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In order to prepare a response strategy for future drug analyses, the number and results of drug cases handled by the Seoul Institute of National Forensic Service were comprehensively evaluated, with a focus on Seoul and its metropolitan areas. In 2022, the Seoul Institute received approximately 12,150 requests for drug testing related to drug abuse and possession, and the urine samples were tested for approximately 16,000 drug species. The most frequently requested test was for cannabis (Δ-9-THC and Δ-8-THC), followed by methamphetamine, MDMA, ketamine, and synthetic cannabinoids. ADB-5'Br-BUTINACA and propyl butylone were newly emerging substances in 2022. These results were consistent with the main drug detection findings of the confiscated materials. During this period, 24 cases of drug-related deaths were reported, of which 6 were suspected to be the result of acute overdose poisoning caused by methamphetamine, MDMA, fentanyl, and heroin. In addition to the controlled substances regulated by the Narcotics Control Act, new psychoactive substances are being found to be circulating, and various measures are required to address this issue. This study is expected to improve future drug analyses methods and assist in establishing drug policies, and responding to future investigations. [Display omitted] • New psychoactive substances are emerging simultaneously at home and abroad. • Ketamine is increasingly popular among drug abusers. • Drug abuse is on the rise among young people. • Drug abuse analysis helps develop responses to future drug influxes. [ABSTRACT FROM AUTHOR]

Medical cannabis is becoming increasingly popular for many different ailments and improvement of general well-being. Particularly CBD-rich extracts are easily available via online pharmacies, health stores or directly from producers. However, almost all of the extracts contain small amounts of THC. Thus, in case of continuous or heavy use of CBD rich cannabis, THC concentrations in hair may rise above accepted legal limits. In our study, we investigated THC, CBN and CBD in hair samples from regular CBD rich cannabis users. The goals were to determine levels of the cannabinoids in hair and to evaluate a possible correlation between regular CBD intake and CBD levels in hair. All participants consumed cannabis extracts from the same producer. It contained CBD at different concentrations and small amounts of THC with a CBD/THC concentration ratio of 30. The self-declared CBD dosage ranged from 4 to 128mg CBD/day, corresponding to a daily THC intake of 0.1 to 4.3mg. After extraction and derivatization, hair samples were analysed using a validated GC/MS-MS method. CBD concentrations ranged from 10 to 325pg/mg of hair, but no significant correlation was observed between CBD concentrations and the daily dose. THC was detected in one sample only at a concentration below our cut-off, whereas CBN was not detected. In this study, we showed that even after repeated consumption of CBD-rich cannabis extracts in medium to high doses, consumers are generally tested negative for THC in hair. [ABSTRACT FROM AUTHOR]

Gamma-hydroxybutyric acid (GHB) is a short-chain fatty acid used recreationally as a drug of abuse due its strong suppressive effect on the central nervous system. The detection window of GHB in blood and urine is very narrow (t1/2=30min) but can be substantially prolonged using alternative matrices such as hair. We here present a newly developed and limited validated method with a solid phase extraction (SPE) using GC-MS/MS to determine concentrations of GHB in hair samples. The soft extraction technique (water and 90min ultrasonic bath) preserves GHB with a high yield and clean extracts. In addition, endogenous GHB can be detected in hair of non-GHB users. However, little is known about GHB concentrations in hair of abstinent, frequent and chronic GHB users. Therefore, we present data from hair samples of healthy volunteers to evaluate the proposed endogenous GHB ranges, and from GHB-dependent patients to address GHB concentrations in hair with GHB intake. In 20 non-GHB users, a mean endogenous concentration of 1.1±0.6ng/mg hair (range of 0.3-2ng/mg) was found. In GHB-dependent patients, concentrations between 6.3-239.6ng/mg hair were found, with no correlation between concentrations in hair and dose of GHB intake. In summary, we present a new and limited validated method, adequately sensitive for the detection of GHB in hair, as well as first-time measurements of GHB concentrations in dependent patients in order to better understand the relationship between the frequency of use/dose and concentrations observed in hair samples. [ABSTRACT FROM AUTHOR]

This paper presents an overview of a set of amphetamines and cannabinoids tests performed on head hair samples from the Medico-Legal sector at the Madrid Department of the Spanish National Institute of Toxicology and Forensic Sciences during the years 2013 and 2014. The hair samples were tested for five stimulant phenylalkylamine derivatives -amphetamine (AP), methamphetamine (MA), 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxy-amphetamine (MDA), and 3,4-methylenedioxy-N-ethylamphetamine (MDEA)- and/or two cannabinoids-Δ(9)-tetrahydrocannabinol (THC) and cannabinol (CBN)- by gas chromatography equipped with mass spectrometry detection in selected-ion monitoring mode, applying a method accredited to ISO/IEC 17025 standards. The test results were interpreted according to the confirmation cut-offs proposed by the Society of Hair Testing (SoHT) to identify chronic drug use. The ratios of positive results were studied in relation to gender, age, hair colour, dyeing and length of the tested samples to assess the independence from these variables or the association with them. Low, medium and high ranges of concentration were also estimated for each drug. 21.94% of the 2954 hair samples tested for phenylalkylamine derivatives were positive for one or more substances. 16.38% of the samples were positive for AP, 12.09% for MDMA and only 0.44% for MA. 6.60% of the tested samples were positive for AP/MDMA combination. A total of 3178 samples were tested for cannabinoids, resulting in 53.40% positive for THC and CBN. Simultaneous tests for phenylalkylamine derivatives and cannabinoids were performed in 2931 of the samples; 14.94% of them were positive for THC, CBN, and one or more amphetamines. According to the results from the statistical analysis, the use of THC and MDMA vary with age and gender among the Medico-Legal sector in an extended area of Spain, while the use of AP appears to be independent of these variables. On the other hand, the results of THC in hair could be influenced by the length of the tested segment; therefore, a consensus regarding the hair length between 3.0 and 5.5cm for THC testing should be reached. [ABSTRACT FROM AUTHOR]

Background: An isomer of the non-psychoactive cannabinoid Δ(9)-THCCOOH was recently detected in blood from cannabis users. The structure of this compound is currently unknown. Therefore, further investigations were performed to elucidate its nature.Methods: Further biological specimens were analyzed using the previously published LC-MS/MS method to evaluate the distribution of this compound in the human body. Hypothetically, the unknown compound was isomeric in the position of the double bond, i.e. Δ(8)-THCCOOH. An in-vitro metabolism study on Δ(8)-THC and Δ(9)-THC was performed to compare the resulting metabolites with the unknown compound.Results: The unknown THCCOOH isomer was detected in all analyzed human body compartments (urine, bile, liver, lung and kidney) except for brain indicating that its detectability is not limited to blood. The in-vitro metabolism assay with the human CYP2C9 isoform led to the formation of THCOH and THCCOOH of Δ(8)-THC and Δ(9)-THC. However, the unknown isomer present in blood exhibited a different retention time than each of the metabolites formed.Conclusion: The unknown THCCOOH isomer accompanied THCCOOH and was detected in various human body compartments. The present in-vitro metabolism study proved that it is not of Δ(8)-THCCOOH structure nor that it is metabolically formed by the human CYP2C9 isoform. [ABSTRACT FROM AUTHOR]

Cannabis products rich in cannabidiol (CBD) and low in Δ9-tetrahydrocannabinol (THC) (e.g., light cannabis in Italy) are becoming widely popular and available on the market as replacements for THC preparations and tobacco for their recreational and/or therapeutic benefits. In this paper, which aims to establish alternative discrimination parameters between hair samples from CBD-rich and THC-prevalent cannabis users, cannabinoid concentrations, such as THC, CBD, 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH) and 11-hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) were quantified in 127 hair samples by a GC-MS/MS technique. Initially, this analysis was able to discriminate two cohorts: cohort 1 (individuals with THC values ≥ 0.05 ng/mg and THC-COOH ≥ 0.2 pg/mg or THC-positive users, n = 60) and cohort 2 (individuals with THC values ranging between 0.01 and 0.05 ng/mg and THC-COOH or 11-OH-THC ≥ LOQs, n = 67). The evaluation of CBD/THC ratio in cohort 2 identified two further sub-cohorts 2a (CBD/THC<<1 or ~ 1, THC-prevalent cannabis users) and 2b (CBD/THC>>1, suspected CBD-rich and THC-low cannabis users). The latter showed unusual profiles for THC metabolites, in particular for 11-OH-THC. Statistical evaluation of the data of cohort 1, cohort 2a and cohort 2b yielded significant differences in CBD/THC and THC/11-OH-THC. Based on the analysis of 337 seized cannabis samples and 630 CBD-rich/light cannabis samples by GC-FID and GC-MS, respectively, we also evaluated statistical differences in the CBD/THC ratio between biological (hair) and plant-derived samples. Considering the legal implications of a positive result, the obtained findings could be relevant for the interpretation of cannabinoid concentrations in hair. Further studies are necessary to elucidate the reason behind the unusual metabolic ratios. [ABSTRACT FROM AUTHOR]

Traffic offences are a common cause of detention in police custody. We hypothesized that drug intoxication while driving could correspond to specific medical conditions of the detainees. Our objective was to evaluate medical features and addictive behaviours of suspected drug drivers and to collect data regarding assaults or injuries in these individuals. We conducted a prospective study (April 2010-December 2011) of suspected drug driving arrestees, who were compared to drink drivers or persons aged over 18 detained for other reasons. Data collected concerned persons' characteristics, reported assaults, and observed injuries. A total of 205 drivers were tested positive for drugs in blood, 116 were either positive for drugs in urine or saliva and negative in blood, or negative in urine. Cannabis-only users accounted for 201 of 205 drug drivers (98%). Suspected drug driving arrestees had good overall health rating. Drug drivers were younger than controls and requested more rarely medical examination (12% vs. 44%, P < 0.0001). They were rarely involved in addiction treatment (3%) and reported assaults or presented traumatic injuries less often than drink drivers and controls (8% vs. 38% and 25%, P < 0.0001). Drug drivers were less often alcohol abusers than controls. Their opinion on custody was better than that of controls and they were considered unconditionally fit for detention more frequently (99% vs. 77%, P < 0.0001). We conclude that arrested drug drivers were young, healthy, and infrequently reported assaults or presented traumatic injuries, which does not put them in a high risk medical condition. Medical care could include brief interventions on addictive behaviours. [ABSTRACT FROM AUTHOR]

Abstract: In New Zealand many children have been removed from clandestine laboratories following Police intervention. In the last few years it has become standard procedure that these children have hair samples taken and these samples are submitted to the laboratory for analysis. There are various mechanisms for the incorporation of drugs into hair. The hair follicle has a rich blood supply, so any drug that may be circulating in the blood can be incorporated into the growing hair. Another mechanism is via external contamination, such as spilling a drug on the hair or through exposure to fumes or vapours. Hair samples were analysed for methamphetamine and amphetamine. From the 52 cases analysed 38 (73%) were positive for methamphetamine (>0.1ng/mg) and amphetamine was detected in 34 of these cases. In no case was amphetamine detected without methamphetamine. The hair washes (prior to extraction) were also analysed (quantified in 30 of the positive cases) and only 3 had a wash to hair ratio of >0.1 (all were <0.5), which may be indicative of a low level of external contamination. This low level of evidence of external contamination suggests that the children are exposed to methamphetamine and are incorporating it into the hair through the blood stream. [Copyright &y& Elsevier]

Abstract: In this paper we present the first assessment of the new German driving licence re-granting medical and psychological assessment (MPA) guidelines by comparing over 3500 urine samples tested under the old MPA cut-offs to over 5000 samples tested under the new MPA cut-offs. Since the enzyme multiplied immunoassay technique (EMIT) technology used previously was not sensitive enough to screen for drugs at such low concentrations, as suggested by the new MPA guidelines, enzyme-linked immunosorbent assay (ELISA) screening kits were used to screen for the drugs of abuse at the new MPA cut-offs. The above comparison revealed significantly increased detection rates of drug use or exposure during the rehabilitation period as follows: 1.61, 2.33, 3.33, and 7 times higher for 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH), morphine, benzoylecgonine and amphetamine respectively. The present MPA guidelines seem to be more effective to detect non-abstinence from drugs of abuse and hence to detecting drivers who do not yet fulfil the MPA requirements to regain their revoked driving licence. [Copyright &y& Elsevier]

Abstract: The differentiation between systemic exposure and external contamination for certain drug groups has been frequently referred to as one of the limitations of in drug testing in hair. When hair samples are used, three steps are usually employed in order to minimise the possibility of external contamination causing a misinterpretation. The first consists of decontaminating hair samples by washing the hair before analysis, the second is the detection of the relevant metabolites in the hair samples and the third is the use of cut-off levels. Difficulty in the interpretation arises when metabolites are not detected either due to external contamination of the hair or low doses of the drugs used. A wash protocol needs to be practical and ideally remove any drug deposited on the external portion of the hair. We propose an additional step that helps considerably in the interpretation of the results with the aim to establish a consensus: the analysis of the wash residue (W) and its comparison with the levels detected in hair (H). The wash residue is the remainder of a quick wash with methanol which is dried and reconstituted in buffer before analysis. The detection of small quantities of analytes that are not susceptible to external contamination in the wash residue, such as metabolites or drugs such as dihydrocodeine, indicates that the washing procedure is in fact able to remove drugs from the hair shaft. Where the W/H ratio is less then 0.1 or null, it would tend to indicate drug use as opposed to environmental contamination. Where the W/H ratio is above 0.1 but less than 0.5, it is likely to indicate possible use possibly combined with a level of external contamination. A W/H ratio greater than 0.5 is likely to indicate that the source of most of the drug in the wash residue is from external contamination. In this last case, the source of levels detected in the hair is questionable, as it is not possible to be absolutely sure that all external contamination was removed, and so use cannot be confirmed. Two hundred and sixteen hair samples from a population where external contamination could be expected (Police Investigations on drug related cases) and their wash residue were analysed. The W/H ratios of 891 results were evaluated over 13 analytes. Between 74 and 100% of the analytes studied produced W/H ratios less than 0.5, in particular in cannabis (93%) and cocaine (95%), where external contamination is more likely because of the way the drug is used. The data do show that while it is very important to always be aware of alternative explanations for test results, the likelihood of external contamination confounding the interpretation of hair tests can be reduced to manageable proportions. [Copyright &y& Elsevier]

Abstract: In Finland, the Act on the Protection of Privacy in Working Life (759/2004) that entered into force in 2004 incorporates provisions related to drug use testing, e.g. on the employers’ right to process in certain situations information on job applicants’ and employees’ drug use. In the same context, provisions were added to the Occupational Health Care Act (1383/2001) on the employer''s obligation to draw up, together with the staff, a written programme dealing with alcohol and drugs for the workplace. The programme defines the overall objectives for and the practices to be observed at the workplace in order to prevent substance abuse and to refer the problem users to treatment. The Occupational Health Care Act also includes provisions on drug tests and the drug test certificate as well as on reimbursement of the expenses of drug tests. Furthermore, the Act lays down a definition of drug tests. Every workplace shall have a plan/programme on drug-free workplace, where the jobs in which the workers have to present a drug test certificate to the employer must be defined. This plan/programme shall be discussed in cooperation on tripartite basis at the workplace. A Government decree on drug use testing (218/2005) has been issued in virtue of the Occupational Health Care Act. It lays down provisions on the practical performance of drug tests, i.e. taking and analysis of samples, and interpretation of the test results. The purpose of the Government decree is to ensure that workplace drug testing is carried out in a way presupposed by a good occupational health care practice and the laboratory quality standards, taking into account the integrity and protection of privacy of the persons tested as well as their other fundamental rights. [Copyright &y& Elsevier]

Abstract: Morphological changes in hair subjected to decontamination protocols were evaluated by scanning electron microscopy (SEM) as part of the National Laboratory Certification Program''s (NLCP) efforts to develop proficiency testing materials in support of Federal Workplace Drug Testing programs. Hair from five different donors was evaluated. Hair samples were subjected to three decontamination protocols: (1) aqueous phosphate buffer, (2) methanol or (3) methylene chloride as models for aqueous, alcohol and polar organic solvent protocols, respectively. Under these protocols, samples of hair were treated for 225min (aqueous), 15min (alcohol), or 15min (polar organic). After decontamination, hair strands were sputter coated with gold/palladium (AuPd) and observed by SEM. Modest lifting of cuticle scales was observed in hair treated with methanol and methylene chloride consistent with some changes to the cell membrane complex (CMC) between cuticle scales. Damage resulting from aqueous buffer treatment ranged from substantial degradation to apparent complete loss of cuticle scales. Fracture structures consistent with cuticle damage were also observed. Each decontamination protocol had a different impact on the cuticle of the hair shaft. [Copyright &y& Elsevier]

Abstract: In the military environment drug abuse is a particular risk for occupational safety. In the Finnish Defence Forces a drug testing program was conducted in 2002–2005; soldiers, professional civilians, and military students were tested when applying for a work or right to study; furthermore, annually 5% of the personnel were subjected to random testing. In total, over 2000 urine samples were analyzed in an accredited laboratory for cannabis, opiates, amphetamines, or cocaine. In this article, the drug testing program as a part of the anti-drug strategy of the Finnish Defence Forces is described, and the findings including practical experiences and financial expenses are reported. Only one person applying for a civilian post tested positive for amphetamine and cannabis. In seven other samples codeine and morphine were detected; these were, however, due to prescribed medication, not drug abuse. In the execution of the program, no particular difficulties were reported. In conclusion, it seems that the use of illicit drugs in the Finnish military is extremely rare, at least partly due to the successful anti-drug strategy. After an elaborate planning, even an extensive drug testing program can be executed without substantial setbacks. In the future, the effectiveness of drug testing programs as a means of improving occupational safety needs to be investigated in controlled studies using comparative design. [Copyright &y& Elsevier]

Abstract: This paper presents an overview of the most common sectioning patterns utilised in the analysis of hair for drug use; report on the major user groups (sectors) that currently make use of hair analysis in the United Kingdom (UK); present the results for the different drug groups analysed in samples of hair samples analysed at TrichoTech between 2001 and 2005. A total of 186,084 tests on 34,626 hair samples were performed for the commonly requested drug groups. There were 145,799 enzyme-linked Immunosorbent positive screening tests (ELISA), which were subsequently confirmed by gas chromatography equipped with mass spectrometry detection (GC–MS). The two major sectors were the Medico-Legal sector (65%) and Workplace (20%). Police (Forensics), Clinical Monitoring, Schools, Research and Insurance accounted together for the remaining 15% of the samples. Combinations of several sections patterns were requested covering periods from the most recent month up to 24 months. The most common sectioning pattern was one single section measuring 3cm, to cover the most recent 3 months (44%), which in some cases was complemented by a further 3cm to cover together 6 months (13%). The second most common sectioning pattern was the analysis of three sections of 1cm each to cover the most recent 3 months (28%), when a more detailed evaluation of drug use pattern was relevant. Samples collected from other areas of the body such as axilla, pubic, chest, beard and leg, constituted 6% of the samples. The analysis of monthly sections plays an important role in the evaluation and interpretation of drug use, particularly in certain Medico-Legal cases. The sectors with the highest rates of positive results were Police (Forensics) (78%), Medico-Legal (62%) and Clinical (54%). The common drugs in each group were cannabinol (27%), cocaine (25%), morphine (17%), amphetamine (13%) and diazepam (15%). The positive rate for the Workplace sector was 10%. The most common drugs detected in the Workplace samples in each group were: THC (4%), codeine (2%), cocaine (2%), MDMA (0.5%) and diazepam (0.1%). The concentration levels of drugs found in samples from the workplace were lower than in the other sectors (95% of cases). The exceptions were for dihydrocodeine and MDMA, where levels were 170 and 143% higher, respectively. However, the maximum levels detected in the Workplace samples were lower. The Medico-Legal sector is the most prevalent sector using hair analysis in the UK but the rate of Workplace sector use of hair testing is increasing. One in 10 workplace hair tests detected the presence of at least one drug, which is twice the rate of detection using urine, which is a 1 in 20 urine sample. This means that the chances of identifying people on drugs in the workplace by testing hair samples are twice as likely than urine samples. [Copyright &y& Elsevier]

Abstract: An on-site oral fluid drug screen, Oratect®, was used to investigate the effects of adulterants and foodstuffs on oral fluid test results. Common foods, beverages, food ingredients, cosmetics and hygienic products were demonstrated not to cause false positive results when tested 30min after their consumption. Evaluations of two commercial oral fluid adulterants, “Clear Choice® Fizzy Flush™” and “Test’in™ Spit n Kleen Mouthwash” suggest their mechanism of action is the clearing of residual drugs of abuse compounds through rinsing of the oral cavity. They do not directly destroy the drug compounds or change the pH of the oral fluid. It is also suggested that a common mouthwash would perform similar action. [Copyright &y& Elsevier]

Cannabidiol prevalent (CBD-rich) cannabis derivatives are increasingly popular and widely available on the market as replacement of THC, tobacco substitutes or therapeutics for various health conditions. In this paper, we evaluate the impact of a repeated CBD-rich cannabis intake on levels of cannabinoids in biological samples. Urine, oral fluid and hair (pubic and head) samples were obtained from a naive user during a 26-day smoking period of one 250-mg CBD-rich cannabis joint/day containing 6.0% cannabidiol (CBD; 15mg) and 0.2% delta-9-tetrahydrocannabinol (THC; 0.5mg). In total, 35 urine, 8 oral fluid and 4hair sample were collected. Cannabinoids concentrations were quantified by a UHPLC/MSn technique. The results suggested that the repeated exposure to CBD-rich cannabis (containing small amounts of THC) can generate positive results in biological samples. Urinary concentrations of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH) were quantitatively detected after 8 days from the smoking start and exceeded the 15ng/mL cut-off limit on day-15 even in the urine sample collected 12h after the last intake. In the oral fluid collected on day-26, no cannabinoids were found before the cannabis intake, thus excluding accumulation, while THC was detectable up to 3h after the cannabis intake, at concentrations progressively decreasing from about 18 to 6ng/mL. Hair samples collected one week after the end of the study turned out negative for THC and THC-COOH, suggesting that this matrix is suitable to discriminate the chronic consumption of CBD-rich cannabis from THC-prevalent products. The obtained findings are relevant for the interpretations of cannabinoids levels in biological fluids, also in light of the legal implications of a positive result. [ABSTRACT FROM AUTHOR]

Abstract: Background: Within a maritime alcohol and drug testing programme, a case showing an unphysiological urine ethanol concentration (235mmol/L, 10.8g/L) was found. The sample contained low levels of the ethanol metabolites ethyl glucuronide (EtG) and ethyl sulphate (EtS) which confirmed prior drinking, but also tested positive for the fermenting yeast Candida albicans which suggested post-sampling ethanol formation. This and other questionable cases prompted investigation of the suitability of urine alcohol testing for the intended application. Methods: Besides the routine measurements of ethanol, illicit drugs and creatinine, randomly selected ethanol-positive and ethanol-negative urines collected within the maritime programme were checked for the presence of EtG and EtS and for fungal and bacterial growth. Data on sample handling and storage was also gathered. Results: Ten of 15 (67%) ethanol-positive and 4 of 9 (44%) ethanol-negative urines contained yeast and/or bacteria. Among the ethanol-positive cases, 4 (27%) were obviously false positives because EtG and EtS were not detected. Microbial action as the reason for false-high ethanol concentrations was indicated in other cases. When 17 bacteria-infected but fungi-negative urines were supplemented with glucose and stored for 1 week at 21°C, ethanol was formed in 2 specimens containing Escherichia coli and E. coli plus P. aeruginosa. In these samples, EtG was also formed on storage while EtS was not. Conclusions: The routines employed for urine collection and handling within this substance abuse programme caused many false-positive identifications of alcohol use with unintended medico-legal consequences. Unpreserved urines stored without cooling should not be used for alcohol testing, given the high risk for microbial interference. [Copyright &y& Elsevier]

Traffic offences are a common cause of detention in police custody. We hypothesized that drug intoxication while driving could correspond to specific medical conditions of the detainees. Our objective was to evaluate medical features and addictive behaviours of suspected drug drivers and to collect data regarding assaults or injuries in these individuals. We conducted a prospective study (April 2010-December 2011) of suspected drug driving arrestees, who were compared to drink drivers or persons aged over 18 detained for other reasons. Data collected concerned persons' characteristics, reported assaults, and observed injuries. A total of 205 drivers were tested positive for drugs in blood, 116 were either positive for drugs in urine or saliva and negative in blood, or negative in urine. Cannabis-only users accounted for 201 of 205 drug drivers (98%). Suspected drug driving arrestees had good overall health rating. Drug drivers were younger than controls and requested more rarely medical examination (12% vs. 44%, P<0.0001). They were rarely involved in addiction treatment (3%) and reported assaults or presented traumatic injuries less often than drink drivers and controls (8% vs. 38% and 25%, P<0.0001). Drug drivers were less often alcohol abusers than controls. Their opinion on custody was better than that of controls and they were considered unconditionally fit for detention more frequently (99% vs. 77%, P<0.0001). We conclude that arrested drug drivers were young, healthy, and infrequently reported assaults or presented traumatic injuries, which does not put them in a high risk medical condition. Medical care could include brief interventions on addictive behaviours., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)