Drugged driving is an increasingly common public health problem in the US. In 2016, accidents resulting from driving after using drugs overtook drunk driving as the leading cause of fatal crashes.1 Experts link increasing collisions by drivers on drugs to marijuana legalization, soaring prescription opioid use, and the misbelief that drugged driving is not as bad as drunk driving.
As a general rule, the more of the drug a person takes, the higher the risk that a person may develop side effects from it.6
A person shouldn’t take Neurontin with alcohol, sleeping pills, or painkillers because they could negatively affect a person’s breathing. A person should always talk to their doctor first before they take the drug with these medications or drinks.
According to Marissa Seamans, a Maryland-based researcher at the Johns Hopkins Bloomberg School of Public Health, “gabapentinoids are increasingly prescribed to patients with opioids and benzodiazepines, which increases the risk of respiratory depression and death.” Seamans explains that “clinicians and patients need to carefully monitor the dosage of these medicines, their interactions, and potentially fatal side effects.”6
When someone drives a vehicle while using drugs (caused by either a legal or an illegal drug), it is known as drugged driving. Drugged driving is illegal in all 50 states. It poses a serious threat to the driver, people inside the vehicle, and anyone on the road.
Drivers who use illegal drugs are 121% more likely to have crashes compared to those who do not use these drugs. Similarly, the crash risk is 125% higher among drivers who use marijuana.3 That said, the results are unadjusted for other factors, such as age, gender, and alcohol use.
44% of fatally injured drivers in car crashes had used one or more drugs in 2016. Notably, the percentage was significantly lower (28%) in 2006. During the same year, 37.9% of fatally injured drivers had driven after drinking alcohol.4
According to the researchers at Columbia University’s Mailman School of Public Health, drugged driving increases fatal crash risk by nearly 300%. Combining drugs with alcohol causes a 23-fold increase in risk.5
In 2014, 5.9 million people aged 16 or older were reported to have driven under the combined effects of alcohol and illicit drugs.6
While the odds of fatal crashes vary depending on the type of study, it is clear that drugged driving is hazardous.
Studies reveal that more people are now driving on drugs than on alcohol.
From 2014 to 2017, the number of people aged 16 or older who were reported to have driven after drinking alcohol in the past year decreased from 27.7 million to 21. 4 million. On the other hand, the number of people aged 16 or older who drove after using drugs increased from 10.1 million to 12.1 million.6, 7
The number of drunk driving cases further decreased to 20.5 million in 2018. However, the number of drugged driving cases increased to 12.6 million.8
Drugged driving is illegal in all states in the US. Many people wrongly believe that driving after using marijuana is legal in the states where medical or recreational use of the drug is legal. Notably, one in three teens mistakenly believes that driving under the influence of marijuana is legal.9
In addition to treating addiction, treatment can also reduce drug-related traffic deaths.
One often-overlooked consequence of drugged driving is that it can kill not only the drivers but also other people who are on the road. Real-life stories of people who have lost their loved ones in drug-related crashes are a wake-up call to parents and policymakers.
Helen Witty is one of the thousands of mothers who have lost their kids to drug-related crashes. Below is the heart-wrenching incident that changed her world forever.
It was a typical day in June 2000 until something unimaginable happened to Helen Witty. A new Audi driven by Carla Wagner (17) hit Helen’s daughter, Helen Marie (16). Carla was under the influence of alcohol and marijuana. She was speeding at 60 mph in a 30 mph zone.
Most notably, Helen Marie, who had just completed her junior year, was not even on the road when the accident occurred. She was rollerblading on a bike path. Later, investigators revealed that the accident happened when inebriated Carla lost her attention when she used her cell phone.
Witty is now the National President of MADD. MADD is an acronym for Mothers Against Drunk Driving. It fights for stronger laws to bring down the number of such deaths to zero. Witty’s full story can be read here.
Rising numbers of drunk driving-associated crash deaths indicate an urgent need to treat addiction. This is even more critical considering the ongoing opioid crisis and the legalization of marijuana.
Between 2007 and 2017, among 102,221 fatally injured drivers, 28,756 tested positive for drugs other than alcohol.10 Among drivers admitted to a trauma center after a vehicle crash, over 50% had used drugs other than alcohol, and 25% had used marijuana.10
According to the National Roadside Survey 2013-2014, one in five nighttime drivers during weekends had tested positive for drugs.11
Drugged driving is dangerous because it can:
Kill the driver, their passengers, or other people on the road.
Cause loss of productivity due to disability and injuries.
Increase the financial burden on individuals and the government.
Using a drug affects many functions in the brain. Altered brain functions can cause slowed responses, incoordination, poor judgment, and sensory changes.
All these factors significantly increase the risk of a fatal crash.
The effect on driving skills depends on the type and amount of the drug used. Scientists know how particular drugs affect specific driving skills. Nonetheless, it is often impossible to pinpoint the effects when a person uses more than one drug at a time.
Like opioids, sedatives depress activity in the brain. They cause drowsiness and dizziness.
Mixing opioids or benzos with alcohol causes a dangerous increase in sedation. The risk of overdose or crash due to an individual drug is lower than when taking multiple drugs.
The effect of cannabis on driving skills can vary depending on the driver. Usually, it slows response and causes impaired judgment, especially impaired judgment of time and distance.
The accurate judgment of time and distance is essential to driving safely. People who drive after using marijuana are more likely to indulge in lane weaving. Moreover, they also tend to be less aware of their speed.
Driving shortly after smoking marijuana can increase the risk of a crash by 25% to 35%.12
Some OTC drugs have side effects that can impair driving skills. These include drowsiness, dizziness, shakiness, and abnormal heart rhythms. OTC medications for cough, allergy, and upset stomach can cause sedation. Thus, people who have to drive vehicles should read the label carefully before taking these drugs.
Marijuana and opioids are the two drugs most commonly involved in drugged driving crashes. In college students, marijuana was the most frequently used drug, followed by cocaine and prescription pain medications.
Among opioids; hydrocodone, oxycodone, and morphine take the top three spots.2 The prevalence of opioids in fatally injured drivers increased sevenfold from 1% in 1995 to 7% in 2015.2 In 2016, nearly 20% of intoxicated drivers tested positive for an opioid.8
Will the burgeoning marijuana industry boost drugged driving fatalities?
The answer is complicated because the effects of marijuana on traffic crashes are inconsistent.
For example, fatal crashes involving marijuana doubled in Washington after the drug became legal in the state in 2012.15 Likewise, traffic deaths involving marijuana in Colorado increased by almost 50% after the recreational use of the drug became legal in the state.16
Nonetheless, these findings do not show a direct cause-and-effect relationship between marijuana use and fatal crashes. A large NHTSA study found no strong link between increased crash risk and marijuana use after adjusting for other contributing factors such as concomitant alcohol use and the age, gender, and race of the driver.8
More research is needed to establish a direct association between marijuana and increased crash risk.
Unlike drunk driving, it is not easy to detect when someone is under in the influence of marijuana. This is because no one knows the blood level of marijuana that causes impaired driving.
To date, there is no reliable roadside test to measure drug levels in the body. Moreover, many drivers mix alcohol with other drugs or marijuana. This makes it almost impossible to pinpoint the cause of the crash.
Some drugs stay in the system for prolonged periods. For example, THC, the main active chemical in marijuana, can remain in the body for up to a week. Thus, testing cannot reveal the time of use or whether the drug in the bloodstream is causing impaired driving.
Moreover, the amount of marijuana in a blood sample may not directly predict the severity of drugged driving. A saliva test may be better at determining drugged driving involving marijuana. According to a Colorado State Patrol (CSP) representative, the state is in the final phase of testing new devices to check saliva.17
Lastly, if the blood level of alcohol is higher than the legal limit, police do not usually order tests to detect drugs.
Drunk driving has a well-documented history. On the contrary, drugged driving is relatively new, and the first legal act to control it came into effect only in the early 1970s.
1897: The first drunk driving arrest was made in London
1910: The first laws against drunk driving came into effect in New York
1936: Dr. Rolla Harger patented a device to detect alcohol intoxication - the Drunkometer
1953: Robert Borkenstein patented a more user-friendly and accurate device - the Breathalyzer
Late 1970's and early 1980's: Lawmakers and police began to tighten their grip on offenders
1980: Candy Lightner from California founded Mothers Against Drunk Driving (MADD) after a drunk driver killed her 13-year-old daughter. MADD lobbied for severe punishment for drunk drivers
2004: All fifty states set legal blood alcohol concentration (BAC) limits of .08%
1973: The federal government issued the Federal-Aid Highway Act. The Act aimed to investigate the association between drug use and highway safety
1988: Congress passed legislation to prohibit drivers who refused to participate in drug or alcohol testing from driving in US territory
1991: The Alcohol-Impaired Driving Countermeasures Act pledged a financial incentive to states that implemented a drugged driving prevention program
2004: An attempt to pass bills that would require all the states to enact drugged driving laws met with failure
2005: Enactment of federal legislation regarding drugged driving
Drunk driving refers to driving after drinking alcohol. Alcohol is one of the most common substances involved in fatal crashes.
Impaired driving is an umbrella term for drugged and/or drunk driving. It means driving when someone is not fit for driving due to various reasons. These can include recent drug or alcohol use, excessive sleepiness, and disorders that affect the driver’s vision, judgment, or driving skills.
According to the law, anyone who has a blood alcohol concentration (BAC) of 0.08% or higher is considered to be driving under the influence of alcohol. They are liable to be punished, as driving with a BAC of 0.08% or higher is illegal.
Identifying drugged driving is far more complicated than drunk driving since dozens of drugs (prescription, OTC, or illegal) can impair driving skills.
Moreover, people respond differently to the same drug. The amount of a given drug that impairs one person’s driving skills may not cause any problem for another. Besides, there are no standard guidelines on what amount of any given drug causes impairment.
Interestingly, when a person uses two different classes of drugs, the overall effect may not be obvious. For instance, stimulants can neutralize drowsiness caused by sedatives.
In the US, drunk driving causes one death every fifty minutes, reports the CDC (Centers for Disease Control).20 No detailed data is available on the deaths of people due to drugged driving. That said, estimates suggest drugged driving causes 8,600 deaths each year.19
The National Institute on Drug Abuse (NIDA) has a list of tips for drugged driving prevention. Sadly, there are no evidence-based programs dedicated to preventing drugged driving. Even worse, many prevention professionals say that they have limited access to resources about drugged driving.22 Most prevention strategies focus on raising awareness and improving access to web-based resources.
There are two primary laws regarding drugged driving. They are zero-tolerance laws and per se laws. The former laws consider any detectable amount of specified drugs in the body illegal. Per se laws consider driving illegal if the amount of specified drugs in the driver’s body is over specified limits.
In the US, 16 states have zero-tolerance laws for one or more drugs, and 8 states have per se laws for one or more drugs. This is according to the Governors Highway Safety Association (GHSA).23
In addition to the laws, some states also have various sobriety testing tools and strategies. These include:24
SFST comprises three tests. These tests check a driver’s eye movement, coordination, and balance. SFST helps identify impairment due to drugs, such as opioids, stimulants, depressants, and marijuana. About 800,000 officers across the country use SFST. In some states, SFST training is not mandatory.
The DRE program was jointly developed by the National Highway Traffic Safety Administration (NHTSA) and the International Association of Chiefs of Police (IACP). Currently, there are 8,000 DRE-certified officers in 37 states and the District of Columbia.
NHTSA developed the ARIDE program as an alternative to the DRE program. Currently, there are over 36,000 ARIDE-certified officers across the country.
Available tests do not accurately measure the amount of a drug in the driver’s body. There are no standard impairment limits for drugs, including marijuana. For alcohol, there is a limit of BAC 0.08%, but no one knows the limits for drugs like marijuana. It may take time for some states to approve saliva testing, which is perhaps more accurate.
Educational campaigns involving teens and parents are a great way to prevent drugged driving. The government encourages local media to disseminate information about the dangers of drugged driving. Some examples of such campaigns include:
Drugged Driving Prevention Night
Drugged Driver activity for teens
Drugged Driving Poster Contest Activity for Teens
Teen Panel Discussion