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

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

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  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

  2. 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

  5. Alcohol, Drugs and Driving Logan, J For Sci, 1996 41(3);457-464

  6. 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

  7. 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

  8. 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

  9. 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) 894–901

  10. 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) 894–901

  11. 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

  12. 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 • N=370 (93%) driver cases suitable for testing Schwilke, dos Santos, Logan, J For Sci, in press 2006

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

  14. 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

  15. Drug Positivity Schwilke, dos Santos, Logan, J For Sci, in press 2006

  16. Fatally Injured Drivers Schwilke, dos Santos, Logan, J For Sci, in press 2006

  17. 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

  18. Alcohol, Drugs and Driving • % Drivers tested for Alcohol FARS Data Set, NHTSA

  19. Alcohol, Drugs and Driving • % Drivers tested for Drugs FARS Data Set, NHTSA

  20. 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

  21. 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

  22. 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

  23. Vehicular Assault and Homicide(2002-2003, n=700 drivers) Logan BK, Barnes L, AAFS, Feb 2006

  24. Alcohol and Drug Use • Fatally injured drivers • Felony collision suspects Logan BK, Barnes L, AAFS, Feb 2006

  25. 51% Drug positive Vehicular Assault and Homicide (2002-2003 n=700 drivers) Logan BK, Barnes L, AAFS, Feb 2006

  26. Combined Alcohol and Drug Use • Fatally injured drivers • Felony collision suspects

  27. Summary Comparing felony suspects and fatally injured drivers. Logan BK, Barnes L, AAFS, Feb 2006

  28. Felony Collisions – Drug use by BAC • 458 drivers had alcohol on board • 43 of 66 (65%) were drug positive • 66 (14%) had BAC <0.08 58% 86% >0.08BAC 14% 21% 28% 7% 7% Logan BK, Barnes L, AAFS, Feb 2006

  29. 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 doesn’t match the BAC - think about other drugs. • Synergistic drug effects can produce marked symptoms even with low BAC. • Predominantly drugs of abuse.

  30. Felony Collisions – Drug use by BAC • 458 drivers (65%) had alcohol on board • 192 of 392 (49%) had drugs present also. • 392 (86%) had BAC >0.08 26.7% 86% >0.08BAC 14% 8.9% 12.8% 4.8% 2.0% Logan BK, Barnes L, AAFS, Feb 2006

  31. 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 >0.08%. • Polysubstance use is the norm, rather than the exception. • Comprehensive toxicology is needed

  32. 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.

  33. 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

  34. 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.

  35. When things go wrong… • Subject seemed “upset” • No SFSTs administered • No DRE called • “voluntary” blood draw. • Toxicology • Morphine 0.13mg/L • Bupropion • Bupropion metabolites

  36. 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 defendant’s) attorneys argued that she had built up a tolerance to the drugs, prescribed to manage pain from a degenerative disease. • (The Victim’s) family has sued the school district for $10 million for negligence.

  37. 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.

  38. 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 LEA’s • Raise awareness of DUID among prosecutors

  39. Officers trained in recognizing drug impairment.

  40. Drugs and Driving Cases Submitted

  41. 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

  42. Drugs and Traffic Fatalities • WA Drivers tested for Drugs

  43. Blood Screening Practices SOFT/AAFS Survey 2005

  44. 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

  45. Use of NHTSA Funding for DUI Emphasis* WSP DUI Enforcement 1999-2004 *402, 157 and 163 funds

  46. Tried and True Approaches Couper and Logan (2005) • Drug pharmacology • Blood concentrations • Effects on driving http://www.nhtsa.dot.gov/people/injury/research/job185drugs/drugs_web.pdf

  47. Acknowledgements • Washington State Patrol • Washington State Toxicology Laboratory • Friends and Colleagues in Forensic Toxicology. Thank You!

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