Barry Knott CEO, Lifeloc Technologies Drugged DrivingOur Collective Challenge
Driving Impairment • Size of the Problem • What constitutes impairment? • What are the levels? • How do we measure it accurately? • Where we are today? • Where must we go?
First: The Alcohol Problem • The harmful use of alcohol results in the death of 2.5 million people annually. ~4% of all deaths globally • There are 60 different types of diseases where alcohol has a significant causal role • In 2005, the worldwide total alcohol consumption equaled 1.6 U.S gallons of pure alcohol per person 15 years and older • Alcohol is a factor in perhaps 30-40% of road deaths globally
How We Arrived at 0.08 BAC Limit • 1988: NHTSA reviews of 177 studies clearly document alcohol impairment at 0.08 BAC • 1982-1997: From studies of drivers involved in fatal crashes in all 50 states and DC it was estimated that .08 BAC laws reduced driver alcohol-related fatal crashes by 8 percent • Not until 2000 did Congress pass the DOT Appropriations Act of FY 2001, adopting .08 BAC as the national illegal limit for impaired driving. • BAC limits provide an objective and simple means by which alcohol impairment can be detected Source: Legislative History of .08 Per Se, Carlos Rodrigues-Iglesias, Connie Wiliszowski and John Lacey, NHTSA, July 2001, DOT HS 809 286.
International Drinking & Driving Limits • Trend continues to reduce limits to <.05 BAC • Limit is .05 BAC in numerous countries • Russia, Sweden and Norway have a limit of .02 BAC
Where are We Today? • Throughout the 1980s, there were impressive declines in drinking and driving in much of the industrialized world. • 50% in the Great Britain, • 28% in Canada and The Netherlands, • 32% in Australia, • 37% in Germany • 26% in the U.S. • Changing public attitudes about drinking and driving, more effective laws, and vigorous enforcement has deterred drinking and driving.
The Overall Drug Problem SOURCE: WORLD DRUG REPORT, 2009 • Cannabis is the most widely used drug around the world. • In 2008 approx. 16 to 38 million problem drug users. • Drug Deaths are 10% of those annually from alcohol.
The Overall Drug Problem Prescription Drug Abusers SOURCE: WORLD DRUG REPORT, 2009 • Globally prescription drug abuse is second only to Cannabis • Between 15-30 million people estimates to be abusing prescription drugs in the US alone • Worldwide prescription drug abuse will soon exceed illicit drug
International Drugged Driving Studies • Study of 3,400 fatally injured drivers in Australiabetween 1990 and 1999, drugs other than alcohol were present in 26.7 percent of the cases • 22,000 blood specimens collected from “drugged” driving suspects in Sweden from 2001 to 2004, between 80% and 85% were positive for at least one illegal substance.
Drugged Driving Studies- US • In 2009 in the USA: • 3,952 fatally injured drivers…. tested positive for drug involvement • 7,281 fatally injured drivers…. had >.08 BAC • More than 16 percent of weekend, nighttime drivers tested positive for illegal, prescription, or over-the-counter medications. Source: (NHTSA) 2007 National Roadside Survey • An estimated 10.5 million people aged 12 or older reported driving under the influence of illicit drugs during the year prior to being surveyed Source: 2009 National Survey on Drug Use and Health (NSDUH
What Constitutes Drugged Driving? • Most drugs, unlike alcohol, do not exhibit a simple relationship between drug blood-content and level of impairment. Alcohol Scale Drug Scale
Many Factors Affect Drug Response • There are large individual differences in response to particular drugs
Drugged Driving Impairment • The number of possible interactions is great (drug-drug interaction, drug-nutrient interaction, drug-disease interaction) • Drug-drug interactions include duplication, opposition (antagonism), and alteration of what the body does to one or both drugs • Many drugs currently being used and several are often taken at the same time. Increasing trend to use multiple substances, either together or at different times Combinations of drugs may have synergistic effects or antagonistic effects Source: NIDA
Percentage of Fatally Injured Drivers Testing Positive for at Least One Drug(2005-2009) Source: NIDA
DUID Measurement "We are not concerned about levels or limits. We are concerned with impairment" Chuck Hayes, National Coordinator for the International Assn. of Chiefs of Police “A lot of effort has gone into the study of drugged driving and marijuana, because that is the most prevalent drug, but we are not nearly to the point where we are with alcohol, We don't know what level of marijuana impairs a driver.” Jeffrey P. Michael, the National Highway Traffic Safety Administration's Impaired-Driving Director. http://www.youtube.com/watch?feature=player_embedded&v=c6zlndA8OOU
Where’s the Evidence? • The effects of both medicinal and recreational drugs on driving performance are much less well understood than those of alcohol • No comprehensive body of research • No national standard on the amount of the drug that drivers should be allowed to have in their blood. • Recently, a Circuit Court in Maryland ruled that the DRE protocol was inadmissible as evidence because “…it is not generally accepted as valid and reliable in the relevant scientific community.”
Example: The THC Challenge • Our most common illegal drug. Unfortunately also one of the most difficult to detect at roadside • Delta 9 is the psycho-active compound in THC • Metabolizes rapidly into other compounds • Rate varies from individual • THC contains lots of other things
Example: The THC Challenge • 13 states have adopted zero-tolerance laws, 35 states including California have no formal standard, and instead rely on the judgment of police to determine impairment • Currently for THC 50ng/mL is the screening cutoff limit for THC. It has to establish impairment level (like .08 BAC) • It has to be accepted as ‘valid and reliable by the scientific community • http://articles.latimes.com/2011/jul/02/nation/la-na-pot-drivers-20110703
Can Technology Help Us? • For Law Enforcement use a THC testing device is ideally: • Non-invasive • Easy to use • Fast • Accurate and reliable • Performed at the roadside
Urine Dip stick for THC • Advantages • Quick • Inexpensive • Only detects metabolites (not Delta 9 as it never shows up in urine) • Wide panel of drugs • Disadvantages • Invasive • Non quantitative
Urine chromatography tests • Advantages • Evidential • Wide spectrum of drugs • Again no delta 9 • But it is quantitative • Disadvantages • Invasive • Expensive • Analyzes metabolites in case of THC. Can’t be used as it won’t detect delta 9 the psycho-active compound) • Slow (hours to days)
Saliva Tests for THC • Advantages • Quick • Inexpensive • Specific but not for delta 9 (perhaps in future) • Wide panel of drugs • Non invasive • Disadvantages • Reliability is being questioned because of mouth contamination • All saliva is not the same • Non quantitative
Oral Fluid Issue: THC example • Correlates well with blood with regard to the presence of Carboxyl THC ….but we’re looking for delta 9 • Some metabolites persist for weeks others for hours • Requires correlation which is not easy • Not to mention other drug interactions
Blood Tests for THC • Advantages • Delta 9 – YEA! • Evidential: accurate and quantitative • Wide spectrum of drugs • Disadvantages • Nothing for roadside today • Invasive • Expensive • Slow • Skilled workers needed for sampling and testing.
Drug Recognition Experts (DRE) • The 12-point DRE examination. • Studies conclude that DRE evaluations are moderately to very accurate in rating intoxication due to drugs. • Overall, the results suggest that the involve are reliable scoring procedure and that scores on the SFSTs are accurate and replicable.
Conclusions: Testing Challenges • Current testing devices are limited to 6 to 8 drug classes, have variable sensitivity and poor reliability in the field. • Due to the rapid synthesize illegal drugs, they are difficult, if not impossible, to detect using standard drug screens • No national guidance. Guidelines were issued in 2007 but follow up on the use of those guidelines has yet to be done. • DRUID program in Europe(2006-2008) has attempted to Harmonize European police Requirements, and evaluate and recommend oral fluid testing devices. Guidelines still forthcoming.
Conclusions: Researchers Wanted • Develop standardized procedures and tools for testing in drugged driver and fatally injured driver populations: • Reliable, rapid oral fluid test devices that can be read at the roadside • Breath tests for detection of recent use of impairing drugs • Continue drug impairment and drugged driving behavioral research • Much more drugged driving data collection and analysis
Conclusions: Enforcement • Make Traffic Law Enforcement a priority • Train more officers to recognize drug impairment. • Routinely screen drivers for drug impairment • Provide toxicology resources to Law Enforcement • Raise awareness of DUID among prosecutors