All trauma professionals are keenly aware of how often alcohol is involved in automobile crashes. Something you may not know is that one third of drug tests for other substances are positive in drivers involved in car crashes!

There has been a 5 percent increase in the number of positive drug screens in drivers over the past 4 years. The drugs range from hallucinogens to prescription pain medications. 

Seventeen states have enacted legislation making it illegal to drive while on various types of legal and illegal drugs. However, these laws are difficult to enforce because:

• They are more difficult to detect, both by law enforcement at the scene and in the hospital
• We don’t know a lot about the impact of these drugs on driving performance
• A positive drug screen does not tell us when the substance was taken and if it is at a significant level

Drug screens are typically obtained in the ED in seriously injured drivers. It’s a good idea to order one in any patient with a significant head injury. This allows the clinician to guess (and it’s just a guess) that the medications may be impairing the mental status exam. Any patients who have a positive screen should have a documented chemical dependency evaluation and be provided with referral information to get further help.

Reference: National Highway Traffic Safety Administration