Drug and Alcohol Prevalence in Seriously and Fatally Injured Road Users Before and During the COVID-19 Public Health Emergency
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Summary
This study addresses a critical gap in knowledge regarding the prevalence of drugs other than alcohol among drivers and other road users who are seriously or fatally injured in motor vehicle crashes. While previous research has estimated population-level prevalence through roadside surveys, data on crash victims remained limited. The study was motivated by the onset of the COVID-19 public health emergency, which altered travel behaviors and potentially impacted substance use patterns. The objective was to examine the prevalence of alcohol, over-the-counter, prescription, and illegal drugs in the blood of these individuals before and during the emergency period. The research utilized a convenience sample of 3,003 seriously or fatally injured roadway users, including drivers, passengers, pedestrians, bicyclists, and e-scooter riders. Data were collected from September 2019 to July 2020 at five Level 1 trauma centers and medical examiner offices in Charlotte, Jacksonville, Miami, Baltimore, and Worcester. Blood samples were obtained during normal clinical treatment or autopsy procedures. The study period was divided into a "Before" phase (September 10, 2019, to March 16, 2020) and a "During" phase (March 17 to July 18, 2020), corresponding to the implementation of statewide mandates. Toxicological analyses were conducted to detect active drug components and metabolites. The results indicate that drug prevalence was high among injured road users before the emergency and increased significantly during it. Among all road users, 63.6% tested positive for at least one active drug during the emergency, compared to 51.0% before. Drivers showed the most pronounced increases: 64.7% tested positive for at least one drug during the emergency, up from 50.8% before. Notably, active THC (cannabis) was more prevalent than alcohol among drivers during the emergency (32.7% vs. 28.3%). Opioid prevalence among drivers nearly doubled from 7.5% to 13.9%. Additionally, the proportion of drivers testing positive for multiple drug categories rose from 17.6% to 25.3%. Pedestrians also showed increased prevalence for several drug categories, though smaller sample sizes limited statistical power for some comparisons. The findings suggest that the highway safety community should be concerned about the rising impact of drugs, particularly cannabis and opioids, alongside alcohol. The observed increases may reflect seasonal variations, differential driving patterns, or stress-related substance use during the pandemic. However, the authors emphasize that these prevalence rates do not determine impairment or crash risk. The study highlights the need for further research to establish whether specific drugs increase the risk of serious injury or fatality in crashes.
Key finding
Drivers testing positive for at least one active drug increased from 50.8% before the public health emergency to 64.7% during, with active THC prevalence (32.7%) surpassing alcohol prevalence (28.3%).
Methodology
dataset
Sample size: 3003
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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- Empirical Findings: observational prevalence, crash risk outcomes