title: Five-year update on the occurrence of alcohol and other drugs in blood samples from drivers killed in road-traffic crashes in Sweden.
abstract: According to statistics provided by the Swedish National Road Administration (Vägverket), a total of 1403 drivers were killed in road-traffic crashes in Sweden between 2003 and 2007. Forensic autopsies were performed in approximately 97% of all deaths and specimens of blood and urine were sent for toxicological analysis. In 60% of cases (N=835) the toxicology results were negative and 83% of these victims were men. The blood-alcohol concentration (BAC) was above the legal limit for driving (>0.2g/L) in 22% of cases (N=315) at mean, median and highest concentrations of 1.7 g/L, 1.7 g/L and 4.9 g/L, respectively. The proportions of male to female drivers with BAC>0.2g/L were 93% vs 7% compared with 83% vs 17% for those with drugs other than alcohol in blood. Drivers with a punishable BAC were over-represented in single vehicle crashes compared with multiple vehicle crashes (67% vs 33%). The opposite held for drivers who had taken a prescription drug (39% vs 61%) and also for drug-negative cases (31% vs 69%). Drugs other than alcohol were identified in 253 cases (18%); illicit drugs only in 39 cases (2.8%), both licit and illicit in 28 cases (2.0%) and in 186 cases (13.3%) one or more therapeutic drugs were present. Amphetamine was the most common illicit drug identified at mean, median and highest concentrations of 1.5mg/L, 1.1mg/L and 5.0mg/L, respectively (N=39). Blood specimens contained a wide spectrum of pharmaceutical products (mean 2.4 drugs/person), comprising sedative-hypnotics (N=93), opiates/opioids (N=69) as well non-scheduled substances, such as paracetamol (N=78) and antidepressants (N=93). The concentrations of these substances in blood were mostly in the therapeutic range. Despite an appreciable increase (12-fold) in number of arrests made by the police for drug-impaired driving after a zero-tolerance law was introduced (July 1999), alcohol still remains the psychoactive substance most frequently identified in the blood of drivers killed in road-traffic crashes.
authors.affiliation: Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Artillerigatan 12, SE-587 58 Linköping, Sweden. wayne.jones@rmv.se
authors.forename: Alan Wayne
authors.initials: AW
authors.lastname: Jones
authors.forename: Fredrik C
authors.initials: FC
authors.lastname: Kugelberg
authors.forename: Anita
authors.initials: A
authors.lastname: Holmgren
authors.forename: Johan
authors.initials: J
authors.lastname: Ahlner
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001334:Automobile Driving / Q000331:legislation & jurisprudence; D002492:Central Nervous System Depressants / Q000097:blood*; D000431:Ethanol / Q000097:blood*; D005260:Female; D053593:Forensic Toxicology; D006801:Humans; D013287:Illicit Drugs / Q000097:blood*; D008297:Male; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000097:blood*; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology
chemical_list: D002492:Central Nervous System Depressants; D013287:Illicit Drugs; D004364:Pharmaceutical Preparations; D000431:Ethanol