Psychoactive substances in seriously injured drivers in Denmark

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Kirsten Wiese Simonsen, Anni Steentoft, IM Bernhoft, T Hels, Brian Schou Rasmussen, Kristian Linnet

This study assesses the presence of a number of psychoactive substances, including alcohol, based on
blood samples from 840 seriously injured drivers admitted to five selected hospitals located in five
different regions of Denmark. The study was a part of the EU 6th framework program DRUID (Driving
Under the Influence of Drugs, Alcohol and Medicines). Blood samples were screened for 30 illegal and
legal psychoactive substances and metabolites as well as ethanol. Danish legal limits were used to
evaluate the frequency of drivers violating the Danish legislation while limit of quantification (LOQ) was
used for monitoring positive drivers. Tramadol is not included in the Danish legislation therefore the
general cut off, as decided in the DRUID project was used. Overall, ethanol (18%) was the most frequently
identified compound (alone or in combination with other drugs) exceeding the legal limit, which is
0.53 g/l in Denmark. The percentage of seriously injured drivers testing positive for medicinal drugs at
levels above the Danish legal limit was 6.8%. Benzodiazepines and Z-drugs (6.4%) comprised the majority
of this group. One or more illegal drugs (primarily amphetamines and cannabis) were found to be above
the Danish legal limit in 4.9% of injured drivers. Young men (median age 31 years) were over-represented
among injured drivers who violated Danish law for alcohol and drugs.
Diazepam (4.4%), tramadol (3.2%), and clonazepam (3.0%) were the medicinal drugs most frequently
detected at levels above LOQ, whereas amphetamines (5.4%) (amphetamine [5.2%] and methamphetamine
[1.5%]), tetrahydrocannabinol (3.7%), and cocaine (3.3%), including the metabolite benzoylecgonine,
were the most frequently detected illegal drugs. A driver could be positive for more than one
substance; therefore, percentages are not mutually exclusive. Poly-drug use was observed in 112 (13%)
seriously injured drivers. Tramadol was detected above DRUID cutoffs in 2.1% of seriously injured
drivers. This is 3.5 times that observed in a Danish survey of randomly selected drivers. Moreover, illegal
and medicinal drug levels above the Danish legal limit were present more than 10 times as frequently as
in injured drivers, whereas ethanol was present more than 30 times as frequently than in randomly
selected drivers. The results indicate that there is an increased risk in traffic when driving under the
influence of psychoactive drugs, especially alcohol in young male drivers.
Original languageEnglish
JournalForensic Science International
Volume224
Pages (from-to)44-50
Number of pages7
ISSN0379-0738
Publication statusPublished - 2013

ID: 43984687