Medication Impaired Driving: Importance of Toxicology in Assessing the Problem and Developing Countermeasures

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Sedate 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 would we know whether we have an issue? Family unit reviews Trauma confirmations Fatally harmed drivers Surviving drivers in lethal accidents Drivers captured for DUI

Alcohol, Drugs and Driving How would we know whether we have an issue? Family unit overviews Trauma affirmations Fatally harmed drivers Surviving drivers in deadly crashes Drivers captured for DUI

Alcohol, Drugs and Driving Household Survey, 2004 (earlier year) Any Illicit Drug Use 19.9 Million 8.3% Marijuana 14.6 million 6.1% Cocaine 2.0 Million 0.8% Methamphetamine 1.4 Million 0.5% Hallucinogens 0.93 Million 0.4% SAMHSA, Household Drug Use Survey, 2004

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 expected 13.5 percent of people matured 12 or more established ( ~32 Million ) drove affected by liquor in any event once in the previous year. In 2003 , an expected 10.9 million people announced driving affected by an unlawful medication amid the previous year. This relates to 4.6 percent of the populace matured 12 or more seasoned. The 2003 rates were 14.1 percent among youthful grown-ups matured 18 to 25 and 3.1 percent among grown-ups matured 26 or more established. These rates were all like the 2002 rates. SAMHSA's National Surveys on Drug Use and Health, 2003, 2004

Alcohol, Drugs and Driving Household Surveys, 2002-3 (DUI captures) 5.9% of drivers 21 and more established revealing that they had driven affected by liquor and illegal medications amid the previous year had been captured for DUI in the previous year 4.8% of those driving affected by just unlawful medications had been captured for DUI in the previous year 2.9% of the individuals who had driven affected by just liquor amid the previous year had been captured for DUI in the previous year. SAMHSA's National Surveys on Drug Use and Health in 2002 and 2003

Alcohol, Drugs and Driving How would we know whether we have an issue? Family unit reviews Trauma confirmations Fatally harmed drivers Surviving drivers in deadly crashes Drivers captured for DUI

Alcohol, Drugs and Driving Drug and Alcohol Use Among Drivers Admitted to a Level-1 Trauma Center 108 Drivers from MVC tried for illegal medication utilize 66% medication/liquor pos. 51% medication 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 tried for illegal medication utilize Alcohol 30.6% Marijuana 26.9% (Alcohol also 37.9%) Cocaine 11.6% Methamphetamine 5.6% Benzodiazepines 11.2% Opiates 10.2% Walsh JM, Flegel R, et al Acc Anal Prev 37 (2005) 894–901

Alcohol, Drugs and Driving How would we know whether we have an issue? Family unit studies Trauma confirmations Fatally harmed drivers Surviving drivers in lethal accidents Drivers captured for DUI

Combined Drug and Alcohol use in Fatally Injured Drivers in Washington State Sample entries from 39 provinces; coroners/medicinal inspectors Drivers who kicked the bucket inside 4hrs of car accident from February 1, 2001 to January 31, 2002 657 activity fatalities 397 (60.4%) drivers 171 (26%) travelers 75 (11.4%) people on foot N=370 (93%) driver cases reasonable for testing Schwilke, dos Santos, Logan, J For Sci, in press 2006

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

Fatally Injured Drivers - 2002 Alcohol as well as medications 62% Drugs display 35% Alcohol cases constructive for medications 41% Schwilke, dos Santos, Logan, J For Sci, in press 2006

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

Fatally Injured Drivers Schwilke, dos Santos, Logan, J For Sci, in press 2006

Alcohol, Drugs and Driving How would we know whether we have an issue? Family unit reviews Trauma confirmations Fatally harmed drivers Surviving drivers in lethal accidents Drivers captured for DUI

Alcohol, Drugs and Driving % Drivers tried for Alcohol FARS Data Set, NHTSA

Alcohol, Drugs and Driving % Drivers tried for Drugs FARS Data Set, NHTSA

Alcohol and Traffic Fatalities 2004 Limitations of FARS information: "One of the real contrasts among States is in the level of testing for driver and non-tenant BACs. These distinctions in testing influence the exactness and dependability of the assessments displayed, which for 2004 territory from a low of 7-percent-known BACs to a high of 82-percent-known BACs. States with higher rates of known BACs yield evaluations of deadly crash liquor inclusion with more prominent exactness and accuracy." NCSA States Alcohol Estimates 2004

Alcohol, Drugs and Driving How would we know whether we have an issue? Family unit overviews Trauma confirmations Fatally harmed drivers Surviving drivers in deadly crashes Drivers captured for DUI

Combined Drug and Alcohol Use in Drivers Suspected of Vehicular Assault and Homicide. Tests gathered: Based on conditions Based on appearance of subject Based on DRE assessment Based on subject demand Based on wounds to presume, and urgent example accumulation. Logan BK, Barnes L, AAFS, Feb 2006

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

Alcohol and Drug Use Fatally harmed drivers Felony crash presumes Logan BK, Barnes L, AAFS, Feb 2006

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

Combined Alcohol and Drug Use Fatally harmed drivers Felony impact suspects

Summary Comparing lawful offense suspects and lethally harmed drivers. Logan BK, Barnes L, AAFS, Feb 2006

Felony Collisions – Drug use by BAC 458 drivers had liquor on board 43 of 66 (65%) were medication positive 66 (14%) had BAC <0.08 58% 86% > 0.08BAC 14% 21% 28% 7% Logan BK, Barnes L, AAFS, Feb 2006

Conclusions About 65% of suspects in vehicular manslaughters and ambushes with blood liquor 0.01 - 0.08g/100mL, have debilitating medications on board. At the point when debilitation doesn't coordinate the BAC - consider different medications. Synergistic medication impacts can create checked side effects even with low BAC. Overwhelmingly medications of mishandle.

Felony Collisions – Drug use by BAC 458 drivers (65%) had liquor on board 192 of 392 (49%) had drugs show too. 392 (86%) had BAC > 0.08 26.7% 86% > 0.08BAC 14% 8.9% 12.8% 4.8% 2.0% Logan BK, Barnes L, AAFS, Feb 2006

Conclusions About 49% of suspects in vehicular murders and attacks with blood liquor more noteworthy than 0.08, have weakening medications on board. The examination more often than not stops with BAC >0.08%. Polysubstance utilize is the standard, as opposed to the exemption. Thorough toxicology is required

Conclusions Combined liquor and medication utilize is an incessant finding in activity injury drivers, crime DUI suspects, and perished drivers. Absence of far reaching testing clouds genuine rates of medication use by drivers in both populaces. Identification of medication use in weakened drivers is constrained by officer mindfulness, absence of preparing, test accumulation and lab assets.

Conclusions Toxicologists are badly arranged to affirm in medication weakness cases, with few unified assets, and restricted significant research Prosecutors are frequently hesitant to take these cases to trial, as they are perplexing, require utilization of master witnesses, include broad disclosure, produce tedious movements, and result in protracted trials

When things turn out badly… School-transport driver charged in death; purportedly took drugs Seattle Times February 28 th 2004 A 42-year-old lady was high on morphine when she drove a school transport that struck and killed a 13-year-old understudy in December, Pierce County police and prosecutors say in charges documented yesterday.

When things turn out badly… Subject appeared to be "furious" No SFSTs controlled No DRE called "willful" blood draw. Toxicology Morphine 0.13mg/L Bupropion metabolites

When things turn out badly Tacoma transport driver not blameworthy in adolescent's demise Seattle times, Sept 2005 A school-transport driver has been found not liable of vehicular crime in the 2003 passing of a 13-year-old kid. Prosecutors said (the litigant) was affected by morphine… (The defendant's) lawyers contended that she had developed a resistance to the medications, endorsed to oversee torment from a degenerative sickness. (The Victim's) family has sued the school region for $10 million for carelessness.

DUID – Nowhere to go however up… Goals Remove medicate disabled drivers from the street. Survey frequency and socioeconomics of DUID Educate about the impacts of medications and driving. Debilitate the medication disabled from driving. Change learned medication driving practices.

Tried and True Approaches Enforcement Make Traffic Law Enforcement a need Train officers to perceive medicate weakness Provide particular preparing in reporting drug hindrance Screen all bringing about drivers for disability Provide toxicology assets to LEA's Raise attention to DUID among prosecutors

Officers prepared in perceiving drug debilitation.

Drugs and Driving Cases Submitted

Tried and True Approach