Practical Considerations and Experiences from Washington State on Impaired Driving with Marijuana Legalization

Transcription

1 Practical Considerations and Experiences from Washington State on Impaired Driving with Marijuana Legalization Darrin T. Grondel, Director Washington Traffic Safety Commission April 2, 2018

2 FIRST COMES MEDICAL Approved by voter Initiative 692 in 1998 Granted: Affirmative defense to criminal prosecution for: Qualifying patients and primary caregivers who possess no more than a sixty-day supply (what is a 60 day supply?) Key events: Definition of sixty-day supply SB oz. and 15 plants Change in federal government s enforcement policy Physician assistants, advanced registered nurse practitioners and naturopaths added as authorizers SB 5073 passes but is partially vetoed by Gov. Gregoire Made it legal if participant in data base vetoed Change in City of Seattle s enforcement policy

3 THEN COMES RECREATIONAL I-502, Nov. 6, 2012 ACLU, Rick Steves & Peter Lewis $6 million Campaign Fund Disclaimer presentation is for historical and instructional purposes and is not intended to be pro or con on the issues.

4 RECREATIONAL VS. MEDICAL MARIJUANA Amount limits, up to either: 1 oz useable MJ (bud) 16 oz infused product (brownies) 72 oz liquid (soda pop) 7 grams concentrate (hash oil) Illegal to grow your own Lab tested, controlled pesticide use Age 21+ Taxed Recreational: Provide MJ to a minor: felony Medical pre-2015: Up to 24 oz useable MJ Can grow up to 15 plants Double that if your are an MJ provider and patient No dispensaries, but cooperatives No lab test, pesticide controls Age 18+ (even providers) Not taxed ( 1/3 ¼ the cost) Need MJ card (not prescription) tamper resistant Doctor, naturopath, PA, nurse practitioner, osteopath DUI 5 ng/ml -- Penalties for illegal grows, quantities

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8 CHANGING WORLD ARE WE PREPARED?

9 Collaboration and Research

10 FLYING CARS

11 MOST CANNABINOID-POSITIVE DRIVERS ALSO TESTED POSITIVE FOR DRUGS/ALCOHOL; TEST STATUS Driver Category 1 Sample Driver Category 2 Sample Driver Category 3 Sample Not Tested Not Tested 2,360 Not Tested 2,360 Not Tested 2,360 Tested - Negative No Drugs, No Alcohol 1,288 No Drugs, No Alcohol 1,288 No Drugs, No Alcohol 1,288 Alcohol Only 671 Cannabinoids Only 188 Alcohol Only < Alcohol Only < Alcohol Only > Alcohol Only > THC Only 118 THC Only 118 Carboxy-THC Only 70 Carboxy-THC Only 70 Cannabinoids + Alcohol Only 275 THC + Alcohol 187 THC + Alcohol < THC + Alcohol > Tested Positive (2,073) Carboxy-THC + Alcohol 88 Carboxy-THC + Alcohol 88 Excluding Alcohol Test Only (179), Drug Test Only (7), Tested with Unknown Results (3) Cannabinoids + Drugs + Alcohol 103 THC + Drugs + Alcohol 66 THC + Drugs + Alcohol < THC + Drugs + Alcohol > Carboxy-THC + Drugs + Alcohol 37 Carboxy-THC + Drugs + Alcohol 37 Cannabinoids + Drugs Only 132 THC + Drugs 76 THC + Drugs 76 Carboxy-THC + Drugs 56 Carboxy-THC + Drugs 56 Other Drugs Only 502 Other Drugs Only 502 Other Drugs Only 502 Other Drugs + Alcohol Only 202 Other Drugs + Alcohol Only 202 Other Drugs + Alcohol Only 202 Total Driver Sample, ,910

12 MARIJUANA AND ALCOHOL USE IN WASHINGTON STATE A m o n g a ll d r ivers invo lved in f a t a l c r a shes , o n e in t h r ee a r e positive for a lcohol a n d / o r d r u g s. T h is n u m b er is likely u n d er - r epor ted since n o t a ll d r ivers in f a t a l c r a shes a r e a c t u a lly tested for a lcohol a n d drugs (60 p ercent o f f a t a l c r a sh invo lved d r ivers were tested for a lcohol a n d d r u g s ). A m o n g d r ivers in f a t a l c r a shes t h a t tested p o sitive for a lcohol o r drugs, 4 4 p ercent tested p o sitive for t wo or more substances ( p o ly - d r u g d r ivers). T h e m o st c o m m o n substance in p o ly - d r u g d r ivers is alcohol, followed by T H C. A lcohol a n d T H C c o m b ined is the most c o m m o n p o ly - d r u g c o m b ination. A lthough r esearch- b a sed estimates o f t h e risks posed by T H C have va r ied g r eatly, a ll studies included in this r eview a g r ee t h a t g iving a lcohol to drivers w h o a r e already c o m p ro m ised by THC w ill o n ly f u r t h er inflate t h e level o f impairment a n d c r a sh r isk. T h e d eadly c o n sequences o f c o m b ining t h ese t wo impairing substances a n d driving a r e already a p p a r ent in Wa shingto n f a t a l c r a sh d a t a. Fo r t h e fir st t ime in , p o ly - d r u g d r ivers b ecame t h e m o st preva lent t y p e o f impaired d r ivers invo lved in f a t a l c r a s h es. S ince , t h e n u m b er o f p o ly - d r u g d r ivers invo lved in f a t a l c r a shes h ave increased a n average o f 1 5 p ercent ever y year. B y 2 016, t h e number o f p o ly - d r u g d r ivers were more t h a n d o u b le t h e n u m b er o f a lcohol -only d r ivers and five t imes higher t h a n the n u m b er o f T H C - o n ly d r ivers invo lved in f a t a l c r a shes. A c c o rd ing to t h e b i o logical r e s u lts o f Wa shingto n s R o a ds ide S u r vey, n early o n e i n f i ve d ayti m e d r i vers m ay b e u n d e r t h e i n fluence of m a r i juana, u p f ro m l e s s t h a n o n e i n t en d r i vers p r ior to t h e i n i t i a ti o n o f m a r i juana r e t a il s a l es.

13 MARIJUANA AND ALCOHOL USE IN WASHINGTON STATE 39.1 percent of drivers who have used marijuana in the previous year admit to driving within three hours of marijuana use. This is similar to the results from Washington s Behavioral Risk Factor Surveillance survey (33.5 percent). More than half (53 percent) of drivers ages believe marijuana use made their driving better. This is a significantly higher rate than drivers ages (13.7 percent) and drivers ages (17.4 percent). Among drivers who have used marijuana in the past year, only 36.6 percent believe that it is very likely or likely that marijuana impairs a person s ability to drive safely if used within two hours of driving, compared to 77 percent of drivers who have not used marijuana in the previous year percent of drivers who have used marijuana in the past year believe it is very likely or likely to be arrested for impaired driving after using marijuana within two hours of driving, versus 70.2 percent of drivers who have not used marijuana in the previous year.

14 RISING FREQUENCY OF POLY-DRUG DRIVERS IN FATAL CRASHES THC Only Alcohol Only One Drug Only (not Alcohol or THC) Poly-Drug (Any combination of the other categories)

15 SIGNS AND SYMPTOMS OF MJ IMPAIRMENT THC and similar compounds bind with receptors (CB1 and CB2) in the brain and other parts of the body affecting the function of the hippocampus (short-term memory), cerebellum (coordination) and basal ganglia (unconscious muscle movements). Reference - Marijuana is a lipid (fat) soluble and tends to stay in the brain Alcohol is water soluble - blood

16 WHAT DO WE KNOW ABOUT CANNABIS 480 Chemical Compounds cannabinoid compounds Cannabinol CBN (1899) Cannabidiol CBD (1963) Delta 9 THC (1964) Cannabigerol CBG Cannabichromenes- CBC Cannabinodial CBDL Cannabicyclol CBL Cannabielsoin CBE Cannabitriol CBT Cannabidivarin CBDV

17 Inhaling - Pulmonary Smoking Vaporizing Dabbing Inhaler Oral - Digestive Edibles Capsules Raw Marijuana

18 Trans mucosal sublingual, intranasal, rectal, ocular Tincture Lozenges Spray - oral/nasal Suppository Transdermal

19 SIGNS AND SYMPTOMS OF MARIJUANA Relaxation Euphoria Relaxed Inhibitions Disorientation Altered time & distance perception Lack of Concentration Impaired Memory & comprehension Jumbled thought formation Drowsiness Mood changes, including panic and paranoia with high dose Heightened senses Body tremors (Major muscle groups: quads, gluts, and abs) Eyelid tremors Red, Bloodshot eyes Possible GVM or green coating on tongue Dilated pupils

20 MARIJUANA REGULATORY PROCESS I Liquor & Cannabis Board sets up regulator y system Depar tment of Health establishing rules for medical marijuana Regulations govern growing, processing, distribution, sales, pesticides, and testing of marijuana 525 approved licenses ( a s o f M a r ch 16, ) 1,044 producers & or processors Current grow canopy: 13.8 million square feet New Medical Market could expand the canopy Sales ( a s o f M a r c h 1 6, ): $ 4.0million average daily sales w/ 37% tax FY $259,785,729 tax obligation $65 million FY $972,729,675 - tax obligation $185 million FY $1,327,025, tax obligation $305 million FY $606 M h t t p s : / / d a t a. l c b. w a. g o v / s t o r i e s / s / W S L C B - M a r i j u a n a - D a s h b o a r d / h b n p - i a 6 v

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22 DEFINITIONS AND TERMINOLOGY THC: The main psychoacti ve substance found in marijuana; a/k/a delta - 9tetrahydrocannabinol (Δ9-THC), dronabinol (Marinol FDA) Hydroxy-THC: The main psychoactive metabolite of THC formed in the body after marijuana consumption; a/k/a 11-Hydroxy -THC or 11-OH-THC Carboxy-THC: The main secondary metabolite of THC; formed in the body after marijuana is consumed. It is NOT active; indicative only of recent use; not useful for per se violations; a/k/a 11-or-9-Carboxy THC or THC-COOH Metabolite: A chemical created in the body as part of the process of breaking down the parent compound Active: has impairing qualities Inactive: has no effect Psychoactive or Active: Causes euphoric and impairing effects (THC and 11 - HydroxyTHC) Cannabidiol (CBD) one of 113 active cannabinoids in cannabis devoid of psychoactive activity (euphoria or intoxication). Pre-clinical research shows promising therapeutic usefulness for anti-seizure, antioxidant, antiinflammatory, analgesic, anti-tumor, anti-psychotic, and anti-anxiety ( -nida/legislative-activities/testimony -tocongress/2016/biology-potential-therapeutic-ef fects-cannabidiol) Chronic Use: Daily or almost daily use. Per Se law: A statutory assignment of a blood concentration (5 nanograms/ml) above which it is an offense to drive *Not intended as a scientific resource, for basic explanation only

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25 ESTIMATED - DURATION OF EFFECTS AFTER SMOKING OR INGESTING THC Peak Effects (After last smoking episode) Smoked 1-30 minutes Duration of Effects Behavioral and psychological effects return to baseline Residual Effects 2-3 hours 3-5 hours Up to 24 hours Oral/Edible 1-3 hours 4-8 hours Dose Dependent Dose Dependent Note: Additional research is needed to understand all methods of ingestion and the effects, durations, and long term-impacts

26 DOES MARIJUANA USE INCREASE CRASH RISK?? Alcohol <.12.05<Alcohol<.08 Alcohol <.05 Distraction Drowsy THC Review of literature revealed varying crash risk and difficult with THC

27 NOT YOUR DADDY S WOODSTOCK WEED % % 2014 Marijuana being sold in stores 20% - 30%

28 THC POTENCY USED IN MOST GOVERNMENT STUDIES

29 ESTIMATED DURATION OF EFFECTS AFTER SMOKING OR INGESTING THC Peak Effects (After last smoking episode) Smoked 1-30 minutes Duration of Effects Behavioral and psychological effects return to baseline Residual Effects 2-3 hours 3-5 hours Up to 24 hours Oral/Edible 1-3 hours 4-8 hours Dose Dependent Dose Dependent A recent study showed that THC blood concentration decreased 73.5% in the first 30 minutes and 90.3% in first 1.4 hours ( % THC). Hartman, R.L. et al., Effect of Blood Collection Time on Measured 9-Tetrahydrocannabinol Concentrations: Implications for Driving Interpretation and Drug Policy. Clinical Chemistry 62, no.2 (2016): *Note: Additional research is needed to understand all methods of ingestion and the effects, durations, and long term-impacts

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32 MARIJUANA REGULATORY PROCESS I Liquor & Cannabis Board sets up regulatory system Department of Health establishing rules for medical marijuana Regulations govern growing, processing, distribution, sales, pesticides and testing of marijuana 258 stores reporting sales of 449 with approved licenses ( a s o f N o v ember 4, ) 904 producers & or processors Current grow canopy: 13.8 million square feet New Medical Market could expand the canopy Sales ( a s o f N o v ember 4, ): $ million average daily sales FY $259,785,729 tax obligation $65 million FY $972,729,675 - tax obligation $185 million FY $539,039,875 - tax obligation $100 million v/m ariju an a/ dash bo ard

33 Medical Marijuana Qualifying Conditions Under Section 16 of the Cannabis Patient Protection Act, the legislature finds that there is medical evidence that some patients with terminal or debilitating medical conditions may, under their healthcare professional's care, benefit from the medical use of marijuana. Some of the conditions for which marijuana appears to be beneficial include, but aren't limited to: Nausea, vomiting, and cachexia associated with cancer, HIV-positive status, AIDS, hepatitis C, anorexia, and their treatments; Severe muscle spasms associated with multiple sclerosis, epilepsy, and other seizure and spasticity disorders; Acute or chronic glaucoma; Crohn's disease; and Some forms of intractable pain. Humanitarian compassion necessitates that the decision to use marijuana by patients with terminal or debilitating medical conditions is a personal, individual decision, based upon their healthcare professional's professional medical judgment and discretion.

34 Medical Marijuana Recognition Card Under the new medical marijuana law, recognition cards are required if patients and designated providers 21 and older wish to have access to the following benefits: Purchase products sales-tax free. Purchase up to three times the current legal limit for recreational users. Purchase high-thc infused products. Grow more than four plants in their residence. Have full protection from arrest, prosecution, and legal penalties, although patients will still have an affirmative defense.

35 DOES MARIJUANA USE INCREASE CRASH RISK?? Alcohol <.12.05<Alcohol<.08 Alcohol <.05 Distraction Drowsy THC Review of literature revealed varying crash risk

36 NOT YOUR DADDY S WOODSTOCK WEED % % 2014 Marijuana being sold in stores 20% - 30%

37 THC POTENCY USED IN MOST GOVERNMENT STUDIES

38 MARIJUANA HAS ALWAYS BEEN THE DOMINATE DRUG IN FATAL CRASHES

39 WTSC DESCRIPTIVE REPORT Reviewed all WA toxicology paper reports and manually entered full toxicology outcomes into a spreadsheet Worked with Dr. Couper to abstract the information for surviving drivers Abstracted full toxicology for everyone in fatal crashes who had toxicology testing (drivers, occupants, nonmotorists) Married to the original FARS record for in-depth fatal crash analysis Initial report focused on data years , DRIVERS wtsc.wa.gov

40 CONSIDERATIONS Officers need to consider the totality of the circumstances and not get locked in just looking for Cannabis see the whole picture Develop and implement an educational campaign with materials in multiple languages and relevant to various cultures Evaluate data collection (e.g. Traffic Crash Data, Toxicology, Poison Control, Hospital, etc.) What information is collected? How is collected? Who has access for analysis? Creation of a Regulatory Agency Full enforcement authority Track from seed to sale Packaging requirements with THC level, not attractive to children Rules and regulations 40

41 CONSIDERATIONS Seek dedicated funding from revenues Marijuana taxes for education and enforcement What Driving Under the Influence of Drugs DUID laws will be considered: Zero Tolerance Illegal to drive with any amount of specified drugs in the body Per se: illegal to drive with amounts of specified drugs in the body exceeding set limits (e.g. 5 ng) delta 9 THC or carboxy Law Enforcement SFSTS, ARIDE, DRE How is DRE viewed for impaired driving? Is this a priority for prosecutors for DUI cases? ARIDE Training programs for LE, prosecutors, judges Electronic Search Warrants Drugged driving is not just a nighttime or weekend issue but is prevalent day and night Emphasis patrol times, media messaging, officer perspective for daytime crashes 41

42 CONSIDERATIONS Chemical Evidence Oral Swabs, Blood or Urine Phlebotomy for LE officers paradigm shift Toxicology evidence collection and analysis how will it be collected? what drugs are collected? Screening levels, sensitivity or tolerances consistent across jurisdictions? How will it be used? Reported? Do all fatally injured drivers have a toxicology examination? Do all surviving drivers get assessed on scene or if transported? Even if no alcohol present or detected? Green labs similar to Wet Labs provide realistic training and experience for officers to conduct SFST and to better screen the occasional or chronic user. Commercial Vehicle Carriers International travel/provincial Safety Manager training for drug and alcohol recognition Drug Testing the FMCSA has noted the highest drug failure rate in 7 years 42

43 DRUG TESTING AMONG DRIVERS INVOLVED IN FATAL CRASHES, % 58.3% 61.1% 56.8% 58.4% 63.0% 55.1% 51.6% 54.2% Tested Not Tested or Unknown if Tested Percent of Drivers Tested

44 120 Cannabinoid-Positive Drivers Involved in Fatal Crashes, % % % 72.5% 57.1% 57.1% % 44.4% % Delta-9 THC Positive Total Cannabinoid-Positive Drivers Percent Delta-9 THC Among Cannabinoid-Positive Drivers

45 THC-Positive+Alcohol>=.08 Drivers Involved in Fatal Crashes, % 68.0% 50.0% 65.6% 38.9% 50.0% 37.8% 45.1% 45.6% THC+Alcohol>=.08 All THC-Positive Drivers Percent THC Drivers with Alcohol >=.08

46 INCREASES IN 2014 Still too soon for answers/impact on traffic safety The frequency of drivers in fatal crashes that tested positive for active THC, alone or in combination with alcohol or other drugs, was highest in 2014 (75 drivers) compared to the previous four-year average (36 drivers). The frequency of drivers tested with alcohol greater than/equal to BAC.08 and no other drugs was lowest in 2014 (51 drivers) compared to the previous four-year average (98 drivers). In 2014, 84.3 percent of drivers positive for cannabinoids were positive for active THC, compared to only 44.4 percent of cannabinoid-positive drivers in In 2014, among the 75 drivers involved in fatal crashes positive for active THC, approximately half (38) exceeded the 5 ng/ml THC per se limit.

47 IMPAIRED DRIVING CASES FILED 42,000 40,000 38,000 41,006 38,191 38,024 36,000 34,701 34,000 32,000 31,730 30,000 28,000 26,000 28, ,363 5/24/2016 WASPC 2016 Spring Exposition and Training Conference

48 STATEWIDE BREATH TESTS 40,000 38,000 37,743 36,000 34,000 35,325 34,587 32,000 31,363 30,000 28,000 26,000 27,595 27,239 24,000 22,000 21,906 20, /24/2016 WASPC 2016 Spring Exposition and Training Conference

49 STATEWIDE BLOOD TESTS 7,200 7,043 6,700 6,200 6,270 5,700 5,468 5,200 5,014 5,131 5,298 4,700 4, /24/2016 WASPC 2016 Spring Exposition and Training Conference

50 DRE EVALUATIONS 1,700 1,573 1,500 1,420 1,300 1, /24/2016 WASPC 2016 Spring Exposition and Training Conference

51 Minutes PROCESSING TIMES NOT INCLUDING PAPERWORK blood breath /24/2016 WASPC 2016 Spring Exposition and Training Conference

52 PIRE ROADSIDE SURVEY PACIFIC INSTITUTE FOR RESEARCH AND EVALUATION Data collection: June, 2014; Nov and June, 2015 Statewide sample -- six counties, five areas within each (Spokane, Yakima, King, Whatcom, Snohomish, Kitsap Alcohol and drugs (75 types, with levels)

53 Six counties, 5 locations JUNE 2014 DATA COLLECTION 926 drivers eligible 97% (917) breath tests 96% (902) saliva 74% (711) blood 95% K & A surveys Male drivers age over-represented: * 21% population * 45% survey sample

54 Have you ever, even once, used marijuana? 69% -- yes T= % -- no T= 273 T= 888 respondents Those who said they used marijuana in the last year were also asked: Have you used marijuana within two hours of driving? 44% -- yes T= 97 56% -- no T = 123 T =220 respondents

55 The drivers who said they d used marijuana within two hours of driving were also asked: when you used marijuana and drove, how do you think it affected your driving? Percentage of drivers: Total number: Did not make any difference in my driving: 62% 60 Made me a better driver: 25% 24 T = 84 (87%) I don t know: 10% 10 Made my driving worse: 3% 3

56 Among the drivers surveyed, 877 answered the question: How likely do you think it is that marijuana impairs a person s ability to drive safely if used within two hours of driving? Percentage: Number of Respondents: Very likely 47% 409 Likely 19% 162 Somewhat likely Not at all likely T= % 197 T= 768 (88%) 12% 109

57 881 Survey respondents answered the question: How likely do you think it is that a person could be arrested for impaired driving after using marijuana within two hours of driving? Percentage: Number of Respondents: T= 881 Very likely 41% 360 Likely 23% 204 Somewhat likely Not at all likely 25% 219 T= 783 (89%) 11% 98

58 Percentage of Washington Drivers THC-positive Before and After Recreational Marijuana Sales 25% 22.2% 19.8% 21.4% 20% 17.5% 18.4% 19.4% 19.4% 15% 14.6% 14.5% 10% 9.2% 7.8% 5% 0% Among daytime drivers, there was a statistically significant increase in THC-positive drivers in both waves 2 and 3 compared to wave 1. Those exceeding the 5ng per se signficantly decreased in wave 2 from wave 1. All other results were not statistically signficant but still 5.3% In this chart, only the points that are connected by a line are statistically significant changes - the stand alone points can be described as 'point in time prevalence estimates with variation due to chance'. Wave 1 (pre-sales) Wave 2 (six mos. Post-sales) Wave 3 (one year post-sales) Daytime Over 5ng per se All Times Nighttime 58

59 Drug-Positive Drivers in Washington State (Average Prevalence Estimates Wave1 - Wave3) THC Only 11.5% THC + Other Drugs (not alcohol) 7.0% Drug Negative 64.7% Illegal Drugs Only 1.5% Medications Only 14.7% Illegal Drugs + Medications 0.6% Differences between waves were not significant so we took an average of the three different values to display this general prevalence chart for drugs. 59

60 Alcohol and Drug-Positive Drivers in Washington State (Average Prevalence Estimates Wave1 - Wave3) Alcohol+THC 1.0% Alcohol+Other Drugs 1.1% Alcohol Only 2.8% No Alcohol or Drugs 61.8% THC 17.5% Other Drugs 15.8% 60

61 UPCOMING PROJECTS Analysis of self-report marijuana use and driving collected during the Roadside Survey BRFSS marijuana use after driving WSU blood-breathe validation of roadside marijuana detection Pullman PD participating in evaluation of using SFST for identifying impairment by marijuana, ARIDE vs. non-aride trained officers WSU analysis of PTCR narrative and diagram of fatal crashes involving THC drivers culpability assignment, cooccurrences, risk factors THC driver data requests AAA, IIHS, WSU, WSU Vancouver, DOL, WSIPP, NIH Evaluators

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