This document discusses drugged driving and the unique legal issues it presents. It notes that 1 in 8 weekend, nighttime drivers test positive for illicit drugs and 33% of fatally injured drivers tested positive for drugs in 2009. Marijuana, cocaine, and prescription drugs are commonly found. Studies show drugs like marijuana negatively impact driving ability. Per se drugged driving laws are complicated by the lack of impairment thresholds like the .08 BAC standard for alcohol. Prosecutors may need drug recognition experts as witnesses. Initial stops, admissibility of tests, the right to confrontation, and jury attitudes also present unique issues in drugged driving cases compared to DWI.
This document summarizes a study that evaluated data from drivers arrested for driving under the influence (DUI) in relation to establishing a per se legal limit for THC levels. The study analyzed data from 602 drivers who tested positive only for THC and 349 drug-free controls. It also analyzed data from 4,799 drivers who tested positive for cannabinoids. The study found poorer performance on field sobriety tests for cannabis-positive drivers but no clear correlation between THC levels and impairment. Establishing a per se legal limit of 5 ng/mL would classify only around 30-49% of cannabis-positive drivers as impaired. The study concludes that a quantitative per se legal limit for THC cannot be scientifically
This document summarizes key points from a conference on building multi-state cases related to pharmaceutical drug crimes. It discusses the roles of various practitioners, agencies, and prosecutors and how to collaborate across states. It outlines strategies for using prescription drug monitoring programs and issues to consider from a prosecutor's perspective. Tips are provided on working with pharmacists, regulatory authorities, out-of-state partners, and the DEA to strengthen multi-state investigations.
This document discusses road safety issues related to the legalization of recreational cannabis in Canada. It summarizes data from Colorado and Washington, the first U.S. states to legalize cannabis, which shows both a small increase and a doubling in the percentage of drivers involved in fatal crashes who recently used marijuana. However, the data is limited and inconclusive. It argues that establishing per se drug limits and effective enforcement of impaired driving laws will be important for maintaining road safety as legalization occurs in Canada.
Underage drinking has negative consequences and contributes to health and social problems. While aggressive prevention efforts since the 1980s have led to positive changes like a 79% decline in alcohol-related traffic deaths among youth aged 16-20, challenges remain. Evidence-based strategies to reduce underage drinking include policies that limit youth access to alcohol, such as minimum legal drinking age laws. Enforcement of underage drinking laws is fundamental to prevention efforts.
ANALYZING SOLUTIONS FOR UNSAFE PHARMACEUTICAL DISPOSAL finalOlivia Chambliss
This document analyzes solutions for unsafe pharmaceutical disposal. It discusses how improper disposal can harm public health and the environment. Researchers interviewed stakeholders like PhRMA, pharmacies, and the public about their views and policy preferences. Options discussed include requiring PhRMA to fund drug drop-off locations, city-funded locations, and putting the burden on consumers. County ordinances requiring PhRMA funding are recommended to hold producers responsible for product lifecycles and improve awareness, health, and environmental protection.
This paper analyzes factors that affect drunk-driving crashes in the U.S. from 1994 to 2010 through a literature review and regression analysis. The model constructed shows macroeconomic conditions like unemployment rate and per capita income, along with microeconomic variables including gasoline prices and alcohol taxes, significantly impact drunk-driving crashes. Previous studies mostly focused on the effects of public policies, while this paper integrates both macro/micro economic variables and policies to examine their combined impacts. Regression analysis is used to quantify the relationships between drunk-driving crashes and selected economic factors.
This document discusses drugged driving and the unique legal issues it presents. It notes that 1 in 8 weekend, nighttime drivers test positive for illicit drugs and 33% of fatally injured drivers tested positive for drugs in 2009. Marijuana, cocaine, and prescription drugs are commonly found. Studies show drugs like marijuana negatively impact driving ability. Per se drugged driving laws are complicated by the lack of impairment thresholds like the .08 BAC standard for alcohol. Prosecutors may need drug recognition experts as witnesses. Initial stops, admissibility of tests, the right to confrontation, and jury attitudes also present unique issues in drugged driving cases compared to DWI.
This document summarizes a study that evaluated data from drivers arrested for driving under the influence (DUI) in relation to establishing a per se legal limit for THC levels. The study analyzed data from 602 drivers who tested positive only for THC and 349 drug-free controls. It also analyzed data from 4,799 drivers who tested positive for cannabinoids. The study found poorer performance on field sobriety tests for cannabis-positive drivers but no clear correlation between THC levels and impairment. Establishing a per se legal limit of 5 ng/mL would classify only around 30-49% of cannabis-positive drivers as impaired. The study concludes that a quantitative per se legal limit for THC cannot be scientifically
This document summarizes key points from a conference on building multi-state cases related to pharmaceutical drug crimes. It discusses the roles of various practitioners, agencies, and prosecutors and how to collaborate across states. It outlines strategies for using prescription drug monitoring programs and issues to consider from a prosecutor's perspective. Tips are provided on working with pharmacists, regulatory authorities, out-of-state partners, and the DEA to strengthen multi-state investigations.
This document discusses road safety issues related to the legalization of recreational cannabis in Canada. It summarizes data from Colorado and Washington, the first U.S. states to legalize cannabis, which shows both a small increase and a doubling in the percentage of drivers involved in fatal crashes who recently used marijuana. However, the data is limited and inconclusive. It argues that establishing per se drug limits and effective enforcement of impaired driving laws will be important for maintaining road safety as legalization occurs in Canada.
Underage drinking has negative consequences and contributes to health and social problems. While aggressive prevention efforts since the 1980s have led to positive changes like a 79% decline in alcohol-related traffic deaths among youth aged 16-20, challenges remain. Evidence-based strategies to reduce underage drinking include policies that limit youth access to alcohol, such as minimum legal drinking age laws. Enforcement of underage drinking laws is fundamental to prevention efforts.
ANALYZING SOLUTIONS FOR UNSAFE PHARMACEUTICAL DISPOSAL finalOlivia Chambliss
This document analyzes solutions for unsafe pharmaceutical disposal. It discusses how improper disposal can harm public health and the environment. Researchers interviewed stakeholders like PhRMA, pharmacies, and the public about their views and policy preferences. Options discussed include requiring PhRMA to fund drug drop-off locations, city-funded locations, and putting the burden on consumers. County ordinances requiring PhRMA funding are recommended to hold producers responsible for product lifecycles and improve awareness, health, and environmental protection.
This paper analyzes factors that affect drunk-driving crashes in the U.S. from 1994 to 2010 through a literature review and regression analysis. The model constructed shows macroeconomic conditions like unemployment rate and per capita income, along with microeconomic variables including gasoline prices and alcohol taxes, significantly impact drunk-driving crashes. Previous studies mostly focused on the effects of public policies, while this paper integrates both macro/micro economic variables and policies to examine their combined impacts. Regression analysis is used to quantify the relationships between drunk-driving crashes and selected economic factors.
This document discusses substance use, abuse, and dependence in forensic and correctional populations. It reports that approximately 65-70% of offenders meet criteria for substance abuse and 40-45% meet criteria for substance dependence or addiction. The document then reviews how evidence of intoxication can in some cases reduce legal culpability through defenses like diminished capacity, insanity, or automatism. However, these defenses are difficult to establish and rarely apply to typical cases. The document concludes that drug or alcohol use rarely eliminates conscious intent, though it may increase reckless behavior, and that traditional substance abuse treatment has lower success rates for offenders than typically estimated. Programs integrating treatment and supervision are more effective at reducing substance use and crime.
This document provides a risk and protection profile for substance abuse prevention in Mason County. It contains data on risk factors for substance abuse organized within the Hawkins and Catalano framework of community, family, school, and individual domains. The data includes standardized comparison profiles of rates for Mason County and similar 'county like us' levels for various indicators related to factors such as availability of drugs, economic deprivation, mobility, antisocial behavior, and problem outcomes over a five-year period. Technical notes are provided on interpreting the profiles and annual trend data.
Are You Eligible for Drug Court in New York?Adam Thompson
If you have been arrested and charged with a criminal offense in the State of New York, you may be facing serious judicial and non-judicial penalties. Learn more about drug court in New York in this presentation.
Favorite slides for safety meeting and drug awarenessMichael Kennedy
This document provides an overview of drug and alcohol testing regulations for commercial drivers. It discusses the types of required testing including pre-employment, random, post-accident, reasonable suspicion, return-to-duty, and follow-up testing. Post-accident testing must be completed within 2 hours for alcohol and 32 hours for drugs if certain accident criteria are met. Follow-up testing plans must include a minimum of 6 tests in the first 12 months. While some states allow medical or recreational marijuana, federal regulations treat marijuana as a schedule 1 drug and positives cannot be verified as negative.
Ignition interlock devices stop drunk driving deaths by Floyd Arthur PPTFloyd Arthur
Ignition interlock devices are breathalyzers installed in vehicles to prevent drunk driving. The document summarizes drunk driving statistics and the effectiveness of ignition interlock laws in reducing drunk driving deaths. Over 50% of drunk driving deaths have been reduced since 1982, but it remains a significant public health issue. Mandatory ignition interlock laws for convicted drunk drivers have decreased alcohol-related fatalities by up to 50% in states like Arizona and West Virginia. Nationwide implementation is recommended to further reduce drunk driving deaths.
10 interesting things about alcohol and other drugs that you might have misse...Andrew Brown
Including - tax revenue from alcohol across Europe, mortality rates for lung cancer, daily doses of OST in Scotland, milligrams of methadone prescribed in Scotland, reasons given for refusing 'place of safety' under the Mental Health Act, calls to the NPIS about drugs, prisoners ability to access drugs and alcohol in England, absconders from prison, re-offending drug offenders in England
Seven Hiring Mistakes that Could Cost You ThousandsPatrick Barnett
This document discusses 7 common hiring mistakes that can cost companies thousands of dollars:
1. Not conducting thorough criminal background checks in all relevant counties and databases. Incomplete checks increase the risk of negligent hiring lawsuits.
2. Failing to use proper consent and disclosure forms required by the Fair Credit Reporting Act (FCRA) when conducting background checks, which can result in large fines.
3. Ignoring FCRA requirements to notify applicants and give them a chance to respond before taking adverse action based on background check results.
4. Not adjusting background check policies to comply with FCRA, state laws, and EEOC guidelines, which can also result in fines or lawsuits.
This document discusses the benefits of creating a healthy work environment free of substance abuse. It provides data showing that alcohol, tobacco, and drug use increases healthcare costs and reduces productivity through absenteeism and accidents. Employers can realize cost savings through education programs, cessation services, and policies that support treatment and recovery. The document recommends steps for employers like establishing employee assistance programs, adopting comprehensive substance abuse policies, and ensuring health plans provide treatment coverage.
Identification of road traffic fatal crashes leading factors using principal ...eSAT Journals
Abstract
Traffic crash fatalities create primary safety concern beyond the traffic congestion and delay. Therefore, the purpose of this study
is to identify the principal components/factors associated with road traffic crash in the U.S. through retrospective reviewing based
on more than two million records of fatal crashes and 38 years (1975-2012) of National Highway Traffic Safety Administration
official’s Fatal Accident Reporting System (FARS) database. This study portrays an integrated geographic information system
and SAS application in order to find the major factors forcing traffic crashes. The resulting geospatial analysis and principal
components analysis yielded critical significant factors causing fatal traffic crashes. The outcomes of this research could be used
in transportation safety policy making and planning significantly.
Key Words: Accident Analysis Prevention, Clustering, Crash Hot Spot, Geographic Information Systems, Principal
Components Analysis, and Traffic Crash
Analyzed data set which contained list of possible factors that can explain the mortality rates. Ran regression models with various permutations and combinations of variables to arrive at a list of variables that can explain variances in mortality rates.
Revised as of April 15, 2013 (Revision #1)
Executive Summary
The Venezuelan federal electoral system is very satisfactory as determined by the overall audit score of 78.83 percent (out of 100 percent). The FDA auditors measured
1) one unsatisfactory passing score for legislation pertaining to electoral finance (52.5 percent);
2) one very satisfactory score for legislation pertaining to candidates and parties (77.9%);
3) two exceptional scores for legislation pertaining to media election coverage
(100 percent) and voters (84.9 percent).
The FDA audit focused on 52 variables, and it utilized matrices, financial analysis, and scoring scales. The most notable areas of the system are Venezuela’s commitment to complete and balanced election coverage, thereby supporting a fair playing field for candidates and parties, and a commitment to people’s right to vote and the act of voting through various innovative and progressive measures. However, electoral finances of candidates and parties are only transparent to the state, and there are no direct caps on campaign contributions and no direct limits on expenditures. The lack of public financial transparency creates the potential for pro-government parties to pursue corrupt financial practices and leave anti-government parties subject to unjust assessments of their finances including targeting their contributors. The lack of caps and limits on electoral finances may create an unfair playing field in the realms of billboards, flyers, posters, and campaign events, because these media are not covered by the complete and balanced coverage requirement. The FDA has no evidence of electoral financial wrongdoing, as does no one else, because only the Venezuelan State through the National Electoral Council is privy to party finances. The FDA recommends reforms that will bring about public electoral finance transparency, caps on campaign contributions and limits on campaign expenditures. If implemented these reforms would make the Venezuelan electoral system a model for the rest of the world. As it stands, these limitations have the potential to allow for corrupt financial practices and create unfair playing fields for candidates and parties.
Overall the FDA recommends that the public get continuously and actively involved with the government legislative process and implementation if they want to protect and advance their democratic voice, and create a society of their choosing.
The document provides crime statistics for 2013 in the 11th Circuit (Miami-Dade County), including the number of reported crimes of murder, rape, robbery, aggravated assault, burglary, larceny, and motor vehicle theft. It also includes maps analyzing crime rates, crime clearance rates, and police department salaries in Miami-Dade County to identify relationships between these factors and areas of high and low crime ("hot spots" and "cold spots"). No clear correlation was found between crime clearance rates and entry-level police salaries.
DRE 2015-2016 Medical Equipment CatalogDRE Medical
DRE sources everything you need for the operating room, including new and professionally refurbished anesthesia machines, patient monitors, surgical lighting, procedure tables, stretchers, electrosurgical units, respiratory ventilators and much more. For more information on products and services from DRE, call 1-800-462-8195 today.
This document discusses substance use, abuse, and dependence in forensic and correctional populations. It reports that approximately 65-70% of offenders meet criteria for substance abuse and 40-45% meet criteria for substance dependence or addiction. The document then reviews how evidence of intoxication can in some cases reduce legal culpability through defenses like diminished capacity, insanity, or automatism. However, these defenses are difficult to establish and rarely apply to typical cases. The document concludes that drug or alcohol use rarely eliminates conscious intent, though it may increase reckless behavior, and that traditional substance abuse treatment has lower success rates for offenders than typically estimated. Programs integrating treatment and supervision are more effective at reducing substance use and crime.
This document provides a risk and protection profile for substance abuse prevention in Mason County. It contains data on risk factors for substance abuse organized within the Hawkins and Catalano framework of community, family, school, and individual domains. The data includes standardized comparison profiles of rates for Mason County and similar 'county like us' levels for various indicators related to factors such as availability of drugs, economic deprivation, mobility, antisocial behavior, and problem outcomes over a five-year period. Technical notes are provided on interpreting the profiles and annual trend data.
Are You Eligible for Drug Court in New York?Adam Thompson
If you have been arrested and charged with a criminal offense in the State of New York, you may be facing serious judicial and non-judicial penalties. Learn more about drug court in New York in this presentation.
Favorite slides for safety meeting and drug awarenessMichael Kennedy
This document provides an overview of drug and alcohol testing regulations for commercial drivers. It discusses the types of required testing including pre-employment, random, post-accident, reasonable suspicion, return-to-duty, and follow-up testing. Post-accident testing must be completed within 2 hours for alcohol and 32 hours for drugs if certain accident criteria are met. Follow-up testing plans must include a minimum of 6 tests in the first 12 months. While some states allow medical or recreational marijuana, federal regulations treat marijuana as a schedule 1 drug and positives cannot be verified as negative.
Ignition interlock devices stop drunk driving deaths by Floyd Arthur PPTFloyd Arthur
Ignition interlock devices are breathalyzers installed in vehicles to prevent drunk driving. The document summarizes drunk driving statistics and the effectiveness of ignition interlock laws in reducing drunk driving deaths. Over 50% of drunk driving deaths have been reduced since 1982, but it remains a significant public health issue. Mandatory ignition interlock laws for convicted drunk drivers have decreased alcohol-related fatalities by up to 50% in states like Arizona and West Virginia. Nationwide implementation is recommended to further reduce drunk driving deaths.
10 interesting things about alcohol and other drugs that you might have misse...Andrew Brown
Including - tax revenue from alcohol across Europe, mortality rates for lung cancer, daily doses of OST in Scotland, milligrams of methadone prescribed in Scotland, reasons given for refusing 'place of safety' under the Mental Health Act, calls to the NPIS about drugs, prisoners ability to access drugs and alcohol in England, absconders from prison, re-offending drug offenders in England
Seven Hiring Mistakes that Could Cost You ThousandsPatrick Barnett
This document discusses 7 common hiring mistakes that can cost companies thousands of dollars:
1. Not conducting thorough criminal background checks in all relevant counties and databases. Incomplete checks increase the risk of negligent hiring lawsuits.
2. Failing to use proper consent and disclosure forms required by the Fair Credit Reporting Act (FCRA) when conducting background checks, which can result in large fines.
3. Ignoring FCRA requirements to notify applicants and give them a chance to respond before taking adverse action based on background check results.
4. Not adjusting background check policies to comply with FCRA, state laws, and EEOC guidelines, which can also result in fines or lawsuits.
This document discusses the benefits of creating a healthy work environment free of substance abuse. It provides data showing that alcohol, tobacco, and drug use increases healthcare costs and reduces productivity through absenteeism and accidents. Employers can realize cost savings through education programs, cessation services, and policies that support treatment and recovery. The document recommends steps for employers like establishing employee assistance programs, adopting comprehensive substance abuse policies, and ensuring health plans provide treatment coverage.
Identification of road traffic fatal crashes leading factors using principal ...eSAT Journals
Abstract
Traffic crash fatalities create primary safety concern beyond the traffic congestion and delay. Therefore, the purpose of this study
is to identify the principal components/factors associated with road traffic crash in the U.S. through retrospective reviewing based
on more than two million records of fatal crashes and 38 years (1975-2012) of National Highway Traffic Safety Administration
official’s Fatal Accident Reporting System (FARS) database. This study portrays an integrated geographic information system
and SAS application in order to find the major factors forcing traffic crashes. The resulting geospatial analysis and principal
components analysis yielded critical significant factors causing fatal traffic crashes. The outcomes of this research could be used
in transportation safety policy making and planning significantly.
Key Words: Accident Analysis Prevention, Clustering, Crash Hot Spot, Geographic Information Systems, Principal
Components Analysis, and Traffic Crash
Analyzed data set which contained list of possible factors that can explain the mortality rates. Ran regression models with various permutations and combinations of variables to arrive at a list of variables that can explain variances in mortality rates.
Revised as of April 15, 2013 (Revision #1)
Executive Summary
The Venezuelan federal electoral system is very satisfactory as determined by the overall audit score of 78.83 percent (out of 100 percent). The FDA auditors measured
1) one unsatisfactory passing score for legislation pertaining to electoral finance (52.5 percent);
2) one very satisfactory score for legislation pertaining to candidates and parties (77.9%);
3) two exceptional scores for legislation pertaining to media election coverage
(100 percent) and voters (84.9 percent).
The FDA audit focused on 52 variables, and it utilized matrices, financial analysis, and scoring scales. The most notable areas of the system are Venezuela’s commitment to complete and balanced election coverage, thereby supporting a fair playing field for candidates and parties, and a commitment to people’s right to vote and the act of voting through various innovative and progressive measures. However, electoral finances of candidates and parties are only transparent to the state, and there are no direct caps on campaign contributions and no direct limits on expenditures. The lack of public financial transparency creates the potential for pro-government parties to pursue corrupt financial practices and leave anti-government parties subject to unjust assessments of their finances including targeting their contributors. The lack of caps and limits on electoral finances may create an unfair playing field in the realms of billboards, flyers, posters, and campaign events, because these media are not covered by the complete and balanced coverage requirement. The FDA has no evidence of electoral financial wrongdoing, as does no one else, because only the Venezuelan State through the National Electoral Council is privy to party finances. The FDA recommends reforms that will bring about public electoral finance transparency, caps on campaign contributions and limits on campaign expenditures. If implemented these reforms would make the Venezuelan electoral system a model for the rest of the world. As it stands, these limitations have the potential to allow for corrupt financial practices and create unfair playing fields for candidates and parties.
Overall the FDA recommends that the public get continuously and actively involved with the government legislative process and implementation if they want to protect and advance their democratic voice, and create a society of their choosing.
The document provides crime statistics for 2013 in the 11th Circuit (Miami-Dade County), including the number of reported crimes of murder, rape, robbery, aggravated assault, burglary, larceny, and motor vehicle theft. It also includes maps analyzing crime rates, crime clearance rates, and police department salaries in Miami-Dade County to identify relationships between these factors and areas of high and low crime ("hot spots" and "cold spots"). No clear correlation was found between crime clearance rates and entry-level police salaries.
DRE 2015-2016 Medical Equipment CatalogDRE Medical
DRE sources everything you need for the operating room, including new and professionally refurbished anesthesia machines, patient monitors, surgical lighting, procedure tables, stretchers, electrosurgical units, respiratory ventilators and much more. For more information on products and services from DRE, call 1-800-462-8195 today.
This document outlines a plan for a company reorganization that will reduce costs. It proposes consolidating several smaller departments into two larger divisions to remove redundant manager and supervisor roles. This restructuring is estimated to save the company $500,000 per year in personnel expenses.
Introduction to pre clinical screening of drugsKanthlal SK
Various Techniques and Methods for screening of new chemical entities in preclinical aspects (both invitro & invivo) for effective and safe clinical usage.
Acute and repeated dose toxicity studies are important for determining the safety of pharmaceuticals intended for human use. Key details include:
- Acute toxicity studies involve single high doses to determine the median lethal dose (LD50) and maximum tolerated dose. Repeated dose studies last 14 days to 3 months.
- Studies are conducted in at least two species, often rats and non-rodents, to identify target organs and toxicity reversibility.
- Animals are observed for signs of toxicity and mortality. Necropsies and histopathology are performed to identify organ damage.
- Sub-acute studies last 14-90 days to determine effects of repeated administration and establish doses for longer term studies.
Part of the MaRS Best Practices Series - Pre-Clinical development workshop
http://www.marsdd.com/bestpractices/
Speaker: Mike Watson. Exec Director Drug Development Services, Ricerca BioSciences
This document summarizes drug use trends and issues in New York State. Some key points:
- New York has higher than average rates of cocaine, illicit drug dependence, and young adult illicit drug dependence compared to other states. Heroin is the most common drug in treatment admissions.
- Approximately 9.82% of New York residents reported past-month illicit drug use compared to the national average of 8.82%.
- Drug-induced deaths in New York are lower than the national average, though still number over 1,700 per year.
- The document outlines state and federal efforts to address issues like prescription drug monitoring programs, drug take-back initiatives, and drugged driving laws.
The document summarizes the results of a survey on drug addiction. It finds that 41% of male respondents and a similar percentage of females believe drugs create dependency. The most commonly used drug in Pakistan is cannabis, used by 3.6% of adults, while opiates affect almost 1%. Drug addiction costs over $600 billion annually in the US due to healthcare, law enforcement, treatment and prevention. The survey aimed to understand perceptions and trends in drug use.
The document summarizes the results of a survey on drug addiction. It finds that 41% of male respondents and a similar percentage of females believe that drugs create dependency. The most commonly used drug in Pakistan is cannabis, used by 3.6% of adults, while opiates affect around 1%. Drug addiction costs over $600 billion annually in the US due to healthcare, law enforcement, treatment and prevention. The survey aimed to understand perceptions and trends in drug use.
Effective Strategies For Intervening With Drug Abusing Offenderslakatos
This document discusses the relationship between substance abuse and criminal offending. It finds that substance abuse is highly prevalent among correctional populations, with approximately 80% of inmates meeting criteria for substance involvement. The document reviews past public safety and public health strategies for intervening with drug-abusing offenders, finding that only integrated public health/public safety programs that combine treatment and criminal justice supervision have consistently reduced recidivism and drug use. It concludes by examining Proposition 36 and other policy initiatives, arguing they should be informed by empirical lessons from prior research.
The document discusses drug addiction as a dangerous disease. It notes that all forms of addiction are bad, whether from alcohol, morphine, or other narcotics. The objective is to eliminate drug problems and monitor drug use trends. A survey was conducted where most people agreed that drug addiction is a mental illness and that drugs can cause dependency. The findings show addiction alters brain function and taking drugs triggers feelings of pleasure. Common drugs in Pakistan include cannabis, opium, and heroin. Drug addiction is a major problem costing over $600 billion annually.
A study which chillingly lays bare the “public health crisis” that arose over a decade in the United States because of excessive alcohol consumption has received severe criticism for relying on comprised data to arrive at that conclusion. It has been criticized by some experts and the Distilled Spirits Council (DSC) for being less consistent, and for not including young adults aged below 18 years, who are increasingly taking to alcohol in America.
The document provides information on several topics related to substance abuse and crime. It summarizes data from a survey of domestic violence calls that found over 48,000 calls in one 24-hour period, with over 14,000 requests for emergency housing and around 5,000 unmet calls. It also notes that 38% of domestic violence victims become homeless at some point. Additionally, it discusses drug enforcement efforts and costs, changes in juvenile drug arrest rates and demographics, relationships between drug use and criminal activity, categories and schedules of drugs, and the influence of alcohol on different types of crimes.
Florida faces challenges with drug use and consequences, including drug-induced deaths higher than the national average. Marijuana and prescription opioids are primary drugs of abuse treated in Florida. Meth lab seizures rose 148% from 2007-2009. Florida is working to address these issues through initiatives like an authorized but not yet operational prescription drug monitoring program and supporting coalitions through Drug Free Communities grants. In 2010, Florida received over $338 million in federal grants to support reducing drug use.
This document discusses substance use, abuse, and dependence in forensic and correctional populations. It reports that approximately 65-70% of offenders meet criteria for substance abuse and 40-45% meet criteria for substance dependence or addiction. The document then reviews how evidence of intoxication may be used to reduce legal culpability through defenses like diminished capacity, insanity, and automatism. However, it notes that intoxication rarely eliminates conscious criminal intent. It concludes that the efficacy of traditional substance abuse treatment has been overestimated for offenders, with integrated treatment and supervision programs showing more promise in reducing substance use and crime.
The document discusses drug courts as an alternative approach to dealing with nonviolent drug offenders compared to the traditional war on drugs approach. It provides an overview of drug courts, noting they began in 1989 and aim to treat substance abuse issues through judicial monitoring while reducing recidivism. The effectiveness of drug courts is debated, as studies show mixed results on reducing recidivism rates compared to traditional probation. While drug courts have grown significantly, concerns remain around their methodology and the types of offenders they target for treatment versus punishment.
This document summarizes strategies to reduce alcohol-related harms through policy. It discusses how problem-oriented policing was used successfully in Australia to identify high-risk bars through feedback audits. This allowed police to target enforcement at the small number of bars responsible for most alcohol-related incidents. The document also discusses how increasing the perceived probability of punishment, rather than punishment severity, is more effective at deterring criminal behavior related to alcohol. High-visibility enforcement campaigns that couple intense enforcement with publicity, such as "Drive Sober or Get Pulled Over", have been shown to reduce drunk driving deaths.
The United Nations Office on Drugs and Crime (UNODC) was established in 1997 to help the UN address issues related to drug trafficking, crime prevention, terrorism, and corruption. It employs around 500 people worldwide and is headquartered in Vienna, with 21 field offices. The agency aims to help governments handle drug, crime, terrorism and corruption issues through research, guidance, and technical/financial assistance. Approximately 90% of its funding comes from voluntary government contributions.
This document summarizes a national dialogue on drug-impaired driving that took place in April 2012. It discusses policy goals of identifying impaired drivers and distinguishing impairment from medication use. Statistics show that in 2009, over 13,000 drivers who died in crashes tested positive for drugs. The document outlines the dangers of drug-impaired driving and different state laws addressing this issue. It also notes challenges with drug evaluation programs and drug testing. Suggestions are made to improve prevention of drug-impaired driving.
Nevada law prohibits drugged driving under a zero-tolerance policy. The Nevada Revised Statutes (NRS) Section 484C.110 defines drugged driving and sets limits for prohibited substances in urine and blood. Driving under the influence of drugs is punishable by fines and jail time, with penalties increasing for repeat offenses or accidents involving injury or death. While facing drugged driving charges, possible defenses include unlawful stop, involuntary ingestion, unfair treatment, or faulty testing procedures.
Taelor, daniale, and raven drug awareness slide showgrandviewschoolok
The document summarizes an interview with Nate King, the Cherokee County Community Sentencing Coordinator, about drug charges and enforcement. King discusses how charges can range from misdemeanors to felonies depending on the type and amount of drugs. He notes that Schedule I drugs, which include methamphetamine and cocaine, carry the harshest penalties. King also explains how officers look for signs of drug use like constricted or dilated pupils, but cannot determine the specific drug without other evidence or testing. Confiscated drugs are sent to the crime lab for analysis and later destroyed.
Illegal Drug Problem in the City of Ormoc As Perceived By User and Non-User R...inventionjournals
The study was conducted primarily to: describe the socio-demographic characteristics of user and non-user respondents; determine the reasons for engaging in illegal drugs among user respondents; document local and national ordinances enacted against illegal drug users; and identify the programs implemented by government and non-government organizations to make the City of Ormoc a drug-free community. The results of the study revealed that the mean age of the illegal drug users was 22 years old. Majority of them were males whose income fell below P10,000.00 in the form of allowance. They were aware of the illegality of the drugs used. Marijuana was the dominant drug abused. Influence of Peers and Curiosity were the topmost reasons why they got into drugs due to misinformation and assurance from friends who claim to have enjoyed the experience as perceived by the respondents. Among the National and Local Ordinances enacted against illegal drugs users in the City of Ormoc were: the implementation of RA 9165 – Dangerous Drugs Act of 2002; LOI 36/97: ALPHA BANAT (Barangay Against Narcotics Abusers and Traffickers) and Information dissemination of the ill effects of drugs through the Barangay Anti-Drug Abuse Counsel (BADAC).
The document reports on substance abuse issues. It finds that substance abuse is one of the top 10 causes of death in Brooklyn, though not nationwide. In Brooklyn in 2002, nearly 90% of drug-related hospitalizations were due to heroin use, and rates were highest among black residents and in certain neighborhoods like Williamsburg. The costs of substance abuse are high both in terms of health effects, like 100,000 deaths annually from alcohol, and economic costs estimated at $276 billion in 1995. Early intervention and treatment can help reduce these impacts.
Age of drinking onset, driving after drinking, and involvement in alcohol rel...Amber Ford
This document summarizes a study that examined the relationship between age of drinking onset and later driving after drinking and alcohol-related crashes. The study used data from a 1992 national survey of over 42,000 respondents. It found that respondents who started drinking at younger ages were more likely to report driving after drinking too much and being in an alcohol-related crash at some point in their life, even after accounting for alcohol dependence and other factors. Specifically, even those who had never been alcohol dependent but started drinking under age 21 were more likely to report an alcohol-related crash compared to those who started drinking at 21 or older. The results suggest that delaying the age of drinking onset may help reduce alcohol-related traffic incidents beyond just the
Similar to drug_toxicology_for_prosecutors_04 (20)
Age of drinking onset, driving after drinking, and involvement in alcohol rel...
drug_toxicology_for_prosecutors_04
1. S P E C I A L T O P I C S S E R I E S
American
Prosecutors
Research Institute
Drug Toxicology
for Prosecutors
Drug Toxicology
for Prosecutors
Targeting Hardcore
Impaired Drivers
Targeting Hardcore
Impaired Drivers
3. S P E C I A L T O P I C S S E R I E S
By Sarah Kerrigan, Ph.D.
Former Bureau Chief
New Mexico Department of Health
Scientific Laboratory Division
Toxicology Bureau
October 2004
Drug Toxicology
for Prosecutors
Drug Toxicology
for Prosecutors
Targeting Hardcore
Impaired Drivers
4. TA B L E O F C O N T E N T S
iii
v Introduction: A Horse of Different Color
1 Drugs and Driving for Prosecutors
3 The Prevalence of Drug-Impaired Driving
5 Alcohol vs. Drug-Related DWI
7 Prevalence of Specific Drugs in DWI
11 Common Drug Effects: Pharmacology for Prosecutors
21 How Can Drugs Impair Driving?
27 Measuring Impairment
31 Toxicology and the Drug Evaluation and
Classification Program
33 Drug Detection and Implications for Driver Impairment
39 Testing Methodology in the Forensic Toxicology Laboratory
43 Case Preparation and the Toxicologist as Expert Witness
47 Conclusion
49 Case Studies
53 Endnotes
55 Acknowledgements
57 Appendix 1: Glossary
61 Appendix 2: Predicate Questions for Toxicologist
5. I N T R O D U C T I O N : A H O R S E
O F A D I F F E R E N T C O L O R
v
Drug impaired drivers kill and maim thousands of people each and every
year in the United States. Unfortunately, prosecuting drug-impaired driv-
ers is a daunting task. Jurors, who are very familiar with alcohol’s effects,
signs and symptoms, often know little or nothing about other drugs.
Tainted by crime shows like CSI: Miami, they may have unrealistic expec-
tations about the nature and quantum of available proof. Unlike alcohol,
most states do not have “per se” limits for drugged driving.
To successfully explain the evidence and issues to jurors in Driving Under
the Influence of Drugs (DUID) cases, prosecutors must understand the
basics of drug toxicology.This publication is designed to provide prosecu-
tors with a basic understanding of drug pharmacology and testing. The
author, Dr. Sarah Kerrigan, is the former Toxicology Bureau Chief of the
New Mexico Department of Health’s Scientific Laboratory Division.Prior
to this, she worked as a Forensic Toxicologist for the California
Department of Justice. Originally trained at the Scotland Yard Forensic
Laboratory in England, Dr. Kerrigan has worked closely with law enforce-
ment officers and prosecutors in DUID (including Drug Recognition
Expert) cases in New Mexico and California.
I would like to acknowledge and thank Michelle Spirk, Forensic
Toxicology Technical Supervisor with the Arizona Department of Public
Safety’s Crime Laboratory System, Colleen Scarneo, ForensicToxicologist-
Supervisor with the New Hampshire Department of Safety’s Toxicology
Lab, and Chuck Hayes, Drug Recognition Expert Regional Operations
Coordinator with the International Association of Chiefs of Police, for
their thoughtful suggestions and review of this publication.Additionally, I
would like to recognize former NTLC Director John Bobo and APRI’s
Senior Counsel Marcia Cunningham, Staff Attorney Lady Stacie Rimes
and Program Assistant JenniferTorre.This publication would not have been
possible without their hard work.
Stephen K.Talpins
Director, National Traffic Law Center
6. D R U G S A N D D R I V I N G
F O R P R O S E C U T O R S
The prosecution of drug impaired driving cases is more complex than
alcohol-related DWI (driving while impaired) cases—both scientifically
and legally. Impairment can be more difficult to discern and prove, thus
making these cases more difficult to prosecute.Although alcohol is a
drug, not all drugs can be considered in the same way.This means that a
case involving a driver suspected of driving under the influence of drugs
(DUID) may require special handling and evaluation. Good communica-
tion and effective integration of law enforcement and legal and scientific
personnel are essential in these cases.
7. T H E P R E V A L E N C E O F
D R U G - I M P A I R E D D R I V I N G
In any given year, millions of Americans operate motor vehicles while
impaired by alcohol or drugs. In 2003, over 32 million persons aged 12
or older drove under the influence of alcohol at least once during the
previous year (1).An estimated 11 million persons reported driving
under the influence of an illicit drug. In DWI cases, states have enacted
per se laws, which prohibit driving with a blood or breath alcohol con-
centration (BAC) of 0.08 (2) regardless of actual impairment (3). In most
states, there are no similar laws with regard to driving under the influ-
ence of drugs—even those commonly understood to impair driving.
There is a growing body of scientific evidence that driving under the
influence of drugs has become a significant problem worldwide. Driving
is a complex task which involves a variety of skills such as coordination,
reaction time, tracking, judgment, attention and perception.Any drug
which affects mental or physical processes has the potential to impair driv-
ing at sufficient dose.According to the 1996 National Household Survey
on Drug Abuse, of the 9 million drivers who drove within two hours of
drug use, the most commonly encountered drugs were marijuana and
cocaine. Despite mounting evidence that driving under the influence of
illegal drugs other than alcohol is common, drugged drivers are less fre-
quently detected, prosecuted, or referred to treatment when compared
with drunk drivers (4).
The 2003 National Survey on Drug Use and Health (NSDUH), con-
ducted by the Substance Abuse and Mental Health Services
Administration (SAMHSA), indicated that an estimated 19.5 million
Americans (8.2% of the population aged 12 or older) had used an illicit
drug during the previous month. Drug abuse, whether it involves con-
trolled substances or the misuse of prescription drugs, has permeated
almost every level of society to some degree:
• In 2003, an estimated 11 million people reported driving under the
influence of an illicit drug during the past year (1).
• As many as 18% of 21 year-olds report drugged driving at least once
during the past year (5).
3
8. • Drugs are used by approximately 10 - 22% of drivers involved in acci-
dents, often in combination with alcohol (6).
• A study of fatally injured drivers from seven states showed that alcohol
was present in more than 50% of the drivers; other drugs were present
in 18% of the drivers (6).
• Positive drug findings in injured drivers who receive medical treatment
range from less than 10% to as high as 40% (6).
• The incidence of drug-use among drivers arrested for motor vehicle
offenses ranges between 15 - 50% (6).
Although it is well understood that drug use can be detrimental to safe
driving, the extent to which drugs impair driving is often difficult to
measure, predict or quantify.The degree of impairment depends upon a
number of variables including the dose, drug history and time since drug
use. Some drugs have the potential to impair driving performance for
extended periods, while others may impair during the “crash” phase, dur-
ing which time drug concentrations may be decreasing or very low.
Drug-impaired driving is often under-reported and under-recognized.
Although it is illegal to drive under the influence of drugs anywhere in
the U.S., statutes vary widely.Toxicology testing is expensive, resources
differ from state to state, and protocols vary between laboratories, further
compounding the problem.
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
4 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
9. A L C O H O L V S .
D R U G - R E L A T E D DW I
5
Alcohol is a drug but not all drugs are alcohol.
Drug-related DWI is inherently more complex than alcohol-related
DWI. Furthermore, the effect of alcohol on the body and on driving has
been well characterized over several decades. Most people are familiar
with the effects of alcohol and its ability to impair driving. However, that
is not always true for other drugs.There are numerous illicit, prescription
and over-the-counter drugs that have the potential to impair the mental
and/or physical processes required for safe driving. Despite the ever-
increasing existence of scientific literature on the impact of drugs on
driving, many drugs have not yet been fully investigated.To complicate
matters, drugs are often used in combination with alcohol or other
drugs, requiring a case-by-case evaluation of the potential for interaction
and possible impairment. Drug-impairment requires the jury to develop
an understanding of the unique effects of specific substances and their
complex potential to impair driving.
As of 2004, all 50 states have established a per se level of ethanol (0.08
g/100mL) in blood, but there are no widely accepted per se standards for
drugs. Drug-impaired driving statutes typically approach the issue in one
or more of three ways:
• Statutes that require the drug to render a driver incapable of driving
safely;
• Statutes that require the drug to impair a driver’s ability to operate a
vehicle safely or require a driver to be under the influence, impaired or
affected by an intoxicating drug; or
• Per se laws that make it a criminal offense to have a specified drug or
drug by-product (metabolite) in the body while operating a vehicle.
Some states’ per se drug laws incorporate a “zero tolerance” standard in
which any detectable level of a specified drug or metabolite constitutes
a violation while a few states list actual drug concentrations at which a
violation occurs.
10. States with zero tolerance drug statutes make the presence of any speci-
fied drug or metabolite in the blood or urine, obtained from a person
who was operating a motor vehicle, a crime in and of itself—i.e., distinct
from a charge of drug-impaired driving.Although these laws facilitate
identification, prosecution and treatment of drivers who misuse drugs,
they are typically used in conjunction with the aforementioned statutes
that require evidence that the person was impaired, incapacitated or
affected by the drug. Comparisons of drugged driving statutes between
states are available elsewhere (7, 8).
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6 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
11. P R E V A L E N C E O F S P E C I F I C
D R U G S I N DW I
Marijuana, stimulants, depressants and opiates are among the most fre-
quently encountered drugs in impaired drivers. However, prevalence
varies with geographical location and emerging drug trends; for example,
there may be increased methamphetamine use on the West coast, com-
pared with increased oxycodone use on the East coast. Drugs of choice
may vary by county and by socioeconomics.Table 1 lists some of the
uses and examples of licit and illicit drugs within each class.
In 2003, marijuana was the most commonly used illicit drug in the
United States (14.6 million users) followed by non-medical use of pre-
scription drugs (6.3 million) (1). Of those persons who abused prescrip-
tion drugs, an estimated 4.7 million abused pain relievers, 1.8 million
abused tranquilizers, 1.2 million abused stimulants and 0.3 million abused
sedative medications. In the same year, estimates for cocaine and hallu-
cinogens were 2.3 million and 1 million, respectively.
Many abused substances have legitimate uses. In states with zero toler-
ance per se drug laws, a valid prescription may constitute a legitimate
defense to the zero-tolerance portion of the statute. In these instances,
prosecution must follow the “impaired” or “under the influence” statute
instead, requiring proof that the person was “affected” to some degree.
Statistical evaluation of drug prevalence varies not only with geographi-
cal location but is also dependent on drug testing methodology and sam-
ple type (blood, urine, saliva, other). Drug testing methodology involves
the use of analytical procedures which may have varying degrees of
sophistication. For example, one toxicology laboratory may utilize differ-
ent analytical procedures and instrumentation from another laboratory.
Laboratories with state-of-the-art instrumentation and testing capabilities
may demonstrate a higher percentage of positive findings than those lab-
oratories with less-sophisticated equipment.The sample matrix, or type
of biological evidence submitted for analysis, can also influence which
drugs are most likely to be detected.This is because many drugs are pres-
ent in a blood sample for a relatively short period of time compared with
7
12. urine. For example, cocaine continues to degrade or break down to ben-
zoylecgonine, even after collection and preservation of a blood sample.
However, cocaine may be present in other body fluids, such as urine, for
a longer period of time. In this way, the choice of biological specimen
may influence the outcome of a particular test.
The length of time that a drug or its metabolite is present in a given bio-
logical sample is often called its detection time.This may vary depending
on the dose (amount), route of administration (injected, inhaled etc.) and
elimination rate (how long it takes the body to get rid of the substance).
The presence of a drug metabolite in a biological fluid may or may not
reflect consumption of the drug recently enough to impair driving per-
formance. For example, the presence of a marijuana metabolite in urine
may not be, by itself, a reliable indicator of either driving impairment or
of recent exposure to the drug. However, an elevated concentration of
THC (the principal active component of marijuana) in blood may be
consistent with recent use of the drug and related driving impairment. In
addition to the analytical test results, supplemental information (including
driving, performance on psychophysical tests, values obtained in physio-
logical assessments, and unusual behaviors, statements or observations)
often is necessary for an appropriate forensic toxicological interpretation
of driving impairment.
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
8 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
13. P R E V A L E N C E O F S P E C I F I C D R U G S I N D W I
9
Depressants Anticonvulsants
Antidepressants
Antihistamines Anxiolytics
(anti-anxiety)
Hypnotics (sleep inducers)
Muscle relaxants
Anticataplectics (works to
prevent a condition which
results in sudden loss of
muscle power following a
stimulus like fright or
shock)
Sedatives (tranquilizers)
Alprazolam,
Amitriptyline,
Carbamazepine,
Carisoprodol, Diazepam,
Diphenhydramine,
Gamma-
Hydroxybutyrate (GHB),
Meprobamate,
Phenobarbital,
Temazepam,Trazodone,
Zolpidem
Stimulants Anorectics (appetite stimu-
lants)
Attention Deficit
Disorders (ADD)
Narcoleptics (to prevent
deep sleep attacks)
Local anesthetics
Amphetamine,
Cocaine,
Methamphetamine,
MDMA*
Opioids Analgesics (pain relievers)
Antitussives (cough sup-
pressants)
Codeine, Fentanyl,
Heroin* Hydrocodone,
Methadone, Morphine,
Oxycodone,
Propoxyphene
Hallucinogens Anesthetic adjuncts (assists
in anesthesia)
Appetite stimulants
Antiemetics (to prevent
vomiting)
Ketamine, Lysergic Acid
Diethylamide* (LSD),
MDMA*, Mescaline*,
PCP*, Peyote*,
Tetrahydrocannabinol
(THC)
* Indicates no currently approved medicinal use in the United States.
Table 1.
Drug Class Medicinal Uses Examples
14. C O M M O N D R U G E F F E C T S :
P H A R M A C O L O G Y F O R
P R O S E C U T O R S
11
Many of the drugs that affect the central nervous system (CNS) pro-
duce characteristic effects.These similar effects provide the basis for most
general drug classification schemes. Drug classes may include depressants,
stimulants, opioids (narcotics) or hallucinogens.The classes themselves can
be further subdivided, based upon the intended use of the drug (Table
1).The effects (signs and symptoms) of some commonly encountered
drug classes are summarized in Table 2.Although many drugs within a
class produce predictable effects, such as ataxia (inability to coordinate
voluntary muscular movements), slow movements or slurred words fol-
lowing a sufficient dose of depressant drug, others are more complicated.
Some substances are not easily classified because they have multiple char-
acteristics. For example:
• Tetrahydrocannabinol (THC), the principal active component of mari-
juana, has both hallucinogenic and depressant effects.
• Methylenedioxymethamphetamine (MDMA) acts as both a stimulant
and a hallucinogen.
• Phencyclidine (PCP) and ketamine have both depressant and hallu-
cinogenic effects.
Although drug signs are determined to a large extent by the pharmacology
(properties and reactions) of the drug, other factors such as dose, drug
use history, mood, environment or setting, as well as the use of other sub-
stances, also help to determine the overall effect.
15. D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
12 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
Depressants Ataxia (uncoordinated movement), decreased blood pressure,
decreased pulse, disorientation, decreased inhibitions, fumbling,
horizontal gaze nystagmus (HGN), ptosis (droopy eyelids),
slow pupillary reaction to light, sluggishness, slowed reflexes,
sedation, slurred speech
Hallucinogens Body tremors, dazed appearance, diaphoresis (excessive perspi-
ration), dilated pupils, disorientation, dysarthria (difficulty in
articulating words), elevated blood pressure, elevated pulse,
memory loss, muscle rigidity, nausea, paranoia, poor coordina-
tion, poor time and distance perception, synesthesia (blending
of the senses), visual/auditory disturbances
Marijuana Ataxia (uncoordinated movement), body tremors, disorienta-
tion, elevated blood pressure,elevated pulse,eyelid tremors, increased
appetite, lack of ocular convergence,poor time and distance percep-
tion, paranoia, reddened conjunctiva, reduced inhibitions, tran-
sient muscle rigidity
Opioids Ataxia (uncoordinated movement), constipation, constricted
pupils, decreased blood pressure, decreased pulse, dry mouth,
dysphoria (state of unwellness or unhappiness), euphoria, facial
itching, low and raspy voice, ptosis (droopy eyelids), puncture
marks, mental clouding, muscle flaccidity, nausea, nodding off,
sedation, slow or no pupillary reaction to light, slow reflexes,
vomiting
PCP Agitation, ataxia (uncoordinated movement), blank stare, con-
fusion, cyclic behavior, diaphoresis (excessive perspiration), dis-
sociative anesthesia (disconnected from pain and surround-
ings), dysarthria (difficulty in articulating words), elevated
blood pressure, elevated pulse, hallucinations, HGN,“moon
walking”, muscle rigidity, nystagmus, vertical gaze nystagmus
(VGN)
Stimulants Anxiety, body tremors, bruxism (teeth grinding), dilated
pupils, dry mouth, excitation, eyelid tremors, euphoria, hyper-
reflexia (overactivity of physiological reflexes), hypervigilance
(abnormal awareness of environmental stimuli), increased
blood pressure, increased pulse, insomnia, irritability, jaw tight-
ness, muscle rigidity, reduced appetite, rhinorrhea (runny
nose), reddening of nasal mucosa, slow pupillary reaction to
light, talkativeness
Table 2.
Drug Signs and Symptoms
16. Many of the drugs encountered in impaired drivers are habit-forming or
addictive. Drugs with high abuse-potential may produce chemical or psy-
chological dependence that may also result in characteristic withdrawal
effects (Table 3).These withdrawal effects may manifest as the exact
opposite of the desired or expected effect of a particular class of drug.
For example, during withdrawal or the “crash” phase following binge use
of methamphetamine (a potent stimulant), an individual may experience
profound lethargy, exhaustion and hypersomnolence.These effects are
more consistent with those of a depressant drug.
To provide expert testimony, toxicologists look at the characteristic
appearance, behavior or observable effects of the drug on the individual.
Most toxicologists adopt a multi-strategy approach to interpretation.
Again, the presence of a drug or drugs in a biological sample provides
valuable insight, but more often than not, other factors will also be con-
sidered.
Pharmacology of a drug can be divided into two disciplines: pharmacoki-
netics and pharmacodynamics.
• Pharmacokinetics – How the drug (pharmacon) moves (kinesis) about the
body.This helps answer questions like “When was the drug used?” and
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13
Stimulants Muscular aches, abdominal pain, tremors, anxiety,
hypersomnolence (extreme fatigue), lack of energy,
depression, suicidal thoughts, exhaustion
Opioids Dilated pupils, watery eyes, rapid pulse, piloerection
(erection/bristling of hairs), abdominal cramps, muscle
spasms, vomiting, diarrhea, tremulousness, yawning,
anxiety, rhinorrhea (runny nose), sweating, restlessness
Depressants Trembling, insomnia, sweating, fever, anxiety, cardio-
vascular collapse, agitation, delirium, hallucinations,
disorientation, convulsions, shock
Marijuana Anorexia, nausea, insomnia, restlessness, irritability,
anxiety, depression
Table 3.
Drug Withdrawal Symptoms
17. “How much was taken?”A simple way to view pharmacokinetics is
“what the body does to the drug.”
• Pharmacodynamics – How the drug interacts with receptors in the brain
(how it affects the brain and consequently the person—mentally and
physically).This helps answer questions like “What are the effects?” and
“How long does it last?”A simple way to view pharmacodynamics is
“what the drug does to the body.”
Pharmacokinetics
The human body recognizes a drug as a foreign substance or xenobiotic.
When exposed, the body attempts to break down and eliminate these
foreign substances. Pharmacokinetics involves absorption (getting the drug
into the body), distribution (movement throughout the body), metabolism
(breaking it down into other chemical components) and elimination (get-
ting it out of the body).These processes largely determine the efficacy (the
ability of the drug to produce a result) or effectiveness of the drug, its con-
centration at the active site (specific brain receptors), and the duration of
the drug effect. Pharmacokinetic properties are used by pharmacologists,
clinical researchers and toxicologists to develop new therapeutics, under-
stand the factors that govern abuse, determine how drugs can be detected
over time and interpret drug effects on human performance.
Route of Administration: How the drug gets into the system.
The onset of action, duration of effects, intensity and quality of the drug
experience may vary depending upon the route of administration (Table
4). Intravenous drug administration provides maximum drug delivery and
rapid onset of effects. However, this bypasses many of the body’s natural
safeguards and may result in complications of intravenous drug use. For
this reason, inhalation and smoking are popular alternatives.When a drug
is smoked, it is rapidly absorbed in the lungs and transported to the brain
via the arterial blood supply. Smoking is a preferred route of crack
cocaine administration due to rapid onset, intensity and euphoria, even
though pipes and smoking apparatus become hot and may burn the lips.
In general, the efficiency and speed of drug delivery (the faster it is deliv-
ered to the brain) increases the potential for abuse and dependency.
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14 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
18. Absorption
For a drug to exert an effect, it must be absorbed into the bloodstream,
traverse membranes, and activate specific receptors.This process is largely
determined by the physical and chemical properties of the drug. Most
drugs can be characterized as acidic, basic or neutral, and unlike alcohol,
which is highly water-soluble, many drugs are also soluble in fat or lipids.
The degree to which a particular drug is water-soluble or fat-soluble
influences how it is distributed throughout the body.
Distribution
As soon as the drug is absorbed into the bloodstream, it is circulated to
surrounding tissues and organs, and the distribution phase begins. Drugs
that are lipid (fat) soluble are distributed more readily into the tissues,
such as the heart, liver, kidney, brain and fat.THC is fat-soluble, which
means it is distributed and stored in tissues and fat depots within the
body, accounting for its gradual release and long half-life (time taken to
eliminate half of the drug).The extent to which a drug is distributed in
the body is given by its volume of distribution (Vd). Highly water-soluble
(hydrophilic) drugs, like ethanol (Vd = 0.5 L/kg), are distributed mainly
in the body water and have low volumes of distribution. Conversely,
drugs with large volumes of distribution, like heroin (Vd = 25 L/kg), are
widely distributed throughout the body, including the tissues (Table 5).
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15
Oral Cannabinoids, opiates, LSD, mescaline, peyote, GHB,
benzodiazepines
Inhalation Solvents, gases, low-boiling-point alkaloids (usually
colorless, complex, organic bases, like cocaine, that
contain nitrogen and usually oxygen)
Intravenous Opiates, cocaine, methamphetamine, PCP
Smoking Marijuana, PCP, crack cocaine, methamphetamine
Intranasal Cocaine, heroin, methamphetamine
Dermal Fentanyl, nicotine
Table 4.
Route Drugs
19. Metabolism
For most drugs, only relatively small amounts are excreted unchanged.To
eliminate a drug, our bodies try to make the substance more soluble in
water.This process makes it easier for us to eliminate the substance in
our urine. Metabolism can affect pharmacological activity—i.e., the way
the drug affects the body. For example, cocaine and THC are broken
down in the body to benzoylecgonine and carboxy-THC respectively,
both of which are pharmacologically inactive (having no effect on the nerv-
ous system).Alternatively, some drug metabolites may be pharmacologically
active, therefore contributing to the overall effect, such as:
• Metabolism of diazepam to nordiazepam (an active metabolite of many
benzodiazepines)
• Carisoprodol to meprobamate
• Codeine to morphine
There are a great many variables that can affect drug metabolism, includ-
ing age, sex, genetic polymorphisms (common genetic mutations that may
relate to specific genetic predispositions), health, disease and nutrition.
Elimination
Elimination is the pharmacokinetic process of getting the drug out of the
body. Drugs are eliminated in two major ways—referred to as zero order
and first order kinetics or elimination. Ethanol is eliminated at a fixed or
linear rate which means that the body eliminates it at a relatively constant
amount per unit of time (zero order kinetics). However, most drugs are
eliminated using first order kinetics, which means that elimination is non-
linear. Rather than referring to a steady elimination rate (e.g. 0.015
g/100mL/hour for ethanol), drug elimination is typically characterized
by a variable half-life or T1/2 (Table 5).When a drug is metabolized in a
non-linear fashion, it is generally not possible to extrapolate backwards
from some known drug concentration to some earlier time and concen-
tration.This is true for the majority of drugs, including cocaine, metham-
phetamine or THC.
Figure 1 illustrates both zero and first order kinetics on a graph that plots
drug concentration over time.The zero order line is straight, while the first
order line curves over time, depending upon a drug’s specific half-life.
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
16 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
20. Because the elimination rate is not constant, toxicologists cannot perform
retrograde calculations for drugs as they might for alcohol.
Figure 1.
It is important to understand the overall dynamic nature of drug phar-
macokinetics.The processes of absorption, distribution, metabolism and elimi-
nation do not occur in a discrete chronological fashion, one simply fol-
lowing completion of the other, but rather, they occur in combination
with each other. Initially following drug administration, absorption will
likely prevail; later, absorption wanes and elimination becomes the dominant
process in the body. Corresponding drug and metabolite concentrations
therefore represent the overall net effect of the pharmacokinetic processes
at the time of sampling. Similarly, corresponding drug effects are also
related to drug pharmacokinetics, or the timeline of drug use. For exam-
ple, initial effects of methamphetamine may include intense euphoria,
talkativeness and excitement, followed by dysphoria (unpleasant feelings),
lethargy and anxiety several hours later. In addition to the relatively
complex way in which many drugs are eliminated, the additional pres-
ence of active metabolites creates yet another level of consideration or
complexity to the interpretation.
A simpler way to consider elimination is this analogy: a baseball dropped
by a 10-year-old child sitting in a tree house, high above the ground, will
fall straight down (alcohol zero order elimination).With practice, the child
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17
21. might even be able to reasonably predict how long the ball takes to hit
the ground (alcohol retrograde). If that same 10-year-old then drops a
maple leaf attached to an acorn, it should hit the ground at about the
same time as the baseball (other drugs with zero order elimination).
However, what would happen if he dropped only the leaf without the
acorn? It will drop much more slowly—as it is tossed and turned in the
breeze—than the baseball or the leaf and acorn.The leaf’s size also
changes during its descent as pieces break off in the wind (changing drug
half-life); this also causes its rate of descent to slow. Eventually the leaf
gets to the ground, but not in a straight line nor in a necessarily highly
predictable time frame (drug first order elimination).
Pharmacodynamics:The dose-response relationship.
The effect of a drug is a result of the drug’s interaction at a given receptor
site. Drugs that affect the central nervous system must reach and bind to
specific receptors for their effects to be exhibited.These drugs act to either
stimulate or depress certain areas of the brain to achieve a response, i.e.
reduce pain, elevate mood, cause sedation, etc.Typically, an increase in the
concentration of the drug modulates the receptor response and enhances
the pharmacologic effect.A relationship exists between the amount of drug
administered (dose) and the corresponding effect (response) on the body,
including the extent to which it may “impair” normal function.This is the
basis of the dose-response relationship.
The duration of a drug’s effects can be estimated, but these may vary with
dose. Residual effects may exist long after the “acute” effects of the drug
have been experienced (Table 5).The link between the amount of drug
and its effect over time is the basis for establishing therapeutic and toxic
drug concentrations.These ranges are widely published for clinical purpos-
es, but there are no “therapeutic concentrations” for many illicit drugs.
Remember: A habitual drug user may develop a tolerance to the
toxic effects of a drug, allowing him or her to withstand concentra-
tions of drug that may be highly toxic or even fatal in a naïve (inexpe-
rienced) subject.
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18 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
22. The pharmacologic effect can be intrinsically dependent on the time since
the dose, rather than the concentration of drug in the blood.This phe-
nomenon is referred to as hysteresis. For example, after consuming ethanol,
a person tends to feel more excited and euphoric during the initial absorp-
tion phase than during the elimination phase, during which time they may
feel more sedated and depressed (Mellanby effect). CNS stimulants like
methamphetamine follow a similar cycle.A given methamphetmine con-
centration (say 0.2 mg/L) in blood may coincide with euphoria, exhilara-
tion, restlessness and stimulation during the initial absorption phase.
However, several hours later, the same drug concentration may coincide
with confusion, depression, anxiety and exhaustion during the elimination
phase.THC exhibits a counterclockwise hysteresis, indicating a slight delay
between the effects and blood concentration. In other words, as the THC
concentration decreases, the subject claims to maintain a subjective “high.”
The pharmacologic effect experienced by the user may be apparent from
vital signs, involuntary reflexes or behavior. For the purpose of determining
impairment, acute or chronic toxicity, blood is considered by most to be
the preferred specimen. If a drug is in the blood, it is able to circulate and
bind to receptors.While a number of laboratories across the country use
urine samples with great success, the presence of the drug in urine is an
indication of drug exposure over a period of hours, days or even weeks
(evidence of past use). For this reason, additional information such as obser-
vations, behavior or clinical signs is very important to the toxicologist.The
presence or absence of characteristic signs may be of interpretive value.
With the exception of ethanol, there is so far no widely accepted correla-
tion between the drug concentration in blood and a corresponding level of
driving impairment among the scientific community.What is more, factors
such as tolerance can have a profound effect on the pharmacodynamic
response in an individual.A quantity of cocaine sufficient to produce a
mild “buzz” in a chronic user could be acutely cardiotoxic in a naïve
(inexperienced) user, resulting in coma and death.
Remember: Vital signs, symptoms and behavioral response observed
by clinicians and law enforcement personnel are highly relevant during
toxicological interpretation.
C O M M O N D R U G E F F E C T S : P H A R M A C O L O G Y F O R P R O S E C U T O R S
19
23. D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
20 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
DrugClinicalHalf-VdDuration%ExcretedPrincipal
DoseLife
*
(L/kg)ofEffect#
unchangedMetabolite(s)
inurine
Alprazolam0.25–2mg6-27h0.9-1.34-8h20%alpha-hydroxyalprazolam+
Carisoprodol200–350mg0.9-2.4h-4-6h<1%meprobamate+
Cocaine40-100mg0.5-1h1.6-2.71-2h<10%benzoylecgonine,ecgonine
methylester
Diazepam4-40mg21-37h0.7-2.64-8h<1%nordiazepam+
,temazepam+
,
oxazepam+
GHB2-4g0.3-1h0.43-6h--
MDMA-8h5-81-4h65%methylenedioxyamphetamine
(MDA)+
Methadone20-200mg15-55h512-24h5-50%2-ethylidene-1,5-dimethyl-3,3-
diphenylpyrrolidine(EDDP)
Methamphetamine2.5-15mg6-15h3-72-4h10-20%amphetamine+
Morphine5-30mg1.3-6.7h2-54-6h<10%conjugatedmorphine
Oxycodone2.5-30mg4-6h1.8-3.74-5h15%oxymorphone+
,conjugatedoxy-
codone
THC2.5-10mg20-57h4-143-6h<1%11-nor-9-carboxy-delta-9-THC
(carboxy-THC)
*
Half-lifeofdrugmetabolite(s)notindicatedinthistable#
Residualeffectsmaylastforextendedperiods+
Pharmacologicallyactivemetabolite
Table5.9-11
24. H O W C A N D R U G S
I M P A I R D R I V I N G ?
Drugs can impair driving by affecting some of the important skills
necessary for safe operation of a vehicle (Table 6). In fact, drug manufac-
turers commonly issue warnings for prescription or over-the-counter
drugs, indicating that the drug may impair mental or physical abilities
required for performing hazardous tasks such as driving.
Coordination
Coordination and psychomotor control are essential because driving is a
physical task. Drugs that affect nerves and muscles may impair braking,
steering, acceleration and manipulation of the vehicle. Once a driver
decides to brake, accelerate, swerve, etc., he or she must be able to effec-
tively carry out the braking, accelerating, swerving. Braking too suddenly
or too late, or using the wrong amount of force on the steering wheel
and over- or under-correcting, can result from drug impairment.
Judgment / Decision-making
Drivers must process information and then make appropriate decisions.
Some drugs affect cognition and have the potential to impair the ability
to concentrate, detect, anticipate risk, avoid hazards or make emergency
decisions. Mood-altering drugs have the potential to affect judgment. For
example, stimulants like cocaine or methamphetamine can produce
exhilaration, excitement and feelings of mental and physical power.This
type of adrenergic response may in turn influence driving behavior—
e.g., increased risk-taking.
Perception
The majority of information that a driver processes is visual. Drugs that
can produce visual or auditory distortions, or drugs that can affect per-
ception of time and distance (e.g., marijuana) have the potential to
impair driving.A side effect of some depressant drugs and therapeutic
21
25. medications is blurred vision.Visual disturbances are also reported with
other drugs, such as cocaine, which can cause flashes of light in peripher-
al vision, known as “snow lights.”
Tracking
Tracking is necessary in order to maintain position on the roadway.
Depressant drugs and marijuana, as well as inhalants and PCP, can impair
tracking ability.This is sometimes observed as weaving or the inability to
maintain the vehicle within the lane (the constant minor over-correc-
tions seen in an attempt to stay within the lane).
Reaction Time
A driver must not only receive information, but must also process it,
make a decision, and then react. Slowed reaction times (reaction deficits),
particularly with respect to braking and steering, may result in character-
istic driving behavior, for example, striking a fixed object, rear-ending
another vehicle, or failure to make an evasive maneuver. Several drugs
can impair reaction time, in particular depressants.
Divided Attention and Multitasking
Driving requires divided attention, rather than focused attention. Divided
attention involves the performance of multiple tasks, simultaneously –i.e.,
multitasking. Drivers must observe road signals and monitor pedestrians
and other vehicles in addition to the environment.At the same time, they
must effectively operate the gas, gears, braking and steering systems.
While many of these functions are well learned, the driving task itself has
a high demand for information processing. Ingestion of depressant drugs
or marijuana may impair divided attention skills, as may stimulants,
which may produce hypervigilance, preoccupation or distractibility.
Progressive symptoms and impairment of some commonly encountered
drugs are summarized in Table 6. Differences between individuals as well
as differences within the same individual at different times can produce
different responses. For example, an individual with a headache takes two
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
22 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
26. aspirin and a short time later the headache is gone.A week later that
same individual again has a headache, takes two aspirin, but the headache
remains, although to a lesser degree.Another person never takes aspirin
for headaches, only acetaminophen, because aspirin causes ringing in her
ears and doesn’t seem to make the headache go away.
The scientific evaluation of driving performance is technically and logis-
tically complex.Various approaches have been taken.Although more than
half (56%) (12) of people who reported driving after marijuana use
claimed that the drug did not affect their ability to drive, it is highly
questionable whether or not individuals can assess their own driving per-
formance.
H O W C A N D R U G S I M P A I R D R I V I N G ?
23
Alprazolam*
Drowsiness, confusion, light-
headedness, weakness, poor
coordination, blurred vision,
fatigue, irritability
Subjective sedation,
impaired vision, reaction
time, memory, tracking, vig-
ilance, cognitive function,
psychomotor function
Carisoprodol*
/
Meprobamate*
Drowsiness, dizziness, ataxia,
slurred speech, tremor, irri-
tability, syncope, weakness
Attention, reaction time,
subjective sedation, psy-
chomotor function
Cocaine Restlessness, euphoria,
dizziness, mydriasis (dilated
pupils), hyperactivity,
irritability, dyskinesia
(impairment of voluntary
movements resulting in
fragmented or jerky
movements), anxiety, tremor,
dysphoria (state of unwellness
or unhappiness), insomnia,
psychosis, fatigue, lethargy
Subjective confusion,
perception, hallucinations,
judgement
Table 6.9-11
Drug Progressive Symptoms Impairment
27. D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
24 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
Diazepam*
Drowsiness, lethargy, ataxia
(uncoordinated movement),
dizziness, confusion
Vigilance, reaction time,
memory, subjective seda-
tion, attention, perception,
anticipation of hazards,
speed control, tracking, psy-
chomotor function
GHB
(Gamma
Hydroxybutric
Acid)
Drowsiness, lethargy, euphoria,
confusion, disorientation,
slurred speech, ataxia (uncoor-
dinated movement), nausea,
vomiting, mydriasis (dilated
pupils), reduced inhibitions,
dizziness, unconsciousness
Cognitive function, psy-
chomotor function, loss of
peripheral vision, visual dis-
turbances
MDMA
(Ecstasy)
(Methylenedioxy-
methamphetamine)
Sensory disturbances, nausea,
dizziness, ataxia (uncoordinat-
ed movement), diaphoresis
(excessive perspiration), mus-
cular rigidity, restlessness,
tremor
Subjective excitability, per-
ception, cognitive function,
attention, memory, psy-
chomotor function
Table 6.9-11
continued
Drug Progressive Symptoms Impairment
Methadone*
Drowsiness, dizziness,
weakness, disorientation, miosis
(constricted pupils), light-head-
edness, visual disturbances
Vision, reaction time, sub-
jective sedation
28. H O W C A N D R U G S I M P A I R D R I V I N G ?
25
* Indicates warning from manufacturer
Methamphetamine*
Restlessness, euphoria, dizzi-
ness, mydriasis (dilated pupils),
dyskinesia (impairment of
movements resulting in frag-
mented or jerky movements),
tremor, dysphoria (state of
unwellness or unhappiness),
insomnia, irritability, nervous-
ness, rapid speech, confusion,
agitation, hyperactivity, psy-
chosis, fatigue, somnolence,
anxiety, delusions
Perception, judgment,
attention, psychomotor
function
Morphine*
Drowsiness, dizziness, lethargy,
ataxia (uncoordinated move-
ment), miosis (constricted
pupils) visual disturbances,
weakness, confusion
Subjective sedation,
reaction time, psychomotor
function, cognitive function
Oxycodone*
Drowsiness, dizziness, lethargy,
miosis (constricted pupils),
weakness, confusion
Psychomotor function,
subjective sedation,
reaction time
Table 6.9-11
continued
Drug Progressive Symptoms Impairment
THC*
Ataxia (uncoordinated move-
ments), confusion, dizziness,
somnolence, euphoria, relax-
ation, hallucinations, speech
difficulty, weakness, malaise,
visual disturbances, paranoia
Perception, subjective seda-
tion, reaction time, memo-
ry, vigilance, attention,
emergency decision mak-
ing, psychomotor function,
cognitive function
29. M E A S U R I N G I M P A I R M E N T
Although the scientific literature on the effects of drugs on driving
skills is extensive and increasing, a great deal more work remains to be
done. For ethical and safety reasons, on-the-road driving studies using
“real-world” doses of drugs like cocaine and methamphetamine are not
feasible.Therefore, a toxicologist must rely on a number of approaches,
which may include:
• Empirical Considerations:What is the pharmacology of the drug?
What effects does it produce? How long does it last?
• Epidemiological Studies: Retrospective studies that discuss drug
use/driving behaviors in a given population of drivers.
• Case Reports: Actual published reports of impaired drivers in the lit-
erature.
• Laboratory Studies: Administer drug and evaluate psychophysical
tests, for example, response time, motor control, divided attention,
memory, vision, mood effects or subjective effects in a controlled set-
ting.
• Simulator Studies: Administer drug and evaluate performance in a
driving simulator, for example, lane position, speed, steering, reaction
time, decision-making or vehicle manipulation.
• Actual Driving Studies: Administer drug and observe actual driving
performance in a real-world setting, for example, highway driving or
city streets.
There are advantages and disadvantages associated with each approach
and these are summarized in Table 7. Collectively, these approaches can
provide a toxicologist with a great deal of useful information.Taken
together, the scientific literature helps determine whether the drug effects
are compatible with safe driving, and specifically how they might impair
a person’s ability to drive.
Drugs may affect normal behavior by enhancing or impairing human
performance, such as cognition or psychomotor skills.The same drug
may be capable of either enhancing or impairing performance, depend-
ing on the dose and pattern of drug use. For example, in laboratory stud-
27
30. ies, single low doses of amphetamine (5-15 mg) and methamphetamine
(10-30 mg) have been shown to improve alertness and psychomotor per-
formance in healthy and sleep-deprived individuals. Real-world doses of
methamphetamine far exceed those used in the controlled studies.
Epidemiological studies, as well as empirical knowledge of the drug
effects at elevated dose, strongly suggest that methamphetamine can
impair skills necessary for safe driving.
Individuals may claim their driving ability was enhanced through drug
use, so be aware of study conditions and be able to explain the relative
merits and caveats. In a similar manner, studies that evaluate drug combi-
nations are readily misrepresented. For example, laboratory studies have
shown that a single low dose of stimulant (methamphetamine) can offset
sedation caused by a depressant (alcohol).This does not equate to a rever-
sal of effects or a zero net effect.Alleviation of sedation in no way infers
that a stimulant will reverse all of the impairing effects of alcohol (judg-
ment, attention, psychomotor function), or vice versa.
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
28 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
31. M E A S U R I N G I M P A I R M E N T
29
Empirical
Considerations
Readily supportable
Extensively published
Can draw inferences for
similar drugs
Does not anticipate an atypical
response
Does not account for poly-drug
use or drug interactions
Not driving or individual specific
Not environment or situation
specific
Easily conducted
May show differences
between populations
May display trends
Large data pool
Largely descriptive and non-
specific
Inferences difficult to make
May be time/location sensitive
Case Reports Involves real-world doses
Actual effects
Relevant populations
Personalized data
First hand accounts
Anecdotal
Lack of control data
Table 7.
Approach Advantages Disadvantages
Laboratory
Studies
Isolates an individual task
Controlled environment
Moderately safe
Real-world doses may not be
administered
Does not simulate driving
Learning effects may develop
towards tests
Simulator
Studies
Controlled environment
May approximate driving
task
Moderately safe
Real-world doses may not be
administered
No consequences or real danger
Not real driving
Small sample size
Actual Driving Realistic driving situation
Potential for real conse-
quences
Closely approximates
driving task
Real-world doses may not be
administered
Liability issues
Ethical constraints
Small sample size
Infrequently conducted
Epidemiological
Studies
32. T O X I C O L O G Y A N D T H E D R U G
E V A L U A T I O N A N D
C L A S S I F I C A T I O N ( D E C )
P R O G R A M
The DEC Program provides specialized training and certification of
law enforcement personnel commonly known as Drug Recognition
Experts (DREs).The DEC process is a systematic, standardized, post-
arrest procedure that can be used to determine whether a person is
impaired by one or more categories of drugs.The evaluation is based
upon a variety of observable signs and symptoms which are proven to be
reliable indicators of drug impairment. For additional information, visit
the NTLC website at www.ndaa-apri.org or contact the NTLC at
703-549-4253 or TrafficLaw@NDAA-APRI.org.
The observations and measurements that are made by a certified Drug
Recognition Expert are extremely important to the toxicologist. DREs
utilize a series of physiological and psychomotor tests to determine the
category or categories of drug present: CNS stimulants, CNS depressants,
narcotic analgesics, hallucinogens, PCP, cannabis or inhalants. Unlike the
classification schemes that are often used by toxicologists, the categories
used by the DEC program are not based on shared chemical structures,
but rather on the “signs” (detectable by an observer, such as bloodshot
eyes) and “symptoms” (the subjective experience of the user, such as nau-
sea). It is the pattern of the effects, rather than a specific effect, that
determines the DEC category.
A DRE’s ability to identify the category of drug is based upon his or her
familiarity with the documented or known effects of the drug.The DRE
evaluation itself is unique only from the standpoint that it provides a
standardized and systematic approach to data collection. Clinical charac-
teristics such as blood pressure, pulse, respiration, body temperature, nys-
tagmus, ocular convergence (ability to cross eyes), pupil size and pupil-
lary reaction to light can be useful indicators of drug use.A detailed
summary of the effects associated with each drug class (DRE Matrix) is
31
33. available through the NTLC and the International Association of Chiefs
of Police (IACP). Other observable effects, such as tremors, coordination,
gait, muscle tone, perception, diaphoresis (extreme sweating), emesis
(vomiting), lacrimation (excessive tearing) and appearance of the con-
junctiva may also provide valuable insight (Table 2).As discussed earlier,
abstinence or withdrawal syndromes resulting from chronic drug use pro-
duce effects that vary considerably from those caused by acute drug
intoxication (Table 3).
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
32 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
34. D R U G D E T E C T I O N A N D
I M P L I C A T I O N S F O R D R I V E R
I M P A I R M E N T
The duration and the intensity of a given drug’s effects depend on the
dose administered, individual metabolism, frequency of drug use and the
presence of other drugs. Because many of these factors are unknown,
toxicological interpretation is often difficult. Questions regarding admin-
istration time can sometimes be answered using the pharmacokinetic
principles, such as drug half-life. For a drug that is eliminated by first order
kinetics, 99% of the drug is eliminated by seven half-lives, with less than
1% remaining in the body. By ten half-lives, 99.9% has been eliminated.
Although detection times for different drugs can be estimated, these vary
with dose, method of analysis and metabolic factors.Although the con-
centration of a particular drug in a blood sample provides important
information, it should be considered in conjunction with reports of driv-
ing behavior, physiological signs and other data.
Blood and urine are the most frequently encountered biological fluids in
DWI casework. However, DWI statutes in some states make provisions
for alternative specimens, for example, saliva.The benefits and weaknesses
of blood, urine and saliva samples are described below:
Blood
Advantages:
• A drug that is circulating in the blood may bind to receptors in the
brain.
• Less-readily adulterated than urine due to method of collection.
• Quantitative, meaning the amount of drug in the blood may have some
interpretive value.
• Detection times are much shorter than in urine.Therefore, a blood
sample that contains a drug is more likely to indicate recent usage
compared to a urine sample.
33
35. Disadvantages:
• Many drugs have a limited detection window in blood; it may be diffi-
cult to collect a sample in a short period of time (transporting individ-
ual from scene to collection site, etc.).
• There are complicated statutory regulations or protocols governing
who is qualified to collect the sample and how it must be collected,
processed and stored.
• Testing of blood is labor intensive and expensive compared to urine.
Urine
Advantages:
• Easily collected.
• Can be screened for drugs more readily (less laboratory time required
as compared to blood testing).
• Longer detection times for most drugs or metabolites.
Disadvantages:
• Limited quantitative meaning for most drugs. In the absence of other
information, a urinary metabolite reported as “present” may have limit-
ed significance when trying to determine whether the individual was
impaired.
• More-readily adulterated, therefore requires careful collection proce-
dures to prevent the sample from being compromised (e.g., diluted,
replaced or manipulated by use of an additive or “masking agent”).
• Urinary detection times are even more difficult to predict due to dif-
ferences in fluid intake, diuresis (excessive elimination of urine) and the
effect of urinary pH on drug elimination.The relative acidity or alka-
linity of the urine can determine how quickly a particular drug is
eliminated from the urine. However, urine drug results may be useful
in determining an approximate time frame during which drug expo-
sure took place. For example, the heroin metabolite 6-acetylmorphine
is detectable in urine for approximately 2-8 hours after ingestion.
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
34 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
36. Saliva
Advantages:
• Easily collected.
• Can be screened for drugs easily.
Disadvantages:
• Some pharmacological interpretation may be possible but there is lim-
ited reference data at present.
• Many drugs have limited detection window in saliva.
• Drugs partition into saliva from the blood to varying degrees; the
degree to which a particular drug is present in saliva depends on many
variables, including the pH of the saliva.
• Possibility of sample adulteration (by mouth).
• Relatively small volume available for analysis—this may prevent defen-
dant from obtaining “independent test.”
Remember: Because the drug dose usually is unknown, it is gener-
ally not possible for a toxicologist to determine exactly when the
drug was administered. However, the toxicologist may be able to
infer an approximate window of drug use. For example,THC increases
very rapidly during marijuana smoking, and upon cessation, is elimi-
nated rapidly from the blood.As a result, elevated levels of THC in
blood are a good indication of recent drug use. Cocaine has a short
half-life and is relatively unstable.Therefore, the presence of elevated
levels of cocaine in a blood sample may also indicate moderately
recent use.The meaning of “recent” use will vary from one drug to
the next.
The characterization of certain, specific concentrations of drugs in blood
as therapeutic, toxic or lethal is often useful, but must be assigned with
caution due to inter-individual differences.These ranges overlap for some
drugs, making it difficult to classify the concentration in this way.
Remember: Human performance may be impaired at therapeutic
concentrations.
D R U G D E T E C T I O N A N D I M P L I C AT I O N S F O R D R I V E R I M PA I R M E N T
35
37. A therapeutic level of a hypnotic or sedative drug can impair driving due
to the central nervous system depressant effects. Even low or sub-clinical
concentrations of some drugs in blood are associated with impaired driv-
ing. Following chronic use of a stimulant drug like methamphetamine or
cocaine, an individual may experience extreme fatigue and exhaustion,
consistent with the “crash” phase of drug use, sometimes called the “down-
side.” During this time, when an individual is experiencing the negative
reinforcing effects, drug concentrations are much lower than during the
acute or “high” phase, when positive reinforcing effects predominate.Thus,
toxicological interpretation is usually based upon a combination of toxi-
cological analyses, case information, and field observations made by law
enforcement personnel or clinicians who may have had contact with the
individual.
Multiple drug use can complicate interpretation, so drug combinations
need to be examined in terms of their ability to interact with each other
and produce additive, synergistic or antagonistic effects:
• Additive effects occur when a combination of drugs produce a total
effect that is equal to the sum of the individual effects
• Synergistic effects occur when a combination of drugs produce a total
effect that is greater than the sum of the individual effects
• Antagonistic effects occur when the effect of one drug is lessened due to
the presence of another drug
A trained toxicologist will be familiar with the types of drugs
that can have additive, synergistic or antagonistic effects.
Interpretation of toxicology results is compounded by a number of fac-
tors which includes, but is not limited to multiple drug use, history of
drug use (chronic vs. naïve user), overall health, metabolism, individual
sensitivity, individual response and withdrawal.The same dose of drug
given to two individuals may possibly produce similar effects but with
varying degrees of severity that elicits a different response.The presence
of a drug alone in a person’s blood or urine does not necessarily mean
that he or she was impaired. Other information, such as documentation
of appearance, behavior, performance on standardized field sobriety tests,
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
36 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
38. DRE evaluation or driving behavior, is also important. Based on a com-
bination of these factors (Figure 2) it is often possible for a toxicologist
to provide expert testimony regarding the consistency of this information
with driving impairment.
Figure 2.
D R U G D E T E C T I O N A N D I M P L I C AT I O N S F O R D R I V E R I M PA I R M E N T
37
39. T E S T I N G M E T H O D O L O G Y I N
T H E F O R E N S I C T O X I C O L O G Y
L A B O R A T O R Y
Most forensic toxicology laboratories that routinely analyze DWI case
samples for drugs utilize a two-tiered approach. Initially, samples are
screened for common drugs or classes of drugs using an antibody-based
test. Samples that screen positive are then re-tested using a second, more
rigorous technique, usually called confirmation.
Screening Tests (Presumptive Tests) vs. Confirmatory Tests
Assume for a moment that you have in your hand a key ring with ten
keys, all made of brass, all appearing to have the same cut. In front of you
is a door with a lock.A few of those will fit in the lock (screening test
with false positives since the keys are structurally similar to each other)
but only one will actually turn and unlock the door (confirmation test).
This holds true for drug testing, as well.
Screening Tests
An immunoassay test is the most common type of screening test for drugs
of abuse. Using this type of test, a drug or metabolite in a biological sam-
ple can be tentatively identified using an anti-drug antibody. If a drug is
present in the sample, the anti-drug antibody will bind to it; if no drug is
present in the sample, the anti-drug antibody will not bind to the sam-
ple.Various methodologies and detection methods are utilized, giving rise
to a number of immunoassays.These include enzyme linked immunosor-
bent assays (ELISA), enzyme multiplied immunoassay technique (EMIT),
fluorescence polarization immunoassay (FPIA), cloned enzyme-donor
immunoassay (CEDIA) and radioimmunoassay (RIA).
Immunoassay test results are considered presumptive, not conclusive,
because the antibodies that are used may cross-react with other substances
to varying degrees, resulting in false positive results.Analogs or substances
that are structurally similar to the drug are most likely to produce a false
positive. For example, common over-the-counter cold medicines that
39
40. contain pseudoephedrine may cause a false positive methamphetamine
immunoassay result.
Most laboratories utilize screening tests only to determine which drugs
or classes of drugs might be indicated.This allows confirmatory tests to
be performed for the drugs indicated by the immunoassay. Since it is
unfeasible to test every sample for every drug using confirmatory proto-
cols, screening tests are used principally to determine where to focus
analytical resources in the laboratory.
Cut-offs
The immunoassay test will have a cut-off value or threshold concentra-
tion, above which a sample is considered positive. Cut-off concentrations
for urinary workplace drug testing are federally mandated by the
Substance Abuse and Mental Health Services Administration (SAMHSA).
These cut-off concentrations do not apply to forensic testing in DUID
casework.The majority of state toxicology laboratories that perform drug
tests in criminal casework set cut-off concentrations below the SAMHSA
guidelines.This is because workplace drug testing cut-offs in urine are set
so that inadvertent drug exposure (e.g. poppy seed ingestion) does not
produce a positive drug test.As a result, the cut-offs are elevated so that
workers who unintentionally expose themselves to drugs are not penal-
ized.The forensic toxicology laboratory may utilize lower cut-off con-
centrations for blood samples compared with urine because of reduced
detection times and concentrations in blood compared to urine. It is
essential for law enforcement personnel to understand the implications of
a negative laboratory result in this context.
Confirmatory Tests
The confirmatory test is more specific and usually more sensitive than the
initial immunoassay test.The most frequently used confirmatory tech-
nique is gas chromatography-mass spectrometry (GC-MS or “GC-Mass
Spec”) although others include high performance liquid chromatography
(HPLC), liquid-chromatography-mass spectrometry (LC-MS) and others.
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
40 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
41. The increased specificity of the confirmatory technique allows the drug
to be qualitatively identified, i.e. the ability to determine specifically
which drug is present. For example, GC-MS can be used to distinguish
structurally related drugs such as pseudoephedrine from methampheta-
mine.A quantitative analysis may be performed in blood samples, where-
by the concentration of the drug is determined.
Unlike the screening tests described earlier, which are performed with
little or no sample preparation, confirmatory drug tests usually require
extensive sample preparation or “clean up.” In other words, the drug must
be isolated from the biological sample prior to testing on the instrument.
This is typically achieved using liquid-liquid extraction or solid phase
extraction, whereby drugs in a complex mixture (e.g., blood, urine) are
separated from the biological sample. Once the drugs are extracted from
the sample, they can then be subjected to confirmatory analysis. For this
reason, confirmatory tests are a great deal more labor-intensive than
screening tests. Depending on the number of drugs that are present, it
may take several days to complete the tests because each drug may
require a different extraction and separate confirmatory analysis.
The basis for most confirmatory techniques is separation and positive
identification. GC-MS is considered the “gold standard” for methods of
confirmatory drug identification. In this method, individual components
(drugs and metabolites) are first separated, based upon their chemical and
physical properties, by the gas chromatograph (GC).The separated
drug(s) then enters the mass spectrometer (MS), where it undergoes
molecular fragmentation, resulting in a characteristic mass spectrum or
fragmentation pattern.This “molecular fingerprint” of the drug, together
with the characteristic retention time from the gas chromatograph allows
the drug to be positively identified.
A helpful and widely used analogy for the GC-MS method is the fol-
lowing: inside the GC oven is a long, thin, coiled column; think of this
column as a racetrack with different types of vehicles (drugs) traveling
around it. Some cars are small and fast (methamphetamine), others big
and slow (alprazolam); the road conditions (internal coating of the col-
umn) also dictate which cars travel faster—cars with special tires might
T E S T I N G M E T H O D O L O G Y I N T H E F O R E N S I C TO X I C O L O G Y L A B
41
42. perform better in the snow, etc.As the cars travel around the track at dif-
ferent speeds they become separated and ultimately each crosses the fin-
ish line (the MS detector) and generates a unique “retention time.”At
the finish line, each car is involved in a serious collision and is essentially
blown apart by the MS; this generates pieces (molecular fragments) of the
car, such as a bumper, hood, headlight, etc.These pieces are then com-
pared with other cars of the same make, model and year (drug stan-
dards)—which allows for a near perfect overlay of car parts (unique drug
fragmentation patterns) and finish times (retention times) for a positive
drug identification.The GC-MS identification is based fundamentally
upon how drugs are “put together” or arranged chemically, including
molecular attractions which ultimately dictates how a molecule or drug
will fragment or “blow up.”
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
42 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
43. C A S E P R E P A R A T I O N A N D T H E
T O X I C O L O G I S T A S E X P E R T
W I T N E S S
Depending upon the evidentiary rules in your jurisdiction, a toxicolo-
gist may be necessary to testify at trial to establish the authenticity of the
toxicology report, chain of custody and the implication and validity of
the test results. Even if such testimony is not necessary to get the evi-
dence admitted, prosecutors must consider carefully the additional bene-
fits of having the toxicologist present to interpret the test results and pro-
vide expert testimony. Obviously, manpower concerns and costs associat-
ed with expert testimony likely limit the use of a toxicologist, but in
some cases, expert testimony from a toxicologist might be essential.This
is especially true in DUID cases, where the effects of drug or poly-drug
consumption, and the meaning of drug concentrations, are not a matter
of common knowledge to the layperson.
It is unlikely that a toxicologist will unequivocally state that all drivers
who have a drug or metabolite in their blood or urine are impaired.
Determination of impairment requires a case-by-case evaluation, so be
sure to obtain the opinion of a toxicologist well before trial. Nothing is
worse than having your own witness deliver an unexpected opinion to
the jury. Since drug effects are complex, toxicologists may ask many
questions before they can arrive at an opinion:
• How was the person driving?
• What was the reason for the traffic stop?
• Was there a crash?
• Was the person injured? What was the nature of the injuries?
• If so, were medications administered at the hospital?
• What is known about the overall health of the individual?
• Were field sobriety tests performed? If yes, what were the results?
• Was a DRE evaluation performed? What were the results?
• What signs, symptoms or behaviors were documented (motor skills,
speech patterns, eye movements, etc)?
43
44. When the DRE Opinion Differs from the Toxicology Report
In most circumstances, the DRE opinion and the toxicology report
agree. But toxicology results that do not agree may need to be addressed
by a toxicologist who is familiar with the DRE evaluation process. For
example, in the “crash” or “downside” phase of stimulant use, a person
experiencing extreme fatigue and exhaustion may appear to be under the
influence of a depressant or narcotic drug. Marijuana and stimulants
increase blood pressure, increase pulse, and can produce eyelid or body
tremors. Stimulants tend to speed up the internal clock and dilate pupils,
and marijuana can distort pupil size and the internal clock.These similar-
ities in the known effects of drugs at varying phases of ingestion or elim-
ination can sometimes make it more difficult to identify the class of drug
responsible.This is further complicated by poly-drug use, whereby the
individual has ingested any number of substances, each of which exhibits
certain characteristics on its own, but together these substances likely
result in a whole host of contradictory signs and symptoms.
Laboratories cannot test for every known drug.Testing is both labor-
intensive and expensive. Each laboratory will likely have a policy for
drug testing in DUID cases that may limit the scope of the tests that are
performed. Some laboratories may screen samples only for common
classes of drugs to the exclusion of other, less common drugs, while
other labs may conduct exhaustive toxicology. Be familiar with both test-
ing protocols and policies governing how drug-related DWI casework is
handled. Keep in mind as well that as newer drugs are developed a
screening and confirmatory test may not yet exist. For these reasons, a
negative toxicology report does not conclusively mean no drugs are in
the person’s system. It may simply mean that the scope of the testing was
too limited, the cutoff was too high, or a test for that particular drug was
not available.
Witness Selection
Forensic toxicology can be divided into three main fields: post-mortem
toxicology, workplace drug testing and human performance toxicology.
Human performance toxicology is concerned with the mental and physical
effects of drugs that may impair a person’s ability to safely operate a
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
44 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
45. motor vehicle.This is a challenging field, and an expert witness must be
familiar with this sub-discipline.
Because of the breadth and scope of toxicology, it is important to deter-
mine that the “expert” has the necessary credentials. For example, a clini-
cal toxicologist who performs drug tests in an emergency room or hos-
pital may not be familiar with the effects of drugs on driving. Likewise, a
toxicologist employed in the field of workplace or employee drug testing
may not have expertise in human performance toxicology.The following
questions may help identify the most appropriate witness for expert testi-
mony (See Appendix for additional questions):
• What type of toxicologist are you?
• Are you familiar with the field of performance toxicology and in par-
ticular, the effects of drugs on driving?
• How did you gain this familiarity?
• What specialized training have you received in this area?
• Are you familiar with drug testing methodology and interpretation of
the results?
• How many times have you been qualified as an expert witness on the
effects of drugs on driving and in what courts?
C A S E PR E PA R AT I O N A N D T H E TOX I C O L O G I S T A S EX P E RT WI T N E S S
45
46. C O N C L U S I O N
DUID cases are both common in occurrence and complex to prose-
cute—legally, scientifically, and from a public policy standpoint.While
prosecutors need not attain the depth of knowledge of a forensic toxicol-
ogist to do justice in these cases, it is essential to have a basic understand-
ing of the scientific principles, together with effective channels of com-
munication with the law enforcement officers and toxicologists who
serve your jurisdiction.
47
47. C A S E S T U D I E S
Case #1:
A 47-year-old female was apprehended for erratic driving. She was
weaving, crossing the center line and striking the median.The officer
noticed she had glassy eyes and slurred speech. During the Standardized
Field Sobriety Tests (SFSTs), she had difficulty following instructions,
maintaining balance and HGN was present.A breath alcohol test was
negative, so a blood sample was drawn for drug testing.Toxicology tests
indicated the following drugs: Chlordiazepoxide (1 mg/L), nordiazepam
(0.6 mg/L), phenobarbital (8.8 mg/L), morphine (70 ng/mL) and
codeine (less than 25 ng/mL).
CLAIM: I was only taking my prescribed medicine.
REALITY:The poor driving, observations, appearance and performance
on SFSTs were well-documented.The toxicology report indicates several
prescription depressant drugs and narcotic analgesics.The observations
and driving behavior are consistent with someone who is under the
influence of a central nervous system depressant. Having a valid prescrip-
tion is not a legitimate defense in most states that adopt “affected by”
DWI statutes.
Case #2:
A 39-year-old male was apprehended for an improper lane change. He
was jittery, could not stand still, had rapid speech and spoke to himself
during the SFSTs. He had difficulty balancing and had trouble concen-
trating. He held on to his trousers for support and balance. Eyelid and
body tremors were noted.A blood sample was drawn.Toxicology tests
indicated the following drugs: Methamphetamine (0.14 mg/L) and
amphetamine (0.04 mg/L).
CLAIM: Methamphetamine has been shown to improve performance!
49
48. REALITY:The officer documented several characteristic indicators of a
central nervous system stimulant.The toxicology confirmed the presence
of a stimulant, methamphetamine and its metabolite, amphetamine.The
observations are consistent with someone who is under the influence of
a central nervous system stimulant drug. Small doses of stimulant drugs
have been shown to improve mental alertness and motor performance in
fatigued or sleep-deprived drivers. However, stimulants generally do not
improve performance in otherwise normal individuals, particularly when
they are used for illicit purposes and are taken in doses significantly high-
er than those used therapeutically.
Case #3:
A 53-year-old male was stopped for a broken tail light.The man per-
formed poorly on the SFSTs and was arrested. No observations of
appearance, demeanor or physical appearance were documented in the
police report.A blood sample was drawn.Toxicology tests indicated a
blood alcohol concentration of 0.05 g/100mL. Because the BAC was
below the per se limit a drug test was performed. Benzoylecgonine (0.3
mg/L) was also present.
CLAIM: I used cocaine yesterday.
REALITY:A cocaine metabolite, benzoylecgonine was detected in the
blood sample. It is not possible to reliably determine when the man used
cocaine based upon the test result and the unknown dose. More impor-
tantly, there are no characteristic indicators of a stimulant drug in the
police report. Based on this information, it is not possible to determine
whether the driver was under the influence of a drug, although it is pos-
sible that the poor performance on the SFSTs might be attributed to the
alcohol.
Case #4:
A 48-year-old man swerved into oncoming traffic, resulting in a near
collision.The officer noticed that his speech was extremely slurred; he
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50 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
49. had watery eyes, and was extremely unsteady on his feet. During the
SFSTs the driver was unable to maintain balance and fell down.The tests
were stopped for his own safety. HGN was present. He told the officer
he drove onto the wrong side of the road because he dropped a tamale
and was leaning over to pick it up.The driver stated he had medical
problems including a back injury.A blood sample was drawn and sent for
alcohol and drug testing.Toxicology tests revealed the following:
Morphine (50 ng/mL), meprobamate (20 mg/L), carisoprodol (2 mg/L),
oxycodone (130 ng/mL), hydrocodone (80 ng/mL), diazepam (0.3
mg/L) and nordiazepam (0.3 mg/L).
CLAIM: I was distracted.
REALITY:The poor driving, observations, appearance and performance
on SFSTs were well documented.The toxicology report indicates several
prescription depressant drugs and narcotic analgesics.The observations
and driving behavior are consistent with someone who is under the
influence of a central nervous system depressant. Many depressant drugs
impair our ability to divide attention, so performing non-essential (dis-
tracting) tasks may further compromise our driving.
Case #5:
A 23-year-old female was apprehended for erratic driving. She crossed
over the center line three times.The officer noticed the woman appeared
relaxed, her eyes were red, and she appeared dazed or disoriented. During
the SFSTs the woman was unable to remember the instructions and the
test had to be restarted a number of times. She was unable to maintain
balance. She admitted drinking two beers earlier in the afternoon.A
blood sample was drawn and sent for alcohol and drug testing.
Toxicology tests indicated the following results: Ethanol (0.05 g/100mL),
THC (4 ng/mL), and carboxy-THC (53 ng/mL).
CLAIM: I smoked marijuana yesterday.
REALITY:The poor driving, observations, appearance and performance
on SFSTs were well documented.The toxicology report indicates both
C A S E S T U D I E S
51
50. alcohol and THC.The observations and driving behavior are consistent
with someone who is under the influence of alcohol and marijuana.
THC disappears from the blood quickly so elevated concentrations in
blood indicate recent smoking.
Case #6:
A 22-year-old male was apprehended for speeding. He had elevated
blood pressure, elevated pulse, dilated pupils, and eyelid and body
tremors. He had difficulty performing SFSTs due to poor coordination
and mental alertness. He appeared extremely lethargic.The DRE officer
believed the man to be under the influence of marijuana.A blood sample
was drawn.Toxicology tests indicated the following drug:
Methamphetamine (0.2 mg/L).
CLAIM: The DRE opinion is incorrect.
REALITY:The officer documented several characteristic indicators of a
central nervous system stimulant. Lethargic behavior is consistent with
the “down” side of methamphetamine use. Many of these observations
are similar to the effects of marijuana, so it can sometimes be difficult to
distinguish the two.The observations are consistent with someone who is
under the influence of a central nervous system stimulant drug.
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
52 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
51. E N D N O T E S
1. 2003 National Survey on Drug Use and Health: National Findings,
Department of Health and Human Services, Substance Abuse and
Mental Health Services Administration, Office of Applied Studies.
Released September 2004 (available online at
http://www.DrugAbuseStatistics.samhsa.gov).
2. For purposes of most DWI statutes, blood alcohol concentration is
measured as a percentage by weight by volume (so a BAC of 0.08 is
0.08 percent by weight by volume) or number of grams per 210 liters
of breath as indicated by a chemical test (so a BAC of 0.08 is 0.08
grams per 210 liters of breath). See, e.g., § 18.2-266, Code ofVirginia
(1950, as amended); § 9-30-5-1, Code of Indiana. For a compilation of
DWI statutes, see, Prior Convictions in DUI Prosecutions;A Prosecutor’s
Guide to Prove Out-of-State DUI/DWI Convictions, Zenaida C. Cacnio,
Ed., National Traffic Law Center, LEXIS/NEXIS (2003).
3. See, Alcohol Toxicology for Prosecutors;Targeting Hardcore Impaired Drivers,
John Bobo, Ed., National Traffic Law Center,APRI (2003) (available
online at
http://www.ndaa.org/apri/programs/traffic/ntlc_home.html).
4.The Feasibility of Drugged Driving Per Se Legislation Consensus
Report 2002,The Walsh Group, JM Walsh (available online at
http://www.walshgroup.org).
5.The NSDUH Report: Drugged Driving, 2002 Update. Department of
Health and Human Services, Substance Abuse and Mental Health
Services Administration (available online at http://www.samhsa.gov).
6. US Department of Transportation, National Highway and Traffic
Safety Administration, Campaign Safe and Sober, Drug Impaired
Driving (available online at http://www.nhtsa.gov).
7. Driving under the influence of drugs (DUID) legislation in the
United States.The Walsh Group and the American Bar Association’s
Standing Committee on Substance Abuse. JM Walsh, G Danziger, LA
Cangianelli and DB Koehler (2002) (available online at
http://www.walshgroup.org).
8. State Law Summary, Driving While Under the Influence of Drugs,
53
52. National Traffic Law Center,American Prosecutors Research Institute.
9. RC Baselt. Drug Effects on Human Performance and Behavior.
Biomedical Publications, Foster City, CA (2001).
10, RC Baselt. Disposition of Toxic Drugs and Chemicals in Man, 6th
Ed.
Biomedical Publications, Foster City, CA (2002).
11. J Wilson.Abused Drugs.AACC Press,Washington DC (1994).
12. Driving After Drug or Alcohol Use Report, 1996 National
Household Survey on Drug Abuse, Department of Health and
Human Services, Substance Abuse and Mental Health Services
Administration, Office of Applied Studies (available online at
http://www.oas.samhsa.gov).
D R U G T O X I C O L O G Y F O R T H E P R O S E C U T O R
54 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
53. A C K N O W L E D G E M E N T S
My sincere thanks to past and present colleagues, toxicologists from
other states, and the Society of Forensic Toxicologists for providing
insight, training and collective experience in this challenging field.
Sarah Kerrigan, Ph.D.
55
54. A P P E N D I X 1 : G L O S S A R Y
Additive Effects The total effect is equal to the sum of the
individual effects of those drugs.
Antagonistic Effects The effect of one drug is lessened due to
the presence of another.
Antidepressant A substance that is used for the treatment
of mental depression.
Ataxia Inability to control voluntary muscular
movement causing staggered or unsteady
motion.
Cardiotoxic A substance that has a toxic effect on the
heart.
Central Nervous System The part of the nervous system (brain and
spinal cord) to which sensory impulses are
transmitted and from which motor impuls-
es pass out, and which supervises and coor-
dinates the activity of the entire nervous
system.
Concentration The amount of a substance in a specified
volume.
Depressant A drug that causes slows down central
nervous system function.
Detection Time The length of time that a drug can be
detected.
Dose Amount or quantity of drug.
57
55. Drug For the purposes of this article, “drug” is
defined as any chemical that affects living
processes and has the potential to impair
those processes.This includes illicit drugs,
prescription medicines, over-the-counter
medicines, dietary supplements, herbals and
botanicals.
First Order Elimination Elimination of a substance in a concentra-
tion-dependent (non-linear) fashion.
Hallucinogen A substance that alters perceptions, for
example, visual images or sounds.
Hysteresis The relationship between drug effects and
time or the lagging of a physical effect on a
body behind its cause.
Mellanby Effect A form of acute tolerance whereby the
perceived effects are more pronounced
when the blood alcohol is rising rather than
falling.
Metabolite A byproduct of a drug, formed naturally by
the body.
Opiate A substance that contains or is derived from
opium.
Opioid Natural or synthetic derivatives of opium in
addition to drugs that mimic the effects of
morphine.
Pharmacokinetics The manner in which a substance moves
throughout the body.This involves absorp-
tion, distribution, metabolism and elimina-
tion.
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58 AM E R I C A N PRO S E C U TO R S RE S E A R C H IN S T I T U T E
56. Pharmacology The study of the preparation, properties,
uses and actions of drugs.
Route of Administration The manner or process by which a sub-
stance, or drug, enters the body, i.e. intra-
venously, orally, etc.
Stimulant An agent that increases the rate of activity.
Synergistic Effect The total effect of multiple drugs that is
greater than the sum of the individual
effects of those drugs.
Volume of Distribution A measure of how widely a drug is distrib-
uted throughout the body.
Zero Order Elimination Elimination of a fixed amount of substance
per unit time.
A P P E N D I X 1 : G L O S S A R Y
59
57. A P P E N D I X 2 :
P R E D I C A T E Q U E S T I O N S F O R
T O X I C O L O G I S T
61
• What is your name, occupation?
• Where do you work?
• Is the laboratory certified or accredited?
• What is your current position?
• What are your job responsibilities or duties?
• How long have you worked at [current job] -previous employment if
applicable?
• What is your academic background?
• What education, training or experience qualifies you as an expert on
the effects of drugs on driving?
• What specialized training have you received in the effects of drugs on
driving?
• Have you testified as an expert on the effects of drugs on driving?
• Did [lab] analyze [sample] of the person in question?
• How was the sample received, identified, packaged and sealed?
• What were you required to do with the sample?
• What was the sample analyzed for?
• What type of testing was used?
• Are these methods generally accepted by the scientific community?
• Were the tests performed in accordance with standard operating proce-
dures?
• Was equipment in proper working order?
• What were the results of the tests?
• Were these results properly recorded [toxicology report]?
• What is [drug]?
• Are you familiar with the effects of [drug]? What are they?
• Is it possible for [drug] to affect driving? How?
• Can [drug(s)] affect a person’s ability to drive safely?
• Were you provided with additional information in order to reach an
opinion [police report, witness statements, DRE report]?
• Are driving behavior, SFST performance, signs and symptoms, etc. con-
sistent with someone who is under the influence of the drug?
Consistent with impaired driving by the drug?
58. American Prosecutors Research Institute
99 Canal Center Plaza, Suite 510
Alexandria,Virginia 22314
Phone: (703) 549-4253
Fax: (703) 836-3195
http://www.ndaa-apri.org