Alcohol, Drugs and Driving research in Finland

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Alcohol, Drugs and Driving research in Finland

• Pirjo Lillsunde
• 23.10.2009

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Research Projects

• DRUID (Driving under influence of drugs),
• EU-project
• Life span of drunken drivers
• Academy of Finland
• (Drunken drivers in the traffic flow
• Monitor study of THL)
• (Regional Community based Accident prevention
  project (South-Pohjanmaa and Kymenlaakso))

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1. DRUID (DRiving Under the Influence of Drugs)

• Funded by European Union in DGVII
  (15.10.2006-14.10.2011).
• 37 research institutes from 19 countries

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Work packages
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1.1 Metanalysis
2.1.1 Protocols
3.2 Scientific eval.
2.1.2 Overview
1.3 Thresholds
2.2a2Cell phone int.
2.2b2Fatal inj-FR.
2.2a12.2b1Controls/cases
1.4 Recommendations
WP5 Rehabilitation
2.2cCharacteristics
2.3.1 Relative risk
2.3.2Pharmacoepidemiology
2.3.3Culpability
4.3 Framework
WP7 Guidelines
WP2 Epidemiology and connections to other tasks
Explanation Yellow Connections, start month
1-6 Light green Connections, start after month
6 Orange WP2 tasks, start month 1-6 Dark green
WP2 tasks, start after month 6
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The aims of DRUID in Finland

• For example
• Prevalence of alcohol, drugs and medicines in
  normal traffic flow
• Drugs in general driving population
• Prevalence of alcohol, drugs and medicines in
  traffic accident drivers
• In injured drivers- hospitals
• In fatal accidents
• Effects of alcohol, drugs and medicines on
  driving
• Relative risk estimations for different
  substances

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1.1. Prevalence of drugs in the normal traffic
flow
This report has been produced under the project
Driving Under Influence of Drugs, Alcohol and
Medicines (DRUID) financed by the European
Community within the framework of the EU 6th
Framework Program. This report reflects only the
authors view. The European community is not
liable for any use that may be made of the
information contained therein.

• Team
• Charlotta Engblom, Anna Pehrsson, Kaarina Langel,
  Tom Blencowe and
• Pirjo Lillsunde

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DRUID road side survey

• In 18 EU-countries
• Prevalence of alcohol, drugs and medicines
  dangerous to traffic safety
• Control group for severly injured drivers (risk
  calculations)
• THL in collaboration with the mobile police and
  Road Administration (Tiehallinto) in 2007-2009

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Sample collection

• Breath tests were perfomed (all drivers)
• Oral fluid samples were collected voluntary with
  written consent
• Analyzed for 58 substances
• Two regions Nyland (Helsinki) and
  Norra-Savolax (Kuopio)
• Sampling protocol covering different day times,
  weekdays, and seasons as well as different types
  of roads, representing the normal traffic flow in
  these areas

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Demografic profile (preliminary results)

• 2866 samples in Nyland and 1324 samples in Norra
  Savolax (total 4190)
• Randomly selected drivers
• Voluntary participation (ethical approvals
  /written consent)
• inclusion rate 43

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Alcohol

• In total 35674 stopped drivers were breathtested
• 0,21 of drivers (n74) had alcohol above 0,5
• In addition 0.75 (267 drivers) were alcohol
  positive but below 0,5
• The results are about same as results from annual
  monitor study (R-study)

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Oral fluid analyses

• Target substances
• selected for the project
• classified as harmful for traffic safety in
  Finland
• in addition some widely used substances
• Of the 4183 analyzed samples, 300 (7,2) were
  positive for one or more substances
• 9 sample (0,22) were positive for illicit drugs
• gtthe prevalence was about the same as prevalence
  for alcohol (0.21 )

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Stimulants
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Opioids
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Cannabis, PCP and non-prescribed medicinal drugs
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Short-acting benzodiazepines t½lt24h
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Long-acting benzodiazepines t½gt24h
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Other hypnotics
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Neuroleptics
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Anti-depressants
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Other substances
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Illicit drugs

• In total 9 drivers who had used an illicit drug
  (7 men, 2 women)
• Mean age 31,6 years (22 58)

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Conclusions of road side survey findings

• In total 0,22 of samples were positive for
  illicit drugs, comparable with 0.21 positive for
  alcohol
• All samples positive for illicit drugs were
  collected in Nyland (Helsinki region)
• A prominent part of samples were positive for one
  or several analysed substances (7,2)
• Most common finding was a benzodiazepine case
  with one or several benzodiazepines (3,7)

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1.2. Injured Drivers / Hospital study

• Severly injured drivers
• injured in road traffic
• taken to Töölö Trauma Center
• Collection continues until April 2010

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1.3. Fatally injured drivers

• Fatally injured drivers in 2006-2008
• Register study on
• Findings of substances
• The role of these substances in the accident
  (culpability study)
• Demographic data (age, gender, day time of
  accident, etc)

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1.4. Relative risk calculations

• Based on findings in
• a) seriously injured drivers (Töölö hospital)
• B) fatally injured drivers
• Corresponding controls (age, gender, etc) matched
  drivers in road side survey

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1.5.

• Analytical evaluation of the Drugwipe 5 and
  RapidSTAT on-site devices for the detection of
  drugs of abuse in oral fluid
• Anna Pehrsson, Tom Blencowe, Kaarina Langel,
  Charlotta Engblom
• and Pirjo Lillsunde
• Department of Alcohol, Drugs and Addiction
• National Institute for Health and Welfare
• Helsinki, Finland
• This report has been produced under the project
  Driving Under Influence of Drugs, Alcohol and
  Medicines (DRUID)
• financed by the European Community within the
  framework of the EU 6th Framework Program.
• This report reflects only the authors view. The
  European community is not liable for any use that
  may be made
• Of the information contained therein.

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Tested devices

• Research done in EU-project DRUID
• Finland, The Netherlands and Belgium
• 8 promising devices were studied for reliability
• Biosens (Biosensor Applications Sweden AB)
• Cozart DDS (Cozart Bioscience Ltd.)
• Dräger DrugTest 5000 (Dräger Safety UK Ltd.)
• Drugwipe 5 (Securetec Detections-Systeme AG)
• OraLab 6 (Varian)
• OrAlert (Transmetron)
• Oratect (Branan Medical Corporation)
• RapidStat (MAVAND Solutions GmBH)

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Drugwipe 5

• Amphetamines (amphetamine 50 ng/mL,
  methamphetamine 25 ng/mL, MDMA 25 ng/mL)
• Cannabis (?9-THC) 30 ng/mL
• Opiates 10 ng/mL
• Cocaine (benzoylecgonine) 30 ng/mL

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RapidSTAT

• Amphetamine 25 ng/mL
• Methamphetamine 25 ng/mL
• Opiates (morphine) 25 ng/mL
• Cannabis (?9-THC) 15 ng/mL
• Cocaine (benzoylecgonine) 12 ng/mL
• Benzodiazepines (oxazepam) 25 ng/mL

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Study overview

• Sampling on roadside sessions, on suspected
  drivers, on volunteer drivers and in
  rehabilitation clinics
• Oral fluid (OF) sample collected with the
  Saliva-Sampler collection device (Statsure
  Diagnostic Systems Inc.)
• Altogether 221 subjects tested with Drugwipe 5
  (136 tests) and/or RapidStat (132 tests) device
• For Drugwipe 5, 59 suspect and 77 non-suspect
• For RapidStat , 57 suspect and 75 non-suspect
• OF sample analyzed with GCMS
• Test results interpreted true positive (TP),
  false positive (FP), true negative (TN) and false
  negative (FN) based on the laboratory
  confirmation result of the OF sample
• Sensitivity, specificity and prevalence
  calculated
• based on these classifications

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Calculations
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Results
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Conclusions

• Drugwipe5
• Good sensitivity and very good specificity for
  amphetamines
• Moderate sensitivity for THC but very good
  specificity
• Specificity for cocaine and opiates was
  excellent, but more positive cases are needed to
  evaluate sensitivity
• RapidStat
• Amphetamine and methamphetamine tests very good
  specificity, sensitivity quite high for
  amphetamine
• Sensitivity and specificity high for THC and
  benzodiazepines
• Specificity for cocaine and opiates was
  excellent, but more positive cases are needed to
  evaluate sensitivity

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2. Life span of drunken driversAcademy of
Finland (2007-2010)
Karoliina Karjalainen, Antti Impinen, Aini
Ostamo, and Pirjo Lillsunde multiprofessional
team Forensic Medicine, Criminal Justice,
Psychology. Sociology etc.
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Aims

• The three main questions of the study are
• what are the factors that lead to driving under
  influence of alcohol and/or drugs?
• what happens to the DUI offenders during their
  subsequent life span in terms of health and
  social position?
• what kind of preventive conclusions can be drawn ?

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Life-Span of drunken drivers Data framework

• Suspected drunken drivers. Selected variables are
  merged from different registers. Statistics
  Finland performs the merging of data.

Random sample of 50
Statistics Finland (TK)
DUI data KTL
I phase
II phase
Mortality
Census
Combined register data
Social Insurance registers
StakesHospital discharge
Vehicle register
Crime register
TK
-
KTLInfectious Diseases
TK
Pension register
TK
Register without ID (Anonymous data) /TK
KTL
III phase

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The first substudies

• Describe
• the trends of driving under the influence of
  alcohol (DUI) and drugs
• Numbers and incidence rates
• Relationship to alcohol consumption
• Examine
• the overall mortality of DUI suspects compared to
  the population
• the main causes of death
• acute intoxication/drunkenness as a contributory
  cause of death
• the hazard of death by substances found
• 6 articles on trends on alcohol and drugs,
  polydrug use, recidivism, and mortality (1 of
  them in press and 1 submitted) 2-4 on way

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Drunken driving in 1989-2007
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Women among suspected drunken drivers 1989-2007
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Drunken driving and alcohol consumption 1989-2007
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Drunken driving cases according to age and gender
1990-2007
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Suspected drunken driving cases in different
months1990-2007
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DUI incidence and times
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Drunken driving cases according to the time of
the year 1989-2007
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Re-arrest

• 1/3 of all DUI offenders are re-arrested during
  15 year period
• Risk factors for re-arrest drug detection, male
  gender, young age, time of occurrence, high BAC
• Amphetamines most risky single substance for
  re-arrest

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Driving under the influence of drugs (DUID)
incidence among men and women 1977-2007
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Poly-drug findings 1977-2007
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Drug findings among suspected drivers 1977-2007
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Re-arrests according to substance findings
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Mortality of drunken drivers (alcohol)Men
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Mortality of drugged driversMen
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Thank you for your attention