for cannabis and stimulants. A general challenge when comparing alcohol and drug findings in biological samples from several countries is connected to differences in study design, particularly the time period for performing roadside surveys, biological matrix types, drugs included in the analytical program, and the cutoff limits used for evaluation of results. For RTC fatalities, the cases included are based on the police requests for legal autopsy or drug testing, which may introduce a significant selection bias. General comparisons between high-income countries and low- and middle-income countries as well as a discussion of possible future trends are included. [ABSTRACT FROM AUTHOR]

Experimental studies on the impairing effects of drugs of relevance to driving-related performance published between 1998 and 2015 were reviewed. Studies with on-the-road driving, driving simulators, and performance tests were included for benzodiazepines and related drugs, cannabis, opioids, stimulants, GHB, ketamine, antihistamines, and antidepressants. The fi ndings in these experimental studies were briefly discussed in relation to a review of epidemiological studies published recently. The studies mainly concluded that there may be a significant psychomotor impairment after using benzodiazepines or related drugs, cannabis, opioids, GHB, or ketamine. Low doses of central stimulants did not seem to cause impairment of driving behavior. [ABSTRACT FROM AUTHOR]

Click here to view the Original Article by K. Gémes et al. [ABSTRACT FROM AUTHOR]

Epidemiological studies of the association between drug use and involvement in road traffic crashes (RTCs) published from January 1998 to February 2015 have been reviewed. Cohort and population studies compared RTC involvement among drug users and non–drug users, case-control studies compared drug use among RTC-involved and non–RTC-involved drivers, and responsibility studies and case-crossover studies were performed for RTC-involved drivers. Difficulties associated with the types of studies are discussed with a special focus on case-control studies. Statistically significant associations between drug use and RTC involvement were found for benzodiazepines and z-hypnotics in 25 out of 28 studies, for cannabis in 23 out of 36 studies, for opioids in 17 out of 25 studies, for amphetamines in 8 out of 10 studies, for cocaine in 5 out of 9 studies, and for antidepressants in 9 out of 13 studies. It was a general trend among studies that did not report significant associations between the use of these drugs and increased RTC risk that they often had either poor statistical power or poor study design compared to studies that found an association. Simultaneous use of two or more psychoactive drugs was associated with higher RTC risk. Studies on the combination of alcohol and drugs have not been reviewed in this article even though this combination is known to be associated with the highest RTC risk. [ABSTRACT FROM AUTHOR]

The prevalence of re-arrest among drunken drivers in relation to different blood alcohol concentrations (BAC) at the time of the offences was studied. Between 38 and 50% of arrested drunk drivers were re-arrested for similar offences The frequency of re-arrests was, however, reduced during 1992 compared with 1986, but only significantly for those with a low BAC interval (60–90 mg/dl). We conclude that drivers with high re-arrest rates have a careless attitude to the Road Traffic Act and require a different treatment and follow-up programme. [ABSTRACT FROM PUBLISHER]

The article presents a study on the role of ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS) in determining ethylglucuronide (EtG) in oral fluid. It states that the presence of EtG in the blood or urine represents that there was a recent alcohol intake. The study asserts that aside from urine and blood, EtG can also be found in oral fluid and can be used to substitute urine and blood testing. The materials and methods used in the study including the preparation of the solutions, as well as the process of sampling are presented. The study concludes that through UPLC-MS-MS, the presence of EtG in oral fluid was quantified. Moreover, the study suggests that there should be further studies for evaluating the pharmacokinetics of EtG.