Median Blood Alcohol Concentration Research Articles

Drugs and violent death: comparative toxicology of homicide and non‐substance toxicity suicide victims

To determine the comparative toxicology of death by homicide and suicide by means other than substance toxicity. Cross-sectional (autopsy reports). Sydney, Australia. A total of 1723 cases of violent death were identified, comprising 478 homicide (HOM) cases and 1245 non-substance toxicity suicide (SUI) cases. Substances were detected in 65.5% of cases, and multiple substances in 25.8%, with no group differences. Illicit drugs were detected in 23.9% of cases, and multiple illicit in 5.3%. HOM cases were significantly more likely to have an illicit drug [odds ratio (OR) 2.09] and multiple illicits (OR 2.94), detected, HOM cases being more likely to have cannabis (OR 2.39), opioids (OR 1.53) and psychostimulants (OR 1.59) present. HOM cases were, however, significantly less likely to have benzodiazepines (OR 0.53), antidepressants (OR 0.22) and antipsychotics (OR 0.23) present. Alcohol was present in 39.6% of cases (median blood alcohol concentration = 0.12), with no group difference in prevalence. The role drugs play in premature death extends far beyond overdose and disease, with illicit drugs associated strongly with homicide.

Alcohol Use and Its Role in Female Homicides in the Western Cape, South Africa

Levels of alcohol use are high in South Africa and not much is known about women's use of alcohol when murdered. The aim of this article is to describe the patterns of blood alcohol concentration (BAC) at the time of death for female homicide victims and to explore the factors associated with having an elevated BAC. A subsample of a national, representative, retrospective mortuary-based study of female homicides ages 14 years and older was analyzed. Data were gathered from medical legal laboratory records, autopsy reports, and police interviews from 153 cases at sampled mortuaries in the Western Cape Province of South Africa in 1999. Sixty-two percent of women who were murdered had a high BAC at the time of their death, with an overall median BAC of .11% (110 mg/100 ml). A quantile regression analysis showed that a raised median BAC at the time of death was positively associated with the victim's age; being unemployed or not known to be employed; and being killed in a rural setting, in a public space, and on a weekend. Significant interactions between type of homicide and employment showed a modification in median BACs for unemployed victims killed by intimate partners compared with employed victims, with a median difference of .19% (190 mg/100 ml) (95% confidence interval: .14%-.23% [140-230 mg/100 ml]). This study highlights the public health impact of excessive alcohol consumption and the need for a comprehensive approach to reduce the harmful effects of drinking.

Age and gender differences in blood-alcohol concentration in apprehended drivers in relation to the amounts of alcohol consumed

This article reports the age, gender, and blood-alcohol concentration (BAC) of people apprehended in Sweden for driving under the influence of alcohol (DUIA) over an 8-year period (2000–2007). Duplicate determinations of ethanol were made in venous blood by headspace gas chromatography and results were reported positive at a cut-off concentration of 0.1 g/L (10 mg/100 ml or 0.01 g%). The mean, median and highest BAC was 1.74 g/L, 1.70 g/L and 5.18 g/L, respectively. The vast majority of offenders were men (89.5%) with a mean age of 39.0 ± 14.6 y (±SD). The women (10.5%) were a few years older 41.8 ± 13.6 y ( p < 0.001). The mean BAC in the men (1.73 ± 0.85 g/L) did not differ significantly ( p > 0.05) from women (1.77 ± 0.87 g/L). The youngest offenders aged 15–20 y ( N = 3513) had a mean BAC of 1.30 ± 0.60 g/L (median 1.32), which was significantly less ( p < 0.001) than people aged 40–50 y ( N = 6644); mean 1.90 g/L (median 2.0 g/L). In 95 individuals (89 men and 6 women) the BAC exceeded 4.0 g/L, which is a level considered to cause death by acute alcohol poisoning. The Widmark formula was used to calculate that a man (80 kg) with a BAC of 1.7 g/L has 95 g ethanol (∼12 units of alcohol) in the body compared with 61 g (∼8 units) for a woman (60 kg). This study verifies that the average drunken driver in Sweden is typically a binge drinker and education programs and treatment for alcohol-use disorder might be a more appropriate sanction than the more conventional penalties for alcohol-impaired driving.

Blood Alcohol Concentrations in Apprehended Drivers of Cars and Boats Suspected to Be Impaired by the Police

Objective. According to the Norwegian Road Traffic Act, car drivers are not allowed to operate a vehicle with a blood alcohol concentration (BAC) above 0.2 g/kg. Depending on the size of the boat or ship, boat drivers/captains/first mates are not allowed to conduct the boat with a BAC above 0.8 g/kg when driving small boats (length less than 15 m) and above 1.5 g/kg when running larger vessels/ships. The new Sea Act of June 2005 states that captains/first mates cannot conduct a ship if he/she has a BAC above 0.2 g/kg. Our aim was to determine the current median BAC in a large population of car and boat drivers in Norway. Our other aim was to study if median BAC was higher in boat drivers than in car drivers who were suspected by the police to be impaired. Furthermore, we wanted to investigate if the BAC levels were differently distributed by gender or age within and between these two groups. Methods. The Norwegian Institute of Public Health analyzes blood samples from all car/boat drivers suspected of driving under the influence of alcohol and non-alcoholic drugs. In the present study, samples submitted between 01.05 and 01.09 in 2002–2004 were included. Drivers, who in addition tested positive for drugs or abuse substances other than ethanol were excluded. Results. There were 321 boat drivers and 3,061 car drivers who were suspected to be under the influence of ethanol only. The median BAC in boat drivers (1.76 g/kg [range 0.02–3.54]) was significantly higher compared to that in car drivers (1.54 g/kg [range 0.00–4.27]). In the car driver group, the mean BAC did not differ significantly between men and women. The median level of BAC was significantly higher in men than in women in the boat driver group (1.77 g/kg with CI 1.69–1.85 vs. 1.27 g/kg with CI 0.78–1.76). Conclusions. Alcohol impairment of car drivers is known to be considered the most important contributing cause of car crash injuries. Driving a boat may demand the same degree of performance skills as driving a car. The median BAC in apprehended boat drivers was considerably high in the present study. The median BAC was also high in car drivers despite strict legislation. The population of drivers of cars in our study, however, is from previous studies known to contain a large proportion of heavy drinkers. Less is known about the drinking habits in boat drivers, and caution is needed in generalizing from our results. However, our results indicate the possible need for stricter legislation and more frequent police control that will hopefully prevent serious accidents caused by ethanol drinking at sea.

High re-arrest rates among drug-impaired drivers despite zero-tolerance legislation

Background A zero-tolerance law for driving under the influence of drugs (DUID) in Sweden led to a 10-fold increase in the number of cases submitted by the police for toxicological analysis. The statutory blood–alcohol concentration (BAC) limit for driving is 0.2 mg/g (∼0.02 g%). Methods An in-house database (TOXBASE) was used to investigate re-arrests for impaired driving over 4 years (2001–2004), which comprised 36,799 cases. The age, gender, re-arrest rate of the offenders and the concentrations of ethanol and amphetamine in blood samples were evaluated. Results We found that 44% of individuals ( N = 16,277) re-offended 3.2 times on average (range 1–23 arrests). Between 85 and 89% of first-time offenders were men and there was also a male dominance among the recidivists (88–93%). The mean age of drunken drivers was ∼40 years compared with ∼35 years for driving under the influence of amphetamine, which was the drug identified in 50–60% of DUID cases, either alone or together with other licit or illicit drugs. The median BAC was 1.5 mg/g (∼0.15 g%), which suggests a dominance of heavy drinkers. The median BAC was even higher in recidivists (1.6–1.7 mg/g). The median concentration of amphetamine in blood was 1.0 mg/L in recidivists compared with 0.5 mg/L in the first-time offenders. About 14% of drunken drivers re-offended 1–10 times compared with 68% of DUID suspects, who were re-arrested 1–23 times. People with only a scheduled prescription drug in blood were re-arrested much less frequently (∼17%) compared with those taking illicit drugs (68%). Conclusions The appreciable increase in number of arrests for DUID after a zero-tolerance law might reflect a heightened enthusiasm by the police authorities armed with knowledge that a prosecution is easier to obtain. Zero-tolerance laws do not deter people from impaired driving judging by the high re-arrest rates. During the sentencing of hardcore offenders, the courts should give more consideration to the underlying substance abuse problem.

Newer antidepressants: evaluation of fatal toxicity index and interaction with alcohol based on Finnish postmortem data

Finnish postmortem toxicology data from 1995 to 2002 was analyzed to obtain improved estimates of fatal toxicity indices for the newer antidepressants and to evaluate their interaction with alcohol. Altogether 284 fatal poisonings were attributed to 12 different newer antidepressants. Venlafaxine, mianserin, moclobemide, and mirtazapine were responsible for significantly more deaths than expected from their sales. Their fatal toxicity indices were higher than those of selective serotonin reuptake inhibitors (SSRIs) but lower than those of tricyclic antidepressants. In fatal poisonings involving alcohol in combination with venlafaxine, mianserin, moclobemide, or mirtazapine, the median blood alcohol concentration (BAC) ranged from 2.35 to 2.7 mg/g, whereas in those involving alcohol in combination with citalopram or fluoxetine the median BAC was 2.9 and 3.4 mg/g, respectively. The BAC was significantly lower in venlafaxine-related deaths than in those involving fluoxetine or citalopram. We conclude that among the newer antidepressants differences are present both in toxicity and in interaction potential with alcohol. The SSRIs appear to present a low risk of fatal poisoning when taken alone or in combination with alcohol, whereas venlafaxine is associated with an elevated risk.

Alcohol and drugs in drivers fatally injured in traffic accidents in Sweden during the years 2000–2002

During the years 2000–2002, alcohol, pharmaceuticals and illicit drugs were analysed in blood samples from fatally injured drivers in Sweden. The total number of drivers was 920 and in 855 of these, corresponding to 93%, a toxicological investigation was performed. About 85% of the drivers were men and 15% were women. All but three women (96%) were car drivers while the corresponding figure for men was about 78% and about 13% were motorcyclists. The number of positive cases increased from 38.9% in year 2000 to 45.9% in year 2002 and alcohol was the most common drug with frequencies of 19.8%, 25.0% and 21.8% for the studied years 2000, 2001 and 2002, respectively. The median blood alcohol concentration ranged from 1.6 to 2.0 mg/mL for men and from 1.2 to 1.8 mg/mL for women. There was a decrease in cases where alcohol was the only drug detected, from 52 out of 58 cases (90%) in year 2000 to 41 out of 61 cases (67%) in 2002. At the same time there was an increase, from 5.4% to 10.0% of illicit drugs, mainly amphetamine, and the cases with multiple drug intake increased from 10% to 26%. The prevalence of pharmaceuticals as the only drug or drugs detected decreased from 14.0% to 10.4% and in the majority of these cases the drug concentrations were within the therapeutic range.

Interaction of alcohol and drugs in fatal poisonings.

In Finnish data from 1995-2000, 1006 fatal poisonings due to alcohol (ethanol), a single drug or both were statistically analysed in retrospect to evaluate the interaction between alcohol and drugs. In 53% of these cases, low concentrations of some common benzodiazepines were present. The median postmortem blood alcohol concentration (BAC) was 3.3 percent per thousand (w/w) in the 615 alcohol poisonings, but significantly lower, ranging from 1.3 to 1.7 percent per thousand, when promazine, doxepin, amitriptyline or propoxyphene were found together with alcohol. When levomepromazine, temazepam or zopiclone were present, the median BAC was also significantly lower, 2.5-2.7 percent per thousand. Citalopram and diltiazem did not exhibit a significant effect. The median BAC was significantly lower in cases with high concentrations than in those with low concentrations of a drug (excluding citalopram), suggesting a positive concentration-effect relationship. Fatal toxicity indices (FTIs) were calculated by relating the number of deaths caused by a drug to the corresponding sales figures. Promazine had an extremely high FTI, followed by levomepromazine, propoxyphene, doxepin and amitriptyline. The other drugs had relatively low FTIs. The results reflect not only the acute toxicity of a given drug-alcohol combination but also the manners of use and abuse of these drugs.

Alcohol education in licensed premises using brief intervention strategies.

The aim of this feasibility study is to present a description of a new approach based on alcohol brief intervention strategies to intervene with at-risk drinkers in licensed premises. The data presented are from a convenience sample of tavern patrons. The intervention called Operation Drinksafe was conducted on 75 occasions in 67 licensed premises in an Australian rural area. There were 2761 voluntary participants who were provided with a personal risk assessment of their alcohol use. The main measurements were the Alcohol Use Disorders Identification Test (AUDIT) combined with a blood alcohol concentration (BAC) reading. The median AUDIT score was 11.0, with 53% scoring in the hazardous range and 25% in the harmful range. For binge drinking, almost two-thirds (62%) of males drank six or more drinks once a week or more compared to 29% of females. Median BAC was 0.03 mg/100 ml with 11% of males above 0.10. Regression analysis revealed that significant predictors of alcohol-related injury were being aged less than 30 years, forgetting the previous night, having had another person express concern about your drinking, and binge drinking weekly or more. The program had high acceptance among licensees and their patrons. Patrons who are ready to change their at-risk drinking behaviour may benefit from this type of minimal intervention when presented in an interesting way in their drinking environments.

P.1.005 Trazodone and priapism

Using a forensic toxicology database (TOXBASE), the toxicological results from 10 years of forensic blood samples from people arrested for driving under the influence of alcohol and/or other drugs were reviewed.Alcohol was the only drug identified in blood in N = 35,704 cases at a median blood-alcohol concentration (BAC) of 1.63 mg/g. The mean age (± SD) of these offenders was 40 ± 15 years and 89% were male. The median BAC was lower (1.30 mg/g) in drivers who had consumed alcohol and used a prescription drug before driving (N = 1,251). The mean age of this group of traffic offenders was 38 ± 13 years and 85% were male. Both the median BAC (0.97 mg/g) and the mean age were lowest (36 ± 11 years, 92% male) in N = 3,153 drivers who had consumed alcohol and used illicit drugs before driving. Cannabis, amphetamine, cocaine and morphine (metabolite of heroin) were the commonest illicit drugs identified in blood samples. Sedative-hypnotics (benzodiazepines) were the major prescription drugs co-ingested with alcohol. Poly-drug use was a common finding in these traffic delinquents, although individuals who only drank alcohol had a higher median BAC and were also several years older than drinking drivers combining alcohol with other drugs before driving.Zero-tolerance legislation did not deter hard-core offenders. In future there should be more focus on treatment for alcohol and substance abuse disorder rather than conventional punishments for this type of traffic crime.

Ethanol Pharmacodynamics at Low Blood Concentrations.

Ranitidine has been shown to produce increases in blood alcohol concentration (BAC) after low doses of alcohol. The objective of this study was to reproduce, in a controlled setting, the BACs seen after low oral doses of ethanol in the presence and absence of ranitidine and to assess the effect of these concentrations on cognitive performance. An active control group (0.45 g per kg alcohol) was included as a validation of the methodology used. A randomized, double-blind, placebo-controlled, four-way crossover study was performed in eight healthy males. Subjects received a 20-min intravenous infusion of 0.10, 0.15, or 0.45 g per kg alcohol or placebo. Blood samples were obtained to measure BAC and psychometric effects were assessed over 8 h. A pharmacokinetic model was used to fit simultaneously the BAC--time profiles of all three doses for each subject. Cognitive improvement was assessed using digit symbol substitution, continuous tracking, and divided attention tests. Analysis of variance was conducted in order to compare peak blood alcohol impairment (E(max)) and area under the alcohol impairment--time curve (AUEC) across treatments. Observed median peak BAC (C(max)) for 0.10- and 0.15-g/kg dose groups (median BACs 15.2 and 27 mg/dl, respectively) were very similar to the target C(max) (13 and 26 mg/dl). Analysis of variance of AUEC and E(max) showed difference in impairment measures after the 0.10- and 0.15-g/kg doses. A significant difference in impairment measures between placebo and the active control, 0.45 g/kg (median BAC of 110 mg/dl) was observed, indicating that the methodology was capable of detecting significant psychomotor effects at the legal limit of BAC. Results indicated that the BAC increments from 15 to 27 mg/dl are not associated with significantly impaired performance and, hence, it is unlikely that increases in BAC of this magnitude, such as those caused by ranitidine therapy, are of any clinical relevance.

The role of alcohol in work-related fatal accidents in Australia 1982-1984.

This paper describes the role of detectable blood alcohol in fatal work injuries. An attempt was made to identify all work-related fatalities that occurred throughout Australia in the period 1982-1984. A research team examined coroners' records and classified 1737 fatal injury cases as being work-related according to study definitions. The following were also extracted from data in coroners' records: (i) whether or not the description of the fatal event indicated that inebriation was likely to have been a factor; (ii) whether or not there was documentation of blood alcohol concentration (BAC), and if so, what it was. The likelihood of inebriation was assessed without knowledge of the victim's BAC. In 1030 (59 per cent) of the 1737 fatal work injury cases, a BAC determination was documented. Zero levels were detected in 867 fatalities (84 per cent), and 163 cases (16 per cent) had non-zero BAC. In the latter group the median BAC was 104 mg%. Sixty-five per cent of measurable BAC cases had BAC greater than 50 mg%. Fatality risk in the non-zero BAC group relative to that of the zero BAC group was elevated for the following factors: marital status--single (risk ratio (RR) = 1.7, 95 per cent confidence interval (CI) 1.1-2.8) or separated/divorced (RR = 2.4, CI 1.5-3.8); occupation as manager, executive or administrator (RR = 2.5, CI 1.5-5.8); and commuting (RR = 1.6, CI 1.2-2.0).(ABSTRACT TRUNCATED AT 250 WORDS)

Incorrect Units of Measurement.

—In the article entitled "Pedestrian and Hypothermia Deaths Among Native Americans in New Mexico: Between Bar and Home," published in the March 11, 1992, issue ofTHE JOURNAL(1992;267:1345-1348), the units of measurement for blood alcohol concentrations reported are incorrect. On page 1345 in the "Results" section of the abstract, the third sentence should read as follows: "At death, 90% of those Native Americans tested were highly intoxicated (median blood alcohol concentrations of 0.24 and 0.18 g/dL [not 0.24 and 0.18 mg/dL] for pedestrian and hypothermia deaths, respectively)." On page 1346 in the "Results" section, the fourth and fifth sentences of the fourth paragraph should read as follows: "Of those tested, alcohol was present in 229 (91%) of the pedestrians, with a median blood alcohol concentration of 0.24 g/dL [not 0.24 mg/dL] (range, 0.10 to 0.71 g/dL) [not 0.10 to 0.71 mg/dL]. Similarly, alcohol was present in 120 (90%) of

Effects of alcohol intoxication on the initial assessment of trauma patients

To evaluate the influence of alcohol intoxication on the initial assessment and treatment of trauma patients. A prospective study of 2,237 trauma patients 18 years of age or older admitted to a Level I trauma center over a 19-month period. The study population was primarily male (78%) and white (73%) and had sustained blunt trauma (79%). One thousand fifty-three patients (47.1%) had positive blood alcohol concentration (BAC); median BAC in patients with any detectable alcohol was 179 mg/dL. When stratified by injury severity categories and compared with nonintoxicated (BAC less than 100 mg/dL) patients, intoxicated patients with an Injury Severity Score (ISS) of 1 to 15 were more likely to undergo the following: field and/or ED intubation (relative risk [RR], 2.22; 95% confidence interval [CI], 1.7 to 2.7); diagnostic peritoneal lavage (RR, 1.83; CI, 1.43 to 2.3); head computed tomography scanning (RR, 1.18; CI, 1.0 to 1.4); and intracranial pressure monitoring (RR, 1.41; CI, 0.74 to 2.7). The effects were less pronounced for those patients with an ISS of more than 15, except for intracranial pressure monitoring where patients with an ISS of more than 15 were 47% more likely to have intracranial pressure monitoring if intoxicated (RR, 1.47; CI, 1.2 to 1.9). Acute intoxication appears to alter the initial assessment of injury severity, resulting in an increased use of invasive diagnostic and therapeutic procedures.

Driving-Impaired Patients Leaving the Emergency Department

We evaluated the frequency with which blood alcohol concentrations were obtained in emergency department patients with presumed alcohol impairment, whether physicians counseled impaired patients not to drive, and whether safe transportation was available. Retrospective chart review and search of the North Carolina Driver History file. Emergency departments of a university and affiliated Veterans Affairs Medical Center (VAMC). Consecutive adult patients at the university (n = 1554) and VAMC (n = 1461) emergency departments. Patients with presumed alcohol-induced impairment (university, 75; VAMC, 88) who did not require hospital admission were identified. Presumed alcohol-induced impairment was defined by any of the following: nurse or physician note specifying the patient was intoxicated; indication in the medical record that the patient had alcohol on their breath; claim by the patient of alcohol use the day of evaluation; or measurement of blood alcohol concentration. Blood alcohol concentrations were measured in 80% of presumed alcohol-impaired university patients (median blood alcohol concentration, 45 mmol/L) and 68% of VAMC patients (median blood alcohol concentration, 58 mmol/L). Driving skills deteriorate with blood alcohol concentrations of 11 mmol/L or greater; however, 63% of university and 88% of VAMC patients with measured blood alcohol concentrations of 11 mmol/L or greater were still impaired when discharged. Only 3.5% of university and 8.7% of VAMC patients impaired at discharge were advised not to drive, whereas 31% of university and 20% of VAMC patients impaired at discharge were supervised by a responsible person. The prevalence of previous driving-while-impaired convictions was high (university, 34%; VAMC, 58%). Presumed alcohol-impaired patients seen in emergency departments frequently have blood alcohol concentrations measured. Despite documented evidence of driving impairment there is little evidence that such patients are counseled not to drive or that safe transportation home is available.

Adaptive changes in cerebral blood flow and oxygen consumption during ethanol intoxication in the rat..

Cerebral blood flow (CBF) and oxygen consumption (CMRO2) were measured during acute and long-term ethanol intoxication in the rat. The purpose was to investigate whether the adaptive changes (development of tolerance) occurring in the CNS during ethanol intoxication were associated with changes in CBF and/or CMRO2. Consistent with other studies we found that acute severe ethanol intoxication (median blood alcohol concentration (BAC = 5.4 mg/ml)) caused a significant decrease in CBF and CMRO2. After 3-4 days of severe intoxication (BAC of 6.6 mg/ml) these physiological variables were less affected indicating that functional tolerance had developed: CMRO2 and CBF during acute ethanol intoxication were 9.3 ml/100 g/min and 60 ml/100 g/min respectively; after the long term intoxication period these variables reached 11.2 ml/100 g/min and 78 ml/100 g/min respectively, i.e. values not significantly lower than those of the control group. After induction of hypercapnia (PaCO2 about 80 mmHg) CBF increased by 360% in the control group; in the acutely intoxicated group CBF increased by only 127% and in the long term intoxicated group by 203% indicating that the cerebrovascular CO2-reactivity had also adapted to the ethanol intoxication. It is concluded that adaptive changes of the CNS to chronic ethanol intoxication comprise alterations in CMRO2, CBF and cerebrovascular reactivity.