THE DETERMINATION OF DRUGS IN BLOOD OF SUSPECTED DRUNKEN DRIVERS BY MEANS OF THE RADIOIMMUNOASSAY

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1 THE DETERMINATION OF DRUGS IN BLOOD OF SUSPECTED DRUNKEN DRIVERS BY MEANS OF THE RADIOIMMUNOASSAY (RIA) W. Arnold and B. Brinkmann Institut fur Rechtsmedizin D-200C Hamburg 54, Butenfeld 34 der Universitat Hamburg, The officia l s ta t is t ic reports of the Federal Republic of Germany concerning the causes of traffic accidents do not take into consideration the influence of medicines and so called drugs (S ta tist. Jahrb.). The frequency is reported with less than 1%. Numerous recent reports, however, indicate that the number of accidents due to medicines is remarkably higher. This difference has various reasons: (1) Drivers under the influence of medicines and drugs do not get noticed unless they cause an accident, whereas those under the influence of alcohol are noticed in traffic controls. Drug influence is only suspected when the typical symptoms of a drunken driver appear and an alcohol odour in the breath is not existent. Even then samples of blood or urine are not taken and reasons such as fatigue and commotio cerebri are considered responsible. (2) Drivers who show only slig h t neurologic symptoms after an accident without any alcohol odour are seldom suspected to be under the influence of drugs. Thus, samples of blood and urine are rarely taken. In cooperation with the hospital we could prove that more than 50% of urine samples of those involved in an accident and who had shown no signs of alcoholization axhibited positive test results for drugs (Arnold u. Taube 1977, Langendorff et al 1978). (3) Driver who show signs of alcohol ization in tests performed by a physician are perhaps weeks or months 506

2 later suspected to have taken drugs in addition. Especially this group was the subject of several examinations. With the help of microanalytic methods such as RIA and spectrometric analyses Moller could prove that about 20% of the blood samples taken for alcohol tests contained in addition medicines. Drasch and his colleagues obtained an even higher percentage in the region of Munich. Recently a steady increase of proceedings with the following facts is observed: A driver causes an accident. By breath tests the suspicion of alcoholization arises. The analysis of the blood sample leads to the result of a concentration of less than 0,8 or 1,3 g /oo which is the penal lim it in Germany. The suspicion of additional influence of medicines and drugs is expressed by the public prosecutor. With the help of microanalytic tests the blood sample is reexamined. In more than 50% of these cases a positive drug concentration is found and thus the proceedings is frequently led to a decision. Taking this into consideration we asked whether and how often positive medicine and drug results could be found in a selected sample. Out of a total of alcohol reports from 1979 we selected those cases where the doctor had stated typical symptoms of alcoholization but where the concentration in the blood was less than 0,5 g /oo. By this, 215 cases of this group were selected. Results and discussion The case material may be derived from table 1. According to the strength of reactions these were divided into two subgroups one of them comprising strong positive re actions the second group indicative for low concentrations (table 2). The remains of the blood samples of these 215 persons were analysed for morphine, amphetamine, methaqualon, 507

3 barbiturate and cocaine. Because of technical reasons only few samples could be tested for benzodiazepine. Up to now 1/4 of these cases led to a positive result. All test results of the substance groups that were analysed by the RIA are given in table 2. As there were some samples with positive reactions in more than one test, our results with special regard to the number of samples are summarized in table 3. In a ll, the tests proved 55 positive cases, that is 25%. 27 cases proved an obvious concentration of drugs, 28 cases were near the lim it where a concentration can be proved. It has to be mentioned that within the group of the obvious cases one proved 3 substances and 4 cases proved 2 substances. To summarize the tests it has to be stated that the analysed samples of persons involved in accidents who showed clear symptoms of alcoholization were in contrast with the small amount of alcohol concentration. After the tria ls had ended with a verdict of 'not g u ilty ', RIA tests were used to find various medicines and drugs. These led to positive results in about 25% of all cases. The group of benzodiazepine was not taken in consideration. In about 13% a higher concentration of various drugs was found which would have had a legal relevance of evidence, that is, without the need of any other evidence. It has therefore to be demanded that in cases with a low alcohol concentration but obvious symptoms of alcoh olization a toxicological screening is applied. We feel that such a screening can be limited to certain groups of substances. This demand has of course also to be applied to suspected cases with a higher concentration and especially to those without odour of alcohol. We believe that a renunciation of such tests leads to a legal insecurity, for these drug consumers threaten the tra ffic safety to a high degree. It has to be feared that these groups profit permanently by the lack of such 508

4 test. The number of such drivers increases steadily. It is not necessary to point out that the lack of taking a blood sample, that is if only a breath test was taken, is an important lack of evidence for example if someone was killed. The lack of taking blood sample might lead to serious omissions in legal proceedings. Table 1 Blood samples tested for drugs f males (m) 194 females (f) 21 total 215 age variation 15 to 80 y. 509

5 Table 2 Test results (RIA) for various drug groups in 215 blood samples positive low concentr. posi ti ve Total age varation and means( ) s ex d i s t r i b u t i o Morph i ne y.(24) 8 m : 1 f I Methaqualone y.(28) 7 m : 2 f j Barbi turates y (29) 36 m: 3 f j Amphetami nes r y. 1 f Cocaine / an 23 y. 2 m Table 3 Summary of RIA performed in 215 blood samples No. of cases Percentage of cases s trongly pos i ti ve % weekly positive % 3 drugs in 1 sample 1 2 drugs in 1 sample 4 510

6 Literatur Arnol d, W., Taube, G. Trunkenheit ohne Alkohol fur Verkehrsmedi zin, Saarbrlicken 1976 Drasch, G., v Kaiiert, G. :.Meyer,L. Veranderungen im Spektrum verkehrsmedizinisch relevanter Arzneimittel in den 1etzten Jahren -... flir Verkehrsmedi zin, Munster 1980 Langen d orff, Arnold, W. Sch ottle, H. Schontag, H. H.U., Zur Bedeutung der Medikamenteneinnahme fur die Verkehrstuchtigkeit Unfa!1 chi rurgie 4 ( 1978), Mo 11 e r, M. Wagner, H. J. Birr, G. Naheres von Medikamenten bei verkehrsauffal1i gen Verkehrsteilnehmern flir Verkehrsmedi zin, Koln 1979 Mb 11e r, M. Klinische und toxikologische Untersuchungen von Blutproben verkehrsauffa llig e r VerkehrsteiInehmer. flir Verkehrsmedi zin, Munster 1980 N. N. Statistisches Jahrbuch der Bundesrepub 1ik Deutschland, Statistisches Bundesamt