title: Prevalence of alcohol and drug use in injured British Columbia drivers.
abstract: OBJECTIVE
  Determine the prevalence of drug use in injured drivers and identify associated demographic factors and crash characteristics.
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  Seven trauma centres in British Columbia, Canada (2010-2012).
  
  
  METHODS
  Automobile drivers who had blood obtained within 6 h of a crash.
  
  
  METHODS
  We analysed blood for cannabis, alcohol and other impairing drugs using liquid chromatography/mass spectrometry (LCMS).
  
  
  RESULTS
  1097 drivers met inclusion criteria. 60% were aged 20-50 years, 63.2% were male and 29.0% were admitted to hospital. We found alcohol in 17.8% (15.6% to 20.1%) of drivers. Cannabis was the second most common recreational drug: cannabis metabolites were present in 12.6% (10.7% to 14.7%) of drivers and we detected Δ-9-tetrahydrocannabinol (Δ-9-THC) in 7.3% (5.9% to 9.0%), indicating recent use. Males and drivers aged under 30 years were most likely to use cannabis. We detected cocaine in 2.8% (2.0% to 4.0%) of drivers and amphetamines in 1.2% (0.7% to 2.0%). We also found medications including benzodiazepines (4.0% (2.9% to 5.3%)), antidepressants (6.5% (5.2% to 8.1%)) and diphenhydramine (4.7% (3.5% to 6.2%)). Drivers aged over 50 years and those requiring hospital admission were most likely to have used medications. Overall, 40.1% (37.2% to 43.0%) of drivers tested positive for alcohol or at least one impairing drug and 12.7% (10.7% to 14.7%) tested positive for more than one substance.
  
  
  CONCLUSIONS
  Alcohol, cannabis and a broad range of other impairing drugs are commonly detected in injured drivers. Alcohol is well known to cause crashes, but further research is needed to determine the impact of other drug use, including drug-alcohol and drug-drug combinations, on crash risk. In particular, more work is needed to understand the role of medications in causing crashes to guide driver education programmes and improve public safety.
authors.affiliation: Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Brubacher
authors.affiliation: Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Herbert
authors.initials: H
authors.lastname: Chan
authors.affiliation: Provincial Toxicology Centre, Vancouver, British Columbia, Canada.
authors.forename: Walter
authors.initials: W
authors.lastname: Martz
authors.affiliation: Provincial Toxicology Centre, Vancouver, British Columbia, Canada Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Schreiber
authors.affiliation: Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Asbridge
authors.affiliation: Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Eppler
authors.affiliation: Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Lund
authors.affiliation: University of Victoria, Centre for Addiction Research of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Macdonald
authors.affiliation: Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Olaf
authors.initials: O
authors.lastname: Drummer
authors.affiliation: Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada Provincial Health Services Authority, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: Roy
authors.initials: R
authors.lastname: Purssell
authors.affiliation: Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Andolfatto
authors.affiliation: Provincial Health Services Authority, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Mann
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rollin
authors.initials: R
authors.lastname: Brant
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000928:Antidepressive Agents / Q000097:blood; D001569:Benzodiazepines / Q000097:blood; D001955:British Columbia; D003430:Cross-Sectional Studies; D004155:Diphenhydramine / Q000097:blood; D004338:Drug Combinations; D000431:Ethanol / Q000097:blood; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000097:blood*; D008297:Male; D008385:Marijuana Smoking / Q000097:blood / Q000453:epidemiology*; D008875:Middle Aged; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D004338:Drug Combinations; D013287:Illicit Drugs; D001569:Benzodiazepines; D000431:Ethanol; D004155:Diphenhydramine
keywords: ACCIDENT & EMERGENCY MEDICINE; EPIDEMIOLOGY; PUBLIC HEALTH; TOXICOLOGY; accidents, traffic