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Beirness, D. Cannabis, alcohol and other drug findings in fatally injured drivers in Ontario. Traffic Injury Prevention, 22 1 , This article examines the prevalence of cannabis, alcohol and other drug use in Ontario drivers who died in crashes between January to December Researchers examined toxological results from the blood samples of fatally injured drivers submitted to the Center of Forensic Sciences for analysis. The sample represents Fell, J. Approaches for reducing alcohol-impaired driving: Evidence-based legislation, law enforcement strategies, sanctions, and alcohol-control policies. Forensic Science Review, 31 2 , — The purpose of this article is to provide a summary of the current research regarding the policies and programs created to help minimize the number of impaired driving highway accidents. Researchers examined what current policies and programs offer effective ways to reduce impaired driving incidents. Yost, G. Evidential breath testing for alcohol, Parliament, the science and the courts Part 2. Canadian Society of Forensic Science Journal, 53 2 , 83— Solomon, R. The shifting focus of Canadian impaired driving enforcement: The increased role of provincial and territorial administrative sanctions. Canadian Criminal Law Review, 25 1 , 25— This report looks at the increasing role that licence suspensions and vehicle impoundments play in enforcing impaired driving laws and sanctions. A literature review was also conducted. Train, A. Cannabis policy diffusion in Ontario and New Brunswick: Coercion, learning, and replication. Canadian Public Administration, 62 4 , — Policy diffusion refers to the interdependent nature of the policymaking process, through which policy decisions made by one government affect policymaking in other governments. This study examines the factors that affected the diffusion of recreational cannabis policy in Canada, speficically focused on two provinces, Ontario and New Brunswick. The authors analysed committee hearings, Hansard debates, and federal and provincial government reports to assess what mechanisms facilitated the diffusion of cannabis policy from the federal government and other jurisdictions to Ontario and New Brunswick. Lancione, S. Non-medical cannabis in North America: an overview of regulatory approaches. Public Health London , , 7— The purpose of this study was to look at the current regulations regarding non-medical cannabis legalization in North America in order to better enforce future policy. In June , researchers conducted an internet search for available published public health resources since January 1, Wigmore, J. Windle, S. Impaired driving and legalization of recreational cannabis. The purpose of this article is to examine the relationship between the legalization of recreational cannabis and fatal accident rates motor vehicles. The road to traffic safety: Mandatory breath screening and Bill C Canadian Criminal Law Review, 23 1 , 1— The purpose of this article is to examine and discuss mandatory alcohol screening with the implementation of the new Bill C Brubacher, J. Medications and risk of motor vehicle collision responsibility in British Columbia, Canada: a population-based case-control study. The Lancet. Public Health. Risk factors for collisions were then compared across various medications the drivers were taking new vs past users. Opioids in oral fluid of Spanish drivers. Drug and Alcohol Dependence, , 35— Mandatory roadside breath screening and oral fluid screening took place in Spain and the results were then examined to find links between specific drugs and their combined use in drivers. Prevalence of alcohol and other psychoactive substances in motor vehicle drivers in Spain, Cross-sectional dataset analysis with studies from and Forensic Science International, , — The increasing role of provincial administrative sanctions in Canadian impaired driving enforcement. Traffic Injury Prevention, 21 5 , — The purpose of this article is to record the changes taking place in Canada in regards to the shift in impaired driving enforcement, as well as the deterrent impact of these implementations. Looking at license suspensions ALS and vehicle impoundments AVI , this paper offers a comprehensive examination of their deterring impacts on impaired driving. Wadsworth, E. Addictive Behaviors, 90, — The purpose of this study was to look at trends in cannabis use by youths in Canada, England, and the United States. Researchers conducted an online study in July of of youths aged The survey consisted of questions regarding their cannabis use, their understanding of the harms associated with cannabis use, accessibility to cannabis, and driving under the influence of cannabis. Masud, M. Epidemiology of drug driving: protocol from a national Canadian study measuring levels of cannabis, alcohol and other substances in injured drivers. BMC Public Health, 20 1 , — This blood was collected from emergency departments following the collisions. Consent was obtained in order to proceed with toxicology. Porath, A. Predicting categories of drugs used by suspected drug-impaired drivers using the Drug Evaluation and Classification Program tests. Traffic Injury Prevention, 20 3 , — Researchers conducted this study in order to understand the best way s to predict what drugs the impaired driver may be under the influence, using known symptoms of drug impairment from the Drug Evaluation and Classification DEC. Cannabis-impaired driving and Canadian youth. The purpose of this article was to examine and explain why cannabis may have more severe impacts of impaired driving on those who are younger and inexperienced with cannabis use. Cannabis use as a risk factor for causing motor vehicle crashes: a prospective study. Addiction Abingdon, England , 9 , — This study was conducted to examine whether drivers who test positive for THC or other drugs at a collision contribute more than those who test negative. Participants were people who needed blood tests following a collision; blood was tested for THC , alcohol, or other drugs. Watson, T. Deterring driving under the influence of cannabis: Knowledge and beliefs of drivers in a remedial program. Canadian Journal of Criminology and Criminal Justice, 61 3 , 1— The purpose of the article was to review literature and previous studies conducted in order to inform the efficacy of remedial programs for driving under the influence of cannabis. Purpose This article examines the prevalence of cannabis, alcohol and other drug use in Ontario drivers who died in crashes between January to December Methodology Researchers examined toxological results from the blood samples of fatally injured drivers submitted to the Center of Forensic Sciences for analysis. Findings Males outnumbered females 4 to 1 among the sample of fatally injured drivers. The authors highlight the higher proportion of drivers positive for THC than alcohol as well as the notable proportion of fatalities testing positive for multi-substance use. The crash and driver characteristics differ between alcohol and drug-impaired fatalities, suggesting differing approaches are required for prevention. Findings highlight the need for greater attention and research on cannabis and other drug use among drivers. Citation Fell, J. Purpose The purpose of this article is to provide a summary of the current research regarding the policies and programs created to help minimize the number of impaired driving highway accidents. Methodology Researchers examined what current policies and programs offer effective ways to reduce impaired driving incidents. Citation Yost, G. Part VIII. Purpose This report looks at the increasing role that licence suspensions and vehicle impoundments play in enforcing impaired driving laws and sanctions. Findings The courts have recognized that the provinces have autonomy to authorize and establish their own impairment-related administrative sanctions. Provinces have increasingly moved in this direction to ensure swift removal of potentially unsafe drivers who pose a risk of impaired driving, as well as to limit those convicted of impaired driving related charges. The article offered various recommended practices, namely that ALS s and AVI s should be broken down into three categories for implementation: mandatory hour ALS s and discretionary hour AVI s police should use to get those suspected of being impaired alcohol or drugs off of the roads mandatory seven-day ALS s and mandatory seven-day AVI s alcohol used for anyone who shows a BAC of. Purpose Policy diffusion refers to the interdependent nature of the policymaking process, through which policy decisions made by one government affect policymaking in other governments. Methodology The authors analysed committee hearings, Hansard debates, and federal and provincial government reports to assess what mechanisms facilitated the diffusion of cannabis policy from the federal government and other jurisdictions to Ontario and New Brunswick. The authors also found these provinces replicated comparable policies such as those for alcohol and tobacco from their own jurisdiction. Citation Lancione, S. Purpose The purpose of this study was to look at the current regulations regarding non-medical cannabis legalization in North America in order to better enforce future policy. Methodology In June , researchers conducted an internet search for available published public health resources since January 1, Police are also now permitted to do roadside impairment tests a saliva test for THC and other substances — if a driver fails a field sobriety test or a saliva test, police can also request a blood sample. One concern that presented itself was that in those with a high tolerance for THC who use frequently, they may not show signs of impairment whereas someone who does not use cannabis frequently may be significantly impaired. Citation Wigmore, J. This mandatory screening is only approved at roadside stops. Citation Windle, S. Purpose The purpose of this article is to examine the relationship between the legalization of recreational cannabis and fatal accident rates motor vehicles. Methodology An examination and review of statistics and literature was conducted. Findings Although the legalization of cannabis is projected to account for a small increase in fatal motor vehicle collisions, the increase is still considered significant as it will also account for thousands of injuries from non-fatal accidents while using cannabis recreationally. THC threshold driving limits, as well as good public awareness are thought to help decrease the amount of impaired motor vehicle collisions. Public awareness and education provided by health care professionals will play a crucial role in the minimization of collisions both fatal and non-fatal. Citation Solomon, R. Purpose The purpose of this article is to examine and discuss mandatory alcohol screening with the implementation of the new Bill C Methodology A review of current laws and literature was conducted. Findings In order for a comprehensive mandatory alcohol screening program to be successful, many more drivers will have to be stopped, as well as have their breath screened. Mandatory alcohol screening globally has been shown to minimize the risk of fatal impaired driving accidents, injuries from non fatal impaired collisions, and overall percentages of the population engaging in impaired driving. Citation Brubacher, J. Purpose This was a study examining the risk of collision while taking various medications. Methodology Mandatory roadside breath screening and oral fluid screening took place in Spain and the results were then examined to find links between specific drugs and their combined use in drivers. Findings Opioids were confirmed in 8. The majority of the confirmed tests for morphine Cocaine and cannabis were also commonly seen as being used in conjunction with opioids. Drivers who were stopped and tested positively for morphine, codeine, and methadone had a higher likelihood for also testing positive for heroin, THC , cocaine, and other elicit drugs. Methodology Roadside positive test reports were reviewed for the years , , and Reports showed that impaired driving occurred more frequently when using cannabis than alcohol. The occurrence of drivers using various drugs multiple positive tests for different drugs without the presence of alcohol was more prevalent in than in The presence of mandatory screening decreased the amount of impaired drivers using drugs. Purpose The purpose of this article is to record the changes taking place in Canada in regards to the shift in impaired driving enforcement, as well as the deterrent impact of these implementations. Methodology Looking at license suspensions ALS and vehicle impoundments AVI , this paper offers a comprehensive examination of their deterring impacts on impaired driving. Monetary penalties and license-reinstatement fees have also shown to be beneficial in deterring impaired driving. Citation Wadsworth, E. Purpose The purpose of this study was to look at trends in cannabis use by youths in Canada, England, and the United States. Methodology Researchers conducted an online study in July of of youths aged Findings Survey data showed that youth from the US reported higher rates of consumption, and driving following cannabis use, and lower rates of perceived harm than youth from both England and Canada. Canadian youth data reported having easier access to cannabis, more frequent rates of driving after using, and higher usage rates than youth in England. Overall, both American and Canadian data showed higher rates of consumption, driving after consumption, and having easier accessibility to cannabis than the data from youth in England. Researchers considered more lenient policy in the US and Canada in comparison to that in England as a potential explanation of the data trends found. Citation Masud, M. Findings By using blood samples, rather than saliva or urine samples, toxicology was able to show stronger correlations with drug impairment. Blood samples offer better results than roadside impairments tests as they are able to show more accurate perceptions of probable impairment. Citation Porath, A. Purpose Researchers conducted this study in order to understand the best way s to predict what drugs the impaired driver may be under the influence, using known symptoms of drug impairment from the Drug Evaluation and Classification DEC. Methodology A literature review was conducted. Purpose This study was conducted to examine whether drivers who test positive for THC or other drugs at a collision contribute more than those who test negative. Methodology Participants were people who needed blood tests following a collision; blood was tested for THC , alcohol, or other drugs. Purpose The purpose of the article was to review literature and previous studies conducted in order to inform the efficacy of remedial programs for driving under the influence of cannabis. Findings Road-side driving under the influence of cannabis DUIC check-points have shown to have the greatest deterring effects for driving under the influence. Participants voiced concern regarding THC roadside drug testing as those who use cannabis more frequently may have a higher tolerance than those who do not — therefore they may test positive for THC levels of the legal limit, but may not be impaired. Previous Page Table of Contents.

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Conflict of interest: the authors declare that they have no conflicts of interest. Pradhan, R. Schwartz, A. Patil, S. Grabbe, M. Leishmaniasis is broadly classified into three types: cutaneous, mucocutaneous and visceral. The visceral form is most dangerous and can result in death. Although leishmaniasis is an ancient disease, its treatment is still challenging. Several drugs, differing in their cost, toxicity, treatment duration and emergence of drug resistance, are used for different types of leishmaniasis. To overcome these limitations, the search for newer drugs and other treatments continues. In this article, we discuss conventional drugs, other treatments, including newer options such as immunotherapy and immunochemotherapy, and future prospects for leishmaniasis treatment. Leishmaniasis, caused by protozoan of the genus Leishmania , is classified into three types: visceral VL , cutaneous CL and mucocutaneous. The currently available treatment options are associated with several limitations including adverse effects AEs , cost, poor efficacy and the need for multiple injections. Emergence of drug resistance is another concern. Recently, owing to a deeper understanding of the disease pathogenesis, newer therapies such as immunotherapy and immunochemotherapy are being tried. Similarly, various therapeutic targets in the metabolic pathways of Leishmania are being continuously explored. In this article, we discuss a number of options for the management of leishmaniasis. Miltefosine has since been used in VL and CL; this has the advantages of being an oral drug with good efficacy and short course, but teratogenicity and drug resistance are its important limitations. Existing drugs repurposed for leishmaniasis include amphotericin B, miltefosine, paromomycin and petamidine. Azole antifungals have also studied for leishmaniasis; itraconazole was found to be superior to ketoconazole and fluconazole for inhibiting growth of most Leishmania strains. It has the advantage of a short course, but its efficacy varies for different Leishmania species, and its use may be associated with dysglycaemia and other AEs. All these therapies are shown in Table 1. To prevent drug resistance, improve compliance, shorten the duration of treatment and thereby reduce the cost of therapy, combination chemotherapy has been developed. Local therapies have been developed for limited CL as options to avoid toxicity with systemic use of drugs. A few mechanistic studies have addressed the principles underlying the use of PDT for the treatment of CL. Cryonecrosis results in release of antigenic substances that induce immune response and result in healing of other lesions. Cryotherapy can be a good option for the treatment of CL, particularly given the various disadvantages of chemotherapy. Radiofrequency RF therapy, a form of thermotherapy, has been tried in patients with CL. They produce various biological functions including immunosuppressive actions. It was found to be well tolerated and effective in patients with VLs refractory to monotherapy with pentavalent antimonial therapy. The immunomodulator protein aggregate magnesium—ammonium phospholinoleatepalmitoleate anhydride was found to improve clinical signs in canine VL and significantly reduce parasite load in the skin. Immunotherapeutic and chemotherapeutic agents have been used to produce a synergistic action in activating the immune system and by the direct action of drugs on the infectious agent. Hydroxynaphthoquinone—buparvaquone acts by depleting adenosine triphosphate ATP levels and thereby producing inhibition of the ETC in amastigotes. Tafenoquine impairs the bioenergetic metabolism of Leishmania promastigotes, causing a rapid drop in intracellular ATP levels, resulting in apoptosis and thereby leading to mitochondrial dysfunction. In experimental studies, simvastatin and atorvastatin and resveratrol were found to inhibit the growth of Leishmania donovani promastigotes. Alkylphospholipid analogues have recently been demonstrated as possible target drugs. In experimental studies, edelfosine killed both Leishmania promastigotes and amastigotes. Polyamines are strongly associated with cell survival, growth and proliferation. Various enzymes involved in polyamine metabolism and folate metabolism can also be used as targets for antileishmanial activity. Chemotherapeutic regimens used for treatment of leishmaniasis are associated with several AEs. Advances in the understanding of the pathogenesis have resulted in development of various drugs targeting different biochemical pathways. Newer treatments such as immunotherapy and immunochemotherapy are gaining importance. Am J Trop Med Hyg ; 59 : — Google Scholar. Pancreatitis induced by pentavalent antimonial agents during treatment of leishmaniasis. Clin Infect Dis ; 18 : 83 — An observational study of 80 cases. An Trop Med Parasitol ; 92 : — 9. Croft SL , Yardley V. Chemotherapy of leishmaniasis. Curr Pharm Des ; 8 : — Injectable paromomycin for visceral leishmaniasis in India. N Engl J Med ; : — World Health Organisation. Control of the Leishmaniases. Geneva : WHO , Google Preview. Clin Infect Dis ; 47 : — 6. Safety and efficacy of miltefosine alone and in combination with sodium stibogluconate and liposomal amphotericin B for the treatment of primary visceral leishmaniasis in East Africa: study protocol for a randomized controlled trial. Trials ; 12 : Exp Dermatol ; 16 : — J Invest Dermatol ; : — 9. Br J Dermatol ; : — Comparison of intralesional meglumine antimoniate, cryotherapy and their combination in the treatment of cutaneous leishmaniasis. Int J Dermatol ; 45 : — Cutaneous leishmaniasis. Treatment with combined cryotherapy and intralesional stibogluconate injection. Int J Dermatol ; 29 : 56 — 9. Treatment of Old World cutaneous leishmaniasis with dapsone, itraconazole, cryotherapy, and imiquimod, alone and in combination. Int J Dermatol ; 48 : — 9. Am J Trop Med Hyg ; 30 : — Thermosensitivity patterns of Old vs. New World cutaneous strains of Leishmania growing within mouse peritoneal macrophages in vitro. Am J Trop Med Hyg ; 32 : — 4. Am J Trop Med Hyg ; 42 : 43 — The efficacy of thermotherapy to treat cutaneous leishmaniasis in Colombia: a comparative observational study in an operational setting. Thermotherapy: an alternative for the treatment of American cutaneous leishmaniasis. Trials ; 13 : 58 — Efficacy of local heat therapy by radiofrequency in the treatment of cutaneous leishmaniasis, compared with intralesional injection of meglumine antimoniate. Clin Exp Dermatol ; 32 : — 4. Immunotherapy and immunochemotherapy in visceral leishmaniasis: promising treatments for this neglected disease. Front Immunol ; 5 : Okwor I , Uzonna JE. Immunotherapy as a strategy for treatment of leishmaniasis: a review of the literature. Immunotherapy ; 1 : — J Clin Invest ; 72 : — J Infect Dis ; : — Badaro R. The use of recombinant gamma interferon associated with pentavalent antimony in therapy for visceral leishmaniasis. Mem Inst Oswaldo Cruz ; 83 Suppl : — 7. Am J Trop Med Hyg ; 48 : — 9. Sundar S , Murray HW. J Infect Dis ; : — 9. Acta Trop ; : — Targeting the cytochrome bc1 complex of Leishmania parasites for discovery of novel drugs. Antimicrob Agents Chemother ; 60 : — J Med Chem ; 53 : — J Med Microbiol ; 56 : — Antimicrob Agents Chemother ; 54 : — Microb Pathog ; 66 : 14 — Which of the following forms of leishmaniasis is most severe? Visceral form. Which of the following drugs can be given by oral route in the treatment of leishmaniasis? Amphotericin B. What is the advantage of liposomal amphotericin B over conventional amphotericin B? Increase efficacy. In which of the following types of aminolaevulinic acid is used as a part of therapy against leishmaniasis? Which of the following routes are used for administration of pentavalent antimonials in the treatment of leishmaniasis? Users are encouraged to Read the article in print or online, paying particular attention to the learning points and any author conflict of interest disclosures. This activity will be available for CPD credit for 2 years following its publication date. At that time, it will be reviewed and potentially updated and extended for an additional period. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign in through your institution. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Summary. Chemotherapeutic agents. Local therapies. Newer options: immunotherapy. Future prospects. CPD questions. Journal Article. Treatment options for leishmaniasis. Pradhan , S. Oxford Academic. Building Cite Cite S. Select Format Select format. Permissions Icon Permissions. Summary Leishmaniasis is broadly classified into three types: cutaneous, mucocutaneous and visceral. Table 1 Open in new tab. Chemotherapeutic agents for leishmaniasis. Table 2 Open in new tab. Local therapies for cutaneous leishmaniasis. 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