An Inventory of Literature on the Relation between Drug Use, Impaired Driving and Traffic Accidents

330 Pages·2003·1.16 MB·English

E.M.C.D.D.A. DRUGS MISUSE RESEARCH DIVISION
HEALTH RESEARCH BOARD

An Inventory of Literature
on the Relation between
Drug Use, Impaired Driving and Traffic Accidents

CT.97.EP.14

Research Team: Colin Gemmell
Trinity College, Dublin

Rosalyn Moran
Drugs Misuse Research Division,
Health Research Board

James Crowley
Professor, Transport Policy Research Institute,
University College Dublin

Richeal Courtney
Medical Expert, for the Health Research Board

EMCDDA: Lucas Wiessing

February 1999
Please use the following citation:

European Monitoring Centre for Drugs and Drug Addiction. An Inventory of Literature
on the Relation betweenDrug Use, Impaired Driving and Traffic Accidents.
(CT.97.EP.14) Lisbon: EMCDDA, February 1999.

Contact Details

Drugs Misuse Research Division
Health Research Board
73 Lower Baggot Street
Dublin 2
Ireland

European Monitoring Centre for Drugs and Drug Addiction
Rua Cruz de Santa Apolónia 23/25
1100, Lisboa
Portugal.

Further copies of this bibliography can be obtained from the EMCDDA at the
above address.
CREDITS

Principal Researchers
Ms Rosalyn Moran, Project Leader, Health Research Board
Professor James Crowley, Professor, Transport Policy Research Institute, UCD
Dr Richeal Courtney, Medical Expert, on behalf of the Health Research Board
Research Assistants
Colin Gemmell (Synthesis and Final Reports)
Sarah Heywood (Literature Search and Collaborative Network)

For the EMCDDA
Lucas Wiessing

Collaborative Network (Ireland)
Dr Alan Baird, Department of Pharmacology, University College Dublin
Dr Bridin Brady, The State Laboratory
Dr Denis Cusack, Medical Bureau of Road Safety, University College Dublin
Professor James Heffron, Department of Biochemistry, University College Cork
Dr Alan Keenan, Department of Pharmacology, University College Dublin
Ms Pauline Leavy, Medical Bureau of Road Safety, University College Dublin
Inspector Brendan Mangan, Garda National Traffic Policy Bureau
Dr Anya Pierce, Department of Toxicology, Beaumont Hospital Dublin
Ms Mary O’Brien (Health Research Board)
Ms Siobhan Stokes, The State Laboratory

Collaborative Network (International)
Sr Javier Alvarez, Universidad Valladolid, Spain
Dr Rainer Christ, Kuratorium für Verkehrssicherheit, Wien
Mr Olaf Drummer, Victoria Institute of Forensic Medicine, Australia
Dr Reinhard Fous, Bundespoliziedirektion, Wien
Ms Sofia Freire, Reitox Focal Point, Lisbon
Mr Klaus Fuchs, Council of Europe, Strasbourg
Mr Johan de Gier, University of Utrecht,The Netherlands
Dr Sabine Haas, Austrian Ministry of Health, Wien
Mr A Aad Hage, Ministry Verkeer en Waterstaat, The Netherlands
Professor Ian Hindmarch, University of Surrey, UK
Professor Anna Kokkevi, Reitox Focal Point, Greece
Professor Hans Peter Krüger, University of Wurzburg, Germany
Mr Hans Laurell, National Road Administration, Borlänge, Sweden
Prof Dr G Leroux-Roels, Universiteit Gent, Belgium
Dr John Oliver, Glasgow University, UK
Herr Andreas Pinzker, Federal Ministry of Science and Transport, Wien
Ms Inge Spruit, Trimbos Institute, The Netherlands
Ms Hilde van Lindt, EU Commission, Brussels
Dr Alain Verstraete, Universiteit Gent, Belgium
Mr Gilles Vincent, EU Commission, Brussels
Introduction

An Inventory of Literature on the Relation between Drug Use, Impaired Driving and
Traffic Accidents was compiled as a resource document to accompany a major review of
the scientific literature on the relation between drug use and driving performance1. The
work was carried out for European Monitoring Centre for Drugs and Drug Addiction -
EMCDDA, Lisbon. The health consequences of drug use are a priority area for the
EMCDDA and impaired driving and road traffic accidents linked to drugs constitute an
important topic on which comprehensive information is lacking.

There is increasing concern across the EU Member States about the role drug use may
play in traffic accidents. This finds expression in different issues related to driving, for
example the risks associated with late night driving and ecstacy/amphetamine use in
dance and night club contexts, the implications for driving of methodone maintenance, or
the consequences of the increasing levels of cannabis use reported in some countries. In a
number of Member States a debate on drug testing of drivers, comparable to that already
existing for alcohol, is gaining momentum.

The literature included here addresses inter alia the relationship between different
patterns of drug consumption, impaired driving and traffic accidents. In addition
literature relating to drug testing procedures and associated legislation regarding
drugimpaired driving in the different EU Member States is included along with
references which address the issues raised by such testing.

This inventory represents a large selection of the available literature on the subject of
drugs and driving. The articles have been sourced from CD-ROM searches, libraries, web
pages, professional organisations, government offices and individuals. They span several
disciplines including psychology, economics, medicine, forensic science, sociology,
politics, law, addiction studies and transport studies. The majority of articles were
identified by key-word searches of relevant databases.

There are major differences in the number of studies, both experimental and
epidemiological, devoted to each of the different drugs. Alcohol has received the greatest
attention by far and has been the subject of intensive investigation for nearly one hundred
years. The antidepressants and benzodiazepines have received considerable attention in
the literature. The amphetamines and cocaine have received less attention. Following
these drugs, cannabis and methadone have been the subject of somewhat less research,
followed by the antihistamines and, finally, the new synthetic drugs including MDMA.
Where the topic of drugs and driving specifically is concerned, most research has
concentrated on alcohol, cannabis and benzodiazepines. The other drugs have certainly
been examined in the context of driving, but not to the extent that the former have been,

1 European Monitoring Centre for Drugs and Drug Addiction. Literature Review on the Relation between
Drug Use, Impaired Driving and Traffic Accidents. (CT.97.EP.14). Lisbon : EMCDDA, February 1999.
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and where the new synthetic drugs are concerned, there is very little direct evidence
available relating to their effects on driving behaviour.

The following alphabetically arranged list of studies gives details of authors, journal/book
names and, in many cases, an abstract or summary of the contents of the study. Where
applicable, the name of the conference at which a paper was presented is given. The
‘workpackage number’ refers to the original breakdown of work in the Workprogramme
developed for the completion of the literature review resulting from this collection of
articles. Thus 1 refers to methodological issues, 2 refers to experimental studies, 3 refers
to field studies, and 4 refers to drug testing procedures and legislation.
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A

Author: ADAMS, H.A. AND WERNER, C.
Year: 1997
Title: From the racemate to the eutomer: (S)-ketamine. Renaissance of a substance?
Journal/Book Name: Anaesthesist
Volume: 46:12 1026-42
Abstract: The pharmacological profile of ketamine: Until recently, clinically available
ketamine was a racemic mixture containing equal amounts of two enantiomers, (S)- and
(R)-ketamine. The pharmacological profile of racemic ketamine is characterized by the so
called dissociative anesthetic state and profound sympathomimetic properties. Among the
different sites of action, N-methyl-D-aspartate (NMDA)-receptor antagonism is
considered to be the most important neuropharmacological mechanism of ketamine.
Effects on opiate receptors, monoaminergic and cholinergic transmitters, and local
anesthetic effects are obvious as well. Following intravenous administration, a rapid
onset of action is seen within 1 min, lasting for about 10 min. The anaesthetic state is
terminated due to redistribution, followed by hepatic and renal elimination with a half-
life period of 2-3 h. For alternative administration, the intramuscular and oral route is also
appropriate. The most important adverse effects are hallucinations and excessive
increases in blood pressure and heart rate. These reactions can be attenuated or avoided
by combining of ketamine with sedative or hypnotic drugs like midazolam and/or
propofol. During controlled ventilation, increases in intracranial pressure are unlikely to
occur. The special pharmacological profile of (S)-ketamine: In general, the
pharmacological properties of (S)-ketamine are comparable to the racemic compound. On
the different sites of action, qualitatively comparable effects were found, but significant
quantitative differences also became obvious. When compared with (R)-ketamine and the
racmic mixture, the analgesic and anesthetic potency of (S)-ketamine is threefold or
twofold higher. Thus, a 50% reduction of dosage is possible to achieve comparable
clinical results. Because of the faster elimination of (S)-ketamine, better control of
anesthesia will be provided. In summary, the pharmacokinetic improvements of (S)-
ketamine are characterized by a reduced drug load, along with more rapid recovery. The
clinical use of (S)-ketamine: The clinical use of (S)-ketamine depends on its analgesic
and sympathomimetic properties, whereas the anaesthetic potency remains in the
background. In clinical anesthesiology, (S)-ketamine, especially in combination with
midazolam and/or propofol, can be used for short procedures with preserved spontaneous
ventilation, for induction of anesthesia in patients with shock or asthmatic disorders, and
for induction and maintenance of anesthesia in caesarean sections. Additional indications
are repeated anesthesia, for example, in burn patients, analgesia during delivery and
diagnostic procedures and intramuscular administration in uncooperative patients. The
value of (S)-ketamine as an analgesic component for total intravenous anesthesia has not
been defined yet. In comparison with opioides, the advantages are related to improved
hemodynamic stability and reduced postoperative respiratory depression. When (S)-
ketamine, especially in combination with midazolam, is used for analgosedation in
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intensive care medicine, a reduction of exogenous catecholamine demand can be
expected. Moreover, the effects on intestinal motility are superior to opioids. In
combination with midazolam and propofol, excellent control of analgosedation was
found, making both combinations suitable for situations in which repeated neurological
assessment of patients is necessary. In emergency and disaster medicine, (S)-ketamine is
of outstanding importance because of its minimal logistic requirements, the chance for
intramuscular administration and the broad range of use for analgesia, anaesthesia and
analgosedation as well. Further perspectives of (S)-ketamine may be the treatment of
chronic pain and the assumed neuroprotective action of the substance.
Workpackage No.: 1

Author: ADLER, C.M., GOLDBERG, T.E., MALHOTRA, A.K., PICKAR, D. AND
BREIER, A.
Year: 1998
Title: Effects of ketamine on thought disorder, working memory, and semantic memory
in healthy volunteers.
Journal/Book Name: Biological Psychiatry
Volume: 1 43:11 811-6
Keywords: ketamine; memory
Abstract: BACKGROUND: The N-methyl-D-aspartate receptor antagonist, ketamine,
produces a clinical syndrome of thought disorder, perceptual distortion, and cognitive
impairment. METHODS: We have administered ketamine to healthy volunteers to
characterize the formal thought disorder and specific memory dysfunction associated
with ketamine. Ten healthy volunteers underwent a double-blind, placebo-controlled,
ketamine infusion (0.12 mg/kg bolus and 0.65mg/kg/hour). Thought disorder was
evaluated with the Scale for the Assessment of Thought, Language and Communication.
Cognitive testing involved working and semantic memory tasks. RESULTS: Ketamine
produced a formal thought disorder, as well as impairments in working and semantic
memory. The degree of ketamine-induced thought disorder significantly correlated with
ketamine-induced decreases in working memory and did not correlate with ketamine-
induced impairments in semantic memory. CONCLUSIONS: This study characterizes the
formal thought disorder associated with ketamine and may suggest that ketamine-induced
deficits in working memory are associated with ketamine-induced thought disorder.
Workpackage No.: 2

Author: AITKEN, C., KERGER, M. AND CROFTS, N.
Year: 1998
Title: Qualitative and quantitative research on drivers who use illicit drugs
Publisher: The Centre for Harm Reduction, The Macfarlane Burnet Centre for Medical
Research, Australia,
Keywords: heroin, opiates, driving, accidents, amphetamines, cannabis, sleepiness,
alcohol, questionnaire, focus groups, Melbourne, quantitative data
Abstract: The research described in this report was conceived in response to the
recommendations made by the 1996 Parliamentary Inquiry into the Effects of Drugs
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(other than alcohol) on Road Safety. It consists of an investigation of the ways in which
patterns of drug use interact with driving behaviour, users' attitutdes to drug use and
driving issues, and their perceptions of the risks involved. It has generated unique
quanitative data on the driving and drug-using behaviour of heroin users in Melbourne.
The project consists of two parts. Qualitative research was conducted using five focus
groups - two with opiate users, two with amphetamine and cocaine users, and one with
cannabis and alcohol users. The product of the focus groups was a large and extremely
rich dataset. Key outcomes include:
* dependent heroin users need to use regularly and frequently, and would find it difficult
to modify their behaviour to decrease accident risk associated with drug driving.
* heroin is commonly used in the car immediately after scoring and prior to driving home
* heroin use has several side-effects which pose risks for driving safety, including
tiredness, poor vision and increased reaction time; conversly, feeling the need for heroin
may also increase accident risk.
* amphetamine use promotes confidence and aggression, and alertness, but extreme
tiredness can set in very suddenly; amphetamines induce greater alcohol consumption
* some users deliberately driver under the influence of amphetamines
* smoking cannabis in the car is common, especially for younger users
* cannabis induces caution in most drivers; may cause forgetfulness, paranoia and
distorted time and distance perception
* alochol and cannabis can be a potent combination, more so if cannabis is used after
significant alcohol intake
* television campaigns aimed at drink-driving are thought to be effective but not relevant
to use of illicit drugs and driving
* alcohol is viewed as more dangerous for driving than heroin, amphetamines or
cannabis.
Information generated in the focus groups was used to construct a short questionnaire
which was administered to 160 illicit drug injectors, 159 of whom turned out to be
primarily heroin users. They were recruited at fixed needle exchanges and drug treatment
centres and via our interviewer's personal networks. In this sample, over half of the
respondents use heroin daily or more often. Although fewer than half of all heroin users
surveyed are drivers, those who are drive frequently and cover over 11,000 kilometers
per year on average (estimated). Almost ten percent are driving unlicensed. It is
tentatively estimated that heroin users comprise one per cent of the victorian driving
population. Our survey respondents frequently drive a short time after using heroin.
Respondents gave frequencies of performance of several heroin-related conditions which
they regarded as dangerous for driving, the most important of which is the tendency to
nod off; this behaviour occurs approximately every two weeks for this sample. Many
heroin users had experienced numerous minor accidents, and eighteen casualty accidents
were reported by the 84 drivers surveyed. About half of all respondents were under the
influence of heroin in some way at the time of their last accident.
Workpackage No.: 2

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Author: ALBERY, I.P., GOSSOP, M. AND STRANG, J.
Year: 1998
Title: Illicit drugs and driving: a review of epidemiological, behavioural and
psychological correlates
Journal/Book Name: Journal of Substance Misuse
Volume: 3, 140-149
Keywords: illicit drugs, driving, cannabis, heroin, cocaine, driving skills
Abstract: Large numbers of individuals use illicit drugs (e.g. cannabis, heroin, cocaine).
The number of people driving vehicles has also increased. There is an increasing overlap
between populations of illicit drug users and drivers. This paper describes the magnitude
and nature of an illicit drugs and driving problem. The relationship betweent the
consumption of illicit substances and driving skills, accident involvement and driving
behaviour are examined using epidemiological data, injury and fatality statistics,
empirical/behavioural evidence and survey research. Problems for the interpretation of
such data are identified, and a number of questions remain unanswered for characterizing
the magnitude and nature of the problem. Measures designed to counter the drugs and
driving issue (e.g. secondary enforcement) are discussed. Proposals are made for further
countermeasures based on current evidence.
Workpackage No.: 1

Author: ALVAREZ, F.J., PRADA, R. AND DEL RIO, M.C.
Year: 1992
Title: Patterns of drug consumption among spanish drivers
Journal/Book Name: Therapie
Volume: 47, 1, 63-6
ISBN/ISSN: 0040-5957
Keywords: adolescence, adult, automobile driving, drug utilization, female, human,
male, middle age, questionnaires, Spain, support, Non U.S. Gov't, Gov't
Abstract: We have analysed regular drug consumption by Spanish drivers. 675 properly
completed questionnaires were received from drivers attending three medical traffic
centres in Valladolid (Spain) for medical examination prior to obtaining or renewing of
their traffic licence in 1990. Among those surveyed, 28.9% were taking regularly drugs,
mainly analgesics (6.5%), antiallergic drugs (5.2%), oral contraceptives (4.6%), anti-
inflammatory drugs (4. 1 %), antihypertensive drugs (3.6%), tranquillizers (3.4%),
hypnotics (2.8%) and drugs for rheumatic disorders (2.7%). The study indicates the
frequent consumption of drugs by Spanish drivers, and suggests the need to regulate drug
consumption by drivers.
Workpackage No.: 3

Author: ALVAREZ, F.J., PRADA, R. AND DEL RIO, C.
Year: 1992
Title: Drugs and alcohol consumption amongst Spanish drivers
Journal/Book Name: Forensic Science International
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Volume: 53, 221-225
ISBN/ISSN: 0379-0738/92
Keywords: drugs, alcohol, driving, Spain
Abstract: We have analysed patterns of alcohol and regular drug consumption by
Spanish drivers. Six hundred and seventy five properly completed questionnaires were
received from drivers attending three medical centres in Valladolid (Spain) for medical
examination prior to obtaining or renewing their driving licence in 1990. Among those
surveyed, 24% were 'daily' drinkers and 56.7% were 'weekly' drinkers, the majority
(55.5%) being 'light' drinkers (1-39g/day of pure alcohol). Of those surveyed 28.9% took
drugs. The most commonly consumed drugs were analgesics (6.5%), anti-allergic drugs
(5.2%) and oral contraceptives (4.6%). Of those driver taking drugs 28.2% were 'daily'
drinkers and 53.8% were 'weekly' drinkers. The study indicates widespread consumption
of alcohol and drugs by Spanish drivers
Workpackage No.: 3

Author: ALVAREZ, F.J. AND DEL RIO, M. C.
Year: 1994
Title: Drugs and driving
Journal/Book Name: The Lancet
Volume: 344, p.282
ISBN/ISSN: 0140-6736
Keywords: drugs, driving, EU-directive
Abstract: Refers to the 1991 European Community directive which laid down minimum
standards of physical and mental fitness for driving licence applicants, and determined
applicants' impaired ability due to alcohol consumption, illicit drug taking, or drugs taken
for legitimate purposes. Each member state is supposed to have regulations in place by
July 1, 1996 Outlines what is covered by directive and shortfalls.
Workpackage No.: 1

Author: ALVAREZ, F.J. AND DEL RIO, M.C.
Year: 1994
Title: Screening for problem drinkers in a general population survey in Spain by use of
the CAGE Scale.
Journal/Book Name: Journal of Studies on Alcohol
Volume: 55, 471-474.
Workpackage No.: 4

Author: ALVAREZ, F.J., DELRIO, M.C. AND PRADA, R.
Year: 1995
Title: Drinking and driving in Spain
Journal/Book Name: Journal of Studies on Alcohol
Volume: 56, 4, 403-407
Keywords: emergency room, united states, alcohol consumption, patterns, driving
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