Accidentalidad vial por consumo de drogas y alcohol: estado actual

Road traffic accidents related to drugs and alcohol: current situation

Introducción: el consumo de alcohol se reconoce como causa importante de accidentes de tránsito por el efecto depresor sobre el sistema nervioso central. Aunque las drogas recreacionales o ilegales tienen una acción similar es poco lo que se conoce sobre su relación con la accidentalidad vial. Objetivo: conocer la situación actual en Colombia y el mundo sobre los efectos del alcohol y las sustancias psicoactivas ilegales en el sistema nervioso central como posibles causas de accidentes de tránsito. Métodos: revisión de la literatura en bases electrónicas utilizando los términos DeCS y MeSH: street drugs, designed drugs, ethanol, cocaine, cannabinoides, amphetamines, injuries, accident traffic y automobile driving. Resultados: algunos estudios en especial en Estados Unidos, se reporta una relación estrecha entre el consumo de sustancias psicoactivas y la accidentalidad vial, con cifras cercanas a las del alcohol. En México también se ha demostrado esta relación. En Colombia la mayoría de publicaciones sobre factores de accidentalidad vial no diferencian el consumo de alcohol de las sustancias psicoactivas, lo cual refleja la falta de programas de promoción y prevención sobre el riesgo de conducir bajo la acción de estas sustancias. Los exámenes para determinar su presencia no se ordenan en forma rutinaria y por los datos existentes no reflejan los costos reales derivados de la atención a víctimas de accidentes de tránsito causados por conducir bajo sus efectos. Conclusiones: la situación actual sobre la accidentalidad vial muestra un preocupante aumento de la mortalidad, morbi­ lidad y discapacidad en países en vías de desarrollo como el nuestro. Se analizaron los efectos del alcohol, cocaína, canabinoides y metanfetaminas sobre el sistema nervioso central que disminuyen las habilidades del individuo para la conducción.

1. Pecten M., editor. Informe mundial sobre prevención de los traumatismos cau­ sados por el transito[monografía en Intemet].Ginebra: OMS; 2004 [citado 23 Mar 2012]. Disponible en: http://www.paho.org/spanish/dd/pub/resumen_infor­ me_mundial_traumatismos.pdf
2. Clasificación de países [monografía en lntemet].Washington: Banco Mundial; 2010. [citado 23 Mar 2012]. Disponible en: http://datos.bancomundial.org/quie­ nes-somos/clasificacion-paises
3. Informe sobre la situacion mundial de la seguridad vial: es hora de pasar a la accion. Ginebra : OMS; 2009.
4 Sakurai S, Cui R, Tanigawa T, Yamagishi K, Iso H. Alcohol consumption before sleep is associated with severity of sleep-disordered breathing arnong professio­ nal Japanese truck drivers. Alcohol ClinExp Res. 2007 Dec;31(12):2053-8.
5 Pastor R, Aragon CM. The role of opioid receptor subtypes in the develop­ ment of behavioral sensitization to ethanol. Neuropsychopharmacology. 2006 Jul;31(7): 1489-99.
6 Job MO, Tang A, Hall FS, Sora I, Uhl GR, Bergeson SE, et al. Mu (mu) opioid receptor regulation of ethanol-induced dopamine response in the ventral striatum: evidence of genotype specific sexual dimorphic epistasis. Biol Psychiatry 2007 Sep 15;62(6):627-34.
7 Voronin K, Randall P, Myrick H, Anton R. Aripiprazole effects on alcohol con­ sumption and subjective reports in a clinical laboratory paradigm--possible in­ fluence of self-control. Alcohol ClinExp Res. 2008 Nov;32(1 l ):1954-6 l.
8. Aryal P, Dvir H, Choe S, Slesinger PA. A discrete alcohol pocket involved in GIRK channel activation. Nat Neurosci. 2009 Aug;12(8):988-95.
9 Davies AG, Pierce-Shimomura JT, Kim H, VanHoven MK, Thiele TR, Bonci A, et al. A central role of the BK potassium channel in behavioral responses to ethanol in C. elegans.Cell. 2003 Dec 12;115(6):655-66.
10 Dopico AM, Chu B, Lemos JR, Treistrnan SN. Alcohol modulation of calcium­ activated potassium channels.Neurochem Int. 1999 Aug;35(2):103-6.
11 Steensland P, Simms JA, Holgate J, Richards JK, Bartlett SE. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, selectively de­ creases ethanol consumption and seeking. ProcNatlAcadSci U S A. 2007 Jul 24;104(30):12518-23.
12 Schuckit M. Ethaool and Methanol. In: Brunton L, editor. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw-Hill; 201o. p. 629-48.
13 Stephens R, Ling J, Heffeman TM, Heather N, Janes K. A review of the lite­ rature on the cognitive effects of alcohol hangover. Alcohol Alcohol 2008 Mar;43(2): 163-70.
14 Oslin D, Atkinson RM, Srnith DM, Hendrie H. Alcohol related dementia: propo­ sed clinical criteria. lnt J Geriatr Psychiatry. 1998 Apr;13(4):203-l 2.
15 Pfefferbaum A, Sullivan EV, Rosenbloom MJ, Mathalon DH, Lim KO. A contro­ lled study of cortical gray matter and ventricular changes in alcoholic men over a 5-year interval.Arch Gen Psychiatry. 1998 Oct;55(10):905-12.
16 Kril JJ, Halliday GM. Brain shrinkage in alcoholics: a decade on and what have we learned?.ProgNeurobiol. 1999 Jul;58(4):381-7.
17 Alexander-Kaufman K, Harper C, Wilce P, Matsumoto l. Cerebellar ver­ mis proteome of chronic alcoholic individuals. Alcohol ClinExp Res. 2007 Aug;31(8):1286-96.
18 Volkow ND, Wang GJ, Hitzemann R, Fowler JS, Overall JE, Burr G, et al. Reco­ very of braio glucosemetabolism in detoxifiedalcoholics. Am JPsychiatry. 1994 Feb;l 51(2):178-83.
19 Baker KG, Harding AJ, Halliday GM, Kril JJ, Harper CG. Neuronal loss in functional zones of the cerebellum of chronic alcoholics with and without Wernicke's encephalopathy. Neuroscieoce 1999;91(2):429-38.
20 Bartsch AJ, Homola G, Biller A, Smith SM, Weijers HG, Wiesbeck GA, et al. Manifestations of early brain recovery associated with abstinence from alcoho­ lism. Brain. 2007 Jan;l30(Pt 1):36-47.
21 Yip L. Ethanol. In: Nelson L, Lewin N, Howland MA, Hoffman R, Goldfrank L, Flomenbaum N, editors. Goldfrank'sToxicologic Emergencies. 9thed. New York: McGraw Hill; 2011.
22 OPS. Beber y Conducir: manual de seguridad vial para decisores y profesionales. Washington: OPS; 2010.
23 OPS. Defunciones por accidentes de transito en países seleccionados de las ame­ ricas 1985-2001. Bol. Epidemial. 2004 Mar;25(1):2-5.
24 Filip M, Alenina N, Bader M, Przegalinski E. Behavioral evidence for the signifi­ cance of serotoninergic (5-HT) receptors in cocaine addiction. Addict Biol. 2010 Jul;15(3):227-49.
25 Phillips K, Luk A, Soor GS, Abraham JR, Leong S, Butany J. Cocaine cardio­ toxicity: a review of the pathophysiology, pathology, and treatment options. Am J CardiovascDrugs. 2009;9(3):177-96.
26 Bravo P, Bravo S. Prevalencia de sustancias psicoactivas asociadas con muertes violentas en Cali. ColombMed. 2005 Ju] 1;36(3):146-52.
27 Demaria S Jr, Weinkauf JL. Cocaine and the club drugs. IntAnesthesiolClin. 2011;49(1):79-101.
28 Goldstein RA, DesLauriers C, Burda AM. Cocaine: history, social implications, and toxicity--a review. Dis Mon 2009 Jan;55(1):6-38.
29 Dietrich JB. Alteration of blood-brain barrier function by methamphetamine and cocaine. Cell Tissue Res. 2009 Jun;336(3):385-92.
30 Prosser JM, Hoffman R. Cocaine. In: Nelson L, Lewin N, Howland MA, Hoff man R, Goldfrank L, Flomenbaum N, editors. Goldfrank'sToxicologic Emergen­ cies. 9thed. New York: McGraw Hill; 2010.
31 Seger D. Cocaine, metamfetamine, and MDMA abuse: the role and clinical im­ portance of neuroadaptation. ClinToxicol (Phila). 201O Aug;48(7):695-708.
32 McGuigan M. Cannabinoids. In: Nelson L, Lewin N, Howland MA, Hoffman R, Goldfrank L, Flomenbaum N, editors. Goldfrank'sToxicologic Emergencies. 9thed. New York: McGraw Hill; 2010.
33 Copeland J, Swift W. Cannabis use disorder: epidemiology and management. Int Rev Psychiatry. 2009 Apr;21(2):96-103.
34 Koob G, Kreek MJ. Stress, dysregulation of drug reward pathways, and the tran­ sition to drug dependence. Am J Psychiatry. 2007 Aug;I64(8):I 149-59.
35 DeLisi LE. The effect of cannabis on the brain: can it cause brain anomalies that lead to increased risk for schizophrenia?.CurrOpin Psychiatry. 2008 Mar;2I(2):140-50.
36 Schuckit MA. Comorbidity between substance use disorders and psychiatric con­ ditions. Addiction 2006 Sep;IOI Suppl I:76-88.
37 Sewell RA, Poling J, Sofuoglu M. Toe effect of cannabis compared with alcohol on driving. Am J Addict. 2009 May;l8(3):185-93.
38 Perra S, Pillolla G, Luchicchi A, Pistis M. Alcohol inhibits spontaneous activity of basolateral amygdala projection neurons in the rat: involvement of the endo­ cannabinoid system. Alcohol ClinExp Res. 2008 Mar;32(3):443-9.
39 Kuhns JB, Wilson DB, Maguire ER, Ainsworth SA, Clodfelter TA. A meta­ analysis of marijuana, cocaine and opiate toxicology study findings among ho­ micide victims. Addiction. 2009 Jul; J 04(7):1122-31.
40. Chiang WK. Amphetamines. In: Nelson L, Lewin N, Howland MA, Hoffman R, Goldfrank L, Flomenbaum N, editors. Goldfrank'sToxicologic Emergencies. 9thed. New York: McGraw Hill; 2010.
41 Song BJ, Moon KH, Upreti VV, Eddington ND, Lee !J. Mechanisms of MOMA (ecstasy)-induced oxidative stress, mitochondrial dysfunction, and organ dama­ ge. Curr Pharm Biotechnol. 2010 Aug;l 1(5):434-43.
42 Fiaschi Al, Cerretani D. Causes and effects of cellular oxidative stress as a result of MOMA abuse. CurrPharmBiotechnol. 2010 Aug; l 1(5):444-52.
43 Moreno S. Lesiones de accidentes de transito Colombia 2010. Forensis. 2011;12(1):254-94.
44 Fondo de Prevencion vial. Que el alcohol no afecta la conducción?. Bogotá: Fon­ do de Prevencion Vial; 2011.
45 Heng K, Hargarten S, Layde P, Craven A, Zhu S. Moderate alcohol intake and motor vehicle crashes: the conflict between health advantage and at-risk use. Al­ cohol Alcohol. 2006 Jul;41(4):45!-4.
46 Mockus A. Cultura ciudadana, programa contra la violencia en Santa Fe de Bo­ gota, Colombia 1995 - 1997:estudio técnico. Washington: BID; 2001.
47. Colombia. Senado.Resolución 000414 de 2002. CódigoNacional de Transito Te­ rrestre
48 Odero W,ZwiAB. Alcohol-related traffic injuries and fatalities in developing coutries: A critica! review of literature[monografía en Internet]. London: London School of Hygiene and Tropical Medicine. Departrnent of Public Health.Health Policy Unit; 1995 [citado 23 Mar 2012].Disponible en: http://www.druglibrary. org/schaffer/misc/driving/s26pl.htrn
49. Odero W, Gamer P, Zwi A. Road traffic injuries in developing countries: a comprehensive review of epidemiological studies. Trop Med lnt Health. 1997 May;2(5):445-60.
50 Garg N, Hyder AA. Exploring the relationship between development and road traffic injuries: a case study from India. Eur J Public Health. 2006 Oct;l6(5):487- 9I.
51 Hasin OS, Stinson FS, Ogbum E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Condi­ tions. Arch Gen Psychiatry. 2007 Jul;64(7):830-42.
52 Harwood HJ, Fountain D, Fountain G. Economic cost of alcohol and drug abuse in the United States, 1992: a report. Addiction. 1999 May;94(5):631-5.
53 Rehm J, Gnam W, Popova S, Baliunas D, Brochu S, Fischer B, et al. The costs of alcohol, illegal drugs, and tobacco in Canada, 2002. J Stud Alcohol Drugs. 2007 Nov;68(6):886-95.
54 Walsh JM, Flegel R, Cangianelli LA, Atkins R, Soderstrom CA, Kems TJ. Epi­ demiology of alcohol and other drug use among motor vehicle crash victims ad­ mitted to a trauma center. Traffic Inj Prev. 2004 Sep;5(3):254-60.
55 National Highway Traffic Safety Administration. Drug Involvement of Fatally Injured Drivers[monografía en Intemet].Washington: NHTSA; 2010.[citado 23 Mar 2012]. Disponible en: http://www-nrd.nhtsa.dot.gov/Pubs/81 l 4 l 5.pdf
56 Goulle JP, Verstraete A, Boulu R, Costentin J, Foucher JP, Raes E, et al. [Illicit drugs, medications and traffic accidents]. Ann Pharm Fr. 2008 Aug;66(4):196- 205.
57 Cimbura G, Lucas DM, Bennett RC, Warren RA, Simpson HM. Incidence and toxicological aspects of drugs detected in 484 fatally injured drivers and pedes­ trians in Ontario. J Forensic Sci. 1982 Oct;27(4):855-67.
58 Mercer GW, Jeffery WK. Alcohol, drugs, and impairrnent in fatal traffic acci­ dents in British Columbia. Accid Anal Prev. 1995 Jun;27(3):335-43.
59 Logan BK, Schwilke EW. Drug and alcohol use in fatally injured drivers in Washington State. J Forensic Sci. 1996 May;41(3):505-10.
60 Mason AP, McBay AJ. Ethanol, marijuana, and other drug use in 600 drivers killed in single-vehicle crashes in North Carolina, 1978-1981. J Forensic Sci. 1984 Oct;29(4):987-1026.
61 Soderstrom CA, Trifi!Jis AL, Shankar BS, Clark WE, Cowley RA. Marijuana and alcohol use among 1023 trauma patients. A prospective study. Arch Surg. 1988 Jun;123(6):733-7.
62 Gerchow J. ["Other intoxicating drugs" in traffic law]. Blutalkohol. I987 Jul;24(4):233-42.
63 Daldrup T, Reudenbach G, Kimm K. [Cannabis and alcohol in traffic]. Blutalko­ hol. 1987 Mar;24(2):144-56.
64 Drummer OH, Gerostamoulos J, Batziris H, Chu M, Caplehom JR, Robertson MO, et al. The incidence of drugs in drivers killed in Australian road traffic cras­ hes. Forensic Scilnt 2003 Jul 8;134(2-3):154-62.
65 McLean S, Parsons RS, Chesterman RB, Dineen R, Johnson MG, Davies NW. Drugs, alcohol and road accidents in Tasmania. Med J Aust 1987 Jul 6;147(1):6- 11.
66 Ramaekers JG, Berghaus G, van LM, Drummer OH. Dose related risk of motor vehicle crashes after cannabis use. Drug Alcohol Depend. 2004 Feb 7;73(2):I09- 19.
67 Oladehinde MK, Adegbehingbe 80, Adeoye AO, Onakoya AO. Central nervous system stimulants: effect on visual functions and occurrence of road traffic acci­ dents. Ann ItalChir. 2009 Jan;80(1):43-8.
68 Carmen del RM, AJvarez FJ. Presence of illegal drugs in drivers involved in fatal road traffic accidents in Spain. Drug Alcohol Depend. 2000 Jan 1;57(3):177-82.
69 Reis AD, Figlie NB, Laranjeira R. Prevalence of substance use among trau­ ma patients treated in a Brazilian emergency room. RevBrasPsiquiatr. 2006 Sep;28(3):191-5.
70 Rodríguez J, Acosta N, Peñaloza R. Carga de enfermedad Colombia 2005: Resul­ tados alcanzados. Documento técnico. Bogotá: Pontificia Universidad Javeriana, Cendex; 2008.
71 Constantin A. Reglamento técnico forense para la determinación del estado de embriaguez aguda. Bogotá: Instituto Nacional de Medicina Legal y Ciencias Fo­ renses; 2005.