DRUGGED DRIVING ~Tour de World 2010~

1. DRUGGED DRIVING ~Tour de World 2010~ Presenter – Rachael Ford BNsg (CT Coordinator) Candor is a registered charitable trust whose beneficiaries are all road users; Research and education about impaired driving ~ Advocates for road victims.

2. Significant Trauma ? • Increasing drug problems poorly resourced - law presuming no such culture has seen growth of an underground road safety problem. • The DRUID project in Europe produced social cost benefit estimates for roadside testing. “Both costs and benefits will depend on the quality of the particular drug screening test device to be applied by the Police” • Cost benefits for using 5 screen panels detecting THC, BZD, COC, Amph, Methamph, opiates were based on Scandinavian experience, but omitted savings from reduced crime and health costs if capture triggers treatment. • Method considered reduced trauma given risk levels and deterrence. • C/Bs better where more drug driving trauma occurs eg Netherlands at 5.9:1Finland; drug driving is so rare that random testing would be a loss-making exercise (Druid C/B analysis of drug driving enforcement by Police – 29/9/2010). • This Dutch estimate is very conservative as knowledge advances and the resultant magnitude of Australian success wasn’t incorporated to the assumptions • Fact - the OR (risk) for pedestrians receiving a fatal versus minor injury is near doubled if the driver who bowls them is drunk or drugged as opposed to a speeder (San Francisco Paediatric Injury Surveillance study by Scorino, Vasse et al 2005)

3. Drink Drive Success • Drink driver deaths slashed from 162 in 1989 to a low of n31* reported in the ESR study for the year to July 2007 *adjusted by MoT up to official n65 based on assumption the rate in non tested population (app. 35 drivers) was 5x the rate in the 150+ tested - shows our drink drive approach mitigates potential risk from rising alcohol consumption. • While Germans use 70% more alcohol than Canadians, Transport Canada reports 11% of Germany’s fatally injured drivers are drunk versus 32% of Canada’s ones. • In Finland, as alcohol consumption increased & drug consumption fell, ‘violence rates did not increase and domestic violence decreased’ (Herttua et al, 2008), and in Norway, rises in alcohol consumption haven’t increased cause specific mortality rates (Rossow, 2007).

4. Harm locus; misuse / specific groups • More beer not wine intake associated with small rises in crashes in research by Mann (Beverage specific associations, ICADTS paper 2004) – ditto a finding of slight impacts on crashes when the drinking age lowered – NZ teens remained exemplary in being the least likely to die of sole drunk driving proportionate to their total deaths (8%) but easier access to illicits? • Everyone knows a “drunk face”, other drug impairment’s hazier. DUIC drivers score highly on the alcohol use disorders identification test =‘s hazardous use (DUIC Dec 2006, Bierness et al, Centre S.A). • It’s separating intoxication from driving wherein countries with AOD issues find relief – also modernising language to “impaired driving”

5. Problem size depends on driver appetites • Crash incidence depends on which drugs are favored somewhere and the prevalence of on road influence Surveys of illicit users indicate a strong belief you’re unlikely to be caught ups offences* • NZ ESR shows meth not cocaine is used - 7/4/2010 man DUIC+M kills 2yr old, 73yr old, self • Random tests of around 1000 drivers in Germany, Denmark and Netherlands found prevalence of THC in general drivers was respectively 0.6%, 0.7% and 4.5%.  In the US survey 7% tested positive for THC – saliva DUIC 5/12/2010Italy – 8 killed •  In New Zealand DUIC prevalence in lower socioeconomic areas was detected in a random survey of 200 drivers between 8am and 9pm as 11.5%.If generalisable to 3 mill licensed drivers this represents minimum prevalence of 7% for THC over 4ng (95% CI) – Candor survey Naenae / Otaki APPETITE FOR DRUG DRIVING UNCHANGED BY A NEW LAW THAT’S 10 YEARS OUT OF DATE*Aitken et al 2000, Davey et al 2001

6. Responses vary based on nous and ambition • Table Source OECD ITF drug drive report 2010, our BAC footer Anti DUI States often require lengthy courses in drink and drug driving basics before a licence is granted. NY is world leading for low DUI harm Major drug driving public education campaigns globally; THC risk the flagship message as: Drug driving is safe or safer than drunk drive in many minds, following 30 years of life costing misinformation; - some ardent legalisers promoted wrong inferences from early flawed /technologically handicapped research eg Marij, Driving and Accident Safety, Jrnl of Psychoactive Drugs 1988, by D Gieringer (Ca. Norml Pres.) • Approaches adopted vary more-so than with drink drive countermeasures - zero tolerance for presence of illicit drugs and non prescribable drugs • per se levels representing likely impairment level that on average is toll signif. • drug presence + proven impairment which can address heavy intoxication from prescribable drugs • a 2 tier system with some infringements and some criminal charges • graded penalties if a risk drug is used in addition to alcohol eg Northern Territory, proposed bill

7. Evaluation • Hospital admissions ; early study found more ER trauma patients are UI cannabis than alcohol* Cannabis user mortality odds by crash x2 ** Opiate disorder clients associated with high crash killing and scene fleeing rates (220 patients in one clinic had killed 17)*** • Results are best measured in down trends in drug and or drink drive deaths per 100,000 and the European Road Safety Observatory recommends countries harmonise DUI program evaluations to include; 1. Mandatory blood tests for deceased drivers for a set of psychoactive drugs (5-6 recommended) 2. The same for all involved drivers surviving fatal crashes, or use of the saliva drug test alongside alcohol breath tests 3. The same mandatory tests for all active road users involved in fatal accidents 4. Eventual extension of the above measures to target severe injury crashes, starting with drivers, later include all active road users. • Some Australian States changed legislation to attempt compliance • A generally more available measure of drug driving programs at this stage (due to testing costs and self report survey unreliability) may be indirect – etoh death rates; for these are certainly increased by DUID where it is common. *Carl Soderstrom et al., Marijuana and Alcohol Use Among 1023 Trauma Patients, Archives of Surgery, 123: 733-7 (1988). ** The impact of cannabis on driving. Bedard et al, Can J Public Health. 2007 Jan-Feb;98(1):6-11 ***Experience of road and other trauma by the opiate dependent patient: a survey report • Albert S Reece Substance Abuse Treatment, Prevention, and Policy May 2008, 3:10

8. U.S.A. a mish mash • 47 US states belong to the DRE program - Police performing complex drug impairment tests on suspects. In 2009 Of 15,050 evaluations submitted 87.75 percent were supported by toxicology* • DUID conviction numbers not reported but diverse standards – some States run combined substances charges and able to charge at 0.04 below legal limits if impaired eg “If the results of the test show a person's alcohol concentration of less than 0.08 (this) may be considered with other evidence of (other) drug use in determining the guilt or innocence of the defendant”. Idaho § 18-8004 • Judiciary frequently trained in sentencing for recidivism prevention • Zero tolerance vs official limit. Failed Senate Bill 212 Montana sought to create limits for med-pot users of 1-5ng (rebuttable inference of impairment), if 1-5ng with alcohol guilty, >5 guilty. Pennsylvania is zero in law, but a Health Dept Directive* sets a limit of ? “reliable quantification” for prosecution THC 5ng – well up on impairing BCL - too high to enable capture due to rapid drop off. From 1989 FMCSA required trucker AOD tests with rewards for low +ves; fails now low – 910% fatal drop** • Michigan Human Services Dept; Transport allowance MMT 18 months Most States have lower drink drive deaths per capita than NZ, but FARS data re DUID is too scant to assess packages *34 Pa Bulletin 990 **(2009 DRE report, IACD).* * Mireille Jacobson Jrnal of law and economics - Vol 46(2003

9. U.K. Response • UK has low drink drive trauma, which Dr Rob Tonbridge told Select Committee this year is due to stripping the drivers licence for 1 year on a 1st offence, irrespective of BAC level, creating high compliance • sits on a large DUID problem uncovered in a major non released survey years ago - a significant association found between illegal drug use and work-related traffic crashes independent of other variables like alcohol* • law makes no distinction between licit / illicit. Some Police have funded own DRE training over in U.S. Intensive field testing slashed DUID fatalities in one area but that effort is unsustainable. • campaign is “not a drink, not a drag” and shows reality • moving forward with roadside testing under urgency in 2011 – likely with DUID remaining a crime. North report recommends keep field tests for licits + institute a BCL; without there may be less incentive for yesterdays smoker to abstain before driving today… “done for a penny, done for a pound” *Smith A,Wadsworth E, Moss S, Simpson S. The scale and impact of illegal drug use by workers. Health and Safety Executive, Lon. 2004

10. Efforts globally - varying success • It’s customary in Europe to deal with drugs separately from abuse of legal substances • But the European Court of Human Rights decreed the right to life (European Convention on Human Rights) creates obligations to put in place “effective criminal law provisions to deter the commission of offences against the person backed up by law enforcement machinery”* • So drug tests occur at the roadside in Germany since 1997 and now also in Switzerland, Finland, Iceland and the Czech Republic and South Africa is progressing it. Not random testing but common, some countries test vehicle for drug traces first Drug driving rates in Nordic countries and DUI harm are low reflecting meld of use patterns & driving laws – safety culture • Finland say just 2% used illicit drugs during the past year and in the 15–24 age group problem use (0.5-0.7%) has halved since 2004 • Method: prevention sections in school curricula, low-threshold treatment, investments in health counseling centres, treatment in prisons, and strong new control methods. Finland drug report to EMCCDA 2009. * Application No 23452/94. 28 October 1998

11. Sweden zero tolerance • Sweden ranks below European averages on drug use and went zero in 1999 with reducing fatalities. As with alcohol no need to show personal impairment • Similar annual road deaths to NZ with twice the population • In 2008 16% involved alcohol (safety net, deliverable D3.11D) =’s half our DUI harm Police say as they often deal with addicts they carry out many field tests and breath check all drivers stopped. Police “cooperate to discourage addiction of alcohol and drugs (using) formalized networks between Police, the social services, public health services and corrections” (Speech by Supt Tom Jensen) • Since Sweden introduced zero tolerance per se legislation sole drug users have represented only 15% of drug impaired driving arrests • Convicted drivers must keep testing drug free for licence reissue • A study of the effectiveness of the zero tolerance law found it to have been unsuccessful in deterring DUID offenders (UK House of Commons Standard note SNVT2884, 25 June 2010). Recidivism over a long window is about 50% likely showing DUID in that culture is typified by hardcore addicts, not the thick end of the wedge of recreational users.

12. Swedish drug drivers recalcitrant Forward, SonjaDriving under the influence of alcohol or narcotics: An in-depth study with convicted drivers, 2010 Swedish Road and Transport Research Institute • “(drink drivers are) living a more normal life, at least on the surface with work and family. For them losing the license because of DD was seen as very shameful • Losing the license many times started a process when they became more aware of their drinking problems and pushed them to ask for help • In contrast Swedish drug drivers had from an early age failed to conform. Many had served long sentences for crimes not necessarily related to driving • Both groups were constantly aware of the police and had developed strategies to avoid being caught. However, drug drivers were more afraid of being charged with possessing drugs than drug driving or even driving without a licence • They did not perceive any pressure from others not to drive. The car was important for getting to places and bringing home stolen goods… treatment need

13. France Go hard vision lately imposed given poor statistics. The road safety council aims to cut drink drive deaths by 1000 and the 250 annual cannabis driving ones* by 100 over 2 years. French police routinely test for drugs after a fatal accident and after an injury accident where the police suspect the driver of DUID, after a road offence that could lead to a driving ban, after speeding, seat belt or helmet offences. Offenders risk going to prison for two years and a fine of €4,500 (£3,893), 3 years suspension or full revokation, confiscation, interlock, training courses. 3 offender classes are treated differentially in responses – Addicts ~ non addicts with bad driving records ~ simple non addict *A cannabis reader: global issues and local experiences, EMCDDA 2008

14. Germany; it depends if you injure • So called zero tolerance for drugs in drivers was introduced in 1998 with drug wipes used after bad driving but really the system is a hybrid • Dodgy drivers standardly drug tested - North Rhine-Westfalia, Germany began using roadside sweat and saliva swabs to check for drug-impaired drivers in 2003 • In 2000, some 7,000 drivers were arrested for drug driving and this had risen to 35,000 by 2008 (Source:AA) • Two tiers of penalty with non injury minor offences treated as DUI infringements and more culpable drug impaired driving triggering a higher level of investigation and possibly criminal prosecution • From 752 dead in 1999 to 399 in 2005 (Progress in reducing DD deaths, explanatory note Pin Flash 5) • One of the fastest EU countries at reducing alcohols role in killer drivers (deceased not measured) which stands around 10%.

15. Victoria background • In 2000, a Section in Road Safety Act created an offence when a person drives or is in charge of a motor vehicle 'while impaired by a drug'. • In 2001, 29% of drivers killed in Victoria had used drugs which hit 40% by 2005. Cannabis and amphetamines detections rose from 16.5% in 2001 to 24.4% in 2005 • In the first 16 months the most common drug detected in apprehended suspects were the benzodiazepine class (present in 74%), followed by cannabis (35%, highest 12ng/ml) • Methamphetamine research (low dose improves skills – w/d increases truck crash risk) led to suggestion of issuing mild ATS in another State; quashed as biorhythms/dependency risks • Under heavy bus based 0.05BAC enforcement (cars phased out) of 1.2 million breath checks yearly drink driving deaths shot up 100% in the risk group – what to do? • Research… local epidemiological identified poly use factor - it was realised effects of recent THC are profound = to a driver with a BAC of 0.15 (Transport Ind Safety Grp - “fatigue, drugs and driving”)Top chart TACweb

16. Vic Road Safety (Drug Drive) Act 2003 • Introduced random drug testing and offence for failing a saliva drug test • Problem – alcohol +ve exclusion for RDT saw drug users parry test via a quick sub limit swill • Doubling of drivers screened between 2005-9 reduced offences from 1/38 to 1/103 cars %age drop in deaths factoring target drugs from 24% to 15%. Entered 5 year trend for reducing injuries and deaths starts • less poly-use on roads via deterrence =‘s a likely factor in less drink drive deaths; 35% of the toll in 2005 – 15% in 2009 NORTHERN TERRITORY ACT 2007 Driving with target drugs in blood - 3 months jail maximum Driving while incapable - 12 months “For this section, a person is taken to be under the influence even though the effect arises from a combination of alcohol and a drug or a combination of drugs.”Chart MBoorman 2010 Vic Pol ICADTS presentation

17. Offenders not all alike – but a/at risk Victoria Police posit 3 types – social, occupational and dependent use(M Boorman presentation to ICADTS conference August 2010). • Victoria requires 8 hour drug driver programs for some offender profiles. Driving Straight DVD and related handbook for drug educators explains effects on driving and the policing with case studies • 44% of apprehended drug drivers have prior drink drives (drugs can be easier on fried livers) • The net is catching at risk users given 1/30 of those caught has died since from drug related mortality Drug and Alcohol Courts Used in Australia for indications from theft up. Coercive DWI courts in the USA reduced recidivism by dependent etoh users from 45% to 13%. Montana found every dollar invested in Family Dependency Treatment Court, returned a $4.74 cost savings in reduced child injury Potential to bring drug drivers re-offence rates (rapid 1st year recidivism in Sweden)in cooey of drink drivers; US National Institute of Justice reviewed 95 drug courts – just 27.5% failed by 2 year mark THC use biggest predictor of novice males crashing (Asbridge, 2005 Accid Anal & Prev) Driving after cannabis was found to predict persistent drink driving in NZ • Begg DJ, Langley JD & Stephenson, Acc Anal & Prev,35, 669-675, 2003). Similar findings; Shope JT & Bingham CR (2002) Drinking-driving as a component of problem driving and problem behaviour in young adults. J. Stud. Alcohol, 63. • Also Clapp et al (2003) Correlation between modes of drinking and modes of driving as reported by students. Acc Anal & Prev,35, At fault crashes ↓ in males treated for THC dependence - Being "at fault" in traffic crashes: does alcohol, cannabis, cocaine, or poly-drug abuse make a difference? M Chipman et al Inj Prev. 2003 Dec 9(4)

18. NZ uses toothpick to batagainst 100+ toll • Similar composition to UK data where 54% of road victims, includes pedestrians, used A or OD’s but magnified - more crashes • Christchurch longitudinal study -youth morelikely to drive drugged than drunk, and to crash as so – in fitting with ESR study (moreTHC than ETOH in dead drivers under 25) • Police increased breath tests by almost 80%in ‘08, catching 10 per cent more • So why is all the budget going to drinkwhen leading youth tolls are also other drug related?

19. Nature of Kiwis raised risks overlooked? • An MoT study of BAC related risks found astronomical risks versus Lund and FARs risk ratings. Nb as many teens die under limit as over • Specially odd as the casualty crash type with the lowest level of excess risk should be alcohol ones for teens; their crash types with the highest risk rises are passenger aboard, bad weather, and weekend travel in a similar jurisdiction for drug use*. *Crash risk among teen drivers: Identification and prediction of excess risk Bingham et al 2007, Univ of Michigan Transportation Research Institute “The proportion of (deceased) drivers in the age group of 15 to 19, using Etoh and driving, is low(8% sole plus similar numbers of their dead drink drivers also using THC) … this contrasts with the high proportion using cannabis and driving(a third, most without alcohol)” - ESR. As cannabis doubles BAC related risk**, alcohol related deaths in teens may be cannabis precipitated, in context of passengers and weekend travel also adding larger independent risks A 3 death chase featured youth THC use, Friday night. Adding further weight to MoT having mistaken dual impairment risk for pure BAC related risk is MoT finding 50x a sober drivers risk in 20-29 year olds at 0.08 vs 15 x risk per other studies **Drummer 2004BAC’s in dead young drivers 2004-7 inclusive; half also used THC

20. Why are drug smash champions NZ last cab off the rank? • While drug driving can be a facet of drink-driving putting the most civilized tippler in the slayer range, an OECD/ITF report says it’s also a distinct issue that requires societal responses of a magnitude comparable to that directed at drink-driving… No rest enabled by Kiwi drug drive response Cross party cowardice – young voter demographic consumes lions share of drugs Fiddled stats– exaggerated speed/alcohol rate via statistical manipulation + under reporting of OD’s as factor Not understood diminished returns from further reductions in drink driver prevalence =‘s ? Linear relationship gone as now hitting poly use bedrock Bribes / perceived conflicting agendas – even Candor Trust was offered quit carrots ? Protectionism of lucrative drug distribution networks in transport Resource Allocation Model- Must stick with current program priorities for 5 years say Officials working on the RAM project 1B – a trial algorithim for speed/drink control setting Police funding by activities; a comparative safety system trial with Vic (running alternate formula 1A apparently incl of drug testing), overseen by Low/Middle Income Country system developers OIA by Akilla to MoT revealed this project as the main barrier

21. Conclusions – ours 99% match those of OECD/ITF team 2010 • “Except for poly-drugging, the magnitude of the crash risks associated with drug use is typically lower than those associated with higher blood alcohol levels • Drug driving is a more complex issue and prevention must account for more subgroups in the population groups within the population, each of which most likely requires a distinct and separate approach … (dependent upon) the variety of different situations in which the behaviour occurs • Several strategies may be required, each with a unique perspective on prevention, enforcement, sanctions, & rehab • Resources should not be siphoned away from those allocated to drink-driving; there needs to be new resources dedicated to the drug-driving issue” Aotearoa has one of the worlds worst problems yet knowledge has been suppressed by policy ever since the doors closed on the 2005 ACC drug driving seminar. We get a zero youth alcohol limit to save 2 lives. Not OK for a youth heavy drug toll place.