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Use of alcohol and illicit drugs by trauma patients in Sao Paulo, Brazil



Alcohol and illicit drugs impair cognitive and psychomotor skills and may thereby increase the risk of involvement in a road traffic crash and other types of injuries. However, the knowledge on the use of psychoactive substances among injured patients presenting to emergency departments in low and middle-income countries remains limited.


To estimate the prevalence of alcohol and illicit drug use among patients with traumatic injuries admitted to an emergency department in Sao Paulo, Brazil.


Blood samples from injured patients requiring hospitalization for more than 24 h due to road traffic crashes, falls, or violence, were collected from July 2018 to June 2019. The samples were analyzed for alcohol and illicit drugs.


A total of 376 patients were included in this study; the median age was 36 years and 80% of patients were male. The majority (56%) of injuries resulted from road traffic crashes, with approximately half of them being motorcyclists. Alcohol, drugs, or both were detected in 32% of samples. The proportion that tested positive was highest for males (35%), for the age group 18–39 years (41%), for singles (43%), and for patients injured at nighttime (44%). Patients injured due to violence had the highest prevalence of alcohol or drugs in their blood samples (44%). Alcohol was most prevalent (23%), followed by cocaine (12%) and cannabis (5%).


The use of alcohol and illicit drugs was common among injured patients in Sao Paulo; it was likely a contributing factor in a third of the injurious accidents. Alcohol was the most prevalent substance followed by cocaine and cannabis.


Alcohol and other psychoactive substances impair cognitive and psychomotor skills and may thereby increase the risk of acute injuries [1], [2], [3], [4]. Data from the World Health Organization indicate that the use of alcohol or drugs was contributing to more than 200,000 road traffic fatalities worldwide in 2013 [5]. Alcohol impairment is well established as one of the main causes of road traffic crashes (RTCs); it has been estimated that each drink may increase the RTC risk by 13% [6]. One in every six patients injured in RTCs in Latin America and the Caribbean reported drinking alcohol before the crash [6].

The use of other psychoactive substances than alcohol is rising worldwide; it was estimated that 5.5% of the world’s population had used controlled drugs in 2018 [7]. Data from 2015 indicate that 12.6% of the Brazilian population use illicit drugs, with cannabis and cocaine as the most frequently used [8]. Use of stimulants (i.e., amphetamines and cocaine) may contribute to the cause of RTCs [9] because users of stimulants may engage in risky behavior [10]. Furthermore, polysubstance use, particularly the use of alcohol combined with one or more substances, significantly increases the risk of RTCs [2] and other injurious accidents in general [1] when compared with the use of a single substance.

More than 90% of the world’s RTC deaths occur in low- and middle-income countries (LMICs) [11]. Brazil is among the countries with the highest numbers of RTC fatalities worldwide with more than 40,000 killed and a mortality rate of approximately 20 deaths/100,000 inhabitants [12]. However, Sao Paulo, the largest city in the Americas with more than 12 million inhabitants, reduced its RTC mortality rate in the past few years from 12.5 deaths/100,000 inhabitants in 2009 to 6.9 deaths/100,000 in 2018 [13]. The rates of driving under the influence (DUI) of alcohol [14] and RTC deaths [13] seem to be decreasing in the city. Despite these changes, the prevalence of alcohol and other drugs is still high in fatally injured victims in Sao Paulo [15], [16]. In addition, one out of four victims of homicides and 15% of fatally injured fall victims had consumed at least one psychoactive substance other than alcohol before injury [15]. Investigations have also found significant prevalence of alcohol and drug use among killed RTC victims in other parts of Brazil [17], [18], among motor vehicle drivers in random road traffic [19], [20], [21], and drug use among truck drivers [22], [23], [24], [25]. However, there is a knowledge gap regarding the use of alcohol and illicit drugs among injured patients presenting to emergency departments (EDs) in Brazil and other LMICs. Injuries related to the use of psychoactive substances are, in most cases, preventable. Knowing the real impact of such substance use in injuries may help in establishing evidence-based public policies to prevent those events, and therefore, decrease the burden on the health care system in not only Brazil but other LMICs.

The aim of this study was to determine the prevalence of alcohol and illicit drug use by patients injured in RTCs, interpersonal violence, and falls who were admitted to the largest ED in the city of Sao Paulo, Brazil.

Section snippets

Study design

This was a cross-sectional study of patients with traumatic injuries admitted to the Clinical Hospital of the University of Sao Paulo Medical School (HC-FMUSP) between July 2018 and June 2019. This institution is the largest hospital in Latin America and patients with complex traumatic injuries are referred to this ED in the city of Sao Paulo. Study procedures included obtaining a blood sample and filling in a questionnaire.

Participants and data collection

Patients older than 18 years of age with injuries from RTCs, violence


During 12 months of sample collection, a total of 909 patients were admitted to the ED. Of these, seven patients refused to participate in our study, another 342 patients were discharged before 24 h or transferred to other hospitals for treatment of less severe injuries, 96 patients died, and 88 did not fulfill the inclusion criteria. As a result, 376 patients (41%) were included in the study. Sociodemographic variables and injury mechanisms are presented in Table 2. The vast majority were


This was the first Brazilian study to investigate the use of alcohol and other drugs among patients with traumatic injuries by analyzing blood samples for alcohol and illicit drugs. The results showed a high prevalence of psychoactive substances among all patients; males and young patients were most likely to test positive. The prevalence was highest among victims of violence. Alcohol was the most commonly used psychoactive substance, followed by cocaine and cannabis.

A previous study of fatally 


We found a high prevalence of alcohol and illicit drugs in the blood samples of injured patients admitted at the largest ED in Sao Paulo. Nearly one out of three patients had used at least one psychoactive substance before their injury. Males and young patients had the highest proportion of alcohol or illicit drug use. Most injured patients had experienced RTCs; however, patients with violence-related injuries had a higher prevalence of psychoactive substances. Alcohol was detected in 23% of

Role of funding sources

This study was sported in part by the University of Sao Paulo Medical School (LIM 40/HC-FMUSP) and by the Sao Paulo Research Foundation (FAPESP) grant number 2017/20,191–6. Henrique Silva Bombana reports and thanks FAPESP for the scholarship grant number 2017/13,882–2.

Declaration of Competing Interest

The authors have no conflict of interest to declare.


The authors wish to thank the support of the University of Sao Paulo Medical School (LIM 40/HC-FMUSP). Authors are grateful to the nursing team involved at sample collection, especially to Andressa Gonçalves, Débora Tagashira, Joseli Caldas and Thalita Lima, and to all professionals working at the emergency department from the HC-FMUSP. Also, to Julio de Carvalho Ponce and Håvard Furuhaugen for the toxicological analysis.

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