Road Safety Authority Annual International Road Safety Conference Alcohol Tackling the crisis on our roads. Dublin Castle 1 st June 2017. 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
Medical Bureau of Road Safety Functions Test blood and urine for alcohol and/or drugs
MBRS Functions Provide Preliminary Breath testing Devices Provide Evidential Breath Testing Instruments
MBRS Functions Update 2017- 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
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.
Alcohol
Physiology Alcohol concentrations absorption metabolism excretion gender differences
Physiology Alcohol concentrations beer 4-6% v/v wine 6-12% v/v spirits 20-40% v/v liqueurs > 40% v/v
Physiology absorption stomach and upper small bowel optimally at 20% peak blood levels at 60-120 minutes absorption, plateau and elimination phases
Physiology Metabolism 95% detoxified in liver excretion 90% excreted by kidney 10-20 mgs% per hour tubular absorption of water, 1:1.3 ratio gender differences
Clinical Pathology history examination chronic gastritis fatty liver cirrhosis gammaglutamyl transpeptidase carbohydrate-deficient transferrin
Clinical Effects of Alcohol Levels (100mg/100ml = 1.0 g/l) and examples 0-50mg%: relaxed and more sociable 50-100mgs%: mild euphoria, reduced co-ordination and reaction [crash risk increases] 100-150mgs%: impaired balance, clumsiness, reduced alertness 150-200mgs%: drunkenness, slurred speech, staggered gait, impaired co-ordination 200-250mgs%: heavy drunkenness, grossly impaired co-ordination 250-300mgs%: extreme drunkenness, stupor, impaired consciousness >300mgs%: unconsciousness, coma, possible death
Autopsy Findings Cardiac Hepatic Pancreatic Muscular Neural Testicular Vascular
Alcohol and Driving
Effects of Intoxicant on Driving Sensory input Concentration Reaction time Action response Risk taking behaviour
Crash Risk
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
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
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
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
Alcohol Consumption in Ireland 2013 (Long and Mongan)
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
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
Fatal Collisions 2008-2012 (RSA Report)
Fatal Collisions 2008-2012 (RSA Report)
Fatal Collisions 2008-2012 (RSA Report)
Causation Causing Contributing Factor Found Multiple factors
Drink (Intoxicant) Driving Legislative History Road Traffic Act 1994 80mg% BAC Road Traffic Act 1995 graded penalties Road Traffic Act 2006 mandatory alcohol testing Road Traffic Act 2010 50mg%& 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
Alcohol Facts - MBRS Table 1 Total Number of Specimens Received within Programmes Programme 2016 2015 2014 2013 Alcohol Blood & Urine 3,020 3,077 2,934 3,310 Table 2 Mean Alcohol Level in Blood and Urine mg Alcohol/100ml 2015 2014 2013 2010 2005 Blood 119.6 104 120 127 171 Urine 147.0 123 137 135 202
Table 3 Gender Profile of Specimens Blood and Urine Gender 2015 2014 2013 No. (%) No. (%) No. (%) Male 2,497 81% 2,377 81% 2,665 80.5% Female 561 18% 521 18% 606 18.3% Not Stated 19 1% 36 1% 39 1.2% Table 4 Age Profile of Specimens Blood and Urine Age Profile 2015 2014 2013 No. (%) No. (%) No. (%) 24 675 22.0% 710 24.2% 844 25.5% 25 34 825 26.8% 826 28.2% 25-44 1,557 47.0% 35 45 654 21.2% 598 20.4% 45 54 449 14.6% 361 12.3% 454 13.7% 55 457 14.9% 412 14.0% 428 13.0% Not Stated 17 0.6% 27 0.9% 27 0.8%
Table 5 Certified Blood Alcohol Level Comparison with previous year mg Alcohol/100ml Blood 2015 2014 2013 No. (%) No. (%) No. (%) 0 20 471 26.9% 499 29.6% 465 25.3% 21 50 66 3.8% 90 5.3% 83 4.5% 51 80 104 5.9% 99 5.9% 124 6.7% 0 80 641 36.6% 688 40.8% 672 81 100 81 4.6% 105 6.2% 96 5.2% 101 150 285 16.3% 300 17.8% 315 17.2% 151 200 370 20.9% 362 21.4% 342 18.6% 201 & Over 379 21.6% 231 13.7% 414 22.5%
TABLE 6 Certified Urine Alcohol Level Comparison with previous year mg Alcohol/100ml Urine 2015 2014 2013 No. (%) No. (%) No. (%) 0 27 319 25.6% 380 30.5% 378 27.9% 28 67 60 4.8% 80 6.4% 87 6.4% 68 107 106 8.5% 99 7.9% 107 7.9% 0 107 485 39.0% 559 44.9% 572 108 135 76 6.1% 89 7.1% 93 6.9% 136 200 235 18.9% 249 20.0% 233 17.2% 201 267 248 19.9% 256 20.5% 281 20.7% 268 & Over 200 16.1% 93 7.5% 177 13.0%
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 2.3 2.9% Can be indication of problem drinking Red - %CDT equal to or > 3.0% Can indicate dependency on drinking
CDT Amber: daily consumption of >60g alcohol for minimum of 1-2 weeks or binge drinking Red: typical daily intake of >100-150g alcohol per day Used in UK in the context of assessing Medical Fitness to Drive and Driver Licensing and for High Risk Offenders
Enforcement / Technology Evidential breath testing introduced 1999 - new generation instruments 2011 (measure down to 9mcg% BrAC level) Currently 86 instruments in Garda Stations MAT introduced 21 st July 2006 1,100+ roadside alcohol screening devices supplied to Gardaí by MBRS 40-50 (estd. under review) checks per 1000 population (c. 2% above limit)
Drugs and Medications
DUID Results (2016)
Classes of Drugs - MBRS Alcohol Cannabis Benzodiazepines Amphetamine / Metamphetamine Cocaine Methadone Opiates
Most Prevalent Drugs (in order) 1. Alcohol 2. Cannabis 3. Benzodiazepines 4. Cocaine 5. Opiates
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
Clinical Assessment Acute signs and symptoms Chronic signs and symptoms Psychological effects Psychomotor effects Physical effects Not whether licit or illicit drugs
Roadside Intoxicant Impairment Testing: Overall Assessment SUBJECT: IMPAIRED / NOT IMPAIRED
Integrated Intoxicant Testing Preliminary Alcohol Test Preliminary Drug Test roadside or Garda station Standardised Impairment Test Evidential Alcohol Test Forensic Laboratory Testing
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
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. 2017.
Medical Bureau of Road Safety School of Medicine and Medical Science Scoil an Leighis agus Eolaíocht an Leighis