Psychoactive drug consumption among truck-drivers: a systematic review of the literature with meta-analysis and meta-regressions


psychoactive drug consumption
systematic review
meta-analysis and meta-regression
occupational health and wellbeing
road safety


Few studies have assessed the entity of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern, since psychoactive substance use has a relevant impact on the drivers’ health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. A systematic review of the literature and meta-analysis was performed in order to provide Occupational Health professionals and policy makers with an updated epidemiological perspective regarding this important issue. The results showed a prevalence of overall drug consumption of 27.6% [95%CI 17.8-40.1], particularly high considering illicit CNS-stimulants (amphetamine consumption of 21.3% [95%CI 15.7-28.1], cocaine consumption of 2.2% [95%CI 1.2-4.1]). It appears that truck drivers choose stimulant substances as a form of performance enhancing drug, in order to increase productivity. However, chronic and high dose consumption has been shown to decrease driving skills, placing these professional drivers at risk for health and road safety. Further research is required, particularly in Europe, in order to fill the knowledge gap and improve the strength of evidence.


The United Nations Office on Drugs and Crime (UNODC). World Drug Report 2018. Available online:

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). European Drug Report 2018: Trends and Developments. Available online:

Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ). The CBHSQ Report: Substance Use and Substance Use Disorder, by Industry. Available online:

Girotto E, Mesas AE, de Andrade SM, Birolim MM. Psychoactive substance use by truck drivers: A systematic review. Occup Environ Med. 2014 Jan;71(1):71-6. doi:10.1136/oemed-2013-101452.

Criezzle AM, Bigelow P, Adams D, Gooderham S, Myers AM, Thiffault P. Health and wellness of long-haul truck drivers and bus drivers: A systematic review and directions for future researches. J Transp Health 2017, 7, 90–109. doi:10.1016/j.jth.2017.05.359.

Apostolopoulos Y, Sönmez S, Shattell MM, Belzer M. Worksite-induced morbidities among truck drivers in the United States. AAOHN J. 2010Jul;58(7):285-96. doi: 10.3928/08910162-20100625-01.

van der Beek AJ. World at work: truck drivers. Occup Environ Med. 2012Apr;69(4):291-5. doi: 10.1136/oemed-2011-100342.

Sieber WK, Robinson CF, Birdsey J, Chen GX, Hitchcock EM, Lincoln JE, Nakata A, Sweeney MH. Obesity and other risk factors: the national survey of U.S. long-haul truck driver health and injury. Am J Ind Med. 2014 Jun;57(6):615-26.doi: 10.1002/ajim.22293.

Guglielmi O, Magnavita N, Garbarino S. Sleep quality, obstructive sleep apnea, and psychological distress in truck drivers: A cross-sectional study. Soc Psychiatry Psychiatr Epidemiol. 2018 May;53(5):531-536. doi:10.1007/s00127-017-1474-x..

Burns N. An integrative review of screening for obstructive sleep apnea in commercial vehicle drivers. Workplace Health Saf. 2014 Mar;62(3):114-20. doi:10.3928/21650799-20140219-05.

Gamble JF, Nicolich MJ, Boffetta P. Lung cancer and diesel exhaust: An updated critical review of the occupational epidemiology literature. Crit Rev Toxicol. 2012 Aug;42(7):549-98. doi: 10.3109/10408444.2012.690725.

Gay Anderson D, Riley P. Determining standards of care for substance abuse and alcohol use in long-haul truck drivers. Nurs Clin North Am. 2008 Sep;43(3):357-65, viii. doi: 10.1016/j.cnur.2008.04.003.

Wagstaff AS, Sigstad Lie JA. Shift and night work and long working hours—A systematic review of safety implications. Scand J Work Environ Health. 2011May;37(3):173-85. doi: 10.5271/sjweh.3146.

Zhang X, Chow EP, Wilson DP, Sun X, Zhao R, Zhang J, Jing J, Zhang L. Prevalence of HIV and syphilis infections among long-distance truck drivers in China: A data synthesis and meta-analysis. Int J Infect Dis. 2013, 17, e2–e7, doi:10.1016/j.ijid.2012.07.018.

World Health Organization (WHO). Drug use and road safety: a policy brief. 2016. Available online:

Korelitz JJ, Fernandez AA, Uyeda VJ, Spivey GH, Browdy BL, Schmidt RT. Health habits and risk factors among truck drivers visiting a health booth during a trucker trade show. Am J Health Promot. 1993 Nov-Dec;8(2):117-23. doi:10.4278/0890-1171-8.2.117.

Girotto E, de Andrade SM, Mesas AE, González AD, Guidoni CM. Working conditions and illicit psychoactive substance use among truck drivers in Brazil. Occup Environ Med. 2015 Nov;72(11):764-9. doi: 10.1136/oemed-2015-102868.

Ramirez M, Bedford R, Sullivan R, Anthony TR, Kraemer J, Faine B, Peek-Asa C. Toxicology testing in fatally injured workers: a review of five years of Iowa FACE cases. Int J Environ Res Public Health. 2013 Nov 14;10(11):6154-68. doi:10.3390/ijerph10116154.

Bragazzi NL, Dini G, Toletone A, Rahmani A, Montecucco A, Massa E, Manca A, Guglielmi O, Garbarino S, Debarbieri N, Durando P. Patterns of Harmful Alcohol Consumption among Truck Drivers: Implications for Occupational Health and Work Safety from a Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2018;15(6):1121. doi:10.3390/ijerph15061121.

Conferenza Unificata. Provvedimento 30 Ottobre 2007, Intesa, ai sensi dell'articolo 8, comma 6, della legge 5 giugno 2003, n. 131, in materia di accertamento di assenza di tossicodipendenza. Available online:

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ. 2015Jan 2;350:g7647. doi: 10.1136/bmj.g7647.

Chien PF, Khan KS, Siassakos D. Registration of systematic reviews: PROSPERO. BJOG. 2012 Jul;119(8):903-5. doi: 10.1111/j.1471-0528.2011.03242.x.

Bragazzi NL, Dini G, Toletone A, Durando P. An Updated Systematic Review with Meta-Analysis Examining Prevalence of Drugs and Alcohol Use among Truck-Drivers. PROSPERO 2016: CRD42016037077 Available online:

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med.2009 Jul 21;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002 Jun 15;21(11):1539-58. doi:10.1002/sim.1186.

Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006Jun;11(2):193-206. doi:10.1037/1082-989X.11.2.193

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997 Sep 13;315(7109):629-34. doi:

Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000 Jun;56(2):455-63. doi:10.1111/j.0006-341X.2000.00455.x

Bombana HS, Gjerde H, Dos Santos MF, Jamt REG, Yonamine M., Rohlfs WJC, Muñoz DR, Leyton V. Prevalence of drugs in oral fluid from truck drivers in Brazilian highways. Forensic Sci Int. 2017 Apr;273:140-143. doi:10.1016/j.forsciint.2017.02.023.

Cerqueira GS, Siqueira RMP, Freitas APF, Leiros WSB, Freitas RM, Silva RC, Fragoso LM. Uso de anfetaminas entre caminhoneiros - um estudo transversal. RevInter 2011, 4, 76-86.

Couper FJ, Pemberton M, Jarvis A, Hughes M, Logan BK. Prevalence of drug use in commercial tractor-trailer drivers. J Forensic Sci. 2002 May;47(3):562-7.

De Oliveira LG, de Souza LM, Barroso LP, Gouvêa MJ, de Almeida CV, Muñoz DR, Leyton V. Occupational conditions and the risk of the use of amphetamines by truck drivers. Rev Saude Publica. 2015;49:61. doi:10.1590/S0034-8910.2015049005944.

De Oliveira LG, Leopoldo K, Gouvea MJ, Barroso LP, Gouveia PA, Muñoz DR, Leyton V. Prevalence of at-risk drinking among Brazilian truck drivers and its interference on the performance of executive cognitive tasks. Drug Alcohol Depend. 2016 Sep 1;166:218-25. doi: 10.1016/j.drugalcdep.2016.07.019.

Drummer OH, Gerostamoulos D, Chu M, Swann P, Boorman M, Cairns I. Drugs in oral fluid in randomly selected drivers. Forensic Sci Int. 2007 Aug6;170(2-3):105-10. doi:10.1016/j.forsciint.2007.03.028

Gjerde H, Christophersen AS, Normann PT, Pettersen BS, Sabaredzovic A, Samuelsen SO, Mørland J. Analysis of alcohol and drugs in oral fluid from truck drivers in Norway. Traffic Inj Prev. 2012;13(1):43-8. doi:10.1080/15389588.2011.627957.

Gjerde H, Sousa TR, De Boni R, Christophersen AS, Limberger RP, Zancanaro I, Oiestad EL, Normann PT, Mørland J, Pechansky F. A comparison of alcohol and drug use by random motor vehicle drivers in Brazil and Norway. Int J Drug Policy. 2014May;25(3):393-400. doi: 10.1016/j.drugpo.2014.01.019.

Guinn, B. Job satisfaction, counterproductive behavior and circumstantial drug use among long-distance truckers. J Psychoactive Drugs. 1983 Jul-Sep;15(3):185-8. doi:10.1080/02791072.1983.10471947.

Ingsathit A, Woratanarat P, Anukarahanonta T, Rattanasiri S, Chatchaipun P, Wattayakorn K, Lim S, Suriyawongpaisal P. Prevalence of psychoactive drug use among drivers in Thailand: a roadside survey. Accid Anal Prev. 2009 May;41(3):474-8. doi: 10.1016/j.aap.2009.01.010.

Knauth DR, Pilecco FB, Leal AF, Seffner F, Teixeira AM. [Staying awake: truck drivers' vulnerability in Rio Grande do Sul, Southern Brazil]. Rev Saude Publica.2012 Oct;46(5):886-93. doi:10.1590/S0034-89102012000500016.

Labat L, Fontaine B, Delzenne C, Doublet A, Marek MC, Tellier D, Tonneau M, Lhermitte M, Frimat P. Prevalence of psychoactive substances in truck drivers in the Nord-Pas-de-Calais region (France). Forensic Sci Int. 2008 Jan30;174(2-3):90-4. doi:10.1016/j.forsciint.2007.03.004.

Laraqui S, Laraqui O, Tripodi D, Manar N, Aoudi YE, Caubet A, Verger C, Ghailan T, Laraqui CH. Prevalence and risk factors of alertness disorders of professional drivers in Morocco. Sante Publique. 2011 Mar-Apr;23(2):89-100. doi:10.3917/spub.112.0089.

Lemire AM, Montégiani M, Dussault C. Alcohol and drug consumption by Québec truck drivers. In Proceedings of the 16th International Conference on Alcohol, Drugs and Traffic Safety, Montreal, QC, Canada, 4–9 August 2002.

Leopoldo K, Leyton V, Oliveira LG. Alcohol use alone and in combination with other drugs among truck drivers on highways in São Paulo State, Brazil: A cross-sectional study. Cad Saude Publica. 2015 Sep;31(9):1916-28. doi:10.1590/0102-311X00047214.

Leyton V, Sinagawa DM, Oliveira KC, Schmitz W, Andreuccetti G, De Martinis BS, Yonamine M, Munoz DR. Amphetamine, cocaine and cannabinoids use among truck drivers on the roads in the State of Sao Paulo, Brazil. Forensic Sci Int. 2012Feb 10;215(1-3):25-7. doi: 10.1016/j.forsciint.2011.03.032.

Lund AK, Preusser DF, Blomberg RD, Williams AF. Drug use by tractor-trailer drivers. J Forensic Sci. 1988 May;33(3):648-61.doi: 10.1520/JFS12474J.

Maarefvand M, Kassaie B, Ghiasvand H, Abolfathi Gharibdoosti R, Khubchandani J. Sexual and Drug Use Risk Behaviors of Internal Long Distance Truck Drivers in Iran. Iran J Public Health. 2016 May;45(5):606-13.

Mabbott NA, Hartley LR. Patterns of stimulant drug use on Western Australian heavy transport routes. Transport Res Part F2 1999, 115–130. doi: 10.1016/S1369-8478(99)00012-1.

Mansur Ade P, Rocha MA, Leyton V, Takada JY, Avakian SD, Santos AJ, Novo GC, Nascimento AL, Muñoz DR, Rohlfs WJ. Risk Factors for Cardiovascular Disease, Metabolic Syndrome and Sleepiness in Truck Drivers. Arq Bras Cardiol. 2015Dec;105(6):560-5. doi: 10.5935/abc.20150132.

Masson VA, Monteiro MI. [Life style, health aspects and work among truck drivers]. Rev Bras Enferm. 2010 Jul-Aug;63(4):533-40.doi: 10.1590/S0034-71672010000400006.

Mieczkowski T. Urinalysis and hair analysis for illicit drugs of driver applicants and drivers in the trucking industry. J Forensic Leg Med. 2010, 17, 254-260. doi: 10.1016/j.jflm.2010.02.014

Mir MU, Khan I, Ahmed B, Abdul Razzak J. Alcohol and marijuana use while driving - an unexpected crash risk in Pakistani commercial drivers: a cross-sectional survey. BMC Public Health. 2012, 12, 145. doi: 10.1186/1471-2458-12-145

Mongkolsirichaikul D, Mokkhavesa C, Ratanabanangkoon K. The incidence of amphetamine use among truck drivers from various regions of Thailand. J Med Assoc Thai. 1988, 71, 471-474.

Moreira RS, Gadani JAAB. A prevalência do uso de anfetaminas por caminhoneiros que passam pela cidade de Dourados-MS. Interbio 2009, 3, 27-34.

Nascimento EC, Nascimento E, Silva JP. Uso de álcool e anfetaminas entre caminhoneiros de estrada. Rev. Saúde Pública 2007, 41, 290–293.

Okpataku CI. Pattern and reasons for substance use among long-distance commercial drivers in a Nigerian city. Indian J. Public Health 2015, 59, 259–263. doi: 10.4103/0019-557X.169649

Peixe TS, de Almeida RM, Girotto E, de Andrade SM, Mesas AE. Use of illicit drugs by truck drivers arriving at Paranaguá port terminal, Brazil. Traffic Inj Prev. 2014, 15, 673-677. doi: 10.1080/15389588.2013.868893

Penteado RZ, Gonçalves CGO, Costa DD, Marques JM. Trabalho e saúde em motoristas de caminhãono interior de São Paulo. Saúde Soc. 2008, 17, 35–45.

Pereira FGF, Aquino RA, Alencar VDM, Pordeus AMJ, Ataíde MBC. Relationship Between Work Process And health Of Truckers. Rev Bras Promoç Saúde 2014, 27, 462-469.

Pidetcha P, Congpuong P, Putriprawan T, Rekakanakul R, Suwanton L, Tantrarongroj S. Screening for urinary amphetamine in truck drivers and drug addicts. J Med Assoc Thai. 1995, 78, 554-558.

Pinheiro MP, Muniz LF, Da Silva MCV, Resill DP, Filho PCPT. Amphetamines consumption and alcohol for truck drivers. J. Nurs. UFPE On Line Recife 2015, 9, 8519–8525.

Pinho RSN. Uso de estimulantes, queixa do sono e estado de humor em motoristas profissionais de caminhão. Dissertação (Mestrado em Ciências Farmacêuticas) - Universidade Federal do Ceará. Faculdade de Farmácia, Odontologia e Enfermagem, Fortaleza, 2005.

Remor KVT, Monteiro MTM, Rosa VD, Iacovski RB, Sakae TM, Galato D. Abusive Consumption of Psychoactive Substances by Truck drivers. Med Clin Rev. 2015, 2, 1.

Riva MM, Marchetti FA, Giupponi V, Mosconi G. Health surveillance of truck drivers: It is not just a question of drugs. Description of a one-year experience. Med. Lav. 2010, 101, 207–217.

Riva MM, Cantamessa F, Borleri D, Mosconi G. Occupational health and safety of road haulage company employees. Med Lav. 2018, 109, 180-189. doi: 10.23749/mdl.v109i3.6827

Sangaleti CT, Trincaus MR, Baratieri T, Zarowy K, Ladika MB, Menon MU, Miyahara RY, Raimondo MI, Silveira JV, Bortolotto LA, Lopes HF, Consolim-Colombo, F.M. Prevalence of cardiovascular risk factors among truck drivers in the South of Brazil. BMC Public Health 2014, 14, 1063. doi: 10.1186/1471-2458-14-1063

Silva OA, Greve JMD, Yonamine M, Leyton V. Drug Use by Truck Drivers in Brazil. Drug-Educ. Prev. Policy 2003, 10, 135-139.

Sinagawa DM, De Carvalho HB, Andreuccetti G, Do Prado NV, De Oliveira KC, Yonamine M, Muñoz,DR, Gjerde H, Leyton V. Association between travel length and drug use among Brazilian truck drivers. Traffic Inj Prev. 2015, 16, 5-9. doi: 10.1080/15389588.2014.906589

Souza JC, Paiva T, Reimão R. Sleep habits, sleepiness and accidents among truck drivers. Arquivos de Neuro-Psiquiatria 2005, 63, 925–930. doi: /S0004-282X2005000600004

Starmer GA, Mascord DJ, Tattam B, Zeleny R. Analysis for drugs in saliva. Canberra: Federal Office of Road Safety, Report No. CR141, 1-66. 1994.

Takitane J, De Oliveira LG, Endo LG, De Oliveira KC, Muñoz DR, Yonamine M, Leyton V. Uso de anfetaminas por motoristas de caminhão em rodovias do Estado de São Paulo: um risco à ocorrência de acidentes de trânsito? Ciênc. saúde coletiva 2013, 18, 1247-1254.

Teles AS, Matos MA, Caetano KAA, Cost LA, França DDS, Pessoni GC, Brunini SM, Martins RMB. Comportamentos de risco para doenças sexualmente transmissíveis em caminhoneiros no Brasil. Rev Panam Salud Publica. 2008, 24, 25–30.

Valway S, Jenison S, Keller N, Vega-Hernandez J, Hubbard McCree D. Risk assessment and screening for sexually transmitted infections, HIV, and hepatitis virus among long-distance truck drivers in New Mexico, 2004-2006. Am J Public Health 2009, 99, 2063-8. doi: 10.2105/AJPH.2008.145383

Williamson A. Predictors of psychostimulant use by long-distance truck drivers. Am J Epidemiol. 2007, 166, 1320-1326. doi: 10.1093/aje/kwm205.

Yonamine M, Sanches LR, Paranhos BA, De Almeida RM, Andreuccetti G, Leyton V. Detecting alcohol and illicit drugs in oral fluid samples collected from truck drivers in the state of São Paulo, Brazil.Traffic Inj. Prev. 2013, 14, 127–131. doi: 10.1080/15389588.2012.696222

Sinagawa DM, De Carvalho HB, Andreuccetti G, Do Prado NV, De Oliveira KC, Yonamine M, Muñoz DR, Gjerde H, Leyton V. Association between travel length and drug use among Brazilian truck drivers. Traffic Inj Prev. 2015, 16, 5-9. doi: 10.1080/15389588.2014.906589

Knauth, DR, Pilecco FB, Leal AF, Seffner F, Teixeira AM. Staying awake: truck drivers’ vulnerability in Rio Grande do Sul, Southern Brazil. Rev. Saude Publica 2012, 46, 886–893.

Kelly E, Darke S, Ross J. A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions. Drug Alcohol Rev 2004, 23, 319–344. doi: 10.1080/09595230412331289482

Gustavsen I, Mørland J, Bramness JG. Impairment related to blood amphetamine and/or methamphetamine concentrations in suspected drugged drivers. Accid Anal Prev. 2006, 38, 490-495. doi: 10.1016/j.aap.2005.11.005

Drummer OH, Gerostamoulos J, Batziris H, Chu M, Caplehorn J, Robertson MD, Swann P. The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes. Accid. Anal. Prev. 2004, 36, 239–248.

Musshoff F, Madea B. Driving under the influence of amphetamine-like drugs. J Forensic Sci. 2012, 57, 413-419. doi: 10.1111/j.1556-4029.2012.02055.

Logan BK, Schwilke EW. Drug and alcohol use in fatally injured drivers in Washington State. J Forensic Sci. 1996, 41, 505-510.

Coambs RB, McAndrews MP. The Effects of Psychoactive Substances on Workplace Performance. 1994 In: Macdonald, S., Roman, P. (Eds.), Drug Testing in the Workplace. Plenum Press, New York, pp. 77–102.

McKim W. Drugs and Behavior. 1986 Cliffs, NJ. Prentice-Hall.

Bolla K, Rothman R, Cadet JL. Dose-Related Neurobehavioral Effects of Chronic Cocaine Use. J. Neuropsych. Clin. Neurosci. 1999, 11, 361–369. doi: 10.1176/jnp.11.3.361

Burns, M. Cocaine Effects on Performance 1993. In: Utzelmann, H.D., Berghaus, G., Kroj, G. (Eds.), Alcohol, Drugs, and Traffic Safety-T’92: Proceedings of the 12th International Conference on Alcohol, Drugs and Traffic Safety, Cologne, Verlag TUV Rheinland, pp. 612–619.

European Agency for Safety and Health at Work (EU-OSHA). A review on the future of work: performance-enhancing drugs. Available online:

Brookhuis KA, Volkerts ER, O’Hanlon JF. Repeated dose effects of lormetazepam and flurazepam upon driving performance. Eur. J. Clin. Pharmacol 1990, 39, 83–87.

Laurell H, Tornros J. The carry-over effects of triazolam compared with nitrazepam and placebo in acute emergency driving situations and in monotonous simulated driving. Acta Pharmacol. Toxicol 1986, 58, 182–186.

O’Hanlon JF, Volkerts ER. Hypnotics and actual driving performance. Acta Psychiatr. Scand. 1986, 332, 95–104.

O’Hanlon, J.F., Haak, T.W., Blaauw, G.J., Riemersma, J.B. Diazepam impairs lateral position control in highway driving. Science 1982, 217, 79–81.

Ramaekers JG, Robbe HWJ, O’Hanlon JJ. Marijuana. Human Psychopharmacol 2000, 15, 551–558.

Ray WA, Fought RL, Decker MD. Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. Am. J.Epidemiol. 1992, 136, 873–883.

Robbe, H.W.J. Influence of marijuana on driving. CIP-Data Koninklinik Bibliothek, 1994. The Hague, Maastricht, The Netherlands.

Bondallaz P, Favrat B, Chtioui H, Fornari E, Maeder P, Giroud C. Cannabis and its effects on driving skills. Forensic Sci Int. 2016, 268, 92-102. doi: 10.1016/j.forsciint.2016.09.007

Asbridge M, Hayden JA, Cartwright JL. Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ 2012, 344 e536. doi: 10.1136/bmj.e536

Hartman RL, Brown TL, Milavetz G, Spurgin A, Pierce RS, Gorelick DA, Gaffney G, Huestis MA. Cannabis effects on driving longitudinal control with and without alcohol. J Appl Toxicol. 2016 , 36, 1418-1429. doi: 10.1002/jat.3295

Hartman RL, Brown TL, Milavetz G, Spurgin A, Pierce RS, Gorelick DA, Gaffney G, Huestis MA. Cannabis effects on driving lateral control with and without alcohol. Drug Alcohol Depend. 2015, 154, 25-37. doi: 10.1016/j.drugalcdep.2015.06.015

Ronen A, Chassidim HS, Gershon P, Parmet Y, Rabinovich A, Bar-Hamburger R, Cassuto Y, Shinar D. The effect of alcohol, THC and their combination on perceived effects, willingness to drive and performance of driving and non-driving tasks. Accid Anal Prev. 2010, 42, 1855-1865. doi: 10.1016/j.aap.2010.05.006

Downey LA, King R, Papafotiou K, Swann P, Ogden E, Boorman M, Stough C. The effects of cannabis and alcohol on simulated driving: Influences of dose and experience. Accid Anal Prev. 2013, 50, 879-886. doi: 10.1016/j.aap.2012.07.016

Dubois S, Mullen N, Weaver B, Bédard M. The combined effects of alcohol and cannabis on driving: Impact on crash risk. Forensic Sci Int. 2015, 248, 94-100. doi: 10.1016/j.forsciint.2014.12.018

Goldsmith RS, Targin, MC, Fanciullo GJ, Martin DW, Hartenbaum NP, White JM, Franklin P. Medical marijuana in the workplace: challenges and management options for occupational physicians. J Occup Environ Med. 2015, 57, 518-525. doi: 10.1097/JOM.0000000000000454

Strand MC, Vindenes V, Gjerde H, Mørland JG, Ramaekers JG. A clinical trial on the acute effects of methadone and buprenorphine on actual driving and cognitive function of healthy volunteers. Br J Clin Pharmacol. 2019, 85, 442-453. doi: 10.1111/bcp.13818

Strand MC, Fjeld B, Arnestad M, Mørland J. Can patients receiving opioid maintenance therapy safely drive? A systematic review of epidemiological and experimental studies on driving ability with a focus on concomitant methadone or buprenorphine administration. Traffic Inj Prev. 2013, 14, 26-38. doi: 10.1080/15389588.2012.689451

Fishbain, DA, Cutler RB, Rosomoff HL, Rosomoff RS. Are opioid-dependent/tolerant patients impaired in driving-related skills? A structured evidence-based review. J Pain Symptom Manage. 2003, 25, 559-77.

Galski, T., Williams, J.B., Ehle, H.T. Effects of opioids on driving ability. J Pain Symptom Manage. 2000, 19, 200-208.

Kaye AM, Kaye A, Lofton EC. Basic concepts in opioid prescribing and current concepts of opioid-mediated effects on driving. Ochsner J. 2013, 13, 525-532.

Wickens CM, Mann RE, Brands B, Ialomiteanu AR, Fischer B, Watson TM, Matheson J, Stoduto G, Rehm J. Driving under the influence of prescription opioids: Self-reported prevalence and association with collision risk in a large Canadian jurisdiction. Accid Anal Prev. 2018, 121, 14-19. doi: 10.1016/j.aap.2018.08.026

Verster JC, Veldhuijzen DS, Patat A, Olivier B, Volkerts ER. Hypnotics and driving safety: meta-analyses of randomized controlled trials applying the on-the-road driving test. Curr Drug Saf. 2006, 1, 63-71.

Dubois S, Bédard M, Weaver B. The impact of benzodiazepines on safe driving. Traffic Inj Prev. 2008, 9, 404-413. doi: 10.1080/15389580802161943

Van Laar MW, Volkerts ER. Driving and Benzodiazepine Use. Mol Diag Ther 1998, 10, 383.

Toennes SW, Kauert GF, Steinmeyer S, Moeller MR. Driving under the influence of drugs - evaluation of analytical data of drugs in oral fluid, serum and urine, and correlation with impairment symptoms. Forensic Sci Int. 2005, 152, 149-155. doi: 10.1016/j.forsciint.2004.08.002

Vindenes V, Lund HM, Andresen W, Gjerde H, Ikdahl SE, Christophersen AS, Øiestad EL. Detection of drugs of abuse in simultaneously collected oral fluid, urine and blood from Norwegian drug drivers. Forensic Sci Int. 2012, 219, 165-171. doi: 10.1016/j.forsciint.2012.01.001

Kelley-Baker T, Moore C, Lacey JH, Yao J. Comparing drug detection in oral fluid and blood: data from a national sample of nighttime drivers. Traffic Inj Prev. 2014, 15, 111-118. doi: 10.1080/15389588.2013.796042

Casolin A. Comparison of Urine and Oral Fluid for Workplace Drug Testing. J Anal Toxicol 2016, 40, 479-485. doi: 10.1093/jat/bkw055

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). EU Action Plan on Drugs 2017-2020. Available online:

Carpenter CS. Workplace drug testing and worker drug use. Health Serv Res 2007, 42, 795-810. doi: 10.1111/j.1475-6773.2006.00632.x