2007 National Roadside Survey of Alcohol and Drug Use by Drivers

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2007 National Roadside Survey of Alcohol and Drug Use by Drivers: Drug ResultsAmphetamines are CNS stimulants and are used both medicinally and as drugs of abuse.Amphetamines are generally taken recreationally and to enhance performance (e.g., truck driversstaying awake). Ecstasy falls within this category, and as a methylated amphetamine derivative italso has hallucinogenic properties. Amphetamines have been associated with crash occurrenceand could logically be associated with driving impairment both in the stimulation and withdrawalstages; in the latter case especially as the drug interacts with fatigue. The analytical methodologyis described in an article by Moore, Coulter, and Crompton (2007).Cannabinoids have a variety of effects on humans and can be associated with stimulant, sedative,and hallucinogenic effects. Both the experimental and epidemiologic evidence on cannabinoids’effects on driving are mixed. When marijuana is found in drivers, however, it is often inconjunction with alcohol, where an impairing effect is more likely. The most prevalent drugdetected in the pilot study was marijuana (Lacey et al., 2007). There appeared to be a strongpositive correlation between the oral fluid and blood tests, and the only discrepancies found inthe pilot study (negative oral fluid and a positive blood) were from 10 cases in which the inactivemetabolites were detected in blood but not the active tetrahydrocannabinol (THC). A positivemetabolite result (THCA) with a negative parent compound (THC) is consistent with less recentuse (e.g., in the days before sample was taken). A positive oral fluid for the parent compound islikely to be associated with very recent THC use, the timeframe consistent with potentialimpairing effects. Thus, such oral fluid results can be very informative. The laboratoryprocedures for testing the oral fluid results have been previously published in several articles(Moore et al., 2006; Moore, Rana, & Coulter, 2007c; Coulter, Miller, Crompton, & Moore,2008).Phencyclidine (PCP) is related to veterinary tranquilizers such as ketamine, that impair motorability, but it also has hallucinogenic effects and is used as a recreational drug. PCP has seriousperformance diminishing effects and has been found in impaired-driving cases. Its determinationin oral fluid has recently been published in Coulter, Crompton, and Moore (2008).Benzodiazepines include many widely prescribed drugs (e.g., Valium®, Xanax®) to reduceanxiety. These drugs act as CNS depressants, show cross-tolerance to ethanol, and are potentiallyassociated with driver impairment. Different types of benzodiazepines have very short to verylong half-lives. For example, the desired/therapeutic effect of lorazepam (Ativan®) is sedation,which would obviously have a detrimental effect on driving a motor vehicle. The most commonbenzodiazepine is diazepam (Valium®) and/or its metabolites: nordiazepam, oxazepam, andtemazepam. The confirmation procedure for the 2007 study included LC/MS/MS confirmationusing the method described in Moore, Coulter, Crompton, and Zumwalt (2007).Barbiturates are still widely prescribed CNS depressants and in some cases as anti-epilepticmedications. Because of their depressive effects, barbiturates are associated with delayedreaction times and possibly loss of concentration; both effects likely to affect drivingperformance.Methadone, a narcotic analgesic, is used both medicinally for opiate detoxification andmaintenance, and for pain relief. It has also been used as a drug of abuse. It may have differentialperformance effects in naïve or recreational users versus tolerant therapeutic users, and certainlydeserves study.Painkillers are a class of drugs that may lead to driving impairment. Commonly used painkillersinclude oxycodone (an opioid). Oxycodone has similar effects to morphine and heroin. If used in26
2007 National Roadside Survey of Alcohol and Drug Use by Drivers: Drug Resultscombination with other depressants of the CNS, such as alcohol or benzodiazepines, it can causesevere impairment or lead to death. Tramadol, an opiate analgesic, has similar effects tooxycodone. Propoxyphene and meperidine, also atypical opiates, are included in the panel. Themethods used for their analysis are described (Rana et al., 2006; Moore, Rana et al., 2007b).Other painkillers such as carisoprodol, a CNS depressant, and muscle relaxant (Soma® alsocalled Miltown®), are used as prescription drugs but can lead to abuse. Even at therapeuticconcentrations, carisoprodol and its metabolite meprobamate may cause driving impairment asthe desired effect is sedation.Antidepressants are most commonly in the form of selective serotonin uptake inhibitors (SSRIs),such as fluoxetine (Prozac®) and sertraline (Zoloft®). They can cause impairment, especially incircumstances where extremely high blood concentrations are measured or if they are takenoutside of medical need or therapeutic treatment. There is also an additional risk of impairmentassociated with combined use with alcohol.Sleep aids such as Ambien® cause drowsiness and may cause dizziness. If consumed withalcohol, there is an increased likelihood of these symptoms. Sleep aids alone or in combinationwith alcohol could have a detrimental effect on driving ability.Other stimulants, such as methylphenidate (sold as Ritalin®), are amphetamine-like prescriptiondrugs commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children andadults. They are CNS stimulants. Some people abuse these drugs by crushing the tablets andsnorting them. The effect of this other stimulant abuse is similar to that of cocaine oramphetamine.Dextromethorphan, a synthetic analog of codeine, is an antitussive widely used in coughmedicines (e.g., Robitussin®, Sucrets®, Vicks Formula 44®). When consumed in high doses inrecreational use, it is a CNS depressant and may have driving impairment effects at those levels.The analytical method has recently been published in Rodrigues et al. (2008).Ketamine (Special K) is used medicinally as a veterinary tranquilizer, but it is also abused as arecreational drug for its psychedelic effects. Ketamine use by humans would likely be associatedwith decrements in skills related to driving.Oral Fluid Collection DeviceFollowing the NRS interview and collection of the breath test, the interviewer requested an oralfluid sample and offered a $10 incentive for providing one. We used the Quantisal(manufactured by Immunalysis Corporation) oral fluid collection device (see Appendix F of theMethodology Report [Lacey et al., 2009a]). The subject placed this device under his/her tongueand its pad changed color (blue) when 1 mL of oral fluid (the necessary sample volume) wascollected. The collection device was then placed into a tube containing 3 mL of a stabilizingbuffer solution, and capped for storage and transport to the laboratory. The steps are illustrated inFigure 2.27
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DOT HS 811 249December 2009
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2007 National Roadside Survey of Alcohol and Drug Use by Drivers

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