Epidemiology and traffic safety: culpability studies

  • Olaf H. Drummer


Scientific proof that drugs capable of impairing skills required for safe driving has only come relatively recently, although the proof for ethanol (alcohol) came almost 40 years earlier. Instrumental in obtaining this evidence has been the use of culpability studies. These have provided an epidemiological basis to demonstrate an increased risk for use of amphetamine-type stimulants, cocaine and for those drivers showing recent use of cannabis through the presence of THC greater 5 ng/mL in blood. Significant increases in risk (through odd’s ratio analysis) using this form of study has not been demonstrated for opiates. Benzodiazepines has provided consistent increases in risk in this form of analysis mainly because they are usually associated with other drugs (including alcohol). However, alcohol-drug and impairing drug-drug combinations generally show a very high culpability rate and are usually higher than one impairing drug alone. Culpability studies complement case control and other types of epidemiological evidence that links, or attempts to link, recent drug use with a vehicular crash.


Crash Risk Vehicular Crash WKDQ WKRVH 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Borkenstein FR, Crowther RF, Shumate RP, Zeil WB, Zylman R (1974) The role of the drinking driver in traffic accidents. Blutalkohol 11Google Scholar
  2. 2.
    Terhune KW (1986) Problems and methods in studying drug crash effects. Alcohol, Drugs and Driving 2: 1–13Google Scholar
  3. 3.
    Terhune KW, Fell JC (1982) The role of alcohol, marijuana and other drugs in the accidents of injured drivers: Tech. Rep. under Contract No. DOT-HS-5-01179. Calspan Field Services Inc, Buffalo, New YorkGoogle Scholar
  4. 4.
    Robertson MD, Drummer OH (1994) Responsibility analysis: a methodology to study the effects of drugs in driving. Accid Anal Prev 26: 243–247PubMedCrossRefGoogle Scholar
  5. 5.
    Timby N, Sjogren H, Bjornstig U, Eriksson A (1998) Crash responsibility versus drug and alcohol use among fatally injured and hospitalized motor vehicle drivers in Sweden. Alcohol Clin Exp Res 22: 1838–1841PubMedGoogle Scholar
  6. 6.
    Crouch DJ, Birky MM, Gust SW, Rollins DE, Walsh JM, Moulden JV, Quinlan KE, Beckel RW (1993) The prevalence of drugs and alcohol in fatally injured truck drivers. J Forensic Sci 38: 1342–1353PubMedGoogle Scholar
  7. 7.
    Chipman ML, Macdonald S, Mann RE (2003) Being “at fault” in traffic crashes: does alcohol, cannabis, cocaine, or polydrug abuse make a difference? Inj Prev 9: 343–348PubMedCrossRefGoogle Scholar
  8. 8.
    Drummer OH, Gerostamoulos J, Chu M, Batziris H, Caplehorn JRN, Robertson MD (2004) The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes. Accident Analysis and Prevention 36: 239–248PubMedCrossRefGoogle Scholar
  9. 9.
    Drummer OH, Gerostamoulos J, Batziris H, Chu M, Caplehorn J, Robertson MD, Swann P (2004) The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes. Accident Analysis & Prevention 36: 239–248CrossRefGoogle Scholar
  10. 10.
    Soderstrom CA, Dischinger PC, Kufera JA, Ho SM, Shepard A (2005) Crash culpability relative to age and sex for injured drivers using alcohol, marijuana or cocaine. Annu Proc Assoc Adv Automot Med 49: 327–341PubMedGoogle Scholar
  11. 11.
    Terhune KW, Ippolito CA, Hendricks DL, Michalovic JG, Bogema SC, Santinga P, Blomber R, Preusser DF (1992) The incidence and role of drugs in fatally injured drivers. US Department of Transportation, National Highway Traffic Safety Administration, WashingtonGoogle Scholar
  12. 12.
    Longo MC, Hunter CE, Lokan RJ, White JM, White MA (2000) The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability: part ii: the relationship between drug prevalence and drug concentration, and driver culpability. Accid Anal Prev 32: 623–632.PubMedCrossRefGoogle Scholar
  13. 13.
    Lowenstein SR, Koziol-Mclain J (2001) Drugs and traffic crash responsibility: a study of injured motorists in Colorado. J Trauma 50: 313–320PubMedCrossRefGoogle Scholar
  14. 14.
    Soderstrom CA, Birschbach JM, Dischinger PC (1990) Injured drivers and alcohol use: culpability, convictions, and pre-and post-crash driving history. J Trauma 30: 1208–1213; discussion 1213–1214PubMedCrossRefGoogle Scholar
  15. 15.
    Kufera JMA, Soderstrom CMD, Dischinger PCPD, Ho SMS, Shepard AMD (2006) Crash Culpability And The Role Of Driver Blood Alcohol Levels. Annu Proc Assoc Adv Automot Med 50: 87–102Google Scholar
  16. 16.
    Maio RF, Waller PF, Blow FC, Hill EM, Singer KM (1997) Alcohol abuse/dependence in motor vehicle crash victims presenting to the emergency department. Acad Emerg Med 4: 256–262PubMedCrossRefGoogle Scholar
  17. 17.
    McLaughlin JG, Smith RJ, Mattice CR, Scholten DJ (1993) Hospitalization and injury influence on the prosecution of drunk drivers. Am Surg 59: 484–488; discussion 488–489PubMedGoogle Scholar
  18. 18.
    Williams AF, Peat MA, Crouch DJ, Wells JK, Finkle BS (1985) Drugs in fatally injured young male drivers. Public Health Rep 100: 19–25PubMedGoogle Scholar
  19. 19.
    Logan BK (2002) Methamphetamine — effects on human performance and behavior. Forensic Sci Reviews 14: 133–151Google Scholar
  20. 20.
    Drummer OH, Odell M (2001) The forensic pharmacology of drugs of abuse. Arnold, LondonGoogle Scholar
  21. 21.
    Lamers CT, Ramaekers JG, Muntjewerff ND, Sikkema KL, Samyn N, Read NL, Brookhuis KA, Riedel WJ (2003) Dissociable effects of a single dose of ecstasy (MDMA) on psychomotor skills and attentional performance. J Psychopharmacol 17: 379–387PubMedCrossRefGoogle Scholar
  22. 22.
    Laumon B, Gadegbeku B, Martin JL, Biecheler MB (2005) Cannabis intoxication and fatal road crashes in France: population based case-control study. Bmj. 331: 1371. Epub 2005 Dec 1371.PubMedCrossRefGoogle Scholar
  23. 23.
    Logan BK (1996) Methamphetamine and driving impairment. J Forensic Sci 41: 457–464PubMedGoogle Scholar
  24. 24.
    Logan BK (2002) Methamphetamine — effects on human performance and behavior. Forensic Science Reviews 14: 133–151Google Scholar
  25. 25.
    Smart RG, Schmidt W, Bateman K (1969) Psychoactive drugs and traffic accidents. Journal of Safety Research 1: 67–72Google Scholar
  26. 26.
    NHTSA (1992) The incidence and role of drugs in fatally injured drivers. National Highway Traffic Safety AdministrationGoogle Scholar
  27. 27.
    (1993) Are benzodiazepines a risk factor for road accidents? “Benzodiazepine/Driving” Collaborative Group. Drug Alcohol Depend 33: 19–22CrossRefGoogle Scholar
  28. 28.
    Barbone F, McMahon AD, Davey PG, Morris AD, Reid IC, McDevitt DG, MacDonald TM (1998) Association of road-traffic accidents with benzodiazepine use. Lancet 352: 1331–1336PubMedCrossRefGoogle Scholar
  29. 29.
    Jick H, Hunter JR, Dinan BJ, Masen S, Stergachis A (1981) Sedating drugs and automobile accidents leading to hospitalization. American Journal of Public Health 71: 1399–1400PubMedCrossRefGoogle Scholar
  30. 30.
    Leveille SG, Buchner DM, Koepsell TD, McCloskey LW, Wolf ME, Wagner EH (1994) Psychoactive medications and injurious motor vehicle collisions involving older drivers. Epidemiology 5: 591–598PubMedCrossRefGoogle Scholar
  31. 31.
    Honkanen R, Ertama L, Linnoila M, Alha A, Lukkari I, Karlsson M, Kiviluoto O, Puro M (1980) Role of drugs in traffic accidents. Br Med J 281: 1309–1312PubMedCrossRefGoogle Scholar
  32. 32.
    Skegg DCG, Ricards SM, Doll R (1979) Minor tranquilizers and road accidents. British Medical Journal 1: 917–919PubMedCrossRefGoogle Scholar
  33. 33.
    Ray WA, Fought RL, Decker MD (1992) Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. Am J Epidemiol 136: 873–883PubMedCrossRefGoogle Scholar
  34. 34.
    Neutel CI (1995) Risk of traffic accident injury after a prescription for a benzodiazepine. Ann Epidemiol 5: 239–244PubMedCrossRefGoogle Scholar
  35. 35.
    Huestis M (2001) Marijuana: — Efects on human performance and behavior. Forensic Sci Reviews 14: 15–60Google Scholar
  36. 36.
    Drummer OH (2007) Pharmacology and toxicology. In: M Burns (ed): Medical-legal aspects of drugs. Lawyers & Judges Publishing co., Tucson, AZ, 13–22Google Scholar
  37. 37.
    Huestis MA (2002) Cannabis (marijuana) — Effects on human performance and behavior. Forensic Science Reviews 14: 15–60Google Scholar
  38. 38.
    Drummer OH (1994) Drugs in drivers killed in Australian road traffic accidents. Monash University Department of Forensic Medicine, MelbourneGoogle Scholar
  39. 39.
    Ramaekers JG, Berghaus G, van Laar M, Drummer OH (2004) Dose related risk of motor vehicle crashes after cannabis use. Drug and Alcohol Dependence 73: 109–119PubMedCrossRefGoogle Scholar
  40. 40.
    Longo MC, Hunter CE, Lokan RJ, White JM, White MA (2000) The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability: Part I: the prevalence of drug use in drivers, and characteristics of the drug-positive group. Accident Analysis & Prevention 32: 613–622CrossRefGoogle Scholar
  41. 41.
    Grotenhermen F, Leson G, Berghaus G, Drummer OH, Kruger HP, Longo M, Moskowitz H, Perrine B, Ramaekers JG, Smiley A et al (2007) Developing limits for driving under cannabis. Addiction 102: 1910–1917PubMedCrossRefGoogle Scholar
  42. 42.
    Bédard M, Dubois S, Weaver B (2007) The impact of cannabis on driving. Can J Public Health 98: 6–11PubMedGoogle Scholar
  43. 43.
    Longo MC, Lokan RJ, White JM (2001) The relationship between blood benzodiazepine concentration and vehicle crash culpability. J Traffic Med 29: 36–43Google Scholar
  44. 44.
    Isenschmid DS (2002) Cocaine — Effects on human performance and behavior. Forensic Sci Review 14: 61–100Google Scholar
  45. 45.
    Dussault C, Brault M, Lemire AM, Bouchard J (2001) The role of cocaine in fatal crashes: First results of the Quebec drug study: 45th Annual meeting of the Association for the Advancement of Automotive Medicine Google Scholar
  46. 46.
    Mura P, Kintz P, Ludes B, Gaulier JM, Marquet P, Martin-Dupont S, Vincent F, Kaddour A, Goulle JP, Nouveau J et al (2003) Comparison of the prevalence of alcohol, cannabis and other drugs between 900 injured drivers and 900 control subjects: results of a French collaborative study. Forensic Sci Int 133: 79–85PubMedCrossRefGoogle Scholar
  47. 47.
    Movig KLL, Mathijssen MPM, Nagel PHA, van Egmond T, de Gier JJ, Leufkens HGM, Egberts ACG (2004) Psychoactive substance use and the risk of motor vehicle accidents. Accident Analysis & Prevention 36: 631–636CrossRefGoogle Scholar
  48. 48.
    Drummer OH, Gerostamoulos J, Batziris H, Chu M, Caplehorn JRM, Robertson MD, Swann P (2003) The incidence of drugs in drivers killed in Australian road traffic crashes. Forensic Science International 134: 154–162PubMedCrossRefGoogle Scholar

Copyright information

© Birkhäuser Verlag/Switzerland 2009

Authors and Affiliations

  • Olaf H. Drummer
    • 1
  1. 1.Victorian Institute of Forensic Medicine, Department of Forensic MedicineMonash UniversitySouthbank 3006Australia

Personalised recommendations