1. 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

2. 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

3. 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.

4. 2013 NSC Recommendations
J Anal Toxicol Aug 13.

5. 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

6. 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

7. 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

8. 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

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

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

11. 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

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

13. 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.

14. 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

15. National Roadside Surveys (NRS)
The National Roadside Survey (NRS) was conducted in 1973, 1986, 1996, 2007, &
Alcohol data (breath) collected in all surveys
Drug data collected in 2007 &
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

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

17. NRS – 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%

18. NRS – Drug Findings (Weekend/Night)
Table 4
Weekend Nighttime Drug Prevalence by Drug Category and Test Type
Comparing 2007 Data to Comparable Data
Drug Category
2007
Comparable Data
Oral Fluid Test
Blood
Test
Oral Fluid and/or Blood Test
N %
N %
N %
Illegal Drug % % % % % %
Medications
prescription & over‑the‑counter % % % % % %

19. NRS – THC Findings (Weekend/Night)
Table 5 - Weekend Nighttime Prevalence of THC in 2007 Compared to Comparable Data
The drug with the largest increase in weekend nighttime prevalence from 2007 to was THC
2007
Comparable
Oral Fluid
Test
Blood
Oral Fluid and/or Blood Test
Oral Fluid and/or Blood
N %
N %
N %
N %
N %
N % % % % % % %

20. 4NSCTOX
Laura J. Liddicoat
(608)