Victorian Institute of Forensic Medicine, Victoria, Australia; Department of Forensic Medicine, Australia.
School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
Accid Anal Prev. 2021 Apr;153:105905. doi: 10.1016/j.aap.2020.105905. Epub 2021 Feb 22.
Driving under the influence of drugs, including alcohol, is a globally recognised risk factor for road traffic crashes. While the prevalence of alcohol and other drugs in fatal road crashes has been examined in other countries, recent data investigating drug driving in fatal Australian crashes are limited. This study aimed to examine how the presence of alcohol and other drugs in fatal road trauma in Victoria has changed over time in different road users.
A population-based review of road trauma deaths was performed over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System (NCIS) and the Victorian State Trauma Registry (VSTR). Drugs were grouped according to type and analysed accordingly. Poisson regression models were used to determine change in incidence rates over the study period.
There were 2287 road traffic fatalities with complete toxicology data (97% of all road traffic fatalities). Alcohol (blood alcohol concentration, BAC) was the most commonly detected drug (>0.001 g/100 mL: 21.1%; >0.05 g/100 mL: 18.4%), followed by opioids (17.3%), THC (13.1%), antidepressants (9.7%), benzodiazepines (8.8%), amphetamine-type stimulants (7.1%), ketamine (3.4%), antipsychotics (0.9%) and cocaine (0.2%). Trends demonstrated changing use over time with specific drugs. Alcohol positive road fatalities declined 9% per year in passenger car/4WD drivers (IRR = 0.91, 95% CI: 0.88-0.95). The incidence of strong opioids (oxycodone, fentanyl, morphine, and methadone) increased 6% per year (IRR = 1.06; 95% CI: 1.02-1.10). Methylamphetamine was detected in 6.6% of cases and showed a yearly increase of 7% (IRR = 1.07; 95% CI: 1.01-1.13). The incidence of THC remained unchanged over the period, observed in 13.1% of cases. Stronger opioids were more commonly detected among pedal cyclists (19.0%) and pedestrians (20.9%) while THC was more commonly detected among motorcyclists (19.8%) and other light vehicle drivers (17.6%).
A decline in the prevalence of alcohol in fatalities suggests that law enforcement and public health strategies in Australia to address road fatalities and drink-driving may have had a positive effect. However, increases were observed in the incidence of other potentially impairing drugs including opioids and amphetamines, specifically methylamphetamine, indicating a concerning trend in road safety in Victoria that warrants further monitoring.
在全球范围内，药物（包括酒精）的影响下驾车是道路交通事故的一个公认风险因素。虽然其他国家已经研究过酒精和其他药物在致命道路碰撞中的流行情况，但澳大利亚致命车祸中药物驾驶的最新数据有限。本研究旨在研究在不同道路使用者中，酒精和其他药物在维多利亚州致命道路创伤中的存在情况如何随时间发生变化。
使用国家验尸信息系统（NCIS）和维多利亚州创伤登记处（VSTR）的数据，对 2006 年 7 月 1 日至 2016 年 6 月 30 日期间维多利亚州的道路创伤死亡进行了基于人群的回顾性研究。根据类型对药物进行分组并进行相应分析。使用泊松回归模型来确定研究期间发病率的变化。
共有 2287 例具有完整毒理学数据的道路交通事故死亡（占所有道路交通事故死亡的 97%）。酒精（血液酒精浓度，BAC）是最常检测到的药物（>0.001 g/100 mL：21.1%；>0.05 g/100 mL：18.4%），其次是阿片类药物（17.3%）、四氢大麻酚（THC）（13.1%）、抗抑郁药（9.7%）、苯二氮䓬类（8.8%）、苯丙胺类兴奋剂（7.1%）、氯胺酮（3.4%）、抗精神病药（0.9%）和可卡因（0.2%）。趋势表明，特定药物的使用随时间而变化。乘用车/四轮驱动车驾驶员中酒精阳性道路死亡人数每年下降 9%（IRR=0.91，95%CI：0.88-0.95）。强阿片类药物（羟考酮、芬太尼、吗啡和美沙酮）的发生率每年增加 6%（IRR=1.06；95%CI：1.02-1.10）。甲基苯丙胺在 6.6%的病例中被检测到，每年增加 7%（IRR=1.07；95%CI：1.01-1.13）。在研究期间，THC 的发生率保持不变，在 13.1%的病例中观察到。更强的阿片类药物在骑自行车者（19.0%）和行人（20.9%）中更为常见，而 THC 在骑摩托车者（19.8%）和其他轻型车辆驾驶员（17.6%）中更为常见。
致命事故中酒精流行率的下降表明，澳大利亚为解决道路死亡和酒后驾车问题而采取的执法和公共卫生策略可能已产生积极影响。然而，包括阿片类药物和苯丙胺类兴奋剂在内的其他潜在致损药物的发生率增加，特别是甲基苯丙胺，表明维多利亚州的道路安全出现了令人担忧的趋势，需要进一步监测。
