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

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

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

Alcohol, Drugs and Driving

• Household Survey, 2004 (prior year) – Any Illicit Drug Use – Marijuana – Cocaine – Methamphetamine – Hallucinogens 19.9 Million 14.6 million 2.0 Million 1.4 Million 0.93 Million 8.3% 6.1% 0.8% 0.5% 0.4% SAMHSA, Household Drug Use Survey, 2004

Alcohol, Drugs and Driving

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

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

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

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

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

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 Marijuana

(Alcohol also

Cocaine Methamphetamine Benzodiazepines Opiates 30.6% 26.9%

37.9%)

11.6% 5.6% 11.2% 10.2% Walsh JM, Flegel R, et al Acc Anal Prev 37 (2005) 894–901

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

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

Fatally Injured Drivers - 2002

17% 38% 18% 27% No Alcohol or Drugs Alcohol Only Alcohol and Drugs Drugs Only

Schwilke, dos Santos, Logan, J For Sci, in press 2006

Fatally Injured Drivers - 2002

17% 38% 18% 27% No Alcohol or Drugs Alcohol Only Alcohol and Drugs Drugs Only

•Alcohol and/ or drugs 62% •Drugs present 35% •Alcohol cases positive for drugs 41% Schwilke, dos Santos, Logan, J For Sci, in press 2006

Drug Positivity

Marijuana Cocaine/met Amphetamines ** Benzodiazepines ** Diphenhydramine ** Hydrocodone ** Phenytoin ** Morphine Doxylamine Amitriptyline 1992/93% Pos 2001/02% Pos 11.01 12.7 3.14 1.89 3.51 4.86 1.26 0.63 0.31 0 1.26 0.63 0.31 4.05 2.70 1.89 1.89 1.62 0 1.08

BAC >0.00 (n=150)

n % Cannabinoids Cocaine Diphenydramine Methamphetamine Methadone Nordiazepam Hydrocodone Midazolam MDMA

potentially impairing drug

27 12 7 6 4 4 3 2 1

62

17.33

8.00

4.67

4.00

2.67

2.67

2.00

1.33

0.67

41.33

Schwilke, dos Santos, Logan, J For Sci, in press 2006

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

Alcohol, Drugs and Driving

• % Drivers tested for Alcohol FARS Data Set, NHTSA 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % Deceased Drivers (64%) % Surviving Drivers (25%)

Alcohol, Drugs and Driving

• % Drivers tested for Drugs FARS Data Set, NHTSA 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % 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

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

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

Vehicular Assault and Homicide

(2002-2003, n=700 drivers)

18% 82% No Alcohol or Drugs Alcohol and/or Drugs

Logan BK, Barnes L, AAFS, Feb 2006

Alcohol and Drug Use

38%

•Fatally injured drivers

62% No Alcohol or Drugs Alcohol and/or Drugs 18%

•Felony collision suspects

82%

Logan BK, Barnes L, AAFS, Feb 2006

Vehicular Assault and Homicide

(2002-2003 n=700 drivers)

18% 18%

51% Drug positive

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

Logan BK, Barnes L, AAFS, Feb 2006

Combined Alcohol and Drug Use

17% 38%

•Fatally injured drivers

18% 27% No Alcohol or Drugs Alcohol Only Alcohol and Drugs Drugs Only 18% 18%

•Felony collision suspects

32% 33%

Summary

Comparing felony suspects and fatally injured drivers.

Felony 82%

Deceased 62%

Positive alc and/or drug Any alcohol positive Any drug positive 55% 51%

45% 35%

Logan BK, Barnes L, AAFS, Feb 2006

Felony Collisions – Drug use by BAC 86% >0.08BAC

14%

58% ALCOHOL >0.08

Marijuana Benzodiazepines Opiates Cocaine Amphetamines 7% 7% 21% 28%

Logan BK, Barnes L, AAFS, Feb 2006

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.

Felony Collisions – Drug use by BAC 14% 86% >0.08BAC

26.7% ALCOHOL <0.08

Marijuana Benzodiazepines Opiates Cocaine Amphetamines 8.9%

12.8% 4.8% 2.0% Logan BK, Barnes L, AAFS, Feb 2006

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

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 28 th 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.

• Toxicology  Morphine 0.13mg/L  Bupropion  Bupropion 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.

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.

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

Officers trained in recognizing drug impairment.

4500 4000 3500 3000 2500 2000 1500 1000 500 0 1996 1997 1998 1999 2000 2001 2002 2003

Drugs and Driving Cases Submitted

3000 2500 2000 1500 DRE DUI - Drugs 1000 500 0

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

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

Drugs and Traffic Fatalities

•WA Drivers tested for Drugs

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Deceased Surviving 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004*

Blood Screening Practices

Drug/Drug Class Cut Off (ng/mL) Amphetamines 20-1000 Barbiturates 2-1000 Benzodiazepines Cannabinoids Cocaine met.

Methadone Morphine PCP Meprobamate SOFT/AAFS Survey 2005 1-300 2-50 20-300 20-200 20-200 2.5-100 2-5000 Mode (ng/mL) 50 100 100 20 50 50 50 10 1000

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

Use of NHTSA Funding for DUI Emphasis* 3000 2500 2000 DUI Arrests Linear (DUI Arrests) 1500 1000 500 0 Ja n 99 M ay 99 Se p 99 Ja n 00 M ay 00 Se p 00 Ja n 01 M ay 01 Se p 01 Ja n 02 M ay 02 Se p 02 Ja n 03 M ay 03 Se p 03 Ja n 04 M ay 04 Se p 04 WSP DUI Enforcement 1999-2004 *402, 157 and 163 funds

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

Acknowledgements

• Washington State Patrol • Washington State Toxicology Laboratory • Friends and Colleagues in Forensic Toxicology.