Data Necessary to Develop a Sentinel Surveillance System for Drug Use by Drivers in Crashes: A Review of the Existing Landscape

Abstract

Introduction

Impaired driving continues to be a significant source of injury, death and financial burden on society. Alcohol-impaired driving alone accounted for nearly 11,000 traffic deaths in 2017 (NCSA, 2018). Drugs other than alcohol are also believed to play a substantial role in crashes, injuries and deaths. However, the magnitude of their role is less well understood due to data limitations stemming from a number of barriers to the collection and analysis of this information. Drug testing requires complex, expensive equipment which is not as readily available as breathalyzer equipment used for alcohol impairment testing. Furthermore, even when drivers are tested for drugs, the quality of the information about the kinds of tests performed and the results of those tests is often inadequate for meaningful analysis. But gathering data on impairment from substances besides alcohol is critical to understanding their role in motor vehicle crashes and developing effect countermeasures to prevent injuries and deaths. One possible solution is to develop a sentinel surveillance system. Sentinel surveillance systems facilitate our understanding of potential public health concerns by monitoring threats through the compilation and processing of high quality data from a network of prearranged reporting sites (Nsubuga, et al., 2006).

The objectives of the project reported here were to: (1) identify existing sources of data that can be used to monitor and identify trends in drugs used by drivers involved in crashes on an ongoing basis; (2) establish mechanisms to access and use those data for research purposes; and, (3) to assess the feasibility of developing a sentinel surveillance system to monitor the involvement of non-alcohol drugs in motor vehicle crashes.

Key Findings

• Several emerging issues such as opioid epidemic, rapidly shifting cannabis-legalization climate and the large number of individuals using prescription and over-the-counter drugs accentuate the need for improved data on the prevalence of drugs in drivers
• After consulting existing literature, research resources show that trauma centers are strong candidates for inclusion in a sentinel surveillance system

Methodology

This project took a systematic three-stage approach. The first stage included subject matter expert interviews and a literature review to develop background on potential data sources for a sentinel surveillance system. This involved meetings with state officials and database administrators to get a broad overview of the availability and accessibility of data relevant to the project goals. It also incorporated a thorough review of the literature associated with the use of these databases and a look at previous efforts to link data to create similar public health surveillance systems.

Next, researchers narrowed the evaluation to specific surveillance system approaches. This involved more in-depth discussions with state officials and database administrators to add to what was learned in stage one by focusing on the pros and cons associated with each data source. Thus, while the first stage focused on what data was available, the second stage focused on the best data to include in the sentinel surveillance system.

Finally, the information obtained in stage one and two led to a discussion of how the system would be created based on feasible approaches.

Results

Several emerging issues accentuate the need for improved data on the prevalence of drugs in drivers. These issues include the opioid epidemic, rapidly shifting cannabis-legalization climate and the large number of individuals using prescription and over-the-counter drugs. This type of public health information would not only provide invaluable insight into the increasing impact of various drugs and drug combinations, but would also facilitate the monitoring of changing drug trends in drivers. In addition, these data are critical for developing effective drugged driving countermeasures and deploying limited resources to address impaired driving.

Accurate and representative data related to drugged driving simply do not exist. This lack of reliable data is mostly driven by the cost and complexity of conducting non-alcohol drug testing. There is no “breathalyzer” for drugs other than alcohol. Non-alcohol drug testing most often involves the collection of blood, urine or oral fluid. These techniques can be invasive and require collection from a trained individual. Furthermore, the testing of non-alcohol drugs requires relatively expensive equipment and trained professionals to run these tests. The result of these challenges is that drug testing is rarely performed and, when it is performed, there is tremendous variance in testing procedures and capabilities. Specifically, there are large inconsistencies in drug testing in and procedures across the numerous facilities that perform toxicological testing on drivers.

Given the great importance of drugged driving information to public safety and the inability of existing data to provide this information, the creation of a new sentinel surveillance system is needed to fill this critical public safety gap.