TRENDS OF ETHANOL AND ILLICIT DRUGS USE AMONG DRIVERS INVOLVED IN TRAFFIC CRASHES IN CAMPANIA (ITALY) DURING 2009-2014

In Italy studies regarding the toxicological findings among drivers hospitalized after a crash, are still insufficient and not homogeneous both in the sampling and in the analytical approach. This study assesses trends in the intake of ethanol and/or illicit drugs among drivers (n. 1058) involved in road accidents and admitted to the emergency unit of 16 hospitals of the Campania Region (Italy), from 2009 to 2014. To demonstrate the violation of the Road Safety Law, toxicological analyses were requested by police at the Forensic Toxicology Unit of the Second University of Naples for 434 blood samples. The urine (n. 624) was collected only when the sampling of blood was denied by drivers. A GC/HS-FID methodology was applied to testing the blood alcohol concentration (BAC) in 341 cases of suspect driving under the influence of alcohol (DUI) and in 93 cases of recent use of alcohol associated with illicit drugs (DUID). Validated methods (GC/MS or LC-MS/MS) for amphetamine and analogous,cocaine, opiate, benzodiazepines (n.35 BDZ), methadone, barbiturate, buprenorphine and cannabis metabolites were applied to blood or urine specimens to confirm the presence of psychoactive drugs. Trends in the use of alcohol and drugs among drivers in the years 2009-2011 and 2012-2014 were compared. The BAC greater than 0.5 g/L (legal limit in Italy) was confirmed in 92% of drivers with a significant increase in the period 2012-2014 (n. 231) compared to 2009-2011 (n. 100). The higher incidence of crashes involving drivers with BAC> 1.5 g/L, grows up from 40% to 58% from 2012 to 2014. In DUID cases (n.93) accidents occurred also with a lower BAC involving almost 42% of drivers with BAC in the range 0.8-1,5 g/L and 36% with BAC >1,5 g/L. In blood of DUID cases THC (35%), poly-drugs (31%) and Cocaine (26%) were the most confirmed substances whereas Opiate, BDZ and Methadone were present in < 5 % of cases. In urine THC-COOH was the most frequently identified compound alone (mean 31%) or in combination with other illicit drugs. In fact in drivers, positive for more than one drug (42% during 2009-2011 decreased to 22% in 2012-2014), THC-COOH was almost always present. Interestingly the incidence of Cocaine and BDZ, as only drug used, was duplicated in the years 2012-2014 compared with 2009-2011. Moreover in the accidents due to poly-drug use the cocaine was the drug prevalently confirmed together to THC-COOH. The study shows, since 2012 in Campania (Italy), an increasing involvement of Cocaine and Cannabis, alone or in combination with alcohol and other drug, in causing road traffic accidents. Therefore, in order to collect significant data for the future preventive policies, the use of pharmaceuticals, illicit drugs and alcohol should be routinely checked in all crashes using a forensic analytical approach