DRUG
NFO
clearinghouse
www.druginfo.adf.org.au
PreventionResearchQuarterly
March 2010 ISSN 1832-6013
Drugs and driving
Prevention Research Quarterly
ISSN 1832-6013
© DrugInfo Clearinghouse 2010
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Contents
Drugs and driving
Issues Paper no. 12
Reading and Resource List no. 30
1
24
Issues Paper
DRUG
No. 12 • March 2010
NFO
clearinghouse
www.druginfo.adf.org.au
The role of alcohol and other
drugs in road deaths and
serious injuries
Professor Con Stough and Rebecca King, Drugs and Driving Research Unit,
Brain Sciences Institute, Swinburne University, Melbourne, Victoria
The total number of people killed on Australian roads in 2006 was 1601, with a further 31 204 people
suffering serious injuries.1,2 Many factors are believed to contribute to traffic accidents, including drug
and alcohol use, fatigue and speed. This paper examines the impact of alcohol and other drug use,
including various pharmaceuticals, on road deaths and injuries. It also outlines a number of strategies
that are currently being implemented to minimise and reduce the number of drivers who consume
drugs. Prevention strategies include current education activities in schools, advertising campaigns and
information provided by health professionals. Detecting drug driving, and treatment and education
following the loss of licence due to drug driving, are also discussed. All of these approaches work together
to reduce the number of individuals who drive under the influence of drugs. In addition to a review of
relevant literature, the views of key informants who have professional experience in a range of fields
(alcohol and other drug service delivery, road safety and research) were sought to inform this paper.
Introduction
Alcohol has long been recognised as a major
contributor to fatal road accidents. In 2008
28 per cent of all drivers killed on Victorian roads had
a blood alcohol concentration (BAC) of 0.05g/100mL
(0.05 per cent) or higher.3 Alcohol significantly
increases a driver’s risk of a serious road crash,4 with
drivers over 0.05 per cent BAC being more than
twice as likely to be responsible for the accident than
a driver who is drug- and alcohol-free.5 Figure 1
shows the number of drivers and motorcyclists
killed between 1987 and 2008 with BAC levels over
0.05 per cent.
Over one in 10 (13.4 per cent) Australians aged
14 years and older report illicit drug use within the
past 12 months.6 The most commonly used illicit
drug in Australia is cannabis, followed by ecstasy
(methylenedioxymethamphetamine, MDMA) and
methamphetamine. Although the use of cannabis
has declined since 1998, it has been used recently
by close to one in 10 Australians (9.1 per cent) and
is still a serious road safety concern. The use of
synthetic drugs such as ecstasy, amphetamine and
methamphetamine is steadily increasing around
Australia with over one in 10 (12.0 per cent)
20–29 year olds reporting use within the past
12 months. These types of synthetic drugs are gaining
popularity and are used predominantly by young
people and truck drivers.7
Due to the increasing number of Australians using
illicit drugs there is growing concern over their
involvement in traffic accidents and fatalities. Road
statistics indicate that drug-related road accidents
and deaths have increased dramatically during the
past 15 years. From 1990 to 1993, 22 per cent of all
Victorian drivers killed tested positive for the presence
of drugs other than alcohol (9.6 per cent involved
cannabis, 3.9 per cent amphetamines and other
stimulants, 4.5 per cent benzodiazepines and 3.3 per
cent opioids). This percentage has increased to 33 per
cent in 2004 (12.6 per cent involved cannabis, 4.9
per cent amphetamines and other stimulants, 4.4 per
cent benzodiazepines and 7.1 per cent opioids).3,8–10
These statistics are similar to those reported in other
countries. For instance, in Washington, data have
revealed that the incidence of impairing drugs found
in fatally injured drivers has increased significantly
Issues Paper | No. 12 | March 2010
1
140
120
100
80
60
40
20
0
1987 1988
1989 1990 1991 1992
1993
1994 1995 1996 1997
0.05 to 0.10
1998 1999 2000 2001 2002
0.101 to 0.15
2003 2004 2005 2006 2007 2008
Over 0.15
Figure 1. Number of drivers and motorcyclists killed with a blood alcohol concentration of 0.05g/100mL
or over (TAC, 2009)
during the past decade; from 25 per cent in 1991
to 35 per cent in 2001.11 In particular, fatally injured
drivers who tested positive for methamphetamine
increased a staggering 200 per cent. Schwilke
suggests that this is reflective of the general growth
in popularity of this class of illicit substance.11 The
number of fatally injured drivers in the United
Kingdom who test positive to illicit drugs has also
risen from 3 per cent in the mid-1980s to 18 per cent
in 1999.12 France also saw a significant increase in the
presence of impairing drugs in fatally injured drivers
between 2001 and 2004, with cannabis increasing
from 16.9 per cent to 28.9 per cent, cocaine from
0.2 per cent to 3.0 per cent and amphetamines
from 1.4 per cent to 3.1 per cent.13 These statistics
demonstrate the significant impact that drug driving
has on road safety.
Analysis of drivers injured in road traffic accidents also
reveals the significant impact of drugs on road safety.
A study that screened blood samples taken from 436
injured drivers attending the Alfred Emergency and
Trauma Centre in Prahran, Victoria, reported that
cannabis metabolites were found in 46.7 per cent of
injured drivers, with 7.6 per cent testing positive for
delta-9-tetrahydrocannabinol (THC), the active form
of cannabis. The next highest drug group detected
was benzodiazepines in 15.6 per cent of cases,
2
Drugs and driving
followed by opiates in 11 per cent, amphetamines in
4.1 per cent, methadone in 3 per cent and cocaine
in 1.4 per cent. Polydrug use was also reported
in 9.4 per cent of cases with the most common
combination being benzodiazepines and opiates,
followed by benzodiazepines and cannabis.14
Fatigue alone is also a serious road safety concern.
VicRoads estimate that around 20 per cent of fatal
road accidents involve driver fatigue. Many studies
have shown that moderate sleep deprivation of 17
to 19 hours produces driving impairments that are
equivalent to or worse than those seen at 0.05 per
cent BAC,15–18 while impairments observed at 20 to
24 hours of sleep deprivation have been shown to
be equivalent to 0.1 per cent BAC.15,16 When fatigue
is combined with substance use such as alcohol or
ecstasy, driving impairments are even greater than
with either alone.19–21
Assigning responsibility for accidents
Some studies have moved beyond stating the mere
prevalence of drugs in samples taken from fatally or
seriously injured drivers by using methods to assign
culpability or responsibility for each accident. This
allows us to better understand whether one type of
drug is more impairing than another.
Fatal accidents
In the first of a series of studies, Drummer
collected data for 1045 drivers killed.8 Culpability
or responsibility was determined according to the
mitigating factors (independent of drug analysis), and
drivers were classified as “culpable”, “contributory”,
or “not culpable”. The mitigating factors used
in the analyses were the condition of the road
and vehicle, driving conditions, type of accident,
witness observations, road law obedience, difficulty
of the task involved and the level of fatigue.22
The proportion of drivers classified as “culpable”
(odds ratio, OR) was calculated for each drug type
condition. The large majority (73 per cent) of drivers
in the sample as a whole were classified as culpable,
while only 18 per cent were not culpable. The highest
culpability ratio for any drug alone was found for
alcohol. Culpability ratios were considerably higher for
all drugs in combination with alcohol, except opiates.
More recently, a large study across Victoria, New
South Wales and South Australia revealed that drivers
who tested positive to psychoactive drugs were
more likely to be responsible for a fatal accident.5
The highest culpability ratio for a single drug was
again alcohol. Drivers with a BAC <0.05 per cent
were 1.2 times more likely to be responsible for the
accident, while drivers with a BAC over 0.20 per
cent were found to be 24 times more likely to be
responsible. Drivers intoxicated with cannabis were
also found to be at an increased risk of causing the
fatal accident, with THC concentrations over 5ng/
mL resulting in a culpability ratio of 6.6 (this is a
similar ratio to drivers with a BAC of >0.15 per
cent). Drivers also frequently combined alcohol
and cannabis, further increasing the risk of a fatal
accident. Stimulants significantly increased a driver’s
risk of a serious road crash, particularly in truck drivers
(culpability ratio of 8.8), while benzodiazepines and
opiates were found to have a weak relationship with
crash risk.
Non-fatal accidents
Responsibility analysis has also been used to
determine crash risk for injured drivers.4 Drivers
testing positive to alcohol only, benzodiazepines only,
and the combination of alcohol and cannabis and
alcohol and benzodiazepines, were significantly more
likely to be regarded as responsible for the accident
in comparison with those found to be drug- and
alcohol-free. However, unlike results reported by
Drummer,5 drivers who tested positive to cannabis in
this study were not found to have an increased crash
risk. One explanation for the difference in findings is
that lower concentration levels of THC were reported
in Longo’s study compared to Drummer’s.
Preliminary data from an ongoing Victoria Police and
Swinburne University study conducted in Melbourne
examining responsibility in injured drivers by Ogden et
al. have revealed that alcohol again had the highest
culpability ratio for a single drug; at less than 0.05
per cent BAC drivers were 4.7 times more likely to be
responsible for the accident than drug- and alcoholfree drivers.23 This increased to an OR of >6 for those
drivers who were only a little bit over (0.05–0.08 per
cent BAC), while drivers with a BAC of over 0.20 per
cent were found to be 20 times more likely to be
responsible. The most common illicit drug detected
was cannabis with 18 per cent of drivers testing
positive. Drivers detected with any level of THC had
only a slightly larger crash risk than drug-free drivers
(OR 1.5); however, when THC concentrations were
5ng/mL or more the risk increased dramatically with
an OR >6. Amphetamine-type stimulants were
detected in 13 per cent of drivers and 95 per cent of
these drivers were determined as being responsible
for the accident (Figure 2).
Of interest in this study are the high levels of
benzodiazepines detected, with 21 per cent of
drivers testing positive and 3 per cent with levels in
the toxic range. Most types of benzodiazepines were
associated with moderate increases in crash risk and
were found to be dose-dependant. Alprazolam in
particular stands out with 100 per cent of drivers
detected with this benzodiazepine being responsible
for the accident in which they were injured and half
of the drivers had toxic levels—clear evidence of
misuse. The data suggest that at therapeutic levels
benzodiazepines cause only a slight increase in crash
risk, whereas abuse or misuse is associated with much
higher crash risks.
Polydrug use was also frequently detected with over
20 per cent of drivers injured in traffic accidents in this
sample having more than one drug in their system.
The combinations most often detected were alcohol
and cannabis (OR 5.4), alcohol and benzodiazepines
(OR 13.8) and cannabis and benzodiazepines (OR 6.9).
While responsibility analyses provide important
information about the role of drugs in crashes, they
are not conclusive evidence of a causal relationship
because they only include crash-involved drivers. So,
Issues Paper | No. 12 | March 2010
3
a
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0
Any THC
THC >5
Any alcohol + THC
b
10
5
0
Methamphetamine
Amphetamine
c
MDMA
Methylenedioxyamphetamine (MDA)
20
16
12
8
4
0
Figure 2. Drugs and responsibility analysis from the study
by Ogden et al.23
while the analyses indicate that drugs are associated
with higher crash risk, experimental research is also
needed to examine the link between the presence of
these drugs in the blood and subsequent impairment.
In the next section we describe research that has
examined the effect of various drugs on driving, and
include some direct experimental studies in which
various drugs have been administered to drivers or
participants tested on driving simulators.
Drugs and driving
Alcohol
Alcohol is the most studied drug in relation to driving
impairment. A comprehensive review of 109 articles
about the effects of alcohol on driving-related skills
showed that alcohol, even in low doses, impairs
4
Drugs and driving
driving performance.24 Divided attention tasks
were shown to be extremely sensitive to alcohol
consumption with impairments being reported
at BACs as low as 0.001 per cent. Impairments in
vigilance tasks measuring alertness and concentration
were consistently observed at BACs of 0.03 per cent
and the majority of studies reported impairments in
cognitive tasks, psychomotor skills, perception and
tracking tasks between BACs of 0.04 per cent and
0.06 per cent.
Driving simulator studies demonstrate that alcohol
can be detrimental to many driving skills. Alcohol has
been shown to impair brake reaction time,25,26 divided
attention skills27 and speed control.28,29 Tracking, the
ability to maintain lane position, has consistently
been shown to be impaired by alcohol.30–32 Arnedt
et al. reported that after alcohol consumption,
participants’ speed and lane positions became more
variable and they drove off the simulated road
more frequently.17 Further reductions in driving
performance were observed when alcohol was
combined with prolonged wakefulness. Strayer found
that participants under the influence of alcohol drove
more aggressively by following closer to the car in
front of them which necessitated braking with greater
force.33 Hazard perception has also been reported to
be compromised by alcohol. West et al. reported that
a moderate dose of alcohol increased mean reaction
time to hazards.34 Consistent with these results, Deery
& Love found that subjects with a BAC of 0.05 per
cent took significantly longer to detect hazards than
when sober and responded to those hazards in a
more abrupt manner.35
The road toll, injury statistics, responsibility studies
as well as hundreds of experimental studies, leave
little doubt as to the impairing effects of alcohol,
even in small doses and especially in a complex task
such as driving.
Cannabis
Within a few minutes of inhaling cannabis smoke,
users often report feeling, along with intoxication,
rapid heartbeat, loss of coordination, poor sense of
balance, slower reaction time, distorted perception,
poor concentration and forgetfulness. Following this
acute phase is the residual or rebound phase where
intoxication subsides rapidly and is characterised by
fatigue, excessive sleepiness and inattention.
Table 1. The effects of various licit and illicit drugs on driving-related skills
Drug
Effects on driving-related skills
Alcohol
Impaired psychomotor skills, reaction time, perception, ability to keep the vehicle
within traffic lanes, ability to focus on more than one task, vigilance, brake reaction
time, speed control, increased aggression, decreased hazard perception.
Cannabis
Impaired psychomotor skills, reaction time, ability to keep the vehicle within traffic
lanes, visual functions, attention, ability to maintain speed, rebound fatigue.
Amphetamines
Impaired ability to keep the vehicle within traffic lanes, erratic driving, speed,
increased risk-taking, tunnel vision, rebound fatigue.
Ecstasy (MDMA)
Impaired ability to keep the vehicle within traffic lanes, visual functions, increased
risk-taking, speed control.
Ketamine
Impaired reaction time, balance and coordination, visual functions.
Research examining driving performance and
cannabis indicates a dose-dependant relationship,
with impairments demonstrated for every
performance area related to safe driving: reaction
time; tracking; psychomotor skills; visual functions;
and attention.36 Simulated and on-road driving
studies report impaired perceptual processes, such
as: monitoring the speedometer and maintaining
speed; response to stimuli, such as stopping and
starting; and subsidiary tasks.37–39 Tracking ability
is the most consistently reported driving skill to
be impaired after cannabis consumption and is
highlighted by an increase in the number of cones
hit on a driving course, an increase in sideways
movements of the vehicle and an increase in the
percentage of time spent out of a lane.40–42 In
line with these findings, a study funded by the
National Drug Law Enforcement Research Fund
(NDLERF) at the Drugs and Driving Research Unit
(DDRU) at Swinburne University in Melbourne
found that the consumption of low-dose and highdose cannabis was associated with an increase in
vehicle lane-weaving (straddling solid and barrier
lines).43 Cannabis impairment is most prominent
in the first 2 hours after smoking; however, driving
performance has been shown to be compromised up
to 5 hours after cannabis consumption.36 Drivers can
be impaired first by cannabis intoxication, and later
in the residual phase due to fatigue and inattention.
Despite common stereotypes regarding the low
risk of having an accident under the influence of
cannabis, there is no doubt that cannabis poses a
significant crash risk for drivers.
Amphetamines
Amphetamines can be taken orally, snorted or
injected, with users experiencing increased energy
levels and mental alertness. The effects intensify
with increased doses, and users may become overexcited, talkative and experience a false sense of
self-confidence or superiority. Physical effects of
amphetamines can include increased/distorted
sensations, hyperactivity, dry mouth, increased heart
rate, blurred vision, impaired speech, dizziness,
uncontrollable movements or shaking. In addition to
the physical effects, users often report feeling restless,
anxious and moody.
There has been little research examining the
effects of amphetamines on driving performance.
Laboratory studies show that at low doses
amphetamines improve some skills related to
driving.37,44 However, due to ethical constraints it
is difficult to assess larger recreational doses in the
laboratory. Crash statistics indicate that larger doses
can lead to driving impairments resulting in death
and injury, particularly for truck drivers.5,23 Logan
evaluated actual driving behaviour of drivers arrested
or killed in traffic accident who tested positive for
methamphetamines.45 He reported that drivers often
drifted out of the lane of travel, drove erratically,
had a tendency to weave, sped, drifted off the
road and were involved in high-speed collisions,
suggesting increased risk-taking. The only simulated
driving study to date showed that dexamphetamine
had a deleterious effect on driving performance.
Drivers under the influence of dexamphetamine
were more likely to fail to stop at a red traffic light
and signal incorrectly.46 A more recent study funded
Issues Paper | No. 12 | March 2010
5
by the Australian Research Council (ARC) showed
methamphetamine impaired some aspects of
driving performance despite improvements in simple
reaction time.47 Similar to cannabis, amphetamine
users can experience rebound fatigue due to
prolonged wakefulness.
More research is needed to evaluate the effects of
methamphetamine on driving; in particular it would
be useful to determine the extent of rebound fatigue
at various doses that approximate community use.
However, the rebound effect is likely to cause driving
impairment, therefore individuals should not drive
at any stage after consuming amphetamines and
particularly not drive during the rebound phase. As
some amphetamine users also show fatigue (due to
staying awake and attending rave and dance parties)
the rebound effect is further compounded by fatigue.
This latter issue is also observed in MDMA users.
Ecstasy
An ecstasy (MDMA) pill takes effect after 30–45
minutes, starting with little rushes of exhilaration, and
with intoxication lasting up to 5 hours. Along with
the positive feelings for which the drug is taken, users
may experience disorientation, dry mouth, blurred
vision and involuntary muscular activity.
Further research has examined the effects of
MDMA on driving performance. MDMA has been
demonstrated to improve some aspects of driving
such as speed of manual movement,48 tracking49 and
sustained attention50 and impair other driving skills
such as the ability to perceive and predict motion,48
visual scanning51 and accuracy of speed adaptation.52
A study conducted by De Waard reported that
MDMA-influenced drivers were prepared to accept
higher levels of risk.53 These types of impairment could
have serious consequences as drivers manoeuvre
in traffic. In contrast to Ramaeker and Kuypers’
finding that tracking performance was improved
after MDMA,49 Kuypers et al. found impairments in
tracking ability.21 The difference between these studies
is that Kuypers et al. administered night-time doses
of MDMA in order to more realistically demonstrate
what an MDMA user would experience after taking
the drug during the evening and going to a party.
The impairments reported were additive to sleep loss.
A recent placebo-controlled study at the DDRU in
6
Drugs and driving
which MDMA was administered to 60 participants,
showed performance was significantly worse under
the influence of MDMA.47 Drivers were more likely
to: signal incorrectly; undertake dangerous actions
like skidding; brake inappropriately; follow cars at
an unsafe distance; and speed. While MDMA may
improve some basic driving skills, it also impairs skills
that are essential for driving safely in traffic, especially
when combined with sleep loss.
As the results of these large federal governmentfunded studies (e.g. ARC funded study) become
available it is imperative that the results are
appropriately disseminated to government agencies
and to the wider public. Information that contradicts
stereotypes about the effects of common illicit drugs
(e.g. “that cannabis makes me drive more cautiously”)
is essential in changing driving behaviours in the
wider community and therefore decreasing accidents
and deaths on our roads. The results of these
experimental studies provide specific information
about which driving behaviours are impaired and at
what time after ingestion.
Ketamine
Ketamine is primarily used as an anaesthetic agent
and analgesic in medicine and veterinary practice.54
The hypnotic and hallucinogenic effects of this
drug are gaining popularity among those who
frequent dance parties as well as within the medical
profession.55–56 Psychological effects include novel body
sensations, dissociation, confusion57 and feelings of
invulnerability.54 Physical effects include tachycardia,
tachypnoea, blurred vision, uncoordination and
catatonia.57 Some users describe a spiritual near-death
experience known as the K-hole.54 There have been no
direct studies examining the effects of ketamine upon
driving. Instead, studies have focused on subjective and
objective data and correlate this to whether this may
or may not impair driving. A study by Guillermo et al.
revealed that reaction time is adversely affected by even
subacute doses of ketamine.58 A study undertaken on
dance party volunteers who tested positive to ketamine
revealed that 90 per cent of subjects with ketamine
above the cut-off concentrations of saliva 300 ng/mL
were deemed drug-impaired as determined by roadside
impairment tests.59 Further research on ketamine and
driving is required in a controlled clinical setting.
Opioids
Opioid drugs include opium, heroin, morphine,
codeine, pethidine, oxycodone, buprenorphine and
methadone. Prescription opioids are commonly used
in the community and prescribed for their analgesic
and antitussive properties.
Following an initial intense surge of euphoria, heroin
users alternate between a wakeful and drowsy state
known as “the nod”. Other common effects include
lethargy, disconnectedness, self-absorption, mental
clouding, delirium, the inability to concentrate and
diminished reflexes. Peak effects last for 1–2 hours
and the overall effects wear off in 3–5 hours,
depending on dose. Due to ethical constraints there
are very few experimental studies assessing heroin
effects. An early study conducted in the 1960s found
that heroin produced subjective feelings of sedation
and slowed reaction.60
Methadone and buprenorphine have been found to
be an effective long-term maintenance therapy for
those dependent on heroin.61 Due to this prevalence,
studies have been undertaken to review whether
these substances adversely affect driving ability.
While some studies reveal impairment,62–64 other
studies found that performance impairment does
not differ significantly in comparison to drug-free
subjects.65–68 Results appear to be dose-related
with effects differing between opioid-naïve and
opioid-dependent subjects. O’Neill et al.,66 Hanks et
al.,67 and Brooke et al.68 administered 10–15mg of
morphine, either as an acute dose or every 4 hours,
and found no significant impairment in driving tasks.
In fact morphine was found to improve reaction
time. Nevertheless, while Zacny et al. found that
hand–eye coordination was not affected by
2.5, 5 or 10mg/70kg doses of intravenous
morphine, other psychomotor skills were impaired
relative to the dose administered.62 Bruera et al.
examined patients taking morphine-based drugs
for pain relief.69 Those patients who received an
increased dose within the last 3 days experienced
significant cognitive impairment, with no difference
noted in those patients who were stabilised on a
set dose. Chesher et al. found similar results when
comparing driving ability between patients stabilised
on methadone and those beginning or receiving an
increased dose of methadone.70
A key finding appears to be that patients on a
maintenance dose have no psychomotor impairment
in relation to driving ability. This is likely to be due to
an increased opioid tolerance.71 Therefore, patients
are often advised to stop driving for up to 4 weeks
until their opioid regimen is stabilised.72,73
Benzodiazepines
Benzodiazepines are the most common psychotropic
drugs prescribed in Australia and are frequently used
for the treatment of anxiety and panic disorders.
They are also misused by some to self-medicate for
the adverse effects of other drug use. For example,
they may be used to alleviate withdrawal or “crash”
symptoms that arise from heavy amphetamine use.
Although drugs classed in this category have varying
effects on individuals, they are all known to have some
degree of sedative, hypnotic and anxiolytic action.
There is a lack of conclusive research on the effects
of benzodiazepines on driving skills, in particular in
patient populations for which the drug is intended.
To date, research on the effects of benzodiazepines
on psychomotor performance have provided
inconsistent results. The reports suggest that
benzodiazepines can either impair74–75 or have no
effect on performance tasks that assess drivingrelated skills.76 Improvement in performance has even
been reported,77 which suggests that the variation in
findings may be, in part, due to the variation in an
individual’s response to the drug itself, withdrawal
effects and whether the drug is misused or taken to
improve functioning in various patient conditions.
Driving simulator studies on opioids and
benzodiazepines often conflict with reported crash
risk statistics, because there have been few studies
that examine administration of these substances in a
controlled manner, taking into account the disorder
for which they may be prescribed, tolerance and dose.
Carefully controlled studies using driving simulators
should be a focus of future research in order to
properly inform the general public of the dangers of
driving under the influence of these substances.
Other prescription medications
There are many prescription drugs; however only a
few classes and a limited range of actual drugs within
those classes have been studied experimentally. The
prescription drugs that are reviewed below (and
above e.g. benzodiazepines) are often reported in
Issues Paper | No. 12 | March 2010
7
Table 2. The effects of antidepressants on driving-related skills
Antidepressant
Effects on driving-related skills
Tricyclic antidepressants
(TCA)
Some studies have found that TCAs have a greater relative risk for motor vehicle
accidents,140,141 while others have found no increased risk.142 This variance in findings
could be due to the differing ages of participants as well as the variance in treatment
periods.81
TCAs have antihistaminic and anticholinergic effects which may cause sedation.81
Most individuals adapt to these side effects after the initial treatment period,
particularly if they are not elderly, have no evidence of hepatic dysfunction and are
maintained on a stable dose.81
Selective serotonin
reuptake inhibitors (SSRIs)
These cause less impairment in psychomotor and cognition functioning
than TCAs.79,140,143
Noradrenergic-specific
serotonergics (NASSA)
The NASSA mirtazapine has a sedative effect due to its antihistamine effects. This is
particularly apparent when taken as a morning dose.79,144 However, those who take
mirtazapine as a nocturnal dose show improvement in their performance-based tasks
as opposed to untreated depressives.80
studies showing an impairment in driving behaviours,
cognitive and motor skills or have been shown to
increase crash risk in epidemiological studies.
Antidepressants
Depression can cause symptoms of poor
concentration, attention disturbances, and deficits
in memory and executive function that may impair
driving ability.78 The objective of pharmacological
treatment for depression is to allow the patient to
participate fully in the activities of daily living, and
this includes driving.79 Nevertheless, antidepressants
may impair driving due to their effects on sedation,
agitation and insomnia.79 Studies have revealed that
different classes of antidepressants have differing
effects on driving ability. A study by Brunnauer et
al., examined the effects of tricyclic antidepressants
(TCAs), selective serotonin reuptake inhibitors (SSRIs),
noradrenergic specific serotonergic antidepressants
(NASSAs) and selective noradrenalin reuptake
inhibitors (SNRIs) on driving ability and noted
differences in the measures of reactivity, selective
attention and stress tolerance.79 In another study
Brunnauer et al. found that only 10 per cent of
participants on TCAs passed the tests without
impairments compared to 20 per cent on venlafaxine
(SNRI), 28 per cent on SSRIs and 50 per cent on
NASSAs.80 Table 2 outlines the effects of different
classes of antidepressants on driving.
8
Drugs and driving
As there appears to be a potential risk, counselling
regarding driving safety needs to be tailored to
the individual, taking into account such factors
as age, type and dose of antidepressant, phase of
treatment, co-administered psychotropic drugs and
individual insight into psychomotor and cognitive
impairment.79,81 Again the role of the clinical illness
of depression or anxiety may cause significant
impairment in driving. When most studies have
been conducted in healthy controls it is difficult to
ascertain the relative impairment of depression versus
antidepressant therapy. A depressed unmedicated
patient may be more at risk of accident than a
medicated depressed patient, even though the
medication may itself impair driving. Additionally,
because different classes of antidepressants work
differently on the brain, it is difficult at this stage of
research to be conclusive about the impairing effects
of antidepressants in general.
Antihypertensives
All antihypertensives can impact on driving due
to their vasomotor effects. In the initial stage of
treatment, hypotension and dizziness may occur.
Table 3 outlines the effects of some antihypertensive
medications on driving ability. Patients need to
be informed regarding the risks of taking these
medications and driving, particularly in the treatment
initiation stage.82 However, there are few studies in
this area.
Table 3. The effects of antihypertensive medication on driving-related skills
Antihypertensive
medication
Effects on driving-related skills
Centrally acting
antihypertensives
(e.g. clonidine, methyldopa
and reserpine)
May have a sedative action which calls for particular attention.82
Atenolol (beta blocker)
A comparison study between methyldopa and reserpine and the beta blocker
atenolol revealed that while driving performance deteriorated in those who were
on the centrally acting antihypertensives, kinetic visual acuity (KVA) improved
significantly for those on atenolol.145 Atenolol does cause dizziness; however, this
is short in duration, moderate to weak in action and resolves with a lower dose.146
Angiotensin-converting
enzyme (ACE) inhibitors
(e.g. ramipril)
Have side effects of dizziness, drowsiness, vertigo, hypotension, hyperkalemia and
syncope which may impair driving.146–147
Calcium channel blockers
Have been associated with a decreased risk of motor vehicle accidents.
This could be due to their effects on stabilising abnormal heart rhythms and
relieving angina.88
Oral hypoglycaemics
Hypoglycaemia among those with insulin or noninsulin dependent diabetes mellitus (IDDM and
NIDDM) may result in cognitive–motor slowing and
loss of consciousness. This could negatively impact
driving performance.83 This risk is more associated
with mismanagement of dosage regimens, reduced
food intake or strenuous exercise than with the
medication itself.82
A study by Hemmelgarn et al. explored whether
antidiabetic medication increased the chances of a
motor vehicle crash.83 They concluded that the use
of insulin alone or a combination of sulfonylurea
and metformin increased the risk of a crash by
30–40 per cent, particularly for those on a higher
dose. This risk is higher for those who take a
combination of insulin and oral hypoglycaemics.
On the contrary, no increased risk was found for
those who are on oral monotherapy. Hemmelgarn
et al. are unclear whether this small increased risk
is medication-induced or related to latter-stage
diabetic complications such as retinopathy and
neuropathy, given that treatment regimens correlate
with disease progression.83 However, a driving
simulator study on a group of 25 patients with
IDDM found that while driving performance was not
impaired with mild hypoglycaemia (3.6 mmol/L),
moderate hypoglycaemia (2.6 mmol/L) reduced
driving performance with more swerving, spinning,
crossing the midline and compensatory slow
driving.84 Blood glucose levels are advised to be
tested before driving, especially in those who have
asymptomatic hypoglycaemia.83,85
Antihistamines
Antihistamines are H1-receptor antagonists that are
used widely by those suffering seasonal or chronic
allergic rhinitis.86 Because of their widespread use,
many studies have been undertaken to assess
whether they impact driving (Table 4).75,87
Unfortunately there is not enough research
examining whether prescribed medicines when
appropriately used impair driving behaviour. In some
cases, prescribed medicines may improve driving
behaviours in patients. It is not in the scope of this
report to review every prescription medication.
However, there is much research that is required
before an adequate level of knowledge is gained
on precisely which prescribed medicines impair
driving. This lack of research is a particular problem
in educating the community and medical staff.
A sensible message for many patients in the absence
of clearly articulated findings from research is to
continue to take medications but in many cases to
stop driving.
Issues Paper | No. 12 | March 2010
9
Table 4. The effects of antihistamines on driving-related skills
Antihistamines
Effects on driving-related skills
First-generation antihistamines
(e.g. brompheniramine,
dimenhydrinate and
diphenhydramine)
Have lipophilic properties which enable cross-over through the blood–brain
barrier.86 The depressive action on the central nervous system (CNS) can cause
drowsiness, dizziness, reduced coordination and increased reaction time.106
The sedative effects persist into the next day.86 Anticholinergic effects of dry
mouth and blurry vision are also evident.106
Second-generation
antihistamines (e.g. loratadine)
May also impair driving through psychomotor retardation and drowsiness.82,148
However, the effects are generally milder than those of first-generation
antihistamines and depend on gender, dose and time of intake.82,148
Tolerance tends to develop after 4–5 days.148 O’Hanlon et al. found that
while impairment is sometimes evident at higher than recommended doses,
impairment is small to almost undetectable at recommended doses.149
One exception to this is cetirizine.150
Third-generation antihistamines
(e.g. fexofenadine and
levocetirizine)
Fexofenadine and levocetirizine have been shown to produce no driving
impairment.148 Weiler et al. compared fexofenadine (60 mg), diphenhydramine
(50 mg), alcohol (0.1 per cent blood alcohol concentration) and placebo on
driving performance.87 They found little difference in driving performance
between those participants on fexofenadine or placebo. However, those
participants in the diphenhydramine group performed worse on the driving
tasks than those in the alcohol group.
Polydrug use
Polydrug combinations are often detected in drivers
involved in accidents.88–89 Results of studies indicate,
on the whole, that impairment in driving performance
increases when drivers combine alcohol with other
drugs or use multiple drugs simultaneously.
Ecstasy (MDMA) is frequently used in combination
with other drugs, mainly with alcohol, cannabis and/
or amphetamines.90 An Australian survey revealed
that 40 per cent of MDMA users also consumed
alcohol.91 Studies have investigated the effects of this
combination on driving performance in controlled
experimental settings.21,49,92–94 Overall, while the
central nervous system (CNS) stimulating effect of
MDMA reduces the subjective feelings of alcohol’s
sedative effect, it does not reduce alcohol-induced
psychomotor impairment.49,92,94 This difference
between subjective and objective sedation may result
in risk-taking among drivers.92
Cannabis and alcohol combined have a cumulative
effect.95 A study by Robbe found that when low to
moderate levels of cannabis were taken with sufficient
10
Drugs and driving
alcohol to achieve a BAC of 0.04 per cent, the
participants exhibited marked driving impairment.96
As a BAC of 0.04 per cent is below the defined level
of intoxication, breathalyser tests alone would not
identify this cumulative effect.42
Benzodiazepines and alcohol are both CNS
depressants.97 An additive or synergistic sedative
effect is therefore likely to occur.98 However, studies
investigating these combined effects are limited and
conflicting. English et al. and Taberner et al. suggest
in their research of temazepam and alcohol that
there is no evidence of potentiation or prolongation
of combined effects as each substance displays
different patterns of CNS depressant activity.99,100
In contrast, Van Steveninck et al. and Weathermon
and Crabb measured performance with several
cognitive and psychomotor tests and concluded
that a combination of these two substances does
impair performance.98,101 Neutal suggests that
those who have commenced initial treatment with
benzodiazepines should abstain from alcohol and
driving.102 More research appears to be needed in
regard to the concomitant use of these substances.
In their simulated driving study, Lenne et al. found
no difference between clients on a stabilised dose
of methadone or buprenorphine treatment when
compared with a non-drug control group.103 Both
groups had a BAC of 0.05 per cent. However, when
a therapeutic dose of diazepam was added to
the methadone/alcohol combination a significant
impairment was noted.104 Prescription medications
can also impair driving when used in conjunction with
alcohol. The antihistamines cetirizine and loratadine
have been shown to have additive effects.105 Further
research is needed to assess concomitant use of
antihistamines and other prescribed medications.106
Prevention and early intervention
We now turn our attention to strategies to minimise
and reduce the number of drivers who consume
drugs. We start with current strategies in schools
and move on to discuss advertising campaigns and
information provided by other agencies such as
pharmacists. Next we discuss approaches to detect
drug-driving and conclude by discussing issues
relating to treatment and education following the
loss of licence due to drug-driving. All of these
approaches work together to reduce the number of
individuals who drive under the influence of drugs.
Schools
In Victoria, young drivers, aged 18–25 years, make
up almost one-third of the road toll, and yet this
age group only holds 13 per cent of Victorian
licences.3 The Department of Education and Early
Childhood Development in collaboration with key
road safety agencies (Transport Accident Commission
(TAC), VicRoads, Victoria Police, Department of
Infrastructure, Metlink and RACV) have developed a
traffic education strategy for Victoria. To assist young
people to develop the skills required for safe travel,
the strategy recommends that Traffic Safety Education
(TSE) is provided to children in Preparatory to Year 2,
to children transitioning from primary to secondary
school and to all Year 10 students.
The TSE resource for secondary schools (“Traffic
Safety Essentials—for young road users, not crash
test dummies”) is based on research undertaken
by Barry Elliott and was developed to assist schools
implement a TSE program for Year 10 students.107
The program includes core activities in speed, alcohol
and other drugs, fatigue, and peer group pressure.
It is recommended that a minimum of 12 hours
of class time should be spent on these activities.
These activities are designed to assist students in
improving their decision-making skills, developing an
understanding of consequences and improving safety
for themselves and their peers.
The “Alcohol and other drugs” unit in the TSE
program covers a range of topics from effects of
alcohol, cannabis, methamphetamine and MDMA
on driving, to initiatives implemented in Victoria
such as roadside saliva testing for illicit drugs and
alcohol interlocks. At the end of the unit students
will understand that:
◗◗ it is illegal and unsafe when alcohol and
other drugs are combined with driving, riding
and walking
◗◗ alcohol and other drugs can impact decisionmaking related to safety, impair driving abilities,
and put affected pedestrians at great risk of injury
or death.
The resource is designed for teachers and is free
to those who attend a professional development
session. In 2009, 86 per cent of secondary schools
obtained copies. Initial responses by teachers and
practitioners are that the program targets the correct
audience (pre-licence students). A baseline evaluation
is currently being finalised and further assessment of
use in schools will be carried out in 2010.
Along with TSE, it is also recommended that schools
include drug education as part of their curriculum.
The Department of Education and Early Childhood
Development trains teachers and provides support
to schools in developing their drug education plans.
They provide schools with resources and information
and recommend that government schools deliver
10 hours of drug education each year, at each
year level.108
Students who complete the recommended TSE as
well as drug education, should be well informed
of the effects of different drugs and the possible
consequences of combining them with driving.
Issues Paper | No. 12 | March 2010
11
Advertising campaigns
Mass media campaigns are used around the world to
highlight the road safety message and are successful
at conveying information and changing attitudes.109
An evaluation of 265 campaigns estimated that on
average a road safety mass media campaign will
result in an 8.5 per cent reduction in crashes during
the campaign and a 14.8 per cent reduction after
the campaign. However, the campaigns delivered in
Australia are more comprehensive and long-term than
those delivered in most European countries and the
United States, which may result in larger reductions in
crashes.110
The TAC has used mass media advertising campaigns
since 1989 to promote road safety and reduce the
road toll. The first campaign focused on drink driving
and incorporated mass media and increased police
enforcement with the introduction of “booze buses”.
An evaluation conducted by Monash University’s
Accident Research Centre (MUARC) demonstrated
substantial reductions in road trauma in Victoria due
to the combination of TAC advertising, increased
random breath-testing using “booze buses” and
the speed camera program.111–112 A further MUARC
study evaluating the impact of major factors that
influence road trauma found that the drink-driving
campaign (advertising and enforcement) resulted in a
9–10 per cent reduction in serious road casualties.113
While it is difficult to disentangle mass media
effects from supporting activities, the success of the
intensive drink-driving campaign is highlighted by
the reduction in drivers killed with illegal BACs falling
from 114 in 1989 to 59 in 2007.
The TAC’s drug-driving campaign began in 2004
and was undertaken due to the increase in positive
drug samples from fatally injured drivers. Designed to
coincide with the introduction of roadside drug saliva
testing, TAC began mass advertising which focused
on the risk of detection. The TAC’s advertising
sign-posted the changes to legislation, like the
introduction of drug testing, and demonstrated how
the public will get caught and the penalties associated
with drug-driving. This phase of the campaign was
followed by advertising focusing on education, such
as the effect of cannabis on driving and decisionmaking. Both types of advertising are needed for
an effective campaign along with use of multiple
media, carefully targeted messages and repetition.109
Advertising in conjunction with police enforcement
12
Drugs and driving
builds the public perception of detection and the risks
of drinking and drug-taking much earlier than would
be achieved by enforcement alone.109 The biggest
deterrent is a highly visible advertising campaign
combined with stepped-up enforcement.110–111
At this stage it is too early to know the benefits of the
drug-driving advertising campaign. More educationbased advertising is needed to inform the public of
the risks associated with driving after consuming
different drugs and increased random drug testing
is needed to increase deterrence. The drug testing
regime needs to be broadened to regional areas as
drivers in these areas know they will not get tested,
so there is no deterrence value in advertising risk of
detection. However, it is early days in the campaign
and based on the success of the drink-driving
campaign, in time it is probable that a decrease in
drug-driving injuries and fatalities will be observed.
Pharmacists
Pharmacists are required to counsel consumers about
possible effects of medicines on driving performance
when dispensing prescriptions. This is achieved
through warning stickers on medications combined
with verbal information. Consumer Medicine
Information sheets are also provided that detail all
of the medication’s side effects, including effects on
driving. So while the information is provided to the
individual, it is up to the person to determine if they
adhere to that advice, and also to determine if they
are affected and should be driving. Pharmaceuticals
are perceived to have less of an impairing effect on
driving than alcohol and illicit drugs, with one in
four Australian drivers admitting to ignoring medical
advice not to drive after taking certain prescription
medicines.114 There is a need to improve driver
awareness, knowledge of the effects of medications
on driving performance and also compliance with
medication warnings.115
Queensland Transport undertook a drugs and
driving public education campaign detailing
the effect of over-the-counter and prescription
medications as well as illicit drugs on driving ability.
The campaign involved over 1000 pharmacies that
were supplied with fact cards, display stands and
posters displaying the slogan “Don’t discover the
side effects by accident. Ask the pharmacist if you’ll
be right to drive.” Before the campaign commenced
400 Queensland motorists were surveyed about
attitudes to road safety; over 30 per cent said they
thought medicines would not affect their driving.
This decreased to 13 per cent a year after the
campaign began.116
Educating pharmacists on the effects of prescribed
medicines on driving is a particularly efficient
way to educate the general community and to
therefore reduce the number of accidents caused by
prescription medicines. There may also be natural
medicines that impair driving behaviour, although this
has been significantly less researched than prescribed
medicines. Pharmacists would also be a logical
and efficient resource to use to educate the public.
Work with the National Institute of Complementary
Medicine could also help initiate research in this area.
Role of venues
Venues that serve alcohol and ones that are
frequented by drug users such as nightclubs and
dance parties also have a role in drink- and drugdriving prevention. By limiting levels of intoxication
attained by customers, providing relevant information
on harms of drug and alcohol use and suggesting
alternate means of transport, venues can minimise
drug- and alcohol-related harm.
“Responsible Service of Alcohol” (RSA) programs
were developed to prevent drink-driving by limiting
intoxication levels in licenced premises. In Victoria
it is compulsory to complete an RSA course if you
work at a venue which has on its licence a condition
that requires staff to have an RSA certificate, or
when applying for a new liquor licence. Otherwise,
it is recommended but not compulsory. The half-day
course covers topics including problems associated
with excessive alcohol consumption, alcohol, and
the law, facts about alcohol and handling difficult
customers. The aim is to reduce intoxication and
associated alcohol-related harms by providing liquor
service staff with the knowledge and awareness
necessary to responsibly serve alcohol in licensed
premises. Recommended RSA practices include
providing food, slowing service to intoxicated
customers and taking steps to prevent intoxicated
customers from driving. Early studies showed
that RSA programs reduced levels of customer
intoxication117 with one study finding BACs attained
by customers served by trained staff were close to
half (0.059 per cent) compared with untrained staff
(0.103 per cent).118 However, later larger studies failed
to show the same success,119–120 which may have been
due to a failure of venue management to successfully
implement and encourage RSA principles.121 A study
that evaluated a law enforcement approach to RSA
found that alcohol-related road crashes were reduced
following the introduction of the enforcement
program.122 It has been suggested that to be effective,
RSA programs and principles need to be wholly
supported and encouraged by venue management.
If there is also consistent law enforcement, in which
premises are fined for liquor licence breaches, a more
significant impact on alcohol-related harms including
traffic crashes will result.121–123
Venues can also provide education on drug and
alcohol use to reduce drug driving. One method
to do this is peer education. Peer education models
aim to provide an informative and credible health
promotion message to target populations. In Victoria,
a peer education program called DanceWize (formerly
RaveSafe) run by VIVAIDS, attend a number of large
dance parties to provide education on safe drug
use. At these events DanceWize staff can provide
information and referral advice on a wide range of
health and related issues, including safe sex/sexual
health, drug-driving and how to get home safely
from an event, penalties for drug offences and where
to get legal advice, drug treatments and services,
etc. While few studies have successfully evaluated
peer education models, anecdotal evidence from
youth and community organisations have attested
to peer education being an effective way to educate
young people and illicit drug users.124–125 Studies have
shown that informal advice stemming from a peer’s
experience is seen as more authentic than advice or
information coming from an official source.126–127
In line with these findings, a survey conducted by
DanceWize revealed that the program is well
received by its peers as a site of “real” drug
information and concluded that in situ peer
education appears to be an effective and credible
method of harm minimisation.128
As nightclubs also attract people who use drugs,
a similar peer education program in these types of
venues would be beneficial to raise awareness of
harms associated with drug use, combining alcohol
and drugs and drug-driving.
Detection of impaired driving
Although education is an important contributor to
the reduction in the number of drivers consuming
drugs, for some individuals there also needs to be a
Issues Paper | No. 12 | March 2010
13
perception that there are valid methods of detecting
drug-drivers by police. Without the risk of being
identified, fined or prosecuted, education is not
sufficient to deter some individuals from consuming
drugs and then driving.
Sobriety testing
In response to the rising number of drug-related
motor vehicle accidents and fatalities, performance
tests have been incorporated into many police
programs to detect drivers impaired by drugs other
than alcohol. Although the tests vary from country
to country, they are all based on the same principle:
that certain physiological and/or psychomotor
behaviours will be affected by drug consumption,
and that these effects can be compared to the
normative data for unimpaired (drug-free) individuals.
The tests are designed to assess psychomotor
performance, cognitive functioning and divided
attention. As well as maintaining coordination and
balance, the individual is required to remember
instructions and simultaneously perform more
than one task. Impairment on performance tests is
therefore directly related to impaired driving ability, as
the driving task frequently requires the individual to
divide attention between two or more tasks. The most
common sobriety tests used are the Drug Evaluation
and Classification Program (DECP) developed in the
United States of America, the Field Impairment Tests
(FIT) adapted from the DECP for use in the United
Kingdom, and the Performance Impairment Tests
(PIT), used in Australia.
Victorian sobriety testing
Currently the Victorian police use the Standard
Impairment Assessment (SIA) to identify the presence
of impairment in drivers believed to be under the
influence of drugs other than alcohol. If a police
officer observes a serious driving impairment they can
require the driver to undertake the SIA. The SIA is a
structured and systematic assessment that is carried
out by trained police officers. The assessment consists
of four components: interview and observation (a
standardised series of questions that examine the
circumstances that led to the detainment of the
suspect, as well as recent history of illness, injury,
medical treatment and drug use); physical impairment
test; information review process; and opinion on the
presence of impairment. The physical impairment
test consists of the horizontal gaze nystagmus,
14
Drugs and driving
the walk and turn test, and the one leg stand test.
These tests allow impairment to be identified at a
level that is equivalent to the impairment at a BAC
of 0.05 per cent or above.129 When impairment is
identified by the officer, a blood or urine sample
is taken to confirm the decision. During the first
12 months of the drug detection program in
Victoria, police identified a total of 227 individuals
suspected of driving while impaired by a drug.129
Of these 227 suspects, 181 were charged with
offences. Convictions were obtained in 27 cases with
133 remaining in the court system; thus far no cases
have been dismissed. The results suggest that the
Victorian SIA procedure is effective in identifying and
removing drug-impaired drivers from the road.
Sobriety testing in other states
Other Australian states employ different methods
of drug detection. New South Wales (NSW) police
use a standard set of questions regarding alcohol
or drug consumption and a number of behavioural
and physical signs (breathing, facial colour, speech
patterns, mental state, balance and the state of
the eyes and pupils). Perl and Moynihan suggest
that despite little formal training, NSW police have
been successful in detecting drug-positive drivers,
with approximately 90 per cent of suspected drivers
found to be drug positive.130 In Tasmania, if a driver
is suspected of driving under the influence of a drug,
the police will request the driver to take a sobriety
test. Tests include picking up coins from the floor,
walking heel to toe, handwriting and standing with
eyes closed and touching the nose with an index
finger. Western Australia implemented a program
using the Standardised Field Sobriety Test (SFST) to
identify drug impairment (similar in operation to the
Victorian model) in 2007. Queensland uses a similar
model to NSW which uses a standard question and
observation guide. At the present time, the Northern
Territory and the Australian Capital Territory have no
specific provisions for drug impairment testing and
prosecutions are rare. Clearly an agreed-upon set of
procedures adopted across all states and territories
would have the most impact in deterring individuals
from driving under the influence of drugs. This lack of
uniformity notwithstanding, performance tests are an
effective procedure to detect certain drugs that cause
significant impairment in driving. They probably do not
detect more subtle driving impairment. In an attempt
to detect a larger number of drug-affected drivers than
impairment tests and to therefore provide a greater
deterrent, saliva tests were first introduced in Victoria.
Saliva testing
In December 2003, the Victorian Government
approved the trial of random roadside saliva testing
to identify the presence of drugs in drivers, with
positive drug saliva tests resulting in prosecution and
fines. The cost of illicit drug-related road crashes
and deaths in Australia has been estimated at
$531.6 million annually.131 The cost of administering
saliva-based tests to a driver and the completion of all
evidentiary testing and administrative steps required
to confirm the presence of drugs is calculated at
approximately $833 per detection.132 Considering
that random drug testing is likely to be administered
to a large number of drivers, the cost of introducing
random saliva drug testing is high. However, the cost
of this procedure is likely to significantly reduce with
increasing volume and technological advances, and
its use is likely to decrease a component of motor
vehicle accidents that were predominantly invisible
to alcohol testing. During the past decade there has
been a significant reduction in accidents and deaths
due to alcohol in Australia, although this is not true
for drugs other than alcohol. Therefore, roadside
drug detection is an important next step in reducing
accidents and deaths on our roads.
In a recent publication Boorman and Owens outlined
the general results of the first two years of the
legislative framework (December 2004–December
2006).133 Of the 25 317 drivers (17 965 car drivers
and 7352 truck drivers) who were screened for
drugs on the roadside, 520 were charged with
drug-driving, of which 506 were convicted. The
majority of the roadside tests involved assessment
of methamphetamine, ecstasy and cannabis. Given
that these drugs (particularly cannabis) are widely
taken in our community and have been shown to
impair driving, this initiative is significant in removing
potential future accidents from our roads. Of
particular note is the finding that “…the detection
rate of illicit drug-offending drivers in comparison to
alcohol-offending drivers was double”.133 This is of
particular interest given that if the presence of alcohol
is identified in drivers then drug testing may not then
proceed. The significance of this is that it appears that
alcohol testing is still more of a deterrent than drug
testing. Increasing the number of saliva tests therefore
may significantly increase the number of drivers who
are intercepted with drugs in their system and could
be considered an important next step in the public’s
awareness of drug detection techniques in Victoria.
According to Martin Boorman from Victoria Police,
in 2008, 25 000 saliva tests were performed, which
will progressively increase and double in three years
(compared to 1.4 million random blood tests).
Also of interest are the demographics of drivers
detected with drugs in their saliva. For car drivers,
those who were found to have detectable drugs in
their saliva were more likely to be under the age of
26 years, employed, with a regular licence but with
less than five years experience. Conversely, truck
drivers detected were somewhat older (aged between
31 and 45 years), employed and with greater driving
experience. Clearly the uses of illicit drugs in these
two cohorts are due to different causes.
Educational campaigns aimed at these demographics
is a logical next step in reducing the prevalence of
drugged drivers in our community. Additionally,
the inclusion of other drugs in saliva analysis is also
likely to identify currently undetected drug-affected
drivers, and therefore prevent accidents due to
drugs in general. Benzodiazepines and opiates are
obvious next choices, based on previous collision
research, their effects on the CNS and their use in
our community. Clearly, the introduction of roadside
saliva testing has been a significant, successful and
cost-effective new approach in the detection of
individuals driving under a narrow range of illicit
drugs, which represents a large percentage of
commonly abused drugs in our community.
Treatment and education following
loss of licence
In addition to education and the threat of detection,
treatment and education are also needed after the loss
of licence or successful prosecution for drug-driving.
When a driver has her/his licence suspended or
cancelled for drink- or drug-driving the offender is
required to undertake a licence restoration process.
This is a complicated, lengthy and costly process
which varies from person to person depending on the
type of offence, whether the licence was disqualified
or suspended and the driver’s age. The restoration
process may include payment of fines, participation
in a driver education program, undertaking clinical
Issues Paper | No. 12 | March 2010
15
assessments, court hearings and for drink-drivers the
installation of alcohol interlock devices.
Driver education is an essential part of the
rehabilitation/licence restoration system and when
combined with fines and disqualification periods,
has been shown to be an effective deterrent for
drink-drivers.134 To support the drug-driving licence
restoration process and prevent people drug driving,
Moreland Hall developed the drug-drive education
program. Moreland Hall is the primary drug-drive
educator in Victoria, running six education sessions
per year. The program covers topics including
legislation and the restoration process, substance
effects on driving ability (cannabis, stimulants,
ecstasy, opiates, polysubstance use, and prescription
drugs), risks and consequences of drug driving, and
strategies for safer driving. The program aims to
educate participants on the risks associated with drug
driving and promotes an attitude shift.
However, the drink- and drug-driver education
programs have been criticised for having a “one
size fits all” approach, with substance-dependent
offenders, first-time and low-level offenders all
completing the same education program. The current
program has limited capacity to change drink- and
drug-driving, especially for people with dependence
issues.135
A more effective system may be a streamed approach
that would cater for the different offender groups
and ensure that education and rehabilitation can be
tailored to each type of offender. Best practice for the
treatment and rehabilitation of drink-drive offenders
is to combine education with case management,
psychotherapy and follow-up monitoring and
aftercare. The system has also been criticised as
it does not take into account access and equity
issues. The program is a “user pays” system and as
such it is unlikely that some groups (unemployed,
disadvantaged, serious and recidivist offenders)
will comply and will simply slip through the cracks.
Another issue with the current licence restoration
process is that assessment, rehabilitation or treatment
is not undertaken at the time of the offence but at
the time of re-licensing.
Alcohol interlocks
Alcohol interlocks were developed to reduce
impaired driving and rehabilitate repeat drink-driving
offenders. The devices are fitted to drink-driving
offender’s vehicles and require the driver to blow
16
Drugs and driving
a zero BAC reading before the vehicle will start. At
random intervals when driving, the driver must also
blow into the alcohol interlock to ensure the reading
is still zero. The first alcohol interlock program was
introduced in California over 20 years ago and
today most US states and many European Union
nations have interlock-enabling legislation.136 Alcohol
interlocks are now being used in Victoria for serious
and repeat drink-driving offenders. Legislation was
passed in May 2002 and the first alcohol interlock
device was installed in May 2003.
The Victorian alcohol interlock program begins when
a drink-drive offender has been disqualified from
driving and the disqualification period is about to
end. A magistrate can make it a condition of a new
licence that the offender’s vehicle is fitted with an
alcohol interlock device. Once the minimum interlock
period has expired the driver can make application to
the court to remove the interlock condition. The court
and police will get a report including a printout of
the functioning of the interlock, usage of the vehicle
and any failed attempts to start the car. The cost of
the program is paid by the offender with the average
cost of installation, servicing, maintenance and having
the interlock removed costing approximately $160 per
month. Approximately 18 000 interlocks are currently
installed in Victoria.
Interlocks have been demonstrated to be effective
while the interlock is installed; however, they are
less effective at changing long-term behaviour.137
Research shows that punishment such as alcohol
interlock programs will do little in the long-term
to change the behaviour of people with alcohol
dependence. To enhance the possibility of long-term
behaviour change, punishment needs to be combined
with treatment, rehabilitation and intensive case
management.135,136,138
The Victorian system has been criticised as the
education and interlock programs are only required at
the re-licensing stage rather than the penalty stage.135
As the gap between re-licensing and the offence can
be a number of years, it has been suggested that
treatment and education is required at the penalty
stage to address dependence issues. Best practice is
to shorten the disqualification period if the offender
installs an interlock; the benefit of this system is that
the offender receives earlier rehabilitation as well as
preventing drink-driving.136
Current problems, issues and
suggestions for the future
Many of the experts interviewed believed that
there is a significant lack of understanding of the
effect of various drugs on driving, both acutely and
chronically in our community. Specifically there is a
lack of education and knowledge about how specific
drugs impair driving in the general community. More
detailed analysis and education based on this analysis
may be important in changing community behaviour.
This could also lead to advertising campaigns that are
more compelling and convincing. There are still many
misconceptions about the effect of various drugs
on driving ability. For instance there is a belief that
cannabis leads to safer driving by many regular users.
There is also a belief that amphetamines improve
processing speed which leads drivers to take greater
risks than normal. There is also a common belief
that opiates are safe if they are prescribed. These
assumptions can be easily challenged and defeated in
properly developed media campaigns.
There is a lack of information and research about the
effects of many prescription drugs on driving. There
is also a lack of knowledge about how low levels of
alcohol (i.e. less than 0.05 per cent BAC) combined
with various drugs (licit and illicit) may impair driving.
Again this information needs to be made public if
public behaviour is to be changed.
Although saliva testing for drugs has been successful
in detecting drug-affected drivers, there is still only a
limited number of drugs tested and at levels for some
drugs that may only measure recent use. We know
that many drugs, even at low levels or many hours
after use, can still impair driving. Developing a wider
battery of drugs tested may deter many drivers from
driving. Of course not all drugs impair driving and
the detection of low concentrations of certain drugs
may merely be detecting those drugs and not driving
impairment. This problem may be solved by the
development of computerised roadside assessments
for cognitive and motor functioning. This may be
particularly important in detecting drivers who are
showing fatigue (who have not consumed drugs)
and drivers who are rebounding from previous drug
taking, such as the case of amphetamine users
(i.e. who have no levels of amphetamines in their
system but who show great impairment in driving).
There is a lack of understanding of whether some
drugs improve driving skills in certain types of
patients who use prescribed drugs. For instance,
does a patient with an anxiety disorder drive better
after taking a prescribed medication than without
medication to treat his/her disorder?
Understanding whether patients dependent on
alcohol or other drugs should be allowed licences and
how potential future accidents involving these drivers
can be avoided is important. Is it possible to suspend
licences in patients who are dependent on alcohol or
other drugs before they have had an accident? On
what basis can a person prove that they are no longer
dependent on alcohol or a drug that impairs driving?
In this respect hair analysis could be investigated as
a tool in identifying potential drivers who are still
dependent on drugs. This could then be used to
prevent currently dependent drivers from driving.
Perhaps one of the biggest problems is in the area of
truck driving. Truck accidents have a disproportionate
contribution to the road toll in Australia relative
to motor cars. Saliva testing has identified the use
of amphetamines in truck drivers who use these
substances to drive further and for longer durations.
Unless there is regular drug detection for drivers,
then this issue will remain a problem as there is an
obvious economic advantage for truck drivers (and
their employers) to find ways in which they can drive
a truck greater distances. One expert suggested
that changing legislation that limited the number of
hours a truck driver could continuously work within a
24-hour period is essential. New interventions in the
area of detecting fatigue in truck drivers are starting
to gain momentum. This technology measures basic
visual processes that underpin fatigue such as eye
movements and saccades. Although likely to be
an important next step in reducing fatigue-related
accidents with trucks, their adoption may lead to an
increase in the amount of drug-taking that alleviates
fatigue, such as amphetamines and newer drugs
such as modafinil. Both these drugs may cause
their own impairments to driving and only one is
currently detected by saliva tests. Clearly a unified
national approach is essential in reducing truckrelated accidents in Australia, as many trucks cover
vast distances. In Victoria the legislation relating to
the number of continuous hours of truck driving is
currently being reviewed.
Issues Paper | No. 12 | March 2010
17
Case study
Prevent Alcohol and Risk-Related Trauma in Youth
(PARTY) www.partymelbourne.net.au
Contact person: Jen Thompson, Coordinator,
PARTY program (Prevent Alcohol and Risk-Related
Trauma in Youth), National Trauma Research
Institute
Why the program is run
PARTY is aimed at providing teenagers with an
experience of trauma that will enable them to
recognise potential injury-producing situations,
make prevention-oriented choices, and adopt
behaviours that minimise unnecessary risk.
Program description
One of the National Trauma Research Institute’s
(NTRI) leading educational initiatives is the PARTY
Program. An acronym for Prevent Alcohol and
Risk-Related Trauma in Youth, PARTY is an inhospital injury awareness and prevention program
originally established in Ontario, Canada in 1986.
It was developed by a team of emergency nurses
and doctors who were unhappy with the numbers
of young people presenting to the department as
a result of risk-related activities. The program is
designed to engage and confront young people.
Holding the program within a hospital environment
enhances the experience and leaves a significant
and lasting impression of the consequences of
Encouraging trucking organisations to carry out their
own drug testing at the beginning and end of truck
journeys, which can be independently audited, will
also reduce the incidence of truck drivers taking drugs.
A current study funded by the parliamentary road
action committee and conducted by Edward
Ogden (assessing levels of drugs in non-fatal but
serious car accidents in Victoria) is likely to provide
important results regarding the presence of a wide
range of drugs, licit and illicit, that cause accidents
in Melbourne. The analysis of these results should
be widely disseminated to the community, Victoria
Police and the government agencies described in
this document.
18
Drugs and driving
trauma and risk-taking behaviour. Students are
addressed by emergency services (Victoria Police,
Ambulance Victoria), various health professionals
(doctors, nurses, therapists), and patients and their
families—people who have experienced trauma
and survived, often with significant disabilities.
There is a mixture of Power-Point presentations,
hands-on activities, hospital tours and patient
encounters, to enable students from all learning
persuasions to “get the message”. Initial funding
was from Tattersall’s George Adams Foundation.
The current major sponsor is AAMI Skilled Drivers.
A significant amount of “in-kind” support for the
program is given by staff and volunteers from
The Alfred Hospital that allows the cost of the
program to be reduced. The program is targeted at
young persons aged 15–19 years. It currently runs
fortnightly throughout school terms. At this point
only school students attend the program from both
independent and public educational models.
What’s good about this program?
The PARTY program appears to be a well thought
out intervention and has been shown to effectively
reduce the incidence of traumatic injuries among
its participants in Canada.139 A proper analysis
of its efficacy for an Australian audience should
be conducted. If it is shown to be effective the
program could be applied more widely and with
more “at risk” young groups.
Acknowledgments
The authors wish to acknowledge the contributions of
the following experts in the production of this report:
Karen Marsh, Department of Education and
Early Childhood Development, Drug Education,
Victorian Government
Conrad C Remenyi, Senior Project Officer, Targeted
Programs Branch, Student Learning Programs Division,
Department of Education and Early Childhood
Development, Victorian Government
David Healy, General Manager, Road Safety, Transport
Accident Commission, Victoria
Alan Freedman and Bev Baxter, Pharmacy Guild of
Australia—Victorian Branch
Martin C Boorman, APM, Inspector, Traffic Drug and
Alcohol Section, Technical Unit, Victoria Police
John Quiroga, Senior Education and Training Officer,
Moreland Hall
Professor Phil Swann, VicRoads, Victorian Government
Daniel Holness, DanceWize Coordinator, VIVAIDS
Dr Edward Ogden, Victoria Police, Victorian Government
Jen Thompson, Coordinator, PARTY Program (Prevent
Alcohol and Risk-Related Trauma in Youth), National
Trauma Research Institute
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113. Newstead S, Cameron M & Narayan S 1998 Further modeling
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22
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128. VIVAIDS 2005 “RaveSafe survey”, Melbourne: Centre For Youth
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129. Boorman M 2004 “Detection of drug impaired drivers—
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130. Perl J & Moynahan A 1999 “Special aspects of drugs and
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Issues Paper | No. 12 | March 2010
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Reading and Resource List
DRUG
No. 30 • March 2010
NFO
clearinghouse
www.druginfo.adf.org.au
Drugs and driving
This list is intended as a guide and a starting point for the researcher. It does not aim to be
comprehensive of the subject. For further information please search the library online public access
catalogue, or contact DrugInfo for assistance. The list is sorted chronologically and by author within
each time period. All of the following resources are available in the DrugInfo Clearinghouse Library.
Alcohol and driving—effects
Allen AJ, Meda SA, Skudlarski P, Calhoun VD, Astur
R, Ruopp KC & Pearlson GD 2009 “Effects of alcohol
on performance on a distraction task during simulated
driving”, Alcoholism: Clinical and Experimental
Research 33:4, pp. 617–25.
This study examines the role of the serotonin (5-HT)
system in alcohol-related aggression. Specifically,
it experimentally examined the effects of 5-HT
augmentation on alcohol-related aggression in men.
The results indicated that alcohol intoxication increased
aggression, particularly under low provocation.
Brown TG, Oimet MC, Nadeau L, Gianoulakis
C, Lepage M, Tremblay J & Dongier M 2009
“From the brain to bad behaviour and back again:
neurocognitive and psychobiological mechanisms of
driving while impaired by alcohol”, Drug and Alcohol
Review 28:4, pp. 406–18.
Driving while impaired by alcohol (DWI) is responsible
for substantial mortality and injury. This narrative
review summarises the evidence for the contribution of
neurocognitive and psychobiological mechanisms to DWI
behaviour and recidivism.
Marczinski CA & Fillmore MT 2009 “Acute alcohol
tolerance on subjective intoxification and simulated
driving performance in binge drinkers”, Psychology of
Addictive Behaviors 23:2, pp. 238–47.
check
link
High rates of binge drinking and alcohol-related
problems, including drinking and driving, occur among
college students, however underlying reasons for the
heightened impaired driving rates in this demographic
group are not known. This study investigates the effects
of acute alcohol tolerance on subjective intoxification,
simulated driving performance and willingness to drive in
binge drinkers.
Miller MA, Weafer J & Fillmore MT 2009 “Gender
differences in alcohol impairment of simulated driving
performance and driving-related skills”, Alcohol and
Alcoholism 44:6, pp. 586–93.
24
Drugs and driving
Although laboratory studies indicate that the intensity of
impairment from alcohol is generally dependent on blood
alcohol concentration, some reviews of the literature
suggest that gender is also a contributory factor. This
study tests this hypothesis by measuring alcohol-induced
impairment in men and women in functions relating to
driving performance.
Gustin Jl & Simons JS 2008 “Perceptions of level of
intoxication and risk related to drinking and driving”,
Addictive Behaviors 33:4, pp. 605–15.
This study investigated variables of perceived risk
associated with one’s decision to drink and drive, as
well as with the occurrence and success of intervention
efforts by others in preventing individuals from drinking
and driving.
Alcohol and driving—prevalence
Trimboli L & Smith N 2009 Drink-driving and
recidivism in NSW, Sydney: NSW Bureau of Crime
Statistics and Research.
This bulletin provides information on re-offending among
drink-drivers in NSW. Overall, 15.5 per cent of drink-drivers
returned to court for another drink-driving offence within
five years, and 14.3 per cent returned to court within five
years charged with another offence, such as a registration,
a roadworthiness or a driving licence offence.
www.lawlink.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/
vwFiles/cjb135.pdf/$file/cjb135.pdf
Flowers NT, Naimi TS, Brewer RD, Elder RW, Shults
RA & Jiles R 2008 “Patterns of alcohol consumption
and alcohol-impaired driving in the United States”,
Alcoholism: Clinical and Experimental Research 32:4,
pp. 639–51.
This article investigates prevalence and patterns of alcohol
consumption and alcohol-impaired driving in the United
States. A strong association was found between alcoholimpaired driving and binge drinking.
Senserrick T, Hoareau E, Lough B, Diamantopoulou
K & Fotheringham M 2004 Involvement of 21–26
year olds in drink-driving behaviour, Melbourne:
Monash University.
This project examined the involvement of 21–26 yearold Victorian drivers in drink-driving behaviour following
concerns of their over-representation in alcohol-related,
fatal and serious casualty crashes. A perceived need/
desire to get home was the most commonly reported
reason for drink-driving.
DrugInfo Clearinghouse no. AN66 SEN
www.monash.edu.au/muarc/reports/muarc211.html
Alcohol and driving—interventions
Mills KL, Hodge W, Johansson K & Conigrave
K 2008 “An outcome evaluation of the New
South Wales Sober Driver Programme: a remedial
programme for recidivist drink drivers”, Drug and
Alcohol Review 27:1, pp. 65–74.
This study evaluates the effectiveness of a remedial
program for recidivist drink drivers, the New South
Wales Sober Driver Programme (SDP). The program
combines educational components and elements of
group cognitive behavioural therapy in relation to drinkdriving behaviour. It is delivered in conjunction with
punitive sanctions.
The aims of this study were to assess New Zealanders’
knowledge, attitudes and behaviours around driving
under the influence of psychoactive substances,
including illicit drugs, prescription medicines, and
alcohol, for both users and non-users, and drug drivers
and non-drug drivers.
www.idpc.net/sites/default/files/library/Drug%20
Driving%20in%20New%20Zealand,%20full%20
research%20report,%20August%202009.pdf
Matthews A, Bruno R, Johnston J, Black E,
Degenhardt L & Dunn M 2009 “Factors associated
with driving under the influence of alcohol and
drugs among an Australian sample of regular ecstasy
users”, Drug and Alcohol Dependence 100:1–2,
pp. 24–31.
This study investigates factors associated with driving
under the influence of alcohol and other drugs (ecstasy,
cannabis and methamphetamine) among a group
of regular ecstasy users. Participants were those who
participated in the Australian Ecstasy and related Drug
Reporting System (EDRS) in 2007 and had recently
driven a motor vehicle.
McIntosh J, O’Brien T & McKeganey N 2008 “Drug
driving and the management of risk: the perspectives
and practices of a sample of problem drug users”,
International Journal of Drug Policy 19:3, pp. 248–54.
Bjerre B & Kostela JS 2007 “Positive health-care
effects of an alcohol ignition interlock programme
among driving while impaired (DWI) offenders”,
Addiction 102:11, pp.1771–81.
This paper reports on a qualitative study of the attitudes
and risk management strategies of a sample of problem
drug users in relation to driving while under the
influence of drugs.
This study compares the costs of hospital care and
sick leave/disability pensions between two groups of
driving while impaired offenders. One group was in an
alcohol ignition interlock program and the other had
revoked licences.
Walsh JM, Verstraete AG, Huestis MA & Morland J
2008 “Guidelines for research on drugged driving”,
Addiction 103:8, pp. 1258–68.
Delaney A, Diamantopoulou K & Cameron M 2006
Strategic principles of drink-driving enforcement,
Melbourne: Monash University Accident Research Centre.
This study reviews existing drink-driving enforcement
research conducted by the Monash University Accident
Research Centre to develop operational principles of
drink-driving enforcement and emphasise where the best
results are to be achieved.
www.monash.edu/muarc/reports/muarc249.html
Drug driving
Hammond K 2009 Drug driving in New Zealand:
a survey of community attitudes, experience and
understanding, Wellington: New Zealand Drug
Foundation (NZDF).
This article explores issues surrounding the need to
standardise the variables being used to measure the
public health impact of drug-use on driving and overall
traffic safety.
Australian Institute of Criminology 2008 Drug
driving in Australia, Canberra: Australian Institute
of Criminology.
In 2007 it was estimated that 12 per cent of Australians
aged 14 years and over had driven a motor vehicle
while under the influence of alcohol, and 3 per cent had
driven while under the influence of illegal drugs in the
previous 12 months.
DrugInfo Clearinghouse no. vf AIC 08
www.aic.gov.au/documents/7/A/B/%7B7AB1481A4036-4811-A17E-5FCD841C8167%7Dcfi173.pdf
Reading and Resource List | No. 30 | March 2010
25
Caldicott D, Pfeiffer J, Edwards N & Pearce A
2007 The impact of drugs on road crashes, assaults
and other trauma: a prospective trauma toxicology
study, Canberra: National Drug Law Enforcement
Research Fund
This study examines the experimental and
epidemiologic evidence linking benzodiazepine
use to driving impairment.
DrugInfo Clearinghouse no. research NDLERF 20
www.ndlerf.gov.au/pub/Monograph_20.pdf
Cannabis and driving
Ch’ng CW, Fitzgerald M, Gerostamoulos J,
Cameron P, Bui D, Drummer OH, Potter J & Odell M
2007 “Drug use in motor vehicle drivers presenting to
an Australian, adult major trauma centre”, Emergency
Medicine Australasia, 13 May, pp. 1–7.
This article reports the drug use in injured Victorian drivers
involved in motor vehicle collisions and subsequently
transported to a major adult trauma centre in Victoria.
DrugInfo Clearinghouse no. vf CH’NG 07
Mallick J, Johnston J, Goren N & Kennedy V 2007
Drugs and driving in Australia: a survey of community
attitudes, experience and understanding, Melbourne:
Australian Drug Foundation.
This research focuses on the prevalence of drug driving
in Australia, the driving impairment associated with drug
use, the attitudes and perceptions of drivers towards
drugs and driving and the road safety countermeasures
adopted to address drugs and driving.
DrugInfo Clearinghouse no. AN65 MAL
www.druginfo.adf.org.au/downloads/External_Reports/
Drugs_and_Driving_in_Australia_fullreport.pdf
Amphetamines and driving
Jones AW, Holmgren A & Kugelberg FC 2008
“Driving under the influence of central stimulant
amines: age and gender differences in concentration
of amphetamine, methamphetamine, and ecstasy
in blood”, Journal of Studies on Alcohol and Drugs
69:2, pp. 202–8.
A zero-tolerance law for driving under the influence of
drugs was introduced in Sweden in 1999. This article
reports the age and gender of offenders along with the
concentrations of amphetamine, methamphetamine,
and ecstasy in blood samples analysed since the
institution of the new legislation.
Benzodiazepines and driving
Rapoport MJ, Lanctot KL, Streiner DL, Bedard M,
Vingilis E, Murray B, Schaffer A, Shulman KI &
Herrmann N 2009 “Benzodiazepine use and driving:
a meta-analysis”, Journal of Clinical Psychiatry 70:5,
pp. 663–73.
26
Drugs and driving
DrugInfo Clearinghouse no. vf RAPOPORT 09
Sewell RA, Poling J & Sofuoglu M 2009 “The effect
of cannabis compared with alcohol on driving”,
American Journal on Addictions 18:3, pp. 185–93.
Cannabis and alcohol acutely impair several drivingrelated skills in a dose-related fashion, but the effects
of cannabis vary more between individuals than they
do with alcohol because of tolerance, differences
in smoking technique, and different absorptions of
tetrahydrocannabinol, the active ingredient in cannabis.
Jones AW, Holmgren A & Kugelberg FC 2008
“Driving under the influence of cannabis: a 10year study of age and gender differences in the
concentrations of tetrahydrocannabinol in blood”,
Addiction 103:3, pp. 452–61.
This paper compares age, gender and the concentrations
of THC in blood of individuals apprehended for driving
under the influence of drugs in Sweden, where a zerotolerance law operates.
Fergusson DM, Horwood LJ & Boden JM 2008
“Is driving under the influence of cannabis becoming
a greater risk to driver safety than drink driving?
Findings from a longitudinal study”, Accident
Analysis and Prevention 40, pp. 1345–50.
This study examined the associations between driving
under the influence of (a) cannabis and (b) alcohol, and
motor vehicle collisions during, in a longitudinal study
of a New Zealand birth cohort. The results suggest that,
for some populations, the risks of driving under the
influence of cannabis may now be greater than the risks
of driving under the influence of alcohol.
Jones C, Donnelly N, Wendy S & Weatherburn D
2005 Driving under the influence of cannabis: the
problem and potential countermeasures, Sydney:
BOCSAR
This bulletin assessed (a) whether recent drug drivers
were more likely to self-report accidents than nonintoxicated drivers; (b) the likely deterrent effect of
roadside drug testing (RDT), increasing the severity
of sanctions for drug driving and providing factual
information about accident risk associated with drugdriving; and (c) what factors were predictive of driving
under the influence of cannabis.
www.lawlink.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/
vwFiles/CJB87.pdf/$file/CJB87.pdf
Gamma hydroxybutyrate and driving
In this study, focus group discussion was used to elicit
descriptive experiences of driving under the influence of
gamma hydroxybutyrate (GHB).
This study used a pre- to post-design to evaluate the
influence on drinking-and-driving fatal crashes of
six laws directed at young people aged 20 years and
younger and four laws targeting all drivers. Data on the
laws were drawn from the Alcohol Policy Information
System data set (1998 to 2005), the Digests of State
Alcohol Highway Safety Related Legislation (1983 to
2006), and the Westlaw database.
Opioids and driving
Detection approaches
Bernard JP, Morland J, Krogh M & Khiabani HZ
2009 “Methadone and impairment in apprehended
drivers”, Addiction 104:3, pp. 457–64.
Brady JE, Baker SP, DiMaggio C, McCarthy ML,
Rebok GW & Li G 2009 “Effectiveness of mandatory
alcohol testing programs in reducing alcohol
involvement in fatal motor carrier crashes”, American
Journal of Epidemiology 170:6, pp. 775–82.
Barker JC & Karsoho H 2008 “Hazardous use
of gamma hydroxybutyrate: driving under the
influence”, Substance Use & Misuse 43, pp. 1507–20.
This study investigates apprehended drivers who had
methadone in their blood at the time of apprehension
and the relationship between blood methadone
concentration and impairment as measured by the
clinical test of impairment.
Baewert A, Gombas W, Schinler S-D, PeternellMoelzer A, Eder H, Jagsch R & Fischer G 2007
“Influence of peak and trough levels of opioid
maintenance therapy on driving aptitude”, European
Addiction Research 13:3, pp. 127–35
The Addiction Clinic at Medical University Vienna
conducted a prospective, open-label trial where 40
opioid-dependent patients maintained either on
buprenorphine or methadone were assessed regarding
their traffic-relevant performance.
Prevention approaches
Asbridge M, Mann RE, Smart RG, Stoduto G,
Beirness D, Lamble R & Vingilis E 2009 “The effects
of Ontario’s administrative driver’s licence suspension
law on total driver fatalities: a multiple time series
analysis”, Drugs, Education, Prevention and Policy
16:2, pp. 140–51.
On 29 November 1996, Ontario introduced an
Administrative Driver’s Licence Suspension (ADLS) law,
which required that anyone charged with driving with
a blood alcohol concentration (BAC) over the legal
limit or failing to provide a breath sample would have
their licence suspended for a period of 90 days at the
time the charge was laid. This study evaluates the
effects of Ontario’s ADLS law on total driver fatalities
over a 25-month period after the law was introduced,
and compares Ontario’s experience with that of two
comparison provinces (Manitoba and New Brunswick)
that did not introduce ADLS at that time.
Using data from the United States Fatality Analysis
Reporting System during 1982–2006, the authors
assessed the effectiveness of mandatory alcohol testing
programs in reducing alcohol involvement in fatal motor
carrier crashes.
DrugInfo Clearinghouse no. vf BRADY 09
Global Road Safety Partnership 2007 Drinking and
driving: a road safety manual for decision-makers and
practitioners, Geneva: Global Road Safety Partnership.
The purpose of this manual is to inform readers of
practical ways to develop programs to reduce drinking
and driving.
DrugInfo Clearinghouse no. AN66 GLO
www.grsproadsafety.org/themes/default/pdfs/
Drinking%20Driving%20Manual.pdf
Stough C, Boorman M, Ogden E & Papafotiou
K 2006 An evaluation of the Standardised Field
Sobriety Tests for the detection of impairment
associated with cannabis with and without alcohol,
Canberra: AGPS.
This research aimed to investigate the effects of
cannabis and alcohol on driving performance, and on
Standardised Field Sobriety Test (SFST) performance.
DrugInfo Clearinghouse no. MO62 STO
www.ndlerf.gov.au/pub/Monograph_17.pdf
Audiovisual resources
Moreland Hall 2007 Driving straight. Drugs and
driving educational DVD, Melbourne: Moreland Hall
Fell JC, Fisher DA, Voas RB, Blackman K & Tippetts
AS 2009 “The impact of underage drinking laws
on alcohol-related fatal crashes of young drivers”,
Alcoholism: Clinical and Experimental Research 33:7,
pp. 1208–19.
This DVD is designed to support drug education
programs by providing information about drugs and
driving in the State of Victoria. The DVD contains acted
scenarios based on actual case studies and interviews
with a number of key experts.
DrugInfo Clearinghouse no. adf av AN65 MOR
Reading and Resource List | No. 30 | March 2010
27
All material listed is available from the Australian Drug Foundation library.
Membership to the library is open to professionals in Victoria who work in the areas of health, welfare
and education.
Members are able to borrow from the collection as well as access other services provided by the library.
Membership is free to these groups.
For more information about membership or how to access material:
Tel: 1300 85 85 84
(Monday to Friday, 9am to 5pm)
Fax: (03) 9328 3008
Email:library@adf.org.au
Or visit our website at: www.druginfo.adf.org.au/library
www.druginfo.adf.org.au
DrugInfo Clearinghouse
409 King Street West Melbourne VIC 3003
Email: druginfo@adf.org.au