The need for drugged driving per se laws: a commentary.

OBJECTIVE: Triggered by the new federal commitment announced by the Office of National Drug Control Policy (ONCDP) to encourage states to enact drugged driving per se laws, this article reviews the reasons to establish such laws and the issues that may arise when trying to enforce them. METHODS: A review of the state of drunk driving per se laws and their implications for drugged driving is presented, with a review of impaired driving enforcement procedures and drug testing technology. RESULTS: Currently, enforcement of drugged driving laws is an adjunct to the enforcement of laws regarding alcohol impairment. Drivers are apprehended when showing signs of alcohol intoxication and only in the relatively few cases where the blood alcohol concentration of the arrested driver does not account for the observed behavior is the possibility of drug impairment pursued. In most states, the term impaired driving covers both alcohol and drug impairment; thus, driver conviction records may not distinguish between the two different sources of impairment. As a result, enforcement statistics do not reflect the prevalence of drugged driving. CONCLUSIONS: Based on the analysis presented, this article recommends a number of steps that can be taken to evaluate current drugged driving enforcement procedures and to move toward the enactment of drug per se laws.

Use of alcohol and drugs by Norwegian employees: a pilot study using questionnaires and analysis of oral fluid.

BACKGROUND: The use of alcohol and drugs may affect workplace safety and productivity. Little is known about the magnitude of this problem in Norway. METHODS: Employee recruitment methods with or without individual follow-up were compared. The employees filled in a questionnaire and provided a sample of oral fluid. Samples were analysed for alcohol, ethyl glucuronide (EtG; a biological marker of recent large alcohol intake), psychoactive medicinal drugs and illegal drugs. RESULTS: Participation rates with and without individual follow-up were 96% and 68%, respectively. Alcohol was negative (2.2 ng/ml) in 2.1% of the samples. In-efficiency or hangover at work during the past year was reported by 24.3%, while 6.2% had been absent from work due to the use of alcohol. The combination of self-report and analytical testing indicated that medicinal or illegal drugs had been used during the last 48 h by 5.1% and 1.7% of the participants, respectively; while only 4.2% and 0.4% admitted the use in the questionnaire. CONCLUSIONS: Self-reported data suggest that hangover after drinking alcohol appears to be the largest substance abuse problem at Norwegian workplaces, resulting in absence and inefficiency at work. Analysis of oral fluid revealed that the use of illegal drugs was more common than drinking alcohol before working or at the workplace. The analysis of oral fluid may be a valuable tool in obtaining additional information on alcohol and drug use compared to using questionnaires alone.

Guidelines for research on drugged driving.

AIMS: A major problem in assessing the true public health impact of drug-use on driving and overall traffic safety is that the variables being measured across studies vary significantly. In studies reported in a growing global literature, basic parameters assessed, analytical techniques and drugs tested are simply not comparable due to lack of standardization in the field. These shortcomings severely limit the value of this research to add knowledge to the field. A set of standards to harmonize research findings is sorely needed. This project was initiated by several international organizations to develop guidelines for research on drugged driving. METHODS: A September 2006 meeting of international experts discussed the harmonization of protocols for future research on drugged driving. The principal objective of the meeting was to develop a consensus report setting guidelines, standards, core data variables and other controls that would form the basis for future international research. A modified Delphi method was utilized to develop draft guidelines. Subsequently, these draft guidelines were posted on the internet for global review, and comments received were integrated into the final document. RESULTS: The Guidelines Document is divided into three major sections, each focusing upon different aspects of drugged driving research (e.g. roadside surveys, prevalence studies, hospital studies, fatality and crash investigations, etc.) within the critical issue areas of 'behavior', 'epidemiology' and 'toxicology'. The behavioral section contains 32 specific recommendations; (2) epidemiology 40 recommendations; and (3) toxicology 64 recommendations. CONCLUSIONS: It is anticipated that these guidelines will improve significantly the overall quality of drugged driving research and facilitate future cross-study comparisons nationally and globally.

Laboratory evaluation and field application of roadside oral fluid collectors and drug testing devices.

This study was a part of a collaborative U.S./E.U. international research effort (Roadside Testing Assessment, ROSITA II) to assess illegal drug use among motor vehicle operators suspected of driving while under the influence of drugs and to evaluate the effectiveness of point-of-collection oral fluid drug detection technologies. A goal of the study was to assess commercial oral fluid drug testing devices for potential use in law enforcement. Ten devices were evaluated in the laboratory for their ability to meet manufacturers' claimed (and proposed) cutoff concentrations for the detection of amphetamine(s), cocaine/metabolite, opiates, cannabinoids, and benzodiazepines (2 devices). The field study portion of the research was conducted in major cities in the United States and Western Europe by teams of scientists working in collaboration with the local police. In Salt Lake City, Utah, the Drugwipe, Securetec, Ottobrunn, Germany (Securetec) oral fluids drug testing device was also evaluated in the field by testing suspected drug-impaired drivers. During the initial phase of the field study, 40 subjects were recruited. Drugwipe results were compared with laboratory-based immunoassay and mass spectrometry results and demonstrated that calculated sensitivities were between 75% and 100% depending on drug class. Specificities varied from 36% for cannabinoids to over 95% for opiates. During the second phase of the field study, 267 subjects were recruited. The Drugwipe sensitivities were 36.4%, 35.9%, 42.9%, and 7.7%, respectively, for amphetamine(s), cocaine, opiates, and cannabinoids. The Drugwipe specificities were 99.2%, 97.4%, 99.6%, and 99.6%, respectively, for amphetamine(s), cocaine, opiates, and cannabinoids. Drugwipe failed to meet the study criteria for acceptable device performance, required performance sensitivities, and specificities 90% or greater.

New technology and new initiatives in U.S. workplace testing.

A current perspective of workplace drug testing in the USA is presented covering three major issue areas: (1) epidemiology, (2) new technology and (3) initiatives to reach out and assist small business. First, national illegal drug-use self-reported survey data is compared with national laboratory drug testing results, illustrating a number of inconsistencies. During the 17-year period (1988-2004) the number of laboratory positive test results has decreased by 66% while during the same period self-reported drug-use has increased by 30%. The lack of concurrence between lab results and self-report surveys are examined in light of the typical panel of drugs being tested in U.S. laboratories, the increased specificity of immunoassay screening tests, and the critical issues of adulteration and substitution. Second, a brief review of the state-of-the-science in rapid point-of-collection (POCT) oral fluid drug-testing devices is presented along with some device evaluation findings. In general the window of drug detection in oral fluid is measured in hours. Most of the available oral fluid POCT devices can detect methamphetamine and amphetamines and opiates very well. The ability to detect cocaine appears to vary significantly across devices, while the ability to detect cannabis use is generally poor across all devices. Finally, efforts to reach out and assist small businesses in the development of workplace anti-drug programs are discussed in the context of increasing workplace programs in the European Union.

Evaluation of ten oral fluid point-of-collection drug-testing devices.

Previously, the laboratory evaluations of six point-of-collection oral fluid (POC-OF) drug testing devices were reported. Four additional devices, Oralstat (American Bio Medica); SmartClip (Envitec); Impact (LifePoint); and OraLine IV s.a.t (Sun Biomedical Laboratories), were recently evaluated for their ability to meet the claimed (and proposed) cutoff concentrations set by the manufacturers for the detection of amphetamine(s), cocaine/metabolite, opiates, and cannabinoids (Oralstat also benzodiazepines). With the exception of the Sun Biomedical device, actual false-positive results were not encountered. Most devices performed well for the detection of opiates and amphetamine(s), but approximately half had amphetamine(s) cutoff concentrations greater than that proposed by the Substance Abuse and Mental Health Services Administration (SAMHSA). Only three devices had cocaine cutoffs less than or equal to 20 ng/mL (SAMHSA), and a number of false-negative results were obtained. The devices still were not capable of detecting Delta(9)-tetrahydrocannabinol at 4 ng/mL (SAMHSA). However, sensitivities improved since the initial studies, and approximately half of the devices met the THC-COOH cutoff proposed by SAMHSA. Results from the current and previous evaluations are presented in the paper and indicate that the sensitivity and performance of commercial OF drug testing devices is improving, but remains problematic for the reliable detection of cannabinoid use.

Drug and alcohol use among drivers admitted to a Level-1 trauma center.

The purpose of this research was to determine the incidence and prevalence of drug use, alcohol use, and the combination of drug and alcohol use among motor vehicle crash (MVC) victims admitted to a Level-1 trauma center. In a 90-day study, nearly two-thirds of trauma center admissions were victims of motor vehicle crashes. Blood and urine was collected from 168 MVC victims of whom 108 were identified as the driver in the crash. Toxicology results indicated that 65.7% of drivers tested positive for either commonly abused drugs or alcohol. More than half of the drivers tested positive for drugs (50.9%) other than alcohol, with one in four drivers testing positive for marijuana use. About one-third of those using drugs had also been drinking, but alcohol was detected in only 30.6% of all injured drivers. Within the total MVC patient pool, passenger drug/alcohol use was equivalent to the driver population; however, injured pedestrians had higher rates of alcohol only than other MVC victims. There were no significant differences in drug and alcohol use between MVCs and trauma admissions of other causes. Of the patients with positive toxicology results, less than half (42%) were referred for evaluation for substance abuse disorders.

Drugs and driving.

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.

Epidemiology of alcohol and other drug use among motor vehicle crash victims admitted to a trauma center.

The objectives of this research were to (1) determine the incidence and prevalence of alcohol and other drug use among motor vehicle crash (MVC) victims admitted to a regional Level-I trauma center, and (2) to examine the utility of using a rapid point-of-collection (POC) drug-testing device to identify MVC patients with drug involvement. Blood and urine specimens were routinely collected per clinical protocol for each MVC victim at the time of admission. Blood alcohol concentration (BAC) levels were determined per standard clinical protocol. Clinical urine specimens were routinely split so that a POC drug-testing device for the detection of commonly abused drugs (Marijuana, Cocaine, Amphetamines, Methamphetamines, and Opiates) could be compared to that of the standard hospital laboratory analysis of each urine specimen (which also included Barbiturates and Benzodiazepines). In the six-month period of this study, nearly two-thirds of trauma center admissions were victims of motor vehicle crashes. During this time, blood and urine was collected from 322 MVC victims. Toxicology results indicated that 59.3% of MVC victims tested positive for either commonly abused drugs or alcohol. More patients tested positive for drug use than tested positive for alcohol, with 33.5% testing positive for drug use only, 15.8% testing positive for alcohol use only, and 9.9% testing positive for both drugs and alcohol. Less than half (45.2%) of the substance-abusing patients in this study would have been identified by an alcohol test alone. After alcohol, marijuana and benzodiazepines were the most frequently detected drugs. Point of collection (POC) test results correlated well with laboratory results and provide important information to initiate rapid intervention/treatment for substance use problems among injured patients.

An evaluation of rapid point-of-collection oral fluid drug-testing devices.

New technology is currently being marketed to rapidly test oral fluids for drugs of abuse at the point of collection (POC). There are no nationally accepted standards or cutoff concentrations for detecting drugs in oral fluids and for most analytes there are significant differences in cutoff concentrations across devices. Four devices were evaluated (OralLab), RapiScan, Drugwipe, and SalivaScreen) for their ability to meet manufacturers claims, and proposed federal standards for criminal justice and workplace programs. Human oral fluid fortified with known quantities of drug [drug(s) or metabolite(s)] was used to test these devices. Overall, the performance of these rapid POC oral fluid drug-testing devices was quite variable. Some devices performed well for the analysis of some drug classes but poorly for others. In general, most devices performed well for the detection of methamphetamine and opiates, but all performed poorly for the detection of cannabinoids. The ability to accurately and reliably detect cocaine and amphetamine was dependent on the individual device.

Relationships between urinalysis testing for substance use, medical expenditures, and the occurrence of injuries at a large manufacturing firm.

Drug use among employees continues to be a serious concern for American employers. Over 80% of the large employers in the United States use some form of testing to detect drug use, but this practice is controversial and the cost-effectiveness of drug testing remains largely unknown. This study begins an empirical investigation of the consequences of drug testing by estimating its impact on medical care expenditures and injury rates at a large manufacturing firm in 1996-1999. Multiple regression analyses of a pooled cross-sectional time-series data set were used to separate the impact of drug testing from other factors and to help find the optimal level of testing that was associated with minimum medical expenditures. Results indicated that medical expenditures would be minimized when 42% of the employees in a calendar quarter were drug tested. This implies that, on average, employees should be tested 1.68 times a year. The results also indicated that doubling the testing rate would reduce the odds of incurring any injuries on the job by over half, but the injury rate was already so low that this impact was very small. Hopefully the results of this study will inform the policy debate over drug testing by focusing on real data, as opposed to supposition or political considerations that seem to dominate many discussions.

A field evaluation of five on-site drug-testing devices.

A field study was performed at two police agencies to evaluate the utility and accuracy of five on-site urine analysis drug-testing devices when used to test driving under the influence (DUI) arrestees. The devices evaluated were AccuSign, Rapid Drug Screen, TesTcup-5, TesTstik, and Triage. Standard workplace screening cut-off concentrations were used and samples were tested for marijuana, cocaine and metabolites, amphetamine(s), opiates, and PCP (except opiates 300 ng/mL). Four-hundred arrestees were recruited at each site, informed consent was obtained, and urine specimens were collected from each subject for analysis. Police officers conducted the testing with one device, and trained technicians performed testing with the other four devices. The device used by the officers was rotated. All positive and 5% of the negative samples were confirmed in a laboratory using mass spectrometry. Laboratory cut-off concentrations were 4 ng/mL for carboxy-THC; 50 ng/mL for benzoylecgonine; 100 ng/mL for amphetamines; 50 ng/mL for opiates; and 5 ng/mL for PCP. Approximately one-third (36%) of the subjects tested positive for at least one drug. No randomly selected sample, that tested negative on the devices, tested positive at the laboratory. Based on 800 specimens, the false-negative rate for each device was < 1% for all drug classes. A false positive was defined as testing positive with the device, but the specimen did not contain detectable drug, given the study reporting criteria. For marijuana, benzoylecgonine, and opiates, all devices had < or = 0.25% false-positive rates. For PCP, the false-positive rates were all < or = 1.5%. For amphetamine(s), the false-positive rates were all < or = 1.75%. These rates were adjusted because study confirmation batteries included methylenedioxyamphetamine, methylenedioxymethamphetamine (MDMA), additional over-the-counter sympathomimetic amines, hydromorphone, and hydrocodone. Without the expanded confirmation battery, false-positive rates approached 4% (Triage) for amphetamines and were > or = 2.25% for opiates. Fifty to 90% of the positive amphetamine(s) samples contained MDMA. A similar percentage of the opiate-positive samples contained hydromorphone or hydrocodone. When additional drugs were included in the confirmation testing, it was concluded that the on-site urine analysis drug-testing results were useful in DUI investigations.

Las drogas, el conductor y la seguridad en el tránsito

La preocupación general manifestada en los países desarrollados y en los países en desarrollo respecto de la relación entre los accidentes de tránsito y el uso de drogas psicoactivas llevó al Comité de Expertos de la OMS sobre la Aplicación del Convenio sobre Sustancias Psicotrópicas de 1971 a recomendar que la OMS fortaleciera los programas de investigación en que se examinaba la relación entre el uso de alcohol y sustancias psicotrópicas y las lesiones, casos de invalidez y muertes provocadas por accidentes de tránsito. Además, el Comité de Expertos recomendó que los conocimientos obtenidos y la metodología empleada a esos efectos se aprovecharan para la investigación de accidentes industriales y de Otro tipo. Desde 1973 la morbilidad y mortalidad por accidentes de tránsito han disminuido en los países desarrollados; sin embargo, en los países en desarrollo siguen aumentando a un ritmo alarmante. En vista de la escasez de laboratorios forenses en los países en desarrollo, el Comité de Expertos de la OMS apoyó enérgicamente la creación de nuevos laboratorios para la evaluación de problemas sociales y de Salud pública. El Comité también recomendó que se exhortara a los gobiernos a que exigieran estudios sobre los efectos de las drogas utilizadas aisladamente y en combinación con otras en la capacidad para conducir como condición previa para autorizar el uso de nuevas drogas psicotrópicas en sus países...

Las drogas, el conductor y la seguridad en el tránsito / Drugs, driver and safety

HOY EN DIA EN MUCHOS PAISES SE COMIENZA A RECONOCER LOS IMPORTANTES PRO BLEMAS DE SALUD PUBLICA RELACIONADOS CON EL EFECTO DE LAS DROGAS Y EL ALCOHOL EN LOS ACCIDENTES DE TRANSITO. EN 1976 A SOLICITUD DEL CONSEJO EJECUTIVO, LA ORGANIZACION MUNDIAL DE LA SALUD EMPRENDIO UN PROGRAMA MUN DIAL PREVIO DEBATE DEL TEMA POR LA ASAMBLEA MUNDIAL DE LA SALUD. EN LOS PAISES DESARROLLADOS LOS ACCIDENTES DE TRANSITO SUELEN SER LA CAUSA PRIN CIPAL DE LAS MUERTES VIOLENTAS Y UNA GRAN PROPORCION DE ESTAS MUERTES SE RELACIONA CON EL CONSUMO DE ALCOHOL. TAMBIEN SON MOTIVO DE PREOCUPACION LAS INTERACCIONES ENTRE EL ALCOHOL Y OTRAS DROGAS PUESTO QUE SU CONSUMO COMBINADO ES FRECUENTE ENTRE LOS CONDUCTORES DE VEHICULOS Y OPERARIOS DE MAQUINARIAS

Las drogas, el conductor y la seguridad en el transito / Drugs, driver and safety

Hoy en dia en muchos países se comienza a reconecer los importantes problemas de salud pública relacionados con el efecto de las drogas y el alcohol en los accidentes de transito. En 1976 a solicitud del consejo ejecutivo, la organización mundial de la salud empredio un programa mundial previo debate del tema por la asamblea mundial de la salud. En los países desarrollados los accidentes de tradito suelen ser la causa principal de las muertes vilentas y una gran proporcion de estas muertes se relaciona con el consumo de alcohol. Tambien son motivo de preocupacion las interacciónes entre el alcohol y otras drogas puesto que su consumo combinado es frecuente entre los conductores de vehiculos y operarios de maquinarias

Drugs, driving and traffic safety / edited by Robert E. Willette and J. Michael Walsh

Considers the problems associated with evaluating the effects of drugs on driving and traffic safety and suggests standardized approaches to further work in this field. Chapters evaluate problems of analytical toxicology and epidemiological research and discuss behavioural tests that have been developed to indicate impaired driving performance. Recommendations for systematic test procedures are put forward. The book also features brief sections on the role of public health authorities and the importance of international collaboration. Annexed to the report is an outline of analytical methods for detecting and identifying drugs in blood, urine, and saliva samples, giving sensitivity limits for certain classes of drugs. As an example of a notable effort to reduce accidents through public education, the concluding section records the Nordic Councils recommendations for labelling seven main classes of drugs and reproduces the text of a leaflet that is given to patients when these drugs are prescribed