Increase in driving after cocaine use in Spain: a cross-sectional dataset analysis for 2021.

Objective: Driving under the influence of alcohol and/or drugs impairs skills essential for safe driving, increases the risk of being involved in a traffic accident and is particularly prevalent in Spain. The aim is to assess the prevalence of positive substance driving cases, what factors may be associated with driving after substance use, and the evolution of the progress in the prevalence of drug use among drivers in drivers based on the 2008, 2013, 2018, and 2021 studies. Study design and setting: The present study was conducted in a representative sample of Spanish drivers in 2021 for alcohol (breath) and psychoactive substances [oral fluid (OF)]. The sample size was 2980 drivers, mostly males (76.5%) with a mean age of 41.35 ± 13.34 years. Results: In 2021, 9.3% of drivers tested positive for alcohol and/or drugs. The presence of alcohol alone was observed in 4.2% of drivers, alcohol and another substance in 0.3%, a single drug in 4.4%, and two or drugs other than alcohol in 0.4%. Overall, cocaine cases were the highest registered in 2021 (2.4%), while cannabis (1.9%) and polydrug cases (0.7%) were the lowest, with respect to the 2008/2013/2018 studies. Conclusions: According to our research, in 2021, 9 out of 100 drivers were detected to have some substance in their system. This prevalence remains unacceptably high in Spain, with a marked increase in the frequency of driving after cocaine use. Further interventions and measures must be taken to avoid driving under the influence of alcohol and/or drugs.

Positivity to Cocaine and/or Benzoylecgonine in Confirmation Analyses for On-Road Tests in Spain.

We are using real-life data in order to determine the prevalence of driving with the presence of cocaine and/or benzoylecgonine (BZE), their concentrations, and their use in combination with other drugs. This study assessed data on Spanish drivers with confirmed drug-positive results recorded by the Spanish National Traffic Agency from 2011-2016. Frequencies of positivity for cocaine and/or BZE and concentration of such substances were obtained. Comparisons and univariate and multivariate regression analyses were performed. Drivers who tested positive for cocaine and/or BZE accounted for 48.59% of the total positive results for drugs. In positive cases for both cocaine and BZE, other substances were detected in 81.74%: delta-9-tetrahydrocannabinol (THC) (68.19%), opioids (20.78%) and amphetamine-like substances (16.76%). In the multivariate logistic regression analysis, the frequency of cocaine and/or BZE positive cases decreased with age (OR:0.97) and were less likely among women (OR:0.63). Concentrations (ng/mL) of cocaine (249.30) and BZE (137.90) were higher when both substances were detected together than when detected alone. Positivity to cocaine represented an important proportion among Spanish drivers who tested positive for drugs, and polysubstance use was especially observed in more than 8 out of 10 positive cases for cocaine and/or BZE.

[Driving with a positive test result for alcohol in Spain in 2018.] / Conducir con presencia de alcohol en España en 2018.

OBJECTIVE: The association between alcohol and traffic collision injuries is well established. Our objective was to analyze the frequency of driving with a positive result in on-road tests for alcohol with considering different concentrations of alcohol in exhaled air, as well as driving while positive only for alcohol or for alcohol and drugs. METHODS: In 2018, a cross-sectional study was carried out in a representative sample of motor vehicle drivers on Spanish public roads, excluding cyclists and drivers of vehicles weighing more than 3,500 kg. 2,881 drivers were included in this study. Data was analysed with the statistics program SPSS 24.0. RESULTS: 10.9% (95% CI, 9.8-12.1) of the drivers were positive cases for any substance: In 3.9% (3.2-4.6) alcohol alone (i.e., without any other substance), and in 0.8% (0.6-1.3) alcohol plus another substance, were observed. 2.1% (1.6-2.7) of the drivers had a level of alcohol in expired air higher than the legal allowed limit for drivers (>0.25 mg/L, that excluding novice and profesional drivers). 0.4% (0.2-0.7) of the drivers had an alcohol concentration in expired air >0.60 mg/L. Driving with the presence of alcohol and drugs is observed in two out of ten positive cases for alcohol. CONCLUSIONS: Driving while positive for alcohol is common among Spanish drivers, and drivers positive for alcohol and drugs should not be ignored.

OBJETIVO: La asociación entre alcohol y lesiones por colisiones de tráfico es bien conocida. Nuestro objetivo fue analizar la frecuencia de conducir con presencia de alcohol en las pruebas de control en carretera, considerando diversas concentraciones de alcohol en aire espirado, así como conducir con la presencia de sólo alcohol o alcohol junto con drogas. METODOS: Se ha realizado un estudio transversal en una muestra representativa de los conductores de vehículos de motor en vías públicas españolas, excluyendo ciclistas y conductores de vehículos de más de 3500 kg en 2018. En el estudio se han incluido 2.881 conductores. Los datos fueron analizados con el programa estadístico SPSS 24.0. RESULTADOS: El 10,9% (95% IC, 9,8-12,1) de los conductores fueron casos positivos a alguna sustancia: la presencia de alcohol (solo, sin ninguna otra sustancia) se observó en el 3,9% (3,2-4,6), y alcohol más alguna otra sustancia en el 0,8% (0,6-1,3). El 2,1% (1,6-2,7) de los conductores presentó un nivel de alcohol en aire espirado superior al límite legal (>0,25 mg/L) permitido a los conductores (excepto noveles y profesionales). El 0,4% (0,2-0,7) de los conductores conducían con una concentración de alcohol en aire espirado >0,60 mg/L. Conducir con presencia de alcohol y drogas se observa en dos de cada diez casos positivos a alcohol. CONCLUSIONES: Conducir con presencia de alcohol es frecuente entre los conductores españoles, y no debieran pasar desapercibidos aquellos que conducen después de haber consumido alcohol y drogas.

Prevalence of alcohol and other psychoactive substances in motor vehicle drivers in Spain, 2018: Cross-sectional dataset analysis with studies from 2008 and 2013.

Driving under the influence of substances is particularly common in developed countries. In Spain, in 2010, roadside oral fluid drug screening became mandatory, and in 2014, the zero tolerance legal system was established. The aim of the current study is to analyze the prevalence of alcohol (in breath) and drugs (in oral fluids) in a representative sample of motor vehicle drivers in Spain in 2018. This study focuses specifically on multiple substance use (i.e., polysubstance use), and seeks to analyze the factors associated with driving after consumption of substances, as well as the evolution of the presence of drugs in drivers from 2008, 2013 and 2018 studies. A total of 2881 drivers were included in this study. In 2018, alcohol was detected in 3.9 % of the cases, alcohol plus another substance(s) was found in 0.8 % of the cases, only one drug (excluding alcohol) made up 5.1 % of the cases and drivers testing positives to more than one drug at a time (apart from alcohol) constituted 1.1 %. There were less cases of positives for any drugs or alcohol in 2018 and 2013 (2018: 10.9 %, z=3.6, p=0.0003; 2013: 9.3 %, z=5.7, p<0.0001) than in 2008 (14.0 %), yet the frequency observed in 2018 is more than that of 2013 (z=2, p=0.05). Multiple drug use (without alcohol), increased from 0.5 % in 2008 to 1.1 % in 2018 (z=2.2, p=0.03). Alcohol/drug driving continues to be frequent in Spain, leading to the need for intervention in this field, particularly on polydrug use and driving.

Benzodiazepines in the oral fluid of Spanish drivers.

BACKGROUND: Driving under the influence of alcohol, illicit drugs and certain medicines is not allowed worldwide. Roadside drug testing is considered an important tool for determining such behavior. In Spain, mandatory roadside oral fluid drug testing is carried out regularly. The aim of this study was to determine the prevalence of benzodiazepines and benzodiazepines in combination with other drugs in drivers, examine benzodiazepine concentrations in drivers, and analyze the association of these factors with age and sex. METHODS: This study assessed data on Spanish drivers with confirmed drug-positive results recorded by the Spanish National Traffic Agency (Dirección General de Tráfico) between 2011 and 2016, accounting for 179,645 tests and 65,244 confirmed drug-positive tests. RESULTS: Benzodiazepines were confirmed in 4.3% of all positive roadside drug tests. In most of those cases (97.1%), other substances were also detected, particularly cocaine (75.3%) and cannabis (64.0%). The frequency of benzodiazepine-positive drivers (OR, 1.094; 95% CI, 1.088-1.100) increased with age, while the frequency of drivers who tested positive for benzodiazepines in conjunction with other substances, compared with drivers who tested positive for benzodiazepines alone, decreased with age (OR, 0.903; 95% CI, 0.825-0.988). Nordiazepam (54.8%) and alprazolam (46.9%) were the most common benzodiazepines detected. CONCLUSION: Concomitant use of benzodiazepines and other psychoactive substances was found to be a common behavior among drivers who tested positive on the road. It is important to raise awareness of all those involved in the consumption of driving-impairing substances (authorities, healthcare providers, patients and their families, etc.): roadside detection of driving-impairing substances is suggested, in addition to promoting the use of fewer driving-impairing medications and the provision of clear information to patients.

Conducir con presencia de alcohol en España en 2018 / Driving with a positive test result for alcohol in Spain in 2018

OBJETIVO: La asociación entre alcohol y lesiones por colisiones de tráfico es bien conocida. Nuestro objetivo fue analizar la frecuencia de conducir con presencia de alcohol en las pruebas de control en carretera, considerando diversas concentraciones de alcohol en aire espirado, así como conducir con la presencia de sólo alcohol o alcohol junto con drogas. MÉTODOS: Se ha realizado un estudio transversal en una muestra representativa de los conductores de vehículos de motor en vías públicas españolas, excluyendo ciclistas y conductores de vehículos de más de 3500 kg en 2018. En el estudio se han incluido 2.881 conductores. Los datos fueron analizados con el programa estadístico SPSS 24.0. RESULTADOS: El 10,9% (95% IC, 9,8-12,1) de los conductores fueron casos positivos a alguna sustancia: la presencia de alcohol (solo, sin ninguna otra sustancia) se observó en el 3,9% (3,2-4,6), y alcohol más alguna otra sustancia en el 0,8% (0,6-1,3). El 2,1% (1,6-2,7) de los conductores presentó un nivel de alcohol en aire espirado superior al límite legal (>0,25 mg/L) permitido a los conductores (excepto noveles y profesionales). El 0,4% (0,2-0,7) de los conductores conducían con una concentración de alcohol en aire espirado >0,60 mg/L. Conducir con presencia de alcohol y drogas se observa en dos de cada diez casos positivos a alcohol. CONCLUSIONES: Conducir con presencia de alcohol es frecuente entre los conductores españoles, y no debieran pasar desapercibidos aquellos que conducen después de haber consumido alcohol y drogas

OBJECTIVE: The association between alcohol and traffic collision injuries is well established. Our objective was to analyze the frequency of driving with a positive result in on-road tests for alcohol with considering different concentrations of alcohol in exhaled air, as well as driving while positive only for alcohol or for alcohol and drugs. METHODS: In 2018, a cross-sectional study was carried out in a representative sample of motor vehicle drivers on Spanish public roads, excluding cyclists and drivers of vehicles weighing more than 3,500 kg. 2,881 drivers were included in this study. Data was analysed with the statistics program SPSS 24.0. RESULTS: 10.9% (95% CI, 9.8-12.1) of the drivers were positive cases for any substance: In 3.9% (3.2-4.6) alcohol alone (i.e., without any other substance), and in 0.8% (0.6-1.3) alcohol plus another substance, were observed. 2.1% (1.6-2.7) of the drivers had a level of alcohol in expired air higher than the legal allowed limit for drivers (>0.25 mg/L, that excluding novice and profesional drivers). 0.4% (0.2-0.7) of the drivers had an alcohol concentration in expired air >0.60 mg/L. Driving with the presence of alcohol and drugs is observed in two out of ten positive cases for alcohol. CONCLUSIONS: Driving while positive for alcohol is common among Spanish drivers, and drivers positive for alcohol and drugs should not be ignored

Drivers who tested positive for cannabis in oral fluid: a longitudinal analysis of administrative data for Spain between 2011 and 2016.

OBJECTIVES: This study aimed to assess the association between positive roadside tests for delta-9-tetrahydrocannabinol (THC) and other driving-impairing substances and THC concentrations and the age and gender of THC-positive drivers. DESIGN: This study is based on administrative data. SETTING, PARTICIPANTS AND EXPOSURES: National administrative data on drivers who tested positive in confirmation analysis of driving-impairing substances in oral fluid were assessed (2011-2016, 179 645 tests). PRIMARY AND SECONDARY OUTCOME MEASURES: Frequencies of positivity for THC, THC alone and THC plus non-THC substances (stratification by age and gender in 2016) and THC concentration were obtained. Comparisons and univariate and multivariate regression analyses were performed. RESULTS: Of the 65 244 confirmed drug-positive tests, 51 869 were positive for THC (79.5%). In 50.8% of the THC-positive tests, cocaine and amphetamines were also detected. Positivity for THC and non-THC substances predominated among drivers with low THC concentrations and represented 58.6% of those with levels lower than 25 ng/mL. The mean±SD for age was 29.6±7.7 years (year 2016, n=24 941). Men accounted for 96.3% of all THC-positive drivers. With increasing age, positivity for THC decreased (OR 0.948; 95% CI 0.945 to 0.952; p<0.0001), and positivity for THC and non-THC substances increased (OR 1.021; 95% CI 1.017 to 1.024; p<0.0001). Men were associated with higher THC concentrations (OR 1.394; 95% CI 1.188 to 1.636; p<0.0001). CONCLUSIONS: Cannabis positivity is frequent among drivers, and polysubstance use is common. Hence, focusing on younger drivers and those with low THC concentrations is encouraged. This study provides evidence on the current implementation of roadside drug testing in Spain and aims to characterise driving under the influence (DUI) of cannabis to increase the awareness of all involved to help them avoid DUI.

Opioids in oral fluid of Spanish drivers.

BACKGROUND: Driving under the influence of certain drugs is not allowed, and roadside drug testing is being considered an important tool for deterring driving under the influence of them. This study aimed to assess the presence and concentration of opioids, as well as their combined use with other drugs (laboratory confirmation after the on-road screening) in Spanish drivers between 2011 and 2016. METHODS: In Spain, mandatory roadside breath alcohol and oral fluid drug testing (screening) are carried out by the Traffic Police using Dräger Alcotest® 6810 device, and Dräger DrugTest® 5000, DrugWipe®, or Alere™ DDS®2 Mobile Test System. For positive cases in the period covered, 65,244, confirmation analysis and quantification using chromatographic techniques were performed. RESULTS: Opioids were confirmed in 8.6% of positive cases, being 7.2% positives to 6-acetylmorphine (6-AM), 6.5% to morphine, 5.4% to codeine, and 4.1% to methadone. The majority of the confirmed tests for morphine (96.5%), codeine (88.4%) and methadone (81.9) were also positive for 6-AM. The presence of other drugs, particularly cocaine and cannabis, was very common. Concentration values reached important levels. Positive results for morphine (0.1%), codeine (0.6%) or methadone (0.4%) alone were very infrequent. CONCLUSIONS: Drivers with a confirmed positive roadside test for morphine, codeine, and methadone had also consumed heroin and/or other illicit drugs, such as cocaine and/or THC, and at relevant concentrations. Improving interventions to combat the problem of driving under the influence of driving-impairing substances is a priority.