title: Prevalence of alcohol and other drugs and the concentrations in blood of drivers killed in road traffic crashes in Sweden.
abstract: BACKGROUND
  Drunk or drug-impaired drivers represent a major public health and societal problem worldwide. Because over 95% of drivers killed on the roads in Sweden are autopsied, reliable information is available about the use of alcohol and/or other drug before the crash.
  
  
  METHODS
  This retrospective 4-year study (2008-2011) used a forensic toxicology database (TOXBASE) to evaluate the concentrations of alcohol and other drugs in blood samples from drivers killed in road-traffic crashes.
  
  
  RESULTS
  The mean age of all victims (N = 895) was 48 ± 20 years, and the majority were male (86%). In 504 drivers (56%), the results of toxicological analysis were negative and these victims were older; mean age (± SD) 47 ± 20 years, than alcohol positive cases (35 ± 14 years) and illicit drug users (34 ± 15 years). In 21% of fatalities, blood-alcohol concentration (BAC) was above the statutory limit for driving (0.2 g/L), although the median BAC was appreciably higher (1.72 g/L). Illicit drugs (mainly amphetamine and cannabis) were identified in ~7% of victims, either alone (2.5%), together with alcohol (1.8%) or a prescription drug (2%). The psychoactive prescription drugs identified were mainly benzodiazepines, z-hypnotics and tramadol, which were found in the blood of 7.6% of crash victims.
  
  
  CONCLUSIONS
  The high median BAC in fatally-injured drivers speaks strongly towards alcohol-induced impairment as being responsible for the crash. Compared with alcohol, the prevalence of illicit and psychoactive prescription drugs was fairly low despite a dramatic increase in the number of drug-impaired drivers arrested by the police after a zero-tolerance law was introduced in 1999.
authors.affiliation: 1Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Ahlner
authors.forename: Anita
authors.initials: A
authors.lastname: Holmgren
authors.forename: Alan Wayne
authors.initials: AW
authors.lastname: Jones
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D002492:Central Nervous System Depressants / Q000097:blood*; D002648:Child; D016208:Databases, Factual; 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*; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002492:Central Nervous System Depressants; D013287:Illicit Drugs; D004364:Pharmaceutical Preparations; D000431:Ethanol
keywords: Alcohol; driving; drugs; impairment; traffic fatalities