Drug Impaired Driving: Importance of Toxicology in Assessing the Problem and Developing Countermeasures

1
Drug Impaired Driving Importance of Toxicology
in Assessing the Problem and Developing
Countermeasures
Barry K Logan PhD, DABFT WA State
Toxicologist Director, Forensic Laboratory
Services Bureau Washington State Patrol

• McGovern Award Dinner
• Cosmos Club, Washington DC, June 2006

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Alcohol, Drugs and Driving

• How do we know if we have a problem?
• Household surveys
• Trauma admissions
• Fatally injured drivers
• Surviving drivers in fatal crashes
• Drivers arrested for DUI

3

Alcohol, Drugs and Driving

• How do we know if we have a problem?
• Household surveys
• Trauma admissions
• Fatally injured drivers
• Surviving drivers in fatal crashes
• Drivers arrested for DUI

4

Alcohol, Drugs and Driving

• Household Survey, 2004 (prior year)
• Any Illicit Drug Use 19.9 Million 8.3
• Marijuana 14.6 million 6.1
• Cocaine 2.0 Million 0.8
• Methamphetamine 1.4 Million 0.5
• Hallucinogens 0.93 Million 0.4

SAMHSA, Household Drug Use Survey, 2004
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Alcohol, Drugs and Driving
Logan, J For Sci, 1996 41(3)457-464
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Alcohol, Drugs and Driving

• Household Survey, 2003-4 (Driving)
• In 2004, an estimated 13.5 percent of persons
  aged 12 or older (32 Million) drove under the
  influence of alcohol at least once in the past
  year.
• In 2003, an estimated 10.9 million persons
  reported driving under the influence of an
  illicit drug during the past year. This
  corresponds to 4.6 percent of the population aged
  12 or older.
• The 2003 rates were 14.1 percent among young
  adults aged 18 to 25 and 3.1 percent among adults
  aged 26 or older. These rates were all similar to
  the 2002 rates.

SAMHSA's National Surveys on Drug Use and Health,
2003, 2004
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Alcohol, Drugs and Driving

• Household Surveys, 2002-3 (DUI arrests)
• 5.9 of drivers 21 and older reporting that they
  had driven under the influence of alcohol and
  illicit drugs during the past year had been
  arrested for DUI in the past year
• 4.8 of those driving under the influence of only
  illicit drugs had been arrested for DUI in the
  past year
• 2.9 of those who had driven under the influence
  of only alcohol during the past year had been
  arrested for DUI in the past year.

SAMHSA's National Surveys on Drug Use and Health
in 2002 and 2003
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Alcohol, Drugs and Driving

• How do we know if we have a problem?
• Household surveys
• Trauma admissions
• Fatally injured drivers
• Surviving drivers in fatal crashes
• Drivers arrested for DUI

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Alcohol, Drugs and Driving

• Drug and Alcohol Use Among Drivers Admitted to a
  Level-1 Trauma Center

108 Drivers from MVC tested for illicit drug use
66 drug/ alcohol pos. 51 drug pos.
Walsh JM, Flegel R, et al Acc Anal Prev 37
(2005) 894901
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Alcohol, Drugs and Driving

• Drug and Alcohol Use Among Drivers Admitted to a
  Level-1 Trauma Center

108 Drivers from MVC tested for illicit drug use
Alcohol 30.6 Marijuana 26.9 (Alcohol
also 37.9) Cocaine 11.6 Methamphetamine
5.6 Benzodiazepines 11.2 Opiates 10.2
Walsh JM, Flegel R, et al Acc Anal Prev 37
(2005) 894901
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Alcohol, Drugs and Driving

• How do we know if we have a problem?
• Household surveys
• Trauma admissions
• Fatally injured drivers
• Surviving drivers in fatal crashes
• Drivers arrested for DUI

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Combined Drug and Alcohol use in Fatally Injured
Drivers in Washington State

• Sample submissions from 39 counties coroners/
  medical examiners
• Drivers who died within 4hrs of traffic crash
  from February 1, 2001 to January 31, 2002
• 657 traffic fatalities
  397 (60.4) drivers
  171 (26)
  passengers
  75 (11.4) pedestrians
• N370 (93) driver cases suitable for testing

Schwilke, dos Santos, Logan, J For Sci, in press
2006
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Fatally Injured Drivers - 2002
Schwilke, dos Santos, Logan, J For Sci, in press
2006
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Fatally Injured Drivers - 2002

• Alcohol and/ or drugs 62
• Drugs present 35
• Alcohol cases positive for drugs 41

Schwilke, dos Santos, Logan, J For Sci, in press
2006
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Drug Positivity
Schwilke, dos Santos, Logan, J For Sci, in press
2006
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Fatally Injured Drivers
BAC gt0.00 (n150) BAC gt0.00 (n150)
n
Cannabinoids 27 17.33
Cocaine 12 8.00
Diphenydramine 7 4.67
Methamphetamine 6 4.00
Methadone 4 2.67
Nordiazepam 4 2.67
Hydrocodone 3 2.00
Midazolam 2 1.33
MDMA 1 0.67
potentially impairing drug 62 41.33
Schwilke, dos Santos, Logan, J For Sci, in press
2006
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Alcohol, Drugs and Driving

• How do we know if we have a problem?
• Household surveys
• Trauma admissions
• Fatally injured drivers
• Surviving drivers in fatal crashes
• Drivers arrested for DUI

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Alcohol, Drugs and Driving

• Drivers tested for Alcohol FARS Data Set, NHTSA

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Alcohol, Drugs and Driving

• Drivers tested for Drugs FARS Data Set, NHTSA

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Alcohol and Traffic Fatalities 2004
Limitations of FARS data
One of the major differences among States is in
the degree of testing for driver and non-occupant
BACs. These differences in testing affect the
accuracy and reliability of the estimates
presented, which for 2004 range from a low of
7-percent-known BACs to a high of
82-percent-known BACs. States with higher rates
of known BACs yield estimates of fatal crash
alcohol involvement with greater accuracy and
precision. NCSA States Alcohol Estimates 2004
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Alcohol, Drugs and Driving

• How do we know if we have a problem?
• Household surveys
• Trauma admissions
• Fatally injured drivers
• Surviving drivers in fatal crashes
• Drivers arrested for DUI

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Combined Drug and Alcohol Use in Drivers
Suspected of Vehicular Assault and Homicide.
Samples collected Based on circumstances Based
on appearance of subject Based on DRE
evaluation Based on subject request Based on
injuries to suspect, and exigent sample
collection.
Logan BK, Barnes L, AAFS, Feb 2006
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Vehicular Assault and Homicide(2002-2003, n700
drivers)
Logan BK, Barnes L, AAFS, Feb 2006
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Alcohol and Drug Use

• Fatally injured drivers

• Felony collision
• suspects

Logan BK, Barnes L, AAFS, Feb 2006
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Vehicular Assault and Homicide (2002-2003 n700
drivers)
Logan BK, Barnes L, AAFS, Feb 2006
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Combined Alcohol and Drug Use

• Fatally injured drivers

• Felony collision
• suspects

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Summary

• Comparing felony suspects and fatally injured
  drivers.

Felony Deceased
Positive alc and/or drug 82 62
Any alcohol positive 55 45
Any drug positive 51 35
Logan BK, Barnes L, AAFS, Feb 2006
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Felony Collisions Drug use by BAC

• 458 drivers had alcohol on board

• 43 of 66 (65) were drug positive

• 66 (14) had BAC lt0.08

58
86 gt0.08BAC
14
21
28
7
7
Logan BK, Barnes L, AAFS, Feb 2006
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Conclusions

• About 65 of suspects in vehicular homicides and
  assaults with blood alcohol 0.01 - 0.08g/100mL,
  have impairing drugs on board.
• When impairment doesnt match the BAC - think
  about other drugs.
• Synergistic drug effects can produce marked
  symptoms even with low BAC.
• Predominantly drugs of abuse.

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Felony Collisions Drug use by BAC

• 458 drivers (65) had alcohol on board

• 392 (86) had BAC gt0.08

• 192 of 392 (49) had drugs present also.

26.7
86 gt0.08BAC
14
8.9
12.8
4.8
2.0
Logan BK, Barnes L, AAFS, Feb 2006
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Conclusions

• About 49 of suspects in vehicular homicides and
  assaults with blood alcohol greater than 0.08,
  have impairing drugs on board.
• The investigation usually stops with BAC gt0.08.
• Polysubstance use is the norm, rather than the
  exception.
• Comprehensive toxicology is needed

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Conclusions

• Combined alcohol and drug use is a frequent
  finding in traffic trauma drivers, felony DUI
  suspects, and deceased drivers.
• Lack of comprehensive testing obscures true rates
  of drug use by drivers in both populations.
• Detection of drug use in impaired drivers is
  limited by officer awareness, lack of training,
  sample collection and laboratory resources.

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Conclusions

• Toxicologists are ill-prepared to testify in drug
  impairment cases, with few centralized resources,
  and limited relevant research
• Prosecutors are often reluctant to take these
  cases to trial, as they are complex, require use
  of expert witnesses, involve extensive discovery,
  generate time consuming motions, and result in
  lengthy trials

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When things go wrong

• School-bus driver charged in death allegedly
  took drugs
• Seattle Times February 28th 2004
• A 42-year-old woman was high on morphine when she
  drove a school bus that struck and killed a
  13-year-old student in December, Pierce County
  police and prosecutors say in charges filed
  yesterday.

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When things go wrong

• Subject seemed upset
• No SFSTs administered
• No DRE called
• voluntary blood draw.
• Toxicology
• Morphine 0.13mg/L
• Bupropion
• Bupropion metabolites

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When things go wrong

• Tacoma bus driver not guilty in teenager's death
• Seattle times, Sept 2005
• A school-bus driver has been found not guilty of
  vehicular homicide in the 2003 death of a
  13-year-old boy. Prosecutors said (the
  defendant) was under the influence of morphine
• (The defendants) attorneys argued that she had
  built up a tolerance to the drugs, prescribed to
  manage pain from a degenerative disease.
• (The Victims) family has sued the school
  district for 10 million for negligence.

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DUID Nowhere to go but up

• Goals
• Remove drug impaired drivers from the road.
• Assess incidence and demographics of DUID
• Educate about the effects of drugs and driving.
• Discourage the drug-impaired from driving.
• Change learned drug-driving behaviors.

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Tried and True Approaches

• Enforcement
• Make Traffic Law Enforcement a priority
• Train officers to recognize drug impairment
• Provide specialized training in documenting drug
  impairment
• Screen all causing drivers for impairment
• Provide toxicology resources to LEAs
• Raise awareness of DUID among prosecutors

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Officers trained in recognizing drug impairment.
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Drugs and Driving Cases Submitted

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Tried and True Approaches

• Toxicology
• Have a more comprehensive policy in testing for
  drugs in traffic crimes
• Test all deceased drivers for the presence of
  drugs and alcohol
• Report to FARS
• Test for both illicit and prescription drugs at
  realistic cut-offs

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Drugs and Traffic Fatalities

• WA Drivers tested for Drugs

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Blood Screening Practices
Drug/Drug Class Cut Off (ng/mL) Mode (ng/mL)
Amphetamines 20-1000 50
Barbiturates 2-1000 100
Benzodiazepines 1-300 100
Cannabinoids 2-50 20
Cocaine met. 20-300 50
Methadone 20-200 50
Morphine 20-200 50
PCP 2.5-100 10
Meprobamate 2-5000 1000

SOFT/AAFS Survey 2005
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Tried and True Approaches

• Government
• Provide incentives to states to pass DUID laws,
  including per se approach for controlled
  substances
• Provide incentives and resources targeted at
  traffic law enforcement
• Collect and provide drug test data to document
  trends and demographics
• Coordinate research efforts in DUID detection,
  technology, research and investigation

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Use of NHTSA Funding for DUI Emphasis
WSP DUI Enforcement 1999-2004
402, 157 and 163 funds
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Tried and True Approaches

• Couper and Logan (2005)
• Drug pharmacology
• Blood concentrations
• Effects on driving

http//www.nhtsa.dot.gov/people/injury/research/jo
b185drugs/drugs_web.pdf
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Acknowledgements

• Washington State Patrol
• Washington State Toxicology Laboratory
• Friends and Colleagues in Forensic Toxicology.

• Thank You!