The first comprehensive study of illicit drug use and motor vehicle trauma has found that one in eight of those who end up in the emergency major trauma centre, whether a driver, passenger, cyclist or pedestrian, test positive for an illicit drug – and that 77% of these are under the influence of methamphetamine.
The study, led by clinicians at the Royal Melbourne Hospital and published in the journal, Drug and Alcohol Review, calls for routine testing of all motor vehicle trauma patients to be tested for illicit drugs in order to get a clear picture of what the authors argue is a need for more education of drivers about the impact of illicit drug use and road trauma.
Australasian emergency departments (EDs) routinely test patient alcohol levels following major trauma. Although blood is sent to forensic labs for drug testing for judicial purposes, results are not available to clinicians.
A major study of motor vehicle related trauma patients attending both adult major trauma centres in Victoria, Australia, was conducted at the Royal Melbourne Hospital and The Alfred used a saliva test to determine the prevalence of common illicit drugs, with results immediately available at the bedside.
The study screened more than 1300 patients over 12 months from August, 2018. It found that:
- 13% (173) tested positive to at least one illicit substance
- Almost 77% (133) tested positive for meth/amphetamine
- One in five had more than one illicit substance detected
The bulk (almost 92%) testing positive for drugs in motor vehicle accidents were actually in the vehicle, with 2% cyclists and 5% pedestrians. Compared to those without drugs in their system – and having been in motor vehicle accidents – they were younger (35 versus 43 years) and more likely to end up in the ED overnight.
Importantly those testing positive were more likely to represent to the ED within 28 days of the initial motor vehicle related trauma.
The study is the first to accurately look at major road accident trauma in people testing positive for illicit drugs who require a major trauma centre compared to the usual point of data collection which is at roadside drug testing. A study done in 2007 in a single hospital using blood testing on any patient who presented after a motor vehicle accident, found that cannabis was the most commonly detected drug while only 4.1% of patients were found to have amphetamines in their blood. According to co-author, Dr George Braitberg, “while these studies have very different patient cohorts, the change in the prevalence of amphetamines is alarming,” he said.
In 2015, the Victorian Road Trauma report stated that approximately 10% of deaths and 12% of the serious injuries occurring on Victorian roads were associated with alcohol and illicit drug driving and that drugs and alcohol were suspected to be involved in half of the fatalities of 16 to 17-year-old passengers.
However, according to A Prof Knott, from the Royal Melbourne Hospitals’ Emergency Department and the lead author of the current study, these figures are estimates based on preliminary findings from police members first on scene, and not formal toxicological reports. “We expected there to be a substantial overlap between illicit drug use and high-risk behaviours associated with alcohol consumption. But we identified an important group who have only illicit drugs in their system after their trauma event. Knowing they are drug affected and by what class of drugs is important for their initial assessment and care and allows us to provide early interventions ,” he said.
The authors conclude that the outcomes of the study “supports the need for urgent preventive strategies.” The paper also argues that the SPIT-T saliva test used in this study should be adopted in EDs across Australia. In current emergency medicine practice, the detection of illicit substances is limited to urine and blood sample testing. These typically take many hours to days to return results. In addition, there is no requirement for testing of other victims of motor vehicle related trauma including cyclists, pedestrians and passengers, “which does not give an accurate reflection of the extent illicit drugs are having on road trauma outcomes,” A Prof Knott said.
The authors of the paper argue that the low rate of patient refusal and large numbers screened by ED staff suggests that point-of care testing for illicit substances in major trauma is acceptable and feasible: “his study and ongoing surveillance may be used to inform driver education strategies.”