Transcript Poly-Substance Impaired Drivers

Poly-substance Impaired Drivers
4th Annual Association of Ignition Interlock Program
Administrators Conference
May 17th, 2016
Laura J. Liddicoat
NSC/NHTSA Toxicology Fellow
Center for Forensic Science Research & Education
Frederic Rieders Family Renaissance Foundation
DUID Data
Data on overall drug-impaired driving is
hard to find
 No lab tests for ALL drugs
 Test menus vary from lab to lab
 Protocols to “stop testing” are common
Some data sets for limited situations
 Drivers involved in fatal crashes – FARS
 Drivers arrested on suspicion of DUID
 National Roadside Survey – General public
Drug Testing: Current State
 No standard methods or cut-offs.
 Patchwork of procedures and approaches.
 Scope and methods are tailored to local
conditions.
 Technology is expensive and constantly evolving.
 Resources dictate what services the laboratory
can provide.
 Local laws dictate what samples are allowed
and/or drive “stop testing” protocols.
 Limited data on the overall extent of drug
involvement in alcohol-positive drivers.
2013 NSC Recommendations
J Anal Toxicol. 2013 Aug 13.
2013 Drug Prevalence - NSC
Drug
# of Labs in Top 20
THC (Marijuana)
13
Alprazolam
13
Diazepam
13
Cocaine
13
Morphine
13
Oxycodone
12
Hydrocodone
12
Carisoprodol/Meprobamate
11
Zolpidem
11
Methamphetamine
9
Clonazepam
9
Amphetamine
9
*”Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities",
Logan, et al, Journal of Analytical Toxicology 2013
2013 Drug Prevalence - NSC
Drug
Methadone
Lorazepam
Codeine
Diphenhydramine
Tramadol
Phencyclidine (PCP)
Hydromorphone
Citalopram
Temazepam
Oxazepam
Trazodone
Oxymorphone
# of Labs in Top 20
9
9
7
6
6
5
5
4
3
2
2
2
*”Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities",
Logan, et al, Journal of Analytical Toxicology 2013
2013 Drug Prevalence - NSC
Drug
Butalbital
Dihydrocodeine
Pseudoephedrine
6-Acetylmorphine
Fentanyl
MDMA (Ecstasy)
Fluoxetine
Venlafaxine
Gabapentin
Cyclobenzaprine
Amitriptyline
Topiramate
# of Labs in Top 20
2
2
2
2
2
2
1
1
1
1
1
1
*”Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities",
Logan, et al, Journal of Analytical Toxicology 2013
2013 Drug Prevalence - NSC
Drug
THC (Marijuana)
# of Labs in Top 20
13
THC is the most prevalent drug (other than alcohol)
detected in drivers.
Physical Detriments
Balance
Coordination
Reaction Time
Muscle Strength
Body Tremors
Reddened eyes
Cognitive Processes Affected
Attention/Vigilance
Time and Distance Perception
Information Processing
Short Term Memory
Judgment & Decision Making
Perception
CNS Depressants (15/36)
Drug
Alprazolam
Diazepam
Carisoprodol/Meprobamate
Zolpidem
Clonazepam
Lorazepam
Diphenhydramine
Temazepam
Oxazepam
Trazodone
Butalbital
Gabapentin
Cyclobenzaprine
Amitriptyline
Topiramate
# of Labs in Top 20
13
13
11
11
9
9
6
3
2
2
2
1
1
1
1
CNS Stimulants – Dissociative Anesthetic
Drug
Cocaine
Methamphetamine
Amphetamine
Pseudoephedrine
MDMA (Ecstasy)
Phencyclidine (PCP)
# of Labs in Top 20
13
9
9
2
2
5
Narcotic Analgesics (11/36)
Drug
Morphine
Oxycodone
Hydrocodone
Methadone
Codeine
Tramadol
Hydromorphone
Oxymorphone
Dihydrocodeine
6-Acetylmorphine
Fentanyl
# of Labs in Top 20
13
12
12
9
7
6
5
2
2
2
2
Antidepressants
Drug
Citalopram
Fluoxetine
Venlafaxine
# of Labs in Top 20
4
1
1
Drug combinations within and between drug
classes are numerous and varied.
An Evaluation of Data from Drivers Arrested for Driving
Under the Influence in Relation to Per se Limits for
Cannabis. (May 2016); Logan, et al.
Table 7: Confirmed Cannabinoid-Positive Cases with Alcohol
and Other Drug Data (n=4,799)
Other Drugs (+) Other Drugs (-)
Total
Alcohol POS
777 (16.1%)
2,075 (43.2%)
2,852 (59.4%)
Alcohol NEG
830 (17.2%)
1,117 (23.2%)
1,947 (40.6%)
1,607 (33.4%)
3,192 (66.5%)
4,799 (100%)
Total
Sponsored by: AAA Foundation for Traffic Safety
Authors: Barry Logan, Ph.D, F-ABFT, Sherri L. Kacinko, Ph.D, F-ABFT,
Douglas J. Beirness, Ph.D.
An Evaluation of Data from Drivers Arrested for Driving
Under the Influence in Relation to Per se Limits for
Cannabis. (May 2016); Logan, et al.
Table 8: Rates of other drug- and alcohol-positives among cannabinoid-positive cases
Drug Class
% Positive
Alcohol
59.4
Opiates
18.8
Benzodiazepines
15.5
Cocaine
8.6
Amphetamines
5.0
Methadone
3.6
Phencyclidine
1.2
Barbiturates
0.72
Propoxyphene
0.16
Any Other Drug
33.4
National Roadside Surveys (NRS)
 http://search.usa.gov/search?utf8=%E2%9C%93&affiliate=dotnhtsa&query=national+roadside+survey&searchCommit=Search
 The National Roadside Survey (NRS) was conducted
in 1973, 1986, 1996, 2007, & 2013-2014
 Alcohol data (breath) collected in all surveys
 Drug data collected in 2007 & 2013-2014
 Drug/alcohol use rates were presented as national
prevalence rates calculated from the percentage of
drivers using alcohol or drugs and adjusted with an
appropriate weighting scheme.
 To determine driver use of a wide variety of potentially
impairing drugs, including illegal drugs and legal
medicines
NRS – Alcohol Findings
Figure 1
Percentage of Weekend Nighttime Drivers by BrAC
Category in the 5 National Roadside Surveys
NRS – 2013-2014 Drug Findings
% DrugPositive
% DrugPositive
Oral Fluid Test
Blood Test
Oral Fluid and/or Blood
Test
Weekday
Daytime
19.0%
21.6%
22.4%
Weekend
Nighttime
19.8%
21.2%
22.5%
Time of Day
% Drug-Positive
Table 2
Overall Drug Prevalence by Data Collection Period
and Type of Test in the 2013-2014 NRS
Drug prevalence did not appear to differ between
day- and night-time
NRS – Drug Findings (Weekend/Night)
2007
Oral
Fluid Test
Drug
Category
Illegal Drug
N
%
Blood
Test
2013-2014 Comparable Data
Oral Fluid
Oral Fluid
and/or
Test
Blood Test
N
%
N
%
N
635 11.4% 297
9.8%
699
12.4% 779
4.0%
277
3.9% 211
%
Blood
Test
N
%
13.8% 422 14.3%
Oral Fluid
and/or
Blood Test
N
%
849 15.1%
Medications
201
prescription &
over-the-counter
3.0% 169
3.9% 155
4.9%
266
Table 4
Weekend Nighttime Drug Prevalence by Drug Category and Test Type
Comparing 2007 Data to 2013-2014 Comparable Data
4.9%
NRS – THC Findings (Weekend/Night)
2007
Oral Fluid
Test
N
%
Blood
Test
N
%
438 7.7% 234 7.6%
2013-2014 Comparable
Oral Fluid
and/or Blood
Test
N
%
499
8.6%
Oral Fluid
Test
N
%
604 11.4%
Blood
Test
N
%
Oral Fluid
and/or Blood
Test
N
%
414 14.2% 666
12.7%
Table 5 - Weekend Nighttime Prevalence of THC in 2007 Compared to 2013-2014
Comparable Data
The drug with the largest increase in weekend
nighttime prevalence from 2007 to 2013-2014
was THC
4NSCTOX
Laura J. Liddicoat
[email protected]
(608) 239-0230