alcohol, marijuana and dui

Monday, July 17, 2017

Things that I think I know but are probably just my opinion, and there are lots of numbers.

The NFL and Minnesota Vikings suspended Michael Floyd for the first 4 games of the 2017 season after he was convicted of extreme DUI in Arizona. In December, Mr. Floyd was found asleep at the wheel of his SUV with a blood alcohol level was measured at 0.217. His NFL suspension is in addition to the court’s punishment of 24 days in jail and 96 days of house arrest. It took just a little while for the NFL to react.

Drunk drivers are not beloved in the ER. It has to do with the sad knowledge that more than 10,000 people die each year associated with a DUI, either as the driver or the victim of their crime.

There is difficulty in decision making. Is the patient being belligerent or very quiet because of the effect of alcohol? or is there an associated head injury? In a larger hospital, the decision point is easy…the trauma patient with altered mental status, regardless of whether alcohol is involved gets a CT scan to look for bleeding. In a rural setting, where there isn’t a CT scanner on every corner, the decision is grayer whether the patient should be transferred by ambulance for an emergent scan. In foul weather (think blizzard or monsoon) that transfer decision may put other people, like EMTs and paramedics at risk. Watchful observation may be appropriate but there is little backup if things go south and that puts the patient at risk. And should the transferring ambulance leave the area for a prolonged transfer, those people in the vicinity may be left without any emergency transportation.

Those who drink and drive are not in the minority and there are a whole lot of people who make poor choices. According to the Centers for Disease Control and Prevention, 1.1 million people were arrested for driving under the influence. However, based on national surveys, there were more than 111 million self-reported instances of impaired driving in 2015. It seems that as a nation, we are very fortunate that “only” 10,000 people died.

Alcohol remains the drug of choice by people who drive while impaired, but marijuana use is increasing, with more than 1 in 8 weekend and nighttime drivers having the drug in their system. Having that marijuana in your system increases the risk of a crash by 25%.

Just a reminder:there is no legal limit of alcohol intoxication. The legality has to do with the activity being performed:

  • It’s de facto illegal to drive a car with an alcohol level greater than 0.08 BUT one can be found to be impaired at lower levels depending upon function
  • The legal limit to drive a commercial vehicle with a CDL (commercial drivers license) is 0.04
  • 0.04 is the same limit that the FAA imposes to fly an airplane
  • There is no limit for a surgeon to operate, but most of us would hope that level is absolute zeroThere is no legal limit to walk on the stree
  • The legal limit for a minor is zero

As for marijuana, whether the drug is prescribed for a medical situation or used recreationally, there are legal limits. Quoting from the Colorado Department of Transportation: Colorado law specifies that drivers with five nanograms of active tetrahydrocannabinol (THC) in their whole blood can be prosecuted for driving under the influence (DUI). However, no matter the level of THC, law enforcement officers base arrests on observed impairment”

 Widespread legal marijuana use is a new phenomenon and it will be interesting to see the effect on the frequency of impaired drivers on the road and the numbers of their vicitims in the ER.

When it comes to alcohol, emergency department doctors, nurses and techs care for a lot of drunk people, whether it is due to intoxication, withdrawal or trauma. Mr. Floyd is just one of the more than 3.8 million intoxicated patients who need care every year. And he is not the only celebrity, sports star who has made a significant error in judgement. He’s fortunate , however, that he fell asleep at the wheel while his car was stopped. Perhaps it was his potential victims who were thankful that he didn’t fall asleep driving 70 mph on the interstate and crashing into their school bus.

And those are just some of the things that I think I know…at least that’s my opinion.




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