Traffic issue

Road traffic crashes (RTC) lead to approximately 1.3 million deaths and 20–50 million injuries worldwide annually. Human factors (e.g. speeding and other unsafe driving maneuvers, driving while impaired with alcohol or drugs, driver error, distraction, fatigue, neglect of seat belt use) play a contributing role in up to 95% of RTC. This chapter focuses on current efforts to reduce this significant burden on global health with respect to one particularly lethal contributor to RTC, driving while impaired with alcohol and/or drugs (DWI).

DWI is implicated in from 20 to 40% of all RTC. Among the many psychoactive substances that can impair safe driving ability, alcohol is the one most often detected in DWI-related traffic events. Compared to 0.0 g alcohol/dl blood concentration (i.e. BAC = 0.0%), RTC risk is 4–10 times higher at BAC between 0.05 and 0.07%. Accordingly, the criminal statutory limits for DWI and the administrative thresholds that trigger more severe relicensing sanctions are most frequently set at BAC of 0.05–0.08% and 0.02–0.05%, respectively.

The diversity of licit and illicit drugs with varying degrees of potency, purity, and performance- impairing properties, in addition to their potential synergistic effects when combined with alcohol and/or other substances, makes defining impairment and hence detection and prosecution of drug-impaired drivers an ongoing challenge. As a result, many jurisdictions have adopted per se laws whereby detection of any illicit drugs in the organism when driving is grounds for a conviction. In addition, courts increasingly recognize a detection of drug-impaired driving executed by Drug Recognition Experts using a highly structured roadside behavioral assessment. These and other measures for dealing with DWI with drugs are receiving growing attention from road traffic administrators and researchers.

DWI is a tenacious problem. Large-scale international efforts to curtail DWI, after realizing significant progress over the past few decades, have stalled since the 1990s, with some jurisdictions more recently showing a slight uptick. Unfortunately, a first conviction for DWI fails to deter many drivers from continuing to commit DWI. Approximately 20% of female and 38% of male DWI first-time offenders are reconvicted within 5 years of their conviction. The transition from first time to repeat offender status (i.e. recidivism) is accompanied by heightened risk, as recidivists contribute disproportionately to traffic-related morbidity compared to other driver groups. Overall, stabilization in the epidemiology of DWI and the risks associated with recidivism make effective prevention and intervention efforts vital to reduce the health burden of DWI.

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