State of Knowledge of Drug-Impaired Driving
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State of Knowledge of Drug-Impaired Driving FINAL REPORT Technical Report Documentation Page 1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. DOT HS 809 642 4. Title and Subtitle 5. Report Date September 2003 State of Knowledge of Drug-Impaired Driving 6. Performing Organization Code 7. Author(s) 8. Performing Organization Report No. Jones, R. K.; Shinar, D.; and Walsh, J. M. 9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) Mid-America Research Institute 611 Main Street Winchester, MA 01890 11. Contract or Grant No. DTNH22-98-D-25079 12. Sponsoring Agency Name and Address 13. Type of Report and Period Covered National Highway Traffic Safety Administration Final Report Office of Research and Technology 400 7th Street, S.W. 14. Sponsoring Agency Code Washington, DC 20590 15. Supplementary Notes Amy Berning and Richard Compton were the Contracting Officer’s Technical Representatives for this project. 16. Abstract Examines the current state of knowledge of drug-impaired driving. The review covers a broad range of related research, including the detection and measurement of drugs in drivers, experimental research on the effect of drugs on the performance driving-related tasks, drug prevalence in various populations of drivers, drug-crash risk, and countermeasures for drug-impaired driving. The review covers scientific literature published since 1980. 17. Key Words 18. Distribution Statement drug-impaired drivers, experimental research, This report is available from the National Technical drug detection, drug measurement, Information Service, Springfield, Virginia 22161, epidemiologic research, drug-related traffic (703) 605-6000, and free of charge from the crashes, driving under the influence of drugs, NHTSA web site at www.nhtsa.dot.gov drug-crash countermeasures 19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price unclassified Form DOT F 1700.7 (8-72) Reproduction of completed page authorized CONTENTS CONTENTS ..................................................... i FIGURES ...................................................... iii TABLES ....................................................... iii EXECUTIVE SUMMARY .........................................v INTRODUCTION AND APPROACH ..............................v DETECTION AND MEASUREMENT OF DRUGS IN DRIVERS ...... vi EXPERIMENTAL RESEARCH ................................. vii EPIDEMIOLOGIC RESEARCH................................. viii COUNTERMEASURES FOR DRUG-IMPAIRED DRIVING .......... x 1 - INTRODUCTION .............................................1 2 - METHOD ....................................................3 ISSUES ......................................................4 SOURCES OF LITERATURE ....................................5 LITERATURE SEARCH PROCEDURES ...........................5 3 - DETECTION AND MEASUREMENT OF DRUGS .................9 INTRODUCTION AND BACKGROUND ...........................9 GENERAL METHODS AND SPECIMENS FOR DRUG SCREENING .. 11 Blood Testing ..............................................11 Oral Fluid (Saliva) Testing ...................................11 Sweat Testing ..............................................12 Hair Testing ...............................................13 Urinalysis .................................................13 DRUG SCREENING TECHNOLOGY .............................13 THE FUTURE IN DETECTING DRUGS IN DRIVERS ..............16 SUMMARY AND CONCLUSIONS ..............................16 4 - EXPERIMENTAL RESEARCH ................................17 INTRODUCTION .............................................17 NARCOTICS.................................................19 CENTRAL NERVOUS SYSTEM DEPRESSANTS ..................21 CENTRAL NERVOUS SYSTEM STIMULANTS ...................36 CANNABIS ..................................................39 ANTIDEPRESSANTS .........................................42 i ANTIHISTAMINES ...........................................47 OTHER DRUGS ..............................................51 SUMMARY AND CONCLUSIONS ..............................53 5 - EPIDEMIOLOGIC RESEARCH ................................59 INTRODUCTION .............................................59 DRUGS IN CRASH-INVOLVED DRIVERS ........................59 DRUGS IN NON-CRASHED, ON-THE-ROAD DRIVERS ............66 DRUG-CRASH RISK ..........................................68 DRUGS IN DRIVERS STOPPED OR ARRESTED FOR TRAFFIC VIOLATIONS .............................................71 SUMMARY AND CONCLUSIONS ..............................80 6 - COUNTERMEASURES FOR DRUG-IMPAIRED DRIVING ........87 INTRODUCTION .............................................87 DISCUSSION ................................................87 Countermeasure Programs in the United States ...................87 Countermeasure Programs in Other Countries ....................90 SUMMARY AND CONCLUSIONS ..............................91 7 - CONCLUSIONS AND RECOMMENDATIONS ...................93 DETECTION AND MEASUREMENT OF DRUGS IN DRIVERS ......93 EXPERIMENTAL RESEARCH ..................................94 EPIDEMIOLOGIC RESEARCH..................................95 COUNTERMEASURES FOR DRUG-IMPAIRED DRIVING ..........97 INDEX .........................................................99 REFERENCES .................................................105 ii FIGURES Figure 3-1: Drug Detection Periods In Various Specimens ..............10 Figure 5-1: Percent of Fatally Injured Drivers Tested Positive for Various Drugs - Reviewed North American Studies .............................80 Figure 5-2: Mean Percent of Fatally Injured Drivers Tested Positive for Various Drugs - Reviewed North American and Foreign Studies .............82 Figure 5-3: Mean Percent of Drivers Tested Positive for Various Drugs by Type of Injury - Reviewed North American Studies .....................82 Figure 5-4: Relative Crash Risk of Various Drugs by Type of Study Averaged Across Reviewed Studies .......................................84 Figure 5-5: Percentage of Drug-Positive Drivers Among Drivers Stopped or Arrested for DUID by Country .................................85 TABLES Table 3-1: Characteristics of a Method to Detect and Measure Drugs in Body Fluidsa ......................................................14 iii STATE OF KNOWLEDGE OF DRUG-IMPAIRED DRIVING iv EXECUTIVE SUMMARY INTRODUCTION AND APPROACH This is the final report of a project entitled “State of Knowledge of Drug- Impaired Driving.” The project was conducted by Mid-America Research Institute, Inc., of New England for the National Highway Traffic Safety Adminis- tration (NHTSA). David Shinar of Ben Gurion University of the Negev, Israel, and J. Michael Walsh of The Walsh Group, Bethesda, Maryland, made significant contributions. This review examines research published during the 1981-2001 period and references some of the earlier material contained in prior reviews. The scope of the review included foreign as well as U.S. literature with a direct bearing on highway safety. The review emphasizes controlled substances to include marijuana, benzodiazepines, non-benzodiazepine sedative and hypnotic drugs, and others such as amphetamines, cocaine, hallucinogens, and narcotic drugs. However, research related to any other drugs having the potential to significantly impair driving is also included in the review. Applicable research conducted in foreign countries, and documented in the English language, is included. This report is presented in six substantive chapters. Chapter 2 contains a description of the methods followed in determining the topics and issues of concern in the review, identifying, acquiring and screening the documents to be reviewed, and reviewing individual documents. Chapter 3 deals with research pertinent to the detection and measurement of drugs in drivers, and Chapter 4 reviews the experimental literature, including research conducted in a laboratory testing human performance on tasks believed to be related to driving, and research conducted either in a driving simulator or on a closed course testing performance in actual driving tasks. In Chapter 5, we examine literature flowing from epidemiologic studies of drugs and traffic crashes, including literature on the drug use of various subgroups of drivers such as drivers arrested for drunk driving or “drugged” driving. Chapter 6 deals with literature on countermeasures for drug- impaired driving, and Chapter 7 presents our conclusions and recommendations. An index of terms and a bibliographic listing of references follow at the end of the report. Our conclusions and recommendations are organized by the four major types of scientific literature examined in the review, namely: # Detection and measurement of drugs in drivers, # Experimental research on the effects of drugs on performance of driving- related tasks. v STATE OF KNOWLEDGE OF DRUG-IMPAIRED DRIVING # Epidemiologic research on the drugs in driving populations, including drivers in crashes, on-the-road drivers not in crashes, and drivers suspected or convicted of drug-impaired driving. # Research on countermeasures for drug-impaired driving. The conclusions and recommendations are presented below. Examples of documents supporting the specific conclusions are cited, and cross references to pages of this report discussing more general conclusions are provided. DETECTION AND MEASUREMENT OF DRUGS IN DRIVERS Conclusions # A variety of specimens can be assayed for drugs, including urine, blood, sweat, saliva, and hair, among others.