Benzodiazepines in the oral fluid of Spanish drivers

Francisco Herrera-Gómez,F Javier Álvarez,Mercedes García-Mingo

doi:10.1186/s13011-020-00260-y

Abstract

BackgroundDriving under the influence of alcohol, illicit drugs and certain medicines is not allowed worldwide. Roadside drug testing is considered an important tool for determining such behavior. In Spain, mandatory roadside oral fluid drug testing is carried out regularly. The aim of this study was to determine the prevalence of benzodiazepines and benzodiazepines in combination with other drugs in drivers, examine benzodiazepine concentrations in drivers, and analyze the association of these factors with age and sex.MethodsThis study assessed data on Spanish drivers with confirmed drug-positive results recorded by the Spanish National Traffic Agency (Dirección General de Tráfico) between 2011 and 2016, accounting for 179,645 tests and 65,244 confirmed drug-positive tests.ResultsBenzodiazepines were confirmed in 4.3% of all positive roadside drug tests. In most of those cases (97.1%), other substances were also detected, particularly cocaine (75.3%) and cannabis (64.0%). The frequency of benzodiazepine-positive drivers (OR, 1.094; 95% CI, 1.088–1.100) increased with age, while the frequency of drivers who tested positive for benzodiazepines in conjunction with other substances, compared with drivers who tested positive for benzodiazepines alone, decreased with age (OR, 0.903; 95% CI, 0.825–0.988). Nordiazepam (54.8%) and alprazolam (46.9%) were the most common benzodiazepines detected.ConclusionConcomitant use of benzodiazepines and other psychoactive substances was found to be a common behavior among drivers who tested positive on the road. It is important to raise awareness of all those involved in the consumption of driving-impairing substances (authorities, healthcare providers, patients and their families, etc.): roadside detection of driving-impairing substances is suggested, in addition to promoting the use of fewer driving-impairing medications and the provision of clear information to patients.

Highlights

Driving under the influence of alcohol, illicit drugs and certain medicines is not allowed worldwide
The frequency of benzodiazepinepositive cases was higher in females than in males (9.0% versus 4.3%, χ2 = 67.25, p < 0.0001, r = − 0.66), and females were more likely to be positive for benzodiazepines alone (7.5% versus 3.3%, χ2 = 5.56, p = 0.02, r = − 0.59; Table 1)
In the multivariate logistic regression analysis, the frequency of benzodiazepine-positive drivers increased with age (OR, 1.094; 95% confidence interval (95% CI), 1.088–1.100; p < 0.0001), while the frequency of drivers who tested positive for benzodiazepines in conjunction with other substances compared with the frequency of drivers who tested positive for benzodiazepines alone decreased with age (OR, 0.903; 95% CI, 0.825–0.988; p = 0.034)

Summary

Introduction

Driving under the influence of alcohol, illicit drugs and certain medicines is not allowed worldwide. There is a proven relationship between the driving-impairing effects of these substances and involvement in road traffic accidents [2,3,4,5]. It has been shown that the greatest risk for a road traffic accident is related to the use of long half-life benzodiazepines and appears both during the first few weeks of use and when risk); driving under the influence of multiple substances (including alcohol) is a great concern [1]. Benzodiazepines, which are used in the treatment and control of various disorders such as anxiety, insomnia, panic attacks, epilepsy, muscle spasms and pre-surgical stress [7], are sometimes misused by patients (used longer than recommended or in combination with alcohol) and sometimes used illicitly (for recreational purposes or to minimize unwanted effects of other illicit substances) [8,9,10,11]. In the last decade, an increasing number of new nonmedical-use benzodiazepines, the so-called “designer benzodiazepines”, have been introduced into the recreational drug market [12]

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