Poly-substance Impaired Drivers 4th Annual Association of Ignition Interlock Program Administrators Conference May 17th, 2016 Laura J. Liddicoat NSC/NHTSA Toxicology Fellow Center for Forensic Science Research & Education Frederic Rieders Family Renaissance Foundation

DUID Data Data on overall drug-impaired driving is hard to find No lab tests for ALL drugs Test menus vary from lab to lab Protocols to “stop testing” are common Some data sets for limited situations Drivers involved in fatal crashes – FARS Drivers arrested on suspicion of DUID National Roadside Survey – General public

Drug Testing: Current State No standard methods or cut-offs. Patchwork of procedures and approaches. Scope and methods are tailored to local conditions. Technology is expensive and constantly evolving. Resources dictate what services the laboratory can provide. Local laws dictate what samples are allowed and/or drive “stop testing” protocols. Limited data on the overall extent of drug involvement in alcohol-positive drivers.

2013 NSC Recommendations J Anal Toxicol. 2013 Aug 13.

2013 Drug Prevalence - NSC Drug # of Labs in Top 20 THC (Marijuana) 13 Alprazolam 13 Diazepam 13 Cocaine 13 Morphine 13 Oxycodone 12 Hydrocodone 12 Carisoprodol/Meprobamate 11 Zolpidem 11 Methamphetamine 9 Clonazepam 9 Amphetamine 9 *”Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities", Logan, et al, Journal of Analytical Toxicology 2013

2013 Drug Prevalence - NSC Drug # of Labs in Top 20 Methadone 9 Lorazepam 9 Codeine 7 Diphenhydramine 6 Tramadol 6 Phencyclidine (PCP) 5 Hydromorphone 5 Citalopram 4 Temazepam 3 Oxazepam 2 Trazodone 2 Oxymorphone 2 *”Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities", Logan, et al, Journal of Analytical Toxicology 2013

2013 Drug Prevalence - NSC Drug # of Labs in Top 20 Butalbital 2 Dihydrocodeine 2 Pseudoephedrine 2 6-Acetylmorphine 2 Fentanyl 2 MDMA (Ecstasy) 2 Fluoxetine 1 Venlafaxine 1 Gabapentin 1 Cyclobenzaprine 1 Amitriptyline 1 Topiramate 1 *”Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities", Logan, et al, Journal of Analytical Toxicology 2013

2013 Drug Prevalence - NSC Drug # of Labs in Top 20 THC (Marijuana) 13 THC is the most prevalent drug (other than alcohol) detected in drivers. Physical Detriments Cognitive Processes Affected Balance Attention/Vigilance Coordination Time and Distance Perception Reaction Time Information Processing Muscle Strength Short Term Memory Body Tremors Judgment & Decision Making Reddened eyes Perception

CNS Depressants (15/36) Drug # of Labs in Top 20 Alprazolam 13 Diazepam 13 Carisoprodol/Meprobamate 11 Zolpidem 11 Clonazepam 9 Lorazepam 9 Diphenhydramine 6 Temazepam 3 Oxazepam 2 Trazodone 2 Butalbital 2 Gabapentin 1 Cyclobenzaprine 1 Amitriptyline 1 Topiramate 1

CNS Stimulants – Dissociative Anesthetic Drug # of Labs in Top 20 Cocaine 13 Methamphetamine 9 Amphetamine 9 Pseudoephedrine 2 MDMA (Ecstasy) 2 Phencyclidine (PCP) 5

Narcotic Analgesics (11/36) Drug # of Labs in Top 20 Morphine 13 Oxycodone 12 Hydrocodone 12 Methadone 9 Codeine 7 Tramadol 6 Hydromorphone 5 Oxymorphone 2 Dihydrocodeine 2 6-Acetylmorphine 2 Fentanyl 2

Antidepressants Drug # of Labs in Top 20 Citalopram 4 Fluoxetine 1 Venlafaxine 1 Drug combinations within and between drug classes are numerous and varied.

An Evaluation of Data from Drivers Arrested for Driving Under the Influence in Relation to Per se Limits for Cannabis. (May 2016); Logan, et al. Table 7: Confirmed Cannabinoid-Positive Cases with Alcohol and Other Drug Data (n=4,799) Other Drugs (+) Other Drugs (-) Total Alcohol POS 777 (16.1%) 2,075 (43.2%) 2,852 (59.4%) Alcohol NEG 830 (17.2%) 1,117 (23.2%) 1,947 (40.6%) 1,607 (33.4%) 3,192 (66.5%) 4,799 (100%) Sponsored by: AAA Foundation for Traffic Safety Authors: Barry Logan, Ph.D, F-ABFT, Sherri L. Kacinko, Ph.D, F-ABFT, Douglas J. Beirness, Ph.D.

An Evaluation of Data from Drivers Arrested for Driving Under the Influence in Relation to Per se Limits for Cannabis. (May 2016); Logan, et al. Table 8: Rates of other drug- and alcohol-positives among cannabinoid-positive cases Drug Class % Positive Alcohol 59.4 Opiates 18.8 Benzodiazepines 15.5 Cocaine 8.6 Amphetamines 5.0 Methadone 3.6 Phencyclidine 1.2 Barbiturates 0.72 Propoxyphene 0.16 Any Other Drug 33.4

National Roadside Surveys (NRS) http://search.usa.gov/search?utf8=%E2%9C%93&affiliate=dot-nhtsa&query=national+roadside+survey&searchCommit=Search The National Roadside Survey (NRS) was conducted in 1973, 1986, 1996, 2007, & 2013-2014 Alcohol data (breath) collected in all surveys Drug data collected in 2007 & 2013-2014 Drug/alcohol use rates were presented as national prevalence rates calculated from the percentage of drivers using alcohol or drugs and adjusted with an appropriate weighting scheme. To determine driver use of a wide variety of potentially impairing drugs, including illegal drugs and legal medicines

NRS – Alcohol Findings Figure 1 Percentage of Weekend Nighttime Drivers by BrAC Category in the 5 National Roadside Surveys

NRS – 2013-2014 Drug Findings Table 2 Overall Drug Prevalence by Data Collection Period and Type of Test in the 2013‑2014 NRS Drug prevalence did not appear to differ between day- and night-time Time of Day % Drug-Positive Oral Fluid Test Blood Test Oral Fluid and/or Blood Test Weekday Daytime 19.0% 21.6% 22.4% Weekend Nighttime 19.8% 21.2% 22.5%

NRS – Drug Findings (Weekend/Night) Table 4 Weekend Nighttime Drug Prevalence by Drug Category and Test Type Comparing 2007 Data to 2013-2014 Comparable Data Drug Category 2007 2013-2014 Comparable Data Oral Fluid Test Blood Test Oral Fluid and/or Blood Test N % N % N % Illegal Drug 635 11.4% 297 9.8% 699 12.4% 779 13.8% 422 14.3% 849 15.1% Medications prescription & over‑the‑counter 201 3.0% 169 4.0% 277 3.9% 211 3.9% 155 4.9% 266 4.9%

NRS – THC Findings (Weekend/Night) Table 5 - Weekend Nighttime Prevalence of THC in 2007 Compared to 2013-2014 Comparable Data The drug with the largest increase in weekend nighttime prevalence from 2007 to 2013-2014 was THC 2007 2013-2014 Comparable Oral Fluid Test Blood Oral Fluid and/or Blood Test Oral Fluid and/or Blood N % N % N % N % N % N % 438 7.7% 234 7.6% 499 8.6% 604 11.4% 414 14.2% 666 12.7%

4NSCTOX Laura J. Liddicoat lauraliddicoat@gmail.com (608) 239-0230