Introduction: The Italian National Institute of Statistics recorded 5.131 fatal road accidents in 2007. One of the main causes of traffic crashes is driving under the effects of alcohol and/or psychoactive substances (illicit drugs or some medication). In Italy the legal limit of blood alcohol concentration passed from 0.8 g/L to 0.5 g/L in 2007 and the Court can decide if also psycoactive substances have to analysed in blood in fatal accidents. Aims: A retrospective study was carried out to produce epidemiological data concerning the role played by alcohol and psychoactive substances in fatal road accidents. The focus of this study was to establish the dimension of this problem and to describe the characteristics of people involved in road fatalities under psychoactive substance effects. Methods: The material studied is made up of 487 subjects deceased in consequence of road accidents and examined at the Department of Legal Medicine, University of Pavia, during the period from 01-01-1999 to 30-06-2009. More than 70% of people involved in traffic accident were mothorvehicle driver, while pedestrian and cyclist are equally represented. Blood specimens were analyzed for alcohol and in 262 cases also for illicit and therapeutic drugs. Drugs when present were quantitated. Urine, when available, was submitted to immunochemical screening of drugs of abuse and confirmation of positive results by GC-MS. Results:. Alcohol above 0.1 g/L was detected in 205 cases (42.2%) and the concentration measured was above the legal limit (0.5 g/L) in the 70.7% of these cases. A blood alcohol concentration (BAC) between 1.5 g/L e 2.5 g/L was mesured in 55 cases (27%) while 28 subjects (14%) had a BAC higher than 2,5 g/l. Central nervous system active drugs were detected in 23.3% (62 cases). Cocaine and metabolites (29%) and cannabinoids (25%) are the most represented drugs of abuse; opioids were detected in 24 cases, morphine was detected in 9 cases and methadone in 15 ones, and no amfetamine and derivatives are founded. Association with alcohol was found in 25.4% of positive cases for illicit drugs. Conclusions: The incidence of alcohol and drugs among the population involved in fatal traffic accidents highlight the importance of performing qualitative and quantitative blood analyses to assess the effective role of alcohol and drugs in driving impairment.
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