A Survey of Oregon Emergency Physicians to Assess Mandatory Reporting Knowledge and Reporting Patterns Regarding Intoxicated Drivers in the State of Oregon

Objectives: To assess emergency physician reporting patterns in Oregon before and after the passage of a mandatory intoxicated driving reporting law. Methods: A one‐page survey was mailed to 504 emergency physicians in Oregon in April 2004. Data on reporting frequency were collected using a four‐point ordinal scale regarding motor vehicle crash–involved drivers (MIDs) and intoxicated persons attempting to drive away from the emergency department (DAEDs). Paired observations were assessed for a stated increase in reporting activity following passage of the law using the Wilcoxon signed‐rank test. Associations of postlaw reporting and demographic and knowledge factors were sought using Spearman rank correlation analysis. Results: Of the 504 surveys mailed, 298 (59%) were adequate for analysis. Many respondents (57%) were already aware of the law. Most (92%) agreed that physicians should be mandated to report some crimes. MIDs were always reported by 18% of physicians before the law and by 47% afterward, whereas DAEDs were always reported by 56% of physicians before the law and by 69% afterward. Emergency medicine–trained physicians, higher emergency department census, and increased years of experience were associated with a significantly higher increase in reporting pattern after passage of the law for both MIDs and DAEDs. Conclusions: Although 44% of responding emergency physicians in Oregon were unaware of a mandated reporting law for intoxicated drivers presenting to the ED, most physicians stated an increase in their reporting practice.     

Drug-impaired driving and traffic collisions: Study on a cross section of the Italian population

The present study focuses on the association between road accidents and the presence of drugs of abuse markers in the biological fluids of the drivers. Biological fluids collected from 1236 drivers involved in road accidents (54 fatal and 1182 non-fatal crashes) in the Rome area were analyzed for alcohol and psychotropic drugs, as required by judicial authorities. The substance most frequently detected was alcohol (in 19% of non-fatal and 32% of fatal crashes), followed by cannabinoids (12% of non-fatal crashes) and cocaine (9% of non-fatal and 20% of fatal crashes). The results obtained for cocaine and cannabinoids in blood and urine were compared. We observed the absence or low concentrations of the active drug in blood (cocaine was often below 5 ng/ml and THC below 1 ng/ml), whereas urinary concentrations of metabolites were generally high (benzoylecgonine 250–above 5000 ng/ml, THCCOOH 15–270 ng/ml). The risk of being involved in a road accident if cocaine or cannabis markers were present in the urine specimens was evaluated compared to a control population. The odds ratios calculated, being 8.13 for cannabis and 5.32 for cocaine, suggest a strong association between the presence of these drugs in the urine of drivers and traffic accidents, regardless of their presence in blood samples. The present data suggest that the chance of being involved in a road accident is higher than in the control population even if the subject is no longer “under the influence” of cannabis or cocaine at the time of the accident.     

Symbolic Interaction Theory: A Perspective on Drug Abuse and Its Treatment

Symbolic interaction theory is employed to explain the etiology of drug abuse and addiction. Selected interactionist concepts, which are especially pertinent to an understanding of drug abuse, are considered in relation to current drug abuse theory and the literature on the characteristics of drug abusers. The implications of this theoretical perspective for treatment are considered.     

DUI recidivism by intervention adherence: a multiple risk factor approach

ABSTRACT

Background: Multi-component impaired driving interventions can reduce driving under the influence (DUI) recidivism rates; however, outcomes are better for those who complete the interventions and are adherent with program expectations. Research is needed to examine the differences between DUI offenders who are adherent vs. non-adherent to intervention efforts. Objective: The current study utilized a multi-risk factor model to predict recidivism among first-time DUI offenders enrolled in an intervention program. Differences between offenders who were adherent (including program completion) vs. non-adherent with the intervention were examined. Method: Using data from the Mississippi Alcohol Safety Education Program (MASEP) and state administrative records, the current study examined both recidivism rates and rates of intervention completion for all individuals enrolled in the program. The sample was predominantly White (58.8%) and male (80.2%). Results: Individuals who were adherent with the intervention were significantly less likely to recidivate within 3 years. Prior traffic or other criminal violations positively predicted recidivism rates. The likelihood of recidivism varied, with males, African Americans, and younger individuals with less education at greater risk of recidivism. Adherence with the intervention was more common for African American and older participants. Conclusion: The MASEP participants who were adherent with the intervention were significantly less likely to recidivate than those who were non-adherent. However, variance in the multi-component intervention completion rates suggests that the program resonates better with specific population subsets. We argue for researchers and policymakers to further explore how specific population subsets react to varying intervention programs to maximize efforts to reduce impaired driving.     

The Criminal History of Repeat DUI Offenders

This study tested whether repeat driving under the influence (DUI) offenders have more extensive criminal histories, exclusive of DUI and traffic offenses, than first-time offenders. Analysis of arrest and criminal history data from a random sample of 429 DUI arrestees found that being a repeat DUI offender increased the total number of convictions (regardless of severity), misdemeanor convictions, and petty misdemeanor/violation convictions. The results illustrate the challenges of rehabilitating and deterring DUI recidivists and the potential differences between first-time and repeat DUI offenders. Among DUI recidivists, impaired driving is best viewed as just one manifestation of a host of deviant behaviors.     

Effectiveness of interventions for convicted DUI offenders in reducing recidivism: a systematic review of the peer-reviewed scientific literature

Background: Driving under the influence (DUI) is a major cause of death and disability. Although a broad array of programs designed to curb DUI incidents are currently offered to both first-time and recidivist DUI offenders, existing evaluations of the effectiveness of these programs have reported mixed results. Objective: To synthesize the results of DUI program evaluations and determine the strength of the available evidence for reducing recidivism for different types of programs. Methods: A systematic review of all EBSCO databases, EMBASE, PubMed, ProQuest, Sociological Abstracts and TRIS was conducted to identify evaluations of treatments/interventions to prevent DUI offenses. Additional articles were identified from reference lists of relevant articles. Results: A total of 42 relevant studies were identified by the search strategy. Of these, 33 utilized non-experimental evaluation designs or reported insufficient data to allow effect sizes to be calculated, making meta-analysis unfeasible. Evaluations of several different program types reported evidence of some level of effectiveness. Conclusion: Because of the general lack of high quality evidence assessing the effectiveness of DUI prevention programs, it is not possible to make conclusive statements about the types of programs that are likely to be most effective. Nonetheless, there was some evidence to support the effectiveness of programs that utilize intensive supervision and education. There is a need for future evaluations to adopt more scientifically rigorous research designs to establish the effects of these programs.     

我院门诊镇静催眠药应用情况分析

目的:了解我院门诊处方镇静催眠药的应用情况。方法:随机抽取我院2008年3月49791张门诊处方中镇静催眠药处方1317张,分析应用频次排序列前5位药物的用药合理性。结果:应用频次列前5位的镇静催眠药分别为阿普唑仑片、艾司唑仑片(舒乐安定)、劳拉西泮片(罗拉)、唑吡坦片(思诺思)和氯硝西泮片,其药物利用指数值分别为0.54、0.73、0.19、0.81及0.53。结论:我院镇静催眠药应用剂量较合理,与药品说明书所列适应证的相符率较高。     

我院2006—2008年麻醉药品应用分析

目的了解我院麻醉药品临床应用情况及用药趋势,为临床合理用药提供参考。方法采用限定日剂量（DDD）和药物利用指数（DUI）为指标对我院FUGLEHIS系统提供的2006—2008年麻醉药品的应用数据进行统计和分析。结果我院麻醉药品的用量及销售金额逐年增加,芬太尼注射液的用药频度连续3年居第一位,硫酸吗啡缓释片浃施康定）的用药频度连续3年居第二位。结论我院麻醉药品应用基本合理,但尚存在不足之处,应进一步加强对麻醉药品应用的干预和管理。