Road safety threats and occupational health risk associated with psychoactive substance use and dependence risk among commercial drivers: WHO ASSIST evidence from Ghana.

backgroundCommercial drivers increasingly use psychoactive substances, raising the risk of road crashes and occupational injuries. Globally, 1.3 million people die in road crashes each year (90% in low- and middle-income countries), and Africa alone accounted for 250,000 of these deaths in 2021. Ghana as of 2026 had experienced a 18.2% increase in road traffic accidents with the National Road Safety Authority reporting 13,489 road crashes and 2,494 fatalities in 2024. In the first half of 2025 alone, the country had already recorded 7,289 crashes resulting in 1,504 deaths. In Ghana, studies report high prevalence and dependence on alcohol, cannabis, and tramadol among drivers. However, few studies have categorized drivers by ASSIST dependence risk levels (low/moderate/high). This study aims to address that gap and inform road safety and occupational health policy towards achieving SDG target 3.6 on traffic fatalities.

methodsWe conducted a cross-sectional survey of 204 commercial drivers (aged ≥ 18 years) at three bus stations in Duayaw Nkwanta, Ghana. Data were collected via face-to-face interviews using a structured questionnaire adapted from the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). ASSIST composite scores were calculated for each substance and categorized as low, moderate or high risk. We summarized prevalence and mean scores descriptively and used multivariable logistic regression to identify factors associated with any substance use.

resultsAmong 204 commercial drivers (mean age 33 years), 68 (33.3%) reported past-3-month use of at least one non-alcohol psychoactive substance. Mean ASSIST involvement scores were highest for cannabis and for the tramadol/coffee category, indicating greater dependence risk. Based on WHO ASSIST risk classifications, 74% of tramadol/coffee users and all cannabis users were classified as high risk, whereas alcohol users showed lower risk levels (46% high risk, 50% moderate risk, and 4% low risk). In multivariable analysis, owning one’s vehicle (aOR 0.38, 95% CI 0.16 to 0.91, p = 0.030) and having rest breaks during work (aOR 0.44, 95% CI 0.22 to 0.90, p = 0.025) were independently associated with reduced odds of non-alcohol psychoactive substance use. High-risk dependence showed a different pattern. Having rest breaks during working hours was strongly protective, with markedly lower odds of high-risk dependence (aOR 0.14, 95% CI 0.04 to 0.41). Duration at the car park was associated in crude analysis but not after adjustment (cOR 1.33, 95% CI 1.03 to 1.73; aOR 1.28, p = 0.226).

conclusionsThese findings show critical road safety and occupational health concern. High ASSIST risk scores indicate potential substance-related problems among commercial drivers. Although our study did not measure impairment, withdrawal symptoms, or crash outcomes, the presence of moderate or high-risk scores suggests a need for routine screening, brief intervention, and referral services within occupational health and transport regulatory settings. These findings should be interpreted as indicators of possible risk rather than evidence of causation or driving impairment. Targeted interventions are needed in the transport sector. Ensuring compliance with rest-break regulations and promoting driver ownership models may help mitigate stress-driven substance use. Regular screening and counselling could be integrated into occupational health programs. Addressing driver substance dependence is essential for meeting global road safety goals (SDG 3.6) and protecting worker health.