Alcohol, psychoactive substances and non-fatal road traffic accidents - a case-control study

BMC Public Health

Øivind Ekeberg⁴  Ingeborg Rossow³  Per Trygve Normann¹  Hallvard Gjerde¹  Stig Tore Bogstrand² 

[1] Norwegian Institute of Public Health, Division of Forensic Medicine and Drug Abuse Research, PO Box 4404, Nydalen, Oslo, N-0403, Norway;Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Oslo, N-0407, Norway;National Centre for Suicide Research and Prevention, University of Oslo, Sognsvannsveien 21 Bygg 12, 0372, Oslo, Norway;Department of Acute Medicine, Oslo University Hospital, Ullevål, Oslo, N-0407, Norway

关键词: Road traffic accident;    Psychoactive substances;    Injury;    Emergency treatment;    Case–control;    Alcohol;   

Others  :  1163157
DOI  :  10.1186/1471-2458-12-734

 received in 2011-12-14, accepted in 2012-08-20,  发布年份 2012

【 摘 要 】

Background

The prevalence of alcohol and other psychoactive substances is high in biological specimens from injured drivers, while the prevalence of these psychoactive substances in samples from drivers in normal traffic is low. The aim of this study was to compare the prevalence of alcohol and psychoactive substances in drivers admitted to hospital for treatment of injuries after road traffic accidents with that in drivers in normal traffic, and calculate risk estimates for the substances, and combinations of substances found in both groups.

Methods

Injured drivers were recruited in the hospital emergency department and drivers in normal conditions were taken from the hospital catchment area in roadside tests of moving traffic. Substances found in blood samples from injured drivers and oral fluid samples from drivers in moving traffic were compared using equivalent cut off concentrations, and risk estimates were calculated using logistic regression analyses.

Results

In 21.9% of the injured drivers, substances were found: most commonly alcohol (11.5%) and stimulants eg. cocaine or amphetamines (9.4%). This compares to 3.2% of drivers in normal traffic where the most commonly found substances were z-hypnotics (0.9%) and benzodiazepines (0.8%). The greatest increase in risk of being injured was for alcohol combined with any other substance (OR: 231.9, 95% CI: 33.3- 1615.4, p < 0.001), for more than three psychoactive substances (OR: 38.9, 95% CI: 8.2- 185.0, p < 0.001) and for alcohol alone (OR: 36.1, 95% CI: 13.2- 98.6, p < 0.001). Single use of non-alcohol substances was not associated with increased accident risk.

Conclusion

The prevalence of psychoactive substances was higher among injured drivers than drivers in normal moving traffic. The risk of accident is greatly increased among drivers who tested positive for alcohol, in particular, those who had also ingested one or more psychoactive substances. Various preventive measures should be considered to curb the prevalence of driving under the influence of psychoactive substances as these drivers constitute a significant risk for other road users as well as themselves.

【 授权许可】

   
2012 Bogstrand et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bogstrand ST, Normann PT, Rossow I, Larsen M, Morland J, Ekeberg O: Prevalence of alcohol and other substances of abuse among injured patients in a Norwegian emergency department. Drug Alcohol Depend 2011, 117:132-138.
• [2]Drummer OH, Kourtis I, Beyer J, Tayler P, Boorman M, Gerostamoulos D: The prevalence of drugs in injured drivers. Forensic Sci Int 2012, 215:14-7.
• [3]Walsh JM, Flegel R, Cangianelli LA, Atkins R, Soderstrom CA, Kerns TJ: Epidemiology of alcohol and other drug use among motor vehicle crash victims admitted to a trauma center. Traffic Inj Prev 2004, 5:254-260.
• [4]Behrensdorff I, Steentoft A: Medicinal and illegal drugs among Danish car drivers. Accid Anal Prev 2003, 35:851-860.
• [5]Gjerde H, Normann PT, Pettersen BS, Assum T, Aldrin M, Johansen U, et al.: Prevalence of alcohol and drugs among Norwegian motor vehicle drivers: a roadside survey. Accid Anal Prev 2008, 40:1765-1772.
• [6]Vanlaar W: Drink driving in Belgium: results from the third and improved roadside survey. Accid Anal Prev 2005, 37:391-397.
• [7]Gjerde H, Normann PT, Christophersen AS, Samuelsen SO, Morland J: Alcohol, psychoactive drugs and fatal road traffic accidents in Norway: a case–control study. Accid Anal Prev 2011, 43:1197-1203.
• [8]Movig KL, Mathijssen MP, Nagel PH, van Egmond T, De Gier JJ, Leufkens HG, et al.: Psychoactive substance use and the risk of motor vehicle accidents. Accid Anal Prev 2004, 36:631-636.
• [9]Mura P, Kintz P, Ludes B, Gaulier JM, Marquet P, Martin-Dupont S, et al.: Comparison of the prevalence of alcohol, cannabis and other drugs between 900 injured drivers and 900 control subjects: results of a French collaborative study. Forensic Sci Int 2003, 133:79-85.
• [10]Woratanarat P, Ingsathit A, Suriyawongpaisal P, Rattanasiri S, Chatchaipun P, Wattayakorn K, et al.: Alcohol, illicit and non-illicit psychoactive drug use and road traffic injury in Thailand: a case–control study. Accid Anal Prev 2009, 41:651-657.
• [11]Kelly E, Darke S, Ross J: A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions. Drug Alcohol Rev 2004, 23:319-344.
• [12]Verstraete AG: Detection times of drugs of abuse in blood, urine, and oral fluid. Ther Drug Monit 2004, 26:200-205.
• [13]Lacey JH, Kelley-Baker T, Furr-Holden D, Brainard K, Moore C: Pilot Test of New Roadside Survey Methodology for Impaired Driving. Springfield, VA: National Technical Information Service; 2007.
• [14]Gjerde H, Verstraete AG: Estimating equivalent cutoff thresholds for drugs in blood and oral fluid using prevalence regression: A study of tetrahydrocannabinol and amphetamine. Forensic Sci Int 2011, 212:e26-e30.
• [15]Longo MC, Hunter CE, Lokan RJ, White JM, White MA: The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability: part i: the prevalence of drug use in drive the drug-positive group. Accid Anal Prev 2000, 32:613-622.
• [16]Gjerde H, Christophersen AS, Skuterud B, Klemetsen K, Morland J: Screening for drugs in forensic blood samples using EMIT urine assays. Forensic Sci Int 1990, 44:179-185.
• [17]Christophersen AS, Gulliksen M, Hasvold I, Johansen U, Karinen R, Ripel A, et al.: Screening, confirmation and quantification of drugs of abuse in whole blood by LC-MS (ESI). In Abstracts of the 39th Meeting of The International Association of Forensic Toxicologists (TIAFT), August 26-30, 2001, Prague. Edited by Balikova M, Novakova E. Prague: Charles University; 2001:P85.
• [18]Gjerde H, Fongen U, Gundersen H, Christophersen AS: Evaluation of a method for simultaneous quantification of codeine, ethylmorphine and morphine in blood. Forensic Sci Int 1991, 51:105-110.
• [19]Christophersen AS: Tetrahydrocannabinol stability in whole blood: plastic versus glass containers. J Anal Toxicol 1986, 10:129-131.
• [20]Gjerde H, Hasvold I, Pettersen G, Christophersen AS: Determination of amphetamine and methamphetamine in blood by derivatization with perfluorooctanoyl chloride and gas chromatography/mass spectrometry. J Anal Toxicol 1993, 17:65-68.
• [21]Kristoffersen L, Smith-Kielland A: An automated alcohol dehydrogenase method for ethanol quantification in urine and whole blood. J Anal Toxicol 2005, 29:387-389.
• [22]Morland J: Driving under the Influence of Non-Alcohol Drugs. Forensic Science Review 2000, 12:79-106.
• [23]Houwing S, Hagenzieker M, Mathijssen R, Bernhoft IM, Hels T, Janstrup K, et al.: Prevalence of Alcohol and Other Psychoactive Substances in Drivers in General Traffic. Part 1: General Results. Leidschendam: SWOV; 2011.
• [24]Øiestad EL, Johansen U, Christophersen AS: Drug screening of preserved oral fluid by liquid chromatography-tandem mass spectrometry. Clin Chem 2007, 53:300-309.
• [25]Vindenes V, Jordbru D, Knapskog AB, Kvan E, Mathisrud G, Slordal L, et al.: Impairment based legislative limits for driving under the influence of non-alcohol drugs in Norway. Forensic Sci Int 2012, 219:1-11.
• [26]Verstraete A, Knoche A, Jantos R, Skopp G, Gjerde H, Vindenes V: Per Se Limits - Methods of Defining Cut-off Values for Zero Tolerance. DRUID Deliverable D1.4.2. Ghent: Ghent University; 2011.
• [27]Taylor B, Irving HM, Kanteres F, Room R, Borges G, Cherpitel C, et al.: The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together. Drug Alcohol Depend 2010, 110:108-116.
• [28]Borkenstein RF, Crowther RF, Shumate RP, Ziel WB, Zylman R: The role of the drinking driver in traffic accidents (The Grand Rapids Study). Blutalkohol 1974, 11(Suppl. 1):1-131.
• [29]Blomberg RD, Peck RC, Moskowitz H, Burns M, Fiorentino D: The Long Beach/Fort Lauderdale relative risk study. J Safety Res 2009, 40:285-292.
• [30]Christophersen AS, Morland J: Frequent detection of benzodiazepines in drugged drivers in Norway. Traffic Inj Prev 2008, 9:98-104.
• [31]Sewell RA, Poling J, Sofuoglu M: The effect of cannabis compared with alcohol on driving. Am J Addict 2009, 18:185-193.
• [32]Fell JC, Voas RB: The effectiveness of reducing illegal blood alcohol concentration (BAC) limits for driving: evidence for lowering the limit to .05 BAC. J Safety Res 2006, 37:233-243.
• [33]Babor T, Caetano R, Edwards G, Giesbrecht N, Graham K, et al.: Alcohol: No ordinary commodity. Reseach and public policy. 2nd edition. Oxford: Oxford University Press; 2010.
• [34]Wagenaar AC, Salois MJ, Komro KA: Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies. Addiction 2009, 104:179-190.
• [35]Wagenaar AC, Toomey TL: Effects of minimum drinking age laws: review and analyses of the literature from 1960 to 2000. J Stud Alcohol Suppl 2002, Suppl. 14:206-225.
• [36]Brand DA, Saisana M, Rynn LA, Pennoni F, Lowenfels AB: Comparative analysis of alcohol control policies in 30 countries. PLoS Med 2007, 4:e151.
• [37]Shults RA, Elder RW, Nichols JL, Sleet DA, Compton R, Chattopadhyay SK: Effectiveness of multicomponent programs with community mobilization for reducing alcohol-impaired driving. Am J Prev Med 2009, 37:360-371.
• [38]Elder RW, Voas R, Beirness D, Shults RA, Sleet DA, Nichols JL, et al.: Effectiveness of ignition interlocks for preventing alcohol-impaired driving and alcohol-related crashes: a Community Guide systematic review. Am J Prev Med 2011, 40:362-376.
• [39]Elder RW, Shults RA, Sleet DA, Nichols JL, Thompson RS, Rajab W: Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes: a systematic review. Am J Prev Med 2004, 27:57-65.
• [40]Matthews A, Bruno R, Johnston J, Black E, Degenhardt L, Dunn M: Factors associated with driving under the influence of alcohol and drugs among an Australian sample of regular ecstasy users. Drug Alcohol Depend 2009, 100:24-31.
• [41]Appenzeller BM, Schneider S, Yegles M, Maul A, Wennig R: Drugs and chronic alcohol abuse in drivers. Forensic Sci Int 2005, 155:83-90.
• [42]Havard A, Shakeshaft AP, Conigrave KM, Doran CM: Randomized controlled trial of mailed personalized feedback for problem drinkers in the emergency department: the short-term impact. Alcohol Clin Exp Res 2012, 36:523-531.