Benzodiazepines in the oral fluid of Spanish drivers

Abstract

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 benzodiazepinepositive 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.

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

“…The increased accident risk when driving with the presence of other drugs is well known. This finding is consistent with polysubstance use observed when assessing confirmed tests for opioids and cannabis in the same period in Spain [ 13 , 14 ] and worldwide [ 2 , 4 , 16 , 17 , 18 ].…”

“…As previously performed [ 5 , 13 , 14 ], this study assessed Spanish National administrative data on laboratory-confirmed drug-positive results obtained from the Spanish National Traffic Agency records corresponding to licensed drivers who underwent drug confirmation analyses between 1 January 2011, and 31 December 2016. Hypothesis, analysis and reporting follow the REporting of studies Conducted using Observational Routinely collected health Data (RECORD) guidelines [ 15 ].…”

“…In Spain, mandatory roadside alcohol and drug testing (screening) are carried out by the Spanish Traffic Police using breath for alcohol (Dräger Alcotest ® 6810 device; Drägerwerk AG & Co. KGaA, Lübeck, Germany) and oral fluid for drugs (Dräger DrugTest ® 5000; Drägerwerk AG & Co. KGaA, Lübeck, Germany, DrugWipe ® ; Securetec Detektions-Systeme AG, Neubiberg, Germany, or Alere™ DDS ® 2 Mobile Test System; Alere Toxicology Services Inc., Los Angeles, CA, USA). All positive results for any substance other than alcohol need to be confirmed and quantified, so a second oral fluid sample of approximately 1 mL is obtained and sent to accredited toxicology laboratories for confirmation analysis and quantification of detected substances using chromatographic techniques [ 5 , 13 , 14 ]. Supplementary Table S1 shows the cut-offs for roadside drug tests for cannabis, cocaine, amphetamine, methamphetamine and opioids that have been used between 2011 and 2016.…”

“…A total of 179,645 roadside drug tests were carried out by the Spanish traffic police between 2011 and 2016 ( Supplementary Table S2 ), 65,244 of which were positive [ 5 , 13 , 14 ]. Supplementary Table S2 shows information on gender distribution in the Spanish Driver population between 2011 and 2016.…”

“…The following groups of licit/illicit drugs and some of their metabolites were assessed in confirmation and quantification analyses according to DRUID project criteria [ 2 , 5 , 13 , 14 ]: (1) amphetaminelike substances (amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxy-N-ethylamphetamine (MDEA), methamphetamine); (2) cocaine and benzoylecgonine; (3) delta-9-tetrahydrocannabinol (THC); (4) opioids (6-acetylmorphine, morphine, codeine, methadone, tramadol); (5) benzodiazepines (hypnotics: flunitrazepam, 7-aminoflunitrazepam; anxiolytics: alprazolam, clonazepam, 7-aminoclonazepam, diazepam, lorazepam, nordiazepam, oxazepam); and (6) z-drugs (zolpidem, zopiclone).…”