4/27/2016. About CCSA. Impaired Driving Research at CCSA. Background. Presentation Overview. Lessons Learned

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1 About CCSA Drug-Impaired Driving i in Canada: Lessons Learned International Conference on Urban Traffic Safety Amy Porath-Waller, Ph.D. April 26, 2016 CCSA is Canada s only agency with a legislated national mandate to reduce the harms of alcohol and other drugs on Canadians. Created by an Act of Parliament in 1988, CCSA has provided national leadership and expert advice, advanced knowledge, and prepared information and resources based on the latest evidence in order to inform policy, practice and programs that bring forward solutions. Together with our partners, we help mobilize individual and collective efforts to achieve collective impact on the major health and social issue of problematic substance use. Ensuring access to a range of quality services to address alcoholand other drug-related harms is at the core of what we do everyday. We believe that hope and recovery are real 2 CCSA s National Priorities and Areas of Action Impaired Driving Research at CCSA Problematic Substance use & Cooccurring Issues Canada s Indigenous People Monitoring & Surveillance Workforce Development Children & Youth Canada s National Framework for Action Treatment & Recovery Cannabis Prescription Drugs Alcohol Impaired Driving National Framework for Action (2005): Collective action for collective impact Studies of DEC program implementation in Canada Accuracy of DRE evaluations Studies of drug-specific indicators in DEC evaluations Examination of drug and alcohol use among fatally-injured drivers in Canada Roadside surveys in British Columbia Studies of validity of SFST for drugs Drug summaries and youth-focused summaries of drug effects on driving 3 4 Presentation Overview Background Background Magnitude of the problem Challenges of addressing drug-impaired driving Enforcement Public education and awareness Alcohol has dominated the field of impaired driving In 1982, 62% of drivers killed in crashes were alcoholrelated Public outrage and government concern about impaired driving reached unprecedented levels Public became less tolerant of impaired driving Behaviour changed Impaired driving deaths fell dramatically 5 6 1

2 Background cont d Drug Use and Driving Despite progress, alcohol-related deaths and injuries remain unacceptably high. In 2012: 33.3% of dead drivers tested positive for alcohol 85.7% of alcohol-positive cases had a blood alcohol concentration (BAC) > 80 mg/dl A drug is any substance which, when taken into the human body, can impair the ability of the person to operate a vehicle safely Focus is on impairment Drugs are a different and more complex issue than alcohol Source: Alcohol and Drug-Crash Problem in Canada 2012 Many research challenges But there is a new problem in the impaired driving forum Challenges account for shortcomings in knowledge 7 8 Why is Drug-Impaired Driving so Complicated? Substances of Interest Many different types of drugs that can impair driving, all of which have different effects Drug effects depend on the body, such as weight, metabolism and elimination Patterns of use differ based on the population (e.g., youth) Polydrug use makes it difficult to identify which drug is present Requires sample of urine, oral fluid or blood Complexities require a different approach to enforcement and adjudication of drug-impaired drivers Marijuana (THC) Stimulants e.g., cocaine, amphetamines, ecstasy (MDMA) Benzodiazepines e.g., diazepam, lorazepam Sedative-hypnotics zolpidem, zopiclone Antidepressants e.g., amitriptyline, nortriptyline Antihistamines e.g., diphenhydramine, chlorpheniramine Muscle relaxants Narcotic Analgesics e.g., codeine, oxycodone morphine Hallucinogens e.g., LSD, phencyclidine (PCP) 9 10 Magnitude of the Problem Self-reported Driving after Drinking and Driving after Cannabis in Canada Self-report surveys Roadside surveys Fatally injured drivers Source: Canadian Alcohol and Drug Use Monitoring Survey

3 t 4/27/2016 Roadside Surveys of Drug Use Among Drivers Provide current, reliable and valid estimate of prevalence of alcohol and drug use by drivers Drivers randomly tested Wed through Sat nights from 9:00 PM to 3 AM Participants provide breath test and oral fluid sample Surveys conducted in British Columbia from and Ontario in Roadside Surveys of Drug Use Among Drivers cont d The 2012 British Columbia Roadside Survey found 7.4% of drivers tested positive for drugs: Depressants (35.6%) Cannabis (25.8%) Stimulants (19%) By comparison, 6.5% of drivers tested positive for alcohol The 2014 Ontario Roadside Survey found 10.2% tested positive for drugs: Cannabis (69%) Stimulants (21%) Opioids (20%) By comparison, 4.0% tested positive for alcohol 14 Ontario Roadside Survey: Driving after Drinking and Drug Use by Age Ontario Roadside Survey: Drug Used Before Driving by Age Group Percent Drugs 13.9 Alcohol Positive Age Group Source: Ontario Roadside Survey Source: Ontario Roadside Survey Fatally-Injured Drivers in Canada Fatally Injured Drivers Positive for Alcohol or Drugs in Canada Data on alcohol use by fatally injured drivers has been collected from coroners/medical examiners in Canada for many years These data have contributed to: Our understanding of the alcohol-crash problem Monitoring trends in the problem Evaluation of drinking-driving countermeasures Since 2000, database has included drug use by fatally injured drivers Source: Canadian Council of Motor Transport Administrators (2011) Cannabis is the most common illicit drug present, either alone or in combination with other substances, among fatally injured drivers Presence of a drug does not necessarily mean the driver was impaired or that the drug contributed to the crash

4 Challenges of Addressing Drug-impaired Driving: Enforcement Enforcement is tasked with measuring the presence of drugs and proving presence related to driving impairment. Alcohol can be measured using breathalyzers but the presence and quantity of drugs must be determined from biological samples There is no equivalent to a BAC level for drugs. Drug metabolites can be detected in the body for days, making it difficult to determine impairment. Drug Evaluation and Classification Program Systematic, standardized 12-step procedure to document the extent of an individual s impairment and identify the category(ies) of drug(s) responsible Involves observations, tests of divided attention and clinical indicators (e.g., body temperature & blood pressure) Concludes with a demand for a sample of urine, oral fluid or blood to be tested for drugs Extensive training and certification required to become a Drug Recognition Evaluator (DRE) DEC Program Effectiveness A study of 1,349 DEC evaluations completed by DREs in Canada documented an overall accuracy rate of 95% (Beirness et al., 2009) DREs reviewing the same case came to the same conclusion with respect to drug category 71% of the time (Beirness et al., 2009) Oral Fluid Screening Oral fluid screening not currently approved in Canada Screening for drugs in samples of oral fluid (saliva) collected at roadside provides a viable means of enhancing the detection of drug use by drivers. Oral fluid screening devices are currently only valid for the detection of a limited number of substances and will not eliminate the need for behavioural testing for impairment or the DEC program Standardized Field Sobriety Test (SFST) The SFST was initially developed and validated to detect drivers impaired by alcohol The test is currently used by police to detect drug impairment SFST s ability to accurately detect drug-related impairment is unclear There have been few studies that have assessed the SFST s ability to accurately detect impairment due to drugs Controlled studies in laboratory settings What Is the Standardized Field Sobriety Test? The SFST has three components: Horizontal Gaze Nystagmus Test (HGN) Eyes follow a slowly moving object as it is moved from side to side One Leg Stand Test (OLS) Stand with one foot about 15 cm off the ground while counting aloud for 30 seconds Walk and Turn Test (WAT) Walk nine steps, heel-to-toe, along a straight line, followed by a turn on one foot, and then return in the same manner in the opposite direction

5 Components of the SFST Study Objective One Leg Stand Horizontal Gaze Nystagmus Walk and Turn To examine the validity of the three components of the SFST to identify drug impairment among suspected drug-impaired drivers Method: Study Sample Method: Statistical Analyses Sample of 2,142 Drug Evaluation and Classification case reports conducted between Central Nervous System (CNS) stimulants (n = 852) Cannabis (n = 703) Narcotic analgesics (n = 312) (n = 135) No drug cases (n = 140) Statistical analyses predicted drug category from performance on the HGN, OLS and WAT tests Follow-up analyses determined the specific clues from the three tests that distinguished the drug categories from the no-drug cases The opinion of the Drug Recognition Evaluator matched the toxicological analysis of the bodily fluid sample Clues of Impairment Assessed Clues of Impairment Assessed (cont d) HGN Test Lack of smooth pursuit Distinct nystagmus at maximum deviation Nystagmus onset before 45 OLS Test Swaying while balancing on one leg Using arms to maintain balance Hopping during test Putting the raised foot down WAT Test Could not keep balance while listening to test instructions Started test before the instructions were completed Stopped walking during the test Did not touch heel-to-toe while walking Stepped off the line Used arms to maintain balance Took the incorrect number of steps

6 Overall Results Results: HGN Test All four drug categories were significantly associated with impaired performance on the HGN, WAT and OLS tests of the SFST (all ps <.0001) Sign of Impairment Increased odds of lack of smooth pursuit* Increased odds of distinct nystagmus at maximum deviation* *p< Affected Drug Categories Results: WAT Test Results: OLS Test Sign of Impairment Decreased odds of keeping balance while listening to test instructions* Decreased odds of touching heel-to-toe while walking* Decreased odds of taking the correct number of steps* *p< Affected Drug Categories CNS stimulants Narcotic analgesics Narcotic analgesics Sign of Impairment Increased odds of swaying while balancing on one leg* Increased odds of using arms to maintain balance* Increased odds of putting raised foot down* Decreased odds of hopping during test to maintain balance* Affected Drug Categories All categories All categories CNS stimulants Narcotic analgesics All categories *p< Summary and Implications All drug categories were significantly associated with impaired performance on the SFST The pattern of signs on the various tests of the SFST varied by drug category, y,providing support for the validity of using this test to detect persons impaired by drugs other than alcohol Preliminary support for the use of the SFST as a screening tool for police to identify people impaired by CNS stimulants,, cannabis or narcotic analgesics These findings could have direct and immediate relevance to the training of police officers and could facilitate the enforcement of drug-impaired driving laws 35 Challenges of Addressing Drug-Impaired Drivers: Public Education and Prevention A review of available Canadian driver s education materials and consultations with jurisdictions uncovered a need for information related to drugs Study of Canadian youth reveals that they are misinformed about the effects of drugs on driving behavior Cannabis may affect driving, but it depends on various factors Driving after cannabis use is not as risky as driving after alcohol use Youth had not heard of many crashes or arrests due solely to cannabis impairment Youth are riding as passengers with impaired drivers 36 6

7 Drug-Impaired Driving Educator Toolkit Toolkit was developed to help jurisdictions provide education to young and new drivers on the topic of drug-impaired driving includes: Backgrounder Did you know? Key Messages Communications package (e.g., sample tweets) Infographic Test Questions Evaluation 4 topic summaries and summary chart Infographic for Youth Summaries on Drugs and Driving Series of knowledge summaries on drugs and driving that cover: Effects of four drug classes on the body and driving Capabilities of police to detect drugimpaired drivers Dangers of driving while impaired by drugs Dangers of riding with a drug-impaired driver Additional Resources Policy briefs: key considerations for addressing impaired driving in Canada Random breath testing Drug per se laws Administrative sanctions for low BAC drivers Drug Evaluation and Classification Program Oral fluid drug screening (COMING SOON) Upcoming Project at CCSA Drug-Impaired Driving in Rural Communities Determine the magnitude of the issue Gain a better understanding of the gaps in knowledge Prevention messaging Clearing the Smoke on Cannabis: Cannabis Use and Driving An Update

8 Summary Drug-impaired driving is a complex issue Further research on drug impairment is needed Need for prevention and public education initiatives, particularly for youth and new drivers More resources for enforcement to facilitate impaired driving laws Contact Information Amy J. Porath-Waller, Ph.D. Director, Research & Policy Division Canadian Centre on Substance Abuse 75 Albert Street, t Suite 500 Ottawa, ON K1P 5E7 Tel.: ext