title: Clinical impairment of benzodiazepines--relation between benzodiazepine concentrations and impairment in apprehended drivers.
abstract: BACKGROUND
  Acute intake of benzodiazepines is followed by concentration-dependent deterioration of performance in controlled experimental studies. Whether this is true in a population of benzodiazepine users is uncertain. We studied the relationship in a population of suspected drugged drivers.
  
  
  METHODS
  In Norway physicians examine and take blood samples from nearly all suspected drivers. Our material comprised 818 samples containing only one benzodiazepine and our reference group consisted of 10,759 cases containing only alcohol.
  
  
  RESULTS
  159 drivers (19%) were considered as not impaired and 659 (81%) as impaired. None of the background factors, e.g. gender, age or time of day when apprehended, related significantly to either the physician's conclusion or to blood levels of benzodiazepines. Impaired subjects had significantly higher blood levels of diazepam (n=411) (P<0.001), oxazepam (n=73) (P<0.05) and flunitrazepam (n=211) (P<0.05) than those not impaired. The risk of being assessed as impaired did rise with increasing benzodiazepine blood level, with odds ratios (ORs) for being assessed as impaired of 1.61, 3.65 and 4.11 for the three supratherapeutic drug levels. The corresponding OR found for different elevated blood-alcohol concentrations were 1.49, 2.94 and 10.49.
  
  
  CONCLUSIONS
  The blood concentration of benzodiazepines was the only characteristic which was related to impairment. This indicated a drug-concentration related effect of benzodiazepines on performance and paves the way for a discussion on legal limits for benzodiazepines in relation to driving.
authors.affiliation: National Institute of Forensic Toxicology, P.O. Box 495, Sentrum, N-0105, Oslo, Norway. jorgen.bramness@labmed.uio.no
authors.forename: Jørgen G
authors.initials: JG
authors.lastname: Bramness
authors.forename: Svetlana
authors.initials: S
authors.lastname: Skurtveit
authors.forename: Jørg
authors.initials: J
authors.lastname: Mørland
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000097:blood; D001334:Automobile Driving; D001569:Benzodiazepines / Q000009:adverse effects* / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D000431:Ethanol / Q000009:adverse effects / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D009664:Norway; D011597:Psychomotor Performance / Q000187:drug effects*
chemical_list: D001569:Benzodiazepines; D000431:Ethanol