PHARMACOEPIDEMIOLOGY
AND
DRUG
SAFETY,
VOL.
5:
255-261 (1996)
ORIGINAL
REPORT
Medica ion Use
by
he D i ing Popula ion
M. CARMEN DEL RIO MD AND
F.
JAVIER ALVAREZ MD
Depa men
o
Pha macology and The apeu ics, Facul y
o
Medicine, Uni e si y
o
Valladolid, 47005 Valladolid, Spain
SUMMARY
This s udy in es iga ed pa e ns o medicine use among Spanish d i e s. The s udy was conduc ed in he
all o 1993 on
1500
d i e s aged o e 16, all o whom comple ed acco dingly and hen e u ned he
ques ionnai es. Among hose su eyed, 45.1% had used d ugs a leas once in he p e ious yea , while
17.3% o d i e s su eyed we e using medicines ch onically. Ch onic use s, he majo i y o whom we e
emale and belonging o he olde age g oup, we e using an a e age o wo d ugs. Cen al ne ous
sys em d ugs (21.7%), espi a o y sys em d ugs (19.2%), ca dio ascula sys em d ugs (14.9%) and
alimen a y ac d ugs (14.3%) we e he mos equen g oups o medica ion used, O hose su eyed
76.5% who ook d ugs egula ly had ne e been wa ned by heal h p o essionals abou he e ec s o he
medica ion use on d i ing skills. The s udy shows bo h how o en d i e s use medica ion as well as he
need o in o m pa ien s and d i e s abou he e ec o medica ion
on
d i ing pe o mance.
KEY
WORDS
-
d ugs; d ugs and d i ing; a ic sa e y
INTRODUCTION
Road a ic acciden s ha e become an impo an
heal h p oblem in de eloped coun ies and hei
p e en ion has long been a p io i y issue.
Undoub edly, alcohol consump ion is one o he
main causes o oad a ic acciden s. Ne e heless,
i
is o en o go en ha o he subs ances, such as
ce ain o ms o medica ion and illegal d ugs,
impai psychomo o skills ela ed
o
d i ing.]
The ela ion be ween d ugs, d i ing and oad
a ic acciden s is a complex one. In labo a o y
expe imen s he apeu ic doses o se e al d ugs
ha e been shown o impai psychomo o skills
ela ed o d i ing.2 Howe e , he e a e ce ain
aspec s which need cla i ying. One is he ela ion
be ween d ug concen a ion and d i ing impai -
men ; ano he , he legal conside a ion o d ug
le els simila o hose o alcohol, e ~.~ In addi ion,
in o ma ion ela ing o he equency o d ug-use
by d i e s and he pe cen age o people who d i e
Add essee o co espondence: F. Ja ie Al a ez, Depa men
o
Pha macology and The apeu ics. Facul y
o
Medicine, Uni-
e si y o Valladolid,
47005
Valladolid, Spain, el:
+(34 83)
423077,
ax:
+(3483) 423022
and
+(3483) 423073.
while unde he in luence
o
psychopha maco-
logical agen s is sca ce, and he igu es a ailable
di e signi ican ly. Pe haps his may be a ibu ed
o he di e si y o explo a o y me hods used in he
cou se
o
he s udies unde aken; hese include
mailed ques ionnai es, p esc ip ion eco ds, pe -
sonal o elephone in e iews, e ~.~-~ Wha is
mo e, d ugs ha e e y o en been ound in body
luids among d i e s in ol ed in oad a ic
acciden s
.
4-8
I has ecen ly been es ima ed ha
a
leas
10%
o all people killed
o
inju ed in oad acciden s
we e using some kind o psycho opic medica ion
ha could ha e been conside ed a con ibu o y
ac o . This ep esen s a di ec cos each yea o he
Eu opean Communi y o a leas
7
billion ECUs,
5000
dea hs and
150,000
inju ies.l0
Unde Eu opean Communi y Council Di ec i e
91/439/EEC, au ho i ies esponsible o he issuing
o d i ing licences mus de e mine he applican 's
lack o impai men due o hei use o alcohol,
illegal d ugs and medicines," al hough he e exis
di icul ies conce ning he implemen a ion
o
his
Di ec i e.
lo
In mos coun ies in o ma ion abou medica ion
use and oad sa e y is sca ce and incomple e, and
CCC 1053-8569/96/040255-07
C
1996 by John Wiley
&
Sons,
L d.
Recei ed
I I
May 1995
Accep ed
13
Decembe 1995
256
M.
C.
DEL
RIO
AND
F.
J.
ALVAREZ
he p esen na ional s udy was ca ied ou on a
sample o Spanish d i e s wi h a iew o analysing
he pa e ns o medica ion used by his sec ion o
he popula ion, and how he use o medica ion
could impai d i ing abili y. Conside a ion has
also been gi en o he in o ma ion ecei ed by
heal h p o essionals conce ning he e ec o
medica ion on d i ing pe o mance, he eby acil-
i a ing he p oposal o measu es as ega ds oad
sa e y. The s udy also analyses heal h s a us, illegal
d ugsI2 and alcohol cons~mp ion,’~ he esul s o
which ha e been published elsewhe e.
and e u ned. All he ques ionnai es we e checked
o comple eness and accu acy. O hese,
1500
we e
p ope ly comple ed. Fu he ques ionnai es
ecei ed
(220
by mid- 1994) we e no conside ed
o analysis. O he mailed ques ionnai es, 2405
we e sen back by mid-1994 because a w ong
add ess was gi en.
The analysis o he da a was ca ied
ou
in he
Da a P ocessing Cen e a Valladolid Uni e si y,
using he s a is ical package SAS
6.07
e sion
(unde he VAX/VMS
5
e sion).
RESULTS
METHODS
The ques ionnai e used included, among o he
i ems, sociodemog aphic da a and pa e ns o
medicine use and d i ing. D i e s we e asked
abou he medicines hey had used in he p e ious
yea and we e using a p esen (when he su ey
was ca ied
ou ).
All he in o ma ion pe aining o
he medica ion (up o se en di e en d ugs) was
eco ded: in each case hey we e asked abou he
egis e ed name o he medicine hey we e using,
he easons o using i , he in ake du a ion, and
whe he he medicine used was o e - he-coun e
o
medically p esc ibed. Each egis e ed pha ma-
ceu ical p epa a ion was coded ollowing he
Ana omical The apeu ic Chemical classi ica ion
sys em.I4 Ch onic d ug use was assessed among
hose su eyed who, a he ime o he s udy, we e
using medica ion. Ch onic
o
egula use was
de ined as when he pe son conce ned had been
using he d ug on a daily basis o a leas
1
mon h.
The
Summa y
o
P oduc Cha ac e i~ ics’~
o each
medica ion was e iewed, and i was s a ed
whe he o no he e was a wa ning abou he
e ec
o
he medica ion on he abili y o d i e
o
use machine y. Those who d ank a leas once a
weekI3 we e e med cu en alcohol d inke s.
The a ge popula ion we e hose membe s
holding a d i ing licence. A sample o 12,000
d i e s was andomly selec ed (by age g oup and
sex) om he Na ional O icial Regis e
o
Spanish
D i e s. The sample size selec ion was based on
esponse igu e a es ob ained om his egis e ,
and he aim was o ob ain a inal sample o a leas
1500 indi iduals.
The ques ionnai e, wi h ins uc ions o comple-
ion, we e mailed o selec ed d i e s be ween
26
Sep embe and 15 Oc obe 1993. By 15 Decembe
o ha yea , 1598 ques ionnai es we e comple ed
The esponse a e
(1720
ou o
12,000:
14.3%) was
as expec ed, and simila o ha ob ained ea lie
om his egis e
(1116
ou o
8200:
13.6%).
Howe e , we mus ecognize ha his
is
a e y
low a e when compa ed wi h hose ob ained in
o he de eloped coun ies. The easons o his
could be: (i) he complexi y o he ques ionnai e,
dealing wi h in o ma ion on ma e s as di e se as
heal h s a us, use
o
medica ion, alcohol and illegal
d ugs. The e o e, comple ion o he ques ionnai e
could be di icul o some people wi h a low edu-
ca ion le el. (ii) As i was clea ly indica ed in he
ques ionnai e ha he s udy was being ca ied ou
by he Na ional T a ic Agency, many d i e s could
ha e been discou aged om answe ing he ques-
ionnai e. (iii) Possibly, ye mos p obably, he ac
ha in he o icial egis e o Spanish d i e s a g ea
numbe o add esses a e inco ec , al hough e e y
d i e s should, acco ding o law, gi e no i ica ion
o any change in add ess. The said egis e is used
o no i ica ion o sanc ions and ines; a w ong
add ess in he egis e p e en s he d i e om
being no i ied, and p esc ip ion ensues
i ,
a e a
ce ain leng h
o
ime, he d i e is no
This s udy is based on
1500
d i e s who, as has
al eady been s a ed, comple ed he ques ion-
nai e.I2-l3 The sample dis ibu ion o esponden s
(by age g oup and sex) did no di e
(p
>
0.05)
om ha o all Spanish d i e s. Table
1
shows he
gende dis ibu ion
o
he sample as ega ds hei
sociodemog aphic cha ac e is ics. The sample
could no be compa ed wi h he en i e d i ing
popula ion on addi ional a iables because he
o icial egis e o Spanish d i e s has in o ma ion
ega ding only age, sex, ype o d i ing licence and
add ess.
O he Spanish d i e s su eyed, 45.1
YO
(676
ou
o
1500,
Table
2)
had used d ugs a leas once in he
0
1996
by
John
Wiley
&
Sons,
L d.
PHARMACOEPIDEMIOLOGY
AND
DRUG
SAFETY.
VOL.
5:
255-261 (1996)
MEDICATION
USE
BY
SPANISH
DRIVERS
257
Table
1
-Sociodemog aphic cha ac e is ics
o
he
d i ing popula ion su eyed
Male Female
n
YO
n
YO
To al 1016 67.7 484 32.3
Age ange
16-20
21-30
31-40
41-50
5
1-60
61-70
>
70
Ma i al s a us
Single
Ma ied
Di o cee
Widowed
Educa ional le el
No
schooling
P ima y
Middle
Seconda y
High
Uni e si y
88
27 1
26
1
180
133
70
13
363
62
1
20
12
11
175
212
264
115
200
8.6
51
26.7 213
25.7 119
17.7 73
13.
I
26
6.9 1
1.3
1
35.7 259
61.1 193
2.0 22
1.2
10
1.1 3
17.9 40
21.7 78
27.0 150
11.8 83
20.5 120
10.5
44.0
24.6
15.1
5.4
0.2
0.2
53.5
39.9
4.5
0.1
0.6
8.4
16.5
31.6
17.5
25.3
pe ious yea (43.4% among males and 48.5%
among emales,
p
<
0.05). As ega ds he numbe
o medicines, mos o hem had used ei he one
(58.0%)
o
wo (28.8%). Th ee
o
mo e d ugs we e
used by 13.2%.
O d i e s su eyed, 17.3% (259 ou o 1500
su eyed, Table 2) we e using medicines ch onic-
ally (16.9% o males and 18.0% o emales,
p
<
0.05), and, he olde he indi idual he mo e
Table 2-Pa e ns
o
medica ion use by Spanish d i e s
common his phenomenon was. O hese, 39%
we e using one d ug, 39% wo d ugs, and 22%
we e using h ee
o
mo e d ugs. Each o hese
indi iduals
(n
=
259,
5
1 1
d ugs, Table 2) was using
an a e age o 1.97
k
1.10 (mean
SD)
medicines
(1.87k0.98 o males
-
n=
172, 323 d ugs
-
and 2.16 1.29 o emales
-
n
=
87, 188 d ugs,
p
=
0.0506).
The ou mos common ch onically used g oups
o d ugs (Table 3) we e cen al ne ous sys em
d ugs (21.7%), espi a o y sys em d ugs
(19.2%),
ca dio ascula sys em d ugs (14.9%) and d ugs o
he alimen a y ac and me abolism (14.3%).
Table 3 shows also he gende dis ibu ion ega d-
ing he medicines used.
Fo
26.4% (Table 3) o he medica ion used
ch onically (135 ou o 51
1)
he e was a wa ning in
he
Summa y
o
P oduc Cha ac e is ics
abou he
e ec o he medica ion on he abili y o d i e and
he sa e use o machine y. Mos medica ions
supplied wi h his wa ning a e ca dio ascula
sys em d ugs (29.6%), cen al ne ous sys em
d ugs (3
1.1
YO)
and espi a o y sys em d ugs
(22.2%). This da a shows ha 4.6%
o
d i e s
(26.4% o he d ugs aken ch onically by 17.3% o
he popula ion) we e using medica ion ha impai s
d i ing pe o mance. Table 3 also shows egis e ed
d ugs in Spain, as well as hose wi h
a
wa ning
conce ning he e ec o he medica ion on d i ing
abili y (503 ou o 3720: 13.5%).
Among all hose su eyed, 62.9% (943 ou o
1500)
we e cu en alcohol d inke s,') and 64.5%
(167 ou
o
259) we e among hose who ook
medicines egula ly. Only 21.6% o hose using
medicines (56 ou o 259) admi ed no ha ing
consumed alcohol when using medicines. I was
Sample dis ibu ion Medica ion use in pas yea Ch onic use
o
medica ion
n n
YO
n
YO
To al
1500
676 45.1 259 17.3
Sex
Male 1016
Female 484
16-20 139
21-30 484
3 1-40 380
41-50 253
51-60 159
61-70 71
>
70 14
Age ange
x2
=
3.5
p
<
0.05
x2
=
0.25
p
<
0.05
441
43.4 172 16.9
235 48.5 87 18.0
66 47.5
235 48.5
157 41.3
105 41.5
70
44.0
38 53.5
5 35.7
28
20.1
66 13.6
50
13.2
42 16.6
40 25.2
28 39.4
5
35.7
0
1996
by
John Wiley
&
Sons, L d.
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY.
VOL.
5:
255-261 (1996)
0
5
Y
6
Table
3
-
Types
o
medica ion used by Spanish d i e s, and wa ning abou medica ion used and d i ing abili y
Ana omical The apeu ic Chemical Medica ion used Regis e ed medica ion
classi ica ion sys em Ch onic use
in
Spain
Pas yea To al Male Female Wa ning* To al Wa ning*
n
YO
n% n
YO
n
YO
n
YO
n% n
Alimen a y ac and me abolism
125 11.4 73 14.3
55
17.0 18 9.6 8 5.9 748 103 13.8
Ca dio ascula sys em
76 6.9 76 14.9 63 19.5 13 6.9$ 40 29.6 294 116 39.4
Blood and blood o ming o gans
27 2.5 27 5.3 7 2.2 20 10.6$ 1 0.7 350 3 0.8
De ma ologicals
7 0.6 4 0.8 2 0.6 2 1.1
0
0.0
386
0
0.0
Geni o-u ina y sys em and
sex
22 2.0 19 3.7 6 1.9 13 6.9$
1
0.7 143 7 4.9
ho mones
excluding sex ho mones
8 0.7
5
1.0 3
0.9
2
1.1
52
1
1.9
0
0.0
An ineoplas ic and immunomodula ing
0
0.0
0
0.0
0
0.0
0
0.0
57
0
0.0
0 0.0
Sys emic ho monal p epa a ions,
Gene al an iin ec i es o sys emic
use
164
14.9 43 8.4 26 8.0 17 9.0 6 4.4 287 31 10.8
agen s
Musculoskele al sys em
59 5.4 34 6.6 19 5.9 15 8.0 7 5.2
159
18 11.3
Cen al ne ous sys em
331 30.2
111
21.7 65 20.1 46 24.5 42 31.1 357 129 36.1
An ipa asi ic p oduc s
0
0.0
0
0.0
0
0.0
0
0.0
13 1 7.7
0 0.0
Respi a o y sys em
238 21.7 98 19.2 65 20.1 33 17.6 30 22.2 548 88 16.0
Senso y o gans
10 0.9 6 1.2 6 1.9
0
0.0
0
0.0
212
4
1.9
Va ious
30 2.7 15 2.9 6 1.9 9 4.8
0 0.0
114 2 1.7
To al sample
1097 100.0 511 100.0 323
100.0
188 100.0 135 26.4 3720 503 13.5
~~~~~ ~~
*The e is a wa ning abou he
e ec
o
he medica ion on he abili y
o
d i e
o
use machine y in he
Summa y
o
P oduc Cha ac e is ics.'4
Chi-squa e male compa ed
o
emale:
p
<
0.05,
$p
<
0
005.
P
5
MEDICATION
USE
BY
SPANISH
DRIVERS
259
no common o hose su eyed
(5.8%,
n
=
15;
4.6%.
n
=
8
o males, and
8.O%,
n
=
7
o emales,
x2
=
1.22,
p
<
0.05)
o epo ha he medica ion
used egula ly a ec ed hei d i ing pe o mance.
Su eyed d i e s who ook d ugs egula ly we e
asked
i
hey had been wa ned by heal h p o-
essionals abou he e ec s o he medica ion used
on d i ing skills: o hese,
76.5%
had ne e been
wa ned,
19.4%
had been wa ned on some
occasions, and
4.1
YO
had equen ly been wa ned.
Simila igu es
(x2
=
0.24,
p
<
0.05)
we e ound
be ween sexes (ne e :
75.6%
males and
78.5%
emales; some occasions:
20.1%
males and
17.7%
emales; equen ly:
4.3%
males and
3.8%
emales).
DISCUSSION
The p esen s udy shows a se ies o in e es ing da a,
he i s o which is ha medicines a e equen ly
used by he popula ion. Ce ain medica ions ha e
been used by
45.1
YO
du ing he las yea and
17.3%
use hem ch onically. I has o be poin ed ou ha
among egula use s, he majo i y ake an a e age
o wo medica ions. Ano he ema kable ac is he
equency o join use
o
alcohol and medica ion.
Finally, and wha is mo e impo an , is ha in
h ee ou o ou cases conce ning egula d ug
use s, heal h p o essionals do no p o ide he
pa ien wi h any in o ma ion as ega ds he e ec
o he medica ion on d i ing abili y.
A compa ison wi h he da a ob ained in o he
s udies is di icul , due o a lack o s anda diza ion
and he di e en ypes o me hodology used. Fo
ins ance, a s udy among he Aus ian popula ion
e ealed ha d ug in ake was epo ed by
44%
in
he
3
mon hs p io o he in e iew, and
27%
in he
p e ious week; u he mo e, he a e age numbe o
d ugs used was
1
.84.5
In a F ench s udy on ic ims
o oad a ic acciden s,
23.6%
admi ed ha ing
aken medica ion
5
days be o e he acciden .6 In a
Finnish s udy on casual ies a ending eme gency
depa men s,
31.6%
said ha hey had used some
medica ion a week ea lie , whils
15.3%
admi ed
ha ing used some medica ion a week p io o he
a~ciden .~ In he Uni ed Kingdom, he equency
wi h which medicines a e used among samples o
he gene al d i ing popula ion anges om
5.5%
o
22%;
o hose medica ions likely o ha e an
e ec on he cen al ne ous sys em, he equency
is be ween
2%
and
5%.8
The p esen s udy also shows ha hese people
o en use a ious ypes o medica ion a he same
ime:
61%
use wo
o
mo e ypes o medica ion.
This makes in e ac ions mo e common and, conse-
quen ly, causes a g ea e de e io a ion
o
psycho-
mo o pe o mance in ce ain cases. Wha is no
su p ising, gi en he ac ha alcohol is usually
consumed in many Eu opean coun ies, is ha
alcohol consump ion among he d i e s su eyed is
equen :
62.9%
among all hose su eyed and
64.5%
among hose who usually use medica ion;
his con i ms he p e ious inding~.'~ A ac o be
conside ed, is ha consuming alcohol and using
medica ion ha e nega i e e ec s on psychomo o
pe o mance, and, as a esul , he e is a g ea e
acciden isk. Wha is mo e, i is app op ia e o
men ion ha only a small numbe o hose who
no mally use medica ion
(5.8%)
admi ha ha
medica ion a ec s hei d i ing pe o mance.
Wi hin he Eu opean communi y, package
inse s include a s a emen ega ding he e ec s o
medica ion on he abili y o d i e o use
machine y." Fu he mo e, he e has ecen ly been
accep ed a h ee- ie wa ning sys em o iden i y he
haza d po en ial o d ugs on d i ing abili y in he
Summa y
o
P oduc Cha ac e is ics."
The e is a
s a emen conce ning medica ion e ec s on he
abili y o d i e among
26.4%
o ch onically used
ypes o medica ion
(4.6%
o all su eyed). This is
impo an , and i is logical o hink ha hese
indi iduals migh expe ience impai men o ce ain
o he acul ies needed o sa e d i ing. Howe e ,
al hough he da a do no pe mi us o s a e whe he
hese people we e in he habi o d i ing unde he
in luence o medica ion, hey do demons a e he
equency wi h which medica ion ha could impai
d i ing pe o mance is used. Fu he mo e, among
all egis e ed medica ions in Spain,
13.5%
con ain
a wa ning ega ding hei e ec on d i ing abili y.
Age and sex a e among he majo ac o s
in luencing he le el o d ug use:16 elde ly and
emale a e he mos common cha ac e is ics o
d ug use s. In he p esen s udy, ch onic use o
medica ion is mo e common among he aged
popula ion, while no signi ican di e ences we e
ound be ween sexes (al hough he igu es o
women we e highe han hose o men). The
eason could be ela ed o he ac ha mos emale
d i e s in Spain belong o he younge age g oups.
In
1993
he e we e abou
15,882,000
d i e s in
Spain, men
(67.3%)
a e mo e han wice as likely
han emales
(32.7%)
o be d i e s.
Finally, and mo e signi ican ly, in
76.5%
o
cases, heal h p o essionals ha e ne e wa ned hei
pa ien s abou he e ec o medica ion on d i ing
0
1996
by
John
Wiley
&
Sons,
L d.
PHARMACOEPIDEMIOLOGY
AND
DRUG SAFETY,
VOL.
5:
255-261 (1996)

260
M.
C.
DEL
R10
AND
F.
J.
ALVAREZ
pe o mance. This inding coincides wi h he da a
encoun e ed
in
p e ious s udies.17 In spi e
o
p oduc in o ma ion and labelling, we belie e''
ha heal h p o essionals
-
doc o s and
chem-
is s
-
should gi e ad ice o hei pa ien s abou
he ex en o which he medica ion p esc ibed (as
well as illness and
alcohol
consump ion) migh
in e e e wi h hei d i ing abili y.
The p esen s udy is
no
wi hou se e al
limi a ions (a low esponse a e, i s desc ip i e
na u e, e c.),
bu
i
does highligh he la ge
numbe
o
d i e s using medica ion ha could impai
d i ing pe o mance. E en
so,
we will admi ha
some
possible a ia ions
in
he ga he ed in o ma-
ion could exis , because we canno exclude o e -
o
unde epo ing medica ion use. The e
is
a
need
o s anda dize he me hodology employed in his
ield,lg
in o de
o
cha ac e ize he ex en
o
his
phenomenon.
In
he
las ew yea s, no only
ha e
legisla i e ules been in oduced, bu special
a en ion has been de o ed o assessing he isk
o being in ol ed in
a
a ic acciden while d i ing
a e using medica ion. Se e al s ~dies'~-~' ha e
shown he inc eased isk o being in ol ed
in
a
oad
acciden when d i ing unde
he
in luence
o
some medica ion, mainly psycho opic medica ion.
The
ull
impac
o
medica ion
on
d i ing
is
di icul
o es ablish, bu i is easy o accep ha
some kinds
o
medica ion in e e e wi h d i ing
pe o mance and, he e o e, could inc ease he
isk
o
oad acciden s.' Road acciden s ep esen
one
o
he
main
public heal h p oblems wo ldwide,
and
he need o de elop policies gea ed owa ds hei
educ ion is becoming mo e
and
mo e u gen . The
ole
o
medica ion as ega ds
oad
sa e y
should
no
be
o go en. Doc o s should be awa e
o
he
possible in luence o he medica ion p esc ibed
on
d i ing
pe o mance, and should in o m hei
pa ien s abou
i .
ACKNOWLEDGEMENTS
Suppo o his s udy was p o ided by he
Di eccion Gene al de T a ico, Minis e io de
Jus icia
e
In e io ,
Mad id (Spain).
REFERENCES
1.
Wille e, R. E. and Walsh,
J.
M.
D ugs, D i ing and
T a ic Sa e y.
WHO O se Publica ion No. 78,
Wo ld Heal h O ganiza ion, Gene a, 1983.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Hindma ch,
I.,
Ke ,
J.
S.
and She wood,
N.
The
e ec s
o
alcohol and o he d ugs on psychomo o
pe o mance and cogni i e unc ion.
Alcohol and
Alcoholism
1991;
26:
71-79.
Consensus De elopmen Panel. D ug concen a-
ions and d i ing impai men .
Jou nal o he
Ame ican Medical Associa ion
1985;
257:
2618-
2621.
Honkanen, R., E ama, L., Linnoila, M.,
e a/.
Role
o d ugs in a ic acciden s.
B i ish Medical Jou nal
Lesch,
0.
M., Len ne ,
S.,
Made , R., Musalek, M.,
Nimme ich e , A. and Wal e , H. Medica ion and
d ug abuse in ela ion o oad a ic sa e y.
Pha ma he apeu ica
1989;
5:
338-353.
Mon as uc,
J.
L., Ca hala,
B.,
Richa d,
J.
P.,
e al.
Medicamen s e acciden s de la ci cula ion.
The apie
Neu eboom, W. and Zweip enning, P. G.
M.
D i ing and he combined use o d ugs and alcohol
in he Ne he lands.
Fo ensic Science In e na ional
Sabey,
B.
The d ugs (medicines) d i ing si ua ion in
he UK. In:
Medicines and Road T a ic Sa e y.
Bu ley, D. and Sil e s one, T. (Eds), Clinical Neu o-
science Publishe s, London, 1988, pp. 1-12.
Skegg,
D.
C.
G., Richa ds,
S.
M. and Doll, R. Mino
anquillise s and oad acciden s.
B i ish Medical
Jou nal
1979;
i:
917-919.
De Gie ,
J.
J.
D i ing Licences and
Known
Use o
Lici o Illici D ugs.
Uni e si y o Limbu g,
Ins i u e o Human Psychopha macology, Maas-
ich, 1993.
Al a ez,
F.
J. and Del Rio, M. C. D ugs and d i ing
(commen a y).
Lance
1994;
344:
282.
Al a ez,
F.
J.
and Del Rio, M.
C.
Illegal d ug aking
and d i ing: pa e ns
o
d ug aking among Spanish
d i e s.
D ug and Alcohol Dependence
1995;
37:
Al a ez,
F.
J.,
Del Rio, M. C. and P ada, R. D ink-
ing and d i ing in Spain.
Jou nal
o
S udies
on
Ca alog0 de Especialidades Fa mace'u icas
1993.
Consejo Gene al de Colegios O iciales de Fa m-
acku icos, Mad id, 1993.
Al a ez,
F.
J.,
P ada,
R.
and Del Rio, M.
C.
D ugs
and alcohol consump ion amongs Spanish d i e s.
Fo ensic Science In e na ional
1992;
53:
22 1-225.
Leu lcens,
H.
G. and U quha ,
L.
Va iabili y in
pa e ns
o
d ug usage.
Jou nal o Pha macy and
Pha macology
1994;
46
(Suppl.
1):
433-437.
Al a ez,
F.
J., P ada,
R.
and Del Rio,
M.
C. Pa e ns
o
d ug consump ion among Spanish d i e s.
The apie
1992;
47:
63-66.
De Gie ,
J.
J.
D ugs O he Than Alcohol and D i ing
in he Eu opean Union.
Uni e si y o Limbu g,
Ins i u e
o
Human Psychopha macology, Maas-
ich, 1995.
1980;
281:
1309-1312.
1988;
43
313-315.
1984;
25:
93- 104.
83-86.
Alcohol
1995;
56:
403-407.
0
1996 by John Wiley
&
Sons, L d.
PHARMACOEPIDEMIOLOGY
AND
DRUG
SAFETY,
VOL.
5:
255-261 (1996)
MEDICATION
USE
BY
SPANISH DRIVERS
26
1
19. Ray,
W.
A.,
Fough , R.
L.
and Decke ,
M.
D.
ion
o
a benzodiazepine.
Annals o Epidemiology
ehicle c ashes in elde ly d i e s.
Ame ican Jou nal
21. He ings, R.
M.
C.
Geneesmiddelen als De e minan
o
Epidemiology
1992;
136:
873-883.
an Onge allen.
Uni e si y
o
U ech , U ech ,
20. Neu el,
C.
I.
Risk
o
acciden inju y a e a p esc ip-
Psychoac i e d ugs and he
isk
o
inju ious
mo o
1995;
5:
239-244.
1995.
0
1996
by
John
Wiley
&
Sons,
L d.
PHARMACOEPIDEMIOLOGY
AND
DRUG
SAFETY,
VOL.
5
255-261 (1996)