It is a known fact that alcohol and other drugs closely correlate to injuries and deaths from accidents and acts of violence. Now, a pioneering study based on victims of these events given first aid care at the Emergency Treatment area of the Hospital das Clínicas (HC) of the Medical School of the University of São Paulo (FMUSP), has come to quantify this cause and effect: 46% of the victims of acts of violence were under the influence of excessively high levels of alcohol, as was 24% of the victims from traffic accidents and 20% of the victims of falls. Furthermore, 14% of those involved in accidents or acts of violence had used marijuana, cocaine or amphetamines some few hours before.
The study, “Alcohol and Drugs in Victims of External Causes”, was funded by FAPESP and coordinated by the specialist in spinal injuries, Júlia Maria D’Andréa. External causes, she explains, include “traffic accidents, traffic accidents involving pedestrians, acts of violence, falls and work-related accidents”. In Brazil, these are the second most common cause of death and the first among those aged between 10 to 49 (1996 data).
Lawful and cheap
In 1996, the Department of Traumatology and Orthopedics of the HC – the emergency surgical center at the HC is the largest emergency treatment center in the country – was invited to join the federal program for the prevention of traffic accidents (PARE the Portuguese acronym – Program for Reductions of Traffic Accidents.) to provide data on the influence of alcohol in accidents.
Júlia was aware of this relation based on statements made by HC Emergency Treatment patients. After all she added, “alcohol is the drug that is most consumed, since its use is lawful, readily accessible and low priced”. The only thing that was missing was an investigation into the relation which would leave no doubt. She looked for data on the subject and was unable to find a detailed sample. Any preventive program such as PARE, would be vulnerable to this missing link: there would be no parameter with which to evaluate the program’s results.
Talking to colleagues, Júlia concluded that a survey based on HC’s Emergency Treatment Center would provide a measure of the effect of alcohol on the cause of accidents. After contacts with the Coroner’s Department (Instituto Médico Legal – IML) of the State of São Paulo and Ovandir Alves da Silva, Professor of the College of Pharmacy of USP, she decided to widen the scope of the project.
In 1998, the team, which also included Naim Sawaia of the Department of Preventive Medicine, Dario Birolini and Renato Poggetti, both of the Surgical Center of the HC, decided to analyze not only traffic accidents but all the events with external causes and not just alcohol but illegal drugs as well. For this, the team requested funding from FAPESP.
Firstly, nursing and medical students at USP took blood and urine samples from patients that consented to participate on an anonymous basis. Questionnaires were also completed. As alcohol is easily metabolized, the blood sample was taken at the most six hours after the accident while the presence of other drugs was checked from the urine samples. Five hundred patients were to be required for a representative sample, all of them within six hours from the time of the accident. The samples were taken at 71 weekly duty shifts of 12 hours, between July 1998 and August 1999.
The team monitored 476 patients, analyzed 469 samples for alcohol content in the blood and 347 for presence of drug traces in urine samples. At the IML, Vilma Leyton coordinated the analysis of blood samples using a chromatograph while the Pharmacology Laboratory of the School of Pharmacy of USP was responsible for the examinations of cocaine, cannabis and amphetamine dosage.
The results proved to be surprising. In 29% of the cases, alcohol was found in the blood (and, among these, 84.1% with dosages over 1 g/liter). A level of 14.1% of the urine samples showed a presence of other drugs. In cases of hospitalization due to the gravity of the injuries, the level of those with alcohol in the blood rose to 41.6% – in line with surveys conducted by IML in which there was a relation between fatalities and alcohol in 40% of the cases surveyed.
One conclusion, says Júlia Maria, is that “alcohol not only provokes more accidents and violence, but also raises the risks of injuries and death”. This conclusion is supported by the high degree of alcohol in the blood in victims of violence that were treated: 46.7%.
The results also proved across the board use of alcohol independent from social class. Even among those with a higher level of education, the number of victims is similar (and even slightly higher) to those that have less or no formal education.
Sex and age, however, were significant factors. Alcohol was identified in 34% of the males and only 14.8% of the females. It was more present in the case of the unmarried (33.2% of them) and separated (26.7%) than in those that were married (17.6%), and furthermore the first two groups were more frequent users. The group most susceptible to the use of alcohol was males between 20 and 40. The abuse of alcohol was most evident among single males between the ages of 18 and 44. The team concluded that the testing for alcoholic dosage in the blood should be routine in the case of emergency treatment.
Although the presence of drugs is smaller than alcohol, the team considered the percentage their presence was found to be alarming at 14%. The most used drug is marijuana (6.3% of the samples), followed closely behind by cocaine (5.7%) and, surprisingly, in third place, a cocktail of drugs (5.9% had a mixture of alcohol, cannabis and cocaine).
If the data obtained from the HC were to be complemented by research in other locations and on a nationwide basis, we would have a more wide-ranging dimension of the problem throughout Brazil.
• Júlia Maria D’Andréa Greve, 49, born in Limeira, state of São Paulo, graduated in Medicine (1975) at the School f Medical Sciences of the Santa Casa of São Paulo, with a Master’s degree (1989) and doctorate (1995) in Rheumatism at FMUSP. She has been a doctor specializing in physiotherapy in the Department of Traumatology and Orthopedics at the Hospital das Clínicas, FMUSP since 1992.
Project: Alcohol and Drugs in Victims of External Causes