Judge Neil Edward Axel District Court of Maryland (retired) Heidi Coleman Chief, Behavioral Research, NHTSA Office of Behavioral Safety Research Maryland Highway Safety Judicial Conference December 2, 2015 Impaired Driving and the Changing Face of the Impaired Driver 1

Impaired Driving: The Good News American’s roads are safer today as a result of the massive public awareness and enforcement campaigns that begun in the early 1980’s The number of alcohol-related traffic fatalities has declined by one half since 1982 Recidivism rate for drunk drivers declined from 33% to 25% from 1995 to

08 Decline in DUI of Alcohol Rates Estimated Percentage of Weekend Nighttime Drivers with BACs ≥ 0.08 Latest Survey ( ): 1.5% 3

NHTSA Research on Impaired Driving The Changing Face of the Impaired Driver

Prevalence of impaired driving Impairment due to the use of alcohol and other drugs Crash risk of impaired driving Strategies to reduce impaired driving Impaired Driving Research: Key Questions 5

National Roadside Survey (NRS) Research Note published February 2015 Full report (3 volumes) in review  Methodology  Alcohol Results  Drug Results Hope to publish reports early in

Four decades of National Roadside Surveys Well developed methodology Nationally-representative sample of drivers Reviewed and approved by Institutional Review Board Voluntary and anonymous About 10,000 drivers in 300 locations across the nation Nighttime weekend sample Daytime comparison NRS - Overview 7

National Roadside Survey Findings: Percentage of Weekend Nighttime Drivers Alcohol Use 1973: 35.9% 2007: 12.4% 2013/2014: 8.3% Marijuana Use 2007 marijuana use (THC): 8.6% 2013/2014 marijuana use (THC): 12.6% Overall Drug Use 2013/2014 all drugs (OTC, prescription or illegal): 22.5% Source: Results of the National Roadside Survey of Alcohol and Drug Use by Drivers, NHTSA Research Note (DOT HS )(February 2015) 8

NRS – Alcohol Results Percentage of Weekend Nighttime Drivers by BrAC Category in National Roadside Surveys 9

NRS – Alcohol Results Alcohol Prevalence by Data Collection Period and BrAC in the 2013–2014 NRS 10

NRS – Drug Results Overall Drug Prevalence by Data Collection Period and Type of Test in the 2013–2014 NRS Time of Day % Drug- Positive Oral Fluid Test % Drug- Positive Blood Test % Drug-Positive Oral Fluid and/or Blood Test Weekday Daytime 19.0%21.6%22.4% Weekend Nighttime 19.8%21.2%22.5%  Drug-positive = over-the-counter, prescription and illegal.  Presence does not equal impairment. 11

NRS – THC Results Weekend Nighttime Prevalence of THC in 2007 Compared to Comparable Data Comparable Data Oral Fluid Test Blood Test Oral Fluid and/or Blood Test Oral Fluid Test Blood Test Oral Fluid and/or Blood Test N % % % % % % % 12

Summary of NRS Results Alcohol use by drivers continues to decline Decrease by more than three-quarters since 1973 Decrease by nearly one-third since 2007 Policies and programs appear to be working Drug use increasing Prescription and over-the-counter use up slightly Illegal use up significantly Marijuana use up by nearly 50% since

Crash Risk Study 14

Crash Risk Study Results – Alcohol Crash Risk Alcohol Crash Risk Adjusted for Age and Gender 15

Crash Risk Study Results – Drug Crash Risk Unadjusted Odds Ratios between Drug Class Use and Crash Risk 16 Drug of Interest Unadjusted Odds Ratio P Value THC (Marijuana) Sedatives Narcotic Analgesics Antidepressants Stimulants Illegal Drugs Legal Drugs Significant findings (p value ≤.01) for two types of drugs – THC (marijuana) – Illegal drugs

Crash Risk Study Results – Drug Crash Risk Adjusted Odds Ratios between Drug Class Use and Crash Risk - Adjusted for Demographics 17 Drug of Interest Adjusted Odds Ratio 95% CI* P Value THC (Marijuana) – Antidepressants – Narcotic Analgesics – Sedatives – Stimulants – Illegal Drugs – Legal Drugs – When adjusted for factors we know are associated with crash risk (e.g., age, gender) No significant findings Age/gender accounted for elevated THC and illegal drug risk

Study confirms elevated risk based on alcohol Study does not demonstrate elevated risk based on drugs Consistent with previous well controlled studies However, study does not indicate that drug use by drivers is risk-free In some situations, drugs (other than alcohol) can seriously impair driving ability and increase crash risk Due to increased prevalence of drugs (NRS), further monitoring and research is warranted Crash Risk Study - Summary 18

Washington State – Roadside Survey of Alcohol and Drugs Examine the Effects of Inhaled Cannabis on Driving Performance Crash Risk – Fatally and Seriously Injured Drivers Expert Panel on Impact of Legalizing Marijuana on the DWI System (NCREP project) Evaluation of Oral Fluid Drug Testing Devices (Allere; Drager) Evaluation of the Advanced Roadside Impairment Driving Enforcement (ARIDE) Curriculum Other Drugged Driving Research 19

Dangerous Trends ↑ Marijuana use ↑ Public acceptance of use ↓ Penalties for possession ↓ Public perception of harmfulness 20

More Dangerous Trends “The profile of a drugged driver has changed substantially over time.” Drugged drivers with 3 or more drugs in system doubled to 21.5% 70% of drivers who tested positive for cocaine, also tested positive for alcohol 55% of drivers who tested positive for marijuana, also tested positive for alcohol Prescription drugs most prevalent drug found in drugged drivers involved in fatal crashes in 2010 (46.5%) F. Wilson, J. Stimpson, Fatal Crashes from Drivers Testing Positive for Drugs in the U.S., 1993–2010, 129 Public Health Reports, p (Jul-Aug. 2014) 21

Marijuana Studies Based on real and simulated driving studies, marijuana can negatively affect: Driver attentiveness Impaired time, speed & distance estimation Ability to draw on information obtained from past experiences Decreased car handling performance Increased reaction times “Drugged Driving”, NIDA DrugFacts (Oct. 2013); Drugs and Human Performance Fact Sheets, Cannabis/Marijuana, NHTSA (April 2014) 22

Marijuana & Alcohol   Some research shows that impairment increases when marijuana use is combined with alcohol   Studies have found that many drivers who test positive for alcohol also test positive for THC “Drugged driving,” NIDA Infofacts, (2010) 23

The problem though is that... “It is difficult to establish a relationship between a person’s THC blood or plasma concentration and performance impairing effects.” Drugs and Human Performance Fact Sheets, Cannabis/Marijuana NHTSA (April 2014) 24

Implications 25

District Court Issues Blood Tests Missouri v. McNeely, 133 S.Ct (2013) Crawford/Melendez-Diaz/Bullcoming Statutory presumptions Admissibility of DRE testimony Delays, postponements, trials Is “treatment as directed” sufficient or effective 26

The Future Research on drugs & impairment Per se laws? SFSTs for drugged driving cases New drug testing methods 27

Other Research Published Nov 2014 Important Note of Caution Now distributed with requests for FARS drugged driving data 28

Questions? 29