Drugged driving

ALSO KNOWN AS: Driving under the influence; impaired driving

DEFINITION: Drugged driving is the operation of a vehicle with a measurable quantity of an abusive or nonabusive substance in the body. Impaired driving results from any amount of illicit substance, such as heroin, cocaine, and marijuana, and impairing amounts of legal substances, such as sedatives or prescription painkillers. Driving under the influence of drugs can be particularly pronounced when the substance or substances are combined with alcohol.

Statistics

Drugged driving has become a growing problem in the United States and across the globe; twenty-first-century rates in the United States approach those of drunk driving, and the US Centers for Disease Control and Prevention estimated that 12.6 million Americans drove under the influence of marijuana or other drugs in 2018. Data collected by survey and reporting organizations, such as the Fatality Analysis Reporting System and the Monitoring the Future drug-use survey in teenagers, suggest that drugs are identified seven times more often than alcohol in youth drivers on weekend nights.

Nearly one-third of high school seniors admit to riding with an impaired driver or driving a car while impaired from drug use. Marijuana is the primary drug associated with drugged driving in youth and all other age groups; the second and third most frequently used are cocaine and methamphetamines, respectively.

A growing concern is the contribution of prescription painkillers and sedatives to drugged driving. In the United States, impaired driving rates from benzodiazepines or opiates approach those of drugged driving with cocaine.

Risk Groups

People age fifty-five years and older are at particular risk of impaired driving from the sedating effects of prescription drugs through normal use or misuse. Any person who uses a sedating prescription or nonprescription drug may experience impaired driving; people who obtain multiple prescriptions of painkillers, sedatives, or antidepressants are most likely to experience drug misuse and driving impairment.

The most common drugged-driving risk group, however, is youth, especially new drivers. Approximately 25 percent of vehicle-related fatalities that occur each year involve drivers younger than age twenty-five years. In 2021, the number of young drivers who were killed in car crashes rose 11 percent from the prior year, from 1,899 to 2,116, according to the National Highway Traffic Safety Administration. Prior offenders of drunk or drugged driving laws comprise another at-risk population.

Testing

Documenting drugged driving is complicated, in part because impairment thresholds are frequently unknown and evaluation methods are not standardized. For example, studies show that marijuana and stimulants increase the likelihood of poor decision-making and response times while driving. Connecting the use of these drugs with specific vehicle crashes is difficult, however, because of overlapping use, low testing rates, and poor understanding of the behaviors that cause reckless driving. Furthermore, each year, hundreds of crashes go unreported, often to prevent legal ramifications for the driver. Also, many drivers under the influence of drugs can go unnoticed, and many will not readily admit drug use. Therefore, the numbers of drivers impaired by drugs is likely much higher than what studies and reports are able to show. Better and more frequent drug testing can support the connection between drug use and impaired driving.

Testing for drug impairment is more complex than testing for blood alcohol content (BAC). Choices about what drugs to test for and what methods to use remain unclear. Because drug levels in the body fluctuate nonlinearly, tested concentrations are not always predictive of effect. In addition, circulating drug metabolites can impair ability at least as much as the original drug but may not affect test results. Finally, drug testing must be conducted rapidly, because the primary drug can dissipate within hours despite lingering impairment.

Testing can be performed on urine, blood, or oral fluids. Blood tests report the most accurate drug concentrations but are invasive, costly, and time consuming. Urine is less indicative of drug effects and is difficult to test reliably in the field. Both blood and urine testing can require offsite laboratory evaluation, which adds to the cost and timeliness of results.

Oral fluid testing, conversely, is easy to administer and provides reasonable accuracy. However, these tests still do not evaluate metabolites, and they do not always have evidence-based cut points that reflect impairment. Oral kits have become preferred for field use because they are rapid-use tests that do not require a laboratory. Although rapid tests provide the best option for identifying drugged drivers quickly and are more accessible for law enforcement, they have lower sensitivity and more false positives than laboratory tests.

A barrier to frequent drugged-driving testing is appropriate drug identification. Law enforcement must identify behaviors representing drug use before ordering tests; the ability to distinguish the types of drugs by symptoms is crucial to minimize what drugs are tested for. Drug-recognition-expert programs are being developed to address this need and to educate law enforcement officers about the symptoms of specific drug use.

Prevention

Prevention is implemented through the education of three populations: new drivers, who are often unaware that drugged driving poses risks and consequences similar to those of drunk driving; law enforcement professionals, who need to identify and test persons who are suspected of drugged driving; and health professionals, who can identify risks associated with specific prescriptions or persons on multiple high-risk drugs.

A reduction in drugged driving rates and prevention of future offenses requires improved testing technology and application, greater professional education and outreach efforts, and broad public-health awareness campaigns. These efforts can be supplemented by clear legal restrictions, especially zero tolerance policies for illicit drug use while driving. Partnered efforts for public education, especially youth antidrug campaigns, are necessary deterrents, as are fines and arrests for drugged driving.

Over-the-counter and prescription drugs pose a greater challenge for prevention and legislation, as these drugs are legal and common. However, even therapeutic dosages can affect driving in some people. The efforts of health professionals to educate the public about the sedating effects of legal drugs and about the risks of misuse and drugged driving should be at the forefront.

Bibliography

“2021 Data: Young Drivers.” National Highway Traffic Safety Administration, U.S. Department of Transportation, Aug. 2023, crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/813492.pdf. Accessed 19 September 2024.

"DrugFacts: Drugged Driving." National Institute on Drug Abuse. NIH, May 2015. Web.27 Oct. 2015.

Dupont, Robert L., et al. “Drugged Driving Research: A White Paper.” Institute for Behavior and Health, 31 Mar. 2011. obamawhitehouse.archives.gov/sites/default/files/ondcp/issues-content/drugged-driving/nida‗dd‗paper.pdf. Accessed 19 Sept. 2024.

“Impaired Driving.” Center for Disease Control, 16 May 2024, www.cdc.gov/impaired-driving/about/index.html. Accessed 19 September 2024.

Maxwell, J. C. “Drunk Versus Drugged: How Different Are the Drivers?” Drug and Alcohol Dependence 121 (2012): 68–72. Print.

Yellman, M.A., et al. "Transportation Risk Behaviors among High School Students — Youth Risk Behavior Survey." MMWR Supplements, vol. 69, no. 1, 2020, pp. 77–83. CDC, dx.doi.org/10.15585/mmwr.su6901a9. Accessed 19 Sept. 2024.