Drugs other than alcohol (medicines and illicit drugs) in people involved in fatal road accidents in Spain

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1 Drugs other than alcohol (medicines and illicit drugs) in people involved in fatal road accidents in Spain F.J. A lv a r e z 1, M. S a n c h o 2, J. V ega3, M.C. D el R io 1, M.A. R a m s2, D. Q u e ip o 3 D epartm ent o f Pharm acology and T herapeutics1, and Legal M edicine3, Faculty o f M edicine, University o f V alladolid, Valladolid, Spain. National Toxicological C entre2, M adrid, Spain. IN T R O D U C T IO N In the last few years there has been a grow ing interest in the role played by substances other than alcohol in the field o f road safety (Alvarez & Del Rfo, 1994; Direction G enerale des Transports de la C om m ission E uropeenne, 1995). In this category w e include tw o groups o f substances w hich are com pletely different, especially as regards their use and posibilities o f intervention: illegal drugs and m edicines. A lthough both groups o f substances can im pair driving ability and increase the risk o f road traffic accidents, there are m any aspects related to them and o f w hich w e have very little know ledge (C onsensus D evelopm ent P anel, 1985; Direction G enerale des T ransports de la Com m ission Europeenne, 1995). Thus, as the relation betw een alcohol and driving ability im pairm ent is clearly established, this cannot exists sim ilarly in the case o f m edications and illegal drugs (C onsensus D evelopm ent Panel, 1985). T he real im portance o f m edications and illegal drugs regarding their link to road traffic accidents is not exactly know n, although it has been said that at least 10% o f all people killed or injuried in road-traffic accidents w ere taking som e sort o f psychotropic m edication that m ay have been a contributory factor (D e G ier, 1993). C oncerning Spain, a driver population based survey carried out by the U niversity o f Valladolid and the N ational T raffic A gency (Del Rfo & A lvarez, 1996) revealed that about 5% o f Spanish drivers are taking regularly (at least for 1 m onth duration) m edication w hich can im pair driving perform ance (m edication w ith a w arning in the sum m ary o f product characteristics about the effect o f the m edication on driving ability). W ith regard to illicit drugs, the sam e survey (Del Rfo & A lvarez, 1995) reveals that it is frequent for these people to drive after taking illegal drugs (3% ). This present study has been carried out with a view tow ards analysing the presence o f m edicines and/or illegal drugs in people killed in road traffic accidents. The specific objectives w ere to characterize the presence o f different groups o f substances, their existing levels, that is their presence alone or together with other substances. The study w as supported by the National

2 Traffic A gency (D ireccion G eneral de T rafico, M adrid), and it is the first one to be carried out with these characteristics in our country. M E T H O D S S tu d y 1: This study w as carried out at the U niversity o f V alladolid and supported by the N ational Traffic A gency (M adrid). 322 blood sam ples from people killed in road traffic accidents w ere obtained betw een January 1994 and O ctober In 37 cases analytical procedures could not be carried out, and as results the final sam ple w as o f 285 cases. N um bers w ere 255 m ale and 30 fem ales. 33.7% (n= 96) w ere cases o f people betw een 16 and 25 years o f age, 45.3% (n= 129) w ere betw een 26 and 45, andl 21.0% (n= 60) w ere over % (n= 113) w ere cases o f people killed on w eek days (M onday to Friday) and 60.3% (n= 172) at w eekends (Saturday and Sunday). T he average age (± SD) w as 34.1 ± 13.2, 33.9 ± 13.1 fo r m en and 36.0 ± 14.7 for w om en. In the said study inform ation regarding sex, age, day o f the w eek and time o f the fatal accidents w as obtained. A nalytical procedures w ere not carried out w ith any legal objective but w ith research pourposes. S tu d y 2: B lood sam ples o f 979 people killed in road traffic accidents w ere obtained betw een 1992 and T he cases w ere referred to the Instituto N acional de Toxicologfa (N ational Toxicological Centre, M adrid) by the forensic doctors o r as instructed by the ju d g e. 887 w ere m ale w hile 86 w ere fem ale (the sex w as not know n in 6 cases). W ith reference to the days o f the w eek, figures w ere as follow s: M onday 123, T uesday 101, W ednesday 104, T hursday 102, Friday 139, Saturday 207 and Sunday 200 (the day o f the w eek w as unknow n in 3 cases). The average age o f the people involved in fatal accidents w as 35. In these cases inform ation exists as regards the characteristics o f the person involved and the accidents thanks to the report w ritten by traffic agents. Furtherm ore, inform ation about the forensic d o cto rs' investigation are available. Analytical procedures were carried out with legal objectives. A n alytical p rocedures: B lood sam ples w ere analyzed for alcohol (ethanol) by H ead Space G aschrom atography. All sam ples w ere also screened for the presence o f drugs other than alcohol (m edicines and illegal drugs) by im m unological o r chrom atographic m ethods w hen appropriate. Positive results after screening w ere confirm ed by alternative m ethods ( G C /M S, H P L C o r G C m ethods) and the concentrations o f the psychoactive drugs o r m etabolites w ere determ ined (Peat & F inkle, 1992; Tedeschi et al., 1992)

3 S ta tistic a l a n a ly sis: A nalysis o f the data w as conducted in the Data P rocessing Centre at Valladolid U niversity. Statistical analysis w as by m eans o f SA S softw are version 6.07 (SA S Institute SA S). p-v alues 0.05 w ere considered to show significant differences. R E S U L T S T able 1 sum m arizes the m ain findings o f the study. A ny substance [not including alcohol on its ow n] w as found in betw een 13.8% and 15.8% o f the sam ples o f people involved in fatal road accidents in Spain. In both studies m edicines w ere detected [7.5% -9.1% ], w hich w ere slightly less frequent than illicit drugs [8.3% -10.2% ]. Several possible com binations o f substances detected, including alcohol, are also show n in that Table 1. As regards the presence o f only one substance, albeit an illegal drug or a m edication, this is m uch m ore com m on am ong m edicines (42% -46% ) than am ong illegal drugs (about 24% in both studies). W hen considering their presence together w ith alcohol, this com bination is m ore frequent in the cases in w hich som e illegal drugs w ere found (about 55% o f the cases in both studies), rather than w hen som e m edications w ere detected. In the latter case, how ever, a great change has been observed betw een sam ples: 23.1% in study 1, and 36.5% in study 2. Table 2 show s the presence o f the different kinds o f illegal drugs found in the blood o f people involved in fatal road accidents in Spain. M ore than one illegal drug w as found in the blood o f several people killed in m otor road accidents. T hat w ay, in study 1 illegal drugs w ere found in 29 people (Table 1), accounting for a total o f 46 different substances (Table 2). In study 2 the respective figures w ere 81 (Table 1) and 109 (Table 2). That m eans that the average num ber o f illegal drugs found w ere 1.58 in study 1 and 1.34 in study 2. Table 2 show s the percentages o f the total sam ple. C ocaine w as the m ost com m on illegal drug found: 45% o f the cases. The second place w as fo r opiates (27.5% -30.4% ). C annabis, am phetam ineas and other sustances w ere less frequently detected. R egarding m edicines, the average num ber o f m edicines found w ere 1.46 in the first study and 1.32 in the second study. B enzodiazepines w ere the m ost com m on m edication found: 605% in the study 1 and 43.9% in study 2. The second place w as non-opioids analgesic d rugs, 23.7% (9 de 38) in study 1 and 18.4% (18 de 91) in study

4 T a b le 1 : P r e sen ce o f m ed icin e s an d illicit d ru gs in p eo p le in v o lv e d road a ccid en ts in Spain. in fa ta l Study 1 [n = 285] n % S tudy 2 [n =979] n % M edicines M edicines + alcohol M edicines + illegal drugs M edicinies + alcohol + illegal drugs Illegal drugs Illegal drugs + alcohol M edicines Illegal drugs Any substance T a b le 2 :T yp es o f illicit d ru gs found in S p a in. in p eo p le in v o lv e d in fatal road a c c id e n ts Study 1 Study 2 n % n % Any illicit drugs Amphetam ine Cocaine C annabis Opiates Other substances

5 D IS C U S S IO N The data presented here show that m edicines and illegal drugs are frequently found in people killed in road traffic accidents in Spain. The presence o f any m edication and/or illegal drugs was detected in about 14% o f the sam ples screened. A s regards m edication-positive cases only the m edication w as detected [not alcohol, not illegal drugs] in about 40% o f the sam ples, in about 55% o f the illegal drug-positive cases another substance [alcohol o r m edication] w as found. In both kinds o f substances, the presence o f m ore than one illegal drug o r m edicine is frequent. Thus, the presence o f several substances, is o f relevance w hen considering the the link betw een the presence o f substances and their role in road-traffic accidents. C ocaine am ong the illegal drugs, and benzodiazepines am ong m edications, w ere the m ost com m on substances found. The present data show that as in m ost developed countries m edication and illegal drug detection in people involved in fatal road traffic accidents is com m on (Ferrara et al., 1994). R E F E R E N C E S A lvarez FJ, D el R io M C. D rugs and driving [C om m entary], L ancet, 1994; 344: 282. C onsensus D evelopm ent Panel. D rug Concentrations and driving. Journal o f the American M edical Association, 1985; 257: D e G ier JJ. D riving licenses and know n use o f licit and ilicit drugs. M aastricht: U niversity o f L im burg, Institute for H um an Psychopharm acology, 1993 (IHP 93-39). Del R io M C, A lvarez FJ. Illegal drug taking and driving: patterns o f drug taking am ong Spanish drivers. D rug and A lcohol D ependence, 1995; 37: D el Rfo M C, A lvarez FJ. M edication use by the driving population. Pharm acoepidem iology and D rug Safety, 1996; 5: D irection G enerate des T ransports de la C om m ission E uropeenne. L 'alcool, les drogues et les m edicam ents et securite routiere. Brussels: D irection G enerate des T ransports de la C om m ission Europeenne, 1995 (V II/392/1995). F errara SD, G iorgetti R, Z ancaner S. Psychoactive substances and driving: State o f the art and m ethodology. A lcohol, Drugs and D riving, 1994; 10: Peat M A, Finkle BS. Toxicological assay o f psychoactive substances in biological fluids. In: Ferrara SD, Giorgetti R (Eds), M ethodology in m an-m achine interaction and epidem iology on

6 drugs and driving safety. Padova: A RFI, 1992; Tedeschi L, F rison G, C astagna F, Ferrara SD. C om presive E IA /G C screening and G S-M S confirm ation o f psychoactive substances in blood and urine. In: Ferrara SD, G iorgetti R (E ds), M ethodology in m an-m achine interaction and epidem iology on dru g s and driving safety. Padova: A RFI, 1992; A C K N O W L E D G E M E N T S Support for this study w as provided by the D irectio n G eneral de T rafico, M inisterio del Interior (Spain)