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TraumaTox Report Released Today

drplatypus

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Australian Science Media Centre - 13 April 2007



Rapid Roundup: New trauma and drugs report - experts comment



New findings that suggest legal and illegal drug use is almost as dangerous as alcohol on the road will be released today. The study, called The impact of drugs on road crashes, assaults and other trauma - a prospective trauma toxicology study is the largest of its kind ever carried out. It has significant national and international implications for motor vehicle crash prevention strategies, the law and the management of trauma.



A full copy of the study is available on the AusSMC website at www.aussmc.org/documents/NDLERF.pdf



Note for Adelaide based journalists. The study will be launched at Ayers House, North Terrace (The Ballroom) at 11am on Friday 13 April by SA Police Commissioner Mal Hyde. The Authors of the report will be available for interviews.



Feel free to use these quotes in your stories or if you would like to contact an author or an expert in this area, call the Australian Science Media Centre on (08) 8207 7415 or email us. Any further quotes will also be released on our website at www.aussmc.org/impact_of_drugs.php

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Dr David Caldicott is the Emergency Research Fellow at Royal Adelaide Hospital's Emergency Department and project manager of the study.



"This is the largest study of its kind and it's unique in that we measured everyone that came through the emergency department with a trauma injury rather than a select group. We also tested blood not urine which is more accurate and measured the quantity of the drug in the system.



The findings showed that some drugs, both illegal and legal, can be almost as dangerous on the road as alcohol and also raised issues with elderly people and indigenous groups that we hadn’t appreciated before. The study has implications for all walks of life. We look forward to seeing it being used by legislators and life-savers alike.



It is written by doctors, all of whom were determined to ensure that the primary message was for harm minimization, and we believe that there are real lessons for consumers, particularly in the area of drug driving. We think that because of the medical emphasis, illicit drug users might treat the report with a credibility not often afforded to more politicised reports. It provides real science to support drugs policy in Australia, a country that increasingly has allowed research to be tempered and tampered with by political and moral ideologies.”

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Dr Richard Midford is Associate Professor at the National Drug Research Institute, Curtin University.



"This is good basic research on the extent of alcohol and other drug use by people who present for hospital treatment because of injury. The large number of patients and testing for a range of drugs permitted identification of a number of important associations between type of drug use and nature of injury. The evidence as to the extent of drug driving and associated injury is particularly compelling. This information is likely to be useful in developing policy responses across a range of areas from law enforcement to the workplace.”

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Dr Alex Wodak is Director of the Alcohol and Drug Service at St. Vincent's Hospital in Sydney.



"The use of blood rather than urine specimens is a great advance on other studies but the problem is that we have very much more limited understanding of the correct interpretation of blood levels for most drugs apart from alcohol. Another problem is trying to decide whether the relationship between the toxicology results and the trauma outcomes was causal or just an association and that question is the very crux of the issue.

For me the biggest problem of studies like this is the policy implications. The authors' first recommendation is that the drugs referred to are dealt with 'more effectively'. But what exactly does that mean?

Personally, I find it hard to understand why, if cannabis actually causes so many road crashes, we prefer to see such a dangerous drug distributed by criminals and corrupt police. After all, the drug that kills 19,000 Australians a year is taxed and regulated and political parties still accept generous donations from the tobacco industry. So if I had my way, cannabis would be taxed and regulated and packets would sport a sign saying 'cannabis may cause road crash deaths'."



Australian Science Media Centre (AusSMC)

Ph: (08) 8207 7415

Fax: (08) 8207 7413



[email protected]

www.aussmc.org



PO Box 237

RUNDLE MALL SA 5000
 
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Hi, Dr Platypus

Did your study include a comparison of accident-involved drivers who were positive for cannabis but not alcohol versus the control group (group 3)?

It would seem to me that this would be most germane to the issue of cannabis and accident involvement? (I looked for this comparison in the report but couldn't find it).

Also (and I know that this is acknowledged in the report) the control group seems to be unrepresentative in the sense that most of the samples were surely obtained in the daytime, whereas the alcohol/drug taking profile at night is likely very different.

(I'm not having a go at the study - I worked in the road safety biz myself for several years, and I understand the difficulties of working with imperfect data.)
 
At a remote location, and don't have data to hand, but happy to forward it when back in department. Offhand, I know that the numbers were substantial. Will certainly be addressing that in the academic papers to follow. You could argue from a pharmacodynamic perspective that the combination of THC and ETOH is every bit as interesting, having a synergistic effect on attentiveness.
As to the control group, completely agree, but we needed something and door-knocking Adelaidians at the time didn't seem an option! What WAS surprising, and isn't in the report really, are the numbers of CONTROLS that were positive- we underestmated the numbers of stoners in SA by a country mile=D
 
NEWS: AdelaideNow - 14/04/07 'Drug drivers a big crash risk'

Drug drivers a big crash risk
BEN WAY
April 14, 2007 12:15am

NEARLY 15 per cent of drivers seriously injured in road crashes are under the influence of sedatives, including Valium, yet police are unable to test for the drugs.

A Royal Adelaide Hospital study of more than 2000 people found almost twice as many trauma patients tested positive to benzodiazepines – a class of drugs which include Valium – than they did for methamphetamines.

Currently police test for alcohol, cannabis and methamphetamines. Alcohol is the most common drug found in seriously injured crash victims with almost 22 per cent testing positive, and cannabis second with 17 per cent.

RAH Trauma Service director Dr William Griggs said the 12-month study indicated there was an increasing need to expand roadside testing to include Valium.

"The findings have significant implications for SA law enforcement and policy making," he said.

"It also shows cannabis remains a serious cause of serious road crash injuries. There's still a lot of people who don't understand the danger of using cannabis and this study makes the risks very clear."

Police Commissioner Mal Hyde said the findings "were not surprising" and more expansive drug testing had to be considered. "We do need to be thinking about how far we can go and how much more effective we can be," he said.

The study also found about one-quarter of people seriously injured in workplace accidents were under the influence of at least one drug.

"The correlation between serious trauma patients and positive drug testing results surprised us," Dr Griggs said.

AdelaideNow
 
Dr Platypus.

Thanks, I'd be interested to see the data when you can post it. Your point about the interaction of alcohol and cannabis is well taken. Isolating the cannabis effect without the alcohol is most interesting to me, having participated in alcohol-impairment experiments in the 1980s. My subjective experience was that alcohol produced way more impairment than cannabis, and of course the combination of the two is the worst of all.

Your study is very interesting in that it includes a control group (however imperfect), something lacking in most of the literature.

Willaim Griggs says ""It also shows cannabis remains a serious cause of serious road crash injuries. There's still a lot of people who don't understand the danger of using cannabis and this study makes the risks very clear."

As I read the report, this finding is not clear at all, unless I've missed something. In fact, I don't think this is even a conclusion of the research. The only reasonable test is to compare accident-involved drivers positive to cannabis but not alcohol, compared to the control group positive to cannabis but not alcohol, which is the comparison I'm seeking. As you mention, the proportion of the control group positive to cannabis is surprisingly high.

Note: I'm not defending driving under the influence of cannabis, but I'm interested in the relative risk of doing so sans-alcohol.
 
I appreciate the thoroughness of your reading, and I completely agree with you. Although I can't really get into the details for political reasons, there was dissent- substantial dissent- about how the results were portrayed. Within the RAH research team, there was a majority faction committed to the science, and a minority- of one- who saw it as an opportunity for collusion with law enforcement.

Sorry to be so cryptic, but alot will become more clear in the articles to follow. The report should have been released a year ago, and wasn't because of the academic's determination not to infer causality from the results, and the funding body's irritation at our stubborness. The suggestion of causality is incorrect, factually, scientifically and statistically.

There is a strong association, however- maybe the sorts of people who happen to smoke cannabis are more likely to crash their car for reasons other than cannabis...

The reporting of the report in it's own right was intriguing. SAPOL PR orchestrated the interviews, and along with The Advertiser (possibly the most inaccurate paper in Australia for reporting drugs stories) colluded to ensure that the views of the majority, as well as the Project Manager, were not heard. An intriguing anthropological exercise in the manipulation of the media if ever I saw one....:\
 
There is a strong association, however- maybe the sorts of people who happen to smoke cannabis are more likely to crash their car for reasons other than cannabis...

Yes, tobacco smokers are also significantly more likely to be involved in vehicle accidents than non-smokers (or at least that was true when I was last familiar with the literature in the 1980s. In fact, given the decline in smoking rates in the last 20 years, I'd guess that the association is even stronger than it was then.) But nobody concludes from that that nicotine impairs driving skills.
 
But there is evidence, now generally accepted that marijuana has been shown to impair performance on driving simulator tasks and on open and closed driving courses for up to approximately 3 hours. Specific effects include decreased car handling performance, increased reaction times, impaired time and distance estimation, inability to maintain headway, lateral travel, subjective sleepiness, motor incoordination, and impaired sustained vigilance- none of which are seen with cigarette smoking...
 
What about the paranoia/anxiousness that makes sure you drive the speed limit and avoid crashing.. I agree with all of the above but my point makes most bad drink drivers I've seen slow right the hell back and drive sensible wwhen they're stoned driving...

Also driving to work early after using sleeping aids the previous night can be dangerous.
 
But there is evidence, now generally accepted that marijuana has been shown to impair performance on driving simulator tasks and on open and closed driving courses for up to approximately 3 hours. Specific effects include decreased car handling performance, increased reaction times, impaired time and distance estimation, inability to maintain headway, lateral travel, subjective sleepiness, motor incoordination, and impaired sustained vigilance- none of which are seen with cigarette smoking...

No argument there, I was just using tobacco to illustrate that association alone does not demonstrate causation.
 
cannabis makes me dopey ~ therefore less good at driving . Simple really.
 
My boss almost cut my nuts for printing this off today but from reading i just shows a message that has been reinforced an enforced over and over.

what concerns me though is the benzodiazepines testing, there is no way off testing how much the benzodiazepine has been taken considerering the more you take a benzo the better the body becomes at excreating it. Ie if someone had a termazpam a day ago for the first time it would show up, whereas someone who uses regularly would not have a reading.
 
I thought it was the opposite? Benzos build up in the body much like pot.?
 
Valium has a really long half-life...200 hours 8o I'd assume that would accumulate if someone was taking enough of it regularly.
 
My psych. explained that the more off a benzo's you have the quicker it get metabolise, thats why you have to more and more to have same effect. I may be wrong, so if someone wants to correct me go nuts cause i'd to know for sure. Ps we where talking about lorazapam so eack may be different.

Each persons metabolism of a benzo depends on age, health, height, weight etc. so say valium has a half life off 200 hrs may be true in an elderly person or some who has taken for first time, but half would be a lot shorter.

Some times i have swallowed massive dose's off benzo's and been able to make it to work 12 hrs later so i think my psych idea might be on the money.
 
^ There's a big difference between the actual metabolite half life, and the active half life. The active half life is the period during which you'll actually feel effects, in valium its about 12 hours from memory. The actual metabolites will stay in your system much, much longer. Unless your Psych is right :) I'm just going from what I've read.
 
i've been reading my uni books for 1 1/2 hrs and can't sort it. anyone else got an idea's to help with above i see my psych next week and he's got heaps better books than me, don't believe anything off the net, make sure it's referenced.
 
Firstly, the half life of different Benzodiazepines can vary considerably depending upon structure, which in turn determines route of metabolism. Drugs such as Diazepam and chlordiazepoxide are metabolized into a N-demethylated metabolite (nordiazepam) which is active and has the very long half life. Other benzos metabolize differently producing either active or non-active metabolites e.g. alprazolam --metabolized--> hydroxylated derivative which is active, and oxazepam--metabolized-->glucuronide which is not active.


As for the question raised concerning long term benzo use; an interesting study done by Oswald et al (British Journal of Med 284; p860-864 and discussed in Pharmacology by Rang et al) looked at the effects of long term Nitrazepam and Lometazepam use on sleep quality compared to placebo, over a 32 week treatment regimen. Placebo didn't make appreciable differences, and the two benzos displayed very similar patterns for the 32 week period. While 'Sleep Score' was higher upon commencement of treatment, both drugs achieved a lower score after 32 weeks (below the normal sleep score) with Lometazepam scoring lowest.
 
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