Odds of culpability associated with use of impairing drugs in injured drivers in Victoria, Australia

Drummer, Olaf H.; Gerostamoulos, Dimitri; Rago, Matthew Di; Woodford, Noel; Morris, Carla; Frederiksen, T; Jachno, Kim; Wolfe, Rory

doi:10.1016/j.aap.2019.105389

Cited by 58 publications

(54 citation statements)

References 46 publications

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“…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 ].…”

Section: Discussionsupporting

confidence: 89%

“…Of note, polysubstance use was observed in over 8 out of 10 positive cases for cocaine and/or BZE. It is well known that there is a high risk for fatal and serious injuries from road accidents when driving with the presence of various drugs [ 2 , 3 , 4 ]. The implementation of roadside drug testing in association with an efficient punitive system could be an efficacious public health intervention for maintaining safe driving [ 1 , 5 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The recorded estimation for accident involvement after consuming cocaine was 2.96 (95% CI 1.18–7.38); for involvement in fatal accidents it was 1.66 (95% CI 0.91–3.02); and for injuries in accidents it was 1.44 (95% CI 0.93–2.23) [ 3 ]. Furthermore, multiple drug use involving cocaine is associated with a very increased risk [ 2 , 3 , 4 ], thus, constituting a great concern, especially if alcohol consumption is detected.…”

Section: Introductionmentioning

confidence: 99%

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

Herrera‐Gómez

Gutiérrez-Abejón

García-Mingo

et al. 2021

IJERPH

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Herrera‐Gómez

Gutiérrez-Abejón

García-Mingo

et al. 2021

IJERPH

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“…A 2019 Australian responsibility analysis found increased risk of collision responsibility in drivers testing positive for benzo diaze pines (OR 3•2) but not in drivers testing positive for antidepressants or antipsychotics. 27 We found that drivers prescribed highpotency opioids had increased risk of collision responsibility when compared with nonusers or with past users. Previous researchers also found increased collision risk associated with opioids.…”

Section: Discussionmentioning

confidence: 73%

Medications and risk of motor vehicle collision responsibility in British Columbia, Canada: a population-based case-control study

Brubacher

Chan

Erdelyi

et al. 2021

The Lancet Public Health

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Background Many medications impair driving skills yet their influence on collision risk remains uncertain. We aimed to systematically investigate the risk of collision responsibility associated with common classes of prescription medications.Methods In this population-based case-control study we analysed linked driving and health records in British Columbia, Canada from Jan 1, 1997, to Dec 31, 2016. The study cohort included all drivers involved in an incident collision (defined as first collision after 3 collision-free years) that resulted in a police report. We scored police collision reports and classified drivers as responsible for the collision (cases) or not responsible (controls); drivers with indeterminate scores were excluded. We used logistic regression to determine odds of collision responsibility in drivers with current prescriptions for medications of interest versus drivers without prescriptions. To explore whether risk of collision responsibility was related to medication effect or driver factors, we compared risk in current medication users versus past users. To study whether drivers developed tolerance to medication effects, we compared risk in new (first 30 days of a prescription) versus established users. FindingsDuring the study period, 4 906 925 drivers had their driving licence linked to health records; of these drivers, 747 662 unique drivers were involved in 837 919 incident collisions between Jan 1, 2000, and Dec 31, 2016. 382 685 drivers responsible for the collision (cases) and 332 259 drivers not responsible (controls) were included in the final analysis; 122 975 drivers with indeterminate responsibility were excluded. We found increased risk of collision responsibility in drivers prescribed sedating antipsychotics (adjusted odds ratio [aOR] 1•35 [98•75% CI 1•25-1•46]), long-acting benzodiazepines (aOR 1•30 [1•22-1•38]), short-acting benzodiazepines (aOR 1•25 [1•20-1•31]), and high-potency opioids ( aOR 1•24 [1•17-1•30]). Among medications used for medical indications, the highest risk was seen in drivers prescribed neurological medications: cholinergic drugs (aOR 1•83 [1•39-2•40]), anticholinergic agents for Parkinson's disease (aOR 1•45 [1•08-1•96]), dopaminergic agents (aOR 1•20 [1•04-1•38]), and anticonvulsants (aOR 1•20 [1•14-1•26]). People currently taking benzodiazepines, non-sedating antidepressants, high-potency opioids, and anticonvulsants had increased risk compared with past users, and we did not find increased risk in new compared with established users of these drugs.Interpretation Drivers prescribed benzodiazepines or high-potency opioids are at increased risk of being responsible for collisions and this risk does not decrease over time. Several other classes of medications are associated with increased risk, but this association might be independent of medication effect. These findings can guide medication warnings and prescription choices and inform public education campaigns targeting impaired driving.

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“…The most recent and authoritative meta-analyses in this field suggest that cannabis-positive drivers are approximately 1.1-1.4 times more likely to be involved in a crash than sober drivers 15,16 and are also more likely to be culpable for a crash. 17 Notably, however, there have also been major recent studies in which no increases in crash or culpability risk were detected, 18 particularly when drivers had low blood THC concentrations (<5 ng/mL). 19 Overall, the increase in crash risk associated with THC is similar to that associated with a low-range blood alcohol concentration (BAC; 0.01-0.05 g/L), 20 although some analyses suggest that crash risk and culpability with cannabis may be greater with higher blood THC concentrations.…”

Section: Cannabis and Crash Risk: Evidence From Epidemiological Studiesmentioning

confidence: 99%

Medical cannabis and driving

Arkell¹,

McCartney²,

McGregor³

2021

Aust J Gen Pract

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Odds of culpability associated with use of impairing drugs in injured drivers in Victoria, Australia

Cited by 58 publications

References 46 publications

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

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

Medications and risk of motor vehicle collision responsibility in British Columbia, Canada: a population-based case-control study

Medical cannabis and driving

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