Impaired Driving: Progress and Challenges Brian Jonah Senior Research Scientist Traffic Injury Research Foundation National Conference of State Legislatures Atlanta, GA May 14, 2009
Overview Global road safety situation Impaired driving situation Hard core impaired drivers Impaired driving interventions Drugs and driving 2
Global Road Safety 1.2 million people killed annually on roads- 3,200 fatalities every day. About 50 million injured annually. Global cost of road collisions estimated to be $518 billion (1-2% of GNP). Road toll expected to decrease by 30% in high-income countries over next 20 years but increase by 80% in low and middle income countries due to increased motorization. 3
Global Rank of Disease or Injury (2002) based on DALY s* 2002 1. Ischaemic heart disease 2. Cerebrovascular disease 3. Lower respiratory infections 4. HIV/AIDS 5. Chronic pulmonary disease 6. Perinatal conditions 7. Diarrhoeal diseases 8. Tuberculosis 9. Trachea, bronchus, lung cancers 10. Road traffic injuries 2030 1. Ischaemic heart disease 2. Cerebrovascular disease 3. HIV/AIDS 4. Chronic obstructive pulmonary disease 5. Lower respiratory infections 6. Diabetes mellitus 7. Trachea, bronchus, lung cancers 8. Road traffic injuries 9. Tuberculosis 10. Perinatal conditions *Disability adjusted life years lost 4
Young people are prime victims in road collisions Leading cause of death among 15-19 year olds. Second leading cause among 10-14 year olds and 20-24 year olds. Third leading cause among 5-9 year olds. Loss of our young people has major socio-economic impact 5
Rank of Disease or Injury for Males in U.S. Males 1. Ischaemic heart disease 2. Road traffic accidents 3. Lung trachea or bronchial cancer 4. HIV/AIDS 5. Alcohol use 6. Cerebrovascular disease 7. Chronic obstructive pulmonary disease 8. Homicide and Violence 9. Self-Inflicted Injuries 10. Unipolar major depression Females 1. Ischaemic heart disease 2. Unipolar major depression 3. Cerebrovascular disease 4. Chronic obstructive pulmonary disease 5. Lung trachea or bronchial cancer 6. Breast cancer 7. Osteoarthritis 8. Dementia and other degenerative and hereditary CNS disorders 9. Diabetes mellitus 10. Road traffic accidents 6
Impaired Driving Significant progress was achieved in the late 1980s and early 1990s in reducing drunk driving. Many jurisdictions implemented a range of programs and policies to address the problem. Impaired driving continues to be a leading cause of death and injury in road crashes. Hard core drunk drivers are an important part of the problem. Young impaired drivers are at very high risk for death and injury. 7
Number of Non-drinking and Drinking Fatally Injured Drivers and Pct. Positive Blood Alcohol Concentration (BAC) in US: 1990-2007 70 18,000 60 15,000 Percent 50 40 30 46 45 43 41 38 39 38 36 36 36 37 37 37 36 35 36 37 38 12,000 9,000 6,000 Number 20 10 1990 1992 1994 1996 1998 2000 2002 2004 2006 Pct Positive Non-Drinking Drinking 3,000 0 Year 8
Percent of Fatally Injured Drivers Positive for Alcohol : US, 2007 62% 38% + BAC 87% 80+ mg% 0 BAC 13% 1-79 mg% 9
Percent of Fatally Injured Drivers Positive for Alcohol : US, 2007 0 BAC 58% 42% + BAC 55% 29% 8% 8% > 160 mg% 81-160 mg% 50-80 mg 1-49 mg% 10
Percentage of All Drivers in Fatal Crashes Positive for Alcohol in US: 1990-2007 35 30 33 31 30 28 25 27 26 26 24 24 24 26 25 25 24 24 25 26 26 Percent 20 15 10 5 Pct Positive 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 Year 11
Percent of Fatally Injured Drivers With BACs Over 80 mg% by Age Group: U.S., 2007 60 50 40 30 20 10 0 <16 16-20 21-24 25-34 35-44 45-54 55-64 65-74 >74 12
Percent of Drivers in Serious Injury Crashes that Involved Alcohol in Canada: 1995-2006 40 30 Percent 20 21 21 20 20 20 20 19 19 18 19 18 19 10 0 1996 1998 2000 2002 2004 2006 13
Alcohol among nighttime drivers 88% not drinking Drinking 12% 14
BACs of drivers in nighttime surveys Percent 7 6.4 6 5 4 3 2 1 2.3 2.1 0.9 0.02-.05.051-.08.081-.15 >.15 15
Since the new millennium Progress basically halted. Same pattern holds for all the reliable indicators we have. Declines were due to socially responsible individuals who drink less and drink and drive less. Despite progress, the problem persists at unacceptable levels. 16
Who is the problem? NHTSA (2001) survey data shows that problem drinkers account for 27% of all drivers but account for 46% of the drinking and driving trips. These drivers are the hard core impaired drivers. 17
Profile of the Hard Core They often drink and drive -- this is frequent and routine behavior for them. They usually have consumed large amounts of alcohol -- this is extremely dangerous for them and others. Many of them are alcohol dependent. They usually have a history of prior DWI convictions 18
High BACs predominate In most jurisdictions, the average BAC is.17:» among fatally injured drivers» among injured drivers» among arrested drivers 19
Few, but dangerous Although high BAC drivers account for less than 1% of the nighttime drivers on the roads, they are responsible for as many as 60% of the serious collisions. 20
Hard core repeat offender Repeat offender -- operationally defined in terms of prior convictions. Using this definition, the best official statistics suggest that about 30-40% of impaired convictions involve a repeat offender. 21
Hard core repeat offender Even this is an underestimate because of low probability of:» Getting detected and arrested (Odds are anywhere from 1 in 200 to 1 in 2,000).» Getting convicted (Many cases are plea-bargained or result in acquittal at trial). 22
Summary The hard core should be our priority for drinking-driving driving countermeasures. But by no means should this exclude our focus on social drinkers or young drivers. 23
Solutions to Drinking & Driving.08 legal limit Sobriety checkpoints Administrative license revocation Vehicle impoundment Assessment/treatment of offenders Alcohol ignition interlocks 24
Sanctions and programs are not enough The drunk-driving system is replete with loopholes and inconsistencies that compromise its efficiency and effectiveness. There are problems at all levels -- in enforcement, prosecution, sanctioning and supervision that allow savvy DWI offenders in particular to slip through the cracks. Offenders are not consistently subject to programs that we know are effective. 25
Fixing the system The system needs to be streamlined, integrated, and loopholes eliminated. In partnership with 14 major criminal justice agencies in the U.S., TIRF has identified where the problems are, and how to fix them to improve the efficiency and effectiveness of the system. 26
Working Group on DWI System Improvements The goal of the annual meeting in 2008 was to identify priority recommendations to address drunk driving among offenders and reduce alcohol-related deaths and injuries. 10 priority recommendations were developed focusing on:» research» programs and interventions» the justice system 27
Research recommendations Improve the quality and quantity of data and data collection process to support research initiatives and decision-making. Discover answers to key questions:» Pathways to DWI offending;» Effective strategies for dealing with DWI offenders;» Targeted interventions for specific types of DWI offenders;» Gender-specific strategies;» Financially viable strategies for rural areas;» Effective strategies for poly-substance abuse offenders. 28
Program recommendations Expand DWI programs that work and discontinue those that do not. Establish effective practices and principles for the implementation and delivery of impaired driving strategies. Enhance training and education for practitioners regarding effective impaired driving strategies. Increase funding to support agency personnel. 29
System recommendations Make DWI a priority across the justice system. Enhance measures of system effectiveness. Improve communication and cooperation across all levels of the system. Make screening and treatment available at all phases of the system. 30
Blue Ribbon Panel to Develop Driver Alcohol Detection System for Safety (DADSS) Created in 2007, Panel includes representatives from NHTSA, other governments, vehicle manufacturers, parts manufacturers, researchers, MADD. Objective is a device that can measure alcohol in the body in reliable and transparent manner. Also, want to increase use of current alcohol interlocks by convicted DWIs Considering various technologies such as tissue or distant spectroscopy, transdermal. Not likely to have technology for 5-10 years 31
Summary Drinking and driving should be a priority traffic safety issue. Emphasis should be on hard core Efforts are needed on many fronts with different groups of offenders. Efforts are needed to make the system more effective and efficient. More effort on technology to deter impaired driving 32
Drugs and Driving 33
Do drugs impair driving skills Yes. Experimental studies show a wide range of drugs impair critical skills and abilities (e.g., response times, concentration). Some have a potent impact particularly those with a sedative/hypnotic effect s (e.g., valium). Some have a moderate effect (e.g., cannabis) and others are less impairing (e.g., stimulants). 34
Do drugs impair driving skills Epidemiological (real world) studies are weak and vague. The evidence that cannabis is related to crash risk is mixed.» Some studies report that the crash risk is actually lower than the average driver,» Others report crash risk is 1.5-2.5 times greater. Studies of benzodiazapines show the crash risk is 1.6-5.0 times greater. 35
Do people use them and drive? Survey by Canadian Centre on Substance Abuse» Roadside survey conducted 9:00pm-3:00am Wed-Sat in 3 British Columbia cities June 2008» 1200 drivers provided oral fluid for lab testing» 10% +ve+ for drugs and 8% +ve+ for alcohol» Cannabis- 4.6%; Cocaine- 4.6%» Alcohol use more common for 19-24 year olds» Drug use was very similar for 16-54 year olds NHTSA 2007 report roadside survey which tested for alcohol and drugs coming out soon. 36
Are drugged drivers involved in crashes? Yes. Overall incidence of drugs among drivers killed or injured in road crashes is in the 14-17% range. Most commonly detected substance is cannabis (about 10-11% 11% of cases); next are benzodiazepines found in about 5-9% 5 of cases. Testing of fatally injured drivers is low. Drugs frequently detected in blood in combination with alcohol (up to 75%). Therefore, evidence of the contribution of illicit drugs to crashes is inconsistent and inconclusive. 37
Summary Many drugs impair skills and abilities deemed important for the safe operation of a vehicle. Many of these drugs are used by people when they drive. Many of these drugs are found in drivers involved in collisions. The risks of these drugs (contributory effects) are not well established. On balance, the evidence shows that the problem is by no means trivial even though still not well understood. 38
Staying informed 39 www.tirf.ca