Which drugs are associated with highest risk for being arrested for driving under the influence? A case-control study. Psychoactive substance use and the risk of motor vehicle accidents. Prevalence of drugs in oral fluid from truck drivers in Brazilian highways. Amphetamine, cocaine and cannabinoids use among truck drivers on the roads in the State of Sao Paulo, Brazil.
The aim of this study was to determine the association between drug type and arrest for driving under the influence of drugs ( DUID ) by calculating odds ratios ( ORs ) using a case-control design . A DUID arrest is in most cases related to aberrant or risky driving and might therefore be regarded as a proxy for a drug related traffic crash . The ' cases ' were 2738 drivers arrested on suspicion of drugged driving from April 2008 to March 2009 with blood alcohol concentrations below the legal limit of 0.2g/L ; 794 were arrested due to involvement in road traffic crashes , whereas 1944 were arrested for other reasons , mainly dangerous driving , suspected impairment when stopped in traffic controls , or because of phone calls to the police from other road users or observers . The ' controls ' were 9375 r and om drivers in normal traffic , also with alcohol concentrations below this limit . Blood sample s from ' cases ' and oral fluid sample s from ' controls ' were analyzed for 15 drugs that have legislative concentration limits in Norway , in addition to two other commonly detected psychoactive drugs . The most prevalent illicit drug in the control group was tetrahydrocannabinol ( THC ; 0.58 % ) , which was also commonly found in sample s from drivers arrested due to road crash ( 15.6 % ) or arrested for other reasons ( 21.8 % ) . Amphetamine/methamphetamine was most prevalent among arrested drivers involved in crashes ( 30.6 % ) and drivers arrested for other reasons ( 56.9 % ) , whereas only 0.18 % of the control group was positive for amphetamine/methamphetamine . The single-use substances which gave highest OR for police arrest were amphetamine/methamphetamine , alprazolam , clonazepam and oxazepam . The majority of the alprazolam and clonazepam findings were probably due to non-therapeutic use of medicinal drugs purchased on the illegal market . Combinations of two or more drugs yielded higher ORs than the use of single substances ; combinations of amphetamine/methamphetamine and benzodiazepines gave the highest risk The driving performance is easily impaired as a consequence of the use of alcohol and /or licit and illicit drugs . However , the role of drugs other than alcohol in motor vehicle accidents has not been well established . The objective of this study was to estimate the association between psychoactive drug use and motor vehicle accidents requiring hospitalisation . A prospect i ve observational case-control study was conducted in the Tilburg region of The Netherl and s from May 2000 to August 2001 . Cases were car or van drivers involved in road crashes needing hospitalisation . Demographic and trauma related data was collected from hospital and ambulance records . Urine and /or blood sample s were collected on admission . Controls were drivers recruited at r and om while driving on public roads . Sampling was conducted by research ers , in close collaboration with the Tilburg police , covering different days of the week and times of the day . Respondents were interviewed and asked for a urine sample . If no urine sample could be collected , a blood sample was requested . All blood and urine sample s were tested for alcohol and a number of licit and illicit drugs . The main outcome measures were odds ratios ( OR ) for injury crash associated with single or multiple use of several drugs by drivers . The risk for road trauma was increased for single use of benzodiazepines ( adjusted OR 5.1 ( 95 % Cl : 1.8 - 14.0 ) ) and alcohol ( blood alcohol concentrations of 0.50 - 0.79 g/l , adjusted OR 5.5 ( 95 % Cl : 1.3 - 23.2 ) and > or=0.8 g/l , adjusted OR 15.5 ( 95 % Cl : 7.1 - 33.9 ) ) . High relative risks were estimated for drivers using combinations of drugs ( adjusted OR 6.1 ( 95 % Cl : 2.6 - 14.1 ) ) and those using a combination of drugs and alcohol ( OR 112.2 ( 95 % Cl : 14.1 - 892 ) ) . Increased risks , although not statistically significantly , were assessed for drivers using amphetamines , cocaine , or opiates . No increased risk for road trauma was found for drivers exposed to cannabis . The study concludes that drug use , especially alcohol , benzodiazepines and multiple drug use and drug-alcohol combinations , among vehicle drivers increases the risk for a road trauma accident requiring hospitalisation Traffic accidents are responsible for 1.25 million deaths worldwide and are the most common cause of death among those aged 15 - 29 years . In Brazil , traffic accidents caused more than 44,000 deaths in 2014 . The use of psychoactive drugs is an important risk factor for being involved in traffic accidents . Previous studies have found that psychoactive substances are commonly used by truck drivers in Brazil to maintain their extensive work schedule and stay awake while driving during nighttime hours . The state of Sao Paulo is one of the most important states regarding goods transportation . Important highways cross through Sao Paulo to other regions from Brazil and to other countries in Latin America . This study aims to determine the prevalence of illicit drug use by truck drivers in the state of Sao Paulo through toxicological analyses of oral fluid . Truck drivers were r and omly stopped by police officers on federal roads during morning hours . Oral fluid sample s were collected using the Quantisal ™ device . In addition , a question naire concerning sociodemographic characteristics and health information was administered . Oral fluid sample s were screened for amphetamine , cocaine , and tetrahydrocannabinol ( Δ9-THC ) by ELISA and the confirmation was performed using ultra performance liquid chromatography with t and em mass spectrometry detection ( UPLC-MS/MS ) . Of the 764 drivers stopped , 762 agreed to participate . The participants were driving an average of 614 km and 9.4h a day . Of the total sample s , 5.2 % ( n=40 ) tested positive for drugs . Cocaine was the most frequently found drug ( n=21 ) , followed by amphetamine ( n=16 ) and Δ9-THC ( n=8 ) . All drivers were men with an average age of 42.5 years . With these results we were able to verify that many truck drivers were still consuming psychoactive drugs while driving , and cocaine was the most prevalent one . This reinforces the need for preventive measures aim ed at controlling the use of illicit drugs by truck drivers in Brazil Drugs are important risk factors for traffic accidents . In Brazil , truck drivers report using amphetamines to maintain their extensive work schedule and stay awake . These drugs can be obtained without prescription easily on Brazilian roads . The use of these stimulants can result in health problems and can be associated with traffic accidents . There are Brazilian studies that show that drivers use drugs . However , these studies are question naire-based and do not always reflect real-life situations . The purpose of this study was to demonstrate the prevalence of drug use by truck drivers on the roads of Sao Paulo State , Brazil , during 2009 . Drivers of large trucks were r and omly stopped by police officers on the interstate roads during morning hours . After being informed of the goals of the study , the drivers gave written informed consent before providing a urine sample . In addition , a question naire concerning sociodemographic characteristics and health information was administered . Urine sample s were screened for amphetamines , cocaine , and cannabinoids by immunoassay and the confirmation was performed using gas chromatography-mass spectrometry ( GC-MS ) . Of the 488 drivers stopped , 456 ( 93.4 % ) provided urine sample s , and 9.3 % of them ( n=42 ) tested positive for drugs . Amphetamines were the most commonly found ( n=26 ) drug , representing 61.9 % of the positive sample s. Ten cases tested positive for cocaine ( 23.8 % ) , and five for cannabinoids ( 11.9 % ) . All drivers were male with a mean age of 40 ± 10.8 years , and 29.3 % of them reported some health problem ( diabetes , high blood pressure and /or stress ) . A high incidence of truck drivers who tested positive for drug use was found , among other reported health problems . Thus , there is an evident need to promote a healthier lifestyle among professional drivers and a need for preventive measures aim ed at controlling the use of drugs by truck drivers in Brazil
Best- evidence synthesis demonstrated a conflicting level of evidence for associations between the use of-amphetamine-type substances and the risk of sustaining an injury , and a moderate level of evidence between amphetamine use and the risk of death due to road trauma .
This is the first review to synthesis e evidence regarding the association between amphetamine-type substance use and the risk of injury or death due to a road traffic accident .
More conclusive evidence of death due to road trauma among amphetamine users may reflect significant and global deficits in functioning associated with effective vehicular control under the influence of this substance .
Amphetamine-type substances are frequently detected among drivers injured or killed due to road-trauma .
However , the role of this substance in crash causation remains equivocal .
We performed a systematic review to evaluate existing evidence regarding the association between amphetamine use and the risk of injury or death due to road traffic accidents .