Drugs and Driving: Developing a Sentinel Drug_FARS for Research

 描述（由申请人提供）：文献中存在关于药物对驾驶影响的验证结果。这是一个重大关切，因为据报告，2013年有990万人在非法药物影响下驾驶。死亡分析报告系统（法尔斯）是对美国所有致命车辆碰撞的普查，是一个可以揭示这种差异的信息来源。 然而，目前无法确定所进行的测试，因为法尔斯仅记录阳性结果而非阴性结果。这一差距是理解毒品和驾驶影响的主要障碍。法尔斯也没有区分活性四氢大麻酚，负责大麻的急性影响，和非活性代谢物，可以持续数周。因此，我们不知道致命受伤的司机是否在事故发生时受到大麻的影响，或者是否在事故发生前几天消费。这些缺陷排除了进行研究，评估药物参与碰撞，趋势，或药物驾驶法的影响。在某些设有集中法医实验室的州，存在关于致命受伤司机的全面和高质量数据。法尔斯目前的结构没有利用这一信息，因为没有建立任何机制将这些报告系统联系起来。这项研究的长期目标是通过开发一个可靠的数据库，使用毒理学数据，可以支持有效的药物驾驶研究，以减少与毒品有关的交通伤害。这项R21探索性赠款的主要目的是证明开发一个哨兵药物-FARS研究数据库的可行性，以调查有关药物和交通事故风险的重要问题。随后的目标包括确定致命受伤的司机参与药物的流行和趋势，并确定潜在的州和县，为未来的研究开发一个全面的药物FARS。这项研究是一项创新的，具有成本效益的，可持续的应用数据链接的医学检查，毒理学和法尔斯数据库，以解决公共卫生需要的数据对药物使用和驾驶。一个多学科专家工作组将就交通死亡事故毒理学数据库模型的开发提供咨询意见。将检查来自三个州（马里兰州、华盛顿和西弗吉尼亚州）的毒理学实验室和医学检查员数据，并将数据统一为通用数据元素。在州一级将毒理学数据与法尔斯联系起来，将丰富关于碰撞情况和促成因素的质量数据。该数据库将用于确定准确的吸毒驾车流行率和趋势。还将对法尔斯的药物测试进行深入分析，以确定制定全面药物-法尔斯的候选州。这项研究将产生一个研究数据库（Sentinel Drug-FARS），使研究人员能够确定与个别药物和驾驶有关的风险，并设计，监测和评估针对药物驾驶的干预措施。这些目标的实现将可能影响从地方到国家一级的核心毒理学药物数据收集和联系方法。本研究将 还有助于数据处理的标准化，以便于进行跨州和跨时间的比较。

 DESCRIPTION (provided by applicant): Conflicting results exist in the literature on the effects of drugs on driving. This is a major concern as 9.9 million persons reported driving under the influence of illicit drugs in 2013. The Fatality Analysis Reporting System (FARS), a census of all U.S. fatal vehicle crashes, is a source of information that could shed light into this discrepancy. However, currently it is not possible to determine tests performed as FARS only records positive and not negative results. This gap is a major impediment to understanding the impact of drugs and driving. FARS also does not distinguish between the active THC, responsible for the acute effects of marijuana, and the inactive metabolites, which can persist for weeks. Therefore, we do not know if fatally injured drivers were under the influence of marijuana at the time of the crash or if the consumption occurred days prior the crash. These deficiencies preclude conducting studies evaluating drug involvement in crashes, trends, or the effects of drugged driving laws. Comprehensive and high quality data on fatally injured drivers exists in certain states with centralized forensic laboratories. The current structure of FARS does not utilize this information as no mechanism is in place to link these reporting systems. The long-term objective of this study is to reduce drug related traffic injuries by developing a reliable databas using toxicology data that can support valid drugged driving research. The main aim of this R21 exploratory grant is to demonstrate the feasibility of developing a sentinel Drug-FARS research database to investigate important issues regarding drugs and traffic crash risk. Subsequent aims include determining the prevalence and trends in drug involvement in fatally injured drivers; and identifying potential states and counties for development of a comprehensive Drug-FARS for future research. This study is an innovative, cost-effective, and sustainable application of data linkage of medical examiner, toxicology, and FARS databases to address the public health need for data on drug use and driving. A multi-disciplinary Expert Working Group will advise on the development of a toxicology database model for traffic fatalities. Toxicology laboratory and medical examiner data from three states, Maryland, Washington, and West Virginia will be examined and data harmonized into common data elements. Linkage of toxicology data with FARS at the state level will enrich the quality data on crash circumstances and contributing factors. The database will be used to determine accurate drugged driving prevalence and trends. In-depth analyses of drugs testing in FARS will also be conducted to identify candidate states for development of a comprehensive Drug-FARS. This research will result in a research database (Sentinel Drug-FARS) that will enable researchers to determine risks related to individual drugs and driving, and to design, monitor and evaluate interventions targeting drugged driving. The fulfillment of the aims will potentially influence the core toxicoloy drug data collection and linkage methodology from the local to the national levels. This study will also contribute to standardize the data process to facilitate comparison across states and time.