Emerging Issues

For decades, the public health community has recognized that enforcement and incarceration are not the only solutions to solving the nation’s misuse and abuse of licit and illicit drugs (Lancet, 2001). Instead, addiction is best managed as a chronic health condition with evidence-based treatment provided in lieu of, or in combination with, incarceration (Chandler et al., 2009). Many interventions are based on the principle of harm reduction, an approach designed to minimize the negative effects of a health behavior, without necessarily eradicating the behavior (Hawk et al., 2017). Harm reduction interventions have been demonstrated to be effective against drug addiction and overdose (Haegerich et al, 2019; Ritter & Cameron, 2006). An example of this type of approach designed to reduce drug-impaired driving is a program to increase awareness and acceptance of taking alternative forms of transportation while under the influence of drugs (Watson & Mann, 2018). Another strategy would be to enroll convicted drug-impaired drivers into remediation and treatment programs rather than incarceration and other more punitive measures. While there is little evidence rehabilitation programs can reduce drug-impaired driving, these programs have been demonstrated to be effective in reducing alcohol-impaired driving (see Alcohol Problem Assessment and Treatment). One small-scale study of convicted drivers in Ontario, Canada, found that 6 months after completion of a rehabilitative educational and treatment program, participants self-reported a decrease in substance use and misuse, and in negative consequences of misuse (e.g., relationship, legal, financial problems) (Wickens et al., 2018). In addition, it is important to note that many existing countermeasures designed primarily to address alcohol impairment, such as DWI courts, are likely to be effective at reducing drug-impaired driving; however, more research is needed to evaluate their efficacy at preventing drug-impaired driving, specifically. For this current edition of Countermeasures That Work, these cross-cutting countermeasures will continue to be described in Alcohol-Impaired-Driving Countermeasures. This placement will be evaluated in future editions.

Another emerging issue with a direct influence on the countermeasures of drug-impaired-driving laws and enforcement of drug-impaired driving is the increasing availability of reputable drug screening tools, for cannabis and other drugs. Blood analysis is considered the “gold standard” of drug screening due to its long history, extensive study and evaluation, and ability to produce quantifiable results. However, it has several constraints including the relative invasiveness of the procedure, the need for a warrant, and often the need to transport the driver to a healthcare facility for the drawing of blood. The latter is especially salient since many drugs are metabolized quickly (Bloch, 2021). One approach to minimizing the burden of performing blood testing for drugs, is training law enforcement officers as phlebotomists. For those States that allow this practice, training officers to draw blood saves money by eliminating hospital and phlebotomist fees, reduces the time required for specimen collection, and simplifies the chain of custody, among other benefits. In 1995 Arizona was the first State to implement a training program for law enforcement officers (NHTSA, 2019). As of 2019 Indiana, Maine, Minnesota, Ohio, Pennsylvania, Rhode Island, Utah, Idaho, Texas, Colorado, and Washington State had implemented law enforcement phlebotomy training programs (Bergal, 2019; NHTSA, 2019). While warrants are generally required for drawing blood from drivers suspected of impairment, many States permit the issuing of electronic warrants (“e-warrants”), also reducing the time required to draw blood after a crash or traffic stop (Bergal, 2019). An alternative to blood analysis is oral fluid testing. Oral fluids can be collected from drivers and sent to a toxicological laboratory for screening and confirmatory testing or collected and tested on-site. Note that the latter technique still requires further confirmatory testing in a laboratory. Both forms of oral fluid analysis are less invasive than blood analysis and on-site oral fluid testing can produce results within minutes. In addition, oral fluid requests do not require a warrant (Bloch, 2021). However, a positive test result from an on-site oral fluid test indicates the presence of a drug category,[1] not the quantity of the substance. Also, there are known performance issues with certain devices, including false positive results (i.e., indicating a drug is present when it is not). For example, Buzby et al. (2021) found that three out of five commercially available devices examined (Alere DDS2 Mobile System [DDS2], AquilaScan Oral Fluids Testing Detection System, Securetec DrugWipe S 5-Panel [DrugWipe]), did not meet the recommended levels of performance suggested as part of the Roadside Safety Testing Assessment, in aggregate or for individual drug assays. Two devices, the Dräger DrugTest 5000 (DDT5000) and the Dräger DrugCheck 3000 (DDC3000), had overall performance measures over 97% for sensitivity, specificity, and accuracy (Buzby et al., 2021). While oral fluid roadside testing is not sufficient for ascertaining drug impairment, the results can be used to help law enforcement officers decide to draw blood and perform laboratory testing or to involve a DRE (see Enforcement of Drug-Impaired-Driving Laws). As of 2021 there were 24 States that had statutes allowing the collection of oral fluid samples from drivers suspected of impairment. Alabama, Indiana, and Michigan have had active or pilot oral roadside testing programs (Bloch, 2021). As this is an area of growing research, future editions of Countermeasures That Work may include testing programs as a stand-alone countermeasure or as a component of an existing countermeasure.

[1] Devices vary on substances they can test for, and detection (threshold) levels of those drugs.