***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Aims To determine the relative detection rates of urine versus oral fluid testing in a safety sensitive industry and the correlation with diagnosed substance use disorders and possible impairment at work . Methods The trial involved 1,500 paired urine and oral fluid tests  performed in accordance with Australian St and ard/New Zeal and St and ard ( AS/NZS ) 4308:2008 and AS 4760:2006 . Workers who returned a positive test were screened for substance use disorders , as defined by DSM-5 , and for possible impairment at work following that particular episode of substance use . Results Substances were detected in 3.7 % ( n = 56 ) of urine sample s and 0.5 % ( n = 8) of oral fluid sample s ( p < 0.0001 ) . One worker ( 0.07 % ) had a substance detected on oral fluid alone versus 49 workers ( 3.3 % ) who had substances detected on urine alone . Twelve workers returned a positive result , defined as being consistent with the use of an illicit drug or a controlled substance without a clinical indication and prescription . Nine workers tested positive on urine alone , one on oral fluid alone and two on both ( p = 0.0114 ) . Of note , 6/11 workers who tested positive on urine had possible impairment at work and 2/11 had a substance use disorder versus 2/3 and 0/3 , respectively , who tested positive on oral fluid . Conclusions Urine drug testing performed in accordance with AS/NZS 4308:2008 is more likely to detect overall substance use and illicit drug use than oral fluid testing conducted in accordance with AS 4760:2006 . Urine testing performed in accordance with AS/NZS 4308:2008 may also be more likely to detect workers with possible impairment at work and substance use disorders than oral fluid testing performed in accordance with AS 4760:2006 There were 13,176 roadside drug tests performed in the first year of the r and om drug-testing program conducted in the state of Victoria . Drugs targeted in the testing were methamphetamines and Delta(9)-tetrahydrocannabinol ( THC ) . On-site screening was conducted by the police using DrugWipe , while the driver was still in the vehicle and if positive , a second test on collected oral fluid , using the Rapiscan , was performed in a specially outfitted " drug bus " located adjacent to the testing area . Oral fluid on presumptive positive cases was sent to the laboratory for confirmation with limits of quantification of 5 , 5 , and 2 ng/mL for methamphetamine ( MA ) , methylenedioxy-methamphetamine ( MDMA ) , and THC , respectively . Recovery experiments conducted in the laboratory showed quantitative recovery of analytes from the collector . When oral fluid could not be collected , blood was taken from the driver and sent to the laboratory for confirmation . These roadside tests gave 313 positive cases following GC-MS confirmation . These comprised 269 , 118 , and 87 cases positive to MA , MDMA , and THC , respectively . The median oral concentrations ( undiluted ) of MA , MDMA , and THC was 1136 , 2724 , and 81 ng/mL. The overall drug positive rate was 2.4 % of the screened population . This rate was highest in drivers of cars ( 2.8 % ) . The average age of drivers detected with a positive drug reading was 28 years . Large vehicle ( trucks over 4.5 t ) drivers were older ; on average at 38 years . Females accounted for 19 % of all positives , although none of the positive truck drivers were female . There was one false positive to cannabis when the results of both on-site devices were considered and four to methamphetamines Driving has been regarded as an activity of daily living that is important in maintaining a person 's independence in the community , access to employment , and social activities . Many patients , however , using opioid medications on a regular basis ( Chronic Opioid Analgesic Therapy : COAT ) to ameliorate their intractable pain have been restricted from driving out of concern that skills would be impaired and driving safety compromised by these medications . Yet there are no driving studies which have explored the effects of using opioid analgesics for an extended period of time . This pilot study was design ed to determine the effects of medically prescribed , stable opioid use on the driving abilities of patients with persistent , nonmalignant pain . Sixteen patients with chronic nonmalignant pain on COAT , who met criteria for participation in the study , underwent a comprehensive off-road driving evaluation using measures which have been shown to be sensitive in predicting on-road driving performance . The evaluation consisted of a pre-driver evaluation ( PDE ) , a simulator evaluation ( SDE ) , and behavioral observation during simulator performance .  Patients in the COAT group were compared to a historical control group of 327 cerebrally compromised patients ( CComp ) who had undergone the same evaluation and then passed an on-road , behind-the-wheel evaluation ( BTW Pass ; n = 162 ) or failed ( BTW Fail ; n = 165 ) . Results revealed that COAT patients generally outperformed the CComp patients as a group by equaling or exceeding PDE and SDE scores of the BTW Fail patients as well as the BTW Pass patients on all measures that differentiated the groups . Notably , COAT patients had a relatively poorer performance than CComp patients on specific neuropsychometric tests in the PDE ; however , the differences were not statistically significant and did not imply a systematic pattern of scores that reflected domain-specific deficits . Behaviorally , COAT patients were generally superior to CComp patients , also ; however , COAT patients had greater difficulty in following instructions and as well as a tendency toward impulsivity , like the BTW fail group . While there was general support for the notion that COAT did not significantly impair the perception , cognition , coordination , and behavior measured in off-road tests that have been regarded as requisite for on-road driving , method ological problems may limit the generalizability of results and recommendations are made for research beyond a pilot study BACKGROUND Effects of cannabis , the most commonly encountered non-alcohol drug in driving under the influence cases , are heavily debated . We aim to determine how blood Δ(9)-tetrahydrocannabinol ( THC ) concentrations relate to driving impairment , with and without alcohol . METHODS Current occasional ( ≥1 × /last 3 months , ≤3days/week ) cannabis smokers drank placebo or low-dose alcohol , and inhaled 500 mg placebo , low (2.9%)-THC , or high (6.7%)-THC vaporized cannabis over 10min ad libitum in separate sessions ( within-subject design , 6 conditions ) . Participants drove ( National Advanced Driving Simulator , University of Iowa ) simulated drives ( ∼0.8h duration ) . Blood , oral fluid ( OF ) , and breath alcohol sample s were collected before ( 0.17h , 0.42h ) and after ( 1.4h , 2.3h ) driving that occurred 0.5 - 1.3h after inhalation . We evaluated st and ard deviations of lateral position ( lane weave , SDLP ) and steering angle , lane departures/min , and maximum lateral acceleration . RESULTS In N=18 completers ( 13 men , ages 21 - 37years ) , cannabis and alcohol increased SDLP . Blood THC concentrations of 8.2 and 13.1μg/L during driving increased SDLP similar to 0.05 and 0.08g/210L breath alcohol concentrations , the most common legal alcohol limits . Cannabis-alcohol SDLP effects were additive rather than synergistic , with 5μg/L THC+0.05g/210L alcohol showing similar SDLP to 0.08g/210L alcohol alone . Only alcohol increased lateral acceleration and the less-sensitive lane departures/min parameters . OF effectively documented cannabis exposure , although with greater THC concentration variability than paired blood sample s. CONCLUSIONS SDLP was a sensitive cannabis-related lateral control impairment measure . During drive blood THC ≥8.2μg/L increased SDLP similar to notably-impairing alcohol concentrations . Despite OF 's screening value , OF variability poses challenges in concentration-based effects interpretation Background A significant proportion of road traffic crashes are attributable to alcohol and marijuana use while driving globally . Sale and use of both substances is illegal in Pakistan and is not considered a threat for road traffic injuries . However literature hints that this may not be the case . We did this study to assess usage of alcohol and marijuana in Pakistani commercial drivers . Methods A sample of 857 commercial bus and truck drivers was interviewed in October 2008 at the largest commercial vehicle station in Rawalpindi and Islamabad , Pakistan .  Time location cluster sampling was used to select the subjects and a structured question naire was used to assess the basic demographic profile , substance abuse habits of the drivers while on the road , and reasons for usage of illicit substances while driving were recorded . Self reported information was collected after obtaining informed consent . Chi square and fisher exact tests were used to assess differences between groups and logistic regression was used to identify significant associations between driver characteristics and alcohol and marijuana use . Results Almost 10 % of truck drivers use alcohol while driving on Pakistani roads . Marijuana use is almost 30 % in some groups . Statistically different patterns of usage are seen between population subgroups based on age , ethnicity , education , and marital status . Regression analysis shows association of alcohol and marijuana use with road rage and error behaviours , and also with an increased risk of being involved in road crashes . The reported reasons for using alcohol or marijuana show a general lack of awareness of the hazardous nature of this practice among the commercial driver population . Conclusion Alcohol and marijuana use is highly prevalent in Pakistani commercial drivers . The issue needs to be recognized by concerned authorities and methods such as r and om breath tests and sobriety check points need to be employed for proper law enforcement The purpose of this article is to compare the differential rate of detection of illicit drugs when using two distinct sample types , hair and urine specimens . The specimens were collected from persons who applied for employment as a truck driver , or were collected from r and omly selected currently employed truck drivers . The data is examined for job applicants and employees to determine if any differences in outcomes are associated with employment status or specimen type . The data is also assessed for specific patterns associated with particular drugs and their assay outcomes . Overall , it was determined that drug positive cases are relatively rare . Job applicants are more likely to test positive for an illicit drug than a currently employed driver . Applicants are more frequently positive for a drug by a factor of 3 for both urinalysis and hair analysis when compared to currently employed drivers . Approximately 2 % of applicants were urine positive and 9 % hair positive for an illegal drug . Considering employed truck drivers 0.6 % were drug positive by urinalysis and 3 % when using hair analysis . It is concluded that hair assays detect more drug use than urinalysis . It is also concluded that when urine and hair assay outcomes are non-concordant the typical case is a positive hair analysis with a negative urinalysis The objective of this study was to determine the prevalence of psychoactive drug and alcohol use among general drivers and predictors of the drug use in Thail and . One thous and six hundred and thirty-five motor vehicle drivers were r and omly selected from five geographical regions of Thail and between December 2005 and May 2006 . The prevalence of psychoactive drugs was determined using urine tests by gas chromatography/mass spectrometry ( GC/MS ) . Among 1635 drivers , 5.5 % were tested positive for breath alcohol with 2 % having a level exceeding the legal limit ( > or = 50mg% ) . Psychoactive drug was presented in 158 ( 9.7 % ) urine sample s for drug analysis . The top 3 most frequently detected licit drugs were  antihistamines  ( 2.0 % ) , sedative cough suppressant  ( 0.7 % ) and benzodiazepines ( 0.2 % ) . Illicit drugs detected included amphetamine ( 1.8 % ) , cannabis ( 1.1 % ) ,  mitragynine ( Kratom ) ( 0.9 % ) and morphine ( 0.1 % ) . Only type of driver ( commercial/non-commercial ) was a significant predictor with psychoactive drug use . The prevalence of psychoactive drug use among drivers not involved in road crashes in Thail and was not as low as an earlier study in Europe using objective measurements , particularly among commercial drivers . However , for illicit drugs , the prevalence detected in this study was lower than those of earlier studies from high-income countries Traffic accidents are responsible for 1.25 million deaths worldwide and are the most common cause of death among those aged 15 - 29 years . In Brazil , traffic accidents caused more than 44,000 deaths in 2014 . The use of psychoactive drugs is an important risk factor for being involved in traffic accidents . Previous studies have found that psychoactive substances are commonly used by truck drivers in Brazil to maintain their extensive work schedule and stay awake while driving during nighttime hours . The state of Sao Paulo is one of the most important states regarding goods transportation . Important highways cross through Sao Paulo to other regions from Brazil and to other countries in Latin America . This study aims to determine the prevalence of illicit drug use by truck drivers in the state of Sao Paulo through toxicological analyses of oral fluid . Truck drivers were r and omly stopped by police officers on federal roads during morning hours . Oral fluid sample s were collected using the Quantisal ™ device . In addition , a question naire concerning sociodemographic characteristics and health information was administered . Oral fluid sample s were screened for amphetamine , cocaine , and tetrahydrocann 
    Output:
    
It appears that truck-drivers choose stimulant substances as a form of performance enhancing drug , in order to increase productivity .
However , chronic and high dose consumption has been shown to decrease driving skills , placing these professional drivers at risk for health and road safety .