. Research

Alcohol and Drugs Foundation of Australia

Drugs and Driving

BACKGROUND

"Drug abuse remains a scourge. It affects every level of our society and no one is immune from the threat of being killed or injured in a crash involving a drug-impaired driver. When drugs are taken and a person drives the likelihood of becoming a road toll statistic increases dramatically." (Road Safety Committee 1,1996,p.vii)

Victorians use drugs for recreational, medical and professional purposes and the drug types used vary widely. This trend in licit and illicit drug use is paralleled in many Western societies and is of increasing concern as a health issue generally and, more specifically, as a road safety concern.

The major drugs of concern in terms of driver impairment are the main drugs of abuse and the common prescription drugs including benzodiazepines (minor tranquillisers), tranquillisers, sedatives, antihistamines, antidepressants, narcotic analgesics and antipsychotics. The use of these in Victoria has been identified in the following manner:

TABLE 1: DRUG USE IN VICTORIA

 
1993
1995
1993
1995
DRUG
% USED IN LAST 12 MTHS
% USED IN LAST 12 MTHS
% EVER TRIED
% EVER TRIED
Alcohol
74
75
94
86
Pain Killers
2
-
80
-
Tranquillisers
1
1
3
4
Any Illicit Drug
12
13
34
32
Cannabis
12
12
30
29
Amphetamines
2
2
7
7
Hallucinogens
1
1
5
6
Barbiturates
*
*
3
1
Cocaine
*
1
2
3
Heroin
*
*
2
2
Inhalants
*
*
3
-
Ecstasy
1
*
2
2


Note *Less then 1 % - Not asked in 1995 survey (National Drug Strategy Household Survey as cited in Premier's Drug Advisory Council. 1996, P. 12)

While alcohol do most widely used drug there is an increasing awareness of the use of prescription and illicit drugs and the effects they have on the community.

In March 1996, the Victoria Police provided the Inquiry into the Effects of Drugs (Other than Alcohol) on Road Safety in Victoria with the following breakdown of the prevalence of drugs in drivers involved in collisions:

TABLE 2: COMBINED BLOOD SAMPLE ANALYSIS 1993-1995 DRIVERS INVOLVED IN COLLISIONS

Drugs Found
Percentage  %
No drugs detected
32
Alcohol only detected
26
Drug(s) including alcohol detected
42
 
100
Frequency by drug class:
 
Alcohol
40
Cannabinoids
27
Opiates
17
Benzodiazepines
12
Stimulants
6

(Road Safety Committee 1, 1996, p92)

These statistics highlight the significant overlap between alcohol and drugs and the use of drug combinations. They also highlight that drug use may not only lead to driver fatalities in extreme cases, but may also impair driving factors, for example crash avoidance, which can then result in collisions and injuries, not necessarily death.

In May 1996, Professor Olaf Drummer provided the Inquiry into the Effects of Drugs (Other than Alcohol) on Road Safety in Victoria with a comparison of drugs involved in driver fatalities in two periods - 1990 to 1993 and 1994 to June 1995.

TABLE 3: COMBINED BLOOD SAMPLE ANALYSIS OF DRIVERS INVOLVED IN COLLISIONS (Victorian Data). Comparison of 1990-93 and 1994-mid 1995.

DRUGS CLASS
1990-93 (490)
1990-93 (%)
1994-Mid 1995 (287)
1994-Mid 1995 (%)
Drug free
262
54.0
162
57.0
Alcohol
158
32.0
81
28.0
Alcohol-only
122
25.0
55
19.0
Alcohol plus drug
36
7.3
26
9.1
Drugs only
70
14.3
44
15.3
Drugs
106
21.6
70
24.4
Cannabis
47
9.6
32
11.1

(Road Safety Committee 1, 1996, p. 84)

When these statistics were compared it was found that the incidence of drugs in total driver fatalities had increased from 21.6% to 24.4%. It was also found that the incidence of alcohol had decreased from 32% to 28% and that there was a slight increase in the prevalence of cannabis.

In mid 1997, John Richardson presented updated figures for the prevalence of drugs in driver fatalities at the International Council of Alcohol, Drugs and Traffic Safety Conference. These latest figures show that for the first six months of 1997 drugs were present in 31 % of driver fatalities, alcohol in 28% of cases and that the most commonly found illegal drug was still cannabis.    (Richardson 1997)

TABLE 4: PREVALENCE OF DRUGS IN DRIVER FATALITIES, 1994-95 VICTORIA, NEW SOUTH WALES AND WESTERN AUSTRALIA

DRUG CLASS
NUMBER (1332)
PERCENTAGE (%)
Drug free
694
52.0
Alcohol
455
34.0
Alcohol only
333
25.0
Alcohol plus drug
123
9.2
Drugs only
182
13.7
Drugs
305
23.0
Cannabis
154
11.6
Benzodiazepines
44
3.3
Amphetamines 1 stimulants
49
3.7
Opiates
35
2.6
Other Drugs
84
6.3

(Road Safety Committee 1, 1996, p. 83)

While the driver fatality statistics assist in understanding the impact of drugs on driving, they provide a limited view of the total road crash population, less than one per cent of drivers. Also, the causes of fatal crashes may be different to less severe crashes. Because of these limitations Tables Two and Four are most effective when viewed together.

The Road Safety Committee collated data from New South Wales, Western Australia and South Australia detailing the prevalence of drugs in drug impaired drivers. Using this type of analysis cannabis was again dominant. Apart from the benzodiazepines the incidence of other general prescription drugs was relatively low.

TABLE 5: PREVALENCE OF DRUGS IN DRUG-IMPAIRED DRIVERS

DRUG GROUP
AVERAGE INCIDENCE
Cannabis
65-80
Stimulants
20-30
Benzodiazepines
20-30
Narcotics
20-40
Anti-depressants
0-5
Others
5-20
Note: "average incidence" is an estimate of the likelihood of each drug being detected in samples obtained by the police or at a hospital. (Road Safety Committee 1, 1996, p 98)


The Effects of Drug Use on Driving

While the prevalence of drug use in the community is at a notable level and driver fatalities are increasingly showing a prevalence of licit and illicit drugs, it is important to note that some drugs may not effect driving performance at all. In the case of "high risk" drivers such as epileptics and diabetics, drugs may even assist the user in being a safer driver.

To drive effectively, the Inquiry into the Effects of Drugs (Other than Alcohol) on Road Safety in Victoria identified the following necessary skills and capabilities:
  • Sight
  • Hearing
  • An ability to perceive hazards and identify risk taking behaviour
  • Concentration, alertness and reaction time to make decisions
  • Physical competence to undertake steering and braking movements
  • Accuracy of movements such as steering vehicle within traffic lanes
(Road Safety Committee 1, 1996, p. 47)

Research has shown that drug taking may impair some or all of the above skills and the effects of specific drugs have been identified as follows:
  • Amphetamines and stimulants induce short-term stimulation that increases awareness and confidence and reduces symptoms of sleeplessness. Chronic use can lead to fatigue, restlessness, hearing and sight hallucinations and psychotic personality changes.
  • Benzodiazepines and other central nervous system depressants are sedatives and impair reaction time, reflexes and coordination skills.
  • Cannabis impairs reaction time, reasoning and overall brain function. Its effects can last several hours and appear to vary according to quantity, quality and content.
  • Opiates sedate the user and result in sleepiness, slow reflexes and changeable moods. Regular use can also result in psychological problems and withdrawal symptoms include irritability, physical discomfort and a very unstable personality.
(Road Safety Committee 1, 1996, p.47 and 2 p. 16)

In summary, the main effects of illicit drugs on driving are:
  • impaired reaction times
  • fatigue, and
  • impaired perception loss of attention.

To clarify the impact of drugs on driving effectively, the following research by Drummer looked at the influence of a variety of drugs on driver culpability. Use of all of the drugs identified shows an increase in relative risk except for cannabis, which shows a slight decrease. It is also of note that relative risk is nine times greater when alcohol and drugs are used together than when drug free. According to Drummer, the combination of alcohol and cannabis does not increase the relative risk any more than does alcohol alone.

TABLE 6: RELATIVE RISK BY SPECIFIC DRUG GROUPS

DRUG GROUP
NO.
RELATIVE RISK
SIGNIFICANCE
All Accidents
 
 
 
Drug Free
532
1.00
 
Alcohol only
278
6.00
P<0.001
Alcohol plus drugs
97
9.00
P<0.001
Drugs only
138
1.40
n.s
Cannabis only
43
0.60
n.s
Stimulants only
21
1.60
n.s
Opiates only
13
2.30
n.s
Benzodiazepines only
11
1.90
n.s
Multiple Vehicle Accidents
 
 
 
Drug Free
344
1.00
 
Alcohol only
73
3.40
P<0.001
Alcohol plus drugs
27
6.00
P<0.001
Drugs only
86
1.40
n.s
Cannabis only
27
0.60
n.s
Stimulants only
9
1.20
n.s
Opiates only
9
14
P<0.02
Benzodiazepines only
7
1.90
n.s
Note: n.s - No Statistical Significance (Drummer, 1994, P. 37)

ANALYSIS OF VICROADS 1996 STATISTICS

Looking at VicRoads' 1996 statistics (Graph 1) on total persons seriously injured for each Road User Group, it is of note that the majority of fatalities (52%) and serious injuries (55%) occur m the 17 - 39 year old age bracket. The major exception to this observation is that 19% of all serious injuries suffered by pedestrians occur in the 5 - 16 year old age bracket.

When analysing the 1996 statistics (Graph 2) according to gender it appears that the majority of road users (60%), both killed and injured, are male. This is evidenced by 80% of cyclist fatalities being male as well as 74% of driver fatalities and 100% of motor cyclist fatalities.

On breaking the 17 - 39 year old age bracket information down further (Graph 3), it appears that 8 1 % of drivers and riders killed are male, whereas only 68% of passengers killed are male. The only area in which female statistics outweigh males, is in passengers suffering serious injury. Only 48% of passengers seriously injured are male compared with 76% of drivers. These figures may suggest that women are being seriously injured as passengers of male drivers.

SPECIFIC RISK GROUPS

Australian studies have identified some specific groups that are over represented in fatality statistics. These groups include:

Male Drivers

The VicRoads 1996 statistics clearly identify male drivers and riders as a high-risk group. In 1996, 81% of drivers and riders killed on Victorian roads were males and the majority of those suffering serious injury m Victorian roads were also males.

Truck drivers

Drummer's study (1994) showed that stimulants were present in 21% of truck driver fatalities compared with 3.7% of all drivers. Dr Judith Perl of the Clinical Forensic Medicine Unit of the New South Wales Police Service has completed research which also indicates that heavy vehicle drivers are over-represented in relation to stimulant impairment. In her 1990 study of 260 New South Wales drivers, 22 per cent of the positive samples tested positive to stimulants and half of these were taken from truck drivers. Over half of the truck drivers had been detected by police due to erratic driving.
(Road Safety Committee 1, 1996, p. 101)

Elderly drivers

Another group identified in this manner are elderly drivers who use benzodiazepines. A more specific Risk Analysis study has been completed for elderly drivers with the following findings:

TABLE 7: RELATIVE RISK OF A CRASH THERAPEUTIC DOSES OF PRESCRIPTION DRUGS IN ELDERLY DRIVERS
DRUG
RELATIVE RISK
Drug Free
1.0
Prescription Drugs
 
Any psychoactive drug
1.5
Cyclic antidepressants
2.2
Cyclic antidepressants (high doses)
5.5
Benzodiazepines
1.5
Antihistamines
1.1
Opiate Analgesics
1.1
Alcohol
 
BAC 0.06%
1.5-2
BAC >O. 10%
5.5
(VicRoads, 1995, p. 11)

"Surveys have shown that over the age of 75, some 80% of the population are on regular drug treatment. About one third of this group are taking multiple drugs, three to four at a time. Benzodiazepines were prescribed to 15% of the population"
(McIntyre in Road Safety Committee 1, 1996, p. 12).

Younger drivers

Just as the elderly are identified as being of special concern in regard to drugs and driving, so too are younger drivers. They continually make up a disproportionately large sector of fatalities related to drug impairment and driving, as do males.

TABLE 8: DEMOGRAPHICS IN DRIVERS
DRUG CLASS
MEAN AGE
AGE RANGE
FEMALES
All drivers
34+-15
15-87
22%
Alcohol
31+-12
16-78
10%
Cannabis
25+-6
15-47
8.9%
Benzodiazepines
40+-18
21-80
28%
Stimulants
29+-11
18-73
13%
Opiates
36+-14
16-75
32%
Misc. Drugs
46+-20
16-87
29%
(Drummer, 1996, p. 14)

Country Drivers
When looking at segments of the community who are over represented in drug driving fatality statistics, it is also important to note that Drummer (1997) has calculated that 40% of all fatalities related to drug use occur on country roads. This figure is much higher than the percentage population spread in country areas.

RELATED ISSUES

Areas of concern related to drug impaired driving include the additional effects of alcohol, multiple drug use and fatigue
(Drummer, 1997).

The relative risk when driving under the impairment of drugs increases when alcohol is also involved (Drummer, 1994) and this is true for both illicit and prescription drugs. According to the 1995 National Drug Strategy Household Survey, many illicit drug users drink alcohol in conjunction with their drugs of choice. Also, concern has been raised by the Road Safety Committee (1996) regarding whether the general public is adequately informed regarding the combining of alcohol and prescription drugs.

As was detailed in the segment addressing elderly drivers, one third of this demographic use multiple prescription drugs and the effect of combining medications can magnify driver impairment. Illicit drug users are also at greater risk when they use multiple drugs (both licit and illicit) as are general prescription drug users of all ages. Understanding and awareness of the problems associated with multiple drug use is of concern in all areas of drug use and driving.

Drummer (1997) notes that fatigue is an issue which effects all drivers, especially those who are drug impaired. He states that many crashes related to drug use occur not when the effect of the drug use is at its peak but when the drugs begin to wear off. He believes that many truck crashes occur due to Rebound Fatigue, which occurs once the effects of stimulants subside. He also states that the issue of fatigue accounts for much of the high incidence of traffic fatalities on country roads.

COMMUNICATION METHODS AND TARGET GROUPINGS

The Victorian Branch of the Pharmaceutical Society of Australia has best described five groups in the community
which need targeted public education programs on drugs and their effects on driver performance.

1. People likely to experiment with drugs, illicit and prescribed.

2. The general population, who may be unaware of possible impairment of their driving skills by prescribed an over-the-counter medication. (This group would include persons suffering from medical conditions such as hypertension, depression, anxiety and sleep disturbances).

3. High risk groups. This group would include persons suffering from diabetes, epilepsy or psychiatric conditions who may have slightly higher risks of traffic accidents as compared with unaffected persons.

4. Older persons, who may not be aware of the decrease in their driving performance due to reduced psychomotor skills, eyesight, decision-reaction time or the effect of legally prescribed medication.

5. Persons whose employment is driving.

(Pharmaceutical Society of Australia, Victoria 1996)

Victoria has an impressive record for health campaigns and messages including Quit and Life. Be In It. as well as the high profile TAC campaigns targeting areas of driver safety. Much of the success of these campaigns has been due to a simple core message.

The success of Victoria's drink-drive and speeding campaigns has been accredited to the strong deterrent effect of legislation, effective publicity using the core messages of "Speed Kills' and "Drink Drive, Bloody Idiot" and coordinated enforcement. This approach has been recommended as the ideal basis for future public information campaigns against drug-impaired driving
(Road Safety Committee 1, 1996. p. 160).

In the area of drugs and driving there have been some important influences identified. Pharmacists and doctors are key information providers in relation to prescription and over the counter medicines. It has also been found that high-risk male drivers are most influenced by their girlfriends and spouses (Fell, 1995).

Span (1995) found that in relation to drinking and driving, both men and women rated "fear of crashing" and "fear of being caught" as the main deterrents.
Other deterrents in order of importance included %injuring someone else" and loss of licence".
Stewart et al (1995) also found that it is important to use positive messages when informing about driving safety, such as the focusing on the importance of peers in "looking after" each other. Another important finding in this study was that 18-29 year old males and females believe that driving while impaired occasionally is quite normal and that it is only irresponsible when it becomes habitual.

Span and Saffron (1995) in a review of NSW road safety measures found that advertising on its own does not appear to be an efficient tool for attitudinal or behaviour change, nor is it usually an appropriate way of communicating complex issues. Advertising can, however, increase awareness and reinforce other activities and a 1996 US study has found that Community Service Announcements have the same effect as paid advertising on behaviour change.

The NSW road safety messages study also found that enforcement and legal issues are important deterrents (because drivers can deny the risk of crashing but cannot argue with being caught while impaired).

Span and Saffron (1995) also note that the depiction of crashes in relation to driver impairment can be problematic as the viewer is likely to find reasons for the crash besides drug induced impairment and is likely to attribute the crash to causes beyond the driver's control. Depiction of crashes is also more likely to generate empathy for the victim rather than identification with the driver. Finally, in relation to graphic depiction of crashes, some concern is raised regarding the processing of messages, as people may be unable to watch the entire depiction.
Most of the drugs and traffic safety efforts in the past both in Australia and overseas have focused on the effects of alcohol, but a few tentative steps have been made in public education regarding drugs other than alcohol. These include:
  • ADF pilot campaign on amphetamine use by truck drivers
  • TAC campaign on medications
  • Pharmaceutical Society publications
  • VicRoads elderly driver campaign
  • Victoria Police, inclusion of Drug Misuse in police training course
  • Tranquilliser Recovery and New Existence (TRANX) program
(Road Safety Committee 1, 1996, p. 157)

The ADF harm minimisation program aimed at long haul drivers was evaluated most successfully with a recall rate of 95%, it comprised postcards, toilet / shower room promotion and trucking industry magazine advertising and editorial material plus a telephone information hotline.

The TAC print campaign aimed at older drivers who took prescription medications evaluated poorly due to legal issues, confusing wording and incomplete information. The Pharmaceutical Society provides a number of Self Care information cards, one of which deals with drugs and driving. This has proven successful but requires further funding to have a greater impact.

In the US more specific campaigns, especially aimed at younger drivers, have been devised, a sample of these includes:

Texas Drug & Alcohol Driving Awareness Program

The Council on Alcohol & Drug Abuse - Houston

Designed and certified by the Texas Commission on Alcohol & Drug Abuse this course consists of two classes which will provide 6 hours of drug and alcohol education. Persons holding a C class driver's license may complete this course and receive a 5% reduction on their liability, medical payments, personal injury protection and collision auto insurance. The cost of the course is $30US per person.

American Safety Institute, Inc.

Florida statute requires all first-time drivers attend a four-hour program, registration costs from $25US to $35US. The Department of Highway Safety & Motor Vehicles regulate the program. The main purpose of the program is the educated drivers regarding the dangers of alcohol and drug abuse, when driving a motor vehicle.

MODULE 1:

Statistics How alcohol affects driving What is legal intoxication Inexperience and alcohol Reaction time - it's the real problem

MODULE 2:

Drugs and their effects on driving Deadly combination of drugs and alcohol When can we legally buy alcohol What is addiction

MODULE 3:

License revocation Cost of DUI (driving under the influence) Point system Passing - signs Tailgating Seat belts Intersections

Buzzing & Tooling Down the Road

University of North Colorado, Work site Initiative to Promote Safe Driving Aimed at blue-collar males this program aims to reduce alcohol and drug impaired driving through work place education. Four hour long experiential sessions are preceded by a short introductory session. Evaluation to date suggests that the program has accounted for positive changes in knowledge, behavioural beliefs, attitudes and behaviour among participants.

The key to the success of any communications effort will be the ability to adequately define target groups and to determine an appropriate means and messages for communicating with them. Based on our review of the literature and our extensive experience of drugs, drug use and drug culture, the Australian Drug Foundation recommend that the following groups be targeted.

Pharmacists appear well aware of their 'duty of care' with respect to counselling of users of prescribed medications and some over-the-counter products. Professional practice standards are maintained by the Pharmaceutical Society of Australia who provide on-going professional education and support material as to practice standards in the dispensation of prescribed and non-prescribed medications.

As stated earlier in this Report, the Pharmaceutical Society of Australia (Victorian Branch) has identified five community groupings requiring public education effort with respect to drug use and impairment of driving.


BIBLIOGRAPHY

Chesher G, Lemon J, Clornel M and Murphy G, Are the driving related skills of a client m a methadone maintenance program affected by methadone. NHMRC Road Accident

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Drummer Olaf, 1997, Victorian Institute of Forensic Medicine, Interview, 9/10/97

Drummer Olaf, 1994, Drugs in Drivers Killed In Australian Road Traffic Accidents, The Use of Responsibility Analysis
To Investigate The Contribution of Drugs To Fatal Accidents, Report No. 0594, Victorian Institute of Forensic Pathology, Department of Forensic Medicine. Monash University

Fell JC, 1995, What's New in Alcohol, Drugs and Traffic Safety in the US, National Highway Tragic Safety Administration, paper presented at International Council of Alcohol, Drugs and Traffic Safety Conference, Adelaide

National Centre for Research and Prevention of Drug Abuse. The Fitpack Study, 1997.

National Drug and Alcohol Research Centre (NDARC) Long Term Cannabis Users in the New South Wales North Coast. Monagraph No. 30,1995.

National Drug Strategy Household Survey, Survey Report 1995, Commonwealth Department of Health and Family Services.

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Premier's Drug Advisory Council (PDAC), 1996, Drugs and Our Community - Report of the Premier's Drug Advisory Council Melbourne

Richardson John, 1997, Road Safety Committee Chairman, Paper given at International Council on Alcohol, Drugs and Traffic Safety Conference, Annecy, France

Road Safety Committee, 1996 (1), Inquiry Into The Effects Of Drugs (Other Than Alcohol) On Road Safety In Victoria, Final Report Volume One, Parliament of Victoria

Road Safety Committee, 1996 (2), Inquiry Into The Effects Of Drugs (Other Than Alcohol) On Road Safety In Victoria, Final Report Volume Two, Parliament of Victoria

Span D, 1995, Research on Knowledge, Attitudes and Reported Behaviour on Drink-Driving in New South Wales, paper presented at International Council of Alcohol, Drugs and Traffic

Span D & Saffron D, 1995, The Development of Drink-Driving Mass Media Advertising:
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