Driving Under the Influence, Public Policy, and Pharmacy Practice

2014 ◽  
Vol 28 (1) ◽  
pp. 119-123 ◽  
Author(s):  
Nicholas Sigona ◽  
Karl G. Williams
Keyword(s):  
Motor Vehicle ◽  
Pharmacy Practice ◽  
The Body ◽  
Driving Under The Influence ◽  
Mood Stabilizers ◽  
Legal Responsibility ◽  
Impaired Driving ◽  
Vehicle Accidents ◽  
Driving Impairment ◽  
Drug Impairment

Motor vehicle accidents due to prescription drug impairment have increased in the past decade. Typically, impairment is associated with medications causing excessive drowsiness, such as opioids or benzodiazepines, but the scope of driving under the influence (DUI)-drug charges is reaching into medications that are not typically considered impairing, such as antipsychotics, antiepileptics, and mood stabilizers. Data associating medication use with driving impairment are growing, especially with agents not typically thought of as impairing. Forty-three states currently train drug recognition experts who employ a 12-step evaluation to detect the presence of drug impairment. Seventeen states have instituted “per se” laws, which make it illegal to drive with the presence of drugs or metabolites in the body. Pharmacists should recognize an ethical, professional, and perhaps legal responsibility to inform patients of the risk of impaired driving with prescription agents. Pharmacists should reconsider how they are counseling patients on medication impairment and lower their threshold for warning a patient of potential impairment, expanding to agents typically not thought of as impairing. Pharmacists are in a position to ensure that patients fully understand the risk of impaired driving and the potential for DUI prosecution.

Predicting Alcohol-Impaired Driving among Spanish Youth with the Theory of Reasoned Action

2015 ◽  
Vol 18 ◽  
Author(s):  
José P. Espada ◽  
Kenneth W. Griffin ◽  
María T. Gonzálvez ◽  
Mireia Orgilés
Keyword(s):  
Alcohol Consumption ◽  
Theory Of Reasoned Action ◽  
Motor Vehicle ◽  
Reasoned Action ◽  
Drunk Driving ◽  
Driving Under The Influence ◽  
Impaired Driving ◽  
Vehicle Accidents ◽  
Young Drivers ◽  
Alcohol Impaired Driving

AbstractAlcohol consumption is a risk factor for motor vehicle accidents in young drivers. Crashes associated with alcohol consumption typically have greater severity. This study examines the prevalence of driving under the influence among Spanish youth and tests the theory of reasoned action as a model for predicting driving under the influence. Participants included 478 Spanish university students aged 17–26 years. Findings indicated that alcohol was the substance most associated with impaired driving, and was involved in more traffic crashes. Men engage in higher levels of alcohol and other drug use, and perceived less risk in drunk driving (p < .01). The study confirms that alcohol use and driving under the influence of alcohol are highly prevalent in Spanish young people, and some gender differences exist in these behaviors (p < .01). Furthermore, the study confirms the validity of theory of reasoned action as a predictive model of driving under the influence of alcohol among youth in Spain (p < .001) and can help in the design of prevention programs.

Comparison of Minor Vehicle Impact Occupant Spinal Dynamics to Reported Spinal Manipulation Therapy Loading

2020 ◽  
Author(s):  
Brian M. Boggess ◽  
Douglas R. Morr ◽  
Lee Phelps ◽  
Cameron Trepeck ◽  
Katelyn Supan ◽  
...  
Keyword(s):  
Spinal Manipulation ◽  
Motor Vehicle ◽  
The Body ◽  
Time Duration ◽  
Spinal Loading ◽  
Manipulation Therapy ◽  
Vehicle Accidents ◽  
Duration Magnitude ◽  
Applied Forces ◽  
A Minor

Abstract Motor vehicle impacts result in energy being transferred between the involved vehicles and subsequently to occupants within those vehicles. Similarly, when outside of a vehicle, humans constantly encounter energy transfers within their surrounding environment, inducing internal reactions within their bodies. A common method used by biomechanical engineers is to compare the exposure in a particular event to the general exposures during various activities of daily living (ADL). Such comparisons can be in terms of general inertial loading, such as accelerations, or in terms of specific joint loading (i.e., forces and/or moments). Regardless, to be comparable from the biomechanics standpoint, there needs to be sufficient correlation between the duration, magnitude and/or direction of acceleration or load application. An area of forensic science where such comparisons are common is when a biomechanical engineer is assessing an occupant’s exposure to a minor vehicle accident. In many of these events, the accelerations and loading present are found to be well below any published and accepted injury parameters and to be comparable to published exposures to various ADLs. In this study, spinal loading reported in the published literature during spinal manipulation therapy (SMT) is compared to published spinal exposures in minor vehicle accidents. Extensive research and associated publications regarding both accident reconstruction and biomechanical analyses have studied minor motor vehicle accidents. This current work does not attempt to provide a review of all the volunteer or surrogate studies of occupant exposures available. Instead, this work is the initial phase of a larger study to build on the body of literature that provides quantitative comparisons of human exposures to relatively minor real-world accidents and a wide variety of ADLs, including exposures during the application of common clinical therapies such as SMT. There is a relative lack of studies that quantify the loads applied to patients or develop within patients during various SMT inputs. However, the studies found that do provide quantification suggest that the spinal loading duration, magnitude and direction are similar to that shown to exist in many minor vehicle accidents. For example, Forand [4] reported that SMT inputs applied forces up to 1,000 Newtons (N) to a particular target site (i.e., disc) within a time duration of about 20 to 170 milliseconds (ms). By contrast, spinal loading durations in minor impacts have been shown in the biomechanics literature [9, 11 and 12] and publicly available testing [18] to have similar durations (50 to 250 ms) with distributed neck forces typically less than 500 N. This study has found that like many other ADLs, the spinal loading present during SMT may be comparable to that present in many minor vehicle impacts due to the similar duration, magnitude and direction of the joint loads.

Environment and Health: Vital Intersection or Contested Territory?

2004 ◽  
Vol 30 (2-3) ◽  
pp. 189-215
Author(s):  
Richard W. Clapp ◽  
David Ozonoff
Keyword(s):  
Public Health ◽  
Interpersonal Violence ◽  
Motor Vehicle ◽  
Occupational Exposures ◽  
Poor Quality ◽  
The Body ◽  
Public Health Burden ◽  
Vehicle Accidents ◽  
Environment And Health ◽  
Contaminated Food

The effects of environmental exposure, broadly defined as any exposure from outside the body, on human health are unquestionably the most important determinants of public health. While important genetic determinants of disease exert their effects irrespective of exposure from outside the body, these do not contribute as much to the overall public health burden of disease as factors such as tobacco smoke, poor quality water, inadequate or contaminated food, occupational exposures to dusts and chemicals, motor vehicle accidents, interpersonal violence, air pollution, and other factors external to the body. In many cases, genetic predisposition and environmental exposures combined cause disease in an individual, so it may be impossible to separate out individual biological contributions from various external factors. Nevertheless, it is widely understood that public health concerns populations and communities, and that environmental determinants of health have been paramount throughout human history.

scholarly journals Impact of Prolonged Cannabinoid Excretion in Chronic Daily Cannabis Smokers' Blood on Per Se Drugged Driving Laws

2013 ◽  
Vol 59 (3) ◽  
pp. 519-526 ◽  
Author(s):  
Mateus M Bergamaschi ◽  
Erin L Karschner ◽  
Robert S Goodwin ◽  
Karl B Scheidweiler ◽  
Jussi Hirvonen ◽  
...  
Keyword(s):  
Time Course ◽  
Motor Vehicle ◽  
Research Unit ◽  
The Body ◽  
Blood Collection ◽  
Detection Rates ◽  
Vehicle Accidents ◽  
Drugged Driving ◽  
Urine Concentrations ◽  
Per Se

BACKGROUND Cannabis is the illicit drug most frequently reported with impaired driving and motor vehicle accidents. Some “per se” laws make it illegal to drive with any amount of drug in the body, while others establish blood, saliva, or urine concentrations above which it is illegal to drive. The persistence of Δ9-tetrahydrocannabinol (THC) in chronic daily cannabis smokers' blood is unknown. METHODS Thirty male chronic daily cannabis smokers resided on a secure research unit for up to 33 days, with daily blood collection. Samples were processed in an ice bath during sample preparation to minimize cannabinoid adsorption onto precipitant material. We quantified THC by 2-dimensional GC-MS. RESULTS Of the 30 participants, 27 were THC-positive on admission, with a median (range) concentration of 1.4 μg/L (0.3–6.3). THC decreased gradually; only 1 of 11 participants was negative at 26 days, 2 of 5 remained THC-positive (0.3 μg/L) for 30 days, and 5.0% of participants had THC ≥1.0 μg/L for 12 days. Median 11-hydroxy-THC concentrations were 1.1 μg/L on admission, with no results ≥1.0 μg/L 24 h later. 11-Nor-9-carboxy-THC (THCCOOH) detection rates were 96.7% on admission, decreasing slowly to 95.7% and 85.7% on days 8 and 22, respectively; 4 of 5 participants remained THCCOOH positive (0.6–2.7 μg/L) after 30 days, and 1 remained positive on discharge at 33 days. CONCLUSIONS Cannabinoids can be detected in blood of chronic daily cannabis smokers during a month of sustained abstinence. This is consistent with the time course of persisting neurocognitive impairment reported in recent studies.

Marijuana-Impaired Driving

2018 ◽  
pp. 183-218 ◽  
Author(s):  
Robert L. DuPont ◽  
Erin A. Holmes ◽  
Stephen K. Talpins ◽  
J. Michael Walsh
Keyword(s):  
Drug Testing ◽  
Driving Under The Influence ◽  
Impaired Driving ◽  
The Road ◽  
Driving Impairment ◽  
Safety And Health ◽  
Alcohol Impaired Driving ◽  
Short And Long Term ◽  
On The Road ◽  
License Revocation

Drug-impaired driving is a serious threat to public safety and health on par with alcohol-impaired driving. Marijuana is the most widely used illicit drug among drivers, including those seriously and fatally injured in crashes. Research confirms that marijuana use can cause significant short- and long-term impairment, putting users and others on the road at risk of crash and injury. There is no consistent relationship between the blood concentration of ∆9-tetrahydrocannabinol, the primary psychoactive component in marijuana, and driving impairment. There is substantial precedent and support for zero tolerance per se laws for drugs for drivers arrested for suspicion of driving under the influence. Administrative license revocation is another tool currently used in alcohol-impaired driving cases that could be useful for removing drug-impaired drivers from the road. Recommendations are provided for drug testing, including using new oral fluid screening technology and further research on and monitoring of marijuana-impaired driving.

Discriminant Profile of Young Adulthood Driving Behavior among Brazilian Drivers

2013 ◽  
Vol 16 ◽  
Author(s):  
Renata Maria Dotta-Panichi ◽  
Adriana Wagner ◽  
Jorge Castellá Sarriera
Keyword(s):  
Young Adults ◽  
Alcohol Consumption ◽  
Sensation Seeking ◽  
Motor Vehicle ◽  
Driving Behavior ◽  
Education Level ◽  
Driving Under The Influence ◽  
Vehicle Accidents ◽  
Seeking Behavior ◽  
Traffic Tickets

AbstractThe aim of this article was to describe the driving behavior profile of drivers aged 18 to 25 years old. Four hundred young adults were interviewed, 320 (80%) of them male and 80 (20%) female. Cluster analysis identified a group characterized by sensation-seeking behavior (Cluster 1), a group that did not show any risky driving behavior (Cluster 2), and a group engaged in transgressive behavior and driving under the influence of alcohol and/or drugs (Cluster 3). Discriminant analysis classified successfully and correctly 81.3% of the young adults into their original profiles. Function 1 distinguished cluster 1 from clusters 2 and 3, on the basis of the following factors: higher frequency of alcohol consumption, intrusive behavior, and motorcycle riding, as well as younger age, more aggressive behavior, and lower education level. Function 2 distinguished cluster 3 from cluster 1 and 2, especially as to higher amounts of alcohol consumption, higher frequency of marijuana use and delinquent behavior, larger number of traffic tickets and motor vehicle accidents, higher paternal education level, which were the variables with discriminant values above .20. Characteristics of vulnerability were identified, especially those related to alcohol consumption, drug use, and externalizing issues.

Oral Fluid and Drug Impairment: Pairing Toxicology with Drug Recognition Expert Observations

2019 ◽  
Vol 43 (8) ◽  
pp. 637-643
Author(s):  
Michael T Truver ◽  
Kaitlyn B Palmquist ◽  
Madeleine J Swortwood
Keyword(s):  
Law Enforcement ◽  
Oral Fluid ◽  
Drugs Of Abuse ◽  
The Body ◽  
Driving Under The Influence ◽  
Attractive Alternative ◽  
Liquid Chromatograph ◽  
Non Invasive ◽  
Institutional Review ◽  
Drug Impairment

Abstract According to the Governors Highway Safety Association, drugs are detected more frequently in fatally injured drivers than alcohol. Due to the variety of drugs (prescribed and/or illicit) and their various physiological effects on the body, it is difficult for law enforcement to detect/prosecute drug impairment. While blood and urine are typical biological specimens used to test for drugs, oral fluid is an attractive alternative matrix. Drugs are incorporated into oral fluid by oral contamination (chewing or smoking) or from the bloodstream. Oral fluid is non-invasive and easy to collect without the need for a trained professional to obtain the sample, unlike urine or blood. This study analyzes paired oral fluid and urine with drug recognition expert (DRE) observations. Authentic oral fluid samples (n = 20) were collected via Quantisal™ devices from arrestees under an institutional review board-approved protocol. Urine samples (n = 18) were collected with EZ-SCREEN® cups that presumptively screened for Δ9-tetrahydrocannabinol (cannabinoids), opiates, methamphetamine, cocaine, methadone, phencyclidine, amphetamine, benzodiazepines and oxycodone. Impairment observations (n = 18) were recorded from officers undergoing DRE certification. Oral fluid samples were screened using an Agilent Technologies 1290 Infinity liquid chromatograph (LC) coupled to an Agilent Technologies 6530 Accurate Mass Time-of-Flight mass spectrometer (MS). Personal compound and database libraries were produced in-house containing 64 drugs of abuse. An Agilent 1290 Infinity LC system equipped with an Agilent 6470 Triple Quadrupole MS was used for quantification of buprenorphine, heroin markers (6-acetylmorphine, morphine) and synthetic opioids. Subjects were 23–54 years old; 11 (55%) were male and 9 (45%) were female. Evaluator opinion of drug class was confirmed in oral fluid 90% of time and in urine 85% of the time in reference to scope of testing by the LC–MS methods employed (excludes cannabis and central nervous system depressants). Data indicate that oral fluid may be a viable source for confirming driving under the influence of drugs.

scholarly journals Orthopedic Considerations in the Pedestrian versus Motor Vehicle Accident Polytrauma Patient

2012 ◽  
Vol 2012 ◽  
pp. 1-6
Author(s):  
Jason Samona ◽  
Robert Colen
Keyword(s):  
Lower Extremity ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Treatment Protocol ◽  
The Body ◽  
Morbidity And Mortality ◽  
Lower Extremity Injury ◽  
Concomitant Injuries ◽  
Vehicle Accidents ◽  
Lack Of Information

Pedestrian versus motor vehicle accidents (PVMVAs) are a common cause of morbidity and mortality around the globe. Past models of PVMVAs assume lower-extremity vehicle contact as the initiating event, with a subsequent predicted injury sequence consisting of a lower extremity injury followed by injury to the body, head, and upper extremities. The term “fatal triad” was first coined by Farley, which described concomitant injuries to the skull, pelvis, and extremity fractures. Over the years, this once well-accepted model of injury has been under scrutiny by numerous orthopedic researchers, and it has lost credibility. This case presentation glaring reveals that the patient incurred which is referred to as the “fatal triad”, in contrast to the commonly circulated thoughts of biodynamic mechanisms of PVMVA fractures. More research in this arena is warranted. This lack of information contributes to the morbidity and mortality associated with such devastating injuries. The overlying theme displayed in the data analyzed in this paper demonstrates the vital importance of the orthopedic surgeon in the management of the PVMVA patient. No matter the particular mechanism of injury, occurrence, or agreed-upon treatment protocol, the role of the orthopedic physician is instrumental to the wellbeing of the PVMVA trauma patient.

scholarly journals CHALLENGING ISSUES RELATING TO COMPREHENSIVE EXAMINATION IN MOTOR VEHICLE INJURIES: FORENSIC MEDICAL ASPECTS

2020 ◽  
Vol 20 (3) ◽  
pp. 192-196
Author(s):  
H. Zaritskyi
Keyword(s):  
Motor Vehicle ◽  
State Institution ◽  
Motor Vehicle Accidents ◽  
Morphological Features ◽  
The Body ◽  
Medical Documentation ◽  
Primary Data ◽  
Initial Examination ◽  
Vehicle Accidents ◽  
The Moment

Motor vehicle traumas are among the most common causes of injury both in Ukraine and around the world. Comprehensive examinations enable investigating and judicial authorities to investigate and detect crimes in cases of motor accident. The purpose of the study was to identify the most common challenging issues arising during the complex expert examinations traumas caused by motor vehicle accidents (MVA) and the ways to solve them by analyzing data obtained from forensic examinations of non-survivors in motor vehicle accidents in Ukraine. Results and discussion. According to 45 complex examination reports from the State Institution «Main Bureau of Forensic Medical Examination of the Ministry of Health of Ukraine» it was impossible to identify the position of the victims at the moment of trauma (and to identify the places the victims set in the car salon) due to the lack of primary data in 20% of the cases studied; and in only 5 cases it was possibility to establish the position of the victims at the moment of injury. Determining the location of the victim in the car, pedestrian, etc. can be only identified by characteristic and specific injuries, which are not always paid attention during the initial examination of cadavers. A lot of medical records can omit the description of some injuries (size, localization, shape, morphological features, etc.) or do not provide complete information that impedes the investigative of motor vehicle accidents. Another cause to identify the position of MVA non-survivor is inability to indicate the mechanism and sequence of damage to the car during the auto-technical expert examination. Conclusion. The study has shown that the main factors impeding the MVA investigation and clarifying the picture of event are: violation of the «Rules for conducting forensic expert examination of corpses in the forensic examination bureau» during the initial examination; the absence or poor quality description in the protocols and guidelines for the inspection of the accident scene, including physical evidence and the condition of the vehicle; the inability to establish the nature of injuries on the body of victims or non-survivors and damage to vehicles due to delays in the investigation of crimes; drawbacks in filling in and keeping medical documentation: absence or incomplete description of damage (size, shape, location, morphological features, etc.).

scholarly journals Cannabis and Driving

2021 ◽  
Vol 12 ◽  
Author(s):  
Godfrey D. Pearlson ◽  
Michael C. Stevens ◽  
Deepak Cyril D'Souza
Keyword(s):  
Motor Vehicle ◽  
Current Knowledge ◽  
Driving Under The Influence ◽  
Public Health Issue ◽  
Blood Levels ◽  
Research Gaps ◽  
Vehicle Accidents ◽  
Alcohol Impaired Driving ◽  
Medicinal Cannabis ◽  
Time Courses

As more states in the U.S legalize recreational and medicinal cannabis, rates of driving under the influence of this drug are increasing significantly. Aspects of this emerging public health issue potentially pit science against public policy. The authors believe that the legal cart is currently significantly ahead of the scientific horse. Issues such as detection procedures for cannabis-impaired drivers, and use of blood THC levels to gauge impairment, should rely heavily on current scientific knowledge. However, there are many, often unacknowledged research gaps in these and related areas, that need to be addressed in order provide a more coherent basis for public policies. This review focuses especially on those areas. In this article we review in a focused manner, current information linking cannabis to motor vehicle accidents and examine patterns of cannabis-impairment of driving related behaviors, their time courses, relationship to cannabis dose and THC blood levels, and compare cannabis and alcohol-impaired driving patterns directly. This review also delves into questions of alcohol-cannabis combinations and addresses the basis for of per-se limits in cannabis driving convictions. Finally, we distinguish between areas where research has provided clear answers to the above questions, areas that remain unclear, and make recommendations to fill gaps in current knowledge.

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