Drugs and Driving

Abstract

The authors present a global overview on the issue of drugs and driving covering four major areas: (1) Epidemiology and Prevalence--which reviews epidemiological research, summarizes available information, discusses the methodological shortcomings of extant studies, and makes recommendations for future research to better define prevalence and epidemiology; (2) Effects of Medicinal and Illegal Drugs on Driving Performance--focuses on the six classes of drugs most often found in impaired and injured drivers, draws conclusions regarding the risk of these drugs to traffic safety and discusses the need for additional research; (3) Toxicological Issues--discusses ways to identify drug users via behavioral testing and analytical techniques, reviews the approaches used by different countries, screening and confirmation techniques, alternative specimens (e.g., urine, oral fluid, sweat), and how rapid roadside testing could be coupled with behavioral and laboratory testing in an effective approach to identifying and prosecuting drugged drivers; (4) Driving Under the Influence of Drugs [DUID] Laws--provides an overview of DUID laws in the United States and Europe, discusses the basic tenets of these laws, the various types of DUID statutes, the reasons why many existing laws hinder the prosecution of drugged drivers and the rationale for developing per se legislation as a strategy to more effectively manage the drugged driver problem.

Drug and Alcohol Involvement in Four Types of Fatal Crashes

“…There is a growing interest in the extent to which the use of drugs by drivers is related to crash involvement (Dobbs, 2005;Jones et al, 2003;Moskowitz and Wilkinson, 2004;Walsh et al, 2004). These reviews have covered laboratory, simulator, and research studies of arrested and crashinvolved drivers and on-road studies of specifi c driving skills.…”

Relationship Between Oral Fluid and Blood Concentrations of Drugs of Abuse in Drivers Suspected of Driving Under the Influence of Drugs

“…On the other hand, the oral cavity can be contaminated by intranasal and smoked drug use, leading to extremely high concentrations in oral fluid. It is also difficult to obtain sufficient sample volume for the analysis 6 , and the concentrations of benzodiazepines in this matrix are low 4 . Some correlation between oral fluid drug concentrations and impairment has been described 4,7,8,9,10 .…”

“…It is also difficult to obtain sufficient sample volume for the analysis 6 , and the concentrations of benzodiazepines in this matrix are low 4 . Some correlation between oral fluid drug concentrations and impairment has been described 4,7,8,9,10 . In addition, Toennes et al 11 demonstrate that oral fluid is superior to urine in correlating with serum analytical data and impairment symptoms of drivers under the influence of drugs of abuse.…”

“…Oral fluid can be obtained easily by non--medical personnel in a non--invasive and observable way. Other advantages of oral fluid analysis are less interference caused by endogenous compounds as compared to blood or urine 5 and the presence of the parent drug 4 . On the other hand, the oral cavity can be contaminated by intranasal and smoked drug use, leading to extremely high concentrations in oral fluid.…”

Effects of alcohol on automated and controlled driving performances

“…In particular, it has been shown for many years that impairment of driving due to ethanol is a main factor in road traffic accidents and that blood alcohol concentration (BAC) is clearly linked with the probability of being involved in a road accident (Borkenstein et al 1964;Robertson and Drummer 1994;Zador et al 2000;Blomberg et al 2009;Phillips and Brewer 2011). Alcohol is thus the most commonly detected substance in fatally injured drivers, and epidemiological evidence indicates that the risk of accident increases with alcohol alone and when alcohol is combined with licit or illicit psychotropic drugs (Skurtveit et al 2002;Odgen and Moskowitz 2004;Vingilis and MacDonald 2004;Walsh et al 2004;Brady and Li 2012;Mørland et al 2011). The relative risk estimated using the Odds Ratio is of 5.6 for a BAC between 0.5 and 0.79 g/l and of 15.5 for alcoholization greater than or equal to 0.8 g/l (Movig et al 2004); the number of drivers responsible for accidents rises to 2.3 for cannabis alone, to 9.4 for alcohol alone, and to 14.1 for the alcohol-cannabis combination (Biecheler et al 2008).…”