title: Sedative-hypnotics are widely abused by drivers apprehended for driving under the influence of drugs.
abstract: BACKGROUND
  Sedative-hypnotics are commonly encountered in drivers apprehended for driving under the influence of drugs (DUID). Previous research has mainly concentrated on the residual effects of the drugs.
  
  
  METHODS
  In this study, the extent of sleep medication use and abuse among drivers apprehended on suspicion of DUID was assessed. Additionally, the prevalence and concentrations of the drugs, concomitant use of other drugs of abuse, and the age and sex of the drivers positive for the most commonly prescribed sedative-hypnotics (temazepam, midazolam, nitrazepam, zopiclone, and zolpidem) in DUID cases in Finland in 2009 to 2011 were examined.
  
  
  RESULTS
  Sedative-hypnotics were found in 3155 samples of the 13,248 that were analyzed. Temazepam was present in over half of the cases (57.9%), along with other benzodiazepines such as midazolam (13.1%) and nitrazepam (7.0%) and the non-benzodiazepine hypnotics zopiclone (12.2%) and zolpidem (9.8%). The mean age of the drivers using the studied sedative-hypnotics was 33.5 years. Many of the drivers were polydrug users; concomitant stimulant use was found in nearly half of the cases. Cannabis and alcohol were also very common co-findings. In nearly 20% of the cases, the driver had taken more than 1 of the studied sedative-hypnotics; only 2.5% had no findings other than a single sedative-hypnotic in their blood. The drug use pattern of those positive for zopiclone and zolpidem was somewhat different from that of users of benzodiazepine sedative-hypnotics; their age was higher and the concomitant use of illegal stimulants was markedly less prevalent than among the users of temazepam, midazolam, and nitrazepam.
  
  
  CONCLUSIONS
  There were very few cases in our study population where the positive sedative-hypnotic finding could have been due to appropriate medical use. The extremely prevalent concomitant use of other psychoactive drugs and the high median serum concentrations of the studied sedative-hypnotics suggest their widespread abuse among apprehended drivers.
authors.affiliation: *Vita Laboratory, Vita Health Care Services Ltd, Helsinki; †Department of Forensic Medicine, Hjelt Institute, University of Helsinki; ‡Medical School, University of Eastern Finland, Kuopio; §LADR GmbH MVZ Dr. Kramer & Colleagues, Geesthacht, Germany; ¶National Bureau of Investigation Forensic Laboratory, Vantaa, Finland; and ‖Medical Department I, University of Lübeck, Germany.
authors.forename: Pirkko
authors.initials: P
authors.lastname: Kriikku
authors.forename: Hannes
authors.initials: H
authors.lastname: Hurme
authors.forename: Lars
authors.initials: L
authors.lastname: Wilhelm
authors.forename: Janne
authors.initials: J
authors.lastname: Rintatalo
authors.forename: Jukka
authors.initials: J
authors.lastname: Hurme
authors.forename: Jan
authors.initials: J
authors.lastname: Kramer
authors.forename: Ilkka
authors.initials: I
authors.lastname: Ojanperä
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000697:Central Nervous System Stimulants / Q000097:blood; D000066448:Driving Under the Influence / Q000706:statistics & numerical data*; D000431:Ethanol / Q000097:blood; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000097:blood*; D013287:Illicit Drugs / Q000097:blood*; D008297:Male; D002189:Marijuana Abuse / Q000097:blood / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D015813:Substance Abuse Detection; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D006993:Hypnotics and Sedatives; D013287:Illicit Drugs; D000431:Ethanol