The relationship between blood benzodiazepine concentration and vehicle crash culpability

© International Association for Accident and Traffic MedicineOBJECTIVE: The purpose of this study was to determine the relationship between blood benzodiazepine concentration and crash risk. METHODS: Blood samples from 2500 injured drivers were analyzed for benzodiazepines and the relationship between concentration and crash risk was assessed using culpability analysis. Benzodiazepine concentrations were expressed as a proportion of the peak concentration of the drug in blood or plasma for a standard therapeutic dose of the drug. RESULTS: There were 68 drivers (2.7%) who tested positive for at least one benzodiazepine. Of these, 16 (23.5%) also tested positive for alcohol. Drivers who tested positive for benzodiazepines, either alone or in combination with alcohol, had a higher culpability rate than drug-free drivers. There was a significant linear relationship between benzodiazepine concentration and culpability for drivers who tested positive for benzodiazepines alone. CONCLUSION: The results here provide clear evidence of increased culpability associated with benzodiazepine use, which was marked at higher concentrations.Marie C. Longo, Robert J. Lokan and Jason M. Whit

Comparison of urine and oral fluid as matrices for screening of thirty-three benzodiazepines and benzodiazepine-like substances using immunoassay and LC-MS(-MS)

Benzodiazepines are the most frequently detected medicinal drugs in drivers. The use of benzodiazepines is associated with an increased road accident risk. In this study, the presence of benzodiazepines detected by liquid chromatography-(tandem) mass spectrometry [LC-MS(-MS)] in oral fluid and urine samples obtained from drivers stopped during a roadside survey was compared. In addition, the sensitivity and selectivity of enzyme multiplied immunoassay technique (EMIT | II Plus) relative to LC-MS(-MS) was determined for both matrices. A total number of 1011 urine samples were collected and screened for benzodiazepines using immunoassay (IA) (EMIT II Plus; cutoff 300 ng/mL). In the IA-positive (n = 25) and a group of randomly selected negative urine samples (n = 79), the presence or absence of benzodiazepines was confirme

Drug use and the severity of a traffic accident

Several studies have showed that driving under the influence of alcohol and/or certain illicit or medicinal drugs increases the risk of a (severe) crash. Data with respect to the question whether this also leads to a more severe accident are sparse. This study examines the relationship between the use of alcohol, illicit drugs and/or medicinal drugs and the severity of an accident within a group of drivers that were involved in a crash in The Netherlands. Blood samples of 993 drivers, collected in the period from October 1998 through September 1999, were linked to accident characteristics as available from the National Transport Research Centre. The outcome measure was the severity of the accident. An accident was considered severe when the accident had resulted in hospital admission or death. All the blood samples obtained after the accident were screened for the presence of alcohol, illicit drugs (opiates, amphetamines and amphetamine-like substances, cocaine and metabolites, methadone, cannabinoids) and medicinal drugs (benzodiazepines, barbiturates and tricyclic antidepressants). The strength of the associations between exposure to the different classes of alcohol/drugs/medicines and the severity of the accident was evaluated using logistic regression analysis and were expressed as odds ratios (OR), adjusted for age, gender, time of the day, day of the week and urban area. The most frequently detected drugs were cannabinoids, benzodiazepines and cocaine. Our results showed no clear association between the use of alcohol, illicit drug and/or medicinal drug use and the severity of the accident. Given the process of obtaining blood samples from drivers involved in accidents and the retrospective nature of the study, we cannot rule out the occurrence of selection bias. Therefore, our findings need further confirmation. (c) 2004 Elsevier Ltd. All rights reserved

Quantitative analysis of 33 benzodiazepines, metabolites and benzodiazepine-like substances in whole blood by liquid chromatography-(tandem) mass spectrometry

A quantitative method using high-performance liquid chromatography–mass spectrometry (LC–MS, ion trap) after matrix supported liquid–liquid extraction is described for the simultaneous determination in whole blood of 33 benzodiazepines including metabolites and benzodiazepine-like substances. The limits of detection (LOD) range from 0.0001 to 0.0126 mg/l. Linearity is satisfactory for all compounds. The extraction recoveries for the benzodiazepines in whole blood are between 60 and 91%, desmethyldiazepam, OH-bromazepam and brotizolam excepted. Selectivity, accuracy and precision are satisfactory for clinical and forensic purposes.<br/