Transcript drug driving responses

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.
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 5.9:1
Finland; 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)
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).
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”
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 5/12/2010
Italy – 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
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
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
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
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
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
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.
Swedish drug drivers recalcitrant
Forward, Sonja Driving 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
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
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%.
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 TAC web
Vic Road Safety (Drug Drive) Act 2003
Introduced random drug testing and offence
1st offence
for failing a saliva drug test
Problem – alcohol +ve exclusion for RDT saw
Traffic ticket
drug users parry test via a quick sub limit swill
$322 fine
3 months suspension
1st if you elect court $1,289 +
Doubling of drivers screened between 2005-9 challenge
6 month suspension
reduced offences from 1/38 to 1/103 cars
%age drop in deaths factoring target drugs from
nd offence in court
2
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
$6,646 +12 months
3rd and subsequent $12,892 + 12
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)
NZ uses toothpick to bat against 100+ toll
Similar composition to UK data where
Finland in past year
54% of road victims, includes pedestrians,
used A or OD’s but magnified - more crashes
Christchurch longitudinal study -youth more
likely to drive drugged than drunk, and to
crash as so – in fitting with ESR study (more
THC than ETOH in dead drivers under 25)
2% adults used illicits
Report to EMCCDA
UK
10%
NHS drug misuse report
2009
NZ MoH 2007/8 A
and D Survey
16%...
one in 3 of them
reported driving while
feeling drugged past
year
Police increased breath tests by almost 80%
in ‘08, catching 10 per cent more
So why is all the budget going to drink
when leading youth tolls are also other drug related?
ACC liabilities MVC a/c
Head Injuries – MC/Cars
Spinal Injuries –
Both head and spinal
2002 – 1.9B
689
156
62
Total – 897
2004 – 2.5B
724
154
2006 – 3.5B
964
211
2008 – 5.0B
1121
215
104
Total - 1440
Now – 6.9B
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
Bingham et al 2007, Univ of Michigan Transportation Research Institute
100
Crash risk x
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
Drunk drivers E grade
86
80
60
NZ Teens
Others
40
20
20
15
3
0
“The proportion of (deceased) drivers in the age group of 15 to 19, using
0.02
0.08
Etoh and driving, is low (8% sole plus similar numbers of their
BAC 0.02 0.08
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 2004
2004
-7
inclu
sive
0
1-20
2150
51
80
81100
101150
15200
201250
> 250
No
test
1519yr
74
9
2
4
3
6
9
1
0
21
2024yr
45
8
0
3
2
13
14
12
3
23
BAC’s in dead young drivers 2004-7 inclusive; half also used THC
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
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.