Driving Under the Influence of Non-alcohol DrugsReview of Earlier Studies* | 10 |
JØRG G. MØRLAND
Contents
10.1 Introduction
10.2 Methodological Issues
10.2.1 Controlled Experimental Studies
10.2.2 Analytical Epidemiological Studies (Allowing Traffic Accident Risk Evaluation)
10.2.3 Survey Studies (Descriptive Epidemiological Studies)
10.3 What Do We Know about Different Groups of Drugs and Traffic Safety?
10.3.1 Benzodiazepines and Related Drugs
10.3.1.1 Controlled Experimental Studies
10.3.1.2 Analytical Epidemiological Studies
10.3.1.3 Descriptive Epidemiological Studies
10.3.1.4 Conclusions
10.3.2 Cannabis
10.3.2.1 Controlled Experimental Studies
10.3.2.2 Analytical Epidemiological Studies
10.3.2.3 Descriptive Epidemiological Studies
10.3.2.4 Conclusions
10.3.3 Opioids
10.3.3.1 Controlled Experimental Studies
10.3.3.2 Analytical Epidemiological Studies
10.3.3.3 Descriptive Epidemiological Studies
10.3.3.4 Conclusions
10.3.4 Amphetamine and Related Drugs
10.3.4.1 Controlled Experimental Studies
10.3.4.2 Analytical Epidemiological Studies
10.3.4.3 Descriptive Epidemiological Studies
10.3.4.4 Conclusions
10.3.5 Antihistamines
10.3.5.1 Controlled Experimental Studies
10.3.5.2 Analytical Epidemiological Studies
10.3.5.3 Descriptive Epidemiological Studies
10.3.5.4 Conclusions
10.3.6 Antidepressants
10.3.6.1 Controlled Experimental Studies
10.3.6.2 Analytical Epidemiological Studies
10.3.6.3 Descriptive Epidemiological Studies
10.3.6.4 Conclusion
10.3.7 Summary
10.4 The Assessment of Drug Impairment
10.5 Roadside Detection of Non-alcohol Drugged Driving
10.5.1 Observation of Behavior
10.5.2 Drug Screening
10.6 Legislation
10.7 Non-alcohol Drugged Driving in Norway
10.8 Prevention
10.9 Further Research
10.10 Conclusions
Acknowledgments
References
The negative role of alcohol in vehicular traffic has been recognized for a long time, as documented by epidemiological and experimental research in several countries (Borkenstein et al. 1974; Simpson 1986; Kerr and Hindmarch 1998). In spite of legal and other countermeasures to combat drunken driving, it still persists at an almost unacceptable level as demonstrated, for example, by a high recidivism rate for convicted drunken drivers in many countries (Brewer et al. 1994; Wells-Parker et al. 1995), and by high percentages of alcohol involvement in fatal crashes. In fact, the US National Highway Traffic Safety Administration estimated that 44% of fatal crashes in 1993 involved alcohol use (US National Highway Traffic Safety Administration 1994). The risk of causing a fatal car accident for a driver with a high blood alcohol level has been demonstrated to be greatly increased (Perrine et al. 1971; Borkenstein et al. 1974; Klebelsberg 1988; Sleet et al. 1989; Robertson and Drummer 1994).
During recent years, the problem of drugged driving (i.e., driving under the influence of non-alcohol drugs) has received considerable attention. In many countries the first studies in this field dealt with possible dangerous side effects which could occur during treatment with medicinal drugs in therapeutic doses (Seppala et al. 1979). As drug abuse and drug dependence problems developed in the United States and Europe, interest on illicit drug and abuse of medicinal drugs and traffic safety has increased. The Pompidou group of the European Council this year (1999) arranged a seminar on “Road traffic and illicit drugs.” In this seminar as well as from several reviews of the literature published in recent years (Hindmarch et al. 1991; Ferrara 1987; Albery et al. 1998; Moskowitz 1976; Seppala et al. 1979), it has been stated that our knowledge about drugged driving is less comprehensive than about drunken driving. Two main questions have frequently been discussed as the most important ones for any non-alcohol drug:
• To what extent will the use of a particular drug constitute a risk to traffic safety?
• To what extent do drivers on the roads use a particular drug which might constitute a traffic hazard?
In the following review I will first briefly discuss the methods available to answer these questions in Section 10.2. Then some results will be presented for the groups of drugs which have been studied, to an extent allowing some answers to the two main questions, in Section 10.3. This will be followed by sections briefly discussing assessment of drug impairment in practice, problems connected with the detection of potentially dangerous drugged driving and some legal issues. Finally, a short description of the situation in Norway, which has a very high detection rate of drugged drivers, will be given in addition to a discussion of prevention and future research issues in this field.
10.2 Methodological Issues
The information obtained with relevance to the first of the two main questions, “To what extent will the use of a particular drug constitute a risk to traffic safety?,” has originated from two major sources (Simpson and Vingilis 1992): (a) Controlled experimental studies and (b) Analytical epidemiological investigations.
10.2.1 Controlled Experimental Studies
This type of study comprises a series of different performance tests thought to be of importance for various aspects of the process of operating a car, as well as simulated driving and real driving under controlled conditions (Table 10.1). The idea behind the performance tests is that they should represent important mental and behavioral functions relevant to driving. Particular emphasis has been put on tests that measure sedation and drowsiness, divided attention, continuous perceptual-motor co-ordination, speed and accuracy of decision making, vigilance and short-term memory, to mention a few (de Gier and Vermeeren 1995; Vermeeren et al. 1993). It has also been pointed out that a battery of tests which are mutually independent should be used to characterize the effects of the drugs tested (Zacny 1995). Many drugs have so far been tested in experiments with single or combinations of various performance tests. Simulated driving experiments have not been conducted to the same extent. Simulators can be of two major types, interactive (wherein the driver has control of the speed and the path of the vehicle) and non-interactive (wherein the driver is only capable of making decisions, but cannot actually control the vehicle) (Irving 1988). Various levels of sophistication with respect to computer interface, robotics, and virtual reality applications a...
