Driving, Drinking, and Drug Use

31. Breath Testing for Other Drugs in DUI Enforcement

"The results of this investigation provide further support to the possibility of using exhaled breath as a readily available specimen for drugs of abuse testing. There is a possibility that exhaled breath will develop into a new matrix for routine drug testing and present an alternative to already used matrices like urine, blood, oral fluid, sweat and hair. Each matrix may have its specific advantages and disadvantages. Since exhaled breath may be as easy to collect as in alcohol breath testing, it may present a new, more accessible matrix than blood at the roadside and elsewhere when the sampling procedure is an obstacle. We previously observed that exhaled breath methadone increases after intake [2]. If a correlation to blood concentration can be shown for exhaled breath levels, it may become a substitute matrix for monitoring impairment. One advantage of exhaled breath may be the detection of 6-AM, which is problematic in blood."

Olof Beck, et al., "Detection of drugs of abuse in exhaled breath using a device for rapid collection: comparison with plasma, urine and self-reporting in 47 drug users," Journal of Breath Research, 7 (2013) 026006 (11pp), http://dx.doi.org/10.1088/1752...

32. Oral Fluid Test Evaluations for DUI Enforcement

"It is disturbing that the sensitivities of the cannabis and cocaine tests were all quite low, although further testing of the cocaine tests is desirable due to the low prevalences and the low concentrations encountered in this study. There are several countries in Central and Southern Europe for which these two substance classes are of special interest. On the other hand, it seems the sensitivities of the devices are generally better for amphetamines, a frequently encountered drug class among the DUI drivers in the Nordic countries. The suitability of the device for the intended national DUI population should also be considered, for example, PCP is rarely, if ever, found in Europe, therefore at the current time utilising a PCP test is unnecessary. Since the on-site tests are relatively expensive the suitability of all the individual substance tests incorporated in the device should be considered.
"The evaluation showed that none of the evaluated tests is on a desirable level (>80% for sensitivity, specificity and accuracy) for all of the separate tests that they comprised. However, there were tests that performed already on a promising level for one or more substance classes. The DrugTest 5000 had the best overall results. The next best device was Rapid STAT, which performed at a similar level, except for the cocaine test which was somewhat less sensitive. Clearly the best device in terms of sensitivity for amphetamines was the DrugWipe 5+."

Driving under the Influence of Drugs, Alcohol and Medicines (DRUID Project) 6th Framework Programme, "Analytical evaluation of oral fluid screening devices and preceding selection procedures," Deliverable 3.2.2 (Finland: National Institute for Health and Welfare, March 30, 2010), p. 95.

33. Thresholds for Serum THC Level Compared With Blood Alcohol Content

"Risk thresholds could be formulated only for THC which was the most prevalent illicit drug in the general driving population and in injured/killed drivers. The prevalence of THC across all countries that participated in DRUID is 1.37%. This is about one third of the alcohol prevalence. The epidemiological, the experimental and the meta-analytical approaches result in rather low risk estimations. Epidemiological case-control studies assess at maximum a 2.4-fold risk for injury, experimental studies and meta-analysis rank the risk between 0.5 and 2 times than that of sober driving. So THC seems to be much less impairing and risky than most of the other examined substances. Although a relationship between THC concentration and accident risk was found in the epidemiological studies, it was only possible to set an exact THC cut-off by a meta-analysis of experimental studies. Thereby it was found that the serum concentration of 3.8ng/mL THC (?2ng/mL in whole blood) causes the same amount of impairment as 0.5g/L alcohol. This value could be an empirical basis for a threshold discussion. The meta-analysis could also be used to define limits comparable to lower BAC levels."

Schulze, Horst, et al., "DRUID (Driving under the Influence of Drugs, Alcohol and Medicines) Final Report: Work performed, main results and recommendations," Project Funded by the European Commission under the Transport RTD Programme of the 6th Framework Program, Project No: TREN-05-FP6TR-S07.61320-518404-DRUID (Federal Highway Research Institute, Germany, Aug. 1, 2012), p. 84.

34. Marijuana, Alcohol, and Driving

"As with cannabis, alcohol use increased variability in lane position and headway (Casswell, 1979; Ramaekers et al., 2000; Smiley et al., 1981; Stein et al., 1983) but caused faster speeds (Casswell, 1977; Krueger & Vollrath, 2000; Peck et al., 1986; Smiley et al., 1987; Stein et al., 1983). Some studies also showed that alcohol use alone and in combination with cannabis affected visual search behavior (Lamers & Ramaekers, 2001; Moskowitz, Ziedman, & Sharma, 1976). Alcohol consumption combined with cannabis use also worsened driver performance relative to use of either substance alone. Lane position and headway variability were more exaggerated (Attwood et al., 1981; Ramaekers et al., 2000; Robbe, 1998) and speeds were faster (Peck et al., 1986).
"Both simulator and road studies showed that relative to alcohol use alone, participants who used cannabis alone or in combination with alcohol were more aware of their intoxication. Robbe (1998) found that participants who consumed 100 g/kg of cannabis rated their performance worse and the amount of effort required greater compared to those who consumed alcohol (0.05 BAC). Ramaekers et al. (2000) showed that cannabis use alone and in combination with alcohol consumption increased self-ratings of intoxication and decreased self-ratings of performance. Lamers and Ramaekers (2001) found that cannabis use alone (100 g/kg) and in combination with alcohol consumption resulted in lower ratings of alertness, greater perceptions of effort, and worse ratings of performance."

Laberge, Jason C., Nicholas J. Ward, "Research Note: Cannabis and Driving -- Research Needs and Issues for Transportation Policy," Journal of Drug Issues, Dec. 2004, pp. 978.

35. Cannabis Use and Motor Vehicle Accident Risk

"Our primary analysis looked at the risk of a motor vehicle collision while under the influence of cannabis and included all nine studies (relating to 49 411 participants). The pooled risk of a motor vehicle collision while driving under the influence of cannabis was almost twice the risk while driving unimpaired (odds ratio 1.92 (95% confidence interval 1.35 to 2.73); P=0.0003); we noted heterogeneity among the individual study effects (I2=81%).
"We also assessed culpability and non-culpability studies separately and explored differences between motor vehicle collisions resulting in deaths and non-fatal injuries. Meta-analyses on subgroups of studies explored the potential effect of specific features related to study design and potential biases: case-control studies versus culpability studies, fatal collisions versus non-fatal collisions, and high quality studies versus medium quality studies (fig 3?).
"High quality studies had a pooled odds ratio that was higher than that for medium quality studies, although both results showed a significant association at the 0.05 level. Furthermore, case-control studies (2.79 (1.23 to 6.33); P=0.01) estimated the effect of cannabis use on crash risk to be higher than that estimated by culpability studies (1.65 (1.11 to 2.46); P=0.07). Studies of fatal collisions (2.10 (1.31 to 3.36); P=0.002) had a pooled odds ratio that was statistically significant, but studies of non-fatal collisions (1.74 (0.88 to 3.46); P=0.11) did not show significant results.
"In all studies assessing cannabis use in conjunction with alcohol, the estimated odds ratio for cannabis and alcohol combined was higher than for cannabis use alone, suggesting the presence of a synergistic effect."

Asbridge, Mark, et al., "Acute Cannabis Consumption and Motor Vehicle Collision Risk: Systematic Review of Observational Studies and Meta-analysis," British Medical Journal, 2012;344:e536 doi: 10.1136/bmj.e536 (Published 9 February 2012).