Comparison of traffic data and blood alcohol concentration among fatally injured drivers in Norway and Sao Paulo, Brazil, 2005-2015.

Objective: Road traffic crashes (RTCs) are responsible for a large number of deaths worldwide, but low- and middle-income countries frequently present higher rates of deaths; for example, Norway, a high-income country, has a rate of 2.0 drivers killed per 100,000 inhabitants, whereas Brazil, a middle-income country, has a rate of 18.4. A significant fraction of RTCs are related to use of psychoactive substances, especially alcohol, due to its availability, legality, and relatively low price. The aim of the present study was to evaluate differences in alcohol-related fatal RTCs in Sao Paulo, the largest city in Brazil, and Norway during an 11-year period (2005-2015). Methods: The authors compared databases of drivers killed in RTCs in Sao Paulo and in Norway, a country renowned for its success in reducing traffic fatalities and keeping them at a low level. Results: In total, 772 victims from Norway (11 years, 2005 to 2015) and 584 victims from Sao Paulo (2 years, 2005 and 2015) were analyzed. Sao Paulo presented higher proportions of motorcycle drivers, men involved in RTCs, and blood alcohol concentration (BAC)-positive cases. The mean BAC for alcohol-positive cases was similar in both sites. For both regions, the percentage of alcohol-positive cases decreased during the study period (from 45.6% to 35.3% in Sao Paulo and from 24.4% to 15.8% in Norway) but remained higher for Sao Paulo. Conclusions: The study shows a different profile of RTC victims and higher alcohol consumption among drivers in Sao Paulo. The differences between the sites can possibly be attributed to public policies regarding traffic safety and alcohol control, which could be further improved by following the Norwegian model in Sao Paulo.

Driver-related risk factors of fatal road traffic crashes associated with alcohol or drug impairment.

Fatal road traffic crashes are often related to speeding, non-use of a seatbelt, and alcohol/drug-impaired driving. The aim of this study was to examine associations between driving under the influence of drugs and/or alcohol and driver-related risk factors that have been reported as significantly contributing causes of fatal road traffic crashes. The data were extracted from Norwegian road traffic crash registries and forensic toxicology databases. Drug/alcohol investigated car and van drivers and motorcycle riders fatally injured in road traffic crashes in Norway during 2005-2015 were included in this study (n = 772). Drug and alcohol concentrations corresponding to 0.5 g/kg alcohol in blood were used as the lower limits for categorising drivers/riders as impaired; 0.2 g/kg was the upper limit for being categorised as sober. Associations between driver-related risk factors and impairment from specific substance groups were calculated using multivariable logistic regression, adjusted for other substance groups, age, and sex, and were reported when the confidence intervals did not contain the value 1 or lower. Substances found in concentrations above the impairment limits were mainly alcohol (20%), medicinal drugs (10%: benzodiazepines, opioids, z-hypnotics), stimulants (5%: amphetamines, methylphenidate, and cocaine), and cannabis (4%: THC). The drug/alcohol-impaired drivers had compared to the sober drivers more often been speeding (68% versus 32%), not used a seatbelt (69% versus 30%), and been driving without a valid driver license (26% versus 1%). Logistic regression analysis showed that impairment from alcohol or stimulants (mainly amphetamines) was associated with all three risk factors, medicinal drugs with all except speeding, and impairment from cannabis (THC) with not having a valid driver license. Among motorcycle riders, drug/alcohol impairment was associated with not having a valid driver license and non-use of a helmet. At least one of the risk factors speeding, non-use of a seatbelt/helmet, and driving without a valid license were present among the vast majority of the drug/alcohol-impaired fatally injured drivers and riders, and also among more than half of the fatally injured sober drivers.

Fatally injured drivers in Norway 2005-2015-Trends in substance use and crash characteristics.

Objective: Norway introduced a "Vision Zero" strategy in 2001, using multiple approaches, aiming toward a future in which no one will be killed or seriously injured in road traffic crashes (RTCs). Official statistics show that the number of fatally injured road users has declined substantially from 341 deaths in 2000 to 117 in 2015. In-depth crash investigations of all fatal RTCs started in Norway in 2005. The aim of this study was to investigate whether fatal crash characteristics, vehicle safety features, and prevalence of drugs and/or alcohol among fatally injured drivers and riders has changed during 2005-2015, accompanying the reduction in road fatalities. Methods: Data on all car/van drivers and motorcycle/moped riders fatally injured in RTCs during 2005-2015 were extracted from Norwegian road traffic crash registries and combined with forensic toxicology data. Results: The proportion of cars and motorcycles with antilock braking systems and cars with electronic stability control, increased significantly during the study period. The prevalence of nonuse of seat belts/helmets and speeding declined among both fatally injured drivers and riders. In addition, the prevalence of alcohol declined, though no significant change in the total prevalence of other substances was noted. Conclusion: The observed changes toward more safety installations in cars and motorcycles and lower prevalence of driver-related risk factors like alcohol use, speeding, and nonuse of seat belts/helmets among fatally injured drivers/riders may have contributed to the decrease in road traffic deaths.

Toxicological findings in suspected drug-impaired drivers in Norway - Trends during 1990-2015.

This study describes trends in drug use among drivers suspected of driving under the influence of drugs, apprehended by the police in Norway during 1990-2015. Chromatographically determined toxicological findings in blood samples were retrospectively investigated. Drug findings above defined cut-off concentrations were considered positive; hence making the annual prevalence comparable during the 26 years studied. Blood samples from 112,348 drivers were included, of which 63% were positive for drugs; 43% had combined drug with alcohol or other drugs. In total, 87% of the drug-positive drivers were men, and a higher proportion of them were positive for illicit drugs compared to the women. Benzodiazepines and related drugs were found in 57% of the drug-positive drivers, stimulants in 51%, cannabis (tetrahydrocannabinol, THC) in 34%, and opioids in 18%. The types of benzodiazepines and opioids changed over time. The age distribution also changed; the proportion of drug-positive drivers above 40 years of age increased for all drug classes. The annual number of suspected drug-impaired drivers increased by 122% from 1990 to 1999, and by 54% from 2000 to 2015; the annual number of drug-positive samples increased by 260% from 1990 to 1999, and by 60% from 2000 to 2015. During 2000-2015, an increasing prevalence of amphetamines was found among suspected drug-impaired drivers above age 30; the highest rate of increase was observed among those at or above age 40. In the same period, the prevalence of benzodiazepines and related drugs decreased among all age groups, whereas the prevalence of THC increased; the highest prevalence and rate of increase were among suspected drug-impaired drivers under the age of 30. The results from this study indicate a slight change in the types of drugs used by drivers in Norway.

Increasing use of cannabis among arrested drivers in Norway.

OBJECTIVE: The availability of cannabis in Norway seems to have increased according to seizures by customs and police. On the other hand, national population surveys have not found any increase in self-reported use of cannabis. This investigation aimed at studying trends in cannabis use among suspected drug-impaired drivers apprehended by the police in Norway. METHODS: A time series observational study of cannabis use among all drivers tested for drugs during 2000-2015 was performed. Descriptive analyses of trends in frequencies and combined use of cannabis with other drugs or alcohol for different age groups and gender were conducted. RESULTS: Tetrahydrocannabinol (THC) is the main psychoactive substance in cannabis and was detected in blood samples from 18,767 suspected drug-impaired drivers. The annual number of THC findings increased during the years 2000-2015 for all age groups. For cannabis-only users, young drivers aged 20-29 years dominated during the whole period, whereas for multidrug-cannabis users the median age increased steadily during 2000-2015. After 2009, the annual increase in THC findings escalated; THC-only findings increased the most. CONCLUSIONS: Increasing numbers of THC-positive drivers were found among all age groups and genders; the strongest trend was observed between 2009-2015 for young drivers testing positive only for THC.

Determination of 21 drugs in oral fluid using fully automated supported liquid extraction and UHPLC-MS/MS.

Collection of oral fluid (OF) is easy and non-invasive compared to the collection of urine and blood, and interest in OF for drug screening and diagnostic purposes is increasing. A high-throughput ultra-high-performance liquid chromatography-tandem mass spectrometry method for determination of 21 drugs in OF using fully automated 96-well plate supported liquid extraction for sample preparation is presented. The method contains a selection of classic drugs of abuse, including amphetamines, cocaine, cannabis, opioids, and benzodiazepines. The method was fully validated for 200 µL OF/buffer mix using an Intercept OF sampling kit; validation included linearity, sensitivity, precision, accuracy, extraction recovery, matrix effects, stability, and carry-over. Inter-assay precision (RSD) and accuracy (relative error) were <15% and 13 to 5%, respectively, for all compounds at concentrations equal to or higher than the lower limit of quantification. Extraction recoveries were between 58 and 76% (RSD < 8%), except for tetrahydrocannabinol and three 7-amino benzodiazepine metabolites with recoveries between 23 and 33% (RSD between 51 and 52 % and 11 and 25%, respectively). Ion enhancement or ion suppression effects were observed for a few compounds; however, to a large degree they were compensated for by the internal standards used. Deuterium-labelled and 13 C-labelled internal standards were used for 8 and 11 of the compounds, respectively. In a comparison between Intercept and Quantisal OF kits, better recoveries and fewer matrix effects were observed for some compounds using Quantisal. The method is sensitive and robust for its purposes and has been used successfully since February 2015 for analysis of Intercept OF samples from 2600 cases in a 12-month period. Copyright © 2016 John Wiley & Sons, Ltd.