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Summer 2000

RESEARCH ARTICLE

DUI: Demographics and Drug Concentrations Indicative of Impairment

Shanitut T. Muantongchin, Evan Beard, Judy Echols, J.D., Anthony J. Macherone, M.A. and G. John Digregorio, M.D., Ph.D.

Driving under the influence continues to be a major problem in urban, suburban and rural America. Each year, tens of thousands of people lose their lives in automobile accidents when they themselves or the driver of the other vehicle were intoxicated. During 1998 alone, there were 15,935 alcohol-related deaths in the United States, with an average of one fatality every 33 minutes accounting for 38% of all fatal crashes. According to the National Highway Traffic Safety Administration (NHTSA), in 1997, 1.5 million drivers were arrested for driving under the influence: an arrest rate of 1 out of every 122 licensed drivers. The NHTSA also states that about 30% of Americans will be involved in an alcohol-related accident at some point in their lives[1]

Although commonly perceived as being solely based on the amount of ethyl alcohol in the blood, DUI convictions cover any kind of drug that can impair normal driving skills. The objective of this study is to correlate driving under the influence (DUI) arrests with substance abuse, accidents, and the demographics of the accused. The study incorporates data obtained in a large metropolis in the United States from July 1998 through June 1999. Six hundred and eighty six samples were obtained for the study from persons suspected of DUI. These individuals may have been driving erratically or they may have been involved in an automobile accident. Within the following article we will report: the gender of the accused and the number of incidents involving accidents for both genders; the frequency of various age groups involved in DUI arrests; the most commonly detected drugs; the frequency of co-administration of drugs and alcohol and; the frequency of people using one or more substance when driving. Albeit the above correlations offer insight into the problem of DUI in the United States, the unique aspect of this study was that the data allowed us to determine the exclusive use of a single substance, its concentration and its correlation to DUI arrests. Herein, we shall also present some of this information, as it is not available in the literature and will hopefully prove valuable to the forensic toxicologist when assessing the impairment of an individual's driving skills when alcohol is not an exclusive antecedent to a DUI arrest.

The analysis of each sample was performed through a battery of assays including thin layer chromatography, immunoassays, and gas chromatography. From these analytical tools, our lab was able to detect and quantitate about 90 drugs. Of the 686 cases submitted, 67 were determined to be not prosecutable either because only urine was submitted or no alcohol or drugs were detected in a concentration that would warrant prosecution. Of the 619 prosecutable cases, 537 (87%) were males and 82 (13%) were females. Of these, 108 males and 47 females were involved in automobile accidents (see Figure 1). The 19-24 year old age group was determined to have the highest incidence of DUI arrests with the 25 to 30 year old range being the second most common group (see Figure 2). The average age of those arrested for DUI was 33 with a range of 15 to 79 years old. Three hundred and eighty four (62%) of those arrested for DUI were found to have ethanol in the blood. The drug found in the second highest frequency was the marijuana metabolite 11-nor-Delta9-THC-COOH which was detected in 32% of the perpetrators. In 21% of the cases, the primary cocaine metabolite, benzoylecgonine was the third most common substance found (see Figure 3). Cocaine was determined to be the most common drug co-administered with ethanol. Morphine / codeine follows with nordiazepam and marijuana appearing as the third and fourth most common, respectively (see Figure 4). It was determined from the data that most often the individual arrested for DUI was under the influence of a single substance, ethanol being the substance of choice, although a significant number of individuals were found to have two or more substances in their system at the time of arrest (see Figure 5).

As mentioned above, the data allowed correlation of the concentration of an exclusively ingested substance with the incidence of DUI arrest. Although we have concentration data for all of the major families of abused substances, we shall only present results for several of the most common substances found in our sample set due to space limitations. Of the 188 cases where only ethyl alcohol was detected, the average concentration was 0.20±0.08 g/dL (range 0.02-0.43 g/dL). Only 26 cases involved cocaine use exclusively. Twelve of these tested positive for both cocaine and BZE, with the average concentration being 110±115 ng/mL (22-345 ng/mL) and 1830±916 ng/mL (323-3720 ng/mL), respectively. The remaining 14 cases tested positive for BZE only and had an average concentration of 1160±972 ng/mL (123-2950 ng/mL). Finally, phencyclidine (PCP) was detected by itself 11 times, with an average concentration of 67±30 ng/mL (25-118 ng/mL).

Through evaluation of the data provided in this study, we have the opportunity to not only examine demographic information pertaining to individuals arrested for DUI in a large United States metropolis but to also examine exclusive use of a single drug and present concentration data relevant to its effect on driving and impairment.

National Commission Against Drunk Driving (NCADD) (NCADD) Fact Sheet

The work presented herein was made possible with the sponsorship of the Fredric Rieders Family Renaissance Foundation.

FEATURE ARTICLE

A Golden Apple Renaissance Man

By Joseph R. DiPalma, M.D.

On April 11 of this year, G. John DiGregorio, M.D., Ph.D., Executive Director of the Fredric Rieders Family Renaissance Foundation, received the Golden Apple Award for the third time from the students of MCP/Hahnemann Medical College. This coveted award is competed for by over 500 faculty members and it's not a popularity contest. Rather, it is strictly judged on the basis of teaching ability, setting an example of professionalism and relationship to the problems of students. What does Dr. DiGregorio have that makes him a consistent winner? In appearance - tall and athletic; in manner - confident and direct; in affect - friendly and engaging. All combined, these qualities make him an "open door" type of person.

Dr. DiGregorio earned his undergraduate degree from Penn State University where he attended on an athletic scholarship. While at Penn State, he developed an interest in chemistry and majored in this subject. After graduating he made the choice of qualifying for a doctoral degree in Pharmacology at Hahnemann University. His graduate research and thesis concentrated on chemical entities from plant sources. The main anthocyanin of Dionea Muscipula (Venus Flytrap) was identified and it’s potential as an autonomic drug was determined. These researches led to papers in Nature and the British Journal of Pharmacology. As a result of this work Dr. DiGregorio developed special skill in chromatography and radioimmunoassay technology. These techniques were to shape his subsequent research career.

Upon receiving the Ph.D. degree, Dr. DiGregorio accepted the position of instructor in the Pharmacology Department at Hahnemann where his talents in exploration of new frontiers and his natural enthusiasm for conveying knowledge insured his rapid advancement to associate professor in a few short years. During this time his main research concerned drugs of abuse. With grants from NIH he was able to develop valuable technology for the determination of levels of drugs in salvia that related to blood levels.

Twelve years after receiving his PhD he was accorded the extraordinary privilege of matriculation for the M.D. degree while still teaching part time at Hahnemann. By an extremely challenging effort he received the M.D. degree in 1978. Following this, two years of residency qualified him for Boards in Internal Medicine. Now a critical decision had to be made. Should he abandon academe for a much more lucrative clinical enterprise? Not Dr. DiGregorio! He decided to remain in academia and pursue the part time clinical work he could manage in his spare time.

The year was 1981, his age 41. He was ready to launch an ambitious research and educational program. A summary of his accomplishments over the next twenty years would include outstanding teaching of medical and graduate students, residents and fellows. He conducted research to ascertain the pharmacokinetics of anti-motion sickness drugs in zero gravity for the space program, vitamin blood levels in health and disease, determination of the levels of abuse drugs in fetal meconium, salvia, urine and hair. One of his special interests was the appropriate use of pain medications. At the same time Dr. DiGregorio served on important committees and was consultant to drug companies. He also authored and edited a textbook of pharmacology, and books on pain and prescription drugs.

One might conclude that intense professional activities might preclude a stable and happy home life. Quite the contrary, a devoted father to a daughter and son he insured that they had a maximum opportunity for happiness and success in life. His son is legally blind and with help from Dr. DiGregorio and his wife he graduated veterinary school. His daughter received an M.D. degree from Hahnemann and is now an accomplished anesthesiologist.

Scientist, physician, educator, author, administrator, family man and humanist, Dr. DiGregorio is an ideal choice to be Director of the Fredric Rieders Family Renaissance Foundation. He sets the example that the Rieders Family hopes to emulate in the programs of seminar’s, summer fellowships and the nature of the research performed by its members.

SEMINAR SCHEDULE

MALDI/MS Applications - July 20, 2000. Presented by Catherine Bentzley, Ph.D.

Summer Mentoring Program Presentation Day - August 17, 2000. Presented by Summer Mentoring Program Mentors and Students

Postmortem Artifacts - September 21, 2000. Presented by Michael Rieders, Ph.D.

Ionic Liquids - October 19, 2000. Presented by Anthony Macherone, M.A.

Bismuth Toxicity - November 16, 2000. Presented by Joseph DiPalma, M.D.

To Be Announced - December 14, 2000. Presented by Robert Middleberg, Ph.D.

Chemical Sensitivity - January 18, 2001. Presented by G. John DiGregorio, M.D., Ph.D.

Herbal Update - February 15, 2001. Presented By George Jackson, Ph.D.

Clinical Adverse Effects of Drugs - March 15, 2001. Presented by Tony Piraino, M.D., Ph.D.

UPCOMING EVENTS

Summer Mentoring Program - 2000

The Fredric Rieders Family Renaissance Foundation is pleased to announce the participants in the 2000 Summer Mentoring Program. Acceptance in the program is highly competitive and based upon academic achievement and motivation to excel in the fields of basic, applied and biomedical research. Five teachers and ten high school students have been accepted. They will be divided into five groups consisting of one teacher and two students. Each group will be assigned a research project which is to be completed within the eight week program. This years projects are: Carbon Monoxide Stability in Heme; Cyanide Stability and the Fate of Cyanide in the Presence of Formaldehyde; Methemoglobin Stabilizing Project (Year 3); Catecholamine Project (Year 2) and; GHB / GBL Stability in Various Beverages. The tasks involve literature research, laboratory assignments, participation in a weekly progress meeting, preparation of a presentation for the annual Intern Day and various other tasks. The Students will be required to attend a weekly lecture series and the teachers will participate in a weekly journal club.

The teaching participants are: Felicia Barbieri, Ph.D. - Gwyned-Mercy College; Kia Ireland, M.S. - William Penn HS; James King, Ph.D. - University City HS; Joseph Loverro, M.S. - Dobbins HS and; James Rush, Ph.D. - W.B. Saul HS. The summer 2000 student participants are: Krystal Bagley - Mastermann HS; Sarai Fife - Archbishop Carol HS; Deanne Grant - Central HS; Marcus Jackson - Abraham Lincoln HS; Marene La Fontane - Mastermann HS; Erika Powell Central HS; Staci Ross - William Penn HS; Carolyn Sok - Central HS; Jonathon Treitel - Central HS and; Tuyet-Trinh Truong - Philadelphia HS for Girls.

Other Participants in our program include Catherine Bentzley, Ph.D. and Andrea Garcia, B.S. both from the University of the Sciences in Philadelphia and Germaine Robinson, a graduate student at Thomas Jefferson University. These participants will be working on special projects for the Foundation including MALDI-TOF analysis of amiodorone in heart tissue and conversion of cocaine and its metabolites to a single analyte.

The staff of the Foundation would like to extend their congratulations to all the program participants and look forward to a productive summer.