DWIQ Myths and Misconceptions of Alcohol and Drug

DWIQ Myths and Misconceptions of Alcohol and Drug Impaired Driving Rachel Smith Traffic Safety Resource Prosecutor Louisiana District Attorneys Association

Louisiana State Police Crime Lab Stats 2018 - 56% of samples. 08 or greater. - Of 44% that undergo tox screen, 51% test positive for at least 1 drug of impairment. = Approximately 78% of blood samples test positive for alcohol or one drug of impairment.

Top 5 Drugs in Impaired Driving BLOOD Tox Screens from LSPCL 2014 2015 2016 2017 36% THC-COOH 2018 Carisoprodol/mets 16% THC-COOH 15% THC-COOH Diazepam/mets 14% Diazepam/mets 13% Methamphetamine/mets 12% Methamphetamine/mets 22% Methamphetamine/mets 30% THC-COOH 10% Carisoprodol/mets 11% Diazepam/mets 10% Diazepam/mets 23% THC-COOH/THC-OH 46% 17% Cocaine/mets 24% 11% Hydrocodone/mets 7% Methamphetamine/mets 9% Carisoprodol/mets 8% Cocaine/mets 16% Diazepam/mets Methamphetamine/mets 6% Cocaine/mets 7% Alprazolam 13% Alprazolam 8%

Myth #1 We should treat all DWI’s the Same

. 08 Blood Alcohol Content = IMPAIRED

You MUST understand marijuana impairment!!!

3 Main Marijuana Components Detected in Blood: • THC = ACTIVE IMPAIRING cannabinoid • 11 -OH-THC (Hydroxy Metabolite) = ACTIVE IMPAIRING metabolite • THCCOOH (Carboxy Metabolite)= INACTIVE metabolite

Unlike alcohol, which is hydrophilic, marijuana is lipophilic Impairment can continue after THC is no longer detected in the blood After ingestion, it quickly crosses the blood/ brain barrier b/c the brain is fatty Where it IMPAIRS

Effects of Blood Collection Time on Measured Δ 9 Tetrahydrocannabinol Concentrations: Implications for Driving Interpretation and Drug Policy Hartman, R. L. , et al. (2016) ◦ 10 minutes -38. 2 ng (11. 4 – 137 ng) ◦ 25 mins – 11. 9 ng (1. 6 – 40. 8 ng) ◦ 60 mins – 6 ng (1. 4 -19. 8) ◦ 1 hour 25 minutes – 4. 1 ng (0 -14. 7 ng) THC concentrations decreased 90. 3% by 1. 4 hours post-dose. Note: The “high” dose of THC was 6. 7%. For 1 gram botanical marijuana, this would be 67 mg of THC.

NHTSA Marijuana Impaired Driving Report to Congress DOT HS 812440 July 2017

THC in Blood Affected By: Frequency of Use Metabolism Strain and Potency of Marijuana or THC Concentrate Manner of Ingestion

Strain and Potency of Marijuana Stains of marijuana that have low to no CBD are highly desirable because the CBD acts as a regulator of THC binding affinity

Manner of Ingestion smoking vs. edibles vs. vapes

THC Levels in Whole Blood – Smoked vs. Oral Journal of Analytical Toxicology, Vol. 28. September 2004 Relationship of Delta 9 -Tetrahydrocannabinol Concentrations in Oral Fluid and Plasma after Controlled Administration of Smoked Cannabis. Marilyn Huestis, Edward Cone. Clinical Chemistry 55: 12 2180– 2189 (2009) Delta 9 -Tetrahydrocannabinol (THC), 11 -Hydroxy-THC, and 11 -Nor-9 -carboxy-THC Plasma Pharmacokinetics during and after Continuous High-Dose Oral THC. Eugene W. Schwilke, David M. Schwope, Erin L. Karschner, et. al.

Maureen Dowd, NY Times, On Her Experience with Legalized Marijuana For an hour, I felt nothing. I figured I’d order dinner from room service and return to my more mundane drugs of choice, chardonnay and mediocre-movies-on-demand. But then I felt a scary shudder go through my body and brain. I barely made it from the desk to the bed, where I lay curled up in a hallucinatory state for the next eight hours. I was thirsty but couldn’t move to get water. Or even turn off the lights. I was panting and paranoid, sure that when the room-service waiter knocked and I didn’t answer, he’d call the police and have me arrested for being unable to handle my candy. I strained to remember where I was or even what I was wearing, touching my green corduroy jeans and staring at the exposed-brick wall. As my paranoia deepened, I became convinced that I had died and no one was telling me. It took all night before it began to wear off, distressingly slowly.

Residual Concentrations in Chronic Frequent Users THC 24 hours = 12 subjects = > 1 ng but < 5 ng 1 Day - Highest – 2. 9 ng Day 7 = All subjects = < 1 ng Day 30 = 2 subjects = Last THC positive sample (Note: by day 10 max THC would be under the LSPCL LOQ) Hydroxy 22 Participants positive upon admission Day 3 = 1 still positive at. 5 ng (Note: by day 2 max THC-H would be under the LSPCL LOQ) Carboxy 29 participants positive upon admission Day 3 = <10 ng Day 6 = <5 ng Day 22= 85% still positive (Note: by day 19 max THC-C would be under the LSPCL LOQ) Residual THC in Chronic Frequent Smokers – Impact of Prolonged Cannabinoid Excretion in Chronic Daily Cannabis Smokers’ Blood on Per Se Drugged Driving Laws, Bergamaschi, Karschner, Goodwin, Scheidweiler, Hirvonen, Queiroz, Huestis (2012)

“The practical reality of identifying evaluating, arresting, and sampling suspected impaired drivers means that the THC concentration measured in the blood specimen reflects neither the concentration in the subject’s blood at the time of arrest, nor the concentration of active drug in the brain. ” “A quantitative threshold for per se laws for THC following cannabis use cannot be scientifically supported. ”

Poor correlation of THC level in the blood or oral fluid with impairment precludes THC blood or oral fluid levels as an indicator of driver impairment.

There is no scientific basis for the adoption of THC per se laws for driving.

Myth #2 Toxicology is the Silver Bullet for Drug Impaired Driving Case

Reporting the results: Example of future THC and/or metabolites reporting

How to Prosecute These Cases: Back to Basics Thorough Officer DRE Tox Support Prosecutor

Toxicology =

Myth #3 SFST’s Are Just For Alcohol

Isn’t it true SFST’s are just for alcohol? !? !

Definition of SFST’s in 2018 Manual There are three SFSTs, namely HGN, WAT and OLS. Based on a series of controlled laboratory studies, scientifically validated clues of alcohol impairment have been identified for each of these three tests. They are the only SFST’s for which validated clues have been identified. Revised: 02/2018

Definition of SFST’s in 2018 Manual There are three SFSTs, namely HGN, WAT and OLS. Based on a series of controlled laboratory studies, scientifically validated clues of impairment have been identified for each of these three tests. They are the only SFST’s for which validated clues have been identified. Revised: 02/2018

SFST’s detect IMPAIRMENT SFST’s … “scientifically validated clues of IMPAIRMENT have been identified for each of these three tests…. . ” ARIDE 2018 Divided Attention Test Requires the subject to focus on mental and physical tasks at the same time. Ex. ’s = WAT & OLS Used to Assess Information Processing Memory Judgment Balance Reactions Vision Muscle Control Coordination Needed For: Steering Acceleration Braking React appropriately to traffic Etc.

“Know and recognize typical clues of alcohol and/or other drug impairment that may be seen during administration of SFST’s” “Alcohol is a CNS depressant”…. “Under the influence of alcohol or many drugs, a person’s ability to divide attention becomes impaired. ” “Some of the most significant evidence from all three phases of DWI detection can be related directly to the effects of alcohol/ or other drugs on divided attention ability. ” “Alcohol and many drugs reduce a person’s ability to divide attention. ”

Although original validation studies were developed to determine reliable indicators of a drivers BAC, this was done by using tests to detect IMPAIRMENT.

In fact……. “The validity of the tests when they are administered in the context of drug evaluations was examined in a retrospective analysis of the records of the Phoenix DRE unit. It was found that a suspect’s performance on the tests provides valid cues of drug impairment. ”

“HGN may also indicate consumption of seizure medications, phencyclididine, a variety of inhalants, barbiturates, and other depressants. ”

And of course…. . DRE Validation Studies!!!!!

Other Studies…… Marijuana “The consumption of THC does impair performance on the SFST’s. ” The Evaluation of the sensitivity of the SFST’s to Detect Impairment Due to Marijuana Intoxication; Papafotiou, Carter Stough 2004 “The field sobriety tests proved to be sensitive to impairment by marijuana. When multiple tests re used in conjunction with one another, the officer can be certain they are making a correct decision to arrest. ” A 2 Year Study of THC Concentrations in Drivers: Examining Driving and Field Sobriety Test Performance, Declues, Perez, Figueroa 2016

Other Studies…… Other Drugs “These findings provide support for the use of SFST as a screening tool for law enforcement to identify impairment in persons who have used CNS stimulants, CNS depressants, cannabis, or narcotic analgesics. ” An Examination of the Validity of the SFST in Detecting Drug Impairment Using Data from the DEC program; Porath, Beirness 2014

Myth #4 It’s All Natural So It’s Harmless

But it is safe because it’s “natural” and “from the earth, ” right?

BHO=Butane Hash OIL Extracting the resin which contains THC from the marijuana plant using highly flammable BUTANE producing concentrated THC.

Myth #5 The Streets Will be Paved With Gold

Drug Impaired Driving

25% Increase MJ DUI Citations 112% Increase MJ and Alcohol Citations 40% Increase Fatal Crashes 145% Increase in drivers testing positive for MJ

Reports to Poison Centers and Emergency Rooms - MJ related Mental Health Hospital Visits Increased by 5 x - MJ related Poison Center calls increased by 79%

Most Admissions/ Calls: Children < 5 Children 13 – 19 - drowsiness/lethargy - Agitated/irritable - Confusion - tachycardia

Hyperemesis: - Cyclic attacks of vomiting and nausea - Has lead to 3 deaths in Colorado - Caused by frequent cannabis use

Psychosis: - Daily use = 3 x more likely - High Potency THC daily use = 5 x more likely

- Became jittery and incoherent - Friends and family had never seen him like this - Refused to leave condo

Documented Adverse Effects of Marijuana Use, Besides DWI • European study-showed that ER visits increased and had neuro-behavorial features presented: • • Agitation/aggression 22. 9% Psychosis 20% Anxiety 20% Vomiting 17. 1% • • • 34 y. o. veteran presented with profound psychosis following recent initiation of heavy, daily mj wax use Incoherent speech and odd behaviors, appeared to be in a dream like state about his combat experience Given 4 mg risperidone, condition persisted Condition improved on day 8 of hospitalization Demonstrates the potential psychotropic effects that mj wax • A case of butane hash oil (marijuana wax)-induced psychosis • Cardiovascular complication of Marijuana and Related Substances: A Review • Acute Coronary Syndrome- risk of acute myocardial infarction (heart attack) increases 5 x w/in 1 hr of exposure • Cerebrovascular Disease-ischemic stroke is the most commonly reported adverse cardiovascular effect • Sudden Cardia Death-ventricular arrhythmia following cannabis use may result in dizziness, temp unconsciousness, cardiac arrest, or sudden death • Death by self-mutilation after oral cannabis consumption • 35 y. o. man presented with behavioral disturbances of sudden onset after oral cannabis use with major selfmutilation (attempted amputation of right arm, self-enucleation of both eyes, and impalement) which resulted in death • Cannabis resin found in his home tested for “high” levels of THC (31 -35%) • Femoral blood- THC 13. 5 ng/m. L, 11 -OH-THC 4. 1 ng/m. L, THC-COOH 14. 7 ng/m. L • Hair tested was consistent with chronic users

But these situations are only happening in states that have legalized marijuana….

Baton Rouge The incident occurred in April 2018 and involved two (2) females, a 22 year old and her 16 year old sister, who had ate "cereal bars" after the 22 year old had ordered them off the internet and/or an Instagram site. The packaged was sent from Lutz, Florida, which is approx. 15 -20 miles outside of Tampa, Florida. The 22 year old's actions that were observed by Officers at the residence: she was standing in the living room, waving back and forth at the Officer when he walked inside. She then randomly and repeatedly started saying that she wanted to have sex (to put it clean and professional), then repeatedly kept asking the Officer on scene and responding Fire Dept. personnel if they wanted to have sex. She then went and sat still on the couch and never moved her upper body, only moving her head side to side and not speaking and/or unable to talk. The 16 year old's actions that were observed by Officers at the residence: she was sitting on the sofa crying with EMS and Fire Dept. personnel attempting to calm her down for several minutes. When her 22 year old sister came and sat down on the couch, the 16 year old then got up and went and laid down in a corner in the living room in a fetal position and continued to cry. EMS was finally able to calm both subjects down and transport them to OLOL Hospital for further evaluation and/or treatment.

Crime Rates Up - 20% Increase Violent Crime 2012 -2017

Myth #6 It’s all regulated and tested for safety

A 2015 study of marijuana products determined: • 17% had accurate THC potency (within +/- 10% • 23% had underlabeled THC potency (greater than 10% more) • 60% had overlabeled THC potency (greater than 10% less)

10/4/2019 -Associated Press out of Los Angeles reports that: • “Dank” vapes have been confirmed to be an illegal company linked to the mysterious lung illnesses. • The empty Dank boxes and cartridges are purchased on line, filled by anyone with any drug and used to lure customers. • The brand is not legal and not tested. • They sell for about $20 after filled about 1/3 of what a legit cartridge sells for. • Thousands of empty and filled Dank cartridges have been seized by LE nation wide in illegal vape-cartridge operations.

9/27/2019 Seeking answers, NBC News commissioned one of the nation's leading cannabis testing facilities to test a sampling of THC cartridges — 18 in all — obtained from legal dispensaries and unlicensed dealers. The findings were deeply troubling. Of the three purchased from legal dispensaries in California, the Canna. Safe testing company found no heavy metals, pesticides or residual solvents like Vitamin E. But 13 out of the other 15 samples from black market THC cartridges were found to contain Vitamin E. Canna. Safe also tested 10 of the unregulated cartridges for pesticides. All 10 tested positive. The products all contained myclobutanil, a fungicide that can transform into hydrogen cyanide when burned. Guess what brands were on their list?

September 2019 - Minnesota official announce seizure of 75 k THC vaping cartridges believed to be from out of state. New Hope, Minn. Nearly 77, 000 illegal vaping cartridges seized from a home in Minnesota in what authorities said was the largest haul in state’s history. Street value up to $3. 8 million Guess what illegal THC growers and business don’t do? PAY TAXES!! Guess where most of the extraction “lab” are located? In neighborhoods!

April 2019 – New York Times Reports: ‘Getting Worse, Not Better’: Illegal Pot Market Booming in California Despite Legalization COSTA MESA, Calif. — In the forests of Northern California, raids by law enforcement officials continue to uncover illicit marijuana farms. In Southern California, hundreds of illegal delivery services and pot dispensaries, some of them registered as churches, serve a steady stream of customers. And in Mendocino County, north of San Francisco, the sheriff’s office recently raided an illegal cannabis production facility that was processing 500 pounds of marijuana a day. California gives cities wide latitude to regulate cannabis, resulting in a confusing patchwork of regulation. Los Angeles, San Francisco, San Jose and San Diego have laws allowing cannabis businesses, but most smaller cities and towns in the state do not — 80 percent of California’s nearly 500 municipalities do not allow retail marijuana businesses.

Myth #7 It’s ok to drive because I have a prescription

The warnings on prescription bottles are there for a reason! October 2011: Prescription Medication Usage and Crash Culpability in a Population of Injured Drivers by Patricia Dischinger, Jingyi Li, Gordon S. Smith, Shiu Ho, Kimberly Auman, and Dawn Shojai A study by the Association for the Advancement of Automotive Medicine found that 50 percent of drivers took at least one prescription drug in the past week. With an increasingly aging population and prevalence of prescription medications, medical professionals and researchers are paying much more attention to the hidden dangers. When two or more such drugs are reported, the odds ratio for having caused the crash was almost 8 times that for drivers on fewer or no drugs, among the oldest drivers (45+). This project’s culpability analyses indicate that 2 or more CNS-acting drugs do increase the likelihood of the driver being culpable for the crash.

Prescription Drugs Give Drivers a False Sense of Security Many drivers disregard or are oblivious to the dangers. Patients cocoon themselves into assuming that if their doctors prescribe those medications, they must be safe, because they’re not illicit street drugs or alcohol, or because their doctor didn’t warn them. Make no mistake: Many prescription medications impair the critical eye-hand coordination and cognitive abilities that are crucially needed for safe driving, such as: • Motor skills • Balance • Coordination • Spatial orientation • Reaction time How Do Prescription Drugs Affect Driving? Although the same drug may affect people differently (depending on height, weight, sex, and metabolism), common effects may include: • Drowsiness • Reduced reaction times • Aggressive or reckless driving Even over-the-counter cold medicines can turn someone into a sleepy and dangerous driver.

July 2010 - New York Times: “Drivers on Prescription Drugs are Hard to Convict” The accident that killed Kathryn Underdown had all the markings of a drunken-driving case. The car that hit her as she rode her bicycle one May evening in Miller Place, N. Y. , did not stop, the police said, until it crashed into another vehicle farther down the road. The driver could not keep her eyes open during an interview with investigators, according to the complaint against her, and her speech was slow and slurred. But the driver told the police that she had not been drinking; instead, the complaint said, she had taken several prescription medications, including a sedative and a muscle relaxant. A former doctor on prescription drugs killed two people in a crash in Wisconsin in April 2008. She was charged with vehicular manslaughter and driving under the influence of drugs — an increasingly common offense, law enforcement officials say, at a time when drunken-driving deaths are dropping and when prescriptions for narcotic painkillers, antianxiety medications, sleep aids and other powerful drugs are rampant.

Thank You Rachel Smith Traffic Safety Resource Prosecutor Louisiana District Attorneys Association Office – 225 -343 -0171 Cell – 225 -202 -5790 Rachel@ldaa. org