Prevalence of driving with blood drug concentrations above proposed new legal limits in Norway: Estimations based on drug concentrations in oral fluid

Gjerde, Hallvard; Normann, Per T.; Christophersen, AsbjÃ ̧rg S.; Mørland, Jörg

doi:10.1016/j.forsciint.2011.03.021

Cited by 15 publications

(5 citation statements)

References 32 publications

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“…Obtaining drug levels for psychoactive substances from drivers in MVC and injured or deceased drivers may be a method of differentiating prevalence among drugs. While there may be legislation in some countries mandating drug testing of drivers in MVC, obtaining blood for the measurement of drug concentrations in random drivers is difficult due to a high refusal rate [71]. Data collection is improved in some studies by offering monetary incentives and collecting urine or oral fluid samples instead of blood.…”

Section: Forensic and Legal Considerationsmentioning

confidence: 99%

In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

2013

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Despite their improved pharmacokinetic profile, the Z-drugs, zolpidem, zopiclone, and zaleplon, have a spectrum of adverse effects comparable to benzodiazepines. This review focuses on the impairment from Z-drugs on cognition, behavior, psychomotor performance, and driving ability. Z-drugs are short-acting GABA agonists that reduce sleep latency without disturbing sleep architecture. Bizarre behavioral effects have prompted warnings on the prescription, dispensation, and use of Z-drugs. Psychomotor impairment, falls, and hip fractures are more likely to occur with Z-drugs that have longer half-lives, that are taken at higher-than-recommended doses and when mixed with other psychoactive substances including alcohol. Zopiclone and higher doses of zolpidem are more likely to cause anterograde amnesia than zaleplon. Z-drugs, especially zolpidem, are associated with complex behaviors such as sleepwalking, sleep-driving, and hallucinations. Patients taking zopiclone and zolpidem have an increased risk of motor vehicle collisions, over double that of unexposed drivers. Driving impairment occurs with zopiclone and higher doses of zolpidem but is unlikely to occur after 4 h post-zaleplon administration. The residual effect of Z-drugs on next-day cognitive and psychomotor performance has significant impact on lifestyle, safety, and occupational considerations, including motor vehicle and machine operation. The risk-benefit analysis of Z-drugs in the treatment of insomnia, particularly in the elderly, may not favor treatment due to the increased risks of falls and motor vehicle collisions. Prescribers should warn patients taking Z-drugs of minimum time thresholds before they operate machinery or drive motor vehicles.

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Section: Forensic and Legal Considerationsmentioning

confidence: 99%

In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

2013

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“…The problem posed by driving under the influence of drugs (DUID) other than alcohol has led to the introduction of zero-tolerance laws for driving under the influence of controlled (scheduled) substances [3,4]. People use recreational illicit drugs to experience euphoria, to make themselves more extrovert or daring and such things are unacceptable when skilled tasks, such as driving, are performed [5].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden

Ahlner

Holmgren

Jones

2013

Scand J Public Health

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“…In this country, a blood concentration of D of 0.342 mg/L is considered equivalent to a blood–ethanol concentrations of 1.12 g/L (0.12 g%), which might surprise traffic safety experts and clinical pharmacologists. 39,40 The optimal therapeutic concentration of D depends on a person’s age, clinical diagnosis, and how long the medication has been taken.…”

Section: Discussionmentioning

confidence: 99%

Concentrations of Diazepam and Nordiazepam in 1000 Blood Samples From Apprehended Drivers—Therapeutic Use or Abuse of Anxiolytics?

Jones

Holmgren

2012

Journal of Pharmacy Practice

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Using an in-house forensic toxicology database, we selected 1000 cases of driving under the influence of drugs (DUIDs) over a 12-month period if diazepam (D) and nordiazepam (ND) were both present in the blood samples. Quantitative analysis of D and ND in blood was done by solvent extraction (butyl acetate) and capillary column gas chromatography (GC) with a nitrogen-phosphorous (N-P) detector. The limits of quantitation of this analytical method for D and ND in blood were 0.05 mg/L. The correlation between D and ND concentrations in blood was statistically significant (r = .58, P < .001), as expected for a parent drug and its primary metabolite. However, the frequency distributions were markedly skewed to the right with mean (median) and highest concentrations of 0.37 (0.20) and 6.1 mg/L for D and 0.39 (0.20) and 5.6 mg/L for ND. The mean (median) total concentration (D + ND) was 0.76 mg/L (0.50 mg/L), and the concentration ratios D/ND and ND/D were 1.29 (median 0.95) and 1.41 (median 1.06), respectively. In 90 cases (9%), the concentration of D in blood exceeded 0.83 mg/L, which corresponds to an upper therapeutic limit in plasma (∼1.5 mg/L), assuming a plasma/blood distribution ratio of 1.8:1.

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Prevalence of driving with blood drug concentrations above proposed new legal limits in Norway: Estimations based on drug concentrations in oral fluid

Cited by 15 publications

References 32 publications

In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden

Concentrations of Diazepam and Nordiazepam in 1000 Blood Samples From Apprehended Drivers—Therapeutic Use or Abuse of Anxiolytics?

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