ISSN 1681ISSN — 5157

Drugs in focus Briefing of the European Monitoring Centre for Drugs and Drug Addiction

Responding to drug driving in Europe 20

Many of the accidents and deaths that and are generally Until then, this policy briefing occur on European roads are caused impairing; of the opioids, heroin can summarises the key issues facing by drivers whose performance is impair severely, methadone less so, policymakers and describes impaired by a psychoactive substance. and buprenorphine even less. The developments across Europe that may Alcohol alone is estimated to account data for stimulant drugs such as assist decision-making on the topic. for up to 10 000 road deaths a year , and ecstasy in the European Union, one quarter of are more mixed, but suggest that high Reducing the loss of life caused by all road deaths. No comparable doses are associated with impairment. driving under the influence of figures are available for road Yet, an objective measure for psychoactive substances requires accidents related to illicit drugs and impairment for each drug, similar to the measures that are based on a psychoactive medicines, though these alcohol concentration, remains scientific understanding of this have been receiving increasing elusive. complex phenomenon. The attention over the past decade. challenge to legislators is to Studies on the effects of psychoactive The complex issue of drug driving is design sound and effective laws substances on driving performance currently being investigated by DRUID, that can be enforced, and that suggest that while both illicit and a major EU project that began in give a clear message to the therapeutic drugs can affect driving, 2006 and will continue until 2010. public. the effects and their extent can vary DRUID aims to provide a solid basis for greatly from substance to substance. harmonised, EU-wide regulations for Wolfgang Götz, The latest research suggests that driving under the influence of alcohol, EMCDDA Director can reduce performance drugs and medicine.

Definition Driving under the influence: Depending on the country’s laws, this may refer to a driver who has: a measured reduction of cognitive or psychomotor skills, impulsivity; or more than a defined amount of drug in the blood, expected to produce such effects at that level; or any trace of drugs in the blood.

Key issues at a glance

1. Reports of drug driving incidents often receive much media 4. Various psychoactive medicines, which might or might not be attention. But, few countries have reliable statistics on the legally prescribed and consumed, can impair driving skills. prevalence of driving under the influence of drugs. 2. Obtaining sound scientific evidence on behavioural effects, 5. Currently, police experience considerable difficulty with prevalence and accident risk is difficult with the available the accurate and rapid identification of drug driving at the data. Many of the studies have small samples and it is roadside. often difficult to generalise from their results. 3. Reflecting the scientific debate about the precise 6. The effectiveness of information campaigns to prevent drug effects of the substances, the legal definition of the offence driving is open to question. Key audiences may not be hearing of driving under the influence of drugs differs among the message, or they may be ignoring it. EU Member States. Drugs in focus 202/2009

1. Extent of drug driving The number of people sampled has medicines and illicit drugs, others do. In is not studied in many ranged from under 50 to over 10 000, Finland and Sweden, new zero-tolerance European countries with more than one third of the studies laws for illicit drugs were passed following reporting on fewer than 500 individuals. the experience that the offence of Studies on drug prevalence in drivers impaired driving was extremely difficult to published between 1999 and 2007 National legislation or policies may also prove. In Cyprus, this problem is provide data for only 13 of the limit the scope and comparability of addressed by prosecuting such drivers for 27 EU Member States and Norway. prevalence studies. For example, random illegal consumption of drugs. However, roadside tests for drugs are not permitted Belgium and the United Kingdom Random roadside surveys of drivers, which in most countries. In some countries, tests specifically prohibit use of a test result for can give a representative picture of the are only carried out for illicit drugs, and drug driving as evidence for any other entire driving population, are available for the prevalence of psychoactive medicines offence. cannot be ascertained. three EU Member States and Norway. Evidence of drug-taking may be detected Other surveys provide data on drug use A positive test for alcohol may override in different biological samples, including among specific subsets of drivers. While any requirement for drug testing, with blood, urine, , sweat and even hair. some studies considered only drivers resource limitations and prosecution Blood is the ideal matrix for legal proof of involved in fatal accidents, others looked requirements taking priority over any need impairment, but roadside screening by at sample groups of injured drivers, killed for comprehensive data gathering. This oral fluid (saliva) is desirable for drivers, drivers involved in accidents, and has been the case in Denmark, Estonia, convenience. Threshold levels for the drivers suspected of driving under the Ireland and Portugal. The French SAM drugs may be set at the lower limit of influence of alcohol or drugs. However, study, one of the most extensive studies in detection, or at levels where impairment the results of these various studies are not recent years on the subject, was made may be expected to start. However, while scientifically comparable. possible by a change to the national some drugs, including cannabis and Road Code obliging the police, in defined opioids, appear to have a dose- Generally, cannabis is the most common circumstances, to test all drivers for drugs. dependent impairing effect, others such as illicit substance detected, and amphetamines do not. Tolerance and benzodiazepines are the most commonly New international guidance for interactions with alcohol or other drugs reported psychoactive medicines. Overall, standardisation of study designs have complicate calculations further. In France, the evidence points to much higher been drawn up with the assistance of the drivers found combining drugs with prevalences of both illicit and prescription EMCDDA and the European alcohol receive a higher penalty. drugs, often in combination with alcohol, Commission’s DG Transport. It takes into among drivers involved in accidents or account differences between countries’ 4. Responding to suspected of driving under the influence of legislation and testing policies, providing psychoactive medicines drugs or alcohol. over a hundred recommendations subdivided into the areas of behaviour, Psychoactive medicines, such as The overall scarcity of information epidemiology, and toxicology. painkillers (opioids), sedatives continues despite a recommendation (benzodiazepines), and 3. Where to draw antihistamines can have sometimes made in 2002 by the European the line — or lines? considerable effects on the capabilities of Commission’s expert working group on drivers. Results from studies suggest that drugs, medicines and driving that all Most European countries take one of two drivers may be using these drugs either for drivers involved in a fatal accident should approaches to defining the offence of medical reasons following prescription, or be tested for alcohol and drug use. driving under the influence of drugs. misusing them, sometimes together with Eleven countries only penalise impaired illicit substances. Concern is also growing 2. Barriers to building up driving, whether caused by illicit drugs or about the possible impact of the scientific evidence medicines. Eleven other countries have increasing numbers of drug users receiving adopted a ‘zero-tolerance’ policy, opioid substitution treatment. More than 30 studies on the prevalence penalising any driving after drug-taking. In of drugs among drivers have been carried seven countries, these two approaches Most countries’ laws penalise impairment out across Europe since 1999. However, are combined in a tiered response to drug from any drug, whether illicit or medicinal. these studies have used various methods driving offenders. In France, Austria and Portugal, some and sampled different groups of drivers, impairing psychoactive medicines such as making it difficult to draw overall Some ‘zero-tolerance’ countries make no benzodiazepines are not covered by the conclusions. distinction between driving law, though they may be covered by a general offence such as group on drugs, medicines and driving 2004, a system in Victoria, Australia uses dangerous driving. In contrast, laws in the recommended that police involved in two saliva tests in series at the roadside to Czech Republic, Estonia, Poland, Slovenia traffic control receive mandatory training achieve a low false positive rate; and Slovakia penalise driving with any in recognising the signs of impairment due prosecution will be based on the results of trace of a substance, even if medicinal. to drugs. These tests may include, for a subsequent laboratory confirmation of Seven countries (Belgium, Czech example, examination of the size of the the second sample. In the EU, while Republic, Germany, Latvia, Luxembourg, pupils, coordination tests, behavioural France uses roadside saliva tests, Slovakia, Finland) have adopted a tests, reactions and manner of speaking. prosecution is based on the results of a two-stage system that penalises any trace Yet by 2007, only four EU countries . of an illicit substance with a non-criminal (Belgium, Portugal, Sweden, United or lower-level criminal fine, but more Kingdom) reported obligatory training 6. Are prevention severely penalises impairment by any in this area for traffic police, while campaigns effective? substance. In Latvia, impairment by a 11 reported some ad hoc training. medicinal substance will incur a lower fine Furthermore, the tests are not the same in Surveys carried out in some countries than any trace of an illicit substance. In each country. have revealed a lack of awareness about Finland and Sweden, drivers found with the influence of illicit drugs on driving medicines may be exempted from charge Oral fluid (saliva) might be acceptable for ability. They also show that many drivers if they can provide a medical prescription, roadside screening of drivers — urine is not are unaware of the effects of combining though they may still be charged if their appropriate to indicate impairment. The drugs and alcohol. Among older drivers, driving was judged impaired. reliability of devices for roadside saliva awareness is often lacking of the effects of testing, however, has yet to be confirmed. psychoactive medicines on driving 5. Testing for drug driving Of the nine on-site saliva-testing devices performance. Furthermore, many drivers evaluated by the EU’s Rosita-2 project may be ignorant of laws prohibiting After stopping a driver, the police officer between 2003 and 2005, not one could driving under the influence of such may need to perform an initial screening be recommended for roadside screening medicines. for drug use, by analysing behaviour or of drivers. The limitations of the devices biological samples. In February 2002, the might be compensated to some extent by Prevention campaigns targeting drug European Commission expert working modifying the testing protocol. Since driving have been carried out in several EU Member States. These generally take the form of mass media campaigns, often Drug driving in EU Member States may be defined as impairment caused including information on drugs within a by drugs or having any trace of drugs in the blood (‘zero tolerance’), and wider campaign focussing on alcohol. some countries combine both definitions in a two-tier system General messages that reach young users of cannabis, however, are unlikely to be Zero tolerance Impairment listened to, or even noticed, by older users Two-tier system of psychoactive medicines, and vice No information versa. Similarly, both groups may feel that warnings about alcohol do not apply to them. Prevention programmes are more likely to succeed if they are tailored to their target group.

Providing clear information to patients taking psychoactive medicines may prevent them from driving while adversely affected. For this, most countries rely on the patient information leaflet inside the packaging, for example advising caution if the patient feels sleepy. Yet the patient’s subjective senses are not always reliable or accurate. The use of a clear symbol or pictogram on the outer packaging of medicines that may affect driving ability is Source: European Legal Database on Drugs currently reported by only five countries. Drugs in focus is a series of policy briefings published by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in Lisbon. The briefings are produced regularly in the 23 official languages of the European Union plus Norwegian and Turkish. Original language: English. Any item may be reproduced provided the source is acknowledged.

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Cais do Sodré, 1249-289 Lisbon, Portugal Tel. +351 211210200 • Fax +351 218131711 [email protected] • www.emcdda.europa.eu TD—AD—09—002—EN—C Responding to drug driving in Europe: Conclusions and policy considerations 1. Surveys on the prevalence of drugs in drivers need to be 4. National laws and their enforcement need to strike a conducted in all EU Member States. Testing all drivers balance between concerns about ensuring road safety and involved in a fatal accident for drug and alcohol use would the therapeutic needs of individuals. provide an important source of information for monitoring the problem.

2. New guidelines on study design are available that 5. Legal frameworks require review, as even with the take into account the variety of legal and practical limitations of existing testing methodology, more effective constraints in different countries. They aim to procedures are possible. And, new options are likely to improve comparability among studies and may become available. facilitate exchange of best practice.

3. Policymakers should consider the latest scientific 6. Prevention campaigns should target specific risk groups information available when designing legal responses. The and substances; be based on scientific evidence; and level at which a driver will be deemed in breach of the law rigorously evaluated for impact on behaviour and attitudes. should be clear for all stakeholders and the public.

Key sources EMCDDA (2007), Drugs and driving, Selected issue, European Monitoring Centre for Drugs and Drug Addiction, Lisbon. EMCDDA (2008), Drug use, impaired driving and traffic accidents, Insights No 8, European Monitoring Centre for Drugs and Drug Addiction, Lisbon. Laumon, B., Gadegbeku, B., Martin, J., Biecheler, M. (2005), ‘Cannabis intoxication and fatal road crashes in France: population based case-control study’, BMJ 331, p. 1371. Pompidou Group (2000), Road traffic and drugs, Council of Europe Publishing, Strasbourg. Pompidou Group (2004), Road traffic and psychoactive substances, Council of Europe Publishing, Strasbourg. Walsh, J.M., Verstraete, A.G., Huestis, M.A., Mørland, J. (2008), ‘Guidelines for research on drugged driving’, Addiction 103, pp. 1258–68.

Web sources DRUID project: http://www.druid-project.eu/

International Council on Alcohol, Drugs and Traffic Safety (ICADTS): http://www.icadts.org/

Legal approaches to drugs and driving, Topic overview: http://eldd.emcdda.europa.eu/html.cfm/index19034EN.html

Parliament of Victoria, Australia — outline of drug testing program: http://www.parliament.vic.gov.au/research/2006DBroadsafety.pdf

Rosita — Roadside testing assessment: http://www.Rosita.org

OFFICIAL PUBLISHER: Office for Official Publications of the European Communities © European Monitoring Centre for Drugs and Drug Addiction, 2009 DIRECTOR: Wolfgang Götz AUTHOR: Brendan Hughes EDITOR: Peter Fay GRAPHIC CONCEPTION: Dutton Merryfield Ltd, United Kingdom Printed in Luxembourg