title: Can a simple clinical test detect impairment of zopiclone and alcohol? - A randomized controlled trial.
abstract: OBJECTIVE
  The risk of traffic accident involvement is increased among patients prescribed the z-hypnotic drug zopiclone. Clinical test observations able to indicate drug impairment are therefore essential. This study compared the findings of a simplified clinical test of impairment (SCTI) with those of a battery of computerized psychomotor tests of impairment (CPTI).
  
  
  METHODS
  16 healthy young male volunteers attended a research unit on four different study days, receiving in randomized order either placebo, zopiclone 5mg, zopiclone 10mg, or alcohol 50g. The SCTI was performed twice and the CPTI was performed three times on each study day, with blood samples being collected for drug analysis.
  
  
  RESULTS
  The SCTI (and the CPTI) was able to demonstrate impairment at 1.5h, but no major impairment was found at 7h with the SCTI, after intake of both zopiclone and ethanol. The CPTI detected a significantly higher proportion of impaired observations than the SCTI, both for zopiclone and for ethanol, at all concentration levels. The sensitivity of the clinical tests in detecting blood drug concentrations often associated with impairment, due to zopiclone (above 23ng/ml) and alcohol (above 0.5g/l), was low, revealing 27 per cent and 18 per cent, respectively. The specificity, however, was higher, both for zopiclone (88 per cent) and for alcohol (96 per cent).
  
  
  CONCLUSIONS
  The SCTI may be a useful tool, especially during roadside investigation, when the police are in doubt as to whether the apprehended driver is impaired or not. A subject, who has consumed zopiclone or alcohol, tested with the SCTI, with one or more subtests diverging from a habitual result, is likely to have a blood zopiclone concentration above 23ng/ml or a BAC above 0.5g/l. A negative result, however, is less helpful.
authors.affiliation: Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway; Department of Pharmacology, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway. Electronic address: knut.hjelmeland@fhi.no.
authors.forename: Knut
authors.initials: K
authors.lastname: Hjelmeland
authors.affiliation: Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway; Department of Pharmacology, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway. Electronic address: igusta@ous-hf.no.
authors.forename: Ingebjørg
authors.initials: I
authors.lastname: Gustavsen
authors.affiliation: Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway; Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319 Oslo, Norway. Electronic address: jean-paul.bernard@diakonsyk.no.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Bernard
authors.affiliation: Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway; Faculty of Medicine, University of Oslo, PO Box 1072, Blindern, N-0316 Oslo, Norway. Electronic address: jorg.morland@fhi.no.
authors.forename: Jørg
authors.initials: J
authors.lastname: Mørland
mesh_terms: D053961:Azabicyclo Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood*; D000067401:Blood Alcohol Content; D004311:Double-Blind Method; D000066448:Driving Under the Influence; D053593:Forensic Toxicology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood*; D008297:Male; D009664:Norway; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood*; D011597:Psychomotor Performance / Q000187:drug effects*; D012680:Sensitivity and Specificity; D015813:Substance Abuse Detection / Q000295:instrumentation*
chemical_list: D053961:Azabicyclo Compounds; D000067401:Blood Alcohol Content; D006993:Hypnotics and Sedatives; D010879:Piperazines; C515050:zopiclone
keywords: Clinical testing; Ethanol; Impairment; SFST; Zopiclone