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Research Report
Norlen Mohamed, MD
Wahida Ameer Batcha
Nurul Kharmila Abdullah, MD
Muhammad Fadhli Mohd Yusoff, MD
Sharifah Allyana Syed Mohamed Rahim
Mohd Shah Mahmood, MD
Research Report
Norlen Mohamed, MD
Wahida Ameer Batcha
Nurul Kharmila Abdullah, MD
Muhammad Fadhli Mohd Yusoff, MD
Sharifah Allyana Syed Mohamed Rahim
Mohd Shah Mahmood, MD
MIROS 2012 All Rights Reserved
Published by:
Research report : alcohol and drug use among fatally injured drivers
In urban area of Kuala Lumpur / Norlen Mohamed ... [et al.]
(Research report. MRR 02/2012)
ISBN 978-967-5967-23-8
1. Drunk driving--Research--Malaysia.
2. Drinking and traffic accidents--Research--Malaysia.
I. Traffic accidents--Research--Malaysia. II. Norlen Mohamed, 1970-.
III. Series.
363.12514072
Norlen M, Wahida AB, Nurul Kharmila A, Muhammad Fadhli MY, Sharifah Allyana SMR & Mohd Shah M
(2012), Alcohol and Drug use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur, MRR 02/2012,
Kuala Lumpur:Malaysian Institute of Road Safety Research.
DISCLAIMER
None of the materials provided in this report may be used, reproduced or transmitted, in any form or
by any means, electronic or mechanical, including recording or the use of any information storage and
retrieval system, without written permission from MIROS. Any conclusion and opinions in this report
may be subject to reevaluation in the event of any forthcoming additional information or investigations.
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Contents
List of Figures v
List of Tables vi
Acknowledgement vii
Abstract ix
1.0 Introduction 1
1.1 Driving Under Influence of Alcohol 2
1.1.1 How Alcohol Impaired Driving 3
1.1.2 Risk of Crash Involvement 4
1.2 Driving Under the Influence of Drug 6
2.0 Methods 8
2.1 Design and Study Population 8
2.2 Data Sources 9
2.3 Data Collection Process 10
3.0 Results 13
Section 1: General Road Traffic Deaths 13
3.1 Number of Fatal Road Traffic Deaths 13
3.2 Road Traffic Deaths by Gender and Ethnic Group
Composition 14
3.3 Age-sex Distribution of Road Traffic Deaths
Presented to the Department of Forensic
Medicine, HKL, 20062009 14
3.4 Distribution of Road Traffic Deaths
by Types of Road User 15
3.5 Distribution of Road Traffic Deaths by Types
of Accident 15
3.6 Number of Fatal Cases according to the Types
of Case and Types of Road User 15
3.7 Trimodal Death of Road Users 17
iii
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
List of Figures
Page
v
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
List of Tables
Page
vi
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Acknowledgements
vii
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Abstract
ix
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
1.0 Introduction
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Findings from the Grand Rapid Study, which was done in 1964,
showed that drivers who had consumed alcohol had a higher
risk of crash involvement in comparison to drivers with a zero
BAC. The finding also indicated that the risk of crash involvement
increased rapidly as the BAC rose as shown in Figure 1. These
results provided the basis for setting up legal blood alcohol limits
and breathe content limits in many countries around the world,
typically at 0.08 g/dl (WHO 2004).
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Table 1 Relative risk of alcohol related road crashes at various BAC level
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
2.0 Methods
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Two data source were used, the post-mortem files which include
(post-mortem reports, police 61 forms, post-mortem drafts, and
toxicology reports) obtained from the Department of Forensic
Medicine, Kuala Lumpur Hospital and the police-based accident
data obtained from MIROS Road Accident Analysis and Database
System.
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
For driving under the influence of drug, for illicit drug such
as Opiates (heroin, morphine, codeine), Cannabis (THC),
Amphetamines (MDMA, Methamphetamine), Ketamine and
Cocaine, a driver is said to test positive for drugs if the result
of the blood test is positive. However, for medicinal drugs
such as diazepam, aprazolam, midazolam, benzodiazepines,
chloraphenyramine and carbamazephine, the therapeutic dose
range was considered before decision was made whether it
could be classified as a case of driving under the influence. This is
because within the therapeutic dose range, the drugs are known
to compromise some components of function for safe driving
such as alertness level. Those drugs with concentrations below
the therapeutic dose range will be excluded from under the
influence even though this might have effects on safe driving
function.
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
level were listed for each positive case. For medicinal drugs,
before the final list for driving under the influence of drug was
issued, second opinion from a clinical toxicologist was sought.
All Road Traffic Accident (RTA) deaths from 20062009 were traced from
the Death Registry Book, Forensic Medicine Department, HKL
List of post-mortem number was submitted to Assistant Officer of Medical Record, Record
Management Unit, Forensic Medicine Department, HKL
Data collection (Accident data, injury details and toxicology results were recorded into
data collection template)
Matching with police-based data were done based on police report number and personal
identification number
Data Analysis
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
750
No. of RTA deaths eligible for data collection after excluding misclassified cases
and sensitive cases that were under court proceedings
670 This number of cases were used for analysis of general road traffic deaths
No. of RTA deaths that have toxicology results either negative or positive
(alcohol and drug)
509
No. of RTA deaths classified as group of drivers (four wheel vehicle drivers, riders
and cyclists)
Final number of cases eligible for analysis of driving under the influence of
391 substance use
143
Figure 3 Flow chart for searching of driving under the influence of drug and alcohol
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
3.0 Results
Section 1: General Road Traffic Deaths
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
among males (age group 29 and below) account for 54.6%. For
the female road users, the highest number was from the 2029
age group with 20 cases, followed by those from age group
3039.
The cases included in this study are divided into two different
categories; Brought-in-Dead (BID) and Dead-in-Department
(DID). BID case is defined as a case in which the victim is
pronounced dead before arrival at the hospital. A DID case is
defined as any case in which the victim dies in the Emergency
Department or in the ward. The majority of cases presented to
HKL were BID cases which accounted for 80% of the total cases,
as shown in Figure 8. The Dead-in-Department (DID) cases
accounted for 20% of the total cases.
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Number
Age
Figure 5 Age-sex distributions of fatal road traffic death at the Department of Forensic
Medicine, HKL, 20062009
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
There were 532 BID cases and 138 DID cases recorded for this
study. Data breakdown based on DID cases for vulnerable road
users (motorcyclists, pillion riders, pedestrians and cyclists)
shows that most of the deaths for DID cases happened on the
same day of the accident. Motorcyclists accounted for the largest
number with 52 cases of death occurring within one (1) day of
the accident, followed by pedestrians and pillion riders with
12 and six cases respectively. In addition, there were two cases
of death among motorcyclists recorded within two days after
the accident, and three cases after three days of the accident.
Besides that, there was one case of death each recorded for
cyclist and pedestrian three days after the accident. The detailed
comparison for all road users can be referred to in Figure 9.
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
1 day 11 2 5 1 0 4 0 1
2 days 2 0 0 0 0 0 0 0
3 days 1 0 0 0 0 0 0 0
More than 3 3 0 0 1 0 1 0 0
days
Unknown 6 0 0 0 0 1 0 0
Total 377 35 110 26 22 74 4 20 670
Out of 670 cases, 509 (76.0%) cases were eligible for analysis of
substance use related problem. The other 24.0% of cases were
excluded for detailed analysis of substance use, as toxicology
result was not available due to pending results or samples not
collected. Of the 670 cases comprising all types of road user, 112
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Number of death
Test result
Figure 10 Number of road traffic deaths (all road users) by status of toxicology result
cases (16.7%) were tested positive for alcohol only and 54 cases
(8.1%) were tested positive for drug only. In addition, 16 cases
(2.5%) were tested positive for both alcohol and drug (Figure 10).
Out of 509 cases eligible for detailed analysis for substance use,
391 (76.8%) of them were individuals who operated the vehicle
during the accident. This group will be noted as group of drivers.
14.2% were pedestrians. Others were either back or front seat
passengers or pillion riders. Because pillion riders, back, and front
seat passengers were not of primary concern for driving under
the influence, the subsequent analysis focuses on the group
of drivers that included four wheels vehicle drivers, riders, and
cyclist.
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Table 4 Road traffic death cases by types of substance use, types of case and group of drivers
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Figure 11 Prevalence of substance use among fatal drivers, riders and cyclists by year
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Figure 12 Distribution and specific rate of cases with positive substance use by day
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Distribution (%) of road traffic death cases (+ve substance use) by time
Specific fatality rate (%) of cases with positive substance use by time
Figure 13 Distribution and specific rate of cases with positive substance use by time
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Percentage
Age
Table 5 Fatal road traffic cases with positive substance use by types of
accident
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Mean = 178.56
Std. Dev. = 77.725
N = 91
Limit 20 mg /
100 ml Limit 80 mg /
100 ml
Limit 50 mg /
100 ml
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
The incidences of fatal drivers positive for illicit drugs was 10%,
with opiates group at the top of the list (5.4%) followed by
amphetamines (2.8%), cannabis (1.02%) and ketamine (0.8%). For
medicinal drug, the benzodiazepines group is at the top of the
list with incidences of 6.9% (refer Table 7).
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Table 8 Categories of drugs found among group of fatal drivers positive for
drug
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Table 9 Chi-square analysis between types of case and status of substance use
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
4.0 Discussion
This study found that driving under the influence of alcohol and
drug among groups of drivers involved in fatal crashes is very
alarming. The study revealed that 23.3% of the fatal drivers were
positive for alcohol, 11% positive for drug and 2.3% were positive
for both drug and alcohol. When combined (all those who tested
positive for substance use for either alcohol or drug), the study
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
The positive effects of lowering the BAC legal limit have been
documented globally. For example, in Austria, after the legal
BAC limit was lowered from 0.08 to 0.05 in 1998, Bartl and
Esbenger (2000) conducted a short term evaluation on the
effects of lowering the legal BAC limit in the country. The authors
concluded that the short term evaluation indicated a significant
reduction of drunk driving in combination with intensive police
enforcement and reporting in the media. They also stated that
the number of drivers with 0.08 or higher decreased at the same
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Limitations of Study
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
36
Table 13 Results of scientific paper reviews on the effect of lowering the legal BAC limit by Mann et al. (2001)
37
Australia, reduction of the legal limit Kloeden and Distribution of BACs among drivers in Pre-post Reduction of the limit to 50 mg% resulted
from 80 to 50 mg% in 1991 in South McLean (1994) Adelaide comparisons in significant in the BACs of drivers breath-
Australia tested in road-side surveys.
Australia, reduction of the legal limit McLean et al. Distribution of BACs in fatally injured Pre-post Reduction of the limit to 50 mg% resulted
from 80 to 50 mg% in 1991 in South (1995) drivers and drivers tested in roadside comparisons in a temporary reduction in the BACs of
Australia surveys in Adelaide night-time drivers and a reduction in the
proportion of fatally injured drivers with
BACs over 80 mg% - no statistical analyses
reported.
Australia, reduction of the legal limit Henstridge et al. Numbers of serious collisions, fatal Time series Reduction of the limit to 50 mg% resulted
in New South Wales and Queensland (1997) collisions and single vehicle night-time analysis in significant reductions in all collision and
from 80 to 50 mg% between 1982 collisions fatality measures in both states.
and 1992
(continue)
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Location Author Measures Design/ Impact
analysis
United States, reduction of limit to Johnson and Fell Fatal collisions involving alcohol (six Pre-post Significant reductions in nine of the 30
80 mg% in five states between 1983 (1995) measures) comparisons comparisons. Only one state (Maine) had
and 1990 no significant effects on any measures.
United States, reduction of limit to Hingson et al. Fatal collisions involving alcohol Pre-post Significant reductions (16%) in proportion
80 mg% in five states between 1983 (1996) comparisons, of collisions involving a driver with a BAC of
and 1991 with matched 80 mg% or higher.
control states
United States, reduction of limit to Scopatz (1998) Fatal collisions involving alcohol Pre-post Significant reductions in proportion of
80 mg% in five states between 1983 comparisons, collisions involving a driver with a BAC
and 1991 with matched of 80 mg% or higher, but the magnitude
control states varies depending on which states are
used as comparisons.
38
United States, reduction of limit to 80 Foss et al. (1999) Various measures of alcohol involvement Multiple Significant reductions in police-reported
mg% in North Carolina in 1993 in collisions; BAC levels of fatally injured time series alcohol fatalities; no other significant effects
drivers analysis with observed.
comparison
states
United States, reduction of limit to Apsler et al. Various measures of fatal collisions Multiple time Significant reductions in alcohol-related
80 mg% in 11 states between 1983 (1999) involving alcohol series analysis fatalities in nine out of 33 analyses.
and 1994
United states, reduction of limit to 80 Vaos et al. (2000) Fatal collisions involving drinking-drivers Weighted Significant reductions in drivers with low
mg% by 1997 with low BACs (1090 mg%) and fatal least-squares BACs and with high BACs involved in fatal
collisions involving drivers with high regression collisions.
BACs (100 mg% and above)
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Sweden, reduction of the lower legal Nostrum and Numbers of fatal collisions, single vehicle Time series Reduction of the lower limit to 20 mg%
limit from 50 to 20 mg% in 1990 Laurell (1997) collisions and total collisions analysis resulted in significant reductions in all
collisions and fatality measures.
(continue)
Location Author Measures Design/ Impact
analysis
Sweden, reduction of the upper legal Borchos (2000) Numbers of fatal collisions and severe Time series Reduction of the upper limit to 100 mg%
limit from 150 to 100 mg% in 1994 injury collisions analysis resulted in significant reductions in fatal
collisions; the impact on severe injury
collisions was similar but more variable.
France, reduction of the legal limit Mercier-Guyon Numbers of fatalities involving a Pre-post Reduction of the limit to 50 mg% was
from 80 to 50 mg% in 1996 (1998) drinking-driver in Haute-Savoie comparisons associated with a decline in the numbers
of fatalities involving a drinking-driver;
no analysis reported.
Denmark, reduction of the legal limit Bernhoft (2000) Proportion of injury and fatal collisions Pre-post Reduction of the limit to 50 mg% was
from 80 to 50 mg% in 1998 classed as DUI comparisons associated with a decline in the proportion
of injury collisions and an increase in the
proportion of fatal collisions classed as DUI;
no analysis reported.
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
5.0 Conclusion
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
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Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
References
Biecheler, MB, Peytavin, JF, Fancy, F & Martineau, H., (2008), SAM
survey on drugs and fatal accidents: search of substance
consumed and comparison between drivers involved under
the influence of alcohol and cannabis, Traffic Injury Prevention,
9: 1121.
42
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Howat, P, David, S & Ian, S (1991), Alcohol and driving: is the 0.05%
blood concentration limit justified?, Drug and Alcohol Review,
2(10): 151166.
43
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
Peck, RC, Gebers, MA, Vaos, RB & Romano, E (2008), The relationship
between blood alcohol concentration (BAC), age, and crash
risk, Journal of Safety Research, 39(9): 311319.
44
Alcohol and Drug Use Among Fatally Injured Drivers in Urban Area of Kuala Lumpur
45
Research Report