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Date: April 30, 2024 Tue
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Results for driving under the influence (europe)
3 results foundAuthor: Schulze, Holst Title: Driving Under the Influence of Drugs, Alcohol and Medicines in Europe — findings from the DRUID project Summary: Roadside surveys conducted in 13 countries across Europe, in which blood or oral fluid samples from 50,000 drivers were analysed, revealed that alcohol was present in 3.48 %, illicit drugs in 1.90 %, medicines in 1.36 %, combinations of drugs or medicines in 0.39 % and alcohol combined with drugs or medicines in 0.37 %. However, there were large differences among the mean values in the regions of northern, eastern, southern and western Europe. Although the absolute numbers were quite low, the prevalence of alcohol, cocaine, cannabis and combined substance use was higher in southern Europe, and to some extent in western Europe, than in the other two regions, whereas medicinal opioids and ‘z-drugs’, such as zopiclone and zolpidem, were detected more in northern Europe. Studies of hospitalised, seriously injured car drivers were conducted in six countries, and studies of car drivers killed in accidents took place in four countries. Among the injured or killed drivers, the most commonly consumed substance was alcohol alone, followed by alcohol combined with another substance. The use of illicit drugs alone was not frequently detected. After alcohol, the most frequently found substance among injured drivers was tetrahydrocannabinol (THC) followed by benzodiazepines, whereas, among drivers killed in accidents, it was benzodiazepines. The results of the roadside surveys and the hospital surveys were combined in a case–control study to calculate the relative risk of being seriously injured or killed in a traffic accident. The project assigned the investigated substances to one of four groups, according to whether the increased risk was considered to be slight, medium, considerable or high. The findings showed that alcohol is still one of the most dangerous psychoactive substances used by drivers. The biggest risk for a driver of being seriously injured or dying in a traffic accident arises from high blood alcohol levels or from combinations of alcohol, drugs or medicines. Most of the seriously injured or killed drivers who tested positive for alcohol were severely intoxicated. However, results of interviews in two countries showed that problem drinkers do not believe that alcohol impairs their driving. Intensive drug users were more likely than moderate drug users to drive under the influence, with the latter taking a more responsible approach to driving under the influence of drugs. Alcohol and drugs were detected more often in male drivers. Medicines were detected mainly in middle-aged and older female drivers, but, among drivers seriously injured or killed in accidents, medicines were more often found in male drivers in the same age ranges, often in combination with other substances. Experimental studies suggested that the illicit stimulants d-amphetamine, MDMA (‘ecstasy’) and cocaine have no negative influence on fitness to drive, but studies of drivers injured and killed in accidents found considerably higher median drug levels for stimulants, and such levels may have detrimental effects on self-perception, critical judgement and risk-taking. A night of sleep deprivation alone impairs performance to a similar degree to the 0.8 g/l blood alcohol concentration (BAC), i.e. higher than the common legal driving limit of 0.5 g/l, and MDMA in combination with alcohol (or sleep deprivation) causes dramatic impairment of driving performance; stimulants do not compensate for alcohol use or sleep deprivation. A few medicines can cause impairment of which the patient is unaware. A number of recommendations were made to update the wording of the 1991 European Council Directive on Driving Licences, referring to licence withdrawal due to consumption of drugs and psychoactive substances. Very few public information campaigns regarding drug-driving were evaluated for their impact — and some of them evaluated only awareness of the campaign, rather than if it changed driver behaviour. Psychoactive medicines on the EU market were classified into four categories depending on their influence on fitness to drive, and it was demonstrated that a pictogram on the package indicating the risk when driving was effective in changing patients’ intended behaviour. In collaboration with experts of the Pharmacovigilance Working Party of the European Medicines Agency, recommendations could be presented for improving the package information leaflet for category II (moderately impairing) and category III (severely impairing) medicines. It was also shown that a software package could assist physicians and pharmacists in giving advice to patients when prescribing and dispensing such medicines, respectively. Legal limits, consistently enforced, are the single most effective approach to combat drink-driving. The maximum standard legal limit should be 0.5 g/l BAC, and stricter limits for certain risk groups (novice drivers, professional drivers) should be considered. As mixed intoxication with other substances poses a greater risk, the alcohol limit must be lower in such cases. To combat drug-driving, most countries either operate a zero tolerance policy or take into account degree of impairment, sometimes in a two-tier system. Legal limits may be set low, at the limit of detection, or higher to take effects into consideration. For example, while the project set a detection limit of 1 ng/ml in whole blood for THC in the roadside surveys, it was found that 2 ng/ml THC in whole blood (3.8 ng/ml THC in serum) seems to cause impairment equivalent to 0.5 g/l BAC. Such equivalents could not be calculated for other drugs. It is not realistic to develop cut-off limits for all substances. Regarding driving under the influence of medicines, a legal limit for patients undergoing long-term treatment is inappropriate; sanctions should be based on degree of impairment. None of the roadside oral fluid testing devices achieved the target value of 80 % sensitivity, specificity and accuracy for all the individual substances tested. Thus, when considering the suitability of a device, the type and prevalence of drugs within the target population should be considered. An evaluation of a checklist of clinical signs of impairment, such as bloodshot eyes, did not give promising results; more experience and better training of police officers may improve this. In the near future, analysis of dried blood spots could be a much quicker and less invasive method of proving an offence than taking a sample of whole blood from a driver using a syringe. Transport and storage of dried blood spots are also much easier than for whole blood. A cost–benefit evaluation found that increased enforcement of drug-driving sanctions, based on roadside oral fluid screening, is potentially cost-beneficial, particularly for countries where the level of enforcement is currently low. However, increasing drug-driving enforcement at the expense of a reduction in drink-driving enforcement may actually decrease the positive impact on road safety. As the risk and share of injuries is higher for alcohol, targeting driving under the influence of alcohol should always be the first priority of law enforcers. Withdrawal of the driving licence is an effective deterrent and sanction, more so than prison or fines, but only when it is implemented quickly and for a period of 3–12 months (longer leads to non-compliance). Combining licence withdrawal with rehabilitation/treatment is more effective than licence withdrawal alone. Withdrawal of the licence of patients undergoing long-term treatment, including substitution treatment, should be based on an individual assessment of a patient’s fitness to drive overall, not simply on substance consumption. Some driver rehabilitation schemes can reduce recidivism by an average of 45 %. Drivers with addiction or similar problems are unlikely to benefit from a rehabilitation programme and should be matched to more appropriate treatment. Rehabilitation options should vary according to the needs of different offenders. Details: Luxembourg: Publications Office of the European Union, 2012. 57 pp. Source: Internet Resource: Accessed January 17, 2013 at: http://www.emcdda.europa.eu/attachements.cfm/att_192773_EN_TDXA12006ENN.pdf Year: 2012 Country: Europe URL: http://www.emcdda.europa.eu/attachements.cfm/att_192773_EN_TDXA12006ENN.pdf Shelf Number: 127336 Keywords: Driving Under the Influence (Europe)Drugged DrivingDrugs and DrivingDrunk Driving |
Author: Veisten, Knut Title: Cost-Benefit Analysis of Drug Driving Enforcement by the Police Summary: One of the deliverables in DRUID WP3 is a cost-benefit analysis (CBA), an assessment to what degree (increased) enforcement against driving under the influence of drugs is profitable in economic terms for the society, together with an assessment of which of the existing devices for such enforcement are more profitable. The policy goal of increased enforcement, targeting driving under the influence of psychoactive substances, would be to increase societies’ benefits (reduce societal costs) through a deterrence effect that should reduce prevalence and driving under the influence of psychoactive substances, and subsequently reduce the tolls of fatalities and injuries. This implicitly assumes that individual behaviour is affected by the increased presence of police at the roadside and/or the word-ofmouth of acquaintances being tested and/or that the particular driver is tested. While positive benefits in the CBA will be due mainly to an expected decrease in fatalities and injuries, there are other effects of an enforcement increase that will be counted as negative benefits, particularly the additional time use of the road users. The cost of increased enforcement against driving under the influence of drugs will comprise the costs of control equipment and police work, as well as additional medical and judicial costs in case of suspicions and convictions. Both costs and benefits may depend on the quality of the particular drug screening test device to be applied by the police. Even if the particular device selection normally is beyond the CBA, e.g., that some hypothetical/average device is assumed in the analysis, in the case of drug screening the selection of device might become more decisive for the results. Data are collected from the three participating countries: Belgium, Finland, and the Netherlands. Also the CBA is applied to these three countries. Applying these three countries as case studies may prove illustrative, in that they have different baseline levels of drug screening. Although the CBA model will have some limitation (stiffness) in terms of differentiating effects with respect to the baseline level, it will appear that the current control level will affect the outcome of the CBA. However, estimating the effect of control change on prevalence (the “deterrence effect”) is indeed a very complex issue, and the approach in our CBA must be regarded as fairly simplified. The input variables and different scenarios for the CBA are complex and must often be based partly on assumptions. The primary assumption relates to the deterrence effect. Firstly, the effect of increased enforcement will depend on the relative increase with respect to the reference level; the deterrence effect will most probably not be linear – there will be relatively less effect of higher increases. The quality of the device, its sensitivity (how good it is at detecting true positives), will affect the objective risk of being detected when tested for drugs. Cost figures for devices are generally not available from producers. Therefore we use a common unit price for the disposable devices. Based on information received, unit prices may be reduced substantially for large quantity purchases. We use the estimates for six different groups of drugs: amphetamines (including metaamphetamines), benzodiazepines, cocaine, medical opioids, opiates and cannabis. The selection of these six groups is based on the fact that these six are more or less the standard groups of drugs that are included in the on-site oral fluid screening devices for drugs. This report has been produced under the IP DRUID of the EU 6th Framework Program and reflects only the authors' view. The European Commission is not liable for any use of the information contained therein. Details: Gladbach, Germany: DRUID, 2011. 48p. Source: Internet Resource: Accessed July 18, 2013 at: http://www.druid-project.eu/cln_031/nn_107548/Druid/EN/deliverales-list/downloads/Deliverable__3__3__1,templateId=raw,property=publicationFile.pdf/Deliverable_3_3_1.pdf Year: 2011 Country: Europe URL: http://www.druid-project.eu/cln_031/nn_107548/Druid/EN/deliverales-list/downloads/Deliverable__3__3__1,templateId=raw,property=publicationFile.pdf/Deliverable_3_3_1.pdf Shelf Number: 129436 Keywords: Cost-Benefit AnalysisDriving Under the Influence (Europe)Drugged Driving |
Author: Hargutt, Volker Title: Driving under the influence of alcohol, illicit drugs and medicines. Risk estimations from different methodological approaches. Summary: The objective of this deliverable is to assess the risk of driving with alcohol, illicit drugs and medicines and to deliver substance concentration thresholds for per se legislation. Therefore the results of all epidemiological and experimental studies conducted in DRUID are integrated in this deliverable. In case of combating driving under influence of alcohol, legislative regulations and enforcement practices are clearly defined. Regarding alcohol a clear correlation between consumption, blood concentrations and the score of driving impairment is proved for several years, whereas up to now defining limits for combating drugged driving comprises a lot of challenges. Thus per se limits for alcohol are based on scientific risk research which is a prerequisite to assure the compliance of the population with these regulations. Determining legislative regulations against drugged driving is more difficult, as a variety of aspects have to be taken into account. Especially defining risk thresholds for psychoactive substances is a challenging task. The most relevant information in order to determine thresholds is the information about the accident risk in traffic dependent on different concentrations of single substances. Direct information about the accident risk in traffic can only be gained by conducting epidemiological studies. Thus the data regarding risk estimates of psychoactive substance use in traffic are taken from the DRUID deliverable 2.3.5 In cases where low prevalence epidemiological data do not allow risk calculation (odds ratios) of different concentration ranges from single psychoactive substances the results of experimental studies should be taken into account. In order to integrate study results resulting from different methodologies, a reference curve is helpful. Here alcohol data delivered with these different study methodologies are used as the golden standard. Further on a harmonization of the system for DUI of alcohol and non-alcohol drugs (DUID) leads to achieve the compliance of the population. Therefore impairment limits corresponding to the 0.5 g/L limit for alcohol were defined for the drugs where scientific evidence showed a dose-response relationship for impairment. The main finding of this report is that the three substance categories, which are connected with extremely high risks (OR>10), are the two high alcohol concentrations (0.8 - 1.2 and > 1.2 g/L) and the combination of alcohol and drugs, all of them present with moderate prevalence rates of about 0.4%. In the risk range from a 5-to 10-fold injury alcohol including all concentrations is dominant with a prevalence rate of 3.5%. Moreover the epidemiological doubtful risk of amphetamines, medicinal opioids/opiates and drug-drug combinations are also in this range, but showing much lower prevalence rates (for amphetamines 0.08%) and therefore less demand for action. The group of illicit opiates, z-drugs and cocaine shows risks between 2-3 and prevalence rates lower than 0.5%. The risk associated with cannabis seems to be similar to the risk when driving with a low alcohol concentration (between 0.1 g/L and 0.5 g/L), which is slightly increased to about 1-3 times that of sober drivers. The proposed risk threshold for THC equivalent to 0.5 g/L alcohol is 3.8 ng/ml serum with an added value for measurement error and confidence interval. Thus alcohol, especially in high concentrations must remain focus number one of traffic safety efforts and the combination of alcohol and drugs or medicines seems to be a topic, which should be addressed more intensively because it leads to very high risks in traffic. In determining substance concentration thresholds, stimulant drugs like amphetamines and cocaine pose a particular challenge. The correlation between drug concentration and risk of traffic accidents/impairment is variable or insufficiently documented. In experimental studies, at the (rather low) doses that were given, driving performance increases rather than decreases. However, in epidemiological studies the accident risk is increased, but the data should be handled with care as the risk is calculated with only a few cases. Regarding legally prescribed medicines use it is not reasonable to define cut-off values for patients especially if they are in long-term treatment. Other than with drug users, the responsibility and compliance of patients under long-term treatment is usually high. The disease itself may affect the driving behavior even more and the use of medication could decrease this effect. Dosage effects were only investigated and observed with single users or new users. Hence, an impairment check is an objective way to judge recreational use. Thus a balance between concerns about ensuring road safety and the therapeutic needs of individuals is guaranteed. Additionally a separation of drinking, medicine consumption and driving is necessary and the respective information should be part of the physician's consultation. The epidemiological studies in DRUID have shown that drivers very often use more than one psychoactive substance including alcohol. The combination of alcohol and drugs or medicines, or the combination of more than one drug, increases the accident-risk exponentially. If risk thresholds respective lower effect limits will be implemented, they shouldn't be simply combined in the case of combined consumption. Because of the highly increased accident risk of combined consumption stricter regulations should be elaborated for this case. Details: Gladbach, Germany: Federal Highway Research Institute. 2011. 120p. Source: Internet Resource: Accessed April 5, 2016 at: http://www.bast.de/Druid/EN/deliverales-list/downloads/Deliverable_1_3_1.pdf?__blob=publicationFile Year: 2011 Country: Europe URL: http://www.bast.de/Druid/EN/deliverales-list/downloads/Deliverable_1_3_1.pdf?__blob=publicationFile Shelf Number: 138566 Keywords: Driving Under the Influence (Europe)Drugged DrivingDrugs and DrivingDrunk Driving |