{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:45:15Z","timestamp":1789181115935,"version":"build-2803163510"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Impaired driving is an important public health issue, but its prevalence is challenging to monitor.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To report the prevalence of alcohol, cannabis, recreational drugs, and sedating medications in injured Canadian drivers, identify demographic and collision factors associated with drug or alcohol use, and compare the prevalence of drug-involved driving in different parts of Canada.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study prospectively obtained blood samples from injured drivers treated in 15 Canadian trauma centers and measured blood levels of tetrahydrocannabinol (THC; the main impairing compound in cannabis), alcohol, stimulants, opioids, and depressants from January 2019 to June 2023. Data were analyzed from April to May 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Blood levels of THC, alcohol, stimulants, opioids, and depressants.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Demographic and collision details were extracted from medical records. The crude prevalence for each substance class among all injured drivers and in selected subgroups was computed. Logistic regression models identified factors associated with substance use.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 8328 injured drivers (mean [SD] age, 43 [18] years; median [IQR] age, 40 [28-57] years; 5605 male [67.3%]; 2723 female [32.7%]), 4568 (54.9%) tested positive for an impairing substance and 1798 (21.6%) tested positive for 2 or more substance classes. Depressants, as a class, were detected in 2368 drivers (28.4%). THC was the most commonly detected single substance (1354 drivers [16.3%]), followed by alcohol (1341 drivers [16.1%]). Stimulants (1057 drivers [12.7%]) and opioids (905 drivers [10.9%]) were also detected. Substances were detected less often in drivers aged 75 years or older (195 of 455 drivers [42.9%]) and younger than 19 years (149 of 304 drivers [49.0%]). THC was most common in drivers aged 19 to 24 years, alcohol in drivers aged 19 to 34 years, stimulants in drivers aged 35 to 44 years, opioids in drivers aged 55 to 64 years, and depressants in drivers aged 65 to 74 years. Males had similar prevalence of substance use as females (3141 males [56.0%] vs 1427 females [52.4%]); more males used alcohol (adjusted odds ratio [aOR], 1.53; 95% CI, 1.21-1.92), cannabis (aOR, 1.66; 95% CI, 1.48-1.86), and stimulants (aOR, 1.53; 95% CI, 1.34-1.75), but males were less likely to have used a depressant (aOR, 0.54; 95% CI, 0.47-0.62). Rural drivers were more likely to use alcohol (aOR, 1.51; 95% CI, 1.29-1.76), stimulants (aOR, 1.32; 95 CI, 1.03-1.70), depressants (aOR, 1.28; 95% CI, 1.09-1.51), opioids (aOR, 1.26; 95% CI, 1.08-1.47), any substance (aOR, 1.40; 95% CI, 1.20-1.63), or multiple classes of substances (aOR, 1.55; 95 CI, 1.23-1.95). There was substantial geographic variation in the prevalence of substance use in injured drivers.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>These findings suggest that impaired driving is a substantial road safety concern in Canada. Continued monitoring is required to develop targeted interventions and to evaluate the effectiveness of prevention measures.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.6379","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T15:00:46Z","timestamp":1745334046000},"page":"e256379","source":"Crossref","is-referenced-by-count":11,"title":["Prevalence of Impairing Substance Use in Injured Drivers"],"prefix":"10.1001","volume":"8","author":[{"given":"Jeffrey R.","family":"Brubacher","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Erdelyi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Simmons","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Dalhousie Medicine, Saint John, New Brunswick, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floyd","family":"Besserer","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raoul","family":"Daoust","sequence":"additional","affiliation":[{"name":"Department of Emergency and Family Medicine, University of Montreal, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"\u00c9mond","sequence":"additional","affiliation":[{"name":"Department of Family and Emergency Medicine, Universit\u00e9 Laval, Quebec City, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Eppler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques S.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"MacPherson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirk","family":"Magee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Dalhousie University, Dalhousie University, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Mercier","sequence":"additional","affiliation":[{"name":"Department of Family and Emergency Medicine, Universit\u00e9 Laval, Quebec City, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Ohle","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Parsons","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Memorial University, St John\u2019s, New Foundland and Labrador, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagadish","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Saskatchewan, Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian H.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada"},{"name":"School of Public Health, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Vaillancourt","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Wishart","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"issue":"4","key":"zoi250257r2","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.jsr.2009.07.002","article-title":"The Long Beach\/Fort Lauderdale relative risk study.","volume":"40","author":"Blomberg","year":"2009","journal-title":"J Safety Res"},{"issue":"8","key":"zoi250257r3","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1111\/add.13347","article-title":"The effects of cannabis intoxication on motor vehicle collision revisited and revised.","volume":"111","author":"Rogeberg","year":"2016","journal-title":"Addiction"},{"issue":"6","key":"zoi250257r4","doi-asserted-by":"publisher","first-page":"e374","DOI":"10.1016\/S2468-2667(21)00027-X","article-title":"Medications and risk of motor vehicle collision responsibility in British Columbia, Canada: a population-based case-control study.","volume":"6","author":"Brubacher","year":"2021","journal-title":"Lancet Public Health"},{"issue":"6","key":"zoi250257r5","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1016\/j.euroneuro.2016.02.012","article-title":"Amphetamine-type stimulant use and the risk of injury or death as a result of a road-traffic accident: a systematic review of observational studies.","volume":"26","author":"Hayley","year":"2016","journal-title":"Eur Neuropsychopharmacol"},{"key":"zoi250257r6","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.aap.2016.08.001","article-title":"Medication use and the risk of motor vehicle collisions among licensed drivers: a systematic review.","volume":"96","author":"Rudisill","year":"2016","journal-title":"Accid Anal Prev"},{"key":"zoi250257r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2019.105389","article-title":"Odds of culpability associated with use of impairing drugs in injured drivers in Victoria, Australia.","volume":"135","author":"Drummer","year":"2020","journal-title":"Accid Anal Prev"},{"key":"zoi250257r10","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2022.106694","article-title":"Correlation between oral fluid and blood THC concentration: a systematic review and discussion of policy implications.","volume":"173","author":"Robertson","year":"2022","journal-title":"Accid Anal Prev"},{"issue":"4","key":"zoi250257r11","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1136\/injuryprev-2012-040488","article-title":"Interpretation of postmortem forensic toxicology results for injury prevention research.","volume":"19","author":"Drummer","year":"2013","journal-title":"Inj Prev"},{"issue":"3","key":"zoi250257r13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009278","article-title":"Prevalence of alcohol and drug use in injured British Columbia drivers.","volume":"6","author":"Brubacher","year":"2016","journal-title":"BMJ Open"},{"issue":"9","key":"zoi250257r14","doi-asserted-by":"publisher","first-page":"1616","DOI":"10.1111\/add.14663","article-title":"Cannabis use as a risk factor for causing motor vehicle crashes: a prospective study.","volume":"114","author":"Brubacher","year":"2019","journal-title":"Addiction"},{"issue":"1","key":"zoi250257r15","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1186\/s12889-020-09176-5","article-title":"Epidemiology of drug driving: protocol from a national Canadian study measuring levels of cannabis, alcohol and other substances in injured drivers.","volume":"20","author":"Masud","year":"2020","journal-title":"BMC Public Health"},{"issue":"2-3","key":"zoi250257r16","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/S0379-0738(01)00538-2","article-title":"Delta(9)-THC, 11-OH-Delta(9)-THC and Delta(9)-THCCOOH plasma or serum to whole blood concentrations distribution ratios in blood samples taken from living and dead people.","volume":"123","author":"Giroud","year":"2001","journal-title":"Forensic Sci Int"},{"issue":"3","key":"zoi250257r18","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.3758\/s13428-021-01627-0","article-title":"Using cluster-robust standard errors when analyzing group-randomized trials with few clusters.","volume":"54","author":"Huang","year":"2022","journal-title":"Behav Res Methods"},{"issue":"3","key":"zoi250257r19","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1037\/gpr0000123","article-title":"Do P values lose their meaning in exploratory analyses? It depends how you define the familywise error rate.","volume":"21","author":"Rubin","year":"2017","journal-title":"Rev Gen Psychol"},{"key":"zoi250257r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2022.106713","article-title":"Impacts of alcohol and opioid polysubstance use on road safety: systematic review.","volume":"173","author":"Beaulieu","year":"2022","journal-title":"Accid Anal Prev"},{"key":"zoi250257r21","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.aap.2012.06.017","article-title":"Risk of road accident associated with the use of drugs: a systematic review and meta-analysis of evidence from epidemiological studies.","volume":"60","author":"Elvik","year":"2013","journal-title":"Accid Anal Prev"},{"issue":"4","key":"zoi250257r22","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1136\/injuryprev-2020-043840","article-title":"Prescription medication use as a risk factor for motor vehicle collisions: a responsibility study.","volume":"27","author":"Asbridge","year":"2021","journal-title":"Inj Prev"},{"key":"zoi250257r23","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108177","article-title":"Residual blood THC levels in frequent cannabis users after over four hours of abstinence: a systematic review.","volume":"216","author":"Peng","year":"2020","journal-title":"Drug Alcohol Depend"},{"issue":"2","key":"zoi250257r25","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1080\/00450618.2019.1687753","article-title":"Prevalence of drugs in injured drivers in Victoria, Australia.","volume":"53","author":"DiRago","year":"2019","journal-title":"Aust J Forensic Sci"},{"issue":"3","key":"zoi250257r26","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1002\/dta.1393","article-title":"Alcohol and drugs in seriously injured drivers in six European countries.","volume":"5","author":"Legrand","year":"2013","journal-title":"Drug Test Anal"},{"key":"zoi250257r27","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2019.109914","article-title":"Prevalence of therapeutic drugs in blood of drivers involved in traffic crashes in the area of Bologna, Italy.","volume":"302","author":"Pelletti","year":"2019","journal-title":"Forensic Sci Int"},{"issue":"4","key":"zoi250257r28","doi-asserted-by":"publisher","first-page":"7403","DOI":"10.22605\/RRH7403","article-title":"Comparing rural traffic safety in Canada and Australia: a scoping review of the literature.","volume":"22","author":"Mason","year":"2022","journal-title":"Rural Remote Health"},{"issue":"5","key":"zoi250257r29","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/j.aap.2009.05.008","article-title":"Identification of differences between rural and urban safety cultures.","volume":"41","author":"Rakauskas","year":"2009","journal-title":"Accid Anal Prev"},{"issue":"3","key":"zoi250257r30","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.jsr.2008.02.030","article-title":"The relationship between blood alcohol concentration (BAC), age, and crash risk.","volume":"39","author":"Peck","year":"2008","journal-title":"J Safety Res"},{"issue":"1","key":"zoi250257r31","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s42238-024-00240-0","article-title":"Attitudes toward driving after cannabis use: a systematic review.","volume":"6","author":"Boicu","year":"2024","journal-title":"J Cannabis Res"},{"issue":"7","key":"zoi250257r33","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1001\/archgenpsychiatry.2009.36","article-title":"Cross-national associations between gender and mental disorders in the World Health Organization world mental health surveys.","volume":"66","author":"Seedat","year":"2009","journal-title":"Arch Gen Psychiatry"},{"issue":"3","key":"zoi250257r34","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1080\/09595230412331289482","article-title":"A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions.","volume":"23","author":"Kelly","year":"2004","journal-title":"Drug Alcohol Rev"},{"issue":"6","key":"zoi250257r35","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1111\/j.1360-0443.2010.02902.x","article-title":"Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey.","volume":"105","author":"Swendsen","year":"2010","journal-title":"Addiction"},{"key":"zoi250257r1","unstructured":"World Health Organization. Global status report on road safety 2023. Published December 13, 2023. Accessed March 14, 2025. https:\/\/www.who.int\/publications\/i\/item\/9789240086517"},{"key":"zoi250257r8","unstructured":"Ontario Ministry of Transportation. 2022 Roadside survey of alcohol and drug use by drivers in Ontario: final report. Published 2023. Accessed March 14, 2025. https:\/\/www.library.mto.gov.on.ca\/SydneyPLUS\/Sydney\/Portal\/default.aspx?component=AAAAIY&record=983dae99-27e7-4847-8957-896fe5b8433b&lang=en-US"},{"key":"zoi250257r9","unstructured":"Berning? A, Compton? C, Wochinger? K. Results of the 2013\u20132014 National Roadside Survey of Alcohol and Drug Use by drivers. US Department of Transportation National Highway Traffic Safety Administration. Published February 2015. Accessed March 14, 2025. https:\/\/www.nhtsa.gov\/sites\/nhtsa.gov\/files\/812118-roadside_survey_2014.pdf"},{"key":"zoi250257r12","unstructured":"Statistics Canada. Census profile, 2021 census of population. Published February 9, 2022. Updated November 15, 2023. Accessed March 14, 2025. https:\/\/www12.statcan.gc.ca\/census-recensement\/2021\/dp-pd\/prof\/index.cfm?Lang=E"},{"key":"zoi250257r17","unstructured":"Mechanda? K, Puderer? H. How postal codes map to geographic areas. Statistics Canada Geography Division. Published February 2007. Accessed March 14, 2025. https:\/\/publications.gc.ca\/Collection\/Statcan\/92F0138M\/92F0138MIE2007001.pdf"},{"key":"zoi250257r24","unstructured":"Thomas? FD, Berning? A, Darrah? J, . Drug and alcohol prevalence in seriously and fatally injured road users before and during the COVID-19 public health emergency. National Highway Traffic Safety Administration. Published October 2020. Accessed March 14, 2025. https:\/\/rosap.ntl.bts.gov\/view\/dot\/50941"},{"key":"zoi250257r32","unstructured":"Statistics Canada. National cannabis survey, 2023. Published March 18, 2024. Accessed March 14, 2025. https:\/\/www150.statcan.gc.ca\/n1\/en\/daily-quotidien\/240318\/dq240318e-eng.pdf?st=U90_8TXK"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2833126\/brubacher_2025_oi_250257_1744746603.46132.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T15:00:57Z","timestamp":1745334057000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2833126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,22]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.6379","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,22]]}}}