Consistent association between hypnotics/sedatives and non-traffic injuries. Results from a national household survey
Introduction
Injuries are one of the main causes of death and disability among people aged under 60 years worldwide (World Health Organization, 2011) and the leading cause of death among children, adolescents and young adults in Europe (EuroSafe, 2013). In 2030, it is expected that mortality due to injuries will reach 10% (World Health Organization, 2015). In Spain, injuries are the leading cause of mortality among people aged from 1 to 39 years (INE, 2016). Furthermore, in developed countries, for each injury-related death, about 30 injured people are hospitalized and over 300 are attended by skilled health staff (Espitia-Hardeman and Paulozzi, 2005).
Health burden related to psychoactive substance abuse or dependence is constantly increasing (by 52% between 1990 and 2010, measured in disability-adjusted life years for illicit drugs, according to Degenhardt et al., 2013). Regarding injuries, an increased risk of road crashes related to driveŕs use of psychoactive drugs has been consistently observed in many previous studies (Dassanayake et al., 2011, European Monitoring Center for Drugs and Drug Addiction, 2014a, Penning et al., 2010). However, there are few studies that assess this association for unintentional non-traffic injuries (UNTIs), a much more frequent subgroup of injuries. Road crash injuries only account for 10% of all hospital treated injuries in the European Union (EuroSafe, 2013). Therefore, UNTIs have a greater impact on social and economic spending due to the higher health costs that they generate.
Previous studies have assessed the association between alcohol and cannabis – the most widely consumed illegal drug in Western countries- and the risk of UNTIs (Barrio et al., 2012, Bogstrand et al., 2011, Gerberich et al., 2003, Vitale and van de Mheen, 2006). However, the association between psychostimulants such as cocaine, amphetamines and ecstasy, and the frequency of UNTIs has not yet been addressed. It is also surprising not to find enough evidence from epidemiologic studies to determine the effects of hypnotics/sedatives consumption on UNTIs, given that in some countries they are more used than cannabis (European Monitoring Center for Drugs and Drug Addiction, 2014b). Toxicological studies reveal a high prevalence of cocaine and benzodiazepines among subgroups of UNTIs populations (Carrigan et al., 2000, McDonald et al., 1999, Perez et al., 2009, Reis et al., 2006) suggesting that this association may exist. For instance, in a recent review, the use of hypnotic and sedatives appears to be related with an increased risk of falls in older people (Park et al., 2015). Although biological plausibility supports this hypothesis, especially for hypnotic/sedative drugs group, it is not easy to isolate the specific effect of chronic psychoactive drug use on the risk of UNTIs from those resulting from confounding factors. Furthermore, the low frequency of use of some subtypes of drugs, limits the power of previous studies to detect these associations. Thus, more epidemiological studies are needed to corroborate the results of experimental studies in a real-life context and to better quantify the excess risk of UNTIs of hypnotic and psychostimulant users in relation to non-users. From a public health perspective, they can also guide policymakers in the promotion of measures to prevent or reduce the risk of UNTIs occurring at work, at home or when performing recreational activities.
Although they do not allow the identification of causal associations, if the sample size is sufficient to account for confounding factors and to detect weak associations precisely enough, cross sectional designs are a useful approach to assess the magnitude of the association between chronic exposures to psychoactive drugs and the frequency of UNTIs. In a previous work by our group using this design, we observed a clear association between cannabis and UNTIs (Barrio et al., 2012).
In the present study, we aim to quantify the relationship between patterns of use of psychostimulants, hypnotics/sedatives as well as alcohol consumption and the frequency of UNTIs in Spain, after adjusting for the confounding effect of sociodemographic characteristics and the use of other drugs and assessing interactions with gender and age.
Section snippets
Participants and data collection
Participants were individuals aged 15–64 from a pooled sample of the Spanish 2005 and 2007 Household Surveys on Alcohol and Drugs (EDADES). Further methodological details can be found elsewhere (Delegación del Gobierno para el Plan Nacional sobre Drogas, 2008). Briefly, in each survey a sample of subjects aged 15–64 years was recruited from the population resident in households using a probabilistic three-stage cluster sampling without replacement procedure and selecting both urban and rural
Results
Table 1 shows the distribution of the participants according to sociodemographic variables and the patterns of use for each subtype of drug stratified by age and gender separately. A total of 25,160 males and 26,489 females were recruited in the pooled sample. In terms of sociodemographic characteristics we found larger prevalences of subjects aged 15–34, singles and people employed among men. All prevalences of psychoactive drugs use were higher in males, except for hypnotics/sedatives. On the
Discussion
This study shows a consistent and strong association between the use of alcohol and hypnotics/sedatives and the frequency of UNTIs, and a weaker association between the use of psychostimulants and UNTIs. Previous studies have pointed out a link between the use of some psychoactive drugs and injuries finding high prevalence rates of positive drug tests among injured patients (Bailey, 1993, Bogstrand et al., 2011, Macdonald et al., 2003, Perez et al., 2009).
Very few studies have quantified the
Conclusions
The results of this study are relevant for public health policy. After taking into account all the drawbacks described above, our results reveal a consistent relationship between hypnotics/sedatives use, alcohol consumption and UNTIs, especially among regular users.
In the same spirit that in studies that evaluate the risks associated with drug use while driving, this nationally-representative-sample based study could guide policymakers in the design and implementations of policies that aim to
Conflicts of interest
None declared.
Funding
This work was supported by the Spanish Network on Addictive Disorders (RTA) grant numbers RD06/0001/1018 and RD12/0028/0018. Writing of the paper was supported by “Ministerio de Economía y Competitividad, Actuación de Formación Posdoctoral” (FPDI-2013-15827).
Acknowledgements
The authors are grateful to the National Plan on Drugs for providing data from the 2005 and 2007 Spanish Household Survey on Alcohol and Drugs. The views expressed in this manuscript do not necessarily represent the official policies or perspectives of these organizations. Thanks also to Mónica Ruiz for her help in searching for information.
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