Prevalence of Alcohol and Drugs in Fatal Road Traffic Injuries (RTIs) in a Thai Population Between 2018 and 2023
Keywords:
road traffic injury, alcohol, drugs, Thai, postmortemAbstract
Objective To determine and compare the prevalence of alcohol, drugs of abuse and medicines in fatal road traffic injuries (RTIs) in Thailand from 2018 through 2023.
Methods A retrospective study was conducted of fatal RTI cases sent for autopsy at the Department of Forensic Medicine, Siriraj Hospital, Mahidol University from 2018 through 2023. Subject data, including sex, age, type of RTI case, blood alcohol concentration (BAC), and urine drug profile, were collected. Descriptive statistics, Chi-square tests, Mann–Whitney U tests, and Kruskal–Wallis H tests were performed as appropriate.
Results From 2018 through 2023 a total of 1,979 fatal RTI cases were included in this study. Of those cases, 1,649 were male (83.3%) and the mean subject age was 37.3 years. The yearly prevalence of driving under the influence (DUI) of alcohol (BAC > 50 mg/dL) during the study period was between 45.80% and 53.40% with the exception of 2022, which showed a significant increase at 57.10% (p < 0.05). The prevalence of drugs in 2023 was 21.00%, a significant difference compared with the prevalence in 2018 of 13.70% (p < 0.05). The prevalence of cannabis use showed an increasing trend, with a statistically significant increase in 2023 (p < 0.05). The preva-lence of multiple drug use also significantly increased over the study period, particularly in 2023 (p < 0.05).
Conclusions The prevalence of drugs of abuse and medication in fatal RTI cases markedly increased over the study period, particularly in 2023. There was a significant increase in cannabis use and poly-drug use in fatal RTI cases over the period, especially in 2023.
References
Seresirikachorn K, Singhanetr P, Soonthornworasiri N, Amornpetchsathaporn A, Theeramunkong T. Characteristics of road traffic mortality and distribution of healthcare resources in Thailand. Sci Rep. 2022;12:20255. PubMed PMID: 36424407.
Behnood A, Mannering FL. The effects of drug and alcohol consumption on driver injury severities in single-vehicle crashes. Traffic Inj Prev. 2017;18:456-62.
Taylor B, Rehm J. The relationship between alcohol consumption and fatal motor vehicle injury: high risk at low alcohol levels. Alcohol Clin Exp Res. 2012;36: 1827-34.
Irwin C, Iudakhina E, Desbrow B, McCartney D. Effects of acute alcohol consumption on measures of simulated driving: a systematic review and meta- analysis. Accid Anal Prev. 2017;102:248-66.
Hels T, Lyckegaard A, Simonsen KW, Steentoft A, Bernhoft IM. Risk of severe driver injury by driving with psychoactive substances. Accid Anal Prev. 2013; 59:346-56.
Sribanditmongkol P, Junkuy A, Homkham N, Worasuwannarak W, Hess JA. Autopsy study of alcohol-associated unnatural deaths in Thailand, 2007-2019. Alcohol Clin Exp Res (Hoboken). 2023;47:2056-67.
Ingsathit A, Woratanarat P, Anukarahanonta T, Rattanasiri S, Chatchaipun P, Wattayakorn K, et al. Prevalence of psychoactive drug use among drivers in Thailand: a roadside survey. Accid Anal Prev. 2009;41: 474-8.
Barone R, Pelletti G, Garagnani M, Giusti A, Marzi M, Rossi F, et al. Alcohol and illicit drugs in drivers involved in road traffic crashes in Italy. An 8-year retrospective study. Forensic Sci Int. 2019;305:110004. PubMed PMID: 31707239
Gjerde H, Frost J. Prevalence of alcohol and drugs among drivers killed in road traffic crashes in Norway during 2011-2020. Traffic Inj Prev. 2023;24:256-61.
Kalayasiri R, Boonthae S. Trends of cannabis use and related harms before and after legalization for recreational purpose in a developing country in Asia. BMC Public Health. 2023;23(1):911. PubMed PMID: 37208663
Wongchanapai W, Dokpuang D, Sasithonrojanachai S, Tamtakerngkit S. Stability of postmortem blood ethanol under experimental conditions. Siriraj Med J. 2008;60:62-65.
Charatprakai P, Sukata S, Phuangphung P. Comparison of blood and urinary cannabis profiles between road traffic injury (RTI) and other causes of death in Thai postmortem cases. Biomedical Sciences and Clinical Medicine. 2025;64:182-92.
Scientific Working Group for Forensic Toxicology. Scientific Working Group for Forensic Toxicology (SWGTOX) standard practices for method validation in forensic toxicology. J Anal Toxicol. 2013;37:452-74.
Christophersen AS, Mørland J, Stewart K, Gjerde H. International trends in alcohol and drug use among vehicle drivers. Forensic Sci Rev. 2016;28:37-66.
Mehranbod CA, Gobaud AN, Branas CC, Chen Q, Giovenco DP, Humphreys DK et al. Trends in alcohol-impaired crashes in California, 2016 to 2021: A time series analysis for alcohol involvement and crash distribution among demographic subgroups. Alcohol Clin Exp Res (Hoboken). 2023;47:1119-31.
Walters JK, Repp KK, Mew MC. Alcohol and drug presence in traffic crash fatalities before and after the COVID-19 pandemic: evaluation of the fatality analysis reporting system (FARS) and linked medical examiner-vital records data in Clackamas, Multnomah, and Washington County, Oregon, 2019-2021. Forensic Sci Int Synerg. 2024;8:100468. PubMed PMID: 38707715
Schumann J, Perkins M, Dietze P, Nambiar D, Mitra B, Gerostamoulos D, et al. The prevalence of alcohol and other drugs in fatal road crashes in Victoria, Australia. Accid Anal Prev. 2021;153:105905. PubMed PMID: 33631704
Beirness DJ, Gu KW, Lowe NJ, Woodall KL, Desrosiers NA, Cahill B, et al. Cannabis, alcohol and other drug findings in fatally injured drivers in Ontario. Traffic Inj Prev. 2021;22:1-6.
D’Orazio AL, Mohr ALA, Chan-Hosokawa A, Harper C, Huestis MA, Limoges JF, et al. Recommendations for toxicological investigation of drug-impaired driving and motor vehicle fatalities-2021 Update. J Anal Toxicol. 2021;45:529-36.
Gjerde H, Jamt REG, Stenehjem JS, Bogstrand ST. Substance use and driver fatality in Norway: an expanded case-control study. Traffic Inj Prev. 2024;26:1-9.
Ji Kwon N, Han E. A review of drug abuse in recently reported cases of driving under the influence of drugs (DUID) in Asia, USA, and Europe. Forensic Sci Int. 2019;302:109854. PubMed PMID: 31255839
Masten SV, Guenzburger GV. Changes in driver cannabinoid prevalence in 12 U.S. states after implementing medical marijuana laws. J Safety Res. 2014;50:35-52.
Carfora A, Campobasso CP, Cassandro P, Petrella R, Borriello R. Alcohol and drugs use among drivers injured in road accidents in Campania (Italy): A 8-years retrospective analysis. Forensic Sci Int. 2018;288:291-96.
Simonsen KW, Hasselstrøm JB, Hermansen SK, Rasmussen BS, Andreasen MF, Christoffersen DJ, et al. The incidence of psychoactive substances and alcohol among impaired drivers in Denmark in 2015-2019. Forensic Sci Int. 2022;333:111207. PubMed PMID: 35144220
