Psychoactive substance use and the risk of motor vehicle accidents. Amphetamine, cocaine and cannabinoids use among truck drivers on the roads in the State of Sao Paulo, Brazil. Association Between Travel Length and Drug Use Among Brazilian Truck Drivers Which drugs are associated with highest risk for being arrested for driving under the influence? A case-control study. Relative Benefits of Stimulant Therapy With OROS Methylphenidate Versus Mixed Amphetamine Salts Extended Release in Improving the Driving Performance of Adolescent Drivers With Attention-Deficit/Hyperactivity Disorder Prevalence of drugs in oral fluid from truck drivers in Brazilian highways. Regional cerebral blood flow response to oral amphetamine challenge in healthy volunteers. The effects of dexamphetamine on simulated driving performance Rebound effects with long-acting amphetamine or methylphenidate stimulant medication preparations among adolescent male drivers with attention-deficit/hyperactivity disorder. Geriatric trauma in the State of Illinois: substance use and injury patterns. Physiologic, subjective, and behavioral effects of amphetamine, methamphetamine, ephedrine, phenmetrazine, and methylphenidate in man Drug use by tractor-trailer drivers. Effects of Amphetamine and Barbiturate on Body Experience The effect of amphetamine on regional cerebral blood flow during cognitive activation in schizophrenia The effect of d-methamphetamine on simulated driving performance. A comparison of alcohol and drug use by random motor vehicle drivers in Brazil and Norway. Smaller amygdala and medial prefrontal cortex predict escalating stimulant use.
The driving performance is easily impaired as a consequence of the use of alcohol and /or licit and illicit drugs . However , the role of drugs other than alcohol in motor vehicle accidents has not been well established . The objective of this study was to estimate the association between psychoactive drug use and motor vehicle accidents requiring hospitalisation . A prospect i ve observational case-control study was conducted in the Tilburg region of The Netherl and s from May 2000 to August 2001 . Cases were car or van drivers involved in road crashes needing hospitalisation . Demographic and trauma related data was collected from hospital and ambulance records . Urine and /or blood sample s were collected on admission . Controls were drivers recruited at r and om while driving on public roads . Sampling was conducted by research ers , in close collaboration with the Tilburg police , covering different days of the week and times of the day . Respondents were interviewed and asked for a urine sample . If no urine sample could be collected , a blood sample was requested . All blood and urine sample s were tested for alcohol and a number of licit and illicit drugs . The main outcome measures were odds ratios ( OR ) for injury crash associated with single or multiple use of several drugs by drivers . The risk for road trauma was increased for single use of benzodiazepines ( adjusted OR 5.1 ( 95 % Cl : 1.8 - 14.0 ) ) and alcohol ( blood alcohol concentrations of 0.50 - 0.79 g/l , adjusted OR 5.5 ( 95 % Cl : 1.3 - 23.2 ) and > or=0.8 g/l , adjusted OR 15.5 ( 95 % Cl : 7.1 - 33.9 ) ) . High relative risks were estimated for drivers using combinations of drugs ( adjusted OR 6.1 ( 95 % Cl : 2.6 - 14.1 ) ) and those using a combination of drugs and alcohol ( OR 112.2 ( 95 % Cl : 14.1 - 892 ) ) . Increased risks , although not statistically significantly , were assessed for drivers using amphetamines , cocaine , or opiates . No increased risk for road trauma was found for drivers exposed to cannabis . The study concludes that drug use , especially alcohol , benzodiazepines and multiple drug use and drug-alcohol combinations , among vehicle drivers increases the risk for a road trauma accident requiring hospitalisation Drugs are important risk factors for traffic accidents . In Brazil , truck drivers report using amphetamines to maintain their extensive work schedule and stay awake . These drugs can be obtained without prescription easily on Brazilian roads . The use of these stimulants can result in health problems and can be associated with traffic accidents . There are Brazilian studies that show that drivers use drugs . However , these studies are question naire-based and do not always reflect real-life situations . The purpose of this study was to demonstrate the prevalence of drug use by truck drivers on the roads of Sao Paulo State , Brazil , during 2009 . Drivers of large trucks were r and omly stopped by police officers on the interstate roads during morning hours . After being informed of the goals of the study , the drivers gave written informed consent before providing a urine sample . In addition , a question naire concerning sociodemographic characteristics and health information was administered . Urine sample s were screened for amphetamines , cocaine , and cannabinoids by immunoassay and the confirmation was performed using gas chromatography-mass spectrometry ( GC-MS ) . Of the 488 drivers stopped , 456 ( 93.4 % ) provided urine sample s , and 9.3 % of them ( n=42 ) tested positive for drugs . Amphetamines were the most commonly found ( n=26 ) drug , representing 61.9 % of the positive sample s. Ten cases tested positive for cocaine ( 23.8 % ) , and five for cannabinoids ( 11.9 % ) . All drivers were male with a mean age of 40 ± 10.8 years , and 29.3 % of them reported some health problem ( diabetes , high blood pressure and /or stress ) . A high incidence of truck drivers who tested positive for drug use was found , among other reported health problems . Thus , there is an evident need to promote a healthier lifestyle among professional drivers and a need for preventive measures aim ed at controlling the use of drugs by truck drivers in Brazil Objective : To investigate whether the use of the stimulants amphetamines and cocaine by truck drivers in Brazil was related to travel length . Methods : Truck drivers were r and omly stopped by the Federal Highway Police on interstate roads in Sao Paulo State during morning hours from 2008 to 2011 and invited to participate in the project “ Com and os de Saúde nas Rodovias ” ( Health Comm and s on the Roads ) . Participants were asked about the use of drugs , travel distance , and age , and gender was recorded . Sample s of urine were collected and analyzed for amphetamine , benzoylecgonine ( a metabolite of cocaine ) , and carboxytetrahydrocannabinol ( THC-COOH ; a metabolite of cannabis ) by immunological screening and quantification by gas chromatography – mass spectroscopy . Results : Current use of amphetamine , cocaine , and cannabis was reported by 5.7 % , 0.7 % , and 0.3 % of the truck drivers , respectively . Amphetamine , benzoylecgonine , and THC-COOH were found in urine sample s from 5.4 % , 2.6,% and in 1.0 % of the drivers , respectively . There was a significant association between the positive cases for amphetamine and reported travel length ; 9.9 % of urine sample s from drivers who reported travel length of more than 270 km were positive for amphetamine , and 10.9 % of those drivers reported current use of amphetamines . In most cases , appetite suppressants containing amphetamines had been used , but the purpose was most often to stay awake and alert while driving . Truck drivers with travel length of more than 270 km had significantly higher odds ratio ( OR ) for having a urine sample that was positive for amphetamine when adjusted for age as confounding factor ( OR = 9.41 , 95 % confidence interval [ CI ] , 3.97–22.26 ) . No significant association was found between the use of cocaine or cannabis and travel length . Conclusion : Truck drivers who reported driving more than 270 km had significantly higher frequencies of urine sample s positive for amphetamine and reported significantly more frequent current use of amphetamines than those who reported shorter driving distances The aim of this study was to determine the association between drug type and arrest for driving under the influence of drugs ( DUID ) by calculating odds ratios ( ORs ) using a case-control design . A DUID arrest is in most cases related to aberrant or risky driving and might therefore be regarded as a proxy for a drug related traffic crash . The ' cases ' were 2738 drivers arrested on suspicion of drugged driving from April 2008 to March 2009 with blood alcohol concentrations below the legal limit of 0.2g/L ; 794 were arrested due to involvement in road traffic crashes , whereas 1944 were arrested for other reasons , mainly dangerous driving , suspected impairment when stopped in traffic controls , or because of phone calls to the police from other road users or observers . The ' controls ' were 9375 r and om drivers in normal traffic , also with alcohol concentrations below this limit . Blood sample s from ' cases ' and oral fluid sample s from ' controls ' were analyzed for 15 drugs that have legislative concentration limits in Norway , in addition to two other commonly detected psychoactive drugs . The most prevalent illicit drug in the control group was tetrahydrocannabinol ( THC ; 0.58 % ) , which was also commonly found in sample s from drivers arrested due to road crash ( 15.6 % ) or arrested for other reasons ( 21.8 % ) . Amphetamine/methamphetamine was most prevalent among arrested drivers involved in crashes ( 30.6 % ) and drivers arrested for other reasons ( 56.9 % ) , whereas only 0.18 % of the control group was positive for amphetamine/methamphetamine . The single-use substances which gave highest OR for police arrest were amphetamine/methamphetamine , alprazolam , clonazepam and oxazepam . The majority of the alprazolam and clonazepam findings were probably due to non-therapeutic use of medicinal drugs purchased on the illegal market . Combinations of two or more drugs yielded higher ORs than the use of single substances ; combinations of amphetamine/methamphetamine and benzodiazepines gave the highest risk OBJECTIVE . Automobile accidents are the leading cause of death among adolescents , and collisions are 2 to 4 times more likely to occur among adolescents with attention-deficit/hyperactivity disorder . Studies have demonstrated that stimulants improve driving performance . This study compared 2 long-acting stimulant medications during daytime and evening driving evaluations . METHODS . Adolescent drivers with attention-deficit/hyperactivity disorder were compared on a driving simulator after taking 72 mg of OROS methylpheni date , 30 mg of mixed amphetamine salts extended release , or placebo in a r and omized , double-blind , placebo-controlled , crossover study design . During laboratory testing , adolescents drove a driving simulator at 5:00 pm , 8:00 pm , and 11:00 pm . Driving performance was rated by adolescents and investigators . RESULTS . The study included 35 adolescent drivers with attention-deficit/hyperactivity disorder ( 19 boys/16 girls ) . The mean age was 17.8 years . The overall Impaired Driving Score demonstrated that OROS methylpheni date led to better driving performance compared with placebo and mixed amphetamine salts extended release , whereas mixed amphetamine salts extended release demonstrated no statistical improvement over placebo . Specifically , relative to placebo , OROS methylpheni date result ed in less time driving off the road , fewer instances of speeding , less erratic speed control , more time executing left turns , and less inappropriate use of brakes .  OROS methylpheni date and mixed amphetamine salts extended release worked equally well for male and female adolescents and equally as well with teenagers who have combined and inattentive subtypes of attention-deficit/hyperactivity disorder . CONCLUSIONS . This study vali date s the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder . In the study , OROS methylpheni date promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release Traffic accidents are responsible for 1.25 million deaths worldwide and are the most common cause of death among those aged 15 - 29 years . In Brazil , traffic accidents caused more than 44,000 deaths in 2014 . The use of psychoactive drugs is an important risk factor for being involved in traffic accidents . Previous studies have found that psychoactive substances are commonly used by truck drivers in Brazil to maintain their extensive work schedule and stay awake while driving during nighttime hours . The state of Sao Paulo is one of the most important states regarding goods transportation . Important highways cross through Sao Paulo to other regions from Brazil and to other countries in Latin America . This study aims to determine the prevalence of illicit drug use by truck drivers in the state of Sao Paulo through toxicological analyses of oral fluid . Truck drivers were r and omly stopped by police officers on federal roads during morning hours . Oral fluid sample s were collected using the Quantisal ™ device . In addition , a question naire concerning sociodemographic characteristics and health information was administered . Oral fluid sample s were screened for amphetamine , cocaine , and tetrahydrocannabinol ( Δ9-THC ) by ELISA and the confirmation was performed using ultra performance liquid chromatography with t and em mass spectrometry detection ( UPLC-MS/MS ) . Of the 764 drivers stopped , 762 agreed to participate . The participants were driving an average of 614 km and 9.4h a day . Of the total sample s , 5.2 % ( n=40 ) tested positive for drugs . Cocaine was the most frequently found drug ( n=21 ) , followed by amphetamine ( n=16 ) and Δ9-THC ( n=8 ) . All drivers were men with an average age of 42.5 years . With these results we were able to verify that many truck drivers were still consuming psychoactive drugs while driving , and cocaine was the most prevalent one . This reinforces the need for preventive measures aim ed at controlling the use of illicit drugs by truck drivers in Brazil UNLABELLED Functional brain imaging is a powerful tool for examining the central nervous system ( CNS ) response to pharmacologic challenges . Amphetamine is of interest both because of its role as a stimulant of the dopaminergic system and because of its use to alter mood in mood-disordered patients , particularly in patients suffering from depression . In this study , we report the effects of oral D-amphetamine relative to placebo on regional cerebral blood flow ( rCBF ) measured by SPECT in healthy volunteers to characterize the normal CNS response to this primarily dopaminergic stimulant . METHODS SPECT was used to assess changes in rCBF induced by amphetamine in 16 healthy volunteers . Subjects received placebo and then 0.4 mg/kg oral amphetamine in a fixed-order single-blind design and were imaged on a triple-head tomograph . Another six healthy volunteers received placebo at both times to assess normal rCBF variability . rCBF changes were assessed with a three-dimensional voxel-based analysis integrated into an automated co registration system . Data were automatically normalized to whole-brain counts and coregistered . Result ant rCBF changes were evaluated parametrically through the formation of an image whose voxel values were based on the paired t statistic . RESULTS Amphetamine increased rCBF in two mesial prefrontal zones ( Brodmann 's areas 8 and 10 ) , inferior orbital frontal lobe ( area 11 ) , brain stem ( ventral tegmentum ) , anteromesial temporal lobe ( amygdala ) , and anterior thalamus . Amphetamine decreased rCBF to motor cortex , visual cortex , fusiform gyrus , posterolateral temporal lobe , and right lateral temporal lobe . CONCLUSION Our data suggest that amphetamine induces focal increases and decreases in rCBF in healthy volunteers in areas primarily innervated by dopamine pathways and in areas with secondary ( primarily limbic ) affiliations . These data are consistent with glucose metabolic data from autoradiographic studies in animals , in which the largest increases are seen in brain stem , followed by striatum , thalamus , and frontal and sensory cortices . Frontopolar and temporal increases observed in our study appear to be unique to humans Rationale The number of road fatalities related to the presence of amphetamines in drivers has been relatively constant over the past 10 years . However , there remains uncertainty as to the extent that these drugs induce driving impairment , and whether any such impairments translate to an increase in road fatalities . Objectives To examine the acute effects of 0.42 mg/kg dexamphetamine on simulated driving performance , and to establish which , if any , simulated driving abilities become impaired following dexamphetamine administration . Methods A repeated- measures , counter-balanced , double-blind , placebo-controlled design was employed . Twenty healthy volunteers completed two treatment conditions—0.42 mg/kg dexamphetamine and placebo . Performance was assessed using a driving simulator task .  Blood and saliva sample s were obtained prior to the driving tasks and immediately after task completion ( 120 min and 170 min post-drug administration , respectively ) . Results Mean dexamphetamine blood concentrations were 83 ng/ml and 98 ng/ml at 120 min and 170 min , respectively . Results indicated a decrease in overall simulated driving ability following dexamphetamine administration during the day-time but not the night-time scenario tasks . Contributing to this performance reduction , “ incorrect signalling ” , “ failing to stop at a red traffic light ” and “ slow reaction times ” were the behaviours most strongly affected by dexamphetamine . Conclusions The decrease in simulated driving ability observed during the day-time driving tasks are consistent with the perceptual narrowing or tunnel vision that is associated with dexamphetamine consumption This study investigated whether OROS methylpheni date ( OROS MPH , Concerta ) or extended-release mixed amphetamine salts ( se-AMPH ER , Adderall XR ) were associated with worsening of driving performance , or drug rebound , relative to placebo 16 - 17 hours post-ingestion . Nineteen male adolescent drivers aged 17 - 19 with attention-deficit/hyperactivity disorder ( ADHD ) were compared on a virtual reality driving simulator and an on-road drive after taking 72 mg of OROS MPH , 30 mg of se-AMPH ER , or placebo . Medication was taken at 08:00 in a r and omized , double-blind , placebo-controlled , crossover study . Participants drove a simulator at 17:00 , 20:00 , 23:00 , and 01:00 , and drove their own cars over a 16-mile road course at 24:00 . The main outcome measures were composite scores of driving performance . Neither OROS MPH nor se-AMPH ER was associated with significant worsening of simulator performance relative to placebo 17 hours post-ingestion in group comparisons . However , inattentive on-road driving errors were significantly more common on se-AMPH ER relative to placebo at midnight ( p = 0.04 ) , suggesting possible rebound . During both late simulator and on-road testing , driving performance variance was approximately 300 % greater during the se-AMPH ER compared to the OROS MPH condition As the elderly population increases and they lead more active and healthy lifestyles , their exposure to the threats of injury multiply . Undoubtedly , the geriatric population will comprise a growing percentage of trauma patients . The role of alcohol and drug use in geriatric trauma has not been clearly defined . The purpose of this study is to determine the incidence of  alcohol  and illicit drug  use in association with mechanism of injury in all elderly trauma patients presenting to level I and II trauma centers in the State of Illinois over 3 years . A retrospective analysis was performed on 3 years of data ( January 1 , 1994 to December 31 , 1996 ) , provided by the Illinois Department of Public Health as the Illinois Trauma Registry , which describes consecutive trauma patients presenting to level I and II trauma facilities in the State of Illinois . During the study period , there were a total of 134,846 trauma patient entries . Of these 32,382 ( 24.0 % ) were for patients 65 years of age or older . In those patients 65 and older , 1699 ( 5.2 % ) were tested for the presence of alcohol and 845 ( 49.7 % ) tested positive . Of the elderly patients who tested positive for alcohol , 71.8 % were considered intoxicated ( BAC > 80 mg/dL ) .  Urine toxicology screens  were performed on 1785 ( 5.5 % ) elderly trauma patients , and 208 ( 11.6 % ) were positive . Besides alcohol , benzodiazipines and opiates were the most frequently detected drugs . For elderly patients under the influence of alcohol falls ( 49.5 % ) and motor vehicle crashes ( 36.7 % ) were the most common mechanism of injury . For geriatric patients testing negative for alcohol , motor vehicle crashes were a much more common mechanism of injury than falls ( 65.0 % v 25.1 % ) . Falls were a much more common cause of injury in elderly patients using alcohol than in those not using alcohol . Alcohol and substance abuse are possibly significant factors in geriatric trauma . Although only 5 % of elderly trauma patients were tested for alcohol , nearly half had alcohol present on presentation to a trauma center , and the majority of these patients were intoxicated . Prospect i ve studies are needed to determine the true incidence of alcohol use/abuse in the geriatric trauma population and the need for routine alcohol screening of these patients . Detection of alcohol abuse in elderly trauma patients could help identify individuals in need of counseling and rehabilitative treatment . It may also reduce future injuries in these patients Five central ly acting sympathomimetic amines , d‐amphetamine , d‐methamphetamine , ephedrine , phenmetrazine , and methylpheni date , were studied in man . All of these agents increased blood pressure and respiratory rate , produced similar types of subiective changes , and increased the excretion of epinephrine . With regard to these parameters , there was a high concordance between estimates of their relative potencies . The concordance between the potency estimates for the different parameters suggests , but does not prove , that these five agents share a common mode of central action . Further , if the peripheral modes of action as eluci date d by animal studies are true for man , this study suggests that it is unlikely that their central actions in man are a consequence of the release of norepinephrine in the brain Blood or urine sample s or both were obtained from 317 of 359 r and omly selected tractor-trailer drivers asked to participate in a driver health survey conducted at a truck weighing station on Interstate 40 in Tennessee . Altogether , 29 % of the drivers had evidence of alcohol , marijuana , cocaine , prescription or nonprescription stimulants , or some combination of these , in either blood or urine . Cannabinoids were found in 15 % of the drivers ' blood or urine ; nonprescription stimulants such as phenylpropanolamine were found in 12 % ; prescription stimulants such as amphetamine were found in 5 % ; cocaine metabolites were found in 2 % ; and alcohol was found in less than 1 % . These results provide the first objective information about the use of potentially abusive drugs by tractor-trailer drivers . The extent of driver impairment attributable to the observed drugs is uncertain because of the complex relationship between performance and drug concentrations & NA ; Two dosage levels of both d‐Amphetamine and Pentobarbital and a placebo were given to 75 normal females in a r and omized , test‐retest , double blind study of body experience and mood . All the substances ingested led to an increase in the definiteness of the body boundary . The increase following both placebo and d‐Amphetamine significantly exceeded that previously obtained under analogous nonspecific stress . It was proposed that the body boundary enhancing effect derived from the increase in body awareness that the ingestion of a “ drug ” produced . The only consistent alteration of body experience was depersonalization . All the substances ingested led to a significant increase in feelings of Depersonalization . With Pentobarbital this increase significantly exceeded the placebo group , the d‐Amphetamine group , and those previously obtained in a variety of stress situations . Evidence exists that depersonalization is used by normal people as a common mode of coping with altered life experience . Pentobarbital ingestion apparently produces such an alteration . The Pentobarbital groups reported a significantly greater increase in fatigue and decrease in concentration than the d‐Amphetamine groups . Considering all drug groups combined , depersonalization correlated significantly with increased fatigue and a decrease in concentration . While the predominant type of body experience distortion‐‐depersonalization‐‐was increased with these agents , the total distortion following these substances was significantly less than observed in a variety of stress situations . It has been proposed that habitual body l and marks might be predictors of body experience . The major finding was that the greater the potency of the drug the more likely the pattern of body experience was to alter from the habitual baseline body l and mark . Questions were raised for future research as to whether body image variables play a role in the overuse of drugs To explore the role of monoamines on cerebral function during specific prefrontal cognitive activation , we conducted a double-blind placebo- controlled crossover study of the effects of 0.25 mg/kg oral dextroamphetamine on regional cerebral blood flow ( rCBF ) as determined by 133Xe dynamic single-photon emission-computed tomography ( SPECT ) during performance of the Wisconsin Card Sorting Test ( WCST ) and a sensorimotor control task . Ten patients with chronic schizophrenia who had been stabilized for at least 6 weeks on 0.4 mg/kg haloperidol participated . Amphetamine produced a modest , nonsignificant , task- independent , global reduction in rCBF . However , the effect of amphetamine on task-dependent activation of rCBF ( i.e. , WCST minus control task ) was striking . Whereas on placebo no significant activation of rCBF was seen during the WCST compared with the control task , on amphetamine significant activation of the left dorsolateral prefrontal cortex ( DLPFC ) occurred ( p = 0.0006 ) . Both the mean number of correct responses and the mean conceptual level increased ( p less than 0.05 ) with amphetamine relative to placebo . In addition , with amphetamine , but not with placebo , a significant correlation ( p = - 0.71 ; p less than 0.05 ) emerged between activation of DLPFC rCBF and performance of the WCST task . These findings are consistent with animal models in which mesocortical catecholaminergic activity modulates and enhances the signal-to-noise ratio of evoked cortical activity OBJECTIVES Methamphetamine is considered to be one of the most popularly abused drugs by drivers ; however , its exact effect on driving and driving behaviour has yet to be thoroughly investigated . This being despite methamphetamine 's increased prevalence in injured and deceased drivers . METHODS Twenty healthy recreational illicit stimulant users ( 10 male and 10 female ) , aged between 21 and 32 years ( mean = 25.4 years , SD = 3.3 years ) attended two testing sessions involving oral consumption of 0.42 mg/kg d-methamphetamine or a matching placebo . The drug administration was counter-balanced , double-blind , and medically supervised . At each session driving , performance was assessed 2.5 h post drug administration . RESULTS d-methamphetamine ( 0.42 mg/kg ) did not significantly impair overall simulated driving performance 2.5 h post drug administration . At the individual driving variable level , participants in the d-methamphetamine condition were observed to be driving slower when an emergency situation occurred ( T = 44 , p < 0.05 ) , but interestingly , participants in both conditions recorded average speeds in excess of the speed limit ( 100 km/h ) when the emergency situations occurred . The d-methamphetamine condition did also produce four times more infringements where participants did not stop at red traffic light in comparison to the placebo , but this effect was only evident at a trend level ( T = 7 , p = 0.11 ) . CONCLUSIONS The findings presented herein suggest that d-methamphetamine administered at the levels supplied did not impair driving performance in a manner consistent with epidemiological evidence . Further research is certainly required to eluci date the effects of various doses of methamphetamine , alone and in combination with other legal and illicit substances BACKGROUND A large proportion of road traffic crashes are related to driving under the influence ( DUI ) of alcohol or drugs . The aim of this study was to compare the use of alcohol , illegal drugs and psychoactive medicinal drugs among r and om drivers in Brazil and Norway , two countries with the same legal limit for drunk driving , but with marked differences in legislation history , enforcement and penalties for DUI , and to discuss any differences found . METHODS Roadside surveys were conducted on Fridays and Saturdays between noon and midnight . Sample s of oral fluid were collected for analysis of drugs , whereas alcohol was determined by breath testing or by analysis of oral fluid . RESULTS High participation rates of 94 - 97 % were obtained in both countries . The weighted prevalence of driving with alcohol concentrations in breath or oral fluid equivalent to blood alcohol concentrations ( BAC ) above 0.2g/L was 2.7 % ( 95 % CI 2.2 - 3.3 ) in Brazil and 0.2 % ( 95 % CI 0.0 - 0.5 ) in Norway . Stimulants ( amphetamines or cocaine ) were found in sample s from 1.0 % ( 95 % CI 0.7 - 1.4 ) of drivers in Brazil and 0.3 % ( 95 % CI 0.1 - 0.7 ) in Norway . The prevalence of amphetamines was highest among Brazilian truck drivers ( 3.6 % ; 95 % CI 2.0 - 6.4 ) . Tetrahydrocannabinol was found in sample s from 0.5 % ( 95 % CI 0.3 - 0.8 ) of drivers in Brazil and 1.0 % ( 95 % CI 0.6 - 1.5 ) in Norway , whereas benzodiazepines or zopiclone were found in 1.0 % ( 95 % CI 0.7 - 1.4 ) and 1.7 % ( 95 % CI 1.2 - 2.4 ) of the sample s from Brazil and Norway , respectively . CONCLUSIONS The difference in the prevalence of alcohol may be related to the fact that Norway has implemented steps to reduce drunk driving since 1936 , whereas Brazil has attempted to do the same for only a few years . Differences for drugs may be related to different patterns in the use of stimulants , cannabis and medicines Drug addiction is a chronic , relapsing brain disorder . The identification of biomarkers that render individuals vulnerable for the transition from occasional drug use to addiction is of key importance to develop early intervention strategies . The aim of the present study was to prospect ively assess brain structural markers for escalating drug use in two independent sample s of occasional amphetamine-type stimulant users . At baseline occasional users of amphetamine and 3,4-methylenedioxymethamphetamine ( cumulative lifetime use ≤10 units ) underwent structural brain imaging and were followed up at 12 months and 24 months ( Study 1 , n = 38 ; Study 2 , n = 28 ) . Structural vulnerability markers for escalating amphetamine-type drug use were examined by comparing baseline grey matter volumes of participants who increased use with those who maintained or reduced use during the follow-up period . Participants in both sample s who subsequently increased amphetamine-type drugs use displayed smaller medial prefrontal cortex volumes and , additionally , in the basolateral amygdala ( Study 1 ) and dorsal striatum ( Study 2 ) . In both sample s the baseline volumes were significantly negatively correlated with stimulant use during the subsequent 12 and 24 months . Additional multiple regression analyses on the pooled data sets revealed some evidence of a compound-specific association between the baseline volume of the left basolateral amygdala and the subsequent use of amphetamine . These findings indicate that smaller brain volumes in fronto-striato-limbic regions implicated in impulsivity and decision-making might render an individual vulnerable for the transition from occasional to escalating amphetamine-type stimulant use
Best- evidence synthesis demonstrated a conflicting level of evidence for associations between the use of-amphetamine-type substances and the risk of sustaining an injury , and a moderate level of evidence between amphetamine use and the risk of death due to road trauma .
This is the first review to synthesis e evidence regarding the association between amphetamine-type substance use and the risk of injury or death due to a road traffic accident .
More conclusive evidence of death due to road trauma among amphetamine users may reflect significant and global deficits in functioning associated with effective vehicular control under the influence of this substance .
Amphetamine-type substances are frequently detected among drivers injured or killed due to road-trauma .
However , the role of this substance in crash causation remains equivocal .
We performed a systematic review to evaluate existing evidence regarding the association between amphetamine use and the risk of injury or death due to road traffic accidents .