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Drugged Driving: A Serious Public Safety Threat

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National Association of Drug Court Professionals Robert L. DuPont, M.D., President Institute for Behavior and Health, Inc. www.ibhinc.org www.StopDruggedDriving.org – PowerPoint PPT presentation

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Title: Drugged Driving: A Serious Public Safety Threat


1
Drugged Driving A Serious Public Safety Threat
  • National Association of Drug Court Professionals
  • Robert L. DuPont, M.D., President
  • Institute for Behavior and Health, Inc.
  • www.ibhinc.org
  • www.StopDruggedDriving.org

2
Qualifications and Disclosures
  • 1968 Started career in District of Columbia
    Department of Corrections
  • 1970 Founded Narcotics Treatment Administration
  • 1973 to 1977 Second White House Drug Chief
  • 1973 to 1978 Founding Director, National
    Institute on Drug Abuse
  • 1978 to Present President, Institute for
    Behavior and Health, Inc.
  • 1980 to Present Clinical Professor of
    Psychiatry, Georgetown Medical School
  • 1982 to Present Co-founder and Executive Vice
    President, Bensinger, DuPont Associates
    Chairman, Prescription Drug Research Center
    (subsidiary of BDA)

3
Presentation Today
  • Introduction to drugged driving
  • Prevalence of the drugged driving problem
  • National policy efforts to reduce drugged driving
  • Defining a drugged driving violation
  • Drug testing needs
  • Linking drugged drivers to treatment
  • Next steps for drugged driving

4
The Problem
  • Drugged Driving refers to operating a vehicle
    after the use of impairing substances which may
    include
  • Illegal drugs
  • Misused prescription drugs (with and without
    prescriptions)
  • Over-the-counter medications
  • Other chemicals (e.g. inhaling aerosol spray)
  • Drug Court participants, as well as returning
    veterans, many of whom face co-occurring
    diagnoses and addiction issues, are prime
    candidates for arrests for drugged driving

5
A Growing National Focus
  • Drugged driving is an under-recognized highway
    safety problem, particularly among the public
  • Dedicated leadership has elevated drugged driving
    to the national stage in the United States,
    including the Office of National Drug Control
    Policy and National Highway Traffic Safety
    Administration

6
Turning Points
  • December 2009 release of data from the 2007
    National Roadside Survey
  • 2010 National Drug Control Strategy identified
    reducing drugged driving by 10 by 2015 as a
    national priority reaffirmed in 2011 and 2012 in
    the National Strategy
  • The National Institute on Drug Abuse has led by
    promoting a new generation of policy-relevant
    drugged driving research
  • NIDAs 2011 Drugged Driving Research A White
    Paper
  • Leadership from National Association of Drug
    Court Professionals (NADCP), National
    Transportation Safety Board (NTSB), and Mothers
    Against Drunk Driving (MADD)

(ONDCP 2010 2011a 2011b 2012)
7
Drugs Impair Driving
  • Examples of the dangerous effects of drugs on
    driving include
  • Disorientation, poor judgment/decision-making,
    changes in reaction time, distance estimation,
    concentration, impulse control
  • Many factors influence the effects of a drug on a
    driver and can be enhanced by drug-drug
    interactions, including alcohol
  • Drug use triples the risk of fatal crash a
    combination of drugs and alcohol produces 23
    times the risk of fatal crash

(Couper Logan, 2004 Li, Brady Chen, 2013)
8
Drugged Driving Research
  • Decades of research on alcohol and driving, now
    with other drugs
  • Significant prevalence of drugs among driver
    populations
  • National surveys (self-report and random stops)
  • Impaired driving (DUI) suspects
  • Seriously injured drivers
  • Fatally injured drivers
  • There is much more research than the studies
    reviewed in this presentation

(DuPont, et al., 2011)
9
Driving Under the Influence
  • 29.1 million (11.2) drivers aged 12 and older
    report that they drove under the influence of
    alcohol in the previous year
  • 10.3 million (3.9) report driving under the
    influence of illicit drugs
  • But among randomly stopped drivers, impaired
    driving suspects, and seriously and fatally
    injured drivers, we see that drugged driving is
    roughly equal to the problem of drunk driving

(SAMHSA, 2013)
10
National Roadside Survey Drug Use Among Weekend
Nighttime Drivers
  • 16.3 of drivers were positive for potentially
    impairing drugs
  • Most common illegal drugs
  • Cannabis, 8.6
  • Cocaine, 3.9
  • Methamphetamine, 1.3

(Lacey, et al., 2009)
11
NRS Alcohol Use Among Weekend Nighttime Drivers
  • 12.4 of drivers were alcohol-positive
  • Illegal Blood Alcohol Concentrations (BAC) of
    0.08 g/dL or higher steadily decreased during
    this time

(Compton Berning, 2009)
12
Crash-Involved Drivers Taken to Shock-Trauma
  • Half were positive for illegal drugs
  • One third positive for alcohol
  • One quarter positive for both illegal drug(s) and
    alcohol
  • One quarter positive for marijuana 39 of
    marijuana-positive drivers were also positive for
    another drug

(Walsh, et al., 2005)
13
Impaired Driving Suspects
  • A US study of impaired driving suspects showed
    that
  • 31 positive for drugs
  • 86 positive for alcohol
  • 25 positive for both
  • 51 of drivers with BACs below 0.08 were
    drug-positive
  • 22 of drivers with illegal BACs were
    drug-positive

(Buchan, et al., 1998 Fix, et al., 1997)
14
Fatally Injured Drivers
  • Research shows that the while the prevalence of
    alcohol among fatally injured drivers decreased
    from 2005 to 2009, the prevalence of drugs among
    dead drivers increased 18
  • In 2009, one third (33) of all fatally injured
    drivers in the U.S. who had confirmed drug test
    results (n12,055) were drug-positive
  • 28 of drug-positive drivers tested positive for
    marijuana

(NHTSA, 2010)
15
Drug Prevalence Among Fatally Injured Drivers Has
Increased, 2005-2009
(Center for Substance Abuse Research, 2010)
16
Fatally Injured Drivers
  • With national fatally injured driver data we are
    only seeing a part of the picture
  • Only 20 states test at least 80 of fatally
    injured drivers for drugs
  • Testing procedures and panels are not
    standardized
  • Some states do not test for marijuana
  • Research has shown that drug-involved crashes
    occur throughout the day while alcohol crashes
    are more common at night

(Romano Pollini, 2013)
17
Fatally Injured Drivers
  • In a study of fatally injured drivers in
    Washington State (n370), 39 were positive for
    drugs
  • 12.7 were positive for marijuana
  • 41 of all drivers were positive for alcohol
  • Of all alcohol-positive cases, 42 were also
    positive for one or more drug showing the overlap
    in drug and alcohol use among drivers

(Schwilke, Sampaio dos Santos, Logan, 2006)
18
Drugged Driving Policy and Demand Reduction
  • Strong, effective drugged driving laws and
    comprehensive enforcement are crucial elements of
    improved demand reduction
  • Reducing drugged driving is part of the solution
    to
  • Prevent illegal drug use
  • Promote highway safety
  • Deliver substance abusers to treatment with the
    leverage to help them become and stay drug-free

19
Drugged Driving Laws
  • Per se drug laws
  • Impairment laws
  • Administrative license revocation (ALR)
  • Drugged driving laws cannot follow same path as
    alcohol-impaired driving laws

20
Alcohol Impairment Standard
  • Reducing drugged driving is wrongly based on the
    model of 0.08 g/dL BAC
  • Obscures the fact that many drivers are
    significantly impaired at levels well below 0.08
    BAC
  • Tolerance and consumption effects vary among
    alcohol users displaying widely varying degrees
    of impairment at 0.08 BAC or higher
  • Though cases are much more difficult to try,
    impaired drivers under 0.08 BAC can be prosecuted
  • Most Western European countries use 0.05 g/dL
    limit Sweden and Norway use 0.02 g/dL limit

(DuPont, et al., 2013)
21
Mirage of BAC Equivalent for Drugs
  • Alcohol is a poor model for studying impairing
    effects of drugs metabolized in simpler ways
    than drugs
  • No close link between blood or other levels of a
    drug (or drug metabolites) and measured
    impairments
  • Vast number of potentially impairing drugs
  • Drug-drug, drug-alcohol combinations
  • Emergence of synthetic designer drugs

(Reisfield, et al., 2012 DuPont, et al., 2013)
22
Mirage of BAC Equivalent for Drugs
  • Role of tolerance in impairment e.g. methadone
  • Consumption of 50 mg of methadone can be lethal
    to person who has not used opioids in prior few
    weeks or months
  • Chronic administration of methadone at stable
    doses typically produces no measurable impairment
    at higher doses
  • Others factors on impairment include time of day,
    driver age and driver experience

(Reisfield, et al., 2012 DuPont, et al., 2013)
23
The Bottom Line
  • Setting impairment thresholds based on tissue
    levels of drugs or metabolites for illegal drugs
    is not a viable enforcement option
  • 0.08 BAC equivalent is not needed
  • We have abundant successful precedents for using
    the per se standard for drugs of abuse

(Reisfield, et al., 2012 DuPont, et al., 2013)
24
Per Se Drug Laws
  • Under a per se drug law, any identified illegal
    drug level found in a driver is defined as a
    drugged driving violation
  • Modeled on the successful per se drug program
    used for the 10 million American commercial
    drivers and others in safety-sensitive positions
  • In the United States, drivers under age 21 are
    held to a zero tolerance per se standard for
    alcohol

(Walsh, 2009 DuPont, et al., 2012)
25
The Bright Line of Illegality
  • For drivers arrested for impaired driving
  • When the drug use is illegal, the zero tolerance
    per se standard is used
  • When the drug use is legal (e.g. prescription
    drug for which the driver has a valid
    prescription), the impairment standard is used

(Voas, et al., 2013 DuPont, et al., 2012)
26
Impairment Laws
  • Impairment is a hard case to make without per se
    law but it can be done
  • Drivers can be prosecuted for impaired driving
    when they are under 0.08 BAC alcohol
  • Remember that it is illegal to drive impaired
    with no alcohol and no drugs

(DuPont, et al., 2012)
27
Complexity of Marijuana
  • This is a political complexity not a scientific
    complexity
  • A solution
  • When marijuana use is legal, use the impairment
    standard
  • When marijuana use is illegal, use the zero
    tolerance per se standard
  • Caveat Marijuana is illegal throughout the U.S.
    under federal law
  • The two wild cards are state-based medical
    marijuana and legal marijuana in Colorado and
    Washington which will have to be settled by the
    U.S. Supreme Court

28
Policy Focus on Marijuana
  • State-based marijuana policy changes have ignited
    a renewed focus on finding a BAC equivalent for
    marijuana with recommendations between 2 ng/mL
    and 10 ng/mL THC in whole blood
  • Large study of drivers arrested for impairment in
    Sweden over 10 years tested between 30-90 minutes
    after arrest
  • 90 had THC concentrations below 5 ng/mL in blood
  • 61 had THC concentrations below 2 ng/mL in blood
  • 43 had THC concentrations below 1 ng/mL in blood

(Jones, Holmgren, Kugelberg, 2008)
29
Frequency Distribution of Blood THC
Concentrations Among DUI Suspects
  • Under a 5 ng/mL THC limit for blood, only 10 of
    drivers in this study would have been prosecuted

(Jones, Holmgren, Kugelberg, 2008)
30
Washington and Colorado
  • Washington has a 5 ng/ml THC per se limit for
    blood
  • Any driver at or over 5 ng/ml is in violation
  • Colorado has a 5 ng/ml permissible inference
    limit for blood weakest drugged driving law for
    marijuana
  • Inference that any driver at or over 5 ng/ml was
    under the influence at time of arrest but
    impairment must be proved
  • 70 of Colorado drivers arrested for suspicion of
    driving under the influence who test positive for
    active THC test at less than 5 ng/ml
  • Both 5 ng/ml limits per se and permissible
    inference give free passes for most stoned
    drivers

(Wood, 2013)
31
Latest Marijuana Research
  • Recent smoking and/or blood THC concentrations of
    2-5 ng/mL are associated with substantial driving
    impairment
  • Epidemiological research suggests that marijuana
    use doubles risk of motor vehicle crash
  • Whole blood THC concentrations persist multiple
    days after drug discontinuation in heavy chronic
    marijuana users
  • After 3 weeks of abstinence, chronic daily
    marijuana users showed observable impairment
    compared to occasional marijuana users

(Li, et al 2012 Asbridge, et al. 2012 Hartman
Huestis 2013 Karschner et al. 2009 Bosker et
al. 2013)
32
Role of the Pro-Drug Lobby
  • Advocates for permissive drug policies aim to
    legalize the use, production and sale of drugs,
    beginning with marijuana
  • Medical marijuana movement has been successful
    in shifting the lobbys goal to full marijuana
    legalization
  • Psychedelic medicine is the next candidate for
    drug legalization
  • Pro-drug lobby opposes driving restrictions on
    drug users particularly against laws related to
    marijuana

33
Administrative License Revocation
  • Non-criminal penalty system used today to get
    drunk drivers off the road quickly
  • ALR process begins after arrest for impairment is
    made
  • Loss of license for drivers who test at or above
    0.08 BAC alcohol
  • ALR for drugs is the next step in drugged driving
    enforcement
  • Presumption of innocence is preserved for later
    adjudication of criminal charge of DUI or DUID by
    a judge

(National Transportation Board, 2013)
34
Importance of ALR
  • ALR is a potential game-changer because it would
    bring drug testing to the police station in a way
    parallel to alcohol testing
  • Use of on-site oral fluid or urine testing
  • Loss of license for positive screening drug test
    results
  • Laboratory confirmation of positive tests prior
    to adjudication

35
Typical Testing Procedures
  • In the U.S. impairment is determined prior to
    arrest
  • Use of Standardized Field Sobriety Tests (SFSTs)
  • Some states use Drug Recognition Experts (DREs)
  • Specimen testing typically occurs after arrest
  • When illegal BAC is found, testing usually ends
    and driver is charged with drunk driving
  • If an impaired driver has a low BAC then drug
    testing should but does not always occur

36
Improve Drug Testing Procedures
  • Use on-site screening tests for ALL impaired
    driving suspects, including those who have
    illegal BACs
  • Testing technology has improved oral fluid
    testing permits easy specimen collection and
    initial screening results but today few states
    permit its use
  • Laboratory confirmation
  • Address laboratory staff/funding issues
  • Drivers who have illegal BACs and test positive
    for drugs should be charged with an aggravated
    offense, like drivers with high BACs ( 0.15 g/dL)

37
Other Drug Testing Opportunities
  • Drivers in crashes causing serious injuries or
    death, either at the scene or at the
    hospital/trauma center
  • When drugs have been found in vehicles or on
    drivers
  • When drivers admit to recent drug use
  • Highway security checkpoints

38
Education, Training Treatment
  • Incorporate drugged driving into drivers
    education and substance abuse prevention programs
  • Educate groups at higher risk about drugged
    driving, e.g. Drug Court participants
  • Increased training to law enforcement on
    identifying drugged drivers
  • Screen and refer drugged drivers to treatment and
    appropriate monitoring programs to reduce
    recidivism

39
DUI Offender Management
  • Assess DUI offenders for both alcohol and drug
    use problems and other disorders
  • Ensure all DUI offenders are tested for alcohol
    and drugs
  • Close monitoring after conviction using model
    programs that stop alcohol and drug use rather
    than focusing exclusively on driving behaviors

40
DWI/Drug Courts
  • Manage hardcore repeat impaired driving offenders
  • Leverage criminal justice system to improve
    long-term outcomes including reduced recidivism
  • Focus on accountability and long-term treatment
  • Address other issues including mental health
    problems

(Fell, et al., 2011 Hiller, et al, 2009
Michigan SCAO, 2008)
41
DWI/Drug Courts
  • Frequent random drug and alcohol testing with
    immediate consequences
  • Great potential resource to address drugged
    drivers
  • Consider prominent overlap of drug problems among
    alcohol-impaired drivers

(Fell, et al., 2011 Hiller, et al, 2009
Michigan SCAO, 2008)
42
Education Within DWI/Drug Courts
  • Participants in both DWI Courts and Drug Courts
    need to be educated about the risks of drugged
    driving
  • Remind them that it is unsafe and illegal to
    drive under the influence of alcohol and after
    using drugs
  • Place special emphasis on marijuana which many
    people do not recognize as a highway safety threat

43
24/7 Sobriety Program
  • Focuses on keeping DUI offenders abstinent from
    alcohol and drugs
  • Treatment and 12-Step involvement is optional
  • Frequent alcohol and drug testing
  • Twice daily alcohol breath tests (7 AM 7 PM) or
  • SCRAM alcohol monitoring ankle bracelets and
  • Random drug urinalysis or
  • Drug patch
  • Any positive test results in an immediate
    short-term stay in jail

(South Dakota Office of the Attorney General,
2013)
44
24/7 Sobriety Results
  • 55 never fail a test
  • 16.7 fail only one test
  • 12.5 fail only twice
  • 16.9 fail three or more times
  • DUI recidivism substantially lower among 24/7
    participants at 1, 2, and 3 years from program
    completion

(South Dakota Office of the Attorney General,
2012)
45
Community Impact
  • 24/7 Sobriety has helped reduce
  • Repeat drunk driving offenses by 12 at the
    county level
  • Domestic violence by 9
  • Traffic crashes for males between ages 18-40 by
    4
  • Frequent random monitoring linked to swift,
    certain and meaningful consequences mostly
    brief incarceration produces fewer failures

(Kilmer, et al., 2013 DuPont, et al., 2010 )
46
Next Steps for Drugged Driving
  • Use of administrative license revocation to get
    drugged drivers immediately off the roads and to
    increase drug testing of DUI suspects
  • Use of the per se standard to effectively
    identify and prosecute drugged drivers
  • Ongoing research and evaluation of drugged
    driving laws and enforcement strategies
  • Focus on the management of the 1.2 million people
    arrested for DUI each year

47
Conclusions
  • Focusing on drugged driving builds upon and
    enhances efforts to reduce drunk driving they
    are synergetic NOT COMPETITIVE
  • The never-ending search for impairment thresholds
    derails actions to prevent drugged driving and
    enforce laws

48
Conclusions
  • Effective action on drugged driving will achieve
    3 important goals
  • Reduce illegal drug use and reinforce prevention
  • Improve highway safety
  • Provide an important new pathway to treatment and
    recovery for drug users as drunk driving
    enforcement now does for individuals with alcohol
    use problems

49
Thank you!
50
www.StopDruggedDriving.org
  • For more information on drugged driving visit
    IBHs website devoted to this public health and
    public safety problem

51
www.IBHinc.org
  • For more information on other new and important
    ideas to reduce illegal drug use visit IBHs home
    website

52
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