Alcohol and Drug Prevalence Among Seriously or Fatally Injured Road Users: An NHTSA Report Summary

In December 2022, the National Highway Traffic Safety Administration (NHTSA) released a report exploring rates of drug and alcohol use among collision victims. Controlled substances affect drivers in a wide range of ways. 

For example, alcohol impairment decreases response times and causes lapses in judgment. Many types of drugs cause users to experience cognitive impairments and other losses in abilities. 

There have been many studies exploring the role of drugs and alcohol in motor vehicle collisions. However, less research has been conducted to understand the prevalence of drug use in injured pedestrians and bicyclists. 

The 2022 report from the NHTSA provides insight into the role of drugs in accidents involving various road users. Researchers assessed data from seven trauma centers and four medical examiners to learn more about this important topic.

Methods Involved in the NHTSA Report

Seven trauma centers from around the United States were chosen to recover data from. The seven centers implicated in the report were in the following cities:

  • Sacramento, CA
  • Iowa City, IA
  • Worcester, MA
  • Baltimore, MD
  • Miami, FL
  • Charlotte, NC
  • Jacksonville, FL 

Data and specimen collection was conducted from 2019 to 2021. The report’s authors also contacted four medical examiners, allowing them to recover information regarding fatally injured roadway users.  

When patients or decedents were admitted to the relevant trauma center or medical examiner, blood samples were collected. 

These samples are collected by medical staff as a routine part of treatments or autopsies. The blood samples were later analyzed by researchers to determine the presence of certain controlled substances.  

Researchers were able to collect nearly 7,300 samples from roadway users. The report’s authors used this data to learn more about the prevalence of drug and alcohol use among seriously or fatally injured accident victims. 

General Results

More than half of roadway users suffering serious or fatal injuries tested positive for at least one drug. In fact, 55.8% of injured or fatally wounded individuals had blood showing signs of either alcohol or drugs. 

Researchers found evidence for a wide range of controlled substances among injured or killed roadway users. More than 18% of trauma center driver blood samples contained two or more drugs. 

Blood samples from pedestrians showed slightly higher levels of drug use. For example, more than 20% of pedestrians tested positive for at least two drug categories. 

The report categorized controlled substances in a variety of ways. Some of the drugs that were found in participants’ blood samples included: 

  • Alcohol
  • Cannabinoids
  • Stimulants
  • Sedatives
  • Opioids
  • Antidepressants
  • Over-the-counter drugs
  • Miscellaneous 

Drivers, pedestrians, and bicyclists each showed different rates of drug use. Nearly 70% of all drivers tested were positive for the presence of at least one drug. Only 31% of drivers tested negative for alcohol or drug use.

The Prevalence of Various Controlled Substances

Those who were operating motor vehicles at the time of their crash were most likely to show the presence of alcohol. The prevalence of alcohol use was followed by both cannabinoids and opioids. 

Nearly 40% of drivers who were seriously or fatally injured had evidence of alcohol in their blood samples. Over 30% of drivers tested showed evidence of cannabinoids. 

Because so many samples were drawn from drivers, the report provides evidence regarding the prevalence of drug use among different demographics of motorists.  

For example, male subjects were more likely to test positive for stimulants, cannabinoids, and alcohol. Female subjects, on the other hand, showed a higher tendency toward antidepressants and sedatives. 

The association of the individual’s sex with drug positivity was even more stark for those fatally injured. Male decedents tested positive for drugs at a rate of 70.6%. Female decedents tested positive at a rate of 60%. 

Most injured or killed drivers who tested positive for at least one drug were between the ages of 35 and 44. Those from ages 21 to 34 were most likely to test positive for two or more drugs. 

Discussion of the Report’s Context and Findings

At the time of its release, this report was the largest of its kind in the United States. Unlike other studies, this NHTSA report included information regarding bicyclists, passengers, pedestrians, and other roadway users. 

Most of the report’s findings were focused on motor vehicle operators. More than 54% of all individuals sampled in the study tested positive for at least one category of drug. 

The prevalence of cannabinoid use is also notable. Many regions in the country have recently decriminalized certain methods of cannabis consumption.  

This study does not make any claims about the causes of serious motor vehicle collisions. But it does shed light on the presence of controlled substances in those injured or killed in traffic accidents. 

The NHTSA report helps to contextualize the role that drugs and alcohol play in serious roadway injuries and deaths. Although the study does not provide evidence that controlled substance use leads to accidents, many drugs are known to have significant cognitive effects on users.


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