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Objective: To investigate whether the use of recommended therapeutic doses of medicinal drugs has led to suspicion of driving under the influence of drugs (DUID) after implementation of legislative limits for illicit and medicinal drugs in 2012. Methods: Data from suspected drug-impaired drivers apprehended by the police from 2013 to 2015 were selected from the Norwegian Forensic Toxicology Database. The blood samples had been analyzed for benzodiazepines (BZDs), z-hypnotics, opioids, stimulants, certain hallucinogens, and alcohol. Drivers who tested positive for one BZD or a z-hypnotic only, were included in the study. Drug concentrations measured in their blood samples were compared to the maximal obtainable steady state concentrations if the drug had been used in accordance with the recommendations set by the Norwegian Directorate of Health. Results: BZDs or z-hypnotics were found in 10 248 samples, representing 59.6% of the total number of drivers arrested for suspected DUID (n = 17 201). Only one BZD or z-hypnotic with a blood drug concentration above the legislative limit was detected in 390 (2.3%) of the total number of samples. Clonazepam was the most frequently detected BZD (n = 4656), while as a single drug above the legislative limit, it was detected in only 3.6% (n = 168) of the clonazepam-positive blood samples. For drivers testing positive for only one z-hypnotic, drug concentrations above the legislative limit were found in 27% (n = 55) of the blood samples that tested positive for zolpidem and 12.4% (n = 53) of the samples that tested positive for zopiclone. In total, 155 subjects out of 10 248 testing positive for BZDs or z-hypnotics displayed concentrations above the legislative limit but within the concentration ranges that are expected when taking recommended therapeutic drug doses, and 77 below the legislativel limit. Conclusions: The results show that the implementation of legislative limits for BZDs and z-hypnotics may have contributed to DUID suspicion for a small group of patients using therapeutic drug doses; only 1.3% of the suspected DUID offenders had concentrations of only one of those drugs in-line with recommended therapeutic dosing.

Naltrexone blocks opioid effects effectively, but poor compliance limits the clinical usefulness in the treatment of opioid dependence. Long-acting implanted formulations might increase the clinical feasibility. Several implants have been produced, but few clinical reports have been published. This paper describes an open trial with an Australian implant. This implant is claimed to have duration of up to six months with double implants and acceptable levels of side effects. This was explored in the present pilot study with 13 opioid-dependent patients. By single implant of 1.8 g naltrexone the duration judged by naltrexone plasma levels above 1 ng/ml naltrexone was between 2 and 4 months. Double implants maintained such plasma levels for 5–6.5 months. Clinically, the implants appeared promising. Side effects were minimal. During the period with adequate plasma levels of naltrexone, use of opioids was absent and use of other psychoactive drugs reduced. At 1-year follow-up, the patients rated the implants highly positively.

Driving under the influence of alcohol is one of the principal causes of road traffic crashes (RTCs) [1]. The use of alcohol is also a risk factor for other road users, such as pedestrians and bicyclists. The association of alcohol in injurious and fatal RTCs has been well documented in most high-income countries, but data for low- and middle-income countries is scarce, particularly for African countries [2]. The study was a collaborative effort between Kamuzu Central Hospital (KCH), the Norwegian Institute of Public Health (NIPH) and Oslo University Hospital (OUH), with the financial support of UK Aid through the Global Road Safety Facility (GRSF) hosted by the World Bank, the International Council on Alcohol Drugs and Traffic Safety (ICADTS) and the Norwegian Council for Road Safety (Trygg Trafikk). The objective of the study was to generate new knowledge about road traffic injuries in Malawi and the extent of traffic accidents related to alcohol use, to increase capacity to conduct alcohol testing, and develop a database for the findings, which in turn will form the basis for future policymaking to reduce traffic accidents. The objectives were achieved through collecting data on patients who sought treatment after road traffic crashes and admitted to the Emergency Department at KCH in Lilongwe, Malawi. A questionnaire was developed for data collection in cooperation between the project groups in Norway and Malawi. The data included basic information about the patients, alcohol use before the injury, and information about accident circumstances, including types of road users and vehicles involved. Participation was voluntary and anonymous. All weekdays, weekends and nights were covered. Alcohol was measured using a breathalyzer or saliva test for those who were not able to blow. Knowledge and training of local KCH employees to perform alcohol testing and record data were an important aspect of this study. The project was approved by the National Health Science Research Committee (NHSRC) in Malawi. The Regional Committee for Medical and Health Research Ethics in Norway was consulted, and their conclusion was that no formal application was needed, with reference to the Norwegian Health Research Act Section, §2 and 4a. A Data Protection Impact Assessment was performed as required by NIPH. There were 1251 patients in the study, representing nearly 95 per cent of those who were asked to participate. The results show a rather high prevalence of alcohol use among several injured road user groups (totally about 25 percent), particularly among those injured during weekend nights and evenings, but also during weekday evenings and nights. It was estimated that about 15 per cent of injured motor vehicle drivers and riders had BACs above the legal limit of 0.8 grams/L at the time of the crash. The findings also show that it is important to focus on bus/minibus/lorry drivers who often carry passengers, where about one out of five tested positive for alcohol. It is worth noting that pedestrians had the highest prevalence of alcohol use before being injured. They constitute a vulnerable group; they often walk in the dark with no road lighting, no pavements, walkways or safe places to cross the road. Combined with alcohol use their injury risk is even higher. The collected data can contribute to future road traffic safety procedures and measures. The long-term goal is to contribute to sustainable development goal 3, target 3.6, to reduce by half the number of global RTC deaths and injuries. ; Hvert år dør ca. 1,3 millioner personer i trafikkulykker, 30-50 millioner blir skadet. Malawi er et av verdens fattigste land som ligger i sørøst-Afrika og har over 18 millioner innbyggere. Malawi er nå blant verdens 10 land med flest dødsulykker (over 30 døde/100 000 innbyggere, Norge har mindre enn 2/100 000). Det er lite kunnskap om årsakene til ulykkene, bl.a. omfanget av alkoholrelaterte ulykker. Landets alkoholgrense er 0,8 promille for førere av alle grupper motorkjøretøy. Å kjøre under påvirkning av alkohol er en av hovedårsakene til trafikkulykker [1]. Bruken av alkohol er også en risikofaktor for andre trafikanter, som fotgjengere og syklister. Det er godt dokumentert at alkohol er en faktor i skadelige og dødelige trafikkulykker i de fleste høyinntektsland, men data for lav- og mellom-inntektsland mangler, spesielt for afrikanske land [2]. Denne studien var et samarbeidsprosjekt mellom Kamuzu Central Hospital (KCH), Folkehelseinstituttet og Oslo Universitetssykehus, med økonomisk støtte fra UK Aid gjennom Verdensbankens Global Road Safety Facility (GRSF), the International Council on Alcohol, Drugs and Traffic Safety (ICADTS) og Trygg Trafikk. Målet var å generere ny kunnskap om veitrafikk skader i Malawi og omfanget av trafikkulykker knyttet til alkoholbruk, å øke kompetansen i å utføre alkohol-testing, og utvikle en database for å registrere resultatene. Hensikten var å gi et evidensbasert grunnlag for framtidig politikk utforming for å redusere trafikkulykker. Målene ble nådd gjennom å samle inn data om pasienter som søkte behandling etter trafikkulykker og som ble innlagt ved Akuttavdelingen ved KCH i Lilongwe, Malawi. Et spørreskjema ble utviklet i samarbeid med prosjektgruppene i Norge og Malawi. Dataomfanget inkluderte bl.a. grunnleggende informasjon om pasientene, alkohol bruk før skaden, i tillegg til opplysninger om omstendighetene rundt ulykken inkludert type trafikant og kjøretøy. Deltakelse var frivillig og all data ble anonymisert. Alle ukedager ble dekket i undersøkelsen, likeså helger og netter. Alkohol ble målt ved bruk av alkometer eller spyttprøver for pasienter som ikke var i stand til å blåse. Kunnskapsoverføring og opplæring av lokale KCH ansatte i å gjennomføre alkohol testing og dataregistrering var en viktig del av denne studien. Prosjektet var godkjent av den etiske komiteen i Malawi (NHSRC), og regional etisk komité for medisinsk og helsefaglig forskningsetikk (REK) ble konsultert. Deres konklusjon var at ingen formell søknad til REK var nødvendig med henvisning til Helseforskningsloven §2 and 4a. I tillegg ble det gjennomført en personvernkonsekvensutredning, i tråd med General Data Protection Regulation (GDPR) og krav fra Folkehelseinstituttet. Det var 1251 pasienter i studien, nærmere 95 % av de som ble spurt om å delta. Resultatene viser høy prevalens av alkohol bruk blant mange ulike grupper skadde trafikanter (totalt ca. 25%), spesielt blant de skadde under helgene (kveld og natt), men også mye på ukekvelder og netter. Omtrent 15% av de skadde førerne av motorkjøretøy hadde alkoholkonsentrasjon i blodet høyere enn lovlig grense på 0,8 promille på tidspunktet for ulykken. Funnene viser også at det er viktig å fokusere på førerne av buss/minibuss/lastebiler, som ofte har passasjerer om bord, hvorav en av fem testet positivt for alkohol. Det er verdt å merke at fotgjengere hadde høyest prevalens av alkoholbruk før de ble skadd. De er en sårbar gruppe; de går ofte i mørket uten veitrafikk lys og uten fotgjengerfelt eller trygge steder å krysse veien. Kombinert med alkoholbruk er risikoen for skade enda høyere. De innsamlede data kan bidra til framtidige veisikkerhetsprosedyrer og tiltak. Det langsiktige målet er å bidra til bærekraftsmål 3, delmål 3.6, å halvere antall dødsfall og skader i verden forårsaket av trafikkulykker. Denne studien viser hvor viktig det er å samle inn tilstrekkelig og relevant data for helsemyndigheter spesielt i lav- og mellom-inntektsland i kampen mot alkohol-relaterte trafikkulykker, dødsfall og skader. En rekke anbefalinger ble presentert malawiske myndigheter under et virtuelt seminar, på grunn av COVID-19 pandemien, som fant sted høsten 2020. ; This research project was made possible with the financial support of UK Aid through the Global Road Safety Facility hosted by the World Bank, the International Council on Alcohol Drugs and Traffic Safety (ICADTS) and the Norwegian Council for Road Safety (Trygg Trafikk). ; publishedVersion