Alcohol and Drug Prevalence Among Seriously or Fatally Injured Road Users
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Summary
This report addresses a significant knowledge gap regarding the prevalence of alcohol and other drugs among drivers and other road users (pedestrians, bicyclists, passengers) who are seriously or fatally injured in motor vehicle crashes in the United States. While previous National Highway Traffic Safety Administration (NHTSA) studies provided insights into roadside drug use and crash risk, they largely excluded non-driver road users or focused heavily on property-damage-only crashes. Motivated by rising cannabis legalization, the opioid epidemic, and increased prescription drug use, this study aimed to quantify drug presence in a large sample of crash victims to inform future safety countermeasures. The study collected data between 2019 and 2021 from seven Level 1 trauma centers and four medical examiner (ME) offices across the United States. Researchers analyzed blood samples from 7,279 seriously or fatally injured road users, including drivers, pedestrians, bicyclists, and passengers. Blood was collected during routine clinical treatment or autopsy procedures. The samples underwent toxicological screening and confirmation testing for a comprehensive panel of substances, including alcohol, cannabinoids (active THC), stimulants, opioids, sedatives, antidepressants, and over-the-counter drugs. The study design allowed for the analysis of drug prevalence by case source (trauma center vs. ME), position in crash, and driver demographics such as age, sex, and time of crash. Overall, 55.8% of all injured or killed road users tested positive for at least one drug category. Medical examiner cases showed higher overall positivity (67.7%) compared to trauma center cases (54.2%). Cannabinoids were the most prevalent substance detected across all road users (25.1%), followed by alcohol (23.1%), stimulants (10.8%), and opioids (9.3%). Nearly 20% of road users tested positive for two or more drug categories. Among drivers specifically, cannabinoids were the most common finding (25.0%), while alcohol was the most prevalent among fatally injured drivers (38.9%). Drug prevalence varied by road user type; for instance, pedestrians showed higher alcohol positivity than bicyclists. Among drivers, males were more likely to test positive for alcohol, cannabinoids, and stimulants, whereas females were more likely to test positive for sedatives and antidepressants. The findings provide the first large-scale estimate of drug prevalence among seriously and fatally injured road users in the U.S., highlighting the significant presence of non-alcohol drugs, particularly cannabinoids, in this population. The authors caution that these results indicate prevalence only and should not be interpreted as evidence of impairment or increased crash risk. However, the data offer a baseline for monitoring trends in drugged driving and can help traffic safety stakeholders tailor countermeasures for specific regions, demographics, and types of road users. The study also demonstrated the feasibility of conducting such research during the COVID-19 public health emergency.
Key finding
55.8% of seriously or fatally injured roadway users tested positive for at least one drug, with cannabinoids (25.1%) and alcohol (23.1%) being the most prevalent 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