Survey of prevention and information campaigns on psychoactive drugs and driving

Objectives: One of the objectives of the DRUID project is to develop guidelines for spreading information regarding driving under the influence of drugs and medicines, and this aiming at different target groups, including young drivers, patients, physicians, pharmacists,… We reviewed the state-of-the-art of existing information campaigns regarding psychoactive drugs and driving, as well as the documented effectiveness of those campaigns. Methods: In total 55 institutes were contacted, of which 17 (31%) responded and 12 (22%) were able to give information. Information was also gathered through the Internet by means of websites of relevant organizations, Google and YouTube. Results: A total of 75 campaigns were found, from 13 different countries. Twenty-four were launched to inform the general public on the risks associated with driving under the influence of drugs, medicines and/or alcohol. Twenty-nine campaigns were launched to inform young people and 16 campaigns to inform physicians and/or pharmacists. Nine campaigns were designed for teachers, seven campaigns for patients and five campaigns for other target populations. Some campaigns were designed for more than one target group. Information on impact evaluation was available only for seven campaigns. All evaluations showed a positive impact of the campaigns. Conclusions: The majority of the retrieved campaigns concerning driving under the influence of drugs were aiming at young people. The type of medium that is used the most is brochures. Most campaigns are organized by governmental organizations and road safety organizations. As only a few evaluations were found, and these campaigns and their evaluations were performed in many different ways, it is not possible to draw conclusions concerning the association between the design of the campaigns and their effectiveness

Medicines and driving: evaluation of training and software support for patient counselling by pharmacists

Background : The consumption of some psychotropic medicines has a negative effect on the fitness to drive. Pharmacists are expected to give useful advice to patients on their participation in traffic. However, almost no information is available on this topic. Objective : To assess the effect of training and implementation of new dispensing guidelines with regard to driving-impairing medicines, in two types of dispensing support tools. User acceptance was measured as well as the effect on pharmacists' attitudes & awareness, self-reported behaviour and knowledge. Setting Pharmacists from East Flanders in Belgium. Methods : Two intervention groups and a control group participated. The intervention groups followed a training and were provided with a dispensing support tool containing information on the effect of medicines on driving ability, which was either stand-alone (USB stick) or integrated into the daily used software (ViaNova). The three groups filled out a questionnaire prior to and after the intervention period. Main outcome measure : Answers to a pre/post-questionnaire on attitudes and awareness, self-reported behaviour, knowledge and user acceptance. Results : Many pharmacists were already strongly interested in the topic at the beginning of the study. Positive changes in attitude, self-reported behaviour and knowledge were measured mostly in the group of pharmacists for which the information was integrated in their daily used software. These pharmacists asked significantly more about the patients' driving experience, informed them more about driving-related risk and gave more detailed information on impairing effects of medicines. The knowledge of the participating pharmacists on the topic 'medicines and driving' remained generally low. The participants acknowledge the importance of being aware of the topic medicines and driving but they report a lack of information or education. They strongly prefer a tool that integrates the information in their daily used software. Conclusion : Dispensing support tools with information on the potential impairing effect of a medicine on the fitness to drive increases awareness, reported risk communication behaviour as well as knowledge of pharmacists on this topic. Computerised dispensing support tools are most effective when the information is integrated into the daily used dispensing software

Comparison of a checklist for clinical signs of impairment and detection of drugs in saliva

Objectives: In Belgium and some other countries, the police performs on-site drug screening when a driver is suspected of being drug impaired, since the test procedure is time consuming and the screening devices are relatively expensive. The objective of the study is to compare the results of a checklist with drug concentrations in saliva. Method: The checklist used in the DRUID study in the Netherlands was used. Two fifth-year medical students performed the tests on 250 subjects, 50 drivers and 200 subjects attending a methadone clinic. Saliva analysis was performed by UPLC-MS/MS. As several signs were rarely observed, the parameters were reduced to those that were positive in at least 3 out of 250 test subjects. This selection led to a reduction to 13 (out of 28) parameters. A statistical test (Fisher’s exact test) was used to test for correlations between the checklist parameters and the presence of substances in oral fluid. Results: Most parameters did not correlate significantly with drug intake. The pupil tests seemed to be the best predicting parameters, especially for amphetamine and THC. Remarkably, some correlations were found between parameters and drugs where no correlation was expected, e.g. sleepiness and amphetamines. This can possibly be caused by the presence of combination use of drugs in a lot of subjects. The signs were often observed when high drug concentrations were seen in saliva, but in many cases with high saliva drug concentrations, no signs were observed. Conclusions: In general, the checklist correlated badly with drug presence in this population of chronic drug users, but our results also confirm other studies that found that checklists are not very sensitive

Prevalence of psychoactive substances in Dutch and Belgian traffic

Objective: The purpose of this study was to compare the prevalence of psychoactive substances in general traffic in The Netherlands and Belgium. Method: Randomly selected car drivers and drivers of small vans in six police regions in The Netherlands and five police regions in Belgium were included between January 2007 and August 2009. Blood and oral fluid samples were analyzed for 23 substances, including ethanol (alcohol), by means of ultra performance liquid chromatography tandem mass spectrometry or gas chromatography mass spectrometry analysis. Samples were weighted according to the distribution of traffic over eight 6-hour periods. Substance groups were categorized in five mutually exclusive classes: single alcohol use, single illicit drug use, single medicinal drugs use, multiple drug use (including drugs from two or more separate substance groups but excluding alcohol), and drug use (either single or multiple) in combination with alcohol. Results: In total, 7,771 drivers (4,822 in The Netherlands and 2,949 in Belgium) were included in the study. In Belgium, the prevalence of single alcohol (6.4%) and single medicinal drugs (3.0%) was much higher than in The Netherlands (2.2% and 0.6%, respectively), whereas the single illicit drugs were more common in Dutch traffic (2.2%) than in Belgian traffic (0.6%). Compared with the estimated prevalence of psychoactive substances in the general driving public in Europe, the prevalence in Belgium (10.7%) was greater than the European average (7.4%), and the prevalence in The Netherlands was below the European average (5.5%). Conclusions: The observed prevalence of psychoactive substances varies largely between The Netherlands and Belgium. Probable reasons for the differences are the higher level of alcohol enforcement in The Netherlands and nonresponse bias in the Belgian study (for illicit drugs in particular). Furthermore, cultural differences and variances in prescription policy could also be influential

Self reported (il)licit drug use in Belgian drivers

Introduction: There are relatively few data on the prevalence of driving under the influence of drugs in the general population. Aim: To determine the number of drivers who took drugs and medicines by using questionnaires, and comparing to the results of toxicological analysis. Method : 2957 respondents driving a personal car or van completed a questionnaire during roadside surveys to report their use of drugs and medicines during the last two weeks and indicate the time of last intake. The drug classes were combined to benzodiazepines and Z-drugs, antidepressants, codeine, alcohol, cannabis, cocaine, heroin and amphetamines. Drugs were analysed in oral fluid by UPLC-MS/MS. Frequencies in the time categories were calculated and compared with toxicological results. Results : Drug class Self-report/ toxicology Use 24h Unknown Alcohol 1614/196 138/95 180/56 182/15 370/9 713/14 31/7 Antidepressants 110/41 6/3 14/5 50/19 24/8 8/0 8/6 Benzodiazepines and Z-drugs 98/40 4/2 10/9 33/14 30/9 12/4 9/2 Cannabis 79/32 5/4 3/1 10/8 7/3 46/14 8/2 Codeine 60/6 4/2 7/3 9/0 6/0 25/0 9/1 Cocaine 7/5 2/2 0 0 0 4/2 1/1 Amphetamines 5/2 0 0 0 0 3/1 2/1 Heroin 2/1 1/1 0 0 0 1/0 0 Conclusions : Alcohol, antidepressants, cannabis, benzodiazepines and codeine were most commonly used. Most drugs were last used >4h or more before driving. Self-report yielded more positives than toxicological analysis. The percentages of positives were higher among the subjects who reported more recent drug consumption. Disclaimer: This abstract has been produced under the project “Driving Under the Influence of Drugs, Alcohol and Medicines” (DRUID) financed by the European Community within the framework of the EU 6th Framework Program. This abstract reflects only the author's view. The European Community is not liable for any use that may be made of the information contained therein

Social support and health outcomes among individuals living with HIV in the Deep South

Study Purposes: The purposes of this study were: 1) to provide a more comprehensive description of social support and to determine if gender and/or race were associated with social support; 2) to examine relationships between diverse forms of social support and health outcomes such as mental health, HIV disease severity, and physical quality of life; and 3) to analyze gender and racial differences in the associations between social support and health outcomes among individuals living with HIV in the Deep South. Methods: Baseline data from the Duke University Coping with HIV/AIDS in the Southeast (CHASE) Study collected in 2001-2002 were used for this study. Multivariable models based on the Commission for Social Determinants of Health Conceptual Framework were constructed to examine the associations between gender, race, and social support and social support and health outcomes. Stratified analyses were conducted to identify differences in the associations between social support and health outcomes by gender and race. Results: Men were more likely to be socially isolated than women. Non- Hispanic Black individuals were more likely to experience social conflict than non- Hispanic Whites. Greater perceived social support was associated with less psychological distress and exposure to social conflict was associated with more psychological distress. A higher degree of social integration was associated with larger CD4 count values. Interactions between severe stress and perceived social support and severe stress and social isolation were associated with physical health-related quality of life. The strongest predictor of psychological distress among males was perceived social support, while social conflict was the strongest predictor of distress for women. Social conflict was also the strongest predictor of physical health-related quality of life among women. There was a significant difference in the relationship between social conflict and physical health-related quality of life for men and women. For non-Hispanic White individuals, social isolation was associated with physical health-related quality of life, but not for non-Hispanic Blacks. The relationship between social isolation and health-related quality of life was significantly different by race. Conclusions: Multiple components of social support were associated with health outcomes in this study. Although HIV care has traditionally addressed the social needs of clients, medical treatment has increasingly become the focus of care. Reductions in financial support for social support services necessitate improvements in the effectiveness and efficiency of funded social support interventions. Identification of the components of social support that predict health outcomes for HIV-positive individuals living in the Deep South may inform intervention development or guide modifications to existing interventions. Knowledge about the differences in these associations by gender and race may further improve interventions and help identify the highest priority populations. In addition to efforts to improve social support interventions, the health effects of policies that reduce funding to address the social support needs of individuals living with HIV should be carefully evaluated

Analytical evaluation of five oral fluid drug testing devices

Introduction: The correlation with blood drug presence and the easiness of sample collection make oral fluid an ideal matrix for roadside drug tests targeting impaired drivers. Aim: To evaluate the reliability of five oral fluid testing devices: Varian OraLab®6, Dräger DrugTest® 5000, Cozart® DDS 806, Mavand RapidSTAT® and Innovacon OrAlert. Method: More than 760 samples were collected from volunteers either at drug addiction treatment centres or during roadside sessions. Target drug classes were amphetamines, cannabinoids, cocaine and opiates for all devices. Dräger DrugTest® 5000 (137 samples tested), Cozart® DDS 806 (n=138) and Mavand Rapid STAT® (n=133) could also detect the presence of benzodiazepines, while phencyclidine could be detected using Varian OraLab® 6 (n=249) and Innovacon OrAlert (n=110). Samples were tested on-site with one of the selected devices. Volunteers provided an additional oral fluid sample for confirmation analysis by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS). Sensitivity, specificity, accuracy and prevalence were calculated applying Belgian legal confirmation cut-offs. Results : All devices showed good specificity for all drug classes. Sensitivity and accuracy were very variable among devices and drug classes. Overall, when applying Belgian law cut-offs, sensitivity was always unsatisfactory for cocaine (highest sensitivity 50%), moderate or very low for cannabis and amphetamines (23-80% and 17-75% respectively). Conclusions : Considering that cannabis, followed by amphetamines, is the most prevalent drug among impaired drivers in Belgium, only one device was sensitive enough to be used during roadside police controls. This abstract has been produced under the project “Driving Under the Influence of Drugs, Alcohol and Medicines” (DRUID) financed by the European Community within the framework of the EU 6th Framework Program. This abstract reflects only the author's view. The European Community is not liable for any use that may be made of the information contained therei

Galois families of modular forms and application to weight one

We introduce Galois families of modular forms. They are a new kind of family coming from Galois representations of the absolute Galois groups of rational function fields over the rational field. We exhibit some examples and provide an infinite Galois family of non-liftable weight one Katz modular eigenforms over an algebraic closure of F_p for p in {3,5,7,11}