Fierro Inmaculada, Colás Mónica, González-Luque Juan Carlos, Álvarez F Javier
Institute for Alcohol and Drug Studies, Pharmacology and Therapeutics, Faculty of Medicine, & CEIC/CEIm Hospital Clinico Universitario de Valladolid, 47005, Valladolid, Spain.
Directorate General for Traffic (Dirección General de Tráfico), 28071, Madrid, Spain.
Subst Abuse Treat Prev Policy. 2017 May 10;12(1):22. doi: 10.1186/s13011-017-0108-3.
Opioids can impair psychomotor performance, and driving under the influence of opioids is associated with an increased risk of accidents. The goals of this study were i) to determine the prevalence of opioids (heroin, morphine, codeine, methadone and tramadol) in Spanish drivers and ii) to explore the presence of opioids, more specifically whether they are used alone or in combination with other drugs.
The 2008/9 DRUID database regarding Spain was used, which provided information on 3302 drivers. All drivers included in the study provided a saliva sample and mass-chromatographic analyses were carried out in all cases. To determine the prevalence, the sample was weighted according to traffic intensity. In the case of opioid use combinations, the sample was not weighted. The detection limit for each substance was considered a positive result.
The prevalence of opioids in Spanish drivers was 1.8% (95% CI, 1.4-2.3). Polydrug detection was common (56.2%): of these, in two out of three cases, two opioids were detected and cocaine was also detected in 86% of the cases. The concentration (median [Q1-Q3] ng/ml) of the substances was low: methadone 1.71 [0.10-15.30], codeine 40.55 [2.10-120.77], 6-acetylmorphine 5.71 [1.53-84.05], and morphine 37.40 [2.84-200.00]. Morphine was always detected with 6-acetylmorphine (heroin use).
Driving under the influence of opioids is relatively infrequent, but polydrug use is common. Our study shows that 6 out of 10 drivers with methadone in their OF (likely in methadone maintenance programs) are using other substances. This should be taken into account by health professionals in order to properly inform patients about the added risks of mixing substances when driving.
阿片类药物会损害精神运动表现，在阿片类药物影响下驾驶会增加事故风险。本研究的目的是：i）确定西班牙驾驶员中阿片类药物（海洛因、吗啡、可待因、美沙酮和曲马多）的流行率；ii）探究阿片类药物的存在情况，更具体地说，它们是单独使用还是与其他药物联合使用。
使用了2008/9年关于西班牙的DRUID数据库，该数据库提供了3302名驾驶员的信息。纳入研究的所有驾驶员均提供了唾液样本，并对所有样本进行了质谱分析。为确定流行率，样本根据交通强度进行加权。对于阿片类药物联合使用的情况，样本未进行加权。每种物质的检测限被视为阳性结果。
西班牙驾驶员中阿片类药物的流行率为1.8%（95%可信区间，1.4 - 2.3）。多药检测很常见（56.2%）：其中，三分之二的案例中检测到两种阿片类药物，86%的案例中还检测到了可卡因。这些物质的浓度（中位数[第一四分位数 - 第三四分位数]ng/ml）较低：美沙酮1.71[0.10 - 15.30]，可待因40.55[2.10 - 120.77]，6 - 乙酰吗啡5.71[1.53 - 84.05]，吗啡37.40[2.84 - 200.00]。吗啡总是与6 - 乙酰吗啡一起被检测到（使用海洛因）。
在阿片类药物影响下驾驶相对不常见，但多药使用很普遍。我们的研究表明，10名在口腔液中检测出美沙酮的驾驶员中有6名（可能参加美沙酮维持治疗项目）正在使用其他物质。健康专业人员应考虑到这一点，以便在驾驶时正确告知患者混合使用物质的额外风险。
