Alcohol and Drug Prevalence Among Seriously or Fatally Injured Road Users [Traffic Tech]
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Summary
This study addresses the prevalence of alcohol and drug use among road users involved in serious or fatal motor vehicle crashes in the United States. While previous National Highway Traffic Safety Administration (NHTSA) research focused on crash risk using data from property-damage-only or minor injury crashes, this study specifically targets the most severe incidents. The research aims to fill a knowledge gap regarding substance use in crashes resulting in admission to Level-1 trauma centers or death, while also expanding the scope beyond drivers to include pedestrians, bicyclists, and other road users. The methodology involved collecting blood samples from 7,279 road users across seven Level-1 trauma centers and four medical examiner offices in Jacksonville, Worcester, Charlotte, Iowa City, Miami, Sacramento, and Baltimore. Data collection occurred between late 2019 and July 2021. Participants included 4,798 drivers, 1,031 passengers, 983 pedestrians, 255 bicyclists, and others. Approximately 6 ml of blood was collected from each participant and sent to a forensic toxicology lab for screening and confirmatory analysis of alcohol, over-the-counter medications, prescription drugs, and illegal substances, including parent drugs and active metabolites. The results indicate that cannabinoids (active THC) and alcohol were the most prevalent substances, with 25.1% and 23.1% of all road users testing positive, respectively. Stimulants (10.8%) and opioids (9.3%) followed. Medical examiner cases consistently showed higher positivity rates than trauma center cases for every drug category. Overall, 55.8% of road users tested positive for at least one drug or alcohol, and 19.9% tested positive for two or more categories, indicating significant polydrug use. Among drivers specifically, 23.6% tested positive for alcohol, with nearly 20% having a blood alcohol concentration (BAC) of 0.08 g/dL or higher. Notably, 14.2% of drivers had a BAC of 0.15 g/dL or higher. Substance presence was high across all road user types, ranging from 43.1% for bicyclists to 61.0% for other road users. The study concludes that alcohol and cannabis are highly prevalent among seriously or fatally injured road users, with opioids and stimulants also present at notable levels. However, the authors emphasize that the presence of substances does not confirm impairment at the time of the crash. Furthermore, because the sites were selected for their large catchment areas and willingness to participate, the results may not be generalizable to the entire U.S. population. The findings highlight the need for caution when interpreting these data, as they reflect prevalence rather than causation or increased crash risk.
Key finding
Cannabinoids and alcohol were the most prevalent substances among seriously or fatally injured road users, with 25.1% and 23.1% positivity rates respectively, and 19.9% of participants tested positive for multiple drug categories.
Methodology
field_study
Sample size: 7279
Provenance
The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed. Discovered via bulk_ingest_rosap on 2026-05-23 (6 acquisition events logged).
| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | rosap | — | — | 2 | 2026-05-23 |
| archive | success | — | — | — | 1 | 2026-05-23 |
| extract | success | cached | — | — | 2 | 2026-06-10 |
| clean | success | — | — | — | 1 | 2026-06-01 |
| chunk | success | — | — | — | 1 | 2026-06-01 |
| embed | success | — | — | — | 1 | 2026-06-02 |
| enrich | success | — | — | — | 1 | 2026-05-23 |
| promote | success | — | — | — | 1 | 2026-05-23 |
| summarize | success | llm | qwen3.6-27b-prismaquant | summ-v5 | 3 | 2026-06-10 |
| tag | success | vector_similarity | — | — | 19 | 2026-06-11 |
| verify | success | — | — | — | 2 | 2026-06-10 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.
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Information type
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- Empirical Findings: observational prevalence, crash risk outcomes