The impact of drugs on road crashes, assaults and other trauma - a prospective trauma toxicology study

Monograph no. 20

William Griggs, David Caldicott, Jennifer Pfeiffer, Nicholas Edwards, Andrew Pearce, Michael Davey

The primary objective of this study was to determine the prevalence and patterns of use of specific recreational drugs in all patients with injuries requiring assessment by a trauma team at the Royal Adelaide Hospital over a one-year period. The other specific objectives included determining an estimate of the prevalence and patterns of drug use, and severity of injury, in patients presenting to the Emergency Department of the Royal Adelaide Hospital (patients of lesser severity of injury not requiring trauma service management) following a motor vehicle accident and other trauma. It also aimed to examine the correlation between drug use and mechanism, pattern, and severity of injury in patients presenting to the Royal Adelaide Hospital following a motor vehicle accident, and the epidemiological and demographic patterns associated with drug use and trauma.

Determining the prevalence of recreational drug use in patients referred by primary care providers (not hospital inpatients) for unrelated blood tests, as an estimate of the prevalence in the general community, was also an objective. The final objective was to compare the prevalence of recreational drug use in patients presenting following trauma with the estimate of that in the general community. A prospective observational study of recreational drug use in consecutive patients, this therefore included all mechanisms of trauma, such as assault - not just motor vehicle crashes. It ran for a period of 12 months, and involved the identification and quantitative analysis of blood samples for the presence of ethanol, opiates, methadone, amphetamines, benzodiazepines, cannabinoids and cocaine. The results were compared with each patient's prescribed medications, thereby yielding an estimate as to the prevalence of recreational drug use in patients presenting to hospital following a trauma. The study also examined the demographics and patterns of drug use in this population, as well as the correlation between specific drug use and mechanism, pattern and severity of injury. Quantitative analysis potentially allowed inferences to be drawn on the degree of impairment of the trauma victim. This study is one of the largest of its type ever completed, recruiting 2,127 patients from two trauma groups and one control group. Its findings provide compelling evidence of the incidence and severity of drug- and alcohol-related trauma in South Australia. They also have significant implications for health, law enforcement, policy-making and research in relation to the recognition of the impact of drugs on a range of trauma. Patients who are positive for alcohol and other drugs (AODs) create an additional, and presumably otherwise avoidable, financial burden on the health system. Significantly, the findings also add to the growing evidence base for trauma related to drug driving. The key findings of the study confirm that alcohol remains the most common recreational drug found in trauma patients. Other recreational drugs, especially cannabis, are also associated with trauma. There is evidence to suggest that use of recreational drugs before/while driving is associated with increased risk of injury occurrence and severity.