drug impaired driving: importance of toxicology in assessing the problem and developing...

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

Developing Countermeasures

McGovern Award DinnerCosmos Club, Washington DC, June 2006

Barry K Logan PhD, DABFT

WA State Toxicologist

Director, Forensic Laboratory Services Bureau

Washington State Patrol

• 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

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


Logan, J For Sci, 1996 41(3);457-464

• 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

• 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

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


108 Drivers from MVC tested for illicit drug use

Walsh JM, Flegel R, et al Acc Anal Prev 37 (2005) 894–901

66% drug/ alcohol pos.

51% drug pos.

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


108 Drivers from MVC tested for illicit drug use

Walsh JM, Flegel R, et al Acc Anal Prev 37 (2005) 894–901

Alcohol 30.6%Marijuana 26.9%

(Alcohol also 37.9%)Cocaine 11.6%Methamphetamine 5.6%Benzodiazepines 11.2%Opiates 10.2%

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

38%17%

18%

27%

No Alcohol or DrugsAlcohol OnlyAlcohol and DrugsDrugs Only

Fatally Injured Drivers - 2002


38%17%

18%

27%

No Alcohol or DrugsAlcohol OnlyAlcohol and DrugsDrugs Only

Fatally Injured Drivers - 2002

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


Drug Positivity 1992/93% Pos 2001/02% Pos Marijuana 11.01 12.7

Cocaine/met 3.14 3.51

Amphetamines ** 1.89 4.86

Benzodiazepines ** 1.26 4.05

Diphenhydramine ** 0.63 2.70

Hydrocodone ** 0.31 1.89

Phenytoin ** 0 1.89

Morphine 1.26 1.62

Doxylamine 0.63 0

Amitriptyline 0.31 1.08


Fat

ally

Inj

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Dri

vers

BAC >0.00 (n=150)

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


• % Drivers tested for Alcohol FARS Data Set, NHTSA


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% Deceased Drivers (64%)

% Surviving Drivers (25%)

• % Drivers tested for Drugs FARS Data Set, NHTSA


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% Deceased Drivers (63%)% Surviving Drivers (25%)

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

Combined Drug and Alcohol Use in Drivers Suspected of Vehicular Assault and Homicide.

Samples collected:Based on circumstancesBased on appearance of subjectBased on DRE evaluationBased on subject requestBased on injuries to suspect, and exigent sample collection.

Logan BK, Barnes L, AAFS, Feb 2006

18%

82%

No Alcohol or Drugs

Alcohol and/or Drugs

Vehicular Assault and Homicide(2002-2003, n=700 drivers)


18%

82%

No Alcohol or Drugs

Alcohol and/or Drugs

Alcohol and Drug Use

38%

62%

•Fatally injured drivers

•Felony collisionsuspects


18%18%

33% 32%

No Alcohol or Drugs - 18%Alcohol only - 32%Alcohol and Drugs - 33%Drugs Only - 18%

Vehicular Assault and Homicide (2002-2003 n=700 drivers)


51%Drug

positive

38%17%

18%

27%

Combined Alcohol and Drug Use

•Fatally injured drivers

•Felony collisionsuspects

18%18%

33% 32%

No Alcohol or Drugs

Alcohol OnlyAlcohol and Drugs

Drugs Only

SummaryComparing 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%


Felony Collisions – Drug use by BAC

ALCOHOL >0.08MarijuanaBenzodiazepinesOpiatesCocaineAmphetamines14%86%

>0.08BAC

58%

21%

28%7%

7%

•458 drivers had alcohol on board•43 of 66 (65%) were drug positive•66 (14%) had BAC <0.08


ConclusionsAbout 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.

ALCOHOL <0.08MarijuanaBenzodiazepinesOpiatesCocaineAmphetamines

14%86%

>0.08BAC

26.7%

8.9%

12.8%4.8%

2.0%

•458 drivers (65%) had alcohol on board•392 (86%) had BAC >0.08•192 of 392 (49%) had drugs present also.

Felony Collisions – Drug use by BAC


ConclusionsAbout 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

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.

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

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.

When things go wrong…• Subject seemed “upset”

• No SFSTs administered

• No DRE called

• “voluntary” blood draw.

• ToxicologyMorphine 0.13mg/LBupropionBupropion metabolites

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.

• 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.

DUID – Nowhere to go but up…

• 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

Tried and True Approaches

Officers trained in recognizing drug impairment.

0

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1996 1997 1998 1999 2000 2001 2002 2003

Drugs and Driving Cases Submitted

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1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

DREDUI - Drugs

• ToxicologyHave 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


Drugs and Traffic Fatalities

0%10%20%30%40%50%60%70%80%90%

100%19

9319

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0020

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Deceased

Surviving

•WA Drivers tested for Drugs

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 1000SOFT/AAFS Survey 2005

• 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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Sep-9

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DUI Arrests

Linear (DUIArrests)

Use of NHTSA Funding for DUI Emphasis*

WSP DUI Enforcement 1999-2004*402, 157 and 163 funds


http://www.nhtsa.dot.gov/people/injury/research/job185drugs/drugs_web.pdf

Couper and Logan (2005)

– Drug pharmacology

– Blood concentrations

– Effects on driving

• Washington State Patrol

• Washington State Toxicology Laboratory

• Friends and Colleagues in Forensic Toxicology.

Acknowledgements

drug impaired driving: importance of toxicology in assessing the problem and developing...

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