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DRUGGED DRIVING

DRUGGED DRIVING. Hon. Peggy Fulton Hora Judge of the Superior Court (Ret.) MADCP Conference March 12, 2014. SCOPE OF THE PROBLEM. More Drugging and Driving than Drinking and Driving.

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DRUGGED DRIVING

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  1. DRUGGED DRIVING • Hon. Peggy Fulton Hora • Judge of the Superior Court (Ret.) • MADCP Conference • March 12, 2014

  2. SCOPE OF THE PROBLEM

  3. More Drugging and Driving than Drinking and Driving • More drivers tested positive for drugs that may impair driving (14 percent) than did for alcohol (7.3 percent). • Of the drugs, marijuana was most prevalent, at 7.4 percent, slightly more than alcohol CA OTS Roadside Survey Nov. 19, 2012

  4. In a Nutshell • 1:8 weekend, nighttime drivers test positive for illicit drugs • 1:3 (33%) drivers killed in traffic crashes who were tested, and their results reported, tested positive for drugs NHTSA

  5. Drivers under 25 • 1:4 (23%) of fatally injured drivers who tested positive for drugs were under the age of 25. • Almost half (42%) of fatally injured drivers who tested positive for marijuana were under the age of 25. • NHTSA

  6. On the rise • The percentage of mortally wounded drivers who later tested positive for drugs rose 18 percent between 2005 and 2011 “Stoned driving epidemic puts wrinkle in Marijuana debate,” AP (Mar. 18, 2012)

  7. 1/3 deaths + for drugs • 33% of all drivers with known drug-test results who were killed in motor vehicle crashes in 2009 tested positive for drugs (illegal substances as well as over-the counter and prescription medications). • According to the Fatality Analysis Reporting System (FARS),

  8. More Teens Driving After Using Marijuana • 12% of seniors said they drove after using marijuana in 2011, compared with 10% in 2008. • 28 % of high school seniors said they had ridden in a car in the previous two weeks with a driver who had used drugs or alcohol, or said they had driven after using drugs or alcohol themselves Monitoring the Future 2013

  9. True or False? • Marijuana is the most common illicit drug in DWID cases. • TRUE

  10. What Drugs? • Of the 16.3% of drivers positive for drugs, 11.3% were positive for illegal drugs, 3.9% for medications and 1.1% for both illegal drugs and medications. The most common illegal drugs were cannabis (8.6%), cocaine (3.9%) and methamphetamine (1.3%) NHTSA

  11. What drugs? Most common were marijuana and stimulants (cocaine and amphetamines) ¼ were positive for marijuana ~¼ stimulants May not be causal, e.g., people who use drugs may drive more dangerously • Voas, Robert B., Ph.D., Journal of Studies on Alcohol and Drugs (July 2011)

  12. Drugs other than alcohol (e.g., marijuana and cocaine) are involved in about 18% of motor vehicle driver deaths. These other drugs are often used in combination with alcohol "State of Knowledge of Drug-Impaired Driving,“ NHTSA 2003

  13. Tip of the Iceberg • Every state reports BAC in fatal crashes • Only 20 states test for and report illicit drugs

  14. HOW DRUGS AFFECT DRIVING

  15. Behavioral domains relevant to driving • Alertness and arousal • Attention and processing speed • Reaction time and psychomotor functions • Sensory-perceptual functions • Executive functions NHTSA (2009)

  16. Marijuana vs. Stimulants • Marijuana linked to speeding and seatbelt non-use • Stimulants linked to all types of crash fatalities • When someone uses alcohol and another drug, alcohol is main reason for impairment • Alcohol is still the largest contributor to fatal crashes “Deadly Drugged Driving: Drug Use Tied to Fatal Car Crashes,” SceinceDaily (June 23, 2011)

  17. How does MJ affect driving?

  18. Marijuana studies delta-9-tetrahydrocannabinol (THC ) affects areas of the brain that control the body’s movements, balance, coordination, memory, and judgment, as well as sensations “Drugged driving,” NIDA Infofacts, (2010)

  19. Marijuana studies, cont. A meta-analysis of approximately 60 experimental studies—including laboratory, driving simulator, and on-road experiments—found that behavioral and cognitive skills related to driving performance were impaired with increasing THC blood levels “Drugged driving,” NIDA Infofacts, (2010)

  20. Marijuana studies, cont. • Evidence from both real and simulated driving studies indicates that marijuana can negatively affect a driver’s attentiveness, perception of time and speed, and ability to draw on information obtained from past experiences “Drugged driving,” NIDA Infofacts, (2010)

  21. Marijuana studies, cont. • Research shows that impairment increases significantly when marijuana use is combined with alcohol • Studies have found that many drivers who test positive for alcohol also test positive for THC, making it clear that drinking and drugged driving are often linked behaviors “Drugged driving,” NIDA Infofacts, (2010)

  22. Marijuana studies, cont. • A study of over 3,000 fatally injured drivers showed that when marijuana was present in the blood of the driver, he or she was much more likely to be at fault for the accident. • The higher the THC concentration, the more likely the driver was to be culpable “Drugged driving,” NIDA Infofacts, (2010)

  23. Marijuana studies, cont. • Eight of the nine studies found drivers who use marijuana are significantly more likely than people who don’t use marijuana to be involved in motor vehicle crashes. • MJ users more than 2xs more likely to be involved in a crash • “Marijuana Use By Drivers Linked With Increased Risk of Motor Vehicle Crashes,” Join Together, Oct. 7, 2011

  24. Marijuana studies, cont. • driving after smoking marijuana might almost double the risk of being in a serious or fatal crash. “Stoned driving epidemic puts wrinkle in Marijuana debate,” AP (Mar. 18, 2012)

  25. Latest research • Driving under the influence of cannabis almost doubles the risk of a serious crash • Risk is substantially higher if the driver is aged under 35 • Overview of nine previously-published papers which looked at more than 49,000 people • These investigations were deemed to be of high quality because the driver had given a blood sample after the accident or admitted to smoking cannabis prior to the crash British Medical Journal 2/12

  26. “Recent use”? • A recent study found that among chronic cannabis users, performance on driving related tasks was affected as much as three weeks after drug use was stopped. Psychomotor Function in Chronic Daily Cannabis Smokers during Sustained Abstinence (2013) Wendy M. Bosker, Erin L. Karschner, Dayong Lee, Robert S. Goodwin, Jussi Hirvonen, Robert B. Innis, Eef L. Theunissen, Kim P. C. Kuypers, Marilyn A. Huestis, Johannes G. Ramaekers. PLOS ONE 10.1371/journal.pone.0053127

  27. What about “medical” MJ?

  28. Along the road from Kona to Hilo, Hawai’i

  29. “Medical” marijuana • Denial of equal protection to prosecute marijuana users since ”medical” marijuana users couldn’t be prosecuted under per se Love v. State, 271 Ga. 398, 517 S.E.2d 53 (1999) • No so cocaine since there is no legal use except topically Keenum vs State 248 Ga. 474; 546 SE2d 288 (2001)

  30. My 420 Tours

  31. “Colorado Locals Start Marijuana Tourism Business” • sets travelers up in "pot-friendly" hotels • takes them on tours of marijuana dispensaries • secures tickets to pot-related events • First tour sold out

  32. Seattle the day after marijuana was legalized in WA

  33. Aging Boomers

  34. Rx and O-T-C Drugs • Driving impairment can also be caused by prescription and over-the-counter drugs

  35. Use of Rx drugs • Almost 70 percent of Americans take at least one prescription medication Join Together, June 20, 2013

  36. Illicit use of Rx pain medication is second only to marijuana as the most commonly used illicit drug on a college campus now. Young women were more likely than young men to use Rx medication but young men were more likely to divert their prescriptions to contemporaries. Drugged Driving McCabe, SE, et al., “Illicit use of prescription pain medication among college students,” Drug and Alcohol Dependence, 77:37-47, 2005

  37. True or False? • A person impaired by Xanax (Alprazolam) will appear similar to one intoxicated by alcohol? TRUE

  38. “Sleep aids” • Nearly 3 in 10 American women use some kind of sleep aid at least a few nights a week according to the National Sleep Foundation “Mother’s New Little Helper,” The New York Times (Nov. 6, 2011)

  39. FDA Warning Jan. 2013 • Ambien, Ambien CR, Edluar, and Zolpimist • Risk highest for patients taking extended-release forms (Ambien CR and generics) • Women appear to be more susceptible to this risk because they eliminate zolpidem from their bodies more slowly than men

  40. AntidepressantsAbilify, Cymbalta, Elavil, Paxil, Zoloft • Use up 400% in two decades • 11% of people over 23 are using • Third most common drug for 18-44 year olds Pratt, Laura A., et al., “Antidepressant Use in Persons Aged 12 and Over in the United States, 2005-2008,” NCHS Data Brief No. 76 (Oct. 2011)

  41. Antiidepressants, cont. • Antidepressants increase crash risk • Even high doses of antipsychotics NOT associated with an increased risk of a serious crash British Journal of Clinical Pharmacology (Sept. 13, 2012)

  42. “Do Not Operate Heavy Equipment”

  43. Rx studies • Two meta analyses of benzodiazepines (Ativan, Xanax, Valium) showed 60-80% increased crash risk • Increase of 40% for crash responsibility • Benzos with alcohol increase risk 8xs

  44. Rx studies, cont. • Bipolar meds (tricyclic antidepressants) may increase crash risk for those >65 • Sedative antidepressants (Elavil) and pain meds (Vocodin, OxyContin) may increase crash risk “Effects of benzodiazepines, antidepressants and opioids and on driving: A systemic review and meta analysis of epidemiological and experimental evidence,” AAA Foundation Report (2010)

  45. Arizona vs. Fannin 1 CA-CV 11-0615 (Aug. 2012) • Affirmative defense • “Section 28-1381(D) provides a narrow safe harbor for a defendant charged with violating 28-1381(A)(3). • “A person using a drug as prescribed by a medical practitioner licensed pursuant to [A.R.S. T]itle 32, [C]hapter 7 [podiatrist], 11 [dentist], 13 [medical doctor] or 17 [osteopath] is not guilty of violating” 28-1381(A)(3). A.R.S. § 28-1381(D). • D must prove by a preponderance of the evidence that he used prescription drugs as prescribed by a licensed medical practitioner.

  46. DISCUSSION QUESTION • A Sobriety Court participant tests positive for a drug while driving. • Is there a difference between driving impaired by MISUSED prescribed medication vs. methamphetamine? Alcohol vs. “medical” marijuana

  47. Saliva test for recent use • National Institute on Drug Abuse (NIDA) reports there will soon be a saliva test to detect recent marijuana use • The saliva test currently being developed still won’t detect levels, only whether the person has smoked recently or not

  48. DISCUSS: Should we legislate zero tolerance for all substances including illicit, prescribed and over-the-counter medications that can impair driving?

  49. UNIQUE LEGAL ISSUES

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