Research Paper
A comparison of alcohol and drug use by random motor vehicle drivers in Brazil and Norway

https://doi.org/10.1016/j.drugpo.2014.01.019Get rights and content

Abstract

Background

A large proportion of road traffic crashes are related to driving under the influence (DUI) of alcohol or drugs. The aim of this study was to compare the use of alcohol, illegal drugs and psychoactive medicinal drugs among random drivers in Brazil and Norway, two countries with the same legal limit for drunk driving, but with marked differences in legislation history, enforcement and penalties for DUI, and to discuss any differences found.

Methods

Roadside surveys were conducted on Fridays and Saturdays between noon and midnight. Samples of oral fluid were collected for analysis of drugs, whereas alcohol was determined by breath testing or by analysis of oral fluid.

Results

High participation rates of 94–97% were obtained in both countries. The weighted prevalence of driving with alcohol concentrations in breath or oral fluid equivalent to blood alcohol concentrations (BAC) above 0.2 g/L was 2.7% (95% CI 2.2–3.3) in Brazil and 0.2% (95% CI 0.0–0.5) in Norway. Stimulants (amphetamines or cocaine) were found in samples from 1.0% (95% CI 0.7–1.4) of drivers in Brazil and 0.3% (95% CI 0.1–0.7) in Norway. The prevalence of amphetamines was highest among Brazilian truck drivers (3.6%; 95% CI 2.0–6.4). Tetrahydrocannabinol was found in samples from 0.5% (95% CI 0.3–0.8) of drivers in Brazil and 1.0% (95% CI 0.6–1.5) in Norway, whereas benzodiazepines or zopiclone were found in 1.0% (95% CI 0.7–1.4) and 1.7% (95% CI 1.2–2.4) of the samples from Brazil and Norway, respectively.

Conclusions

The difference in the prevalence of alcohol may be related to the fact that Norway has implemented steps to reduce drunk driving since 1936, whereas Brazil has attempted to do the same for only a few years. Differences for drugs may be related to different patterns in the use of stimulants, cannabis and medicines.

Introduction

The number of serious road traffic accidents in low and middle income countries has increased during the last decades. When calculating the sum of years of life lost due to premature mortality and years lived with disability, the so-called disability adjusted life years (DALYs), road traffic accidents was globally ranked as the 10th most important reason for lost years of life or years with disability in 2010 (Murray et al., 2012). The World Health Organization predicts that by 2030 road traffic injuries will rise to become the fifth leading cause of death with 2.4 million fatalities (WHO, 2009).

Ninety-one percent of the world's fatalities on the roads occur in low-income and middle income countries, which have only 48% of the world's registered vehicles (WHO, 2011). The number of fatal traffic crashes has decreased steadily in high income countries for the last decades, but the number is increasing in low and middle income countries (WHO, 2011).

The use of alcohol or drugs (drugs are in this article defined as illicit drugs or psychoactive medicinal drugs) is a contributing factor in a large proportion of traffic accidents. However, only 89 countries, covering 66% of the world's population, have a comprehensive driving under the influence (DUI) law with a BAC limit of 0.5 g/L or less (WHO, 2013), which is often regarded as an appropriate limit because the crash risk increases significantly for BACs above this concentration (Voas et al., 2012, Zador et al., 2000). Some countries have also laws against DUI of illegal and medicinal drugs, either per-se laws, zero tolerance, or impairment laws (OECD, 2010, Vindenes et al., 2012). DUI laws, enforcement and penalties vary between countries and have been implemented at different historical moments. Also, the drivers’ knowledge and respect for the DUI laws vary (Antov et al., 2012); therefore the incidence of driving under the influence of alcohol or drugs and the involvement of alcohol and drugs in fatal crashes varies.

In the USA, the proportion of drivers involved in fatal crashes who had blood alcohol concentrations (BACs) above the legal limit of 0.8 g/L declined from 48% in 1982 to 31% in 2010 (NHTSA, 2011). The prevalence of drunk driving has also decreased (Kelley-Baker et al., 2013). It is likely that this positive trend may be related to changes in laws, enforcement, and public knowledge and opinion.

In a study of fatal traffic accident victims in Porto Alegre, Brazil, alcohol was found in blood samples from 32.2% of the accident victims (Stampe et al., 2010). Analysis of other psychoactive substances was performed for about two thirds of the cases, with positive findings in about 11% of the samples. In a similar study in São Paulo, 42.3% of drivers involved in fatal road traffic accidents where blood samples were analysed for alcohol had blood alcohol concentrations (BAC) above 0.6 g/L (Ponce, Munoz, Andreuccetti, de Carvalho, & Leyton, 2011). In a Norwegian study of 196 drivers killed in 2006–8, 25.0% were found to have BAC above the legal limit of 0.2 g/L, 10.2% were found positive for illegal drugs, and 13.8% were positive for psychoactive medicinal drugs (Gjerde, Christophersen, Normann, & Mørland, 2011). In the recent European project “Driving under the Influence of Drugs, Alcohol and Medicines” (DRUID), the prevalence of alcohol and drugs in blood samples from seriously injured drivers in six countries and fatally injured drivers in four countries were studied. Type of crash (single or multiple vehicle accident) was available for five and three countries, respectively. Among injured drivers, 41–68% of drivers involved in single vehicle accidents and 15–35% of those injured in multiple vehicle accidents had used alcohol or drugs, whereas among drivers killed in road accidents in three countries, 47–58% of those killed in single vehicle accidents and 19–32% of those killed in multiple vehicle accidents had alcohol (above 0.1 g/L) or drugs present in their blood (Isalberti et al., 2011) (for cut-off concentrations see Isalberti et al., 2011 or Houwing et al., 2012). Comprehensive reviews of alcohol and drug findings in injured or killed drivers in many countries have been published (Gonzalez-Wilhelm, 2007, Kelly et al., 2004, Penning et al., 2010, Walsh et al., 2004), confirming that large proportions of the drives had used alcohol or drugs.

To reduce the number of alcohol and drug related traffic crashes, it is important to reduce the number of alcohol and drug impaired drivers on the roads. As the first country in the world, Norway introduced legal BAC limit in 1936. At that time the limit was set to 0.5 g/L, and for many decades the sentence for drunk driving was three weeks in prison and withdrawal of the driver's license for more than a year. The legal limit was lowered to 0.2 g/L in 2001 and the sentence for drunk driving was changed, to only a fine and withdrawal of the driver's license for low BACs and unconditional imprisonment for BACs above 1.2 g/L in addition to a fine and withdrawal of the driver's license. From 1981 the police was allowed to do random breath testing without any particular suspicion of drunk driving, and if the driver refused to give a breath test, a blood sample could be taken by force. For driving under the influence of drugs, Norway had an impairment law until 2012; then a per-se law was introduced with legislative limits for 20 illegal and medicinal drugs (un-prescribed use) (Vindenes et al., 2012). The impairment law still applies for other drugs.

Brazil introduced a legal BAC limit of 0.8 g/L in 1989; this was reduced to 0.6 g/L in 1997. In 2008 the “zero” limit was introduced with suspension of driving privileges for a BAC above 0.2 g/L. Drivers can refuse to give a breath of blood sample. This option is fairly commonly chosen because the penalty seems not to be very much deterring. The sentence for driving with BAC above 0.6 g/L is imprisonment, a fine, and withdrawal of the driver's license for one year. For lower BACs the penalty is a smaller fine as well as withdrawal of the license. The incidence of drunk driving is fairly high; almost 35% of the population of major urban centres reported driving after drinking at least three units of alcohol during the previous 12 months (Pechansky et al., 2009). Previous studies at sobriety checkpoints in Brazil found that 22–38% of the motor vehicle drivers at night-time in weekends had been drinking (Campos et al., 2008, Duailibi et al., 2007). Tougher sanctions were implemented in the country at the end of 2012, where any trace of alcohol found in a blood sample or breath test would allow for legal sanctions. However, for driving under the influence of drugs other than alcohol, Brazil still faces a “grey area”, where sanctions are clearly described in the law, but the assessment of drug impairment lacks definitions for its implementation.

Brazil and Norway had the same legal limit for alcohol of 0.2 g/L at the time of this study (2008–2009); however, the enforcement and penalties for DUI have been different, as described above. The aim of this study was to compare the use of alcohol and drugs among drivers in random traffic in Brazil and Norway, to discuss reasons for the differences and possible interventions.

Section snippets

Methods

Drivers were recruited for this study using stratified multi-stage cluster sampling procedures between August 2008 and September 2009 in Brazil and between April 2008 and March 2009 in Norway. In the first stage, geographical districts were chosen. In Brazil, federal highways within 50 km from the geographical center of the 27 state capitals were chosen, whereas in Norway, roads were selected within 200 km from Oslo, the Norwegian capital and the largest city of the country; within 120 km from the

Results

The refusal rates among those who were asked to participate in the study were 3% in Brazil and 6% in Norway. In total, 3326 drivers were included in Brazil and 2038 drivers in Norway.

The distribution of gender and age among participants in addition to types of vehicles and the distribution of time periods are presented in Table 2. Statistically significant differences between the included drivers in Brazil and Norway (p < 0.05) were observed for gender, for five of the age groups, for all time

Discussion

The main finding of this study was that drunk driving was found to be more common in Brazil than in Norway. The use of stimulants was more common among Brazilian drivers, primarily due to the use of amphetamines by truck drivers, whereas the use of cannabis was more common among Norwegian drivers.

Conclusion

Driving with BAC above the legal limit of 0.2 g/L was found to be more common in Brazil than in Norway. The use of stimulants (amphetamines or cocaine) was more common among the Brazilian drivers, primarily due to high prevalence of amphetamines in samples from truck drivers, whereas the use of cannabis was more common among Norwegian drivers. It is most important to reduce the incidence of drunk driving, because alcohol is commonly used and because alcohol impairment poses a larger risk to road

Role of funding source

The Brazilian roadside survey was sponsored by The National Secretariat for Drug and Alcohol Polices of the Brazilian Government (contract no. 004/2007); whereas the Norwegian roadside survey was sponsored by the European Union through the 6th Framework Program funded integrated project DRUID (contract no. TREN-05-FP6TR-S07.61320-518404-DRUID) and the Norwegian Research Council (contract no. 189735/I10). The funders had no further role in the study design, in the collection, analysis and

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgements

Thanks to the Brazilian Federal Highway Police, the Brazilian Federal Police and the Norwegian Mobile Police Service for stopping drivers for the study. Thanks to Terje Assum for planning time periods and sites for the Norwegian roadside survey. Thanks to Bjørg Pettersen, Ada J. Rognerud, Azemira Sabaredzovic and the staff at NIPH for recruiting drivers and collecting and analyzing samples of oral fluid.

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  • Cited by (0)

    1

    Current address: Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

    2

    Current address: Leonardo Rodrigues Criminalistic Institute, Goiânia, Brazil.

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