Improved recovery of repeat intoxicated drivers using fingernails and blood spots to monitor alcohol and other substance abuse

Objectives: This study reports the results of a pilot program in Kenosha County that used a combination of direct biomarkers extracted from blood spots and nails to monitor repeat intoxicated drivers for their use of alcohol and drugs with a detection window spanning from 3 weeks to several months. The objectives were to test whether the direct biomarkers phosphatidylethanol (PEth), ethylglucuronide (EtG), and 5 drug metabolites would (1) help assessors obtain a more objective evaluation of repeat offenders during the assessment interview, (2) allow for timely identification of relapses and improve classification of drivers into risk categories, and (3) predict recidivism by identifying offenders most likely to obtain a subsequent operating while intoxicated (OWI) offense within 4 years of enrollment in the program.

Methods: All (N = 261) repeat offenders were tested using PEth obtained from blood spots and EtG obtained from fingernails; 159 participants were also tested for a 5 drugs of abuse nail panel. Drivers were tested immediately after the assessment interview (baseline) and at 3, 6, 9, and 12 months after baseline. Based on biomarker results and self-reports of abstinence, offenders were classified into different risk categories and required to follow specific testing timelines based on the program's decision tree.

Results: The baseline analysis shows that 60% of drivers tested positive for alcohol biomarkers (EtG, PEth, or both) at the assessment interview, with lower detection rates (0–11%) for the 5 drug metabolites. The comparison of biomarkers results to self-reports of abstinence identified 28% of all offenders as high risk and assigned them to more frequent testing and more intense monitoring. The longitudinal analysis shows that 56% (completers) of participants completed the program successfully and the remaining 44% (noncompliant) terminated prematurely. Two thirds (68%) of the completers were able to reduce or control their drinking and one third relapsed at least one time during their mandated monitoring periods. After a brief intervention by the assessors, 79% of relapsers tested negative for biomarkers in their repeat tests. The rearrest analysis showed that offenders classified in the noncompliant and relapsers groups were 7 times more likely to receive a new OWI 4 years after enrollment compared to drivers classified as abstainers or controllers. Refractory drivers were monitored the longest and reported no subsequent rearrests.

Conclusion: These findings demonstrate the benefits of more individualized interventions with repeat OWI offenders and calls for further development of multimodal approaches in traffic medicine including those that use direct alcohol biomarkers as evidence-based practices to reduce recidivism.     

Evaluating the Brazilian zero tolerance drinking and driving law: Time series analyses of traffic-related mortality in three major cities

Objective: A zero tolerance alcohol restriction law was adopted in Brazil in 2008. In order to assess the effectiveness of this intervention, the present study compares specific mortality in 2 time series: 1980–2007 and 2008–2013.

Methods: Data on mortality and population were gathered from official Brazilian Ministry of Health information systems. Segmented regression analyses were carried out separately for 3 major Brazilian capitals: Belo Horizonte, Rio de Janeiro, and São Paulo.

Results: In 2 cities (Belo Horizonte and Rio de Janeiro) there were no significant changes in mortality rate trends in 2 periods, 1980 to 2007 and 2008 to 2013, where the observed rates did not differ significantly from predicted rates. In São Paulo, a decreasing trend until 2007 unexpectedly assumed higher levels after implementation of the law.

Conclusion: There is no evidence of reduced traffic-related mortality in the 3 major Brazilian capitals 5.5 years after the zero tolerance drinking and driving law was adopted.     

Blood alcohol concentration in fatally injured drivers and the efficacy of alcohol policies of the new law on road traffic safety: A retrospective 10-year study in autonomous province of Vojvodina,Republic of Serbia

Objective: The aim of this study was primarily to evaluate inebriated fatally injured drivers (FIDs) according to blood alcohol concentration (BAC) in a 10-year period (2004–2013) in Autonomous Province (AP) of Vojvodina, Republic of Serbia, to analyze the efficacy of alcohol polices in the new law on road traffic safety through changes in the number of inebriated FIDs before and after implementation of the law, as well as to identify factors that influence the occurrence of FIDs with BACs above the legal limit.

Methods: All data for this retrospective study were obtained from the Centre of Forensic Medicine, Toxicology and Molecular Genetics of Clinical Centre of Vojvodina, Novi Sad. Autopsy records for each case included age, gender, BAC, type of vehicle, and date of accident (year, month, and recalculated day of the week). BAC was determined by gas chromatography with flame ionization detection. Statistical analysis was carried out by chi-square tests and Student's t test, with P < .05 as a statistical significance, and multiple binary logistic regression.

Results: Of the 354 inebriated FIDs (60% of all FIDs), the majority had BACs between of 0.031 and 0.3 mg/ml (28%), followed by those with BAC > 2.01 mg/ml (23%). The average BAC of those driving under the influence of alcohol (DUIA) for the whole period was 1.235 ± 1.00 mg/ml and the average number of DUIA/year was 35. Among the total number of FIDs there were significantly more males (93.7%; P < .001) than females (6.3%), though the distribution of intoxicated men and women was not different (P > .05). There was a statistically significant difference in the distribution of sober and inebriated FIDs according to age (P < .001) with the predominance of inebriated FIDs between 21 and 30 years. Although gender and age were found to be significant predictors of BAC above legal limit in FIDs, the area under the receiver operating characteristics (ROC) curve showed that the model had poor discrimination (ROC = 0.673). Of all observed FIDs, 65 cases per year were attributed to the first 5-year period (2004–2009) and 49 to the second 5-year (2010–2013) period, which indicates that there was no statistically significant decrease in the number of FIDs after implementation of the new law.

Conclusion: The highest number of intoxicated FIDs during the period in AP Vojvodina were mildly and completely inebriated. In the 4-year post-policy period (2010–2013), the number of FIDs and average BAC levels of inebriated FIDs did not significantly change. The abolition of a permissible BAC should be considered.     

The effectiveness of reducing illegal blood alcohol concentration (BAC) limits for driving: evidence for lowering the limit to .05 BAC

PURPOSE: This scientific review provides a summary of the evidence regarding the benefits of reducing the illegal blood alcohol concentration (BAC) limit for driving and providing a case for enacting a .05 BAC limit. RESULTS: Fourteen independent studies in the United States indicate that lowering the illegal BAC limit from .10 to .08 has resulted in 5-16% reductions in alcohol-related crashes, fatalities, or injuries. However, the illegal limit is .05 BAC in numerous countries around the world. Several studies indicate that lowering the illegal per se limit from .08 to .05 BAC also reduces alcohol-related fatalities. Laboratory studies indicate that impairment in critical driving functions begins at low BACs and that most subjects are significantly impaired at .05 BAC. The relative risk of being involved in a fatal crash as a driver is 4 to 10 times greater for drivers with BACs between .05 and .07 compared to drivers with .00 BACs. SUMMARY: There is strong evidence in the literature that lowering the BAC limit from .10 to .08 is effective, that lowering the BAC limit from .08 to .05 is effective, and that lowering the BAC limit for youth to .02 or lower is effective. These law changes serve as a general deterrent to drinking and driving and ultimately save lives. IMPACT ON INDUSTRY: This critical review supports the adoption of lower illegal BAC limits for driving.     

Effectiveness of lowering the blood alcohol concentration (BAC) limit for driving from 0.10 to 0.08 grams per deciliter in the United States

Objective: The current study evaluates of the effects of lowering the blood alcohol concentration (BAC) limit from 0.10 to 0.08?g/dL across all 50 states in the United States. Our objectives were to (1) estimate the effects of the 0.08?g/dL BAC limit on drinking driver fatal crash rates; (2) compare the effects from early-adopting states to the effects of late-adopting states; (3) determine the effects on drivers with low BACs (0.01–0.07?g/dL) and high BACs (0.08+ g/dL); and (4) estimate the lives saved since 1983 due to the adoption of 0.08?g/dL BAC laws.

Methods: Our study examined annual data from the Fatality Analysis Reporting System (FARS) for each jurisdiction from 1982 through 2014. Our basic outcome measure was the ratio of drinking drivers (BAC ≥0.01?g/dL) to nondrinking drivers (BAC?=?0.00?g/dL). Covariates included 0.10 BAC laws, administrative license revocation (ALR) laws, seat belt laws, minimum legal drinking age (MLDA) laws, and unemployment rates. We utilized autoregressive integrated moving average (ARIMA) models for each state, where the implementation date of the law was modeled as a zero-order transfer function in the series, in addition to any extant trends that may have been occurring simultaneously. Before determining the specific impact of the implementation of 0.08?g/dL BAC laws, we conducted a time series analysis for each state. We tested for between-state mediating factors relating to our covariates.

Results: A total of 38 of the 51 jurisdictions showed that lowering the BAC limit was associated with reduced drinking driver fatal crash ratios, with 20 of those reductions being significant. The total effects showed a 10.4% reduction in annual drinking driver fatal crash rates, which is estimated to have saved an average of 1,736 lives each year between 1983 and 2014 and 24,868 lives in total. Implementing a BAC limit of 0.08?g/dL had significant impacts on both high- and low-BAC fatal crash ratios. Though early-adopting jurisdictions (1983–1999) demonstrated a larger decrease in fatal drinking driver crash ratios than did late-adopting jurisdictions (2000–2005), the results were not statistically significant (P?>?.05).

Conclusions: Our study of the effects of lowering the BAC from 0.10 to 0.08?g/dL in the United States from 1982 to 2014 showed an overall effect of 10.4% on annual drinking driver fatal crash rates, in line with other multistate studies. This research provides strong evidence of the relationship between lowering the BAC limit for driving and the general deterrent effect on impaired-driving fatal crash rates.