Drug-Impaired Driving in the United States and Texas Amber - PowerPoint PPT Presentation

Drug-Impaired Driving in the United States and Texas Amber Trueblood, DrPH,MPH Source: FDA

Foreword • Difficult to measure magnitude of drug-impaired driving • There is no good roadside test for drug levels • Police often do not test for drugs if there is enough evidence of a DUI-alcohol • Presence of drug ≠ impairment • Polydrug use • Limited data available on drugged driving

Background National Roadside Study of Alcohol and Drug Use by Drivers

Drug-Impaired Driving: NHTSA Roadside Survey of Alcohol and Drug Use Drug Percent of Percent of Difference Category Samples Samples 2013-2014 2007 Illegal Drugs 15.1% 12.4% 2.7% Marijuana 12.6% 8.6% 4.0% Medications 4.9% 3.9% 1.0%

Drug-Impaired Driving: United States Number of Drivers with Positive Drug Test, 2008-2017 9,000 8383 7694 8,000 6833 6640 7,000 6572 6540 6096 5946 6,000 5500 5422 5,000 4,000 3,000 2,000 1,000 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Most Commonly Identified Drugs: FARS % (n) of Fatal Drivers with Positive Drug Test United States Texas Cannabinoids 43% (n=3,314) 36% (n=225) Stimulants 30% (n=2,306) 32% (n=203) Narcotics 19% (n=1,490) 12% (n=75) Depressants 18% (n=1,347) 14% (n=85)

Drug-Impaired Driving: Texas Number of Fatalities Due to Drug-Impaired Driving, 2010-2017 800 670 700 662 630 611 590 600 560 559 531 500 400 300 200 100 0 2010 2011 2012 2013 2014 2015 2016 2017

Impacts of Drugs on Driving The dose makes the poison. • Depends on: • Substance(s) - Paracelsus • Dose • Extent of prior use • Individual differences • Acute vs Chronic Use vs.

Impacts of Drugs on Driving

Stimulants • Medicines or drugs that increase alertness, attention, and energy • Amphetamines • Adderall • Methamphetamine • Cocaine • Methylphenidate • Ritalin

Stimulants • Effects • Increased alertness • Increased attention • Increased blood pressure • Increased heart rate • Increased breathing • Decreased ability to focus

Stimulant’s Impact on Driving Impacts motor Reduces Reduces and cognitive balance and ability to focus skills coordination Over- Increased risk confidence in taking driving skills

Marijuana • Marijuana or Cannabis are the dried leaves, flowers, and stems from the Cannabis sativa and Cannabis indica plants • Delta-9-tetrahydocannabinol (THC) • Weed, Grass, Bud, Kush • Effects: • Problems with memory • Problems with learning • Distorted perception • Difficulty in thinking • Loss of coordination

Marijuana’s Impact on Driving • Recent marijuana use approximately doubled one’s risk of traffic crash • Marijuana use impairs: Ability to Road tracking Brake latency gauge time and distance Divided Recognition of attention Ability to pass lights tasks Ability to Inhibitory maintain control headway

Depressants • Psychoactive drugs that slow down the activity of the central nervous system • Alcohol • Barbiturates ( Barbs, Phennies, Birds, Reds ) • Benzodiazepines ( Bars, Candy, Downers, Tranks ) • Sleep Medications ( Ludes, Roofies ) • Heroin • Inhalants • Ketamine

Depressants • Effects • Feel relaxed • Reduced alertness • Reduced heart rate • Reduced breathing • Drowsiness • Dose and mixing more than one depressant can impact your ability to move and breath.

Depressant’s Impact on Driving • Depressant’s Impair: Reaction Concentration Times Ability to Ability to Process Multitask Information

Opioids • Opioids are a class of drugs found in the opium poppy plant to relax the body and relieve pain. • Effects: • Problems with memory • Problems with learning • Distorted perception • Difficulty in thinking • Loss of coordination

Opioid’s Impact on Driving Impacts psychomotor and Increases errors on cognitive driving tasks functioning Drowsiness

Polydrug Use • Using two or more drugs in combination • Using one drug to counteract the effects of another • Using drugs at different times over a short period of days or weeks • Includes alcohol, illegal drugs, prescription drugs, and over-the- counter medicines • Alcohol is the most common drug involved in polydrug use

Polydrug Use and Driving Risk Level Relative Risk Drug Category Slightly increased risk 1-3 Marijuana Medium increased risk 2-10 Benzodiazepines Cocaine Opioid Highly increased risk 5-30 Amphetamines Multiple drugs Extremely increased risk 20-200 Alcohol together with drugs Extremely increased risk 40* Alcohol *adapted from Shulze et al., 2012; Griffiths, 2014; GHSA A Guide for States

Potential Solutions • High-visibility enforcement • Policies • Per Se Drug Laws • Zero Tolerance Laws • Alcohol and drug court • Outreach/Education • Ride-Sharing/Designated Drivers

Recommended Resources • NHTSA Drug-Impaired Driving • GHSA’s report Drug-Impaired Driving: Marijuana and Opioids Raise Critical Issues for States • GHSA’s report Drug-Impaired Driving: A Guide for States, 2017 Update • Drugged Driving AAA Foundation • Countermeasures Against Prescription and Over-the-Counter Drug-Impaired Driving

Summary • While alcohol-impaired driving is decreasing, drug-impaired driving crashes are increasing • Drugs can impact driving ability and increase crash risk • Effects of drugs vary widely across drug categories

Duty of the Medical Examiner and Justice of the Peace to Report Blood Alcohol Concentration Results

Texas Laws Related to BAC Testing and Reporting Reporting toxicology results for fatal crashes to the Texas Department of Transportation (TxDOT)’s Crash Records Section (TxDOT- CRS) is a STATUTORY requirement Transportation Code 550.081 (b) Texas Code of Criminal Procedure Chapter 49

TxDOT CR-1001 – Death/Toxicology Report (ME/JP)

Ways To Report • TxDOT CR-1001 – Death/Toxicology Report (Medical Examiner/Justice of the Peace • Send full autopsy and/or toxicology results • In-house generated form/database, approved by TxDOT • TxDOT’s preferred method is to receive the CR-1001 with the full autopsy and/or full toxicology results

Quick Reference Guide to Blood Alcohol Concentration Reporting in Texas Available for Download at: https://www.texasimpaireddr ivingtaskforce.org/resources/

Amber Trueblood A-Trueblood@tti.tamu.edu 979-317-2542

References 1. Adrian, M. (2015). What the History of Drugs Can Teach Us About the Current Cannabis Legalization Process: Unfinished Business. Substance use & misuse, 50(8-9), 990-1004. 2. Anderson, B. M., Rizzo, M., Block, R. I., Pearlson, G. D., & O'Leary, D. S. (2010). Sex differences in the effects of marijuana on simulated driving performance. Journal of psychoactive drugs, 42(1), 19-30. 3. Alcohol and Drug Foundation. Drugs and Driving. Available at: https://adf.org.au/insights/drugs-and- driving/ 4. Asbridge, M., Hayden, J. A., & Cartwright, J. L. (2012). Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. Bmj, 344, e536. 5. Asbridge, M., Poulin, C., & Donato, A. (2005). Motor vehicle collision risk and driving under the influence of cannabis: evidence from adolescents in Atlantic Canada. Accident Analysis & Prevention, 37(6), 1025-1034. 6. Attwood, D., Williams, R., McBurney, L., & Frecker, R. (1980). Cannabis, alcohol and driving: Effects on selected closed-course tasks. Alcohol, Drugs, and Traffic Safety, 3, 938-953. 7. Azofeifa, A., Mattson, M. E., & Lyerla, R. (2015). Driving under the influence of alcohol, marijuana, and alcohol and marijuana combined among persons aged 16–25 years: United States, 2002–2014. MMWR, 64(48), 1325-9. 8. Barnett, G., Licko, V., & Thompson, T. (1985). Behavioral pharmacokinetics of marijuana. Psychopharmacology, 85(1), 51-56. http://dx.doi.org/10.1007/bf00427321 9. Battistella, G., Fornari, E., Thomas, A., Mall, J. F., Chtioui, H., Appenzeller, M., ... & Giroud, C. (2013). Weed or wheel! FMRI, behavioural, and toxicological investigations of how cannabis smoking affects skills necessary for driving. PloS one, 8(1), e52545. 10. Bech, P., Rafaelsen, L., & Rafaelsen, O. (1973). Cannabis and alcohol: Effects on estimation of time and distance. Psychopharmacologia, 32(4), 373-381. http://dx.doi.org/10.1007/bf00429474