D ug and Alcohol Dependence 57 (2000) 177–182
P esence o illegal d ugs in d i e s in ol ed in a al oad a ic
acciden s in Spain
M. Ca men del Rı´o, F. Ja ie Al a ez *
D ugs and Alcohol Resea ch G oup,Depa men o Pha macology and The apeu ics,Facul y o Medicine,Uni6e si y o Valladolid,
47005
Valladolid,Spain
Recei ed 24 No embe 1998; ecei ed in e ised o m 12 Ma ch 1999; accep ed 30 Ap il 1999
Abs ac
This s udy in es iga ed he p esence o illegal d ugs in he blood o 285 a ally inju ed d i e s in Spain. Illegal d ugs we e
de ec ed in 10.2% o all samples. Illici d ugs alone we e de ec ed in 2.5% and oge he wi h o he subs ances in 7.7%. Cocaine
was he mos common d ug de ec ed. The mean numbe (9S.D.) o subs ances de ec ed was 2.691.2: consis ing o 46 illegal
d ugs, 14 alcohol cases and 16 medicines. Th ee concen a ion le els o he di e en subs ances ha e been es ablished: low,
medium and high- oxic. In 68.9% o he samples in which an illegal d ug was de ec ed, a subs ance was also ound a he
high- oxic le el. The esul s show ha illegal d ugs a e commonly de ec ed in oad acciden ic ims. © 2000 Else ie Science
I eland L d. All igh s ese ed.
Keywo ds
:
Illegal d ugs; Alcohol; Road a ic acciden s; Spain
www.else ie .com/loca e/d ugalcdep
1. In oduc ion
In ecen yea s he ole played by illici d ugs in oad
sa e y has become he objec o inc easing in e es .
Among illegal d ugs a e included g oups which a e
qui e di e se in espec o hei e ec s on he cen al
ne ous sys em, psychomo o pe o mance, and isk-
aking beha iou , oge he wi h o he aspec s. Gene -
ally speaking, and when hese aspec s a e analysed
join ly, i is conside ed ha he e ec s o hese d ugs
impai he abili y o d i e sa ely (Del Rı´o and Al a ez,
1995a). Whils he ela ionship be ween alcohol, im-
pai ed d i ing abili y and acciden isk is well es ab-
lished, in he case o di e en illegal d ugs he e a e
many poin s which equi e cla i ica ion. The hypo hesis
ha d ug- aking d i e s a e a g ea e isk in e ms o
acciden in ol emen has no ye been sa is ac o ily
de e mined (Albe y e al., 1998; Consensus De elop-
men Panel, 1985; Road Sa e y Commi ee, 1996).
Wi hin he Eu opean Union, he di e en membe
s a es ha e legisla ion conce ning wo aspec s: i s ly,
d i ing unde he in luence o di e en illegal d ugs is
o bidden, and, secondly, in acco dance wi h Council
Di ec i e 91/439/EEC, s ipula ion is made ha a d i -
ing licence will no be issued o anyone who abuses, is
dependen upon, o has a diso de b ough abou by
illegal d ugs (Albe y and S ang, 1995; Del Rı´o and
Al a ez, 1995a). I is e y di icul , howe e , o pu his
legisla ion in o p ac ice.
Recen epo s emphasise a ious aspec s conce ning
illici d ugs and d i ing abou which we ha e li le
in o ma ion. In his ega d we should men ion he
ecen e iew om Albe y e al. (1998) on he ma e ,
as well as he s udies conduc ed o he Pompidou
G oup (Council o Eu ope) by K u¨ge e al. (1998) on
he legal p o isions ela ing o illici d ugs and oad
a ic acciden s, and hose by De Gie (1998) on he
p e alence o illici d ugs in oad a ic acciden s. Also,
he e is now a ailable he li e a u e e iew on illici
d ugs and d i ing ca ied ou by he Eu opean Moni-
o ing Cen e o D ugs and D ug Addic ion (1999).
I de e mining he e ec o an illegal d ug on d i ing
abili y is complex in he labo a o y, i is e en mo e so
in a eal-li e d i ing si ua ion. In addi ion, apa om
he e ec o a d ug on psychomo o pe o mance and
abili y o d i e, he e a e o he ac o s ela ed o d ug-
* Co esponding au ho . Tel.: +34-983-423077; ax: +34-983-
423022.
E-mail add ess
:
[email p o ec ed] (F. Ja ie Al a ez)
0376-8716/00/$ - see on ma e © 2000 Else ie Science I eland L d. All igh s ese ed.
PII: S0376-8716(99)00042-3
M.Ca men del Rı´o,F.Ja6ie Al6a ez
/
D ug and Alcohol Dependence
57 (2000) 177–182
178
aking pa e ns which in luence he inal e ec he d ug
will ha e on d i ing abili y: hese include dosage, how
he d ug is adminis e ed, he aking o di e en sub-
s ances simul aneously (e en wi h alcohol), associa ed
mo bidi y, o e dose and wi hd awal symp oms, e c.
(Del Rı´o and Al a ez, 1995a).
The ac ual impo ance o d i ing whils unde he
e ec s o illici d ugs is no ully de ined. I has been
es ima ed ha a ound 10% o all people killed o
inju ed in oad a ic acciden s we e aking some so
o psycho opic medica ion ha may ha e been a con-
ibu o y ac o (De Gie , 1993).
In s udies om a ious coun ies conce ning a ally
inju ed d i e s, he incidence o illegal d ugs is a iable
as is he equency o he di e en subs ances de ec ed
(7–30%); he mos commonly de ec ed illegal d ug is
cannabis (Budd e al., 1989; Gje de e al., 1993; Fe a a
e al., 1994; D umme , 1995; Logan and Schwilke,
1996; Me ced and Je e y, 1995; Hansen e al., 1996;
Ch is ophe sen and Mo land, 1997; Ha mee e al.,
1997; Cha lie and Plom eux, 1998).
In Spain, a p e ious s udy ca ied ou on 1500 d i -
e s showed ha 3% had d i en unde he e ec s o
illegal d ugs du ing he p e ious 12 mon hs (Del Rı´o
and Al a ez, 1995b). Acco ding o a s udy ca ied ou
by he Na ional Ins i u e o Toxicology on 250 d i e s
in ol ed in a al oad acciden s, illegal d ugs, and in
pa icula cocaine, we e de ec ed in 8% o hem (Rams
e al., 1993).
This s udy was unde aken o assess he p esence o
alcohol, illegal and medicinal d ugs in people in ol ed
in a al oad acciden s in Spain. The a icle is speci i-
cally conce ned wi h illegal d ugs and has as i s aims:
(i) o analyse he p esence o illegal d ugs in a ally
inju ed d i e s, (ii) o assess hei p esence alone o in
combina ion wi h o he subs ances, and (iii) o quan i y
he subs ances de ec ed.
2. Me hods
I was s a ed in his s udy ha all in o ma ion ob-
ained would be anonymous and used o scien i ic and
no legal pu poses. The a ge popula ion consis ed o
d i e s killed in oad acciden s. The da a a ailable in
each case was: sex, age, day and ime o he acciden .
Samples o enous blood we e aken wi hin8ho he
ic im’s dea h and we e la e sen o ou cen e.
Samples conce ning 285 oad acciden ic ims om
Janua y 1994 o Oc obe 1996 in he no h o Spain
we e ob ained. Two hund ed and i y- i e (89.5%) ou
o he 285 samples analysed we e men and 30 (10.5%)
we e women. Nine y-six subjec s (33.7%) we e people
belonging o he 16–25 age g oup, 129 (45.3%) we e
be ween 26 and 45 yea s o age and 60 (21.0%) we e
aged o e 45. One hund ed and hi een samples
(39.6%) ep esen ed d i e s a ally inju ed on wo king
days (Monday o F iday) and 172 (60.4%) on non-
wo king days (Sa u day and Sunday). The a e age age
(9S.D.) was 34.1913.2 (33.9913.1 o men and
36.0914.7 o women). O he samples ob ained on
non-wo king days 46% ep esen ed pe sons unde he
age o 26, whils on wo king days he igu e was 29%.
All samples we e also sc eened o he p esence o
d ugs o he han alcohol (medicines and illegal d ugs)
by immunological o ch oma og aphic me hods as ap-
p op ia e. Posi i e esul s a e sc eening we e con i-
med by al e na i e me hods (GC/MS, HPLC o GC
me hods) and he concen a ions o he psychoac i e
d ugs o me aboli es we e de e mined. Blood samples
we e analyzed o alcohol (e hanol) by head space gas
ch oma og aphy (Pea and Finkle, 1992; Tedeschi e
al., 1992).
The subs ances o he han alcohol we e classi ied in o
wo g oups: illegal d ugs, and medicines. Wi hin he
i s g oup, ca ego iza ion in o he ollowing g oups
was es ablished: amphe amine, opia es, cocaine, can-
nabis, syn he ic d ugs (ecs asy) and hallucinogenic
d ugs. Wi hin he second g oup, di e en sub-g oups
we e es ablished, in acco dance wi h he Ana omical
The apeu ic Chemical Classi ica ion sys em. Fo he
p esen s udy, benzodiazepines we e always conside ed
medicinal d ugs. Once a subs ance had been de ec ed,
he samples we e classi ied o he pu pose o his s udy
in o he ollowing g oups: (i) illegal d ugs, (ii) illegal
d ugs wi h alcohol, (iii) illegal d ugs wi h medicines,
(i ) illegal d ugs plus alcohol plus medicines, and ( ) no
alcohol—no d ugs.
Alcohol, illegal d ugs and medicines we e ca ego ized
and, he a ing used was based on h ee le els: low,
medium and high concen a ion (low he apeu ic, he -
apeu ic, and high non- he apeu ic concen a ion o
medicines), such as has p e iously been used in o he
s udies (D umme , 1994). Fo example, o cocaine,
hese ca ego ies ha e been es ablished as: le el low
(B0.1 mg/l), le el-II (0.1–0.25 mg/l) and le el-III (
0.25 mg/l). In ela ion o alcohol, hese ca ego ies ha e
been a bi a ily es ablished as: le el-I o low (0.01–0.49
g/l), le el-II o medium (0.5–0.99 g/l) and le el-III o
high- oxic (]1g/l).
S a is ical analysis o he da a was conduc ed in he
Da a P ocessing Cen e a Valladolid Uni e si y. S a is-
ical analysis was by means o SAS so wa e e sion
6.07 (SAS Ins i u e SAS). P- alues B0.05 we e consid-
e ed o be signi ican di e ences.
3. Resul s
Table 1 shows he p esence o he di e en sub-
s ances ound in Spanish d i e s killed in oad a ic
acciden s. In 40% (n=114) o he cases no subs ance
M.Ca men del Rı´o,F.Ja6ie Al6a ez
/
D ug and Alcohol Dependence
57 (2000) 177–182
179
Table 1
P e alence o d ugs in a ally inju ed d i e s in Spain
%n
No subs ance 40.0114
60.0171Some subs ance
144Alcohol 50.5
29Illegal d ugs 10.2
2.57Alone
+Alcohol 4.212
2.8+Medicines 8
2+Medicines+alcohol 0.7
Medicines 26 9.1
O hese 46 illegal d ugs, in 91.3% o cases he d ug
was accompanied by ano he subs ance, and in only
ou cases (8.7%) was i de ec ed alone (Table 3). O
hese d ugs 19.6% we e ound in combina ion wi h
alcohol only, 43.5% wi h subs ances o he han alcohol,
and 28.3% wi h alcohol plus ano he subs ance. I
should be men ioned ha he mos commonly de ec ed
illegal d ug in combina ion wi h alcohol was cocaine, in
57.1% o cases. In addi ion, opia es we e gene ally
ound in combina ion wi h subs ances o he han alco-
hol, in 78.6% o cases. O he 13 cases encoun e ed o
opia es in combina ion wi h o he subs ances, nine we e
associa ed wi h an analgesic o a benzodiazepine d ug.
As s a ed abo e, ca ego iza ion o he di e en sub-
s ances was based on h ee deg ees o le els. O he 46
subs ances classi ied as illegal d ugs, 63% (n=29) we e
anked in g oup o le el-I, 19.6% in le el-II (n=9) and
27.6% (n=8) in le el-III. Opia es we e p edominan in
le el-III, 45.7% (n=5). O all samples analyzed (29),
illegal d ugs we e ound in 72.4% (n=21) in g oup o
le el-I, in 41.4% (n=9) in le el-II, and in 27.6% (n=8)
in le el-III (Table 4).
In addi ion, o he 29 samples in which some ype o
illegal d ug was de ec ed, in 20 o hese some kind o
subs ance was ound wi h le el-III (illegal d ug le el-III
eigh cases, alcohol le el-III nine cases, and medicinal
d ug le el-III h ee cases) (Table 4); in he emaining
nine cases, six we e ound wi h some ype o le el-II
subs ance, and in he o he h ee all we e le el-I
subs ances.
4. Discussion
This s udy e eals how o en illegal d ugs a e ound
in people killed in oad acciden s, wi h a igu e o
10.2% being de ec ed in he samples analysed. Likewise,
was de ec ed, whils in 60% some subs ance was ound.
Alcohol was ound in 50.5% (n=144), some medica-
ion in 9.1% (n=26) and some illici d ugs we e ound
in 10.2% (n=29).
Rega ding illici d ugs (Table 1), hese subs ances
alone we e de ec ed in 2.5% (n=7), and illegal d ugs
wi h o he subs ances in 7.7% (n=22): o hese, illegal
d ugs wi h alcohol we e de ec ed in 4.2% (n=12), wi h
medicines in 2.8% (n=8), and wi h medicines and
alcohol in 0.7% (n=2).
Cocaine, 7.4% (n=21), was he mos equen ly de-
ec ed d ug, ollowed by opia es, 4.9% (n=14), am-
phe amine and cannabis, 1.4% (n=4), and syn he ic
d ugs, 1.1% (n=3). Table 2 shows hei dis ibu ion in
acco dance wi h some sociodemog aphic cha ac e is-
ics; no di e ences we e obse ed (P 0.5) wi h ega d
o sex, age g oups o days o he week.
In he 29 samples in which some illegal d ug was
de ec ed, a o al o 76 subs ances we e encoun e ed
(mean 2.691.2): o hese 46 we e illegal d ugs, 14
alcohol and 16 medicines (11 benzodiazepines and i e
analgesics–an i-in lamma o y).
Table 2
Sociodemog aphic cha ac e is ics o es ing posi i e o illegal d ugs
To al (n) Kind o illegal d ugsIllegal d ugs
Cannabis Ecs asyCocaine Opia es Amphe amine
n%n%n%n%n%n%
285 29 10.2 21 7.4 14To al 4.9 4 1.4 4 1.4 3 1.1
Sex
255 28 11.0 20 7.8Male 13 5.1 4 1.6 4 1.6 3 1.7
1 3.4 1 3.3 1 3.3Female 30
Age
96 13 13.5 10 10.4 5 5.2 3 3.1 2 2.1 3 3.116–25
129 16 12.4 11 8.5 926–45 6.9 1 0.8 2 1.5 0 1.5
0 45
Day
113 12 10.6 7 6.2No -wo king 3 0.92.6 2 1.8 1 2.63
26.4118.1149.917172Wo king 01.731.2
M.Ca men del Rı´o,F.Ja6ie Al6a ez
/
D ug and Alcohol Dependence
57 (2000) 177–182
180
Table 3
P esence o illegal d ugs alone o wi h ano he subs ances in he blood o a ally inju ed d i e s in Spain
Only wi h alcohol Wi h alcohol andTo al Only wi h o he d ugs Wi hou o he sub-
o he d ugs s ances
%n%n%nn%n%
100 9 19.6 13 28.3 20 43.5 4 8.7To al 46
100 8 38.1 4Cocaine 1921 6 28.6 3 14.3
Opia es 14 100 0 0 2 14.3 11 78.6 1 7.1
Amphe amines 4 100 1 25 2 50 1 25 0 0
10000 25042Cannabis 50 0 0
3Ecs asy 100 0 0 3 100 0 0 0 0
we ha e obse ed he equen combined consump ion
o di e en subs ances including alcohol and medicines
(benzodiazepines and analgesics–an i-in lamma o y): In
91.3% o cases, hese we e de ec ed oge he wi h an-
o he subs ance, wi h a mean in each sample o 2.2.
Also, in 68.9% o cases, some le el-III (high- oxic)
subs ance was de ec ed.
I is ob iously impossible o es ablish a causal ela-
ionship be ween he p esence o illegal d ugs in biolog-
ical luids and oad a ic acciden s, due in pa o he
numbe o con using ac o s which play hei pa
(speed, you h, combined use o o he subs ances, e c.);
howe e , wha has indeed been e ealed in some e-
sponsibili y analysis s udies is ha hose indi iduals
who ha e aken illegal d ugs and d i e a e a g ea e
isk when i comes o being in ol ed in a oad acciden
(D umme , 1994).
As o in o ma ion a ailable in Spain, he e a e ew
s udies ela ing o d ugs and acciden s due o se e al
easons. Fi s o all, samples ( o legal pu poses) a e
only aken o de e mine alcohol (o o he d ugs) in e y
ew cases (gene ally in ewe han 3–5% o dea hs).
Secondly, because o wha we colloquially e e o as
he ‘widow synd ome’, ha is, no a en ion is paid o
whe he he ic im was unde he in luence o alcohol
and/o o he d ugs, o no , i is p e e ed ha he
insu ance companies pay he amilies o he ic im and
he inciden be o go en. Thus, a es o blood alcohol
(and o he d ugs) is ca ied ou only in cases in which
he ic im has shown clea signs o being unde he
e ec o alcohol o o he d ugs. The ac ha es ing
o alcohol in indi iduals killed o inju ed in oad
acciden s has become a o mal equi emen in Spain
(since Decembe 1996), migh cons i u e a means o pu
an end o his si ua ion.
Recen ly (Al a ez e al., 1997) we p esen ed a com-
pa ison o he da a included in his pape (a de e mina-
ion o illegal d ug concen a ion o non-legal
pu poses) wi h ha ob ained be ween 1992 and 1995 in
he Na ional Ins i u e o Toxicology, conce ning 979
people killed in oad acciden s (an analysis ca ied ou
o legal pu poses). Da a om bo h sou ces p o ed
e y simila : 10.2% o posi i e cases in ou s udy,
compa ed wi h 8.3% in he samples p o ided by he
Na ional Ins i u e o Toxicology. In bo h cases cocaine
and opia es ep esen ed he mos commonly de ec ed
d ugs.
Ou da a a e consis en wi h hose encoun e ed in
gene al a he popula ion le el: mul iple d ug aking is
ela i ely common among hose who abuse o a e
dependen and, he join use o d ugs wi h alcohol is
ha m ul due o he ac ha he e is an inc ease in he
nega i e e ec s ha hese subs ances ha e on d i ing
abili y. I is easy o s a e ha he highe he d ug
concen a ion he mo e likely i is ha he indi idual
will be in ol ed in a a al oad acciden , as in he case
o alcohol. Howe e , as men ioned ea lie (Consensus
De elopmen Panel, 1985; Road Sa e y Commi ee,
1996; Albe y e al., 1998), we do no ha e enough
in o ma ion o suppo his.
As was indica ed in he me hodology, and wi h a
iew o es ablishing a anking o he concen a ions o
di e en subs ances in biological luids, h ee le els o
deg ees ha e been de ised. O he 29 samples in which
some ype o illegal d ug was de ec ed, in 68.9% o
cases a le el-III subs ance was ound, co esponding o
high, oxic o sup a he apeu ic le els. I should be
poin ed ou in his ega d ha a close ela ionship
exis s be ween he amoun o alcohol consumed, he
plasma alcohol le els a ained and he deg ee o impai -
men o psychomo o pe o mance and oad acciden
isk. I has no been possible o es ablish a ela ionship
o o he subs ances. A any a e, al hough he me e
p esence o he illegal d ug (in medium o high- oxic
concen a ion) does no allow us o es ablish his as a
causal ac o o he acciden , he de ec ion o high- oxic
le els o d ugs does sugges an inc eased likelihood o a
oad- a ic acciden . In his ega d, in some cases, d ug
concen a ion and isk o impai men ha e been shown;
o ins ance, in No way (Ch is ophe sen and Mo land,
1997): in his coun y he e is usually a clinical exami-
na ion and blood sampling in d i e s who we e d i ing
a e ha ing aken d ugs, and he au ho s s a ed ha
he e was a clea co ela ion be ween he deg ee o
M.Ca men del Rı´o,F.Ja6ie Al6a ez
/
D ug and Alcohol Dependence
57 (2000) 177–182
181
Table 4
Quan i ying illegal d ug concen a ion in he blood o a ally inju ed d i e s
Le el-I Le el-IITo al illegal d ugs Le el-III
%n%nn %n%
46To al illegal d ugs 100 29 63.0 9 19.6 8 17.4
100 13 61.9 5 23.8Cocaine 321 14.3
100 8 57.1 114 7.1Opia es 5 45.7
4Amphe amines 100 1 75.0 3 25
100 4 100Cannabis 4
100 3 1003Ecs asy
14Alcohol 100 1 7.1 3 21.4 10 71.4
100Medicines 516 31.3 5 31.3 6 37.5
100 21 72.4 9To al o samples wi h illegal d ugs 41.429 8 27.6
To al o samples wi h any subs ance 10029 3 10.3 6 20.7 20 68.9
easoning impai men obse ed in he clinical e alua-
ion and he d ug le el de ec ed in blood. Fu he mo e,
he Na ional Heal h Ins i u e in Finland (Lillsunde,
1996) uses a h ee-le el concen a ion ange (low, he a-
peu ic, high concen a ion) wi h a six-le el es ima ion
o impai ing e ec s on d i ing abili y (no p obable,
ai ly imp obable, canno be excluded no con i med,
canno be excluded, qui e p obable, and p obable). The
s udy conduc ed by D umme (1994), in which espon-
sibili y analysis and h ee- ange d ug concen a ions
we e assessed, shows ha hose who had d ug concen-
a ions a medium o high le el we e mo e likely o be
ei he esponsible o o con ibu o y o he acciden s.
In ou s udy we ha e only in o ma ion abou illegal
d ug concen a ion in he blood, and his does no
allow us o es ablish he ac ual esponsibili y o he
illegal d ug in he acciden . Ne e heless, when assess-
ing he possible ela ionship be ween illici d ug concen-
a ions and d i ing impai men / a al acciden , aspec s
like acu e and ch onic d ug use, d ug in e ac ions and
ole ance should be conside ed as well as d ug concen-
a ion (Ch is ophe sen and Mo land, 1997).
In addi ion, he de ec ed medicines among hose
aking illegal d ugs we e benzodiazepines and anal-
gesics. This is no su p ising, since i is usual o
habi ual illegal d ug ake s o consume hese kinds o
medicamen s. These indings coincide wi h hose ob-
ained in o he epo s (Gje de e al., 1993; Ha mee e
al., 1997).
Ou s udy e eals he p esence o illegal d ugs among
people killed in oad acciden s, as well as he high
concen a ion in blood o illegal d ugs and subs ances
ound in combina ion wi h hem (alcohol and
medicines). Cocaine was he mos commonly de ec ed
d ug.
Acknowledgemen s
Suppo o his s udy was p o ided by he Di eccio´n
Gene al de T a´ ico (Na ional T a ic Agency), Minis e-
io del In e io (Home O ice), Mad id, Spain.
Re e ences
Albe y, I.P., Gossop, M., S ang, J., 1998. Illici d ugs and d i ing: a
e iew o epidemiological, beha iou al and psychological co e-
la es. J. Subs . Misuse 3, 140–149.
Albe y, I.P., S ang, J., 1995. Illici d ugs and d i ing. In: Taylo , J.F.
(Ed.), Medical Aspec s o Fi ness o D i e. A guide o Medical
P ac i ione s. The Medical Commission on Acciden P e en ion,
London, pp. 142–156.
Ch is ophe sen, A.S., Mo land, J., 1997. D ugged d i ing, a e iew
based on he expe ience in No way. D ug Alcohol Depend. 47,
125–135.
Al a ez, F.J., Sancho, M., Vega, J., Del Rı´o, M.C., Rams, A., Queipo,
D., 1997. D ugs o he han alcohol (medicines and illici d ugs) in
people in ol ed in a al oad acciden s in Spain. In: Me cie -
Guyon, C. (Ed.), P oceedings o he 14 h In e na ional Con e ence
on Alcohol, D ugs and T a ic Sa e y T’97, ol. 2. CERMT,
Annecy, pp. 677–682.
Budd, R.D., Mu o, J.J., Wong, J.K., 1989. D ug o abuse ound in
a ally inju ed d i e s in Los Angeles Coun y. D ug Alcohol
Depend. 23, 153–158.
Cha lie , C., Plom eux, G., 1998. Alcohol, d ugs, medica ion and
highway sa e y in Belgium. Re . Med. Liege 53, 25–28.
Consensus De elopmen Panel, 1985. D ug concen a ion and d i ing
impai men . J. Am. Med. Assoc. 257, 2618–2621.
De Gie , J., 1993. D i ing Licenses and Known Use o Lici o Illic
D ugs. Ins i u e o Human Psychopha macology, Maas ich.
De Gie , J., 1998. Road a ic and illici d ugs. Council o Eu ope,
S asbou g (P-PG/Ci c ou (98) 1).
Del Rı´o, M.C., Al a ez, F.J., 1995a. Illegal d ugs and d i ing. J.
T a ic Med. 23, 1–5.
Del Rı´o, M.C., Al a ez, F.J., 1995b. Illegal d ug aking and d i ing:
pa e ns o d ug aking among Spanish d i e s. D ug Alcohol
Depend. 37, 83–86.

M.Ca men del Rı´o,F.Ja6ie Al6a ez
/
D ug and Alcohol Dependence
57 (2000) 177–182
182
D umme , O.H., 1994. D ugs in d i e s killed in Aus alian oad
a ic acciden s: he use o esponsibili y analysis o in es iga e
he con ibu ion o d ugs o a al acciden s. Monash Uni e si y,
Vic o ia.
D umme , O.H., 1995. A e iew o he con ibu ion o d ugs in
d i e s o oad acciden s. In: The E ec s o D ugs (O he han
Alcohol) on Road Sa e y, Fi s Repo . Go e nmen P in e ,
Melbou ne, pp. 1–28.
Eu opean Moni o ing Cen e o D ugs and D ug Addic ion, 1999.
Li e a u e e iew on he ela ion be ween d ug use, impai ed
d i ing and a ic acciden s. Eu opean Moni o ing Cen e o
D ugs and D ug Addic ion, Lisbon (CT.97.EP.14).
Fe a a, S.D., Gio ge i, R., Zancane , S., 1994. Psychoac i e sub-
s ances and d i ing: s a e o he a and me hodology. Alcohol
D ugs D i . 10, 1–55.
Gje de, H., Beylich, K.M., Mo land, J., 1993. Incidence o alcohol
and d ugs in a ally inju ed ca d i e s. Accid. Anal. P e . 25,
479–483.
Ha mee , S., Bjo ns ig, U., E iksson, A., Ohman, U., Sola z, A.,
1997. D ug and alcohol use among inju ed mo o ehicle d i e s
in Sweden: p e alence, d i e , c ash, and inju y cha ac e is ics.
Alcohol Clin. Exp. Res. 21, 968–973.
Hansen, A.C., K is ensen, I.B., D agshol , C., B angs up Hansen,
J.P., 1996. Alcohol and d ugs (medical and illici ) in a al oad
acciden s in a ci y o 300 000 inhabi an s. Fo . Sci. In . 79, 49–52.
K u¨ge , H.P., Bud, M.W., Huessy, F.B., Me ke, M., 1998. Illici
d ugs in oad a ic. Council o Eu ope, S asbou g (P-PG/Ci -
c ou (98) 5).
Lillsunde, P., 1996. D ugs and d i ing. Anali ical and epidemiological
aspec s. The Na ional Public Heal h Ins i u e, Helsinki.
Logan, B.K., Schwilke, E.W., 1996. D ug and alcohol use in a ally
inju ed d i e s in Washing on S a e. J. Fo ensic Sci. 41, 505–510.
Me ced, G.W., Je e y, W.K., 1995. Alcohol, D ugs, and impai men
in a al a ic acciden s in B i ish Columbia. Accid. Anal. P e .,
27, 335–343.
Pea , M.A., Finkle, B.S., 1992. Toxicological assay o psychoac i e
subs ances in biological luids. In: Fe a a, S.D., Gio ge i, R.
(Eds.), Me hodology in Man–Machine In e ac ion and Epidemi-
ology on D ugs and D i ing Sa e y. ARFI, Pado a, pp. 95–109.
Rams, M.A., O ega, A., Sancho, M., 1993. In luencia del alcohol y
las d ogas en los acciden es de a´ ico. Re . Esp. D ogodep. 178,
247–252.
Road Sa e y Commi ee, 1996. Inqui y in o he E ec s o D ugs
(O he han Alcohol) on Road Sa e y in Vic o ia, ol. 1, 2.
Vic o ian Go e nmen P in e , Vic o ia.
Tedeschi, L, F ison, G, Cas agna, F, Fe a a, S.D., 1992. Comp esi e
EIA/GC sc eening and GS-MS con i ma ion o psychoac i e sub-
s ances and blood and u ine. In: Fe a a, S.D., Gio ge i, R.
(Eds.), Me hodology in Man–Machine In e ac ion and Epidemi-
ology on D ugs and D i ing Sa e y. ARFI, Pado a, pp. 147–185.
.