1. Drug Impaired Driving: Importance of Toxicology in Assessing the Problem and Developing Countermeasures McGovern Award Dinner Cosmos Club, Washington DC, June 2006 Barry K Logan PhD, DABFT WA State Toxicologist Director, Forensic Laboratory Services Bureau Washington State Patrol

2. 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

3. 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

4. Household Survey, 2004 (prior year) –Any Illicit Drug Use19.9 Million8.3% –Marijuana 14.6 million6.1% –Cocaine2.0 Million0.8% –Methamphetamine1.4 Million0.5% –Hallucinogens0.93 Million0.4% Alcohol, Drugs and Driving SAMHSA, Household Drug Use Survey, 2004

5. Alcohol, Drugs and Driving Logan, J For Sci, 1996 41(3);457-464

6. 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. Alcohol, Drugs and Driving SAMHSA's National Surveys on Drug Use and Health, 2003, 2004

7. 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. Alcohol, Drugs and Driving SAMHSA's National Surveys on Drug Use and Health in 2002 and 2003

8. 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

9. Drug and Alcohol Use Among Drivers Admitted to a Level-1 Trauma Center Alcohol, Drugs and Driving 108 Drivers from MVC tested for illicit drug use Walsh JM, Flegel R, et al Acc Anal Prev 37 (2005) 894–901 66% drug/ alcohol pos. 51% drug pos.

10. Drug and Alcohol Use Among Drivers Admitted to a Level-1 Trauma Center Alcohol, Drugs and Driving 108 Drivers from MVC tested for illicit drug use Walsh JM, Flegel R, et al Acc Anal Prev 37 (2005) 894–901 Alcohol30.6% Marijuana26.9% (Alcohol also37.9%) Cocaine 11.6% Methamphetamine 5.6% Benzodiazepines11.2% Opiates10.2%

11. 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

12. 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

13. Fatally Injured Drivers - 2002 Schwilke, dos Santos, Logan, J For Sci, in press 2006

14. Fatally Injured Drivers - 2002 Alcohol and/ or drugs 62% Drugs present 35% Alcohol cases positive for drugs 41% Schwilke, dos Santos, Logan, J For Sci, in press 2006

15. Drug Positivity Schwilke, dos Santos, Logan, J For Sci, in press 2006

16. –Fatally Injured Drivers BAC >0.00 (n=150) n% Cannabinoids2717.33 Cocaine128.00 Diphenydramine74.67 Methamphetamine64.00 Methadone42.67 Nordiazepam42.67 Hydrocodone32.00 Midazolam21.33 MDMA10.67 potentially impairing drug6241.33 Schwilke, dos Santos, Logan, J For Sci, in press 2006

17. 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

18. % Drivers tested for Alcohol FARS Data Set, NHTSA Alcohol, Drugs and Driving

19. % Drivers tested for Drugs FARS Data Set, NHTSA Alcohol, Drugs and Driving

20. 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

21. 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

22. 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

23. Vehicular Assault and Homicide (2002-2003, n=700 drivers) Logan BK, Barnes L, AAFS, Feb 2006

24. Alcohol and Drug Use Fatally injured drivers Felony collision suspects Logan BK, Barnes L, AAFS, Feb 2006

25. Vehicular Assault and Homicide (2002-2003 n=700 drivers) Logan BK, Barnes L, AAFS, Feb 2006 51% Drug positive

26. Combined Alcohol and Drug Use Fatally injured drivers Felony collision suspects

27. Summary Comparing felony suspects and fatally injured drivers. FelonyDeceased Positive alc and/or drug 82%62% Any alcohol positive 55%45% Any drug positive 51%35% Logan BK, Barnes L, AAFS, Feb 2006

28. Felony Collisions – Drug use by BAC 14% 86% >0.08BAC 58% 21% 28% 7% 458 drivers had alcohol on board43 of 66 (65%) were drug positive66 (14%) had BAC <0.08 Logan BK, Barnes L, AAFS, Feb 2006

29. 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.

30. 14% 86% >0.08BAC 26.7% 8.9% 12.8% 4.8% 2.0% 458 drivers (65%) had alcohol on board392 (86%) had BAC >0.08192 of 392 (49%) had drugs present also. Felony Collisions – Drug use by BAC Logan BK, Barnes L, AAFS, Feb 2006

31. 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

32. 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.

33. 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

34. 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.

35. When things go wrong… Subject seemed “upset” No SFSTs administered No DRE called “voluntary” blood draw. Toxicology  Morphine 0.13mg/L  Bupropion  Bupropion metabolites

36. 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.

37. 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. DUID – Nowhere to go but up…

38. 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 Tried and True Approaches

39. Officers trained in recognizing drug impairment.

40. Drugs and Driving Cases Submitted

41. 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 Tried and True Approaches

42. Drugs and Traffic Fatalities WA Drivers tested for Drugs

43. Blood Screening Practices Drug/Drug ClassCut Off (ng/mL) Mode (ng/mL) Amphetamines20-100050 Barbiturates2-1000100 Benzodiazepines1-300100 Cannabinoids2-5020 Cocaine met.20-30050 Methadone20-20050 Morphine20-20050 PCP2.5-10010 Meprobamate2-50001000 SOFT/AAFS Survey 2005

44. 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 Tried and True Approaches

45. Use of NHTSA Funding for DUI Emphasis* WSP DUI Enforcement 1999-2004 *402, 157 and 163 funds

46. Tried and True Approaches http://www.nhtsa.dot.gov/people/injury/research/job185drugs/drugs_web.pdf Couper and Logan (2005) –Drug pharmacology –Blood concentrations –Effects on driving

47. Washington State Patrol Washington State Toxicology Laboratory Friends and Colleagues in Forensic Toxicology. Acknowledgements