Together with the roadside survey, an observational method for detecting drug-impaired drivers by the police was tested, as Task 4.5 of the IMMORTAL project. The method consisted of a checklist of signs of impairment, supplemented with two questions about recent drug use see Appendix B ; . The checklist was based on several existing checklists, e.g. one developed for the German police Mller, 1998 ; . It was completed by the police officers that also performed the breath test for alcohol. In most cases, completing the checklist took no more than one to two minutes. The method was meant to allow a quick scan of potential drug impairment, aimed at preselecting drivers for the time consuming and relatively expensive on-site screening of body fluids urine or oral fluid ; . The validity of the method was determined by comparing the police officer's final judgement with the results of urine and blood analysis or, in the absence of these, with the self-reported drug use to the research team. Between February 2003 and March 2004, police officers screened 954 drivers. Criteria for suspicion of impairing drug use were one or more of the listed signs of impairment and or self-reported recent drug use. The validity of the screening method was expressed by sensitivity SE ; , specificity SP ; , positive predictive value PPV ; and negative predictive value NPV ; . SE is defined by the percentage of positive screening results among positive drivers. A screening method with high sensitivity has few false negatives. SP is defined by the percentage of negative screening results among negative drivers. A screening method with high specificity has few false positives. PPV is defined by the percentage of true positive screening results among all positive screening results true + false ; . PPV puts SP in the context of drug prevalence; lower prevalence results in lower PPV. NPV is defined by the percentage of true negative screening results among all negative screening results true + false ; . PPV puts SE in the context of drug prevalence; lower prevalence results in higher NPV. Table 6.1 shows the results for signs of impairment alone. Specificity and predictive values of drug detection based on signs of impairment alone were acceptable, but sensitivity was low. The 25.3% sensitivity means that three quarters of all drug users were not detected when using signs of impairment as the only selection criterion.
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GlaxoSmithKline, Teserach Triangle Park, NC 2002 16. UK Prospective Diabetes Study UKPDS ; group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998; 352: 837-53. Schade DS, Jovanovic L, Schneider J. A placebo-controlled, randomized study of glimepiride in patients with type 2 diabetes mellitus for whom diet therapy in unsuccessful. J Clin Pharmacol 1998; 38: 636-641. Dills DG, Schneider J and The Glimepiride glyburide research group. Clinical evaluation of glimepiride versus glyburide in NIDDM in a double-blind comparative study. Horm Metab Res 1996; 28: 426-429. UK Prospective Diabetes Study UKPDS ; group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS 34 ; . Lancet 1998; 352: 854-65. Diabetes prevention program research group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 345: 363-403. Fujioka K, Pans M, Joyal S. Glycemic control in patients with type 2 diabetes mellitus switched from twice-daily immediate release metformin to a once-daily extended-release formulation. Clinical Therapeutics 2003; 25 2 ; : 515-29. 22. Horton ES, Clinkingbeard C, Gatlin M, et al. Neteglinide alone and in combination with metformin improves glycemic control by reducing mealtime glucose levels in type 2 diabetes. Diabetes Care 2000; 23: 1660-1665. Jovanovic L, Dailey G, Huang WC, et al. Repaglinide in type 2 diabetes: a 24-week, fixed-dose efficacy and safety study. J Clin Pharmacol 2000; 40: 49-57. ACS 2 27 2004 Jonhston PS, Feig PU, Coniff RE, et al. Chronic treatment of African-American type 2 diabetic patients with -glucosidase inhibition. Diabetes Care 1998; 21 3 ; : 416-422. 25. Rosenstock J, Brown A, Fischer J, et al. Efficacy and safety of acarbose in metformin-treated patients with type 2 diabetes. Diabetes Care 1998; 21 12 ; : 20502055. 26. Chiasson JL, Josse RG, Gomis R, et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA 2003; 290 4 ; : 486-94. 27. Fonseca V, Rosenstock J, Patwardhan R, et al. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus. JAMA 2000; 283: 16951702. Yki-Jarvinen H, Ryysy L, Nikkila K, et al. Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus. Ann Intern Med 1999; 130: 389-396. Goldstein BJ, Pans M, Rubin CJ. Multicenter, randomized, double-masked parallelgroup assessment of simultaneous glipizide metformin as second-line pharmacologic treatment for patients with type 2 diabetes mellitus that is inadequately controlled by a sulfonylurea. Clinical Therapeutics 2003; 25 3 ; : 890-903. 30. Hoffmann J, spengler M, et al. Efficacy of 24-week monotherapy with acarbose, metformin or placebo in dietary-treated NIDDM patients: the Essen II study. J Med 1997; 103 6 ; : 483-490. 31. Damsbo P, Caluson P, Marbury TC, et al. A double-blind randomized comparison of meal-related glycemic control by repaglinide and glyburide in well-controlled type 2 diabetic patients. Diabetes Care 1999; 22: 789-794. Hollander PA, Schwartz SL, Gatlin MR, et al. Importance of early insulin secretion: comparison of nateglinide and glyburide in previously diet-treated patients with type 2 diabetes. Diabetes Care 2001; 24: 983-988. Wlffenbuttel BHR, Landgraf R, Dutch and German Repaglinide Study Group. A 1year multicenter randomized double-blind comparison of repaglinide and glyburide for the treatment of type 2 diabetes. Diabetes Care 1999; 22: 463-467. Turner RC, Cull CA, Frighi V. et al. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus, progressive requirement for multiple therapies UKPDS 49 ; . JAMA 1999; 281 21 ; : 2005-2012 35. The DECODE Study Group, the European Diabetes Epidemiology Group. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Int Med 2001; 16 3 ; : 397-405. 36. Inzucchi SE. Oral antihyperlgycemic therapy for type 2 diabetes. JAMA 2002; 287 3 ; : 360-372. 37. Electronic Orange Book July 2003 [cited 2003 Aug 29]. : fda.gov cder ob. 38. Garber AJ, Donovan DS, Dandona P, et al. Efficacy of glyburide metformin tablets compared with initial monotherapy in type 2 diabetes. Journal of Clinical Endocrinology & Metabolism 2003; 88 8 ; : 3598-604. 39. Drug Facts and Comparisons 2000. Endocrine and Metabolic Agents [cited 2003 Dec 22]. : efactsweb and hydrochlorothiazide.
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