Patterns of stimulant drug use on Western Australian heavy transport routes

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Abstract

In July 1997, 236 truck drivers were interviewed at three truck stops in Western Australia. The interviews collected information on driver fatigue and stimulant drug taking as a fatigue countermeasure. Drivers have become more aware of fatigue as a problem within the industry over the past two years, however, 27% of drivers reported using stimulant drugs to combat driver fatigue. Interstate drivers use more prescription and illicit stimulant drugs to keep awake while intrastate drivers use more over the counter stimulants. Over the counter stimulants are not perceived as drugs by intrastate drivers because they are easily and legally obtainable and this is reflected within many of their responses.

The most frequent way that drivers obtained stimulant drugs was through a doctor, a chemist or illegal prescription. Anecdotal evidence from the drivers suggests that increasing pressure from the public and the media to eliminate illegally prescribed stimulant use by drivers has made them harder to obtain. Therefore, without fatigue issues within the industry being addressed, an increase in street purchases of illicit stimulants may occur. Prohibition of stimulant drug use without changing industry practices eliminates a fatigue countermeasure and could lead to a serious increase in fatigue-related crashes. The results of this study will help to identify “at risk” groups of drivers who can be targeted for education on fatigue and drug issues.

Introduction

Western Australia has a unique driving environment which presents problems for long distance drivers. This is due to vast distances between rural locations, extremes of temperature and monotonous scenery. Because of such distances, drivers are often faced with a choice of pulling off the road for a rest or pushing themselves to reach the next destination. Common sense would suggest that the safety of the vehicle’s occupants is paramount and that drivers will stop and rest, however, many will continue to drive even when they know it is safer to stop (Brown, 1995). Others will even start a trip feeling tired Fell and Black, 1996, Maycock, 1996. Consequently, extended driving periods and often monotonous scenery contribute to the dangerous act of driving whilst fighting sleep. This is more likely to occur for commercial truck drivers who have tight delivery schedules, penalties for late delivery, job competition, or products which require urgent delivery (e.g. livestock and fresh produce).

Defining driver fatigue has been a research dilemma for over 80 years Brown, 1995, Hartley et al., 1997 due to a lack of agreement on a fatigue measure (Hartley & Mabbott, 1998). As this paper does not allow for the scope of fatigue to be discussed in full (see Brown, 1994, Brown, 1995 for methodological problems associated with fatigue definitions), a simple definition follows. Driver fatigue can be defined as “Loss of alertness which eventually ends in sleep” (Transport, 1998; p. 5). However, performance deterioration occurs long before sleep Mackie and Miller, 1978, Hartley et al., 1997. That prolonged periods of driving may cause a performance decrement and eventually terminate in falling asleep at the wheel presents a safety issue for all road users.

Lisper, Laurell and Van Loon (1986) studied prolonged driving and falling asleep at the wheel and found that sleepy states occur after eight hours of driving. However, there are many other contributory factors to experiencing sleepy states at the wheel. Several studies have made it clear that length of time spent driving is not the only cause of fatigue (e.g. Brown, 1994, Hartley et al., 1996, Arnold and Hartley, 1998, Smiley, 1998, O’Neil et al., 1998). Other research has focused on stress (Heimstra, 1970), experience (Lisper, Laurell & Stening, 1973), blood alcohol levels Gawron and Ranney, 1988, Summala and Mikkola, 1994, sleep disordered breathing (Stoohs, Guilleminault, Itoi & Dement, 1994) and length of rest breaks (Lisper & Eriksson, 1980) as contributing factors of driver fatigue.

Sleep quality (Hillman, 1997), work-rest schedules Shapiro et al., 1997, Rosa, 1998, Heslegrave, 1998, sleep debt and circadian rhythms Kalat, 1995, Belenky et al., 1998, Caldwell and Caldwell, 1998, Dawson et al., 1998 also interact with length of driving period and driving times, as do age and personality (Hartley et al., 1996). Dawson et al. (1998) found that in sleep deprived subjects with sustained wakefulness of between 18 and 27 h, there was decreased performance to a level equivalent of a blood alcohol reading greater than 0.05%. Hartley and Mabbott (1998) also identify several temporal and environmental factors including time spent awake and amount of work prior to trip, breakdowns and delays in loading, irregular and/or unrealistic trip schedules, poor road conditions, unsuitable rest stops and extremes of temperature.

In 1995 the Institute for Research in Safety and Transport at Murdoch University undertook a comprehensive study on driver fatigue and company fatigue management practices. This entailed 18 research assistants interviewing 638 truck drivers and 84 companies across the state of Western Australia. A summary of the findings was given in Arnold et al., 1996a, Arnold et al., 1996b. In brief, the general findings were that 1.41% of the interviewed drivers had nodded off or fallen asleep on the trip prior to being interviewed. Over the preceding nine months, 11% of drivers reported falling asleep occasionally and a further 3% reported it happening very frequently or often. This data was thought to underestimate the exact prevalence of driver fatigue due to the social desirability factors inherent in self-report questionnaires.

The countermeasure of stimulant drug taking to remain alert was reported for 16.3% of drivers and was also considered an underestimation by the research assistants who quoted anecdotal evidence of 20–50% prevalence. For example, Williamson, Feyer, Coumarelos and Jenkins (1992) found that 31.7% of the drivers participating in their study used stimulant drugs to deal with fatigue at least sometimes and 53.3% of those stated it was among the most helpful strategy. It is important to note that in both of the above studies the term “drug” referred to any stimulant drug used by the drivers. Hence, whilst collecting important information on the prevalence of stimulant use within the transport industry, it remained unknown whether the drugs used were licit or illicit.

Starmer, Mascord, Tattam and Zeleny (1994) undertook testing for stimulant drugs in drivers by utilizing saliva samples. Their research supported years of anecdotal evidence that truck drivers use stimulant drugs more than the general driving population. In the general sample of drivers (n=210), 2.86% used stimulants other than caffeine and cotinine, while 29.6% of truck drivers (n=318) used stimulants other than caffeine and cotinine. After excluding caffeine and cotinine, a total of 106 drugs were found in the 318 truck driver samples. The highest percentages of the non-caffeine and non-cotinine stimulants detected were Ephedrine (7.86%), phentermine (7.55%), methamphetamine (5.03%) and amphetamine (5.03%).

Valuable experience was gained from interviewing truck drivers in the Hartley et al. (1996) study. Anecdotal evidence was gathered on the range of stimulant drugs often used within the industry. The stimulants ranged from natural herbal products to illicit drugs manufactured in illegal “backyard” laboratories.

Experience in the slang terms used by truck drivers was gained from interviews with drivers prior to commencement of this study. The terms “speed”, “ox blood”, “goeey” and “whiz” all referred to an illicit stimulant manufactured illegally. The main constituent of the drug is amphetamine or dexamphetamine (Health Promotion Services, Illicit drug fact sheet (HP 6082), Perth, Health Promotion Services, 1997). It is a psychostimulant which hightens arousal of the central nervous system.

Another range of stimulants included “briquettes” and “tenuate dospan” (diethylpropion hydrochloride), and “diet pills”, “shakers”, or “duromine” (phentermine hydrochloride). These drugs are prescription-only and are used more commonly as appetite suppressants. Ephedrine was also said to be a common stimulant used by truck drivers. Stimulants obtainable without prescriptions include “No-Doz” (caffeine tablets), “Guarana” (Guarana, Ginseng and Ginko extracts), and pseudoephedrine based cough medicines.

There are two methods of studying the prevalence of drug use within the heavy transport industry: Objective assays of driver's bodily samples and driver self report. The objective assessment method has been useful in showing the range of drugs used. However, it must also be argued that drivers who volunteer specimens for drug sampling assays create a sampling bias, as those who have recently taken drugs will probably be under represented, as they would not be likely to volunteer to provide a sample.

This study attempts to reveal as much information as possible pertaining to why stimulant drugs are used and in what contexts. Voluntary driver participation is paramount. Therefore, for the purposes of this study, driver self-reports should provide information relevant to the prevalence of stimulant drug use on Western Australian heavy transport routes.

Section snippets

Aims of the study

The aims of this study are to elicit information about the prevalence of stimulant drug use; which drugs are used; which groups of drivers are most at risk; how stimulant drugs are obtained; why drivers use stimulants; the drivers' knowledge of the stimulants and their side effects and attitudes toward stimulant use as a fatigue countermeasure. The drivers sampled in the Hartley et al. (1996) study willingly volunteered information in an informal setting and expressed concern about the problems

Questionnaire design

The questionnaire was developed by the first author, utilizing experience gained from driver interviews during the Hartley et al. (1996) study. Although the questionnaire was aimed primarily at teasing out information on stimulant drug taking behavior, it was given the title “Fatigue Management Questionnaire”. Based on previous experience, it was believed that a title focusing on drugs would disillusion truck drivers from responding in an interview and would decrease the chance of gaining such

Results

A total of 375 drivers were approached for an interview at the three truck stops with a total of 236 completed questionnaires, indicating a 63% consent rate. There were three female drivers and 233 male drivers in total. Drivers ranged in age from 21 to 69 years old with a mean age of 40.65 years (SD=9.68 years). Years of truck driving experience ranged from “just starting” to 50 years, with a mean of 17.75 years (SD=10.14 years). It should be noted that drivers gave responses in years of truck

Trip preparation and incidents on current trip

Results from this study showed eight drivers (3.4%) reported falling asleep on the trip prior to being interviewed, which is more than double the percentage of that found in the Hartley et al. (1996) study (1.41%). That four of the eight drivers who fell asleep reported being prepared for the trip and had eight or more hours preparatory sleep presents an anomaly. Arnold and Hartley (1998) analyzed data obtained in the Hartley et al. (1996) survey and reported that too few hours of sleep was the

Conclusion

Drivers suggested that 28% of operators use stimulants to counter fatigue with nearly two thirds using them on at least half of their trips. Drivers also self-reported that 27% of themselves use stimulants. The results are in line with the 29.6% of truck drivers found to be using stimulants by Starmer et al. (1994), when urine samples were analyzed.

The most commonly used stimulant drugs are amphetamines, followed by prescription appetite suppressants, obtained illegally. Intrastate drivers and

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