Psychoactive substances have major impact on injuries in rural arctic Norway – A prospective observational study

Background - Rural areas have increased injury mortality with a high pre-hospital death rate. Knowledge concerning the impact of psychoactive substances on injury occurrence is lacking for rural arctic Norway. These substances are also known to increase pre-, per- and postoperative risk. The aim was by prospective observational design to investigate the prevalence and characteristics of psychoactive substance use among injured patients in Finnmark county. Methods - From January 2015 to August 2016, patients ≥18 years admitted to hospitals in Finnmark due to injury were approached when competent. Blood was analysed for ethanol, sedatives, opioids, hypnotics and illicit substances in consenting patients, who completed a questionnaire gathering demographic factors, self-reported use/behaviour and incident circumstances. Results - In 684 injured patients who consented to participation (81% consented), psychoactive substances were detected in 35.7%, alcohol being the most prevalent (23%). Patients in whom substances were detected were more often involved in violent incidents (odds ratio 8.92 95% confidence interval 3.24-24.61), indicated harmful use of alcohol (odds ratio 3.56, 95% confidence interval 2.34-5.43), reported the incident being a fall (odds ratio 2.21, 95% confidence interval 1.47-3.33) and presented with a reduced level of consciousness (odds ratio 3.91, 95% confidence interval 1.58-9.67). Subgroup analysis revealed significant associations between testing positive for a psychoactive substance and being diagnosed with a head injury or traumatic brain injury. Conclusion - A significant proportion of injured patients had used psychoactive substances prior to admission. Use was associated with violence, falls, at-risk alcohol consumption, decreased level of consciousness on admittance and head injury

Poor correlation between alcohol concentration in oral fluid and breath in subjects consuming beverages immediately before testing

In previous research projects and clinical settings, alcohol analysis in oral fluid (saliva) has been used as an alternative to breath or blood alcohol testing. In this study we examined whether it is possible to obtain clinically relevant data regarding alcohol consumption in individuals who recently consumed alcohol by analysing oral fluid samples when the recommended rinsing of the mouth is impossible before sample collection. We conducted a study of 89 nightclub patrons in Norway. Before collecting oral fluid samples and performing breath alcohol testing, participants were required to drink a glass of water to remove residual alcohol from the mouth. Oral fluid samples were collected with the Quantisal oral fluid collection device and analysed using an enzymatic method for alcohol. The alcohol concentration in the neat (undiluted) oral fluid was then calculated. Breath alcohol testing was performed using Lion Alcolmeter 500 instruments. No false-negative or false-positive results for alcohol were detected in the oral fluid when compared with those in the breath. The Intraclass Correlation Coefficient of 0.40 indicated a poor correlation between alcohol concentrations in the two sample types. The procedure for collecting oral fluid was suitable for the qualitative determination of alcohol intake but not for quantitative assessment. We recommend that oral fluid samples should not be used for estimating blood or breath alcohol concentrations in people who have recently consumed alcohol or non-alcoholic beverages, as recommended in the instructions for use

Utelivsstudien 2017 – Rusmiddelbruk blant folk «på byen» i Oslo og seks andre byer på Østlandet

En studie av rusmiddelbruk blant personer rekruttert utenfor utesteder/nattklubber i Oslo (n=1018) og seks byer på Østlandet (n=987) ble gjennomført sommeren 2017. Formålet var å 1) sammenligne rusmiddelbruk i Oslo i 2017 med resultater fra en tilsvarende studie gjennomført i Oslo i 2014 (n=1084); 2) undersøke om rusmiddelbruken i Oslo var annerledes enn rusmiddelbruken i byer ellers på Østlandet; og 3) undersøke om rusmiddelbruken blant 16–20 åringer fortsatt var høyt i Oslo og i byene utenfor. Informasjon om rusmiddelbruk ble samlet inn gjennom spørreskjema, alkometermålinger og analyser av spyttprøver/salivaprøver. Undersøkelsen foregikk enkelte helger i juni og august mellom kl. 23 og 04. Rekrutteringsmetoden medfører at vi ikke fullt ut kan sikre at deltakerne er representative for studiepopulasjon, men vi har ingen grunn til å anta systematiske skjevheter, og analyserer data ut fra antakelsen om representative utvalg

Roadside survey of alcohol and drug use among Norwegian drivers in 2016-2017: A follow-up of the 2008-2009 survey

Objective: The objective of this study was to study the use of alcohol and drugs among the general driving population in the southeastern part of Norway and to compare the findings with the results from a similar roadside survey in 2008–2009. Methods: A roadside survey of drivers of cars, vans, motorcycles, and mopeds was performed from April 2016 to April 2017 in collaboration with the Mobile Police Service. Oral fluid was collected using the Quantisal device and analyzed for alcohol, illicit drugs, and psychoactive medicinal drugs. Age, sex, time, and geographical region were recorded. Results: Of the 5,556 drivers who were asked to participate in the study, 518 drivers (9.3%) declined to participate, and 4 samples contained insufficient volume of oral fluid to be analyzed; thus, 5,034 drivers were included. Fifteen drivers (0.3%) suspected by the police for driving under the influence of alcohol or drugs refused to participate in the study, so the alcohol and drug findings represent minimum values. The weighted prevalence of alcohol concentrations above the legal limit of 0.2 g/L was 0.2%, which is similar to the finding in the 2008–2009 survey. The weighted prevalences of medicinal drugs and illicit drugs were 3.0 and 1.7%, respectively; those numbers included more drugs than the 2008–2009 survey and are therefore not comparable. The most prevalent illicit and medicinal drugs were tetrahydrocannabinol (1.3%) and zopiclone (1.4%). The prevalences of benzodiazepines and amphetamines were significantly lower than detected in the 2008–2009 survey. Only one sample tested positive for a new psychoactive substance. Conclusions: The proportion of samples that tested positive for alcohol had not changed since 2008–2009, and the proportions that tested positive for benzodiazepines and amphetamines were lower. There are several possible reasons for the reduction: Implementation of legal limits for 28 drugs in 2012–2016, increased use of drug recognition tests, implementation of drug screening instruments, and automatic number plate recognition by the police since 2010; more focused enforcement of the driving under the influence (DUI) law; better information provided to drivers; and changes in drug prescriptions

Psychoactive substances have major impact on injuries in rural arctic Norway – A prospective observational study

Background Rural areas have increased injury mortality with a high pre-hospital death rate. Knowledge concerning the impact of psychoactive substances on injury occurrence is lacking for rural arctic Norway. These substances are also known to increase pre-, per- and postoperative risk. The aim was by prospective observational design to investigate the prevalence and characteristics of psychoactive substance use among injured patients in Finnmark county. Methods From January 2015 to August 2016, patients ≥18 years admitted to hospitals in Finnmark due to injury were approached when competent. Blood was analysed for ethanol, sedatives, opioids, hypnotics and illicit substances in consenting patients, who completed a questionnaire gathering demographic factors, self-reported use/behaviour and incident circumstances. Results In 684 injured patients who consented to participation (81% consented), psychoactive substances were detected in 35.7%, alcohol being the most prevalent (23%). Patients in whom substances were detected were more often involved in violent incidents (odds ratio 8.92 95% confidence interval 3.24-24.61), indicated harmful use of alcohol (odds ratio 3.56, 95% confidence interval 2.34-5.43), reported the incident being a fall (odds ratio 2.21, 95% confidence interval 1.47-3.33) and presented with a reduced level of consciousness (odds ratio 3.91, 95% confidence interval 1.58-9.67). Subgroup analysis revealed significant associations between testing positive for a psychoactive substance and being diagnosed with a head injury or traumatic brain injury. Conclusion A significant proportion of injured patients had used psychoactive substances prior to admission. Use was associated with violence, falls, at-risk alcohol consumption, decreased level of consciousness on admittance and head injury

Association between speeding and use of alcohol and medicinal and illegal drugs and involvement in road traffic crashes among motor vehicle drivers

Objective: The objective of this study was to study the association between self-reported road traffic crashes (RTCs) and recent use of alcohol and medicinal and illicit drug use and self-reported speeding in the previous 2 years. Methods: During the period from April 2016 to April 2017, drivers of cars, vans, motorcycles, and mopeds were stopped in a Norwegian roadside survey performed in collaboration with the police. Participation was voluntary and anonymous. The drivers were asked to deliver an oral fluid sample (mixed saliva), which was analyzed for alcohol and 39 illicit and medicinal drugs and metabolites. In addition, data on age, sex, and self-reported speeding tickets and RTCs during the previous 2 years were collected. Results: A total of 5,031 participants were included in the study, and 4.9% tested positive for the use of one or more illicit or medicinal drugs or alcohol. We found a significant, positive association between the use of cannabis and RTC involvement (odds ratio [OR] = 1.93; 95% confidence interval [CI], 1.05–3.57; P = 0.035) and also between previous speeding tickets and RTC involvement (OR = 1.39; 95% CI, 1.08–1.80; P = 0.012). In addition, older age groups were found to have a significant, negative association with RTC involvement, with ORs equal to or less than 0.49, when using the age group 16–24 as reference. Conclusion: Speeding, as an indicator of risk behavior, and the use of cannabis were associated with previous RTC involvement, whereas increasing age was significantly associated with lower risk. This is consistent with previous studies on RTCs