American Academy of Forensic Sciences Washington, DC February 21, 2013 Robert L. DuPont, M.D., President Institute for Behavior and Health, Inc. www.ibhinc.org www.stopdruggeddriving.org
Qualifications 1968: Started career in District of Columbia Department of Corrections 1970: Founded Narcotics Treatment Administration 1973 to 1977: Second White House Drug Chief 1973 to 1978: Founding Director, National Institute on Drug Abuse 1978 to Present: President, Institute for Behavior and Health, Inc. 1980 to Present: Clinical Professor of Psychiatry, Georgetown Medical School 1982 to Present: Co founder and Executive Vice President, Bensinger, DuPont & Associates
Drugged Driving as a New National Priority Drugged driving is an under recognized highway safety problem Dedicated leadership has elevated drugged driving to the national stage in the United States: R. Gil Kerlikowske and the White House Office of National Drug Control Policy Department of Transportation and David Strickland of the National Highway Traffic Safety Administration
Turning Points December 2009 release of data from the 2007 National Roadside Survey 2010 National Drug Control Strategy which identified reducing drugged driving by 10% by 2015 as a national priority; reaffirmed in the 2011 and 2012 National Strategy The National Institute on Drug Abuse has led by promoting a new generation of policy relevant drugged driving research For a detailed review see NIDA s 2011 Drugged Driving Research: A White Paper MADD has taken on drugged driving
Where I Can Be Useful Today Reducing drugged driving is WRONGLY based on the model of 0.08 g/dl BAC Obscures the fact that many drivers are significantly impaired at levels well below 0.08 BAC Tolerance and consumption effects vary among alcohol users displaying widely varying degrees of impairment at 0.08 BAC or higher Though cases are more difficult to try, drivers under 0.08 BAC can be prosecuted Most Western European countries use 0.05 g/dl; Sweden and Norway use 0.02 g/dl
Mirage of BAC Equivalent for Drugs Alcohol is a poor model for studying impairing effects of drugs; metabolized in simpler ways than drugs No close link of blood or other levels of a drug (or drug metabolites) and measured impairments Vast number of potentially impairing drugs Drug drug, drug alcohol combinations Emergence of synthetic drugs
Mirage of BAC Equivalent for Drugs Role of tolerance in impairment: e.g. methadone Consumption of 50 mg of methadone can be lethal to person who has not used opioids in prior few weeks or months; chronic administration of methadone at stable doses typically produces no measurable impairment at higher doses Others factors on impairment include time of day, driver age and driver experience Setting impairment thresholds based on tissue levels of drugs or metabolites for illegal drugs is not a viable enforcement option
BAC Equivalent is Not Needed We have abundant successful precedents for using per se standard Under a per se drug law, any identified illegal drug level found in a driver is defined as a drugged driving violation 17 US states have per se type drugged driving statues which now cover 40% of all licensed drivers Modeled on the successful per se drug program used for 10 million American commercial drivers and others in safetysensitive positions In the United States, drivers under age 21 are held to a zero tolerance standard for alcohol
Per Se Standard for Drugged Driving The per se standard is widely used outside the U.S. including Australia, New Zealand and Western European nations Belgium, Finland, France and Sweden have zero tolerance per se laws against drugged driving Zero tolerance uses the limits of detection The per se standard eliminates the ambiguities of proving in each case impairment and the nexus between impairment and illegal drug use
Bright Line of Illegality For drivers arrested for impairment: When the drug use is illegal, the zero tolerance per se standard is used When the drug use is legal (e.g. prescription drug for which the driver has a valid prescription), the impairment standard is used It is illegal to drive impaired with no alcohol and no drugs Impairment is a hard case to make without per se law but it can be done
Complexity of Marijuana It is a political complexity; not scientific complexity Solution: When marijuana use is legal, use the impairment standard When marijuana use is illegal, use the zero tolerance per se standard Caveat: Marijuana is illegal throughout the U.S. under federal law The two wild cards state based medical marijuana and now legal marijuana in Colorado and Washington will be settled by the U.S. Supreme Court
Policy Focus on Marijuana State based marijuana policy changes have ignited a renewed focus on finding a BAC equivalent for marijuana with recommendations between 2 ng/ml and 10 ng/ml in blood Large study of drivers arrested for impairment in Sweden tested between 30 90 minutes after arrest: 90% had THC concentrations under 5 ng/ml in blood 61% had THC concentrations below 2 ng/ml in blood 43% had THC concentrations below 1 ng/ml in blood Using a 5 ng/ml standard for blood (now in WA State), only 10% of drivers in the study would have been prosecuted using this limit
Drugged Driving in Colorado In Colorado, 70% of the drivers arrested for suspicion of driving under the influence of marijuana who test positive for active THC test at less than 5 ng/ml Most of those drivers are prosecuted and convicted presently If the state set a 5 ng/ml limit, those drivers would be given a free pass!
Latest Marijuana Research Recent smoking and/or blood THC concentrations of 2 5 ng/ml are associated with substantial driving impairment Particularly among occasional smokers Whole blood THC concentrations persist multiple days after drug discontinuation in heavy chronic marijuana users After 3 weeks of abstinence, chronic daily marijuana users showed observable impairment compared to occasional marijuana users
Action Steps Administrative License Revocation Drug testing procedures Management of DUI offenders
Administrative License Revocation Non criminal penalty system used today to get drunk drivers off the road quickly ALR process begins after arrest for impairment is made Loss of license for drivers who test positive for drugs Like drivers with 0.08 BAC and drivers who refuse to be tested Presumption of innocence is preserved for later adjudication of criminal charge of DUI or DUID by a judge
Importance of ALR ALR is a potential game changer because it brings drug testing to the police station in a way parallel to alcohol testing Uses on site urine or oral fluid testing Loss of license for positive screening tests Laboratory confirmation prior to adjudication
Improve Drug Testing Procedures Drug testing must become as routine as alcohol testing Use onsite screening tests for ALL impaired driving suspects, including those who have illegal BACs Laboratory confirmation of positives Drivers who have illegal BACs and test positive for drugs should be charged with an aggravated offense, like drivers with high BACs (.15)
Other Drug Testing Opportunities Drivers in crashes causing serious injuries or death, either at the scene or at the hospital/trauma center When drugs have been found in vehicles or on drivers When drivers admit to recent drug use Highway security checkpoints
Substance Abusing Offenders Drivers sentenced for alcohol or drug offenses should be tested for both alcohol and drugs while under supervision New Paradigm offers substantial hope for dramatically reducing recidivism and promoting recovery: South Dakota s 24/7 Sobriety Program for repeat DUI alcohol offenders uses intensive testing for alcohol and frequent random drug testing Zero tolerance: any use leads to swift, certain but brief incarceration
Four Heroes of Drugged Driving Gil Kerlikowske David Strickland Jeff Michael Marilyn Huestis
Summary Don t despair of the scientific and political complexity of drugged driving Alcohol impaired driving provides helpful precedent After 100 years of work, we are still in the early years of dealing with this highway safety threat; many accomplishments and much more work to do Focusing on drugged driving builds upon and enhances efforts to reduce alcohol impaired driving; they are synergetic Drugged driving is a new frontier for forensic science, one in which science can lead and produce major benefits to public safety and public health
Thank you!
www.stopdruggeddriving.org For more information on drugged driving visit IBH s website devoted to this public health and public safety problem Includes IBH White Paper on Drugged Driving for NIDA/ONDCP
www.ibhinc.org For more information on other new and important ideas to reduce illegal drug use visit IBH s home website
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