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Cocaine and Traffic Accident Fatalities in New York City-Reply

Peter M. Marzuk, MD; Kenneth Tardiff, MD, MPH; Andrew Leon, PhD; Marina Stajic, PhD; Edward B. Morgan, MPH; J. John Mann, MD
JAMA. 1990;263(21):2888. doi:10.1001/jama.1990.03440210037021.
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In Reply. —  We are grateful for the correspondence concerning our article. Drs Ravi and Burke bring to our attention that, in a certain percentage of cocainedependent patients, benzoylecgonine can be detected for up to 120 hours. In our study, we too noted that cocaine metabolites were detected in 11 persons who survived in hospitals for greater than 48 hours. We chose our 48-hour cutoff time based on the limited literature in this area. The factors related to cocaine metabolism and elimination require further study, especially now that the pattern of compulsive use may have changed with the introduction of crack. We agree that it cannot be construed that drivers killed in motor vehicle accidents who tested positive for cocaine metabolites were impaired immediately prior to the fatal accident. It should also be noted that cocaine could influence the probability of a motor vehicle accident, either because of an acute


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