title: Alcohol and Drug Use in Injured Drivers - An Emergency Room Study in a Regional Tertiary Care Centre of North West India.
abstract: BACKGROUND
  Statistics show an increasing proportion of alcohol and drug use in drivers in more recent times throughout the world. It has been found that among the various human factors, alcohol consumption, using drugs and subsequent driving on the roads are major risk factors. Traffic regulations in India penalises drivers who drive beyond permissible alcohol limit of 30 mg%. Consumption of psychoactive drugs such as opioid, cannabis and benzodiazepines has been reported mainly among youngsters. Hardly any data is available in Indian context particularly from North-West Zone of India.
  
  
  OBJECTIVE
  To study the pattern of alcohol, opioid, cannabis and benzodiazepines use in injured drivers presenting to a designated trauma centre in Chandigarh zone of North-West India.
  
  
  METHODS
  Consenting injured drivers who presented to the trauma centre in Chandigarh from September 2013 to January 2014 were included. Urine samples collected from the subjects were screened for abusive drug exposure (opioid, cannabis and benzodiazepines) and alcohol using commercial bedside urine immunoassay kits. In urine alcohol positive cases blood samples were collected and analysed for alcohol concentration using standard gas chromatography. Retrograde extrapolation method was used to assess BAC at the time of accident.
  
  
  RESULTS
  A total of 200 injured drivers were included in this study. We found substance consumption in 54.5% of drivers and alcohol (40.5%) was the most prevalent substance consumed followed by opiates (13%), cannabis (7%) and benzodiazepines (7%). More than one substance was shown in urine of 11.5% of drivers. Among 81 alcohol positive screening cases, the quantitative analysis was successfully done for 76 cases. Except one, all cases showed BAC value more than 30 mg% which is the legal limit for driving any vehicle in India. The values of alcohol concentration in blood at the time of accident were in the range of 20 to 391 mg%.
  
  
  CONCLUSIONS
  This study has shown that drivers are consuming not only alcohol but other psychoactive drugs also. Indian traffic regulatory authorities are penalising drunk drivers by doing road side breath alcohol testing with no protocols for drug screening. Appropriate measures should be adopted to screen traffic offenders for psychoactive drugs also.
authors.affiliation: Senior Resident, Department of Forensic Medicine, PGIMER , Chandigarh, India .
authors.forename: Senthil
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Additional Professor, Department of Forensic Medicine, PGIMER , Chandigarh, India .
authors.forename: Yogender Singh
authors.initials: YS
authors.lastname: Bansal
authors.affiliation: Professor, Department of Forensic Medicine, PGIMER , Chandigarh, India .
authors.forename: Dalbir
authors.initials: D
authors.lastname: Singh
authors.affiliation: Additional Professor, Department of Pharmacology, PGIMER , Chandigarh, India .
authors.forename: Bikash
authors.initials: B
authors.lastname: Medhi
keywords: Blood alcohol concentration; Psychoactive drugs; Road traffic accident