Transcript Technology, Toxicology and Drug Driving Laws

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
SAMHSA, Household Drug Use Survey, 2004
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%
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
1992/93% Pos 2001/02% Pos
Marijuana
Cocaine/met
Amphetamines **
Benzodiazepines **
Diphenhydramine **
Hydrocodone **
Phenytoin **
Morphine
Doxylamine
Amitriptyline
11.01
3.14
1.89
1.26
0.63
0.31
0
1.26
0.63
0.31
12.7
3.51
4.86
4.05
2.70
1.89
1.89
1.62
0
1.08
Schwilke, dos Santos, Logan, J For Sci, in press 2006
Fatally Injured Drivers
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
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
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
New Hampshire
Vermont
Hawaii
Wisconsin
California
New Mexico
Illinois
Ohio
Nebraska
West Virginia
Maine
Washington
Rhode Island
Oklahoma
Oregon
District of
Montana
North Dakota
Missouri
Pennsylvania
South Carolina
Maryland
South Dakota
Nevada
Idaho
Wyoming
North Carolina
Indiana
Michigan
New Jersey
Delaware
Utah
Minnesota
Connecticut
Florida
Kentucky
Arkansas
New York
Arizona
Virginia
Georgia
Colorado
Kansas
Texas
Mississippi
Lousiana
Iowa
Alaska
Tennessee
Massachusetts
Alabama
Alcohol, Drugs and Driving
• % Drivers tested for Alcohol FARS Data Set, NHTSA
% Deceased Drivers (64%)
% Surviving Drivers (25%)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
North Carolina
Hawaii
District of Columbia
New Hampshire
Vermont
Virginia
New York
Washington
Connecticut
New Mexico
Arizona
West Virginia
Rhode Island
Maryland
Montana
Pennsylvania
Massachusetts
California
South Carolina
Colorado
Illinois
North Dakota
New Jersey
Ohio
Tennessee
Indiana
Wyoming
Minnesota
Lousiana
Georgia
Missouri
Nevada
Wisconsin
Florida
Alabama
Kentucky
Texas
Michigan
South Dakota
Idaho
Nebraska
Kansas
Iowa
Utah
Delaware
Alaska
Oregon
Arkansas
Maine
Mississippi
Oklahoma
Alcohol, Drugs and Driving
• % Drivers tested for Drugs FARS Data Set, NHTSA
% 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 7percent-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)
51%
Drug
positive
18%
33%
18%
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
33%
32%
Summary
Comparing 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%
Logan BK, Barnes L, AAFS, Feb 2006
Felony Collisions – Drug use by BAC
•458(14%)
•43
•66
ofdrivers
66 (65%)
had
had
BAC
were
alcohol
<0.08
drug
onpositive
board
58%
86%
>0.08BAC
14%
21%
ALCOHOL >0.08
Marijuana
Benzodiazepines
Opiates
Cocaine
Amphetamines
28%
7%
7%
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
•458
•192
•392 of
drivers
(86%)
392 (49%)
had
(65%)
BAC
had
had>0.08
drugs
alcohol
present
on board
also.
14%
26.7%
86%
>0.08BAC
8.9%
ALCOHOL <0.08
Marijuana
Benzodiazepines
Opiates
Cocaine
Amphetamines
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 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.
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 13year-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
DRE
DUI - Drugs
2000
1500
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%
*
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
Deceased
Surviving
Blood Screening Practices
Drug/Drug Class
Amphetamines
Cut Off
(ng/mL)
20-1000
Mode
(ng/mL)
50
Barbiturates
2-1000
100
Benzodiazepines
Cannabinoids
Cocaine met.
Methadone
Morphine
PCP
Meprobamate
1-300
2-50
20-300
20-200
20-200
2.5-100
2-5000
100
20
50
50
50
10
1000
SOFT/AAFS Survey 2005
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
DUI Arrests
2500
2000
Linear (DUI
Arrests)
1500
1000
500
Ja
nM 99
ay
-9
Se 9
p9
Ja 9
nM 00
ay
-0
Se 0
p0
Ja 0
n0
M 1
ay
-0
Se 1
p0
Ja 1
n0
M 2
ay
-0
Se 2
p0
Ja 2
n0
M 3
ay
-0
Se 3
p0
Ja 3
nM 04
ay
-0
Se 4
p04
0
*402, 157 and 163 funds
WSP DUI Enforcement 1999-2004
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.