View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by National Documentation Centre on Drug Use E.M.C.D.D.A. DRUGS MISUSE RESEARCH DIVISION HEALTH RESEARCH BOARD An Inventory of Literature on the Relation between Drug Use, Impaired Driving and Traffic Accidents CT.97.EP.14 Research Team: Colin Gemmell Trinity College, Dublin Rosalyn Moran Drugs Misuse Research Division, Health Research Board James Crowley Professor, Transport Policy Research Institute, University College Dublin Richeal Courtney Medical Expert, for the Health Research Board EMCDDA: Lucas Wiessing February 1999 Please use the following citation: European Monitoring Centre for Drugs and Drug Addiction. An Inventory of Literature on the Relation betweenDrug Use, Impaired Driving and Traffic Accidents. (CT.97.EP.14) Lisbon: EMCDDA, February 1999. Contact Details Drugs Misuse Research Division Health Research Board 73 Lower Baggot Street Dublin 2 Ireland European Monitoring Centre for Drugs and Drug Addiction Rua Cruz de Santa Apolónia 23/25 1100, Lisboa Portugal. Further copies of this bibliography can be obtained from the EMCDDA at the above address. CREDITS Principal Researchers Ms Rosalyn Moran, Project Leader, Health Research Board Professor James Crowley, Professor, Transport Policy Research Institute, UCD Dr Richeal Courtney, Medical Expert, on behalf of the Health Research Board Research Assistants Colin Gemmell (Synthesis and Final Reports) Sarah Heywood (Literature Search and Collaborative Network) For the EMCDDA Lucas Wiessing Collaborative Network (Ireland) Dr Alan Baird, Department of Pharmacology, University College Dublin Dr Bridin Brady, The State Laboratory Dr Denis Cusack, Medical Bureau of Road Safety, University College Dublin Professor James Heffron, Department of Biochemistry, University College Cork Dr Alan Keenan, Department of Pharmacology, University College Dublin Ms Pauline Leavy, Medical Bureau of Road Safety, University College Dublin Inspector Brendan Mangan, Garda National Traffic Policy Bureau Dr Anya Pierce, Department of Toxicology, Beaumont Hospital Dublin Ms Mary O’Brien (Health Research Board) Ms Siobhan Stokes, The State Laboratory Collaborative Network (International) Sr Javier Alvarez, Universidad Valladolid, Spain Dr Rainer Christ, Kuratorium für Verkehrssicherheit, Wien Mr Olaf Drummer, Victoria Institute of Forensic Medicine, Australia Dr Reinhard Fous, Bundespoliziedirektion, Wien Ms Sofia Freire, Reitox Focal Point, Lisbon Mr Klaus Fuchs, Council of Europe, Strasbourg Mr Johan de Gier, University of Utrecht,The Netherlands Dr Sabine Haas, Austrian Ministry of Health, Wien Mr A Aad Hage, Ministry Verkeer en Waterstaat, The Netherlands Professor Ian Hindmarch, University of Surrey, UK Professor Anna Kokkevi, Reitox Focal Point, Greece Professor Hans Peter Krüger, University of Wurzburg, Germany Mr Hans Laurell, National Road Administration, Borlänge, Sweden Prof Dr G Leroux-Roels, Universiteit Gent, Belgium Dr John Oliver, Glasgow University, UK Herr Andreas Pinzker, Federal Ministry of Science and Transport, Wien Ms Inge Spruit, Trimbos Institute, The Netherlands Ms Hilde van Lindt, EU Commission, Brussels Dr Alain Verstraete, Universiteit Gent, Belgium Mr Gilles Vincent, EU Commission, Brussels Introduction An Inventory of Literature on the Relation between Drug Use, Impaired Driving and Traffic Accidents was compiled as a resource document to accompany a major review of the scientific literature on the relation between drug use and driving performance1. The work was carried out for European Monitoring Centre for Drugs and Drug Addiction - EMCDDA, Lisbon. The health consequences of drug use are a priority area for the EMCDDA and impaired driving and road traffic accidents linked to drugs constitute an important topic on which comprehensive information is lacking. There is increasing concern across the EU Member States about the role drug use may play in traffic accidents. This finds expression in different issues related to driving, for example the risks associated with late night driving and ecstacy/amphetamine use in dance and night club contexts, the implications for driving of methodone maintenance, or the consequences of the increasing levels of cannabis use reported in some countries. In a number of Member States a debate on drug testing of drivers, comparable to that already existing for alcohol, is gaining momentum. The literature included here addresses inter alia the relationship between different patterns of drug consumption, impaired driving and traffic accidents. In addition literature relating to drug testing procedures and associated legislation regarding drugimpaired driving in the different EU Member States is included along with references which address the issues raised by such testing. This inventory represents a large selection of the available literature on the subject of drugs and driving. The articles have been sourced from CD-ROM searches, libraries, web pages, professional organisations, government offices and individuals. They span several disciplines including psychology, economics, medicine, forensic science, sociology, politics, law, addiction studies and transport studies. The majority of articles were identified by key-word searches of relevant databases. There are major differences in the number of studies, both experimental and epidemiological, devoted to each of the different drugs. Alcohol has received the greatest attention by far and has been the subject of intensive investigation for nearly one hundred years. The antidepressants and benzodiazepines have received considerable attention in the literature. The amphetamines and cocaine have received less attention. Following these drugs, cannabis and methadone have been the subject of somewhat less research, followed by the antihistamines and, finally, the new synthetic drugs including MDMA. Where the topic of drugs and driving specifically is concerned, most research has concentrated on alcohol, cannabis and benzodiazepines. The other drugs have certainly been examined in the context of driving, but not to the extent that the former have been, 1 European Monitoring Centre for Drugs and Drug Addiction. Literature Review on the Relation between Drug Use, Impaired Driving and Traffic Accidents. (CT.97.EP.14). Lisbon : EMCDDA, February 1999. 4 and where the new synthetic drugs are concerned, there is very little direct evidence available relating to their effects on driving behaviour. The following alphabetically arranged list of studies gives details of authors, journal/book names and, in many cases, an abstract or summary of the contents of the study. Where applicable, the name of the conference at which a paper was presented is given. The ‘workpackage number’ refers to the original breakdown of work in the Workprogramme developed for the completion of the literature review resulting from this collection of articles. Thus 1 refers to methodological issues, 2 refers to experimental studies, 3 refers to field studies, and 4 refers to drug testing procedures and legislation. 5 A Author: ADAMS, H.A. AND WERNER, C. Year: 1997 Title: From the racemate to the eutomer: (S)-ketamine. Renaissance of a substance? Journal/Book Name: Anaesthesist Volume: 46:12 1026-42 Abstract: The pharmacological profile of ketamine: Until recently, clinically available ketamine was a racemic mixture containing equal amounts of two enantiomers, (S)- and (R)-ketamine. The pharmacological profile of racemic ketamine is characterized by the so called dissociative anesthetic state and profound sympathomimetic properties. Among the different sites of action, N-methyl-D-aspartate (NMDA)-receptor antagonism is considered to be the most important neuropharmacological mechanism of ketamine. Effects on opiate receptors, monoaminergic and cholinergic transmitters, and local anesthetic effects are obvious as well. Following intravenous administration, a rapid onset of action is seen within 1 min, lasting for about 10 min. The anaesthetic state is terminated due to redistribution, followed by hepatic and renal elimination with a half- life period of 2-3 h. For alternative administration, the intramuscular and oral route is also appropriate. The most important adverse effects are hallucinations and excessive increases in blood pressure and heart rate. These reactions can be attenuated or avoided by combining of ketamine with sedative or hypnotic drugs like midazolam and/or propofol. During controlled ventilation, increases in intracranial pressure are unlikely to occur. The special pharmacological profile of (S)-ketamine: In general, the pharmacological properties of (S)-ketamine are comparable to the racemic compound. On the different sites of action, qualitatively comparable effects were found, but significant quantitative differences also became obvious. When compared with (R)-ketamine and the racmic mixture, the analgesic and anesthetic potency of (S)-ketamine is threefold or twofold higher. Thus, a 50% reduction of dosage is possible to achieve comparable clinical results. Because of the faster elimination of (S)-ketamine, better control of anesthesia will be provided. In summary, the pharmacokinetic improvements of (S)- ketamine are characterized by a reduced drug load, along with more rapid recovery. The clinical use of (S)-ketamine: The clinical use of (S)-ketamine depends on its analgesic and sympathomimetic properties, whereas the anaesthetic potency remains in the background. In clinical anesthesiology, (S)-ketamine, especially