F. Javier Alvarez

Alcohol, illicit drugs and medicinal drugs in fatally injured drivers in Spain between 1991and 2000

The aim of this study was to assess the presence of alcohol, illicit drugs and medicinal drugs among Spanish drivers involved in fatal road accidents between 1991 and 2000. Samples were obtained for 5745 drivers killed in road accidents from January 1991 to December 2000. Of the samples, 91.7% represented males and 8.3% females; 40.7% were under 30 years of age, 31.9% were under 31-50 years of age, 19.5% were over 51 years of age, and for 7.9% the age was unknown. Between 1991 and 2000, some type of psychoactive substance was detected among 50.1% of those drivers killed in road accidents, this being mainly alcohol (43.8%) and, less frequently, illicit drugs (8.8%) and medicinal drugs (4.7%). In all the cases, in which alcohol was detected, combined use with other substances accounted for only 12.5%, whilst in the case of illicit and medicinal drugs, figures representing combined use with other substances were 75.6% for the former and 65.8% for the latter. For one in every three cases (32.0%), a blood alcohol level over 0.8 g/l was recorded; cocaine (5.2%), opiates (3.2%) and cannabis (2.2%) were the three illicit drugs most frequently detected. Among medicinal drugs, were benzodiazepines (3.4%), anti-depressant drugs (0.6%) and analgesics (0.4%). The results show the frequent presence of psychoactive substances, particularly alcohol, among Spanish motor vehicle users involved in fatal road accidents. It should be pointed out that illicit and medicinal drugs in combination with other substances were a common feature.

Presence of illegal drugs in drivers involved in fatal road traffic accidents in Spain

This study investigated the presence of illegal drugs in the blood of 285 fatally injured drivers in Spain. Illegal drugs were detected in 10.2% of all samples. Illicit drugs alone were detected in 2.5% and together with other substances in 7.7%. Cocaine was the most common drug detected. The mean number (+/- S.D.) of substances detected was 2.6 +/- 1.2: consisting of 46 illegal drugs, 14 alcohol cases and 16 medicines. Three concentration levels of the different substances have been established: low, medium and high-toxic. In 68.9% of the samples in which an illegal drug was detected, a substance was also found at the high-toxic level. The results show that illegal drugs are commonly detected in road accident victims.

Illegal drug taking and driving: patterns of drug taking among Spanish drivers

This study investigated patterns of illegal drug taking among Spanish drivers. The study was conducted in the fall of 1993 on 1500 drivers aged over 16, who properly completed and returned the questionnaires. The statistical SAS package was used. Among those surveyed, 23.5% had taken illegal drugs within their lifetime, 6.1% in the past year, 4.2% in the past month and 3.1% in the past week. Cannabis was the drug most frequently taking drug within lifetime (17.3%), the past year (3.4%), the past month (2.7%) or the past week (2.1%). Of those surveyed, 3% had driven after taking illegal drugs in the last year before the survey, and had been stopped during road checks (P < 0.001) and involved in road accidents (P < 0.0001) more often than those who had not driven under the influence of drugs. The study shows that driving under the influence of illegal drugs is somewhat frequent in Spain.

Prevalence of psychoactive substances, alcohol, illicit drugs, and medicines, in Spanish drivers: A roadside study

Following population, geographic, road type and time criteria, Spain has carried out random, roadside controls of 3302 representative sample of Spanish drivers, including saliva analysis for 24 psychoactive substances and alcohol breath tests. The 81.4% of the drivers were male, with an average age of 34.8±11.8 (mean±SD). The 17% of the drivers were found to be positive to any of the substances analysed. The 6.6% of the drivers found positive to alcohol (>0.05 mg/l in breath), 11% were found positive to any illicit drug, and 2% were positive to one of the medicines analysed. Some drivers were positive in more than one substance. The most common illicit drugs among Spanish drivers were cannabis (7.7%), or cocaine (3.5%), either alone or combined with other substances. The most prevalent medicines were the benzodiazepines (1.6%). As a tendency, higher figures for positive cases were observed among males than in females (being statistically significant the differences for alcohol, cannabis and cocaine). Alcohol and cocaine positive cases were more frequently found among drivers of urban roads. Alcohol positive cases (alone, >0.05 mg/l), were more likely found as age increase (OR=1.02), those driving in urban roads (OR=2.13), and driving at any period than weekdays, while alcohol+drugs cases were more likely found among males (OR=2.819), those driving on urban road (OR=2.17) and driving at night periods. Finding a medicines positive case was more likely as elder the driver was (OR=1.05). There have been differences in the prevalence of positive cases of alcohol, cannabis and cocaine, in relation to the period of the week: in three cases the highest prevalence seen in night time. This study shows the high prevalence of psychoactive substances and alcohol in Spanish drivers, mainly illicit drugs (cannabis). This question requires a response from the authorities and from society, with an integral and multi-disciplinary approach that can heighten the populations awareness of the risks of driving under the influence of certain substances.

Prescribing and Dispensing Guidelines for Medicinal Drugs Affecting Driving Performance

This chapter aims to provide practice-oriented information for prescribing physicians and dispensing pharmacists who want to provide their patients with adequate advice based on a clear understanding of the risks of accident involvement under different treatment conditions. Specific attention will be given to the application of a graded-level warning system based on categorization systems for psychotropic medicines that have been introduced,, and sometimes legally implemented, in several European countries. This warning system allows physicians and pharmacists to select the least impairing medicines within a therapeutic class. Advice for the patient based on three categories has been described in clear instructions, allowing the patient to make the right decision.

ALCOHOL USE AMONG FATALLY INJURED DRIVERS IN SPAIN

Blood from 285 fatally injured drivers in Northern Spain was collected and tested for the presence of alcohol and drugs. Alcohol was detected in 50.5% of all fatalities. Alcohol alone was detected in 44.2% of all samples and in the remaining 6.3% another substance was found together with alcohol. Blood alcohol concentration was classified in different levels. It has been observed that in 35.4% of the cases the blood alcohol level was > or = 0.8 g/l, the legal limit in Spain for car drivers. Alcohol together with other substances was encountered in 18 cases, with medication in 22.2% (4 out of 18), alcohol with illegal drugs in 66.6% of the cases (12 out of 18), and alcohol with medicines and illegal drugs in 11.1% (2 out of 18). Cocaine was the most commonly detected drug. The study shows how widespread the incidence of a high level of alcohol concentration among drivers involved in fatal accidents in Spain.

Medicinal drugs and driving: from research to clinical practice.

From the point of view of traffic authorities, the relationship between medicinal drugs and driving can be seen from a dual perspective. First, countries have regulations against driving under the influence of certain substances (alcohol, illegal drugs, and medicaments) that impair ability to drive. Most countries take one of two positions: ‘zero-tolerance’ – if the substance is detected, the law has been broken; or ‘impairment’, which requires evidence of impairment in the driver who is under the effect of the substance in question [20xOverview of legal provisions, difficulties faced by police, and analysis of prevention attemps in selected european countries. Kruger, H.P. et al. : 63–85See all References[20]. Second, Directive 91/439 EEC on driving licences, in Annex III, establishes the minimum standards of physical and mental fitness of an individual to drive a motor vehicle. It indicates that ‘driving licences shall not be issued to, or renewed for, applicants or drivers who regularly use psychotropic substances, in whatever form, which can hamper the ability to drive safely where the quantities absorbed are such as to have an adverse effect on driving. This shall apply to all other medicinal products or combinations of medicinal products which affect the ability to drive’.All EU member countries have legislation concerning this Directive, although there are differences between them. This would mean that many drivers being treated with medication for a particular illness would not be allowed to receive or renew their driving licence, either because of the illness itself or because of the medication. Once again, this would require information as precise as possible about the medication and its effect on driving ability to facilitate the selection, prescription and information of medicaments.Those of us working in the pharmacological field (experimental pharmacology, clinical pharmacology, pharmacy, pharmaco-epidemiology, and so on), with our very different views, need to join forces to deal with the subject of drugs and driving in a more scientific manner. It is clear that more effort must be made to avoid or reduce as much as possible the occurrence of traffic accidents caused by the effects of medication.

The Use of Medication by the Spanish Population

The aim of the study was to assess patterns of the use of medicines by the general population older than 0 years. The study was based on the information contained in the computerized database from the 1993 Spanish Household Health Survey. A representative sample of the population older than 0 was identified, and a survey of 26,334 persons was carried out. Of the population 45.3% had taken some medicine in the last 2 weeks prior to the carrying out of the survey. The proportion was greater for women (50.6%) than for men (39.6%). With increasing age, the frequency and amount of medication use increased. A little over 20% of the medicines used were not prescribed by a doctor (self‐medication). Data show the frequency of the use of medicines by the Spanish population.

A European approach to categorizing medicines for fitness to drive: outcomes of the DRUID project

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Illicit drugs and fitness to drive: assessment in Spanish Medical Driving Test Centres

This study investigated the incidence of problems related to illicit drugs and fitness to drive among 8043 Spanish drivers assessed in 25 Medical Driving Test Centres at national level. In accordance with Spanish and European Union legislation, driving licences cannot be issued or renewed to people suffering from illicit drug-related problems. A small percentage (0.3%; n=24) of drivers interviewed had problems relating to drug use (abuse, dependence and induced disorders) and half of them (n=12) were also diagnosed as having problems with alcohol. Drivers with illicit drug-related problems were more often involved in road accidents and committed more traffic infractions during the last year (33.3%, n=8, and 79.2%, n=19, respectively) than those without problems related to illegal drug taking (12.3%, n=986, and 9.3%, n=748, respectively). Of drivers with drug problems 70.8% (n=17) were considered fit to drive. The results show that the incidence of drug-related problems is rare among Spanish drivers, and that in three out of four cases drivers with drug-related problems were considered fit to drive.