drug driving: the scientific evidence behind the new ...

DRUG DRIVING: THE SCIENTIFIC EVIDENCE BEHIND THE NEW OFFENCE

DR KIM WOLFF READER IN ADDICTION SCIENCE KING’S COLLEGE LONDON

DRUG DRIVING 2015 KW

1

2011 Government agreed to implement recommendations from the North Report Government’s 2011 Framework for Road safety

“…WE WILL EXPLORE THE CASE FOR I NT RODUCING A N OF F ENCE OF HAVI NG A SPECIFIED DRUG IN THE BODY WHILE DRIVING, IN ADDITION TO THE CURRENT OFFENCE OD DRIVING WHILST IMPAIRED BY DRUGS…..”


2

2012 EXPERT PANEL TERMS OF REFERENCE TO DISCERN WHICH COMPOUNDS FROM THE FOLLOWING LIST S HO U LD FO R M PA RT O F T HE STAT U TO RY IN ST RU M E N T R E LAT E D TO A SPECIFIC OFFENCE OF DRIVING WHILST UNDER THE INFLUENCE OF DRUGS :

Amphetamine-type; Benzodiazepines and hypnotics; Cannabinoids (natural and synthetic); Cocaine (including salt and crystalline forms); Hallucinogens; Opioids (natural and synthetic) Other substances if the group considers they have a similar and significant presence in the population


3

LEVEL OF RISK RATHER THAN IMPAIRMENT OUR APPROACH DID NOT SEEK TO DEFINE, MEASURE OR PRO PO RTION A D RU G LEV EL TO A C ERTAIN D EG R EE O F IMPAIRMENT L E G I S L A T I O N A L R E A D Y I N P L A C E F O R D R I V I N G W H I L S T IMPAIRED

 Section 4 of the Road Traffic Act 1988 of driving while unfit due to drugs I N T E R M S O F O U R T O R D E F I N I N G I M P A I R M E N T F O R D I F F E RENT C L A S S ES O F D RU G S TO O D I F F I C ULT T H E R E I S N O U N I V E R S A L A G R E E M E N T O N H O W T O M E A S U R E IMPAIRMENT I M P A I R M E N T D I F F E R S F O R D I F F E R E N T C L A S S E S O F D R U G S (STIMULANTS VS DEPRESSANTS VS HALLUCINOGENS)


4

CONSIDERATION OF THE SCIENTIFIC EVIDENCE Drug Driving Literature ◦ Meta-analysis of the above drug driving evidence Identify the risk estimates (Odds Ratios) from single and combined use of psychoactive substances when driving in relation to driver safety We considered ORs for: ◦ Roadside survey’s of driving population of apprehended for suspected drug driving/impaired driving and RTCs ◦ From hospital studies (seriously injured and killed drivers) ◦ Case control studies


5

SCIENTIFIC EVIDENCE FOR RISK W E C O N S I D E R E D O D D S R AT I O S ( T H AT E S T I M AT E R I S K ) F R O M D R U I D . •D R U I D C A L C U L A T E D T H E R I S K O F B E I N G S E R I O U S L Y I N J U R E D O R KILLED IN A RTA •B A S E D O N C O N T R O L D A T A F R O M R O A D S I D E S U R V E Y S , C A S E D A T A FRO M HO S PITAL ST UD IES A N D FRO M ST UD IES O N K ILLED DRIVERS. •T H E O R W E R E A D J U S T E D F O R A G E A N D G E N D E R A N D D R U G U S E VS NON DRUG USERS •C O N T R O L S W E R E W E I G H T E D W I T H T H E T R A F F I C D I S T R I B U T I O N , TIME OF DRIVING, ROAD CONDITIONS ETC.


6

There was a lot of information!

http://www.bing.com/images/search?q=image+of+overworked&qs=n&form=QBIR&pq=image+of+overworked&sc =0-14&sp=-1&sk=#view=detail&id= 36044D62108D30D70F28022F32109 DD66A8A69D7&selectedIndex=5 DRUG DRIVING 2015 KW

7

MARCH 2015 NEW LEGISLATION Summary A new offence of driving with certain specified controlled drugs* in excess of specified levels in the body came into force during March 2015.

This offence is an addition to the existing rules on drug impaired driving and fitness to drive. The legislation also provides for a statutory “medical defence” for this new offence, for patients taking their medicines in accordance with instructions. * Controlled drugs are defined in the Misuse of Drugs Act 1971


8

IN PRACTICE Stopped by police for driving offence Breathalysed first Then drug screen. Oral Fluid (saliva test) – only test for cannabis or cocaine at moment If deemed unfit or impaired

Blood sample at Police Station will test for all 17 drugs Image – www.mirror.co.uk


9

CUT-OFFS FOR ILLICIT DRUGS EXPERT PANEL

L E G I S L ATI O N

THC

5 ug/L

THC

2 ug/L

Cocaine

80 ug/L

Cocaine

10 ug/L

BZE

500 ug/L

BZE

50 ug/L

Methylamphetamine

200 ug/L

Methylamphetamine

10 ug/L

MDMA

300 ug/L

MDMA

10 ug/L

Ketamine

200 ug/L

Ketamine

10 ug/L

LSD --------------------------

LSD

1 ug/L

6MAM-----------------------

6MAM

5 ug/L


10

SCIENTIFIC FINDINGS ALCOHOL MOST COMMON

CANNABIS COCAINE A M PHETAMINE -T YPE PRESCRIBED LICENCED DRUGS

Benzodiazepines and Z-drugs Medicinal opioids Opiates, illicit opiates HA LLU CIN OGEN S (K ETAMINE, LS D , G B L, G HB ) NO SURPRISES


11

CANNABIS SEVERAL KEY FACTS

F O R Δ 9- T E T R A H Y D R O C A N N A B I N O L ( T H C ) :

1.

A D U LTS ( 16 TO 5 9 Y R S ) W H O R E P O RTED D RU G -D RIVI NG W I T H ILLEGAL DRUGS (ONCE OR TWICE IN LAST 12 MONTHS), C A N N A B I S WA S T H E M O S T C O M M O N LY U S E D D R U G .

2.

S IG NIFICANT D OS E R ELATED D EC R EMENT IN D R IVING PER FO RMAN CE (O B S ERVED EX PER IMENTAL A N D R EA L-LIFE S I T UAT IO N S ( S I M U L ATO R , L A B O R ATO RY A N D FO R E N S I C T R A F FI C DATA)

3.

R A I S E D B LO O D C O N C E N T R AT I O N S O F T H C A R E S I G N I F I C A N T LY A S S O C I ATE D W I T H I N C R E A S E D T R A F F IC C R A S H A N D S E R IO U S / FATAL INJ URY R ISK

4.

M E TA - A N A LY S I S S H O W M E A N B LO O D C O N C E N T R AT I O N S > 3 . 7 µ g / L IMPAIRS INDIVIDUALS TO A DEGREE COMPARABLE TO BLOOD ALCOHOL LEVELS 50mg/100mL BLOOD.


12

CANNABIS - 2 CANNABIS USE BEHAVIOUR 1.

Smoking a single cannabis cigarette infrequently (recreational use): higher conc THC (21 µg/L - 162 µg/L) causing acute intoxication

2.

In chronic, daily or near daily use over a prolonged period (years), steady-state concentrations of THC ranging between 1 µg/L to 6.4 µg/L

3.

Blood concentrations are maintained by sequestration of the drug from the tissues: falling to