American Association of State Highway and Transportation Officials

Special Committee on Research and Innovation

FY2023 NCHRP PROBLEM STATEMENT TEMPLATE

Problem Number: 2023-G-33

Problem Title

Economic Evaluations of Roadside Driving Under the Influence of Drugs (DUID) Programs.

Background Information and Need For Research

Many states are moving toward legalization or decriminalization of drugs. Doing so creates a dilemma for transportation safety professionals who recognize that these actions will likely increase death and serious injury on the nation’s roads and highways. This is counter to the goals and objectives set forth in strategic planning efforts, such as: Vision Zero, Toward Zero Deaths, State Strategic Highway and Local Safety Plans. An effective countermeasure is needed to counteract drug use while driving. This research attempts to fill this gap. It should be recognized that the outcomes of crashes often become the responsibility of those who operate and design roads, so steps to reduce behaviors that lead to crashes are of benefit to transportation agencies, particularly in the context of the Safe System and the concept of shared responsibility. To assist transportation agencies, policies to deter driving under the influence of drugs (DUID) require sound scientific evidence for measuring and detecting drug prevalence. They also demand resources. Because the use of any resource has a cost, the design, implementation, and use of policies should be guided by what is both scientifically and economically sound. Economic evaluations of policy alternatives should help decide which among them can reasonably be implemented by a given jurisdiction which in turn will increase the implementation of DUID programs that lower crash potential for all concerned stakeholders and road users.

Accurate screening for drugs at the roadside is key to efforts to deter DUID. The use of oral fluid (OF) samples and Drug Recognition Expert (DRE) observations are two methodologies used to screen for DUID. Each of these present many strengths and but also weaknesses, and each are associated with specific benefits and costs. This research intends to outline these issues, benefits, and cost to highlight the value of these needed safety programs in addressing crash reduction. Moreover, given the increasing difficulties associated with recruiting police officers in general, and in training, using, and retaining DREs in particular, it would be useful to assess whether it would be more cost efficient to provide intensive training on how to collect oral fluid specimens for drug-detection to as many officers as possible and to extend the Advanced Roadside Impaired Driving Enforcement (ARIDE) training to as many officers as possible. Transportation agencies responsible for road safety will find significant benefit as effective countermeasures for reducing road deaths and serious injuries related to drugged driving are needed.

Literature Search Summary

Drug-impaired driving is a public and governmental concern in the United States.1 2 The 2013-14 National Roadside Survey (NRS) found 22.5% of U.S. weekend nighttime drivers positive for drugs, a significant increase from the 12.4% of drivers positive for illegal drugs measured in 2007.2 Concern is specially high for cannabis as it is the most frequently detected drug after alcohol in drivers who have crashed.1 3 Despite some uncertainty regarding the concentrations of Delta-9-Tetrahydrocannabinol (THC, cannabis’ main psychoactive component) that trigger impairment,4 cannabis has been found to elevate crash risk,5 although sometimes only when used jointly with alcohol.1 Besides cannabis, many other drugs including anxiolytics, hypnotics, sedatives, etc., could also contribute to crash risk.5 In a meta-analysis of studies assessing crash risk associated with drugged-driving, Elvik reported increases in risk for most of the drugs examined.6

To deter drivers from DUID, the accurate screening and detection for drugs at the roadside is key. To this regard, drug screening and detection methods based on OF samples are becoming increasingly popular, as the method is minimally invasive and appears effective in detecting many types of drugs. 7 8 9 As summarized by Lee & Huestis 8, “oral fluid (OF) is a new biological matrix for clinical and forensic drug testing, offering non-invasive and directly observable sample collection reducing adulteration potential, ease of multiple sample collections, lower biohazard risk during collection, recent exposure identification, and stronger correlation with blood than urine concentrations.” However, issues associated with the accuracy of screening technologies to identify time of drug use, and to assess whether the amount of drug detected was impairing7 10 limit the use of this approach.2

Developed by the Los Angeles Police Department in the 1970’s, and currently managed by the International Association of Chiefs of Police (IACP) with technical assistance from the National Highway Traffic Safety Administration (NHTSA), the Drug Evaluation and Classification (DEC) program trains officers to be Drug Recognition Experts (DREs) who, following a request by a responding officer, assist the officer in determining drug impairment.7 11 Despite some mixed results regarding the efficiency of DREs to detect drug impairment 12, DREs have become a sound strategy for DUID detection. However, the use of DREs presents limitations of their own, including the substantial time and cost required for training DREs and a progressive reduction in the DRE force, which may be at least in part responsible for a severe decline in callouts for DREs by responding officers who get frustrated by a lack of rapid responses (or even any response at all) when reaching out for DREs.12 Indeed, shortage of DREs has been identified in several states as the main limitation of the program.12 13 14

The Advanced Roadside Impaired Driving Enforcement (ARIDE) training has been posited by MADD as a way to “bridge the gap between Standardized Field Sobriety Testing (SFST) and Drug Recognition Expert (DRE) training,” and “provides police officers with the basic skills in identifying and detecting drug-impaired drivers. The training is taught by DRE instructors and also ensures the officer’s SFST proficiency.” 15 Given the shortage of DREs, it has been posited that widening ARIDE training to reach as many patrol officers as possible may be a sensible alternative, 12 15 This possibility needs to be assessed.

Research Objective

1. To assess the cost-effectiveness of alternative drug screening approaches. More specifically, the goal of Aim 1 is to estimate the monetized cost that would be needed to reach a specific screening target (i.e., to identify a percentage of drug-impaired drivers) by widening the ARIDE training; and compare this cost with the cost needed for the DRE/Drug Evaluation Classification (DEC) program to reach similar results. This aim will explore the cost-effectiveness of the approaches under comparison for a range of targets (i.e., the identification of a range of percentages of drug-impaired drivers) and a range of assumptions regarding the percentage of ARIDE and/or DRE training.

2. To assess the costs and benefits associated with policies requiring the collection of oral fluid at the roadside to screen and confirm all drivers suspected of impairment, compared with some law enforcement procedures that halt efforts once a suspect’s BAC is determined to be at or above the per se limit. Aim 2 can be viewed as a variation of Aim 1, in which the screening for drugs is halted (or not) after impairment by alcohol is established. As with Aim 1, a range of targets and assumptions will be examined.

3. To inform traffic safety professionals about the costs and benefits associated with alternative DUID crash countermeasures. The information to be provided by this study will be useful to safety professionals in the strategic highway safety planning, development, and implementation of infrastructure and behavioral safety programs, so that holistic and cost-efficient road safety strategies can be developed to reduce fatal and serious injury crashes to greatest extent possible.

Urgency and Potential Benefits

With increasing legalization and decriminalization of drug involved impairment related crashes will increase. This makes it very difficult for agencies to meet safety goals and targets. This unfortunate rise will require a shifting of infrastructure safety dollars to reduce fatal and serious crashes related to such things as lane departures, cross centerline, and other high severity crash types. A partnership approach is immediately needed to help offset these potential negative consequences. Further, in times of dwindling resources and increasing concerns affecting the ability and willingness law enforcement agencies to make impaired driving detection a priority, determining the resource-optimal policies for DUID screening is of timely significance. The outcome of this research will assist policy makers to decide how to optimally allocate the resources at their disposal.

Implementation Considerations

The concept is to produce monetized evaluations of drug screening approaches. More specifically, the concept is to estimate how much would it cost to reach a specific outcome (proper DUIDs screening and detection) under alternative approaches. Because the cost of each alternative may vary for different targets (i.e., how efficient the approach would need to be) and assumptions, we will conduct sensitivity analyses to achieve a more granular examination of the policies (i.e., repeat the analyses for a range of target outcomes and assumptions).

Some of the assumptions/factors that would be considered could include DUI and DUID prevalence in a community, community size, local laboratory capacity, laws and regulations, and advances in OF detection. Moreover, because policy implementation costs may vary across locations and over time, cost estimates will be obtained separately for these factors, and expressed all in 2021 dollars.

Recommended Research Funding and Research Period

A two-year effort would be required. Most of the first year will be used to review the literature, collect, clean, and integrate all databases (e.g., crash, economic, regulatory data). Most of the second year will be used for building the models, conducting analyses, obtaining estimates and results, and report findings.

We expect all data to be used in this effort to be publicly available.

Funding: s $500,000.

Problem Statement Author(S): For each author, provide their name, affiliation, email address and phone.

Eduardo Romano, Ph.D.

Senior Research Scientist

Pacific Institute for Research and Evaluation (PIRE)

National Capital Region Center (NCRC)

4061 Powder Mill Road, Suite 350

Beltsville, MD, 20705-3113

E-mail: romano@pire.org

Ph:301-755-2724

Eileen Taylor, M.S..

Program Director

Pacific Institute for Research and Evaluation (PIRE)

National Capital Region Center (NCRC)

4061 Powder Mill Road, Suite 350

Beltsville, MD, 20705-3113

E-mail: taylore@pire.org

Ph:301-755-2719

John C. Milton, Ph.D., PE, RSP2IB, PTOE

State Safety Engineer

Washington State Department of Transportation

310 Maple Park Avenue SE

Olympia, WA, 98503

E-mail: miltonj@wsdot.wa.gov

Ph: 360-791-9242

Potential Panel Members: For each panel member, provide their name, affiliation, email address and phone.

Christine Moore

9 Delta Analytical

Christine.Moore@9-delta.com

909-308-4138

Person Submitting The Problem Statement: Name, affiliation, email address and phone.

John Milton

MiltonJ@wsdot.wa.gov

1. Compton RP, Berning A. Drug and alcohol crash risk. Journal of Drug Addiction, Education, and Eradication. 2015;11(1):29.

2. Romano E, Moore C, Kelley-Baker T, Torres-Saavedra PA. The utility of delta 9-tetrahydrocannabinol (THC) measures obtained from oral fluid samples in traffic safety. Traffic injury prevention. 2019;20(7):667-672.

3. Berning A, Compton R, Wochinger K. Results of the 2013-2014 national roadside survey of alcohol and drug use by drivers. Journal of Drug Addiction, Education, and Eradication. 2015;11(1):47.

4. Arkell TR, Spindle TR, Kevin RC, Vandrey R, McGregor IS. The failings of per se limits to detect cannabis-induced driving impairment: Results from a simulated driving study. Traffic injury prevention. 2021;22(2):102-107.

5. Hels TB, Lyckegaard I, Houwing A, et al. Risk of injury by driving with alcohol and other drugs. Driving under the Influence of Drugs, Alcohol and Medicines DRUID, Deliverable 2.3. 5. 2011;

6. Elvik R. Risk of road accident associated with the use of drugs: A systematic review and meta-analysis of evidence from epidemiological studies. Accident Analysis & Prevention. 2013;60:254-267.

7. Compton RP. Marijuana-impaired driving-a report to congress. 2017.

8. Lee D, Huestis MA. Current knowledge on cannabinoids in oral fluid. Drug testing and analysis. 2014;6(1-2):88-111.

9. Moore C. Oral fluid for workplace drug testing: laboratory implementation. Drug testing and analysis. 2012;4(2):89-93.

10. Elvik R. Risk of road accident associated with the use of drugs: A systematic review and meta-analysis of evidence from epidemiological studies. Accident analysis and prevention. 2013;60:254-267. doi:10.1016/j.aap.2012.06.017

11. Seiders GT. Call in the experts: the drug recognition expert protocol and its role in effectively prosecuting drugged drivers. Widener law journal. 2017;26(2):229.

12. Solensten B, Willits DW. Perceptions of Drug Recognition Experts (DREs) and DRE Evidence: A Qualitative Analysis of the Police, Prosecution, and Defense.

13. Susanin R, Lank. O. Shortage of Drug Recognition Experts in the state as drug related crashes on the rise. Eyewitness News 3. https://www.wfsb.com/news/shortage-of-drug-recognition-experts-in-the-state-as-drug-related-crashes-on-the-rise/article_7333dc38-e2f9-11e8-8ca9-0346175c212a.html

14. DeFeciani E. Law enforcement worried about lack of drug recognition experts. 6 News. https://cbs6albany.com/news/local/capital-holiday-lights-in-the-park-organizers-optimistic-after-boost-in-job-applicants

15. MADD. POSITIONS & POLICIES. Accessed 10/07/21, 2021.