Alcohol, drugs, and road traffic crashes in India: a systematic review.

OBJECTIVE India reported the highest number of road traffic crashes, related injuries, and deaths among all countries in the world, with 105,725 road traffic fatalities and 452,922 nonfatal road traffic injuries in 2007. In this report we present a systematic review of available literature on the use of psychoactive substances (alcohol and drugs) among road users, particularly those involved in road traffic crashes (RTCs). METHODS MEDLINE, EMBASE, Ind Medica, and several other databases were searched for reports published between 1980 and 2011 that present data on the prevalence or extent of substance use among road users in India. RESULTS Among the 23 studies eligible for the review, alcohol was reported by all, but only 2 mentioned the use of drugs. Most of the studies were hospital based, included injured or killed road users, and belonged to southern parts of India. Seven studies did not report any method for detecting alcohol use, whereas 7 used analytical testing, 7 used self-reporting, and 2 used observation. Utilizing the various means of verification, the studies reported that 2 to 33 percent of injured and 6 to 48 percent of killed RTC victims had consumed alcohol or drugs; only 2 mentioned drugs without specifying which types. Most studies did not distinguish between drivers, passengers, bicyclists, and pedestrians, and none investigated alcohol or drug use among those responsible for the accident. CONCLUSION A significant proportion of injured or killed road users in India had used alcohol before the accident. However, the existing studies cannot be used to estimate the risk of accident involvement among drunk drivers. There is a need for more rigorous research and capacity building on substance use vis-à-vis road traffic crashes.