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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you can pay me now…

Sunday, November 6, 2016

For football fans, there is nothing worse than a penalty that wipes out a touchdown or erases an interception. Coaches and players work on execution and avoiding errors, especially those that are self-inflicted by penalty. The team that makes the fewest mistakes tends to win the game. So it should come as no surprise that in the real world medical care, the doctor and patient who minimize their error tends to win as well. But while football has officials on the field and in the replay booth, making the right call for medical care is tougher.

Medicine is all about delayed reward. Controlling diseases like high blood pressure, high cholesterol and diabetes can increase quality and quantity of life. But the health care community can only give advice; they can’t go hope with the patient and demand the patient do the right thing. And there are no referees to throw a flag and call out actions that can erase life’s touchdowns.

Some behaviors are not well known and tough to fix. Medications for chronic diseases are supposed to be taken on a regular basis to prevent complications. High blood pressure, high cholesterol and diabetes medications (including insulin) are used to control these diseases to prevent complications. Heart attacks, strokes, blindness and amputations are potentially preventable, but the reward for taking a pill and watching what you eat is 10, 20 or 30 years down the road. Not taking medicine has no upfront risk and there is nobody in a replay booth reminding you to take your emaciation every day.

What is the cost? Individually, it can be an early death or significant disability. For the society, research suggests that failure to comply with medication prescriptions increases medical costs by up to $290 billion a year. 20-30 percent of all prescriptions go unfilled and up to 50% of the time, medication is not taken as directed. This leads to up to 10 percent of all hospital stays and more importantly, 125,000 deaths a year.

Specifically, for diabetes, the numbers are even worse. For those who need medication, not keeping blood sugars under control can increase deaths directly related to diabetes by 50%, and the noncompliance rate does not count deaths from heart disease or kidney failure.

Some behaviors are easy to see and still tough to make better. Drunk driving is unacceptable behavior and it is a societal norm not to drink and drive. Yet while police and the courts are there to throw yellow flags, more than 28 million people admit to that behavior every year and it leads to almost 10,000 deaths a year. Smoking is a behavior that has no positive benefit to the body, and is highly addictive. There are 1 billion smokers worldwide, it directly kills 5 million people a year (167,000 cancer victims in the US) and indirectly kills another 500,000 from second hand smoke. There is no striped shirt blowing the play dead when a person buys a pack of cigarettes.

Why do we care what other people do? The bottom line is that we are our brother’s keepers and resources that are spent on avoidable cancer care, dialysis for kidney failure or nursing homes for stroke victims might be better spent on primary care, preventive medicine, providing good nutrition for the poor and better mental health for those in need. But it’s tough to tell people who have self-inflicted their disease or injury, that society will not look after them…so we pick up the pieces and try to put them back together again. Sometimes, again and again and again.

Financial resources are not unlimited. Taking money out of one bucket, to care for behavior errors leaves less in other buckets. Once upon a time there was a wise commercial for Fram oil filters to increase your cars longevity:

“you can pay me now…or you can pay me later”


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