title: Driving under the influence of drugs in Sweden with zero concentration limits in blood for controlled substances.
abstract: OBJECTIVE
  This article describes the background and implementation in Sweden of zero-concentration limits for controlled drugs in the blood of drivers. Eliminating the need to prove that a person's ability to drive safely was impaired by drugs has greatly simplified the prosecution case, which now rests primarily on the forensic toxicology report. Driving under the influence of a prescription drug listed as a controlled substance is exempt from the zero-limit law provided the medication was being used in accordance with a physician's direction and the person was not considered unfit to drive.
  
  
  METHODS
  The prevalence of driving under the influence of drugs (DUID) in Sweden was evaluated from police reports with the main focus on the toxicological findings. A large case series of DUID suspects was compared before and after introducing zero concentration limits in blood for controlled substances on July 1, 1999. The spectrum of drugs used by typical offenders and the concentrations of various licit and illicit substances in blood were evaluated and compared.
  
  
  RESULTS
  Immediately after the zero-limit law came into force, the number of cases of DUID submitted by the police for toxicological analysis increased sharply and is currently ten-fold higher than before the new legislation. Statistics show that about 85% of all blood samples sent for toxicological analysis have one or more banned substances present. Amphetamine is by far the leading drug of abuse in Sweden and was identified in about 50-60% of all DUID suspects either alone or together with other controlled substances. The next most frequently encountered illicit drug was tetrahydrocannabinol (THC), with positive findings in about 20-25% of cases. Various prescription drugs, mainly sedative-hypnotics like diazepam and flunitrazepam, were also highly prevalent and these occurred mostly together with illicit substances. Opiates, such as 6-acetyl morphine and morphine, the metabolites of heroin, were high on the list of substances identified. Most DUID suspects in Sweden were men (85%) who were poly-drug users combining illicit substances, like amphetamine and/or cannabis, with a prescription medication such as various benzodiazepines.
  
  
  CONCLUSIONS
  Sweden's zero-concentration limit has done nothing to reduce DUID or deter the typical offender because recidivism is high in this population of individuals (40-50%). Indeed, many traffic delinquents in Sweden are criminal elements in society with previous convictions for drunk and/or drugged driving as well as other offenses. The spectrum of drugs identified in blood samples from DUID suspects has not changed much since the zero-limit law was introduced.
authors.affiliation: Department of Forensic Toxicology, University Hospital, Linköping, Sweden. wayne.jones@RMV.SE
authors.forename: Alan Wayne
authors.initials: AW
authors.lastname: Jones
mesh_terms: D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000097:blood; D008297:Male; D016495:Police; D017678:Sex Distribution; D015813:Substance Abuse Detection / Q000331:legislation & jurisprudence / Q000379:methods; D019966:Substance-Related Disorders / Q000097:blood* / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology
chemical_list: D013287:Illicit Drugs