Annex 2: Annotated Bibliography

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Impaired Driving Annotated Bibliography

Citation

Beirness, D.J. et al. (2021). Cannabis, alcohol and other drug findings in fatally injured drivers in Ontario. Traffic Injury Prevention, 22(1), 1-6.

Purpose

This article examines the prevalence of cannabis, alcohol and other drug use in Ontario drivers who died in crashes between January 2016 to December 2018.

Methodology

Researchers examined toxological results from the blood samples of 921 fatally injured drivers submitted to the Center of Forensic Sciences for analysis. The sample represents 86.7% of driver fatalities in Ontario over the time period.

Findings

• Males outnumbered females 4 to 1 among the sample of fatally injured drivers.
• Over half of driver fatalities tested positive for alcohol and/or drugs (53.7%).
• The most common substances detected were THC (27%) and alcohol (26%).
• The authors highlight the higher proportion of drivers positive for THC than alcohol as well as the notable proportion of fatalities testing positive for multi-substance use. The crash and driver characteristics differ between alcohol and drug-impaired fatalities, suggesting differing approaches are required for prevention.
• Findings highlight the need for greater attention and research on cannabis and other drug use among drivers.

Citation

Fell, J. (2019). Approaches for reducing alcohol-impaired driving: Evidence-based legislation, law enforcement strategies, sanctions, and alcohol-control policies. Forensic Science Review, 31(2), 161–184.

Purpose

The purpose of this article is to provide a summary of the current research regarding the policies and programs created to help minimize the number of impaired driving highway accidents.

Methodology

Researchers examined what current policies and programs offer effective ways to reduce impaired driving incidents.

Findings

• The most impactful way to reduce impaired driving is to have checkpoints and random breath testing that are “highly publicized, visible, and frequent”
• Globally, “lowering the legal blood alcohol concentration (BAC) limits for driving to 0.05 g/dL” has shown to have a positive effect in lowering impaired driving accidents
• In the US and other countries, making the legal drinking age older (increasing) has shown to help reduce the amount of fatal impaired driving incidents resulting in death
• for those who have been involved in impaired driving incidents, special Driving Under the influence/Driving While Intoxicated courts, programs which offer mandatory alcohol-monitoring check-ins consistently, and “mandatory alcohol ignition interlocks” are all injunctions/measures which have shown to lower recidivism rates in impaired-driving accidents.

Citation

Yost, G. (2020). Evidential breath testing for alcohol, Parliament, the science and the courts (Part 2). Canadian Society of Forensic Science Journal, 53(2), 83–94.

Purpose

As follow-up to Yost’s first article, this report focuses on the parliamentary response leading up to the Supreme Court of Canada’s decision in 2018 regarding impaired driving records.

Methodology

This article looks at the legal, scientific, and government’s responses to previous impaired driving records and current changes being made.

Findings

• In 2008, the “two-beer” defence was eliminated as it has shown to not be safe in minimizing impaired driving accidents
• In 2018, the laws changed regarding BAC and the need for proof using breath testing was put in place
• On December 18, 2018, Bill C-46 came fully into force. Part VIII.1 replaced all previous provisions regarding transportation offences.
• This new part now accounts for “per se drug driving offences, authorizes roadside screening for drugs, harmonizes penalties and prohibitions, simplifies prosecution of drug-impaired driving offences, authorizes mandatory screening for alcohol at roadside, sets out new rules for proving BAC, and establishes rules for disclosure.”
• “The new Part therefore makes BAC at the time of testing conclusively proven if, for the two tests of the driver, the system blank tests gave a BAC of no more than 10, the calibration checks were within 10% of the target value, there were at least 15 min between the two tests and the BACs produced by the tests were within 20 of each other.”

Citation

Solomon, R., MacLeod, L. & Dumschat, E. (2020). The shifting focus of Canadian impaired driving enforcement: The increased role of provincial and territorial administrative sanctions. Canadian Criminal Law Review, 25(1), 25–58.

Purpose

This report looks at the increasing role that licence suspensions and vehicle impoundments play in enforcing impaired driving laws and sanctions.

Methodology

Researchers examined current impacts of Administrative Licence Suspension (ALS) and Administrative Vehicle Impoundments (AVI) and their relationship with deterring impaired driving. A literature review was also conducted.

Findings

• The courts have recognized that the provinces have autonomy to authorize and establish their own impairment-related administrative sanctions. Provinces have increasingly moved in this direction to ensure swift removal of potentially unsafe drivers who pose a risk of impaired driving, as well as to limit those convicted of impaired driving related charges.
• The article offered various recommended practices, namely that ALSs and AVIs should be broken down into three categories for implementation:
  • mandatory 24-hour ALSs and discretionary 24-hour AVIs
    • police should use to get those suspected of being impaired (alcohol or drugs) off of the roads
  • mandatory seven-day ALSs and mandatory seven-day AVIs
    • alcohol
      • used for anyone who shows a BAC of .05% to .079% or fails a field sobriety test
      drugs
      • used for anyone who fails an oral fluid test or a field sobriety test
      • mandatory 90-day ALSs and mandatory 30-day AVIs
        • used for anyone who fails with a BAC of .08% or more on an ASD

Citation

Train, A., & Snow, D. (2019). Cannabis policy diffusion in Ontario and New Brunswick: Coercion, learning, and replication. Canadian Public Administration, 62(4), 549–572.

Purpose

Policy diffusion refers to the interdependent nature of the policymaking process, through which policy decisions made by one government affect policymaking in other governments. This study examines the factors that affected the diffusion of recreational cannabis policy in Canada, speficically focused on two provinces, Ontario and New Brunswick.

Methodology

The authors analysed committee hearings, Hansard debates, and federal and provincial government reports to assess what mechanisms facilitated the diffusion of cannabis policy from the federal government (and other jurisdictions) to Ontario and New Brunswick.

Findings

• Using the social learning framework developed by Hall (1993), the factors identified as most important in the diffusion of cannabis policy to Ontario and New Brunswick were “coercion”, which is when a more powerful or influential jurisdiction encourages and/or incentivises another jurisdiction to adopt a policy; and “learning” which is when governments use the successes or failures from other jurisdictions as guidance. The authors also found these provinces replicated comparable policies (such as those for alcohol and tobacco) from their own jurisdiction.
• The authors highlighted that “the framework for cannabis legalization was driven entirely at the federal level.” Though for provincial governments the possible variations in policy were regarding “place of use, retail, distribution, workplace safety, and minimum age”, although the minimum age could not be less than 18 years of age.

Citation

Lancione, S., Wade, K., Windle, S., Filion, K., Thombs, B., & Eisenberg, M. (2020). Non-medical cannabis in North America: an overview of regulatory approaches. Public Health (London), 178, 7–14.

Purpose

The purpose of this study was to look at the current regulations regarding non-medical cannabis legalization in North America in order to better enforce future policy.

Methodology

In June 2019, researchers conducted an internet search for available published public health resources (since January 1, 2012).

Findings

• Bill C-46 has put in place impaired driving penalties for drivers who exceed threshold limits for THC (2e5 ng/mL and >5 ng/mL), and for those with alcohol also present in their systems (>2.5 ng/mL THC with blood alcohol concentration >0.5).
• Police are also now permitted to do roadside impairment tests (a saliva test for THC and other substances) – if a driver fails a field sobriety test or a saliva test, police can also request a blood sample.
• One concern that presented itself was that in those with a high tolerance for THC who use frequently, they may not show signs of impairment whereas someone who does not use cannabis frequently may be significantly impaired.

Citation

Wigmore, J. (2020). Mandatory breath alcohol screening in Canada - No more “Reasonable Suspicion.” Forensic Science Review, 32(1), 6–7.

Purpose

The purpose of this article was to examine the new Bill C-46 and Mandatory Alcohol Screening (MAS).

Methodology

A review of (former) Bill C-46 and literature/laws regarding MAS was conducted.

Findings

• Under Bill C-46, MAS does not require reasonable suspicion, however, it does require “the vehicle to be stopped lawfully, the driver to be in care and control of the vehicle, and the police must have the approved screening device close at hand”.
• This mandatory screening is only approved at roadside stops.
• MAS has been shown to demonstrate a decrease in the number of impaired drivers and an increase in stopping/catching those driving impaired.
• Media has highlighted mandatory screening as an infringement on individual rights and freedoms as seen in various news stories/articles (page 7).

Citation

Windle, S., Sequeira, C., Filion, K., Thombs, B., Reynier, P., Grad, R., Ells, C., & Eisenberg, M. (2021). Impaired driving and legalization of recreational cannabis. Canadian Medical Association Journal (CMAJ), 193(14), E481–E485.

Purpose

The purpose of this article is to examine the relationship between the legalization of recreational cannabis and fatal accident rates (motor vehicles).

Methodology

An examination and review of statistics and literature was conducted.

Findings

• Although the legalization of cannabis is projected to account for a small increase in fatal motor vehicle collisions, the increase is still considered significant as it will also account for thousands of injuries from non-fatal accidents while using cannabis recreationally.
• THC threshold driving limits, as well as good public awareness are thought to help decrease the amount of impaired motor vehicle collisions.
• Public awareness and education provided by health care professionals will play a crucial role in the minimization of collisions both fatal and non-fatal.

Citation

Solomon, R. & Chamberlain, E. (2018). The road to traffic safety: Mandatory breath screening and Bill C-46. Canadian Criminal Law Review, 23(1), 1–42.

Purpose

The purpose of this article is to examine and discuss mandatory alcohol screening with the implementation of the new Bill C-46

Methodology

A review of current laws and literature was conducted.

Findings

• In order for a comprehensive mandatory alcohol screening program to be successful, many more drivers will have to be stopped, as well as have their breath screened.
• Mandatory alcohol screening globally has been shown to minimize the risk of fatal impaired driving accidents, injuries from non fatal impaired collisions, and overall percentages of the population engaging in impaired driving.
• MAS programs should be “well-publicized” and promoted politically.

Citation

Brubacher, J., Chan, H., Erdelyi, S., Zed, P., Staples, J., & Etminan, M. (2021). Medications and risk of motor vehicle collision responsibility in British Columbia, Canada: a population-based case-control study. The Lancet. Public Health.

Purpose

This was a study examining the risk of collision while taking various medications.

Methodology

Researchers reviewed “linked driving and health records in British Columbia, Canada from Jan 1, 1997, to Dec 31, 2016.” Participants were drivers involved in an “incident collision” resulting in a police report. Risk factors for collisions were then compared across various medications the drivers were taking (new vs past users).

Findings

• The highest risk of collision was associated with the use of cholinergic drugs, anticholinergic agents for Parkinson’s disease, dopaminergic agents, and anticonvulsants.
• Current drivers who were prescribed benzodiazepines/high-potency opioids were deemed a higher risk of being responsible for accidents/collisions.

Citation

Herrera-Gómez, F., García-Mingo, M., Colás, M., González-Luque, J., & Álvarez, F. (2018). Opioids in oral fluid of Spanish drivers. Drug and Alcohol Dependence, 187, 35–39.

Purpose

The purpose of this study was to examine the “presence and concentration” of opioids in Spanish drivers, with the combined use of other drugs.

Methodology

Mandatory roadside breath screening and oral fluid screening took place in Spain and the results were then examined to find links between specific drugs and their combined use in drivers.

Findings

• Opioids were confirmed in 8.6% of positive cases, notably 7.2% were positives to 6-acetylmorphine (6-AM), 6.5% to morphine, 5.4% to codeine, and 4.1% to methadone. The majority of the confirmed tests for morphine (96.5%), codeine (88.4%) and methadone (81.9) were also positive for 6-AM.
• Cocaine and cannabis were also commonly seen as being used in conjunction with opioids.
• Drivers who were stopped and tested positively for morphine, codeine, and methadone had a higher likelihood for also testing positive for heroin, THC, cocaine, and other elicit drugs.

Citation

Herrera-Gómez, F., García-Mingo, M., & Álvarez, F. (2020). Prevalence of alcohol and other psychoactive substances in motor vehicle drivers in Spain, 2018: Cross-sectional dataset analysis with studies from 2008 and 2013. Forensic Science International, 313, 110266–110266.

Purpose

The purpose of this report is to examine frequency/presence of positive breath tests for alcohol and psychoactive substances in Spanish drivers.

Methodology

Roadside positive test reports were reviewed for the years 2008, 2013, and 2018.

Findings

• 2008 reports has more positive cases for alcohol presence/drug use than those in 2013 and 2018.
• Reports showed that impaired driving occurred more frequently when using cannabis than alcohol.
• The occurrence of drivers using various drugs (multiple positive tests for different drugs) without the presence of alcohol was more prevalent in 2018 than in 2008.
• The presence of mandatory screening decreased the amount of impaired drivers using drugs.

Citation

Solomon, R., MacLeod, L., & Dumschat, E. (2020). The increasing role of provincial administrative sanctions in Canadian impaired driving enforcement. Traffic Injury Prevention, 21(5), 298–302.

Purpose

The purpose of this article is to record the changes taking place in Canada in regards to the shift in impaired driving enforcement, as well as the deterrent impact of these implementations.

Methodology

Looking at license suspensions (ALS) and vehicle impoundments (AVI), this paper offers a comprehensive examination of their deterring impacts on impaired driving.

Findings

• In both British Columbia and Alberta, roadside screening and ALS/AVI sanctions have shown to be beneficial in deterring and eliminating impaired driving within the provinces.
• Monetary penalties and license-reinstatement fees have also shown to be beneficial in deterring impaired driving.

Citation

Wadsworth, E., & Hammond, D. (2019). International differences in patterns of cannabis use among youth: Prevalence, perceptions of harm, and driving under the influence in Canada, England & United States. Addictive Behaviors, 90, 171–175.

Purpose

The purpose of this study was to look at trends in cannabis use by youths in Canada, England, and the United States.

Methodology

Researchers conducted an online study in July of 2017 of youths aged 16-19. The survey consisted of questions regarding their cannabis use, their understanding of the harms associated with cannabis use, accessibility to cannabis, and driving under the influence of cannabis.

Findings

• Survey data showed that youth from the US reported higher rates of consumption, and driving following cannabis use, and lower rates of perceived harm than youth from both England and Canada.
• Canadian youth data reported having easier access to cannabis, more frequent rates of driving after using, and higher usage rates than youth in England.
• Overall, both American and Canadian data showed higher rates of consumption, driving after consumption, and having easier accessibility to cannabis than the data from youth in England.
• Researchers considered more lenient policy in the US and Canada in comparison to that in England as a potential explanation of the data trends found.

Citation

Masud, M., Chan, H., Erdelyi, S., Yuan, Y., & Brubacher, J. (2020). Epidemiology of drug driving: protocol from a national Canadian study measuring levels of cannabis, alcohol and other substances in injured drivers. BMC Public Health, 20(1), 1070–1070.

Purpose

The purpose of this article was to examine current limitations, which exist in current research regarding the regulation of impaired driving (“drug driving”).

Methodology

In this study, researchers used “left-over” samples of blood that were taken from injured drivers who were involved in non-fatal collisions. This blood was collected from emergency departments following the collisions. Consent was obtained in order to proceed with toxicology.

Findings

• By using blood samples, rather than saliva or urine samples, toxicology was able to show stronger correlations with drug impairment.
• Blood samples offer better results than roadside impairments tests as they are able to show more accurate perceptions of probable impairment.
• By using blood sample that were taken shortly after the collisions took place, the results from toxicology are more accurate “approximate drug levels at time of the crash”.

Citation

Porath, A., & Beirness, D. (2019). Predicting categories of drugs used by suspected drug-impaired drivers using the Drug Evaluation and Classification Program tests. Traffic Injury Prevention, 20(3), 255–263.

Purpose

Researchers conducted this study in order to understand the best way(s) to predict what drugs the impaired driver may be under the influence, using known symptoms of drug impairment from the Drug Evaluation and Classification (DEC).

Methodology

Researchers examined 1512 DEC evaluations of drivers suspected of being impaired, who had “ingested central nervous system (CNS) depressants, CNS stimulants, narcotic analgesics, and cannabis.” Evaluations were also completed on a set of participants who were “drug-free.” “Clinical, behavioural, and observational measures”, which predict possible impairment and can indicate the category of drugs one may be under the influence of.

Findings

• Researchers found 13 indicators that were predictive of the “drug category”:
  • “being under the care of a doctor or dentist, condition of the eyes, condition of the eyelids, mean pulse rate, assessment of horizontal gaze nystagmus (HGN), convergence, performance on the One Leg Stand (OLS) Test, eyelid tremors, pupil size in darkness, reaction to light, presence of visible injection sites, systolic blood pressure, and muscle tone”
• The indicator with the largest impact on drug category prediction was “appearance and physiological response of the eye”.

Citation

Brubacher, J., Chan, H., & Staples, J. (2020). Cannabis-impaired driving and Canadian youth. Paediatrics & Child Health, 25(Supplement_1), S21–S25

Purpose

The purpose of this article was to examine and explain why cannabis may have more severe impacts of impaired driving on those who are younger and inexperienced with cannabis use.

Methodology

A literature review was conducted.

Findings

• “Cannabis impairs the psychomotor skills required for safe driving.”
  • Although cannabis is known for its relaxing/euphoric effect, people’s experiences with cannabis are unique and many experience anxiety/paranoia.
  • Driving simulators have shown that those impaired by cannabis are seen to “weave” in and out of traffic more than those who are not impaired. Cannabis also affects “attention, coordination, and reaction time”. Those impaired also struggled with maintaining their speed/the speed limit.
• “Combined use of cannabis with alcohol is very dangerous.”
  • Impairment by both alcohol and cannabis combined has shown to be more dangerous and cause more serious impairment than cannabis or alcohol alone.
  • The combination of substances has also shown an increased risk for crashing/collisions.

Citation

Brubacher, J., Chan, H., Erdelyi, S., Macdonald, S., Asbridge, M., Mann, R., Eppler, J., Lund, A., MacPherson, A., Martz, W., Schreiber, W., Brant, R., & Purssell, R. (2019). Cannabis use as a risk factor for causing motor vehicle crashes: a prospective study. Addiction (Abingdon, England), 114(9), 1616–1626.

Purpose

This study was conducted to examine whether drivers who test positive for THC (or other drugs) at a collision contribute more than those who test negative.

Methodology

Participants were people who needed blood tests following a collision; blood was tested for THC, alcohol, or other drugs. The positive/negative tests were then compared to see if those who tested positive where more likely to have been deemed “responsible” for the collision or “non-responsible.”

Findings

• Of the non-fatal injured drivers, those who tested THC < 5ng/mL did not show any evidence for increased responsibility in the collision
  • However, those who tested THC > 5ng/mL did show some evidence for having increased risk of responsibility for the collision
• It was also found that driving impairment from alcohol or other impairing substances have higher risk factors for roadside collisions than impairment from THC

Citation

Watson, T., Mann, R., Wickens, C., & Brands, B. (2019). Deterring driving under the influence of cannabis: Knowledge and beliefs of drivers in a remedial program. Canadian Journal of Criminology and Criminal Justice, 61(3), 1–20.

Purpose

The purpose of the article was to review literature and previous studies conducted in order to inform the efficacy of remedial programs for driving under the influence of cannabis.

Methodology

A study was conducted using participants in a remedial program for “drink-driving” as well as literature review.

Findings

• Road-side driving under the influence of cannabis (DUIC) check-points have shown to have the greatest deterring effects for driving under the influence.
• Participants voiced concern regarding THC roadside drug testing as those who use cannabis more frequently may have a higher tolerance than those who do not – therefore they may test positive for THC levels of the legal limit, but may not be impaired.

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