Review
Impairment based legislative limits for driving under the influence of non-alcohol drugs in Norway

https://doi.org/10.1016/j.forsciint.2011.11.004Get rights and content

Abstract

Aims

When non-alcohol drugs are detected in blood samples from apprehended drivers in Norway, individualised expert opinions are required to evaluate degree of impairment. For alcohol, legislative limits have been in use since 1936. To harmonize the current practice for driving under the influence of alcohol and non-alcohol drugs, a judicial reform with legislative limits for non-alcohol drugs has been suggested.

Methods

Impairment limits, representing drug concentrations in blood likely to be accompanied by a degree of impairment comparable to a blood alcohol concentration (BAC) of 0.02%, were proposed for 20 psychotropic drugs, including the most prevalent benzodiazepines, cannabis, GHB, hallucinogens and opioids. Limits for graded sanctions, representing drug concentrations in blood likely to induce impairment comparable to BACs of 0.05% and 0.12%, were defined for 13 of the 20 substances. The suggested limits were based on assessments of impairment after single doses of the drugs in naïve individuals. The proposed limits will not apply to individuals with valid prescriptions for medicinal drugs, where the present system with individualised expert evaluations will be maintained.

Conclusion

Norway is the first country planning to implement legislative limits for non-alcohol drugs corresponding to impairment seen at increasing BACs. The background and justification for the suggested limits are presented herein.

Section snippets

Background

Since 1936, Norway has practiced an impairment based law for driving under the influence (DUI) of alcohol (ethanol). The impairment limit for alcohol is now 0.02% and graded sanctions are given for higher blood alcohol concentrations (BACs), with limits corresponding to levels of 0.05% and 0.12%. Several countries have comparable alcohol limits. DUI cases involving non-alcohol drugs are handled differently: in these cases, the judicial process requires an expert witness statement to evaluate

A harmonization of the system for DUI of alcohol and non-alcohol drugs in Norway

The Norwegian Ministry of Transport and Communications sought to establish a new limit based penal process in DUI cases involving drugs not subject to a prescription from a physician. The new system should be based on a zero tolerance policy against impaired driving, disregarding individual tolerance and drug–disease interactions. The Ministry tasked an advisory group to suggest

  • a system for handling DUI cases involving the most frequently used non-alcohol drugs that lead to increased risk of

Benzodiazepines

Despite differences in pharmacokinetics, all benzodiazepines have common pharmacodynamic properties [33]. Equivalence tables which compare the potency (i.e. effect per weight unit) of the different benzodiazepines have been used to compare the different drugs in this class [34], [35].

Several epidemiologic studies have shown an increased risk of traffic accident after ingestion of benzodiazepines, but investigations of dose/concentration–effect relationships are sparse [11], [12], [14], [16],

Comparison of the suggested limits with relevant studies/reports

The proposed legislative limits have been compared to preliminary results from DRUID (personal communication, Gunter Berghaus and Maren Cecilie Strand), a report from the Netherlands [101] on legislative limits for illicit drugs and the Danish legislative limits. Studies from apprehended drivers suspected of DUI in Norway have suggested a relationship between the concentrations of several drugs and the results of a clinical examination [84], [91], [102], [103], [104], [105], [106], [107], [108]

Discussion

Legislation limits have been proposed for a selection of frequently detected psychoactive drugs in DUI cases in Norway. Due to a lack of scientific evidence, a pragmatic approach has been used. The scientific literature for comparing risk of traffic accidents and reduced performance at different concentrations levels after ingestion of drugs and alcohol is sparse, and the suggested limits may be subjected to debate. Since the aim of this work was to harmonize the judicial process involving

Acknowledgements

Thanks are due to Dr. Gunther Berghaus for letting us compare his “impairment” tables from the DRUID study with our suggested legislative limits. We are grateful to Dr. Liliana C. Bachs and her colleagues for performing extensive literature searches for relevant studies. We thank Terje Hammer for providing statistics from the DUI cases received at the Norwegian Institute of Public Health and for making graphic illustrations, and Gerrit Middelkoop for translating the report on legislative limits

References (138)

  • J.G. Bramness et al.

    The risk of traffic accidents after prescriptions of carisoprodol

    Accid. Anal. Prev.

    (2007)
  • J.C. Verster et al.

    Effects of alprazolam on driving ability, memory functioning and psychomotor performance: a randomized, placebo-controlled study

    Neuropsychopharmacology

    (2002)
  • K.M. Jalava et al.

    Lorazepam and diazepam differently impair divided attention

    Pharmacol. Biochem. Behav.

    (1995)
  • M.J. Mattila et al.

    Effects of alcohol, zolpidem, and some other sedatives and hypnotics on human performance and memory

    Pharmacol. Biochem. Behav.

    (1998)
  • M.G. Lenne et al.

    The effects of cannabis and alcohol on simulated arterial driving: influences of driving experience and task demand

    Accid. Anal. Prev.

    (2010)
  • A. Ronen et al.

    Effects of THC on driving performance, physiological state and subjective feelings relative to alcohol

    Accid. Anal. Prev.

    (2008)
  • H. Gjerde et al.

    Alcohol, psychoactive drugs and fatal road traffic accidents in Norway: a case-control study

    Accid. Anal. Prev.

    (2011)
  • F.X. Vollenweider et al.

    Effects of high amphetamine dose on mood and cerebral glucose metabolism in normal volunteers using positron emission tomography (PET)

    Psychiatry Res.

    (1998)
  • I. Gustavsen et al.

    Impairment related to blood amphetamine and/or methamphetamine concentrations in suspected drugged drivers

    Accid. Anal. Prev.

    (2006)
  • K.L. Nicholson et al.

    GHB: a new and novel drug of abuse

    Drug Alcohol Depend.

    (2001)
  • L.A. King et al.

    Seizures in a night club

    Lancet

    (2007)
  • I.J. Bosman et al.

    Forensic cases involving the use of GHB in The Netherlands

    Forensic Sci. Int.

    (2003)
  • A.C. Lahti et al.

    Subanesthetic doses of ketamine stimulate psychosis in schizophrenia

    Neuropsychopharmacology

    (1995)
  • A.W. Jones

    Driving under the influence of drugs in Sweden with zero concentration limits in blood for controlled substances

    Traffic Inj. Prev.

    (2005)
  • J.M. Walsh et al.

    Drugs and driving

    Traffic Inj. Prev.

    (2004)
  • M. Strand et al.

    Psychomotor relevant performance: after single dose administration of opioids, narcoanalgesics and hallucinogens to drug naive subjects

    (2010)
  • M.J. Barker et al.

    Cognitive effects of long-term benzodiazepine use: a meta-analysis

    CNS Drugs

    (2004)
  • I. Lucki et al.

    Chronic use of benzodiazepines and psychomotor and cognitive test performance

    Psychopharmacology (Berl.)

    (1986)
  • C.M. Bradley et al.

    Effects of a mu-opioid receptor agonist (codeine phosphate) on visuo-motor coordination and dynamic visual acuity in man

    Br. J. Clin. Pharmacol.

    (1986)
  • M. Linnoila et al.

    Interaction of alcohol and drugs on psychomotor skills as demonstrated by a driving simulator

    Br. J. Pharmacol.

    (1973)
  • M. Linnoila et al.

    Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving

    Clin. Pharmacol. Ther.

    (1974)
  • G. Pickering et al.

    Comparative trial of tramadol/paracetamol and codeine/paracetamol combination tablets on the vigilance of healthy volunteers

    Fundam. Clin. Pharmacol.

    (2005)
  • W.O. Evans et al.

    The interaction of high altitude and psychotropic drug action

    Psychopharmacologia

    (1966)
  • L.C. Bachs et al.

    The risk of motor vehicle accidents involving drivers with prescriptions for codeine or tramadol

    Clin. Pharmacol. Ther.

    (2009)
  • J.E. Gibson et al.

    Use of self-controlled analytical techniques to assess the association between use of prescription medications and the risk of motor vehicle crashes

    Am. J. Epidemiol.

    (2009)
  • S.G. Leveille et al.

    Psychoactive medications and injurious motor vehicle collisions involving older drivers

    Epidemiology

    (1994)
  • B. Laumon et al.

    Cannabis intoxication and fatal road crashes in France: population based case–control study

    BMJ

    (2005)
  • S. Blows et al.

    Marijuana use and car crash injury

    Addiction

    (2005)
  • D.C. Skegg et al.

    Minor tranquillisers and road accidents

    Br. Med. J.

    (1979)
  • R. Honkanen et al.

    Role of drugs in traffic accidents

    Br. Med. J.

    (1980)
  • B. Hemmelgarn et al.

    Benzodiazepine use and the risk of motor vehicle crash in the elderly

    JAMA

    (1997)
  • D. Currie et al.

    The use of anti-depressants and benzodiazepines in the perpetrators and victims of accidents

    Occup. Med. (Lond.)

    (1995)
  • J.G. Bramness et al.

    Minor increase in risk of road traffic accidents after prescriptions of antidepressants: a study of population registry data in Norway

    J. Clin. Psychiatry

    (2008)
  • The relationship between drivers’ blood alcohol concentration (BAC) and actual driving performance during high speed travel

  • O.H. Drummer

    Benzodiazepines—effects on human performance and behavior

    Forensic Sci. Rev.

    (2002)
  • R.I. Shader et al.

    Can you provide a table of equivalences for benzodiazepines and other marketed benzodiazepine receptor agonists?

    J. Clin. Psychopharmacol.

    (1997)
  • C.H. Ashton, Benzodiazepine equivalence table, 2007....
  • T.R. Leufkens et al.

    Cognitive, psychomotor and actual driving performance in healthy volunteers after immediate and extended release formulations of alprazolam 1 mg

    Psychopharmacology (Berl.)

    (2007)
  • M. Linnoila et al.

    Effects of single doses of alprazolam and diazepam, alone and in combination with ethanol, on psychomotor and cognitive performance and on autonomic nervous system reactivity in healthy volunteers

    Eur. J. Clin. Pharmacol.

    (1990)
  • A. Bond et al.

    Effects of single doses of alprazolam and alcohol alone and in combination on psychological performance

    Hum. psychopharmacol.

    (1991)
  • Cited by (110)

    View all citing articles on Scopus
    View full text