Demographics & Post-Mortem Toxicology Findings in Deaths among People Arrested Multiple Times for Use of Illicit Drugs and/or Impaired Driving

BACKGROUND:

Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem.

METHODS:

This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma.

RESULTS:

Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p<0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p<0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p<0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p<0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids.

CONCLUSIONS:

This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes

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By:  Ahlner J1, Holmgren A2, Jones AW3.

• 1Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden.
• 2Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden.
• 3Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden. Electronic address: wayne.jones@liu.se. 
• Forensic Sci Int. 2016 Feb 3;265:138-143. doi: 10.1016/j.forsciint.2016.01.036.

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What Do We Know Now About the Impact of the Laws Related to Marijuana?

OBJECTIVES:

This study presents information on the status and impact of medical and legalized marijuana, and the latest data on attitudes and prevalence of use since implementation of these laws. Recent reports from epidemiologists in Denver and Seattle are summarized to give the readers a sense of the changes as these laws have taken effect in their communities.

METHODS:

The status of these laws is reviewed and the results of surveys taken before and after the laws were enacted are presented, along with data on changing potency and driving under the influence of marijuana.

SUMMARY:

Prevalence of use by youths has not increased, but their negative attitudes towards the risk of using marijuana have decreased, and use by adults has increased. Potency continues to increase, as has the proportion of drivers testing positive for use of the drug. Data from Denver show increases in hospital admissions, emergency department visits, and calls to poison centers, with decreasing arrests and admissions to substance abuse treatment programs. Data from the Seattle area show similar decreases in treatment admissions and police involvement, but also increased prevalence of more frequent use.

CONCLUSIONS:

Current data suggest that increases in marijuana use preceded legalization in 2012. Treatment admissions were declining before these laws, but some indicators of morbidity seem to be increasing subsequent to legalization, with modest increases in poison center calls in both states and increases in acute medical visits in Denver. Data are needed to understand the relationship between the patterns and amounts of use in terms of consequences, and data on the health conditions of those receiving medical marijuana and the impact of higher potency.

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By:  Maxwell JC1, Mendelson B.

• 1Center for Social Work Research (JCM); Denver Office of Drug Strategy, 1200 Federal Boulevard, Denver, Colorado (BM). 

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Alcohol Use and Firearm Violence

Although the misuse of firearms is necessary to the occurrence of firearm violence, there are other contributing factors beyond simply firearms themselves that might also be modified to prevent firearm violence. Alcohol is one such key modifiable factor. 

To explore this, we undertook a 40-year (1975-2014) systematic literature review with meta-analysis. One large group of studies showed that over one third of firearm violence decedents had acutely consumed alcohol and over one fourth had heavily consumed alcohol prior to their deaths. 

Another large group of studies showed that alcohol was significantly associated with firearm use as a suicide means. Two controlled studies showed that gun injury after drinking, especially heavy drinking, was statistically significant among self-inflicted firearm injury victims. 

A small group of studies investigated the intersection of alcohol and firearms laws and alcohol outlets and firearm violence. One of these controlled studies found that off-premise outlets selling takeout alcohol were significantly associated with firearm assault. 

Additional controlled, population-level risk factor and intervention studies, including randomized trials of which only 1 was identified, are needed. 

Policies that rezone off-premise alcohol outlets, proscribe blood alcohol levels and enhance penalties for carrying or using firearms while intoxicated, and consider prior drunk driving convictions as a more precise criterion for disqualifying persons from the purchase or possession of firearms deserve further study.

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By:  Branas CC, Han S, Wiebe DJ.

Correspondence to Dr. Charles C. Branas, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 (e-mail: cbranas@upenn.edu).

Epidemiol Rev. 2016 Jan 24. pii: mxv010. 

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Correlates of Marijuana Drugged Driving and Openness to Driving While High: Evidence from Colorado and Washington

Aims 

A potential unintended consequence of legalizing recreational marijuana is increased marijuana-related driving impairment. Some states where recreational marijuana is legal have begun implementing interventions to mitigate driving under the influence (DUI) of marijuana, including media campaigns to increase knowledge about DUI laws. However, little is known about the associations between knowledge of DUI laws and marijuana DUI behavior. In this study, we provide new data from a survey of marijuana users in Colorado and Washington to examine associations between marijuana drugged driving and two potential behavioral precursors of marijuana DUI. We also explore other factors that may influence marijuana DUI.

Methods

Data are from an online survey of marijuana users in Colorado and Washington. Respondents who reported any marijuana use in the past 30 days (n = 865) served as the analytic sample. We examined prevalence of two behavioral outcomes: (1) any driving of a motor vehicle while high in the past year and (2) driving a motor vehicle within 1 hour of using marijuana 5 or more times in the past month. Additional outcomes measuring willingness to drive while high were also assessed. Logistic regressions were used to estimate each outcome as a function of two multi-item scales measuring knowledge of the legal consequences of driving high and perceptions that driving while high is not safe. Additional covariates for potential confounders were included in each model.

Results

Prevalence of past-year driving while under the influence of marijuana was 43.6% among respondents. The prevalence of driving within 1 hour of using marijuana at least 5 times in the past month was 23.9%. Increased perception that driving high is unsafe was associated with lower odds of past-year marijuana DUI (OR = 0.31, P < 0.01) and lower past-month odds of driving 5 or more times within 1 hour of using marijuana (OR = 0.26, P < 0.01). Increased knowledge of marijuana DUI laws was also associated with lower odds of each of these outcomes (OR = 0.63, P < 0.01, OR = 0.69, P = 0.02, respectively). Post-estimation Wald tests confirmed the negative associations with marijuana DUI were greater in magnitude for safety perceptions than knowledge of DUI laws. Increased perceptions that driving while high is unsafe was associated with significantly lower willingness to drive after using marijuana while increased knowledge of marijuana DUI laws was not associated with these outcomes.

Conclusions

Despite recent interventions targeting public awareness of the legal consequences of marijuana DUI, our results suggest that knowledge of these laws is a weaker predictor of DUI behavior than perceptions that driving high is unsafe. In addition, safety perceptions predict decreased openness to driving high while knowledge of DUI laws was not associated with openness. These findings suggest that interventions for reducing the incidence of marijuana DUI are likely to be more successful by targeting safety perceptions related to marijuana DUI rather than knowledge of DUI laws. We caution that because these data are limited to an online convenience sample, results may not be generalizable beyond our sample.

Below:  Driving while Under the Influence of Marijuana and Openness to Drive While High

Full article at:  http://goo.gl/fzgF4t

By:  Kevin C. Davis, Jane Allen, Jennifer Duke, James Nonnemaker, Brian Bradfield, Matthew C. Farrelly, Paul Shafer, Scott Novak

RTI International, Research Triangle Park, NC, United States of America

  

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Percentage of persons who reported driving a vehicle under the influence of alcohol alone, marijuana alone, and alcohol and marijuana combined in the past year by age (years)

Percentage of persons who reported driving a vehicle under the influence of alcohol alone, marijuana alone,* and alcohol and marijuana* combined in the past year by age (years) — National Survey on Drug Use and Health, United States, 2014

Motor vehicle accidents are the leading cause of death among youths and young adults aged 16–25 years in the United States (1). The prevalence of drinking and driving among high school students aged 16–19 years has declined by 54%, from 22.3% in 1991 to 10.3% in 2011 (2). However, the prevalence of weekend nighttime driving under the influence of marijuana (based on biochemical assays) among drivers aged ≥16 years has increased by 48%, from 8.6% in 2007 to 12.6% in 2013–2014 (3). Use of marijuana alone and in combination with alcohol has been shown to impair driving abilities (4–9). This report provides the most recent self-reported national estimates of driving under the influence of alcohol, marijuana, and alcohol and marijuana combined among persons aged 16–25 years, using data from the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH) from 2002–2014. Prevalence data on driving under the influence of both substances were examined for two age groups (16–20 years and 21–25 years) and by sex and race/ethnicity. During 2002–2014, the prevalence of driving under the influence of alcohol alone significantly declined by 59% among persons aged 16–20 years (from 16.2% in 2002 to 6.6% in 2014; p<0.001) and 38% among persons 21–25 years (from 29.1% in 2002 to 18.1% in 2014; p<0.001). In addition, the prevalence of driving under the influence of alcohol and marijuana combined significantly declined by 39%, from 2.3% in 2002 to 1.4% in 2014 (p<0.001) among persons aged 16–20 years and from 3.1% in 2002 to 1.9% in 2014 (p<0.001) among persons aged 21–25 years. The prevalence of driving under the influence of marijuana alone declined 18%, from 3.8% in 2002 to 3.1% in 2014 (p = 0.05) only among persons aged 16–20 years. Effective public safety interventions,* such as minimum legal drinking age laws, prohibition of driving with any alcohol level >0 for persons aged <21 years, targeted mass media campaigns, roadside testing (e.g., sobriety checkpoints), and graduated driver licensing programs (10) have contributed to the decline in driving under the influence of alcohol in this population. These or similar interventions might be useful to prevent driving under the influence of other substances, such as marijuana alone or combined with other substances.

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Percentage of Persons Who Reported Driving a Vehicle Under Influence of Alcohol and/or Marijuana

Percentage of persons who reported driving a vehicle under the influence of alcohol alone, marijuana alone, and alcohol and marijuana combined in the past year among persons aged 16–20 years and persons aged 21–25 years — National Survey on Drug Use and Health, United States, 2002–2014

Motor vehicle accidents are the leading cause of death among youths and young adults aged 16–25 years in the United States (1). The prevalence of drinking and driving among high school students aged 16–19 years has declined by 54%, from 22.3% in 1991 to 10.3% in 2011 (2). However, the prevalence of weekend nighttime driving under the influence of marijuana (based on biochemical assays) among drivers aged ≥16 years has increased by 48%, from 8.6% in 2007 to 12.6% in 2013–2014 (3). Use of marijuana alone and in combination with alcohol has been shown to impair driving abilities (4–9). This report provides the most recent self-reported national estimates of driving under the influence of alcohol, marijuana, and alcohol and marijuana combined among persons aged 16–25 years, using data from the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH) from 2002–2014. Prevalence data on driving under the influence of both substances were examined for two age groups (16–20 years and 21–25 years) and by sex and race/ethnicity. During 2002–2014, the prevalence of driving under the influence of alcohol alone significantly declined by 59% among persons aged 16–20 years (from 16.2% in 2002 to 6.6% in 2014; p<0.001) and 38% among persons 21–25 years (from 29.1% in 2002 to 18.1% in 2014; p<0.001). In addition, the prevalence of driving under the influence of alcohol and marijuana combined significantly declined by 39%, from 2.3% in 2002 to 1.4% in 2014 (p<0.001) among persons aged 16–20 years and from 3.1% in 2002 to 1.9% in 2014 (p<0.001) among persons aged 21–25 years. The prevalence of driving under the influence of marijuana alone declined 18%, from 3.8% in 2002 to 3.1% in 2014 (p = 0.05) only among persons aged 16–20 years. Effective public safety interventions,* such as minimum legal drinking age laws, prohibition of driving with any alcohol level >0 for persons aged <21 years, targeted mass media campaigns, roadside testing (e.g., sobriety checkpoints), and graduated driver licensing programs (10) have contributed to the decline in driving under the influence of alcohol in this population. These or similar interventions might be useful to prevent driving under the influence of other substances, such as marijuana alone or combined with other substances.

Via: http://ht.ly/VJxAP 

Relationship of Aggression, Negative Affect, Substance Use Problems & Childhood Delinquency to DWI Recidivism

BACKGROUND:

Driving under the influence remains a pervasive problem. Approximately 30% of those arrested for impaired driving offenses each year are repeat offenders, suggesting that current rehabilitative efforts are not sufficiently effective for reducing driving while intoxicated (DWI) recidivism. Aggression, negative affect, substance use problems, and childhood delinquency have been noted in the population of impaired drivers, but study of these variables on recidivism has been limited.

OBJECTIVES:

The aim of the current study was to examine the effects of aggression, negative affect, substance use problems, and childhood delinquency on DWI recidivism among first time offenders.

METHODS:

In 1992, 6436 individuals in impaired driver programs in New York State were surveyed. A total of 3511 individuals provided names so that state driver abstracts could be reviewed in the future. A total of 2043 matches were found and 1770 remained after excluding those with previous DWI convictions. Driver records were reviewed in 2010 and 2012, providing between 18 and 20 years of follow-up.

RESULTS:

During the follow-up period, 16.5% of individuals were arrested for an impaired driving offense. Multivariate analysis suggested that recidivism was a function of several problems, including: alcohol problem severity, aggression, negative affect, drug problem severity, criminal history, and childhood delinquency.

CONCLUSION:

Impaired driving programs should assess for childhood delinquency, aggressive tendencies, and negative affect as these constructs, along with substance use, are evident among impaired drivers who recidivate. Interventions addressing aggression and negative affect may ultimately prove useful in reducing recidivism.

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By:  Linn BK1, Nochajski T1, Wieczorek W2.

• 1 School of Social Work , University at Buffalo, The State University of New York , Amherst , NY , USA.
• 2 Buffalo State College , Buffalo , NY , USA. 

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