Road Safety Authority Annual International Road Safety Conference

Transcription

1 Road Safety Authority Annual International Road Safety Conference Alcohol Tackling the crisis on our roads. Dublin Castle 1 st June Drink Driving It Has Not Gone Away You Know Professor Denis A. Cusack, Director, Medical Bureau of Road Safety & Forensic & Legal Medicine, UCD School of Medicine

2 Medical Bureau of Road Safety Functions Test blood and urine for alcohol and/or drugs

3 MBRS Functions Provide Preliminary Breath testing Devices Provide Evidential Breath Testing Instruments

4 MBRS Functions Update supply preliminary drug testing devices (Draeger DrugTest 5000) 86 installed in the Garda Stations with EBT instruments and first tranche of 50 for Roadside Testing supplied with further devices to be supplied as requested 72 Gardaí trained (MBRS/GTC) to trainer level in March 2017: training of Garda members New in 2018 next generation PBT devices with enhanced features for operational uses

5 Intoxicant intoxicant includes alcohol and drugs and any combination of drugs or of drugs and alcohol substance which when taken into a body by one mean or another produces a condition of diminished mental and physical ability, hyperexcitability, or stupefaction.

6 Alcohol

7 Physiology Alcohol concentrations absorption metabolism excretion gender differences

8 Physiology Alcohol concentrations beer 4-6% v/v wine 6-12% v/v spirits 20-40% v/v liqueurs > 40% v/v

9 Physiology absorption stomach and upper small bowel optimally at 20% peak blood levels at minutes absorption, plateau and elimination phases

10 Physiology Metabolism 95% detoxified in liver excretion 90% excreted by kidney mgs% per hour tubular absorption of water, 1:1.3 ratio gender differences

11 Clinical Pathology history examination chronic gastritis fatty liver cirrhosis gammaglutamyl transpeptidase carbohydrate-deficient transferrin

12 Clinical Effects of Alcohol Levels (100mg/100ml = 1.0 g/l) and examples 0-50mg%: relaxed and more sociable mgs%: mild euphoria, reduced co-ordination and reaction [crash risk increases] mgs%: impaired balance, clumsiness, reduced alertness mgs%: drunkenness, slurred speech, staggered gait, impaired co-ordination mgs%: heavy drunkenness, grossly impaired co-ordination mgs%: extreme drunkenness, stupor, impaired consciousness >300mgs%: unconsciousness, coma, possible death

13 Autopsy Findings Cardiac Hepatic Pancreatic Muscular Neural Testicular Vascular

14 Alcohol and Driving

15 Effects of Intoxicant on Driving Sensory input Concentration Reaction time Action response Risk taking behaviour

16 Crash Risk

17 Sláinte agus Tiomáint [DUI and the link with Fitness to Drive] Chapter 6.1 and 6.2: Alcohol and Drugs Misuse and Dependence Information Leaflets: Alcohol and Driving; Medicines and Driving; & Driving Under the Influence of Illicit Drugs and/or the Abuse of Prescription Drugs

18 Medical Fitness to Drive Road Traffic (Licensing of Drivers) (Amendment) (No. 2) Regulations 2010 Form D501 (medical report) Form D502 (eyesight report) Patient Advisory Form If applicant is a regular user of drugs or medication that would be likely to make driving unsafe

19 MFtD Guidelines Chapter 6 Drug and alcohol misuse and dependence Group 1 and Group 2 Licences National Driving Licence Service Driver must notify NDLS Cannabis, cocaine, amphetamines, metamphetamine, heroin, methadone and other opiates, benzodiazepines

20 Alcohol Misuse and Dependence Group 1 Driver Persistent misuse driving cessation until minimum 3 months controlled drinking or abstinence (biomarkers if relevant) Dependence 6 months cessation and return to driving requires satisfactory medical assessment Alcohol related seizures Alcohol related disorders Driver must notify NDLS

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24 Alcohol Consumption in Ireland 2013 (Long and Mongan)

25 RSA Review of 2014 RTC Fatalities and Alcohol Toxicology A third (33%) of drivers / motorcycle riders who died in fatal crashes in 2014 had a positive toxicology for alcohol 35% of car drivers killed had a positive toxicology for alcohol 2 out of 5 (40%) motorcyclists killed had a positive toxicology for alcohol 28% of pedestrians killed had a positive toxicology for alcohol 96% of the drivers / motorcycle riders who had a positive toxicology were male Source: The Health Research Board National Drug-Related Death Index (NDRDI) on behalf of the RSA

26 RSA Review of 2014 RTC Fatalities and Alcohol Toxicology The median age for male drivers / motorcycle riders with a positive Blood Alcohol Concentration (BAC) was 38 years The median Blood Alcohol Concentration (BAC) for deceased car drivers was 192mg and the median for deceased motorcycle riders was 104mg (legal limit for nonspecified drivers is 50mg). Source: The Health Research Board National Drug-Related Death Index (NDRDI) on behalf of the RSA

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28 Fatal Collisions (RSA Report)

29 Fatal Collisions (RSA Report)

30 Fatal Collisions (RSA Report)

31 Causation Causing Contributing Factor Found Multiple factors

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33 Drink (Intoxicant) Driving Legislative History Road Traffic Act mg% BAC Road Traffic Act 1995 graded penalties Road Traffic Act 2006 mandatory alcohol testing Road Traffic Act mg%& 20mg% BAC Specified driver (learner, newly qualified, professional driver [goods, bus, public service]) cf. Aviation statutory provisions (Order 1999) Road Traffic Act 2011 mandatory accident testing & intoxicant impairment testing Road Traffic Act 2016

34 Alcohol Facts - MBRS Table 1 Total Number of Specimens Received within Programmes Programme Alcohol Blood & Urine 3,020 3,077 2,934 3,310 Table 2 Mean Alcohol Level in Blood and Urine mg Alcohol/100ml Blood Urine

35 Table 3 Gender Profile of Specimens Blood and Urine Gender No. (%) No. (%) No. (%) Male 2,497 81% 2,377 81% 2, % Female % % % Not Stated 19 1% 36 1% % Table 4 Age Profile of Specimens Blood and Urine Age Profile No. (%) No. (%) No. (%) % % % % % , % % % % % % % % % Not Stated % % %

36 Table 5 Certified Blood Alcohol Level Comparison with previous year mg Alcohol/100ml Blood No. (%) No. (%) No. (%) % % % % % % % % % % % % % % % % % % % % 201 & Over % % %

37 TABLE 6 Certified Urine Alcohol Level Comparison with previous year mg Alcohol/100ml Urine No. (%) No. (%) No. (%) % % % % % % % % % % % % % % % % % % % % 268 & Over % % %

38 CDT Update Carbohydrate-deficient transferrin (CDT) Used to detect heavy alcohol consumption over time Green - %CDT < or equal to 2.2% Indicates not harmful or dependent Amber - %CDT % Can be indication of problem drinking Red - %CDT equal to or > 3.0% Can indicate dependency on drinking

39 CDT Amber: daily consumption of >60g alcohol for minimum of 1-2 weeks or binge drinking Red: typical daily intake of > g alcohol per day Used in UK in the context of assessing Medical Fitness to Drive and Driver Licensing and for High Risk Offenders

40 Enforcement / Technology Evidential breath testing introduced new generation instruments 2011 (measure down to 9mcg% BrAC level) Currently 86 instruments in Garda Stations MAT introduced 21 st July ,100+ roadside alcohol screening devices supplied to Gardaí by MBRS (estd. under review) checks per 1000 population (c. 2% above limit)

41 Drugs and Medications

42 DUID Results (2016)

43 Classes of Drugs - MBRS Alcohol Cannabis Benzodiazepines Amphetamine / Metamphetamine Cocaine Methadone Opiates

44 Most Prevalent Drugs (in order) 1. Alcohol 2. Cannabis 3. Benzodiazepines 4. Cocaine 5. Opiates

45 Impairment Impairment evidence is frequently challenged in Court Standardised impairment testing introduced in November 2014: at roadside or in Garda Station 5 Tests: Romberg balance (and time awareness); one leg stand; finger to nose; walk the line; and pupil diameter measurement 78 Garda Trainers trained to train Gardaí New law requires increased impairment testing use

46 Clinical Assessment Acute signs and symptoms Chronic signs and symptoms Psychological effects Psychomotor effects Physical effects Not whether licit or illicit drugs

47 Roadside Intoxicant Impairment Testing: Overall Assessment SUBJECT: IMPAIRED / NOT IMPAIRED

48 Integrated Intoxicant Testing Preliminary Alcohol Test Preliminary Drug Test roadside or Garda station Standardised Impairment Test Evidential Alcohol Test Forensic Laboratory Testing

49 Summary of DUI Ireland 2017 Evidence based road safety measures Alcohol still the top DUI drug Also now have PDT and per se levels for 3 illicit drugs introduced 13 th April, 2017 New PBT devices in 2018 Impairment evidence remains a critical part of enforcement Enforcement is the key RESOURCE IT

50 These notes are intended for use in conjunction with this educational presentation only. The notes do not constitute medical, legal or medico-legal advice. No part to be reproduced without permission of the author

51 Medical Bureau of Road Safety School of Medicine and Medical Science Scoil an Leighis agus Eolaíocht an Leighis