J O U R N A L O F

CLINICAL
FORENSIC
MEDICINE
Journal of Clinical Forensic Medicine 13 (2006) 308310
www.elsevier.com/locate/jcfm

Original communication

Drugged driving in Hungary 20002004

T. Varga MD, PhD (Professor) *, K. Magori MD, Zs. Hideg (Toxicologist),
G. Somogyi PhD (Toxicologist)
University of Szeged, Department of Forensic Medicine, Szeged National Institute of Forensic Toxicology, Budapest, Hungary

Available online 6 October 2006

Abstract

The authors analyzed the biological samples available in criminal cases that were started because of illicit and prescribed drug-
impaired driving between 2000 and 2004. The result of the on-the-spot clinical test is not informative and cannot be evaluated as it is
mainly aected by the simultaneous presence of alcohol. Licit or illicit drugs in the urine could be detected in 378 people out of 623
people (60.7%), whereas in 59 cases (9.5%) there was some substance present in the blood. The occurrence multiple drugs was high
(36.8%). The joint use of alcohol and drugs has increased in the past few years.
2006 Elsevier Ltd and AFP. All rights reserved.

1. Introduction  Screening immunochemical urine analyzes.

 Blood and urine sample-taking for conrmation ana-
With the spreading of the use of illicit drugs and psycho- lyzes in positive cases.
active substances their role in trac has also increased. The
1998 amendment of the Penal Code (Law LXXVII of 1998) The conformation analyses are carried out centrally in
prohibits driving under the inuence of any substance that the National Institute of Forensic Toxicology. The screen-
adversely aects driving skills. Evidence is mainly carried ing examination is done with a uorescent polarization
out with toxicological methods by analyzing urine and method (FPIA, ABBOTT, AxSYM). The conrmation
blood. analyses were carried out with GC/MS or HPLC-DAD
In our study we report on the results in the past 5 years methods. (LOD THC 2 ng/ml, cocaine 1 ng/ml, ampheta-
after the law came into force. mines, metamphetamines 5 ng/ml, opiates 10 ng/ml, benzo-
diazepines 20 ng/ml).
2. Material and method
3. Results
Following the police action, the on-site investigation is
usually carried out on the perpetrator by a police surgeon The number of samples in the study steadily increased
or a general practitioner, and occasionally the doctors on during 5 years:
duty in hospitals as follows:
2000 5 males 0 females Total 5 persons
 Determination of breath alcohol concentration. If neces- 2001 9 males 2 females Total 11 persons
sary, blood and urine samples are analyzed with head- 2002 49 males 6 females Total 55 persons
space gas chromatographic method. 2003 141 males 6 females Total 147 persons
 Examination of the clinical (somatic, neurological and 2004 375 males 30 females Total 405 persons
psychiatric) symptoms.
Of the examined cases, there were 579 males (92.9%) and
*
Corresponding author. 44 females (7.1%): the male:female ratio was 13:1. The
E-mail address: varga@anat-fm.szote.u-szeged.hu (T. Varga). average age within the examined time interval did not

1353-1131/$ - see front matter 2006 Elsevier Ltd and AFP. All rights reserved.
doi:10.1016/j.jcfm.2006.06.013
 T. Varga et al. / Journal of Clinical Forensic Medicine 13 (2006) 308310 309

change noticeably and there is no dierence between males Table 2

and females (males 25.95 years, females 24.89 years; 1656 Distribution of drugs and psychotropic substances in urine
years). Oenders older than 35 appeared in the last 3 years 2000 2001 2002 2003 2004
and their ratio in the sample is insignicant (in 2002: 2 per- 5 cases 10 cases 49 cases 105 cases 209 cases
sons, in 2003: 18 persons, in 2004: 45 persons, which repre- THC 3 5 30 (61%) 67 (64%) 144 (69%)
sents 11% of the total sample). Amphetamine 0 1 2 (4%) 30 (29%) 47 (22%)
The ratio of alcoholic impairment is low, it only Metamphetamine 1 4 21 (43%) 36 (34%) 42 (20%)
increased in the last examined year and in the year 2004 der.
Opiates 1 1 7 (14%) 16 (15%) 26 (12%)
alcohol could also be detected in the blood of more than Methadone 0 0 0 1 (1%) 8 (4%)
half (55.3%) of the drug-impaired drivers (2000: 20%, Cocaine 0 0 0 9 (9%) 20 (10%)
2001:18.2%, 2002: 14.5%, 2003:16.3%, 2004: 30.1%). At Benzodiazepines 0 1 0 4 (4%) 4 (2%)
the same time the degree of alcoholic impairment is not sig- Other 1 1 5 (10%) 4 (5%) 3 (1%)
nicant, the average blood alcohol concentration is 0.68 Polytoxicomania 1 3 18 (37%) 44 (42%) 73 (35%)
g/l.
The time interval between the action and the sampling
was steadily decreasing but even in 2004 it exceeded 3 Table 3
hours. Distribution of drugs and psychotropic substances in blood
2000 2001 2002 2003 2004
2000: 251 124 min (40480 min) 2 cases 2 cases 6 cases 19 cases 30 cases
2001: 263 130 min (30810 min) Amphetamine 1 0 0 11 (58%) 13 (43%)
2002: 271 145 min (20950 min) Metamphetamine 0 1 4 (66%) 10 (53%) 4 (13%)
2003: 166 101 min (16755 min) der.
2004: 183 119 min (38740 min) Opiates 1 1 1 (17%) 2 (11%) 1 (3%)
Cocaine 0 0 0 5 (26%) 1 (3%)
Benzodiazepines 0 0 0 0 2 (7%)
The pathologic clinical symptoms are summarised in Others 0 0 1 (17%) 0 3 (10%)
Table 1.
The number of on-the-spot immunochemical screening
tests decreased. In 2000 and 2001 they were carried out 4. Discussion
with one exception, whereas in 2004 in only 16.5% of the
cases. The frequency of illicit and prescribed drugs in victims
During the toxicological analyses no drug or psychotro- of trac accidents in North America and Australia nearly
pic substance could be detected in either the blood or the reached or in some cases exceeded the level of alcoholic
urine in the 215 cases. The number of negative tests impairment. In Europe this frequency is lower. On summa-
increased in the second half of the examined period rizing the ndings of 69 epidemiological tests, Kruger1
(2001: 9%, 2002:10.9%, 2003: 28.6%, 2004: 48.4%). The found a rate of 3552% of alcohol, 1719% of illicit drug,
proportion of detected substances did not change in eect 1013% of prescribed drug use in injured or deceased driv-
but cocaine and methadone appeared only in the years ers. Another researcher2 reported on a frequency of 10
2003 and 2004 (Table 2). 25% of illicit drug and 621% of prescribed drug use. In
Illicit and licit drugs could be detected in blood samples Eastern and Central Europe illicit or licit drug in the urine
in 59 cases (Table 3). was detectable in 2.66.3%, whereas 1.73.4% in the blood
The frequency of polytoxicomania is high (36.8%) and of victims who died on the spot in trac accidents.3
did not change noticeably in the examined period. In Hungary the occurrence is considerably lower. Illicit
drugs were found in 0.8% and licit drugs in 5.3% in the
blood of drivers who suered fatal injuries.4 This is lower
Table 1 than the proportion of alcoholic impairment, which is
The rate (%) of the clinical sypmtoms in the dierent groups
34% in people needing hospital care and 35.8% in deceased
Negative Alcohol Drug Drug and drivers who died in trac accidents.5
alone alone alcohol
Driving under the inuence of any substance adversely
127 88 339 69 aecting the driving skills is prohibited by Law LXXIII
Small pupils 0 10.2 5.9 4.3 of 1998. Courts conclude that there was impairment if
Path. reaction of pupils 9.4 42.0 31.9 44.9 the substance can be detected in blood at the time of the
Nystagmus 14.2 29.5 20.4 37.7
action. The legal regulation is virtually identical with those
Positive Romberg sign 18.1 77.3 36.6 65.2
Positive ngernose probe 0 39.8 23.9 56.5 of other European countries.6 During roadside drug tests
Speaking disturbances 3.9 55.7 22.2 40.6 and random police investigations in Europe illicit drugs
Orientation disturbances 0 22.7 18.3 30.4 were detected in 15% of drivers, whereas licit drugs were
Behaviour disturbances 0 31.8 25.9 40.6 present in 515% of them.7 No similar survey has been con-
Injection marks 0 0 3.5 4.3
ducted in Hungary yet.
310 T. Varga et al. / Journal of Clinical Forensic Medicine 13 (2006) 308310
The representativeness of our survey is limited. The
cases were selected by an acting police unit on the spot
and the reason in most cases was a road accident (28.8%)
or some other trac oence. In 6.8% of the cases there
are no data why the procedures were started.
In the past 5 years the number of tests has increased
exponentially but it is still considerably lower than in Wes-
tern-Europe or Scandinavia.8 This can only partly be
explained with the lower occurrence. The time spent before
taking a sample, the small number of on-the-spot immuno-
chemical screening tests and in connection with this the
high and gradually increasing proportion of negative ana-
lytical tests indicate poor performance on the spot of the
accident. The explanation may be that an increasing num-
ber of the tests are not carried out by police surgeons but
by general practitioners and hospital sta attending the
injured.
The average age of the deceased drivers is higher than
what we noticed in cases of illicit drugs, and male domi-
nance is also more expressed.9 The results correspond to
the epidemiological gures of drunken-driving, which
may indicate identical driving attitude.
The high ratio of ocular and cerebellar symptoms are
striking among the clinical signs but their evaluation may
be uncertain in case of the simultaneous presence of alco-
hol and polytoxicomania. At the same time, however, in
more than one-fth of the people under no inuence of
alcohol or drugs showed pathological symptoms, mainly
uncertain or positive Romberg sign and nystagmus. The
opposite of these ndings is also frequent. There were no
pathological alterations in 44.2% of cases indicating posi-
tive analytical results in urine.
The examination of individuals against whom actions
were taken due to the use of illicit drugs indicated that
the simultaneous use of drugs and alcohol is relatively
infrequent in Hungary and shows great regional dierences
but its rate is lower than 10% everywhere.10 At the begin-
ning of the investigated period the gures correspond to
these but in the last year 31.1% of the examined individuals
were under the inuence of alcohol; their ratio was 53.3%
in those persons in whose blood licit and illicit drugs could
be detected. This already corresponds to the frequency of
alcoholic impairment in victims of road accidents and indi-
cates a shift in drinking habits. However, the measured
blood alcohol concentration is considerably lower than in
the accidents caused by drunken drivers.
Substances detected in the urine correspond to the Hun-
garian habits of drug use. Methadone appeared only after
the introduction of substitution therapy, whereas the
spreading of cocaine is a new phenomenon. In the polytox-
icomania cases generally amphetamines, THC and opiates
were used. The small proportion of licit drugs and benzo-
diazepines is striking and cannot be explained from the
available data. In this respect our data do not correspond
to either the literature or the ndings of tests on those
who died in trac accidents.
Altogether in 9.5% of the examined cases could illicit or
prescribed drugs be detected in the blood. THC, which was
detected with the greatest frequency in the urine was not
present in the blood in a single case. This may be explained
with great probability with the long time between the
oence and sampling.
In only 1.03% of the drivers did we nd alcohol in
exhaled air during the roadside survey to determine the fre-
quency of drunken driving. Therefore, it could be esti-
mated that drunken driving would be recognized with a
frequency of 1:100200.11 There has been no similar survey
to detect the use of drugs but it can be estimated that the
ratio is at least one magnitude worse.
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