Driving under the influence of drugs: Correlation between blood psychoactive drug concentrations and cognitive impairment. A narrative review taking into account forensic issues

Blandino, Alberto; Cotroneo, Rosy; Tambuzzi, Stefano; Candia, Domenico Di; Genovese, Umberto; Zoja, Riccardo

doi:10.1016/j.fsisyn.2022.100224

Cited by 10 publications

(8 citation statements)

References 166 publications

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“…Studies focusing on blood toxicological results are increasing in southern European countries, such as Italy, in line with northern countries, where several studies point out blood results, as shown in a review published by Kwon and Han. 16,17…”

Section: Discussionmentioning

confidence: 99%

Blood alcohol concentration and road accidents: Underestimation due to time of the arrival to the emergency department (ED) or delay in blood sampling. A 4-Year Retrospective Study in Rome

et al. 2023

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Alcohol is a significant public health issue, according to the World Health Organization. Our study aims to analyze the correlation between blood alcohol concentrations (BACs) of drivers, their demographic features, and the possible underestimation of BACs due to the time elapsed between hospital admission and blood sampling. Methods: This study includes patients evaluated for BAC levels in the emergency department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCCS from January 2013 to December 2016. BAC levels were compared in patients involved in road crashes according to age group, sex, and time of the accident. The delays in blood sampling and BAC measurement in the ED were recorded for each patient. The time between the accident and access to the hospital in most cases was unknown. Results: A total of 398 patients were included in the analysis, 107 of them had BACs more than 0.05 g/L., and 86 of these individuals had BAC levels more than 0.5 g/L. Road accident patients had higher rates of positive BAC readings at night and on weekends. A significant delay in blood sampling for BAC determination was observed. Discussion: This study demonstrates a critical bias due to the arrival time at the ED and the delay in blood sampling that inevitably influences and underestimates the BAC, resulting in possible false negative results (BAC values below the cutoff). Zero tolerance or a retrospective BAC calculation could mitigate this bias. It is necessary to implement preventive strategies to reduce instances of driving under the influence (DUI) of alcohol.

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Section: Discussionmentioning

confidence: 99%

Blood alcohol concentration and road accidents: Underestimation due to time of the arrival to the emergency department (ED) or delay in blood sampling. A 4-Year Retrospective Study in Rome

et al. 2023

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“…Indeed, it seems that there is a significant risk of unimpaired individuals being mistakenly identified as 'cannabis-impaired' (and vice-versa) under this approach'. In a similar vein, a review by Blandino et al (2022) of Correlations between blood psychoactive drug concentrations and cognitive impairment found that '… the relationship between blood levels [of THC] and impaired driving lacks a clear and proven direction of correlation' (p. 4).…”

Section: Applying the Benchmark To Standard Deviation Of Lateral Posi...mentioning

confidence: 99%

“…For example, in the U.S., under the Fourth Amendment, a ‘reasonable suspicion’ that the driver is impaired must be formed before the driver can be pulled over. That is followed by a preliminary assessment that a drug is the ‘probable cause’ of the impaired driving (based, e.g., on slurred speech), before any evidentiary-level behavioural or toxicological assessments can be undertaken (DuPont et al, 2012).…”

Section: Types Of Drug-driving Enforcement Regime and The Purpose Of ...mentioning

confidence: 99%

“…In response to the irrefutable fact that there is no meaningful relationship between THC concentration and degree of impairment, DuPont advocates strongly for the U.S. States to adopt zero-tolerance per se drug-driving laws. For example, after acknowledging that ‘The relationship between [drug] concentration in blood and behavior is sufficiently complex that the development of per se impairment levels for drugs does not appear to be practical or feasible’, DuPont et al (2012: 37 and 38) go on to advise that ‘The enactment of zero-tolerance drug-impaired-driving per se laws for illegal drugs offers multiple possibilities for increasing the intensity of drugged-driving enforcement and creating greater deterrence of drugged driving’. The same opinion is expressed in a paper co-authored by DuPont (Reisfield et al, 2012), where the title of the paper says it all: ‘The mirage of impairing drug concentration thresholds: A rationale for zero-tolerance per se driving-under-the-influence-of-drugs laws’.…”

Section: Impairment Cannot Be Predicted From Thc Concentration or Pre...mentioning

confidence: 99%

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How to read a paper on the short-term impairing effects of cannabis: A selective and critical review of the literature

White

Burns

2022

Drug Science, Policy and Law

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The prosecution of cannabis-presence driving offences (in the absence of any behavioural evidence of impairment) is ultimately based on the assumption that there is a tight causal relationship between positive toxicology for cannabis and impairment. The main purpose of this review is to examine the evidence for that relationship. We show that most experimental studies have failed to elicit statistically-significant cannabis-induced impairments for many of their possible outcomes. And many studies failed to demonstrate any impairment at all in regular users of cannabis (because of the development of tolerance). We argue that selective reporting by researchers, editors and the media has created the false impression that the evidence for cannabis-induced impairment is strong and consistent. Human beings are ‘over-engineered’ for the psychomotor skills required to drive safely. A benchmark level of cannabis-induced impairment is therefore required to distinguish unproblematic from ‘real-world’ impairment. The conventional benchmarks of statistical significance, effect size and BAC-equivalence are shown to be inadequate. However, a benchmark in terms of 30 years of normal cognitive aging has good face validity. The recent use of cannabis is indicated toxicologically by the presence of delta-9-tetrahydrocannabinol (THC) in blood or oral fluid. Evidence is provided that most THC-positive drivers are not impaired, and certainly not meaningfully impaired. It follows that the justice of stand-alone cannabis-presence driving offences must be questioned.

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“…Alarmingly, the number of new SCI cases in most countries has risen over the last few decades [2]. Patients often experience multiple sequalae to injury, such as loss of sensory and motor function below the site of spinal injury, and in the long term develop complex conditions, including chronic pain [3,4]. As mortality is rare and SCI often occurs at a young age, it can cost up to $5.4 million USD in lifetime care per patient [5].…”

Section: Introductionmentioning

confidence: 99%

Current Spinal Cord Injury Animal Models are Too Simplistic for Clinical Translation

Gliksten

Yip

2023

Journal of Experimental Neurology

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Driving under the influence of drugs: Correlation between blood psychoactive drug concentrations and cognitive impairment. A narrative review taking into account forensic issues

Cited by 10 publications

References 166 publications

Blood alcohol concentration and road accidents: Underestimation due to time of the arrival to the emergency department (ED) or delay in blood sampling. A 4-Year Retrospective Study in Rome

Blood alcohol concentration and road accidents: Underestimation due to time of the arrival to the emergency department (ED) or delay in blood sampling. A 4-Year Retrospective Study in Rome

How to read a paper on the short-term impairing effects of cannabis: A selective and critical review of the literature

Current Spinal Cord Injury Animal Models are Too Simplistic for Clinical Translation

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