If you have issues viewing or accessing this file contact us at NCJRS.gov. ·f" ' • •f , National Institute on Drug Abuse MONOGRAPH SER!ES I .. \ .!\ ·Drugs and Driving , U S, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE • Public Health SelVice • Alcolwl, Drug Abuse, and Mental Health Administration r,l CJ R~ f E~ 2 B\~~-f9 ACQUiSITiONS DRUGS and DRIVING EDITOR ROBERT E. WILLETTE, PH.D. DIVISION OF RESEARCH NATIONAL INSTITUTE ON DRUG ABUSE MARCH 1977 " NIDA RESEARCH MONOGRAPH 11 DEPARTMENT OF HEAL TH. EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE Alcohol. Drug Abuse, and Mental Health Administration For sale by tho Superintendent oC Documents, U.S. Government Printing Office Washington, D.C. 20402 Stock No. 017-021-00576-2 ---------- ---~ The NIDA Research Monograph series is prepared by the Division of Research of the National Institute on Drug Abuse. Its primary objective is to provide ciritcal re­ views of research problem areas and techniques, the content of state-of-the-art conferences, Integrative research reviews and significant original research. Its dual publication emphasis is rapid and targeted dissemination to the scientific and professional community. Editorial Advisory 80ard Avram Goldstein, M.D. Addiction Research Foundation Palo Alto. Callfomia JeromeJaffe, M.D. Coliege of Physicians and Surgeons Columbia Universily. New York Reese T. Jones, M.D. Langley Porler Neuropsychiatric Inslulute University of Califomla San Francisco. Califomia William McGlothlin, Ph.D. Deportment of Psychology. UCLA Los Angeles. Califomia Jack Mendelson, M.D. Alcohol and Drug Abuse Research Center Harvard Medical SchGol Mclean Hospital Belmont. Massachusetts Helen Nowlis, Ph.D. Office of Drug Education. DHEW Washington. D.C. Lee Robins, Ph.D. Washington Universily School of Medicine St. louis. Missouri NIDA Research Monograph series Robert DuPont, M.D. DIRECTOR, NIDA William Pollin, M.D. DIRECTOR, DIVISION OF RESEARCH, NIDA Robert C. Petersen, Ph.D. EDITOR-IN-CHIEF Eunice L. Corfman, M.A. EDITOR Rockwell Building 11400 Rockville Pike r~ockvilie. MalYland. 20852 ACKNOWLEDG.MEN1' A complementary volume to this, entitled ~ugs and ~iving: A Researah Review (contract DDT-HS-4-00994) will be available through the National Technical Information Service. In addition, the reader should be aware of an ongoing DDT National Highway Traffic Safety Administration proj ect (Stat.7- or Knowledge and Information in Alaohol/Drugs and Highway Safety; ror-tlS-S-012l7) that is critically evaluating existing research pertaining to drug related ,. accident risk, and is preparing a comprehensive outline of the additional research required to assess fully the magnitude and extent of the drug/highway safety problem. The final report will be available towards the end of the year. NIDA is grateful for the contribution of DOT observers at the conference. The conference summary in this monograph is an initial probe to identify key areas for future research attention where present findings remain uncertain and sometimes controversial. The conference summary should not be taken as representing DOT policy or interpretations. Thanks are due the people of Research Triangle Institute, who capably organized and coordinated the panel conference, held August 20, 1976 at Rockville, Maryland, under NIDA contract 271-75-1016, from which the papers of this monograph are derived. NIDA Research Monographs are indexed in the INDEX MEDICUS. DHEW publication number (ADM)77-438 Library of Congress catalog card number 77-70426 iv fOREWORD It is now fashionable to recognize the negative effects of the rapid growth of technology in the 20th century. Nowhere is the negative side of this revolution more striking than in the area of drugs and driving. The world is now on wheels. High-speed vehicles are in the hands of virtually everyone over the age of 16. Impaired driving dramatically raises the risks we each face daily--not only the risks inherent in oUlr own driving performance but those which result from the performance of other drivers. Not only has technology let us get behind the wheels of cars, it has also opened a treasure chest of old and new mind-altering chemicals. Only in recent years have we begun to grasp the sig­ nificant role played by alcohol in highway safety. Within the last decade the drug use epidemic has added a complex array of other drugs which influence driving ability. For example, the National Institute on Drug Abuse surveyed the Nation's 1976 high school graduating class finding that just over 8 percent reported daily marihuana use--compared to 5.9 percent who reported daily alcohol use. We knm'l that marihuana intoxication produces severe deterior­ ation in driving performance. We are left to guess at the impact of marihuana use on highway safety- ~and our best guesses are' frightening. No less of a concern is the problem of prescription drug use and the problem of multiple simultaneous drug use. This monograph presents a critical review of the available litera­ ture relating drug use to driving and other complex human performance. It offers recommendations for the future. Adequate studies are scarce. Part of the problem is establishing measures of driving skills and relating these skills to the use of different types of drugs, at various dosage levels, at differing periods of time after drug administration, and in a wide variety of settings. The characteristics of the driving drug user--which change with time, often over very short time periods--also vastly complica.te the issue. Even determining how many accidents are drug-related is difficult. When the concept of "cause" is introduced, the problem is made even more difficult. It is now a matter of urgency to know the implications of drug use for traffic safety and accident risk. Once a body of knowledge is assembled, we can begin to consider proposing preventive or leg~l responses. Towards that end we must isolate a few specific driving compnentl3 that are acceptable indicators of driving skill and measure 'the impairment produced by different drugs at various levels. v The first challenge in highway safety is to measure impairment. Then we must get impaired drivers off the highways. One major cause of impairment is drug use--including alcohol use. The drug user-- and we now knO\~ he is tlustl--is responsible for his behavior, including his driving and his drug use. Once having detected impairment of driving, the sanctions imposed could surely be tailored to fit the causes of the impairment. But the critical first question is detecting impairment. Robert L. DuPont, M.D. DiT'eotoT' NationaZ Institute on DT'ug Abuse vi .,i PREFAcE Research into'-the relationship between drugs and driving high­ lights a complex policy question l'ai»ed by extensive government supported biomedical research efforts. How does one translate incomplete knowledge into appropriate policy decisions, where action or inaction can mean the difference of thousands of lives and hundreds of thousands of serious and. maiming accidents? A related question is: How does one avoid an unnecessary tug of war between the need to expand knmfledge, on the one hand, and the need for serious inquiry concerning the potential application of available but intomplete data OIl the other? Thus, we know that alcohol plays a role in roughly half of all our fatal car crashes - 47,000 deaths in 1976. It plays a role in a fourth to a third of all serious accidents - 1.B million. Apart from the pain and sufferin.g of the individuals fu'1d families involved, the economic costs are astonishing - $25.1 billion. Though the situation with drugs other than alcohol is not as clearcut, there are disturbing straws in the wind. A recent study of 300 Boston area fatal car accidents indicates that 39% involved driver use of alcohol or a combination of alcohol and other drugs. An additional 9% involved other drugs (marihuana, barbiturates, etc.) without alcohol. Of the total drivers, 16% admitted to being under the lllfluence of marihuana at the time of the crash. In other limited surveys from 60 to BO% of marihuana users indicated they sometimes drive while cannabis intoxicated. To some significant but as yet quantitatively uncertain degree, widely used drugs other than alcohol contribute to the toll levelled by alcohol. GiVen these circumstances, some proportion of our current research efforts should be directed towards further elucidation of the mech­ anism of action of such impairment and its precise degree of impact. And some should be directed tcrpolicy research issues which system­ atically and empirically evaluate alternative options for applying present incomplete knowledge to reduce the unnecessary consequences of driving under the influence of various psychoactive drugs. We are not aware of any simple formula for determining these propor­ tions. However, it is our strong conviction after reviewing current efforts along both of these dimensions that two conclusions are clear: a) it is essential to maintain a balanced, vigorous program of re­ search along both of these avenues, and b) presently it is the second area, the area of policy research, which is grossly deficient and needs to be substantially strengthened and reinforced. vii We need to be more certain, for example, of varying consequences and differential levels of success of different approaches to regulating driving under the influence of drugs. ''Hardline'' laws in the fonn of high fines and long prison tenns are not necessarily effective, par­ ticularly if judges and juries therefore refuse to convict. A more effective approach appears to be engendering two kinds of awareness in the public, of the real danger and cost of intoxicated driving, and of a reasonable certainty that violators ,,,ill be caught for it. Sustained public education, large numbers of arrests and a justified public fear of arrest appear to reduce crashes. At the recent Seventh International Conference on Alcohol, Drug and Traffic Safety, in Melbourne, Dr.