Karoliina Karjalainen

Poly-drug findings in drugged driving cases during 1977–2007

Background: Driving under the influence of drugs (DUID) is an increasing public health and traffic safety related problem. We examined the poly-drug findings and their trends among all apprehended DUID offenders in Finland. Methods: A register data from 1977 to 2007 was analysed. The data included a total of 31,963 suspected DUID cases with a positive finding for an illicit/licit drug impairing driving performance. Blood and/or urine specimens were analysed in one central laboratory. Results: Poly-drug findings were common among suspected DUID cases during the entire study period. Seventy-seven per cent of the specimens had a finding from two or more substance groups. Benzodiazepines with alcohol (20% of poly-drug cases) and amphetamines with benzodiazepines (18%) were the most frequently found combinations. Benzodiazepines were present in the five most frequent combinations. The proportion of cases including drugs only increased more rapidly than the proportion of cases including a combination of drugs and alcohol during the last three decades. The level of aggravated drink-driving limit in Finland (BAC>1.2‰ ) was exceeded in 44% of the cases including alcohol. Conclusion: In addition to amphetamines, benzodiazepines formed a major concern among suspected DUID cases. The large proportion of poly-drug findings may indicate extensive substance abuse among DUID offenders.

Mortality and Causes of Death among Drugged Drivers

Background Studying drugged drivers gives complementary information about mortality of drug users, which mainly has been studied among opioid abusers. The aim of this study was to analyse mortality rates and causes of death among drivers under the influence of drugs (DUID) in Finland and compare them with the general Finnish population during 1993–2006. Methods Register data from 5832 DUID suspects apprehended by the police were studied, with a reference group (n=74 809) drawn from the general Finnish population. Deaths were traced from the National Death Register. Survival and differences in mortality hazards were estimated using Kaplan–Meier plots and Cox regression models. Results The hazard of death was higher among male (HR 9.6, CI 8.7 to 10.6) and female (HR 9.1, CI 6.4 to 12.8) DUID suspects compared to the reference population. Among male DUID suspects, cause-specific hazards were highest for poisoning/overdose, violence and suicide. 24% of DUID suspects and 8% of reference subjects were under the influence of drugs/alcohol at the time of death. Poly-drug findings indicated excess in mortality among drugged drivers. Hazard of death was higher among male DUID suspects who had findings for benzodiazepines only (HR 10.0, CI 8.4 to 11.9) or benzodiazepines with alcohol (HR 9.6, CI 8.2 to 11.2), than with findings for amphetamines (HR 4.6, CI 2.7 to 7.6). Conclusion DUID suspects had an increased risk of death in all observed causes of death. Findings for benzodiazepines indicated excessive mortality over findings for amphetamines. Preventive actions should be aimed especially at DUID subgroups using benzodiazepines.

High mortality among people suspected of drunk-driving. An 18-year register-based follow-up

OBJECTIVES The aim of this study was to examine the overall and cause-specific mortality of DUI arrestees compared to a reference population with no history of DUI and to recognize the risk factors of premature death. METHODS The data used were a register of all DUI arrestees between April 1988 and December 2006. All drivers with drug-positive samples were excluded. DUI arrestees were compared to a reference population with no previous history of DUI. Overall and cause-specific hazard ratios were calculated and risk factors were estimated. RESULTS Alcohol causes, diseases of the circulatory system and accidents constituted the most common causes of death among DUI arrestees. Suspected DUI was linked with higher mortality in every observed cause of death. The risk of death by alcohol-related or external cause was especially high. Among women DUI arrests caused sharper increase to the risk of death than increase found among male arrestees. Within the group of DUI arrestees the risk of death was affected by age, sex, marital status, education, multiple arrests as well as time and observed blood alcohol level of the arrest. Half of the suspected DUI cases and one in five of the references had alcohol as a contributing factor to death. CONCLUSIONS Arrest on suspicion of drunk-driving is an indicator for elevated risk of death. Alcohol is often related to deaths of DUI arrestees. Drunk-drivers should be efficiently guided with respect to evaluations and treatments for harmful drinking.

Growing medicine: Small-scale cannabis cultivation for medical purposes in six different countries

BACKGROUND The production and consumption of cannabis for the treatment of medical conditions is of increasing importance internationally; however, research on different aspects of the phenomenon is still scarce. In this article, we report findings from a cross-cultural study of small-scale cannabis cultivation for medical purposes. This kind of comparative study has not been done previously. METHODS The data were gathered with a help of web surveys conducted by the Global Cannabis Cultivation Research Consortium (GCCRC) in Australia, Belgium, Denmark, Finland, Germany and the UK (N=5313). In the analysis we compare reports of medical motives, for what conditions cannabis is used, whether users have diagnoses for these conditions and whether the use of cannabis been recommended as a treatment of those conditions by a medical doctor. Descriptive statistics are used to show the main commonalities and noteworthy disparities across different countries. RESULTS Findings from countries were quite similar, even though several national differences in details were found. Growing cannabis for medical purposes was widespread. The majority of medical growers reported cultivating cannabis for serious conditions. Most of them did have a formal diagnosis. One fifth had got a recommendation from their doctor, but in most cases cannabis use was self-medication which was not discussed with their doctors. CONCLUSION There is a wider demand for licit access for medical cannabis than currently available in these countries. Ideologically, medical growers can be seen distancing themselves from both the legal and illicit drug markets. From a harm reduction perspective, it is worrying that, in the context of present health and control policies in these countries, many medical growers are using cannabis to treat serious medical conditions without proper medical advice and doctors guidance.

The Association between Social Determinants and Drunken Driving: A 15-Year Register-based Study of 81,125 Suspects

AIMS The aim of the study was to examine the association between social background and drunken driving. METHODS A Finnish register on suspected drunken driving was combined with data on social background. There were 81,125 drivers arrested for drunken driving and 86,279 references from 1993 to 2007. RESULTS A low level of education, unemployment, living alone and divorce were strongly associated with drunken driving. In addition, for persons aged 15-24 years, low parental education and income, high own income and possession of a car correlated with higher odds of drunken driving. For working-aged men and women, low income was associated with a higher risk of drunken driving. For working-aged women, also possession of a car was a risk factor. CONCLUSIONS Social factors are associated with drunken driving. In general, people with a lower social position are more prone to drive after drinking. Social differences are visible already in youth, whereas working and own income of young persons signal different risk mechanisms for youth than for working-aged people. Measures for preventing drunken driving are needed within public health policies.

Mental disorders associated with driving under the influence of alcohol and/or drugs: a register-based study

Background/Aims: Mental disorders are associated with driving under the influence (DUI), but the evidence is scarce and mostly focused on a limited group of repeat drunken drivers. Thus, the aim of this study was to examine which mental disorders were risk factors for DUI of alcohol only (DUIA), of illicit drugs (DUID) or of alcohol and psychoactive prescription drugs (DUIAP), and whether and how the risk differs over time. Methods: A register-based case-control study was conducted. Cases (n = 44,188) suspected by the police of DUI during 1997–2007 and controls (n = 45,148) were drawn from the general Finnish population. The official national register of hospital treatments was the data source for mental disorders. The effects of mental disorders on DUI were estimated using logistic regression analysis. Results: Substance use disorders increased the risk of DUI overall. Childhood- and adolescence-onset disorders were a strong predictor of DUID, and bipolar and depressive disorders predicted DUIAP. The risk was highest soon after hospital admission with a psychiatric diagnosis, but it decreased over time. Conclusions: Actions to prevent DUI should be developed and implemented during the treatment of mental disorders.

Personally prescribed psychoactive drugs in overdose deaths among drug abusers: A retrospective register study

INTRODUCTION AND AIMS Psychoactive prescription drug (PPD) abuse-related overdose deaths have increased in many countries in recent decades. We aimed to investigate the role of personally prescribed psychoactive drugs in abuse-related overdose mortality and explore any associations with level of social disadvantage. DESIGN AND METHODS This register linkage study included all 243 people who had died of abuse-related drug-induced poisoning in Finland in 2000 and 2008. Data on registered purchases of psychoactive drugs within one and three years of death were linked to data on the psychoactive drug/s contributing to death in each case. Social disadvantage was measured by receipt of income support, long-term unemployment and disability pension. RESULTS Thirty-six percent of those abusers who had died of a drug overdose had purchased a similarly acting drug within three years of death. In all overdoses, the proportion increased from 20% in 2000 to 49% in 2008 (P < 0.001). A similar increase was seen in purchases within one year of death; from one-tenth in 2000 to one-third of all cases in 2008 (P < 0.001). The majority (83%) of the deceased had received income support, while only 13-14% were long-term unemployed or on disability pension. Disability pension recipients had significantly more prescribed psychoactive drug purchases than non-recipients (P < 0.001 for three and one years within death). DISCUSSION AND CONCLUSIONS Personally prescribed PPDs pose a potential threat to people who abuse drugs. Health-care services should invest greater effort in identifying people who abuse drugs and in monitoring their drug prescriptions.

Personally prescribed psychoactive drugs in overdose deaths among drug abusers: a retrospective register study

INTRODUCTION AND AIMS Psychoactive prescription drug (PPD) abuse-related overdose deaths have increased in many countries in recent decades. We aimed to investigate the role of personally prescribed psychoactive drugs in abuse-related overdose mortality and explore any associations with level of social disadvantage. DESIGN AND METHODS This register linkage study included all 243 people who had died of abuse-related drug-induced poisoning in Finland in 2000 and 2008. Data on registered purchases of psychoactive drugs within one and three years of death were linked to data on the psychoactive drug/s contributing to death in each case. Social disadvantage was measured by receipt of income support, long-term unemployment and disability pension. RESULTS Thirty-six percent of those abusers who had died of a drug overdose had purchased a similarly acting drug within three years of death. In all overdoses, the proportion increased from 20% in 2000 to 49% in 2008 (P < 0.001). A similar increase was seen in purchases within one year of death; from one-tenth in 2000 to one-third of all cases in 2008 (P < 0.001). The majority (83%) of the deceased had received income support, while only 13-14% were long-term unemployed or on disability pension. Disability pension recipients had significantly more prescribed psychoactive drug purchases than non-recipients (P < 0.001 for three and one years within death). DISCUSSION AND CONCLUSIONS Personally prescribed PPDs pose a potential threat to people who abuse drugs. Health-care services should invest greater effort in identifying people who abuse drugs and in monitoring their drug prescriptions.

The arrest of drivers under the influence as a predictor of subsequent social disadvantage and death

BACKGROUND The association between DUI (driving under the influence) and disadvantaged social background has been shown in cross-sectional studies, but less is known about the processes behind this phenomenon. We aimed to examine the effect of DUI arrest on subsequent social disadvantage in Finland during 1993-2006 to provide more understanding about the dynamics of DUI and marginalization and to study DUI arrest as a potential point of intervention. METHODS In this longitudinal, register-based study the Register of DUI suspects (n=68894) was linked with the Employment Register. An age- and gender-matched reference population (n=67740) was drawn from the general Finnish population. A multi-state model was used to estimate the transition intensities between three different states (advantaged social status/disadvantaged social status/death) among three different DUI groups (alcohol only, prescription drugs, illicit drugs). RESULTS Compared to references, the movement of DUI suspects between different social states was more dynamic in that they were more likely to either move to a disadvantaged social state or to an improved status (except DUI suspects using prescription drugs). A DUIs relative risk of death compared to references was high, especially if currently in advantaged social status. The effect of DUI did not diminish over time. CONCLUSIONS Driving under the influence is associated with an increased long-term risk for social disadvantage. DUI arrest could serve as an opportunity for intervention in the marginalization process.

Examining the blurred boundaries between medical and recreational cannabis – results from an international study of small-scale cannabis cultivators

Abstract Aim: To compare characteristics of recreational vs. medical growers in a sample of small-scale cannabis cultivators from 12 countries. Methods: Six thousand eight hundred ninety six respondents who took part in an online survey were divided into three groups as: those who reported growing for recreational use, those cultivating for medical purposes who also reported use of other illegal drugs, and those who reported cultivation for medical use and didn’t use other illegal substances. The groups were compared using multinomial logistic regression. Findings: In comparison to recreational growers, the two groups of medical growers included more females, consumed cannabis more frequently, and were more likely to cite health-related motivations for growing. The medical growers without other illicit drug use shared some of the same features with the medical growers with illicit drug use, but in comparison to both other groups, they were older, used less alcohol and tobacco, and were less likely to be involved in illicit activities other than drug crimes. Conclusions: Findings suggest that claims of medical use are not simply an attempt to justify personal cannabis consumption, but do at least partly reflect a genuine belief in medical benefit. However, those growing cannabis for medical reasons form a heterogeneous group of people.