Introduction: Driving a motor vehicle under the influence of alcohol or illicit drugs is worldwide considered an elevated risk for the traffic safety. Based on the most recent data published by ISTAT (2016), in Italy there were 173.892 road accidents with personal injury during 2015. In Campania region (Italy) (5,869,965 inhabitants) ISTAT calculated, during three years 2013- 2015, on average 4-6 deaths and 20 injured drivers for 100000 inhabitants. In Italy, several epidemiological studies have been carried out accomplishing toxicological tests on the road, ensuring anonymity to drivers. However such studies were applied in restricted geographical areas and for a limited period of observation. Moreover, in Italy studies regarding the toxicological findings among drivers hospitalized after a crash are still insufficient and not homogeneous both in the sampling and in the analytical approach. Aim: Objectives of this study were: a) to assess trends in alcohol, illicit drugs or pharmaceuticals intake by drivers involved in road crashes and admitted to emergency departments of 16 hospitals in the Campania Region, from 2009 to 2016. These 16 hospitals represent the National Health Service for the population of four out of five provinces of the Campania region; b) to propose changes to the current protocols for the assessment of driving disability and provide data for the development of additional preventive policies with regional relevance. Methods: In order to demonstrate the violation of the Road Safety Law, toxicological analyses were requested by the police on biological fluids taken from 1.797 hospitalized drivers. Confirmation analyses were performed only for biological samples resulted positives at immunochemical screenings applied by the hospital laboratories. According to the consensus expressed by patients for blood and/or urine sampling, the analyses were performed on: i) n. 780 blood samples referred to 609 cases of suspect driving under the influence of alcohol (DUI) and to 171 cases of suspected recent use of alcohol associated with illicit drugs (DUID); ii) n. 1017 urine collected from DUID cases, when the sampling of blood was denied by drivers. A GC/HS-FID methodology was used to test blood alcohol concentration (BAC). After L/L or SPE extraction of biological specimens in specific conditions for alkaline, neutral and acid substances, a systematic toxicological analysis (STA) was performed using validated methods for amphetamine and analogous, cocaine, opiate, benzodiazepines (BDZ), methadone, barbiturate, buprenorphine and cannabis metabolites by GC/MS or LC-MS/MS. Results: To study trends in the use of alcohol and drugs, the results obtained during 2009-2011, 2012-2014, and 2015-2016 were compared. The BAC greater than 0.5 g/L (legal limit in Italy) was proved in 91,5 % of drivers apprehend for DUI, as showed in Table I. Table I - Frequency of Blood Alcohol Concentration (BAC) detected in drivers suspected of driving under influence (DUI) in Campania region (Years 2009/2016). BAC (g/L) 2009/2011 2012/2014 2015/2016 (n. 110 drivers) (n. 231 drivers) (n. 268 drivers) LLOQ < 0.02 0 0 4 0.02 - 0.5 10 17 21 0.5-0.8 19 16 25 0.8-1.5 37 65 87 >1.5 44 133 131 The highest incidence of crashes (DUI cases) involved drivers with BAC> 1.5 g/L and represents, almost the 51% of the cases. When alcohol was in association with illicit drugs (n. 171 cases) road accidents occurred with a lower BAC, prevalently involving both drivers with BAC in the range 0.8-1.5 g/L than those with BAC > 1.5 g/L. In the blood of DUID cases, the intake of more than one illicit drug was mainly detected (29%) and the correlation between BAC level and drugs detected is discussed. Cocaine and THC alone were confirmed for almost 27% of drivers whereas Opiate, BDZ and Methadone were revealed in less than 5%. When only the urine were collected (n. 1017 DUID cases), drugs identified are synthesized in TableII. Table II - Frequency of substances detected in drivers suspected of driving under influence of drugs (DUID) in Campania region (Years 2009/2016). Drugs in Urine 2009/11 2012/14 2015/16 (n. 250 drivers) (n. 374 drivers) (n. 393 drivers) Polydrug 88 60 84 THCCOOH 56 101 145 Cocaine 22 54 44 BDZ 8 20 32 Opiates 19 21 10 Methadone 9 10 7 Buprenorphine 3 1 -- Barbiturates 3 4 -- Amphetamines -- -- 3 Total positive cases 208 271 325 Negative cases 42 103 68 Among positive urine (n. 804), the THCCOOH was the most frequently identified compound alone or in combination with other drugs, with an increasing trend in the three periods. Polydrug use was detected in the 29% of drivers. Cocaine alone was detected only in the 15% of the cases, but in the accidents due to polydrug intake it was the drug mainly highlighted in association with THCCOOH and other drugs. Interestingly the incidence of BDZ, as only pharmaceutical substance taken, is constantly increasing, whereas it is falling in poly user drivers. Discussion and Conclusion: In Italy, due to the Road Traffic Laws establish the zero limit for illicit drugs and none therapeutic level for pharmaceuticals, the discovery of any drug in the blood of drivers is considered a severe criminal offence. Nevertheless the blood sampling is not mandatory and the consensus must be required by drivers for the urine or blood sampling. The limits for driving following alcohol consumption with correlated sanctions is graded: despite the legal limit for BAC is 0,5 g/L, only for novice and professional drivers (taxi, bus, trucks) the zero limit in the blood is requested. A BAC in the range of 0.5-0.8 g/L determines an administrative sanction and the BAC > 0.8 g/L is considered a criminal offence with increasing severe sanctions. Even though the deterrence power of sanctions, the results of this study describe, in drivers suspected of DUI, an high incidence of cases with BAC > 1.5 g/L but when drivers were suspected of DUID, the accidents occurred at lowest concentrations. In addition, results obtained by the urine and blood positive of DUID cases show a sharp increasing in the use of cannabis, cocaine and BDZ and a decreasing trend for the polydrug intake. This survey, considering both the data collection period (8 years) and the geographical area covered, could assume an useful meaning in order to evaluate the efficacy of the current protocols applied for the assessment of the driving disability in injured drivers. In fact, the 16 hospitals that requested confirmation analyses (by GC/FID, GC/MS or LC-MS/MS) admit the cases of accident occurred in 4 out of 5 provinces of the Campania region. The study demonstrates that the intake of psychoactive drugs and alcohol should be checked in all the road accidents. Moreover, the blood sampling and a forensic analytical approach should be mandatory to demonstrate a violation of the Road Traffic Law. In fact, among 1797 injured drivers, suspected for DUI or DUID, basing on the immunological tests performed at the hospitals, after confirmation analyses negative results were obtained in 261 cases (14,5%) (n. 48 blood and n. 213 urine). Therefore, only a confirmed positive result, for alcohol or drug use, should assume a judicial meaning to demonstrate a criminal offence. Moreover for the implement of the preventive policies on the road safety in Campania, the toxicological confirmation analyses should be extended to all five regional provinces.
Incidence of alcohol and drugs use among drivers injured in road accidents in Campania (Italy) during 2009-2016 years
CASSANDRO, Paola;CUCCIARDI, Anna;RUSSELLO, Luisa;BORRIELLO, Renata
2017
Abstract
Introduction: Driving a motor vehicle under the influence of alcohol or illicit drugs is worldwide considered an elevated risk for the traffic safety. Based on the most recent data published by ISTAT (2016), in Italy there were 173.892 road accidents with personal injury during 2015. In Campania region (Italy) (5,869,965 inhabitants) ISTAT calculated, during three years 2013- 2015, on average 4-6 deaths and 20 injured drivers for 100000 inhabitants. In Italy, several epidemiological studies have been carried out accomplishing toxicological tests on the road, ensuring anonymity to drivers. However such studies were applied in restricted geographical areas and for a limited period of observation. Moreover, in Italy studies regarding the toxicological findings among drivers hospitalized after a crash are still insufficient and not homogeneous both in the sampling and in the analytical approach. Aim: Objectives of this study were: a) to assess trends in alcohol, illicit drugs or pharmaceuticals intake by drivers involved in road crashes and admitted to emergency departments of 16 hospitals in the Campania Region, from 2009 to 2016. These 16 hospitals represent the National Health Service for the population of four out of five provinces of the Campania region; b) to propose changes to the current protocols for the assessment of driving disability and provide data for the development of additional preventive policies with regional relevance. Methods: In order to demonstrate the violation of the Road Safety Law, toxicological analyses were requested by the police on biological fluids taken from 1.797 hospitalized drivers. Confirmation analyses were performed only for biological samples resulted positives at immunochemical screenings applied by the hospital laboratories. According to the consensus expressed by patients for blood and/or urine sampling, the analyses were performed on: i) n. 780 blood samples referred to 609 cases of suspect driving under the influence of alcohol (DUI) and to 171 cases of suspected recent use of alcohol associated with illicit drugs (DUID); ii) n. 1017 urine collected from DUID cases, when the sampling of blood was denied by drivers. A GC/HS-FID methodology was used to test blood alcohol concentration (BAC). After L/L or SPE extraction of biological specimens in specific conditions for alkaline, neutral and acid substances, a systematic toxicological analysis (STA) was performed using validated methods for amphetamine and analogous, cocaine, opiate, benzodiazepines (BDZ), methadone, barbiturate, buprenorphine and cannabis metabolites by GC/MS or LC-MS/MS. Results: To study trends in the use of alcohol and drugs, the results obtained during 2009-2011, 2012-2014, and 2015-2016 were compared. The BAC greater than 0.5 g/L (legal limit in Italy) was proved in 91,5 % of drivers apprehend for DUI, as showed in Table I. Table I - Frequency of Blood Alcohol Concentration (BAC) detected in drivers suspected of driving under influence (DUI) in Campania region (Years 2009/2016). BAC (g/L) 2009/2011 2012/2014 2015/2016 (n. 110 drivers) (n. 231 drivers) (n. 268 drivers) LLOQ < 0.02 0 0 4 0.02 - 0.5 10 17 21 0.5-0.8 19 16 25 0.8-1.5 37 65 87 >1.5 44 133 131 The highest incidence of crashes (DUI cases) involved drivers with BAC> 1.5 g/L and represents, almost the 51% of the cases. When alcohol was in association with illicit drugs (n. 171 cases) road accidents occurred with a lower BAC, prevalently involving both drivers with BAC in the range 0.8-1.5 g/L than those with BAC > 1.5 g/L. In the blood of DUID cases, the intake of more than one illicit drug was mainly detected (29%) and the correlation between BAC level and drugs detected is discussed. Cocaine and THC alone were confirmed for almost 27% of drivers whereas Opiate, BDZ and Methadone were revealed in less than 5%. When only the urine were collected (n. 1017 DUID cases), drugs identified are synthesized in TableII. Table II - Frequency of substances detected in drivers suspected of driving under influence of drugs (DUID) in Campania region (Years 2009/2016). Drugs in Urine 2009/11 2012/14 2015/16 (n. 250 drivers) (n. 374 drivers) (n. 393 drivers) Polydrug 88 60 84 THCCOOH 56 101 145 Cocaine 22 54 44 BDZ 8 20 32 Opiates 19 21 10 Methadone 9 10 7 Buprenorphine 3 1 -- Barbiturates 3 4 -- Amphetamines -- -- 3 Total positive cases 208 271 325 Negative cases 42 103 68 Among positive urine (n. 804), the THCCOOH was the most frequently identified compound alone or in combination with other drugs, with an increasing trend in the three periods. Polydrug use was detected in the 29% of drivers. Cocaine alone was detected only in the 15% of the cases, but in the accidents due to polydrug intake it was the drug mainly highlighted in association with THCCOOH and other drugs. Interestingly the incidence of BDZ, as only pharmaceutical substance taken, is constantly increasing, whereas it is falling in poly user drivers. Discussion and Conclusion: In Italy, due to the Road Traffic Laws establish the zero limit for illicit drugs and none therapeutic level for pharmaceuticals, the discovery of any drug in the blood of drivers is considered a severe criminal offence. Nevertheless the blood sampling is not mandatory and the consensus must be required by drivers for the urine or blood sampling. The limits for driving following alcohol consumption with correlated sanctions is graded: despite the legal limit for BAC is 0,5 g/L, only for novice and professional drivers (taxi, bus, trucks) the zero limit in the blood is requested. A BAC in the range of 0.5-0.8 g/L determines an administrative sanction and the BAC > 0.8 g/L is considered a criminal offence with increasing severe sanctions. Even though the deterrence power of sanctions, the results of this study describe, in drivers suspected of DUI, an high incidence of cases with BAC > 1.5 g/L but when drivers were suspected of DUID, the accidents occurred at lowest concentrations. In addition, results obtained by the urine and blood positive of DUID cases show a sharp increasing in the use of cannabis, cocaine and BDZ and a decreasing trend for the polydrug intake. This survey, considering both the data collection period (8 years) and the geographical area covered, could assume an useful meaning in order to evaluate the efficacy of the current protocols applied for the assessment of the driving disability in injured drivers. In fact, the 16 hospitals that requested confirmation analyses (by GC/FID, GC/MS or LC-MS/MS) admit the cases of accident occurred in 4 out of 5 provinces of the Campania region. The study demonstrates that the intake of psychoactive drugs and alcohol should be checked in all the road accidents. Moreover, the blood sampling and a forensic analytical approach should be mandatory to demonstrate a violation of the Road Traffic Law. In fact, among 1797 injured drivers, suspected for DUI or DUID, basing on the immunological tests performed at the hospitals, after confirmation analyses negative results were obtained in 261 cases (14,5%) (n. 48 blood and n. 213 urine). Therefore, only a confirmed positive result, for alcohol or drug use, should assume a judicial meaning to demonstrate a criminal offence. Moreover for the implement of the preventive policies on the road safety in Campania, the toxicological confirmation analyses should be extended to all five regional provinces.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
