title: Psychoactive substance use and the risk of motor vehicle accidents. The effects of dexamphetamine on simulated driving performance Examining the effect of dl-3,4-methylenedioxymethamphetamine (MDMA) and methamphetamine on the Standardized Field Sobriety Tests. The effect of d-methamphetamine on simulated driving performance.
abstract: The driving performance is easily impaired as a consequence of the use of alcohol and /or licit and illicit drugs . However , the role of drugs other than alcohol in motor vehicle accidents has not been well established . The objective of this study was to estimate the association between psychoactive drug use and motor vehicle accidents requiring hospitalisation . A prospect i ve observational case-control study was conducted in the Tilburg region of The Netherl and s from May 2000 to August 2001 . Cases were car or van drivers involved in road crashes needing hospitalisation . Demographic and trauma related data was collected from hospital and ambulance records . Urine and /or blood sample s were collected on admission . Controls were drivers recruited at r and om while driving on public roads . Sampling was conducted by research ers , in close collaboration with the Tilburg police , covering different days of the week and times of the day . Respondents were interviewed and asked for a urine sample . If no urine sample could be collected , a blood sample was requested . All blood and urine sample s were tested for alcohol and a number of licit and illicit drugs . The main outcome measures were odds ratios ( OR ) for injury crash associated with single or multiple use of several drugs by drivers . The risk for road trauma was increased for single use of benzodiazepines ( adjusted OR 5.1 ( 95 % Cl : 1.8 - 14.0 ) ) and alcohol ( blood alcohol concentrations of 0.50 - 0.79 g/l , adjusted OR 5.5 ( 95 % Cl : 1.3 - 23.2 ) and > or=0.8 g/l , adjusted OR 15.5 ( 95 % Cl : 7.1 - 33.9 ) ) . High relative risks were estimated for drivers using combinations of drugs ( adjusted OR 6.1 ( 95 % Cl : 2.6 - 14.1 ) ) and those using a combination of drugs and alcohol ( OR 112.2 ( 95 % Cl : 14.1 - 892 ) ) . Increased risks , although not statistically significantly , were assessed for drivers using amphetamines , cocaine , or opiates . No increased risk for road trauma was found for drivers exposed to cannabis . The study concludes that drug use , especially alcohol , benzodiazepines and multiple drug use and drug-alcohol combinations , among vehicle drivers increases the risk for a road trauma accident requiring hospitalisation Rationale The number of road fatalities related to the presence of amphetamines in drivers has been relatively constant over the past 10 years . However , there remains uncertainty as to the extent that these drugs induce driving impairment , and whether any such impairments translate to an increase in road fatalities . Objectives To examine the acute effects of 0.42 mg/kg dexamphetamine on simulated driving performance , and to establish which , if any , simulated driving abilities become impaired following dexamphetamine administration . Methods A repeated- measures , counter-balanced , double-blind , placebo-controlled design was employed . Twenty healthy volunteers completed two treatment conditions—0.42 mg/kg dexamphetamine and placebo . Performance was assessed using a driving simulator task .  Blood and saliva sample s were obtained prior to the driving tasks and immediately after task completion ( 120 min and 170 min post-drug administration , respectively ) . Results Mean dexamphetamine blood concentrations were 83 ng/ml and 98 ng/ml at 120 min and 170 min , respectively . Results indicated a decrease in overall simulated driving ability following dexamphetamine administration during the day-time but not the night-time scenario tasks . Contributing to this performance reduction , “ incorrect signalling ” , “ failing to stop at a red traffic light ” and “ slow reaction times ” were the behaviours most strongly affected by dexamphetamine . Conclusions The decrease in simulated driving ability observed during the day-time driving tasks are consistent with the perceptual narrowing or tunnel vision that is associated with dexamphetamine consumption dl-3,4-methylenedioxymethamphetamine ( MDMA ) and methamphetamine are commonly used illicit drugs that are thought to impair driving ability . The St and ardized Field Sobriety Tests ( SFSTs ) are utilized widely to detect impairment associated with drugs other than alcohol in drivers , although limited evidence concerning MDMA and methamphetamine consumption on SFST performance exists . The aim of this study was to evaluate whether the SFSTs were a sensitive measure for identifying the presence of the specific isomer d-methamphetamine and MDMA . In a double-blind , within-subject , counter-balanced and placebo-controlled study , 58 healthy and abstinent recreational drugs users were administered three treatments : 100 mg of MDMA , 0.42 mg/kg d-methamphetamine , and placebo . For each condition the SFSTs were administered at 4 and 25 h post treatment . d-methamphetamine was not found to significantly impair SFST performance unlike MDMA , which significantly impaired SFST performance in comparison to placebo with 22 % of the sample failing the test at the 4h testing time-point . No differences were observed at the 25 h testing time-point for any of the conditions . It was concluded that the SFSTs are not efficient in identifying the presence of low level d-methamphetamine , and are significantly better at detecting the presence of MDMA at the levels assessed OBJECTIVES Methamphetamine is considered to be one of the most popularly abused drugs by drivers ; however , its exact effect on driving and driving behaviour has yet to be thoroughly investigated . This being despite methamphetamine 's increased prevalence in injured and deceased drivers . METHODS Twenty healthy recreational illicit stimulant users ( 10 male and 10 female ) , aged between 21 and 32 years ( mean = 25.4 years , SD = 3.3 years ) attended two testing sessions involving oral consumption of 0.42 mg/kg d-methamphetamine or a matching placebo . The drug administration was counter-balanced , double-blind , and medically supervised . At each session driving , performance was assessed 2.5 h post drug administration . RESULTS d-methamphetamine ( 0.42 mg/kg ) did not significantly impair overall simulated driving performance 2.5 h post drug administration . At the individual driving variable level , participants in the d-methamphetamine condition were observed to be driving slower when an emergency situation occurred ( T = 44 , p < 0.05 ) , but interestingly , participants in both conditions recorded average speeds in excess of the speed limit ( 100 km/h ) when the emergency situations occurred . The d-methamphetamine condition did also produce four times more infringements where participants did not stop at red traffic light in comparison to the placebo , but this effect was only evident at a trend level ( T = 7 , p = 0.11 ) . CONCLUSIONS The findings presented herein suggest that d-methamphetamine administered at the levels supplied did not impair driving performance in a manner consistent with epidemiological evidence . Further research is certainly required to eluci date the effects of various doses of methamphetamine , alone and in combination with other legal and illicit substances
target: Best- evidence synthesis demonstrated a conflicting level of evidence for associations between the use of-amphetamine-type substances and the risk of sustaining an injury , and a moderate level of evidence between amphetamine use and the risk of death due to road trauma .
  This is the first review to synthesis e evidence regarding the association between amphetamine-type substance use and the risk of injury or death due to a road traffic accident .
  More conclusive evidence of death due to road trauma among amphetamine users may reflect significant and global deficits in functioning associated with effective vehicular control under the influence of this substance .
background: Amphetamine-type substances are frequently detected among drivers injured or killed due to road-trauma .
  However , the role of this substance in crash causation remains equivocal .
  We performed a systematic review to evaluate existing evidence regarding the association between amphetamine use and the risk of injury or death due to road traffic accidents .