Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.
Traffic Inj Prev. 2020;21(2):122-126. doi: 10.1080/15389588.2020.1724977. Epub 2020 Mar 2.
To investigate whether the use of recommended therapeutic doses of medicinal drugs has led to suspicion of driving under the influence of drugs (DUID) after implementation of legislative limits for illicit and medicinal drugs in 2012. Data from suspected drug-impaired drivers apprehended by the police from 2013 to 2015 were selected from the Norwegian Forensic Toxicology Database. The blood samples had been analyzed for benzodiazepines (BZDs), z-hypnotics, opioids, stimulants, certain hallucinogens, and alcohol. Drivers who tested positive for one BZD or a z-hypnotic only, were included in the study. Drug concentrations measured in their blood samples were compared to the maximal obtainable steady state concentrations if the drug had been used in accordance with the recommendations set by the Norwegian Directorate of Health. BZDs or z-hypnotics were found in 10 248 samples, representing 59.6% of the total number of drivers arrested for suspected DUID (n = 17 201). Only one BZD or z-hypnotic with a blood drug concentration above the legislative limit was detected in 390 (2.3%) of the total number of samples. Clonazepam was the most frequently detected BZD (n = 4656), while as a single drug above the legislative limit, it was detected in only 3.6% (n = 168) of the clonazepam-positive blood samples. For drivers testing positive for only one z-hypnotic, drug concentrations above the legislative limit were found in 27% (n = 55) of the blood samples that tested positive for zolpidem and 12.4% (n = 53) of the samples that tested positive for zopiclone. In total, 155 subjects out of 10 248 testing positive for BZDs or z-hypnotics displayed concentrations above the legislative limit but within the concentration ranges that are expected when taking recommended therapeutic drug doses, and 77 below the legislativel limit. The results show that the implementation of legislative limits for BZDs and z-hypnotics may have contributed to DUID suspicion for a small group of patients using therapeutic drug doses; only 1.3% of the suspected DUID offenders had concentrations of only one of those drugs in-line with recommended therapeutic dosing.
为了调查在 2012 年实施非法和药用药物立法限制后，推荐治疗剂量的药用药物的使用是否导致涉嫌吸毒后驾车（DUID）。从 2013 年至 2015 年警方从涉嫌吸毒驾车者那里采集的毒理学数据被选入挪威法医毒理学数据库。血液样本已经分析了苯二氮卓类药物（BZDs）、Z 类催眠药、阿片类药物、兴奋剂、某些致幻剂和酒精。仅测试出一种 BZD 或 Z 类催眠药阳性的驾驶员被纳入研究。将血液样本中测量的药物浓度与如果按照挪威卫生部的建议使用药物，则可达到的最大稳态浓度进行比较。在 17201 名因涉嫌 DUID 被捕的驾驶员中，有 10248 份样本中发现了 BZDs 或 Z 类催眠药，占总样本数的 59.6%。在总共 10248 份样本中，只有 390 份（2.3%）的样本中检测到一种 BZD 或 Z 类催眠药的血液药物浓度超过法定限量。在检测出的 BZDs 中，氯硝西泮最为常见（n=4656），但作为唯一一种超过法定限量的药物，在氯硝西泮阳性血样中仅检测到 3.6%（n=168）。仅对一种 Z 类催眠药呈阳性的驾驶员中，在检测出阳性的唑吡坦血样中，有 27%（n=55）的血样药物浓度超过法定限量，在检测出阳性的佐匹克隆血样中，有 12.4%（n=53）的血样药物浓度超过法定限量。在总共检测出 BZDs 或 Z 类催眠药呈阳性的 10248 例患者中，有 155 例患者的药物浓度超过法定限量，但在接受推荐的治疗剂量时，预期的浓度范围内，而有 77 例患者的药物浓度低于法定限量。结果表明，BZDs 和 Z 类催眠药的法定限量的实施可能导致一小部分使用治疗剂量药物的患者产生涉嫌吸毒后驾车的怀疑；在涉嫌吸毒后驾车的违法者中，仅有 1.3%的人的血液中只有一种药物浓度符合推荐的治疗剂量。
