Drug-impaired driving demands police, legislative and community attention because of the harms it may cause. Many of the problems associated with drug-impaired driving are similar to those associated with drunk driving. However, recent evidence suggests that the prevalence of drug-impaired driving may be equal to, or perhaps higher than, that of drunk driving.1 And although the general trend of driving under the influence of alcohol has been declining in recent years in many countries, thanks, in large part, to broader and persistent attention to this problem, drug-impaired driving specifically linked to traffic fatalities appears to be rising.2 To date, however, a historical focus on drunk driving has somewhat limited law enforcement and policy attention on drug-impaired driving.
Drug-impaired driving is just one aspect of the larger set of problems related to drug use and impaired driving. This guide is limited to addressing the particular harms associated with drug-impaired driving. Related problems not directly addressed in this guide, each of which requires separate analysis, include the following:
Some of these related problems are covered in other guides in this series, all of which are listed at the end of this guide. For the most up-to-date listing of current and future guides, see www.popcenter.org.
Drug-impaired driving - which generally refers to a driver operating a vehicle while having a measurable quantity of a drug (legal or illegal) in the body that impairs driving performance - is a major road and safety concern in many countries, according to a wide variety of sources. In 2009 in the United States, about 4 percent of drivers (or 10.5 million) were drug impaired while driving.3 Among high school seniors, drug-impaired (specifically, marijuana-impaired) driving rates may be higher (about 14 percent from 2001 to 2006) than those of the general population.4 Roadside surveys of drivers’ oral fluid and blood samples reveal that among all weekend nighttime drivers, over 16 percent tested positive for illegal, prescription, or over-the-counter drugs, any of which could impair driving.5 Estimates of the prevalence of drug-impaired driving across different countries - including Australia,6 Germany.7 Canada,8 and New Zealand,9 among others - vary considerably. Regardless of the rate, the problem merits police attention, given the potential harms.
According to a number of studies, young males between the ages of 17 and 24 are at the highest risk for drug-impaired driving offending and victimization,10 although female involvement is increasing.11 Among high school seniors, drug-impaired driving occurs across multiple demographic groups, although lifestyle factors tend to play a stronger role in predicting such driving.12 Persistent offenses of drug-impaired driving among males have been linked to marijuana dependence; early traffic violations, nontraffic violations and convictions before age 18; and personality characteristics such as a weaker ability to control one’s behavior, to avoid harm, and to respect tradition during the offending driver’s teens.13 In Finland, drugged driving is associated with low education and high unemployment, receiving disability pensions, and higher rates of divorce or living alone.14 Given the varying ways in which these studies have been conducted, there is good reason to believe that many drug-impaired drivers are never detected.
Driving under the influence of marijuana - the most commonly used illicit drug - may actually be more common than driving under the influence of alcohol in some countries.15 Some marijuana users perceive marijuana to be a safe drug to use before driving and thus indicate that changes in laws may not influence their future decisions to continue using marijuana before driving.16 These perceptions are particularly troubling given the decriminalization and the changes in medical-marijuana laws that are occurring, or that have already occurred, in the United States and elsewhere. Indeed, driving under the influence of marijuana increases the risk of being involved in motor vehicle crashes.17 However, the drug-impaired driving problem extends well beyond the use of marijuana and includes the use of a wide variety of legal drugs (including those prescribed and those obtained over the counter) and illegal drugs - which include stimulants, depressants, antidepressants, narcotics, hallucinogens, sleeping pills, and other intoxicating substances.18
Drug-impaired driving can damage communities in a number of ways, many of which are similar to the harms associated with drunk driving.†These harms can include the following:
† See Problem-Specific Guide No. 36, Drunk Driving, for further information.
Understanding the factors that contribute to your problem will help you frame your own local analysis questions, determine good effectiveness measures, recognize key intervention points, and select appropriate responses.
Jurisdictions with significant local drug market activity likely have correspondingly high drug-impaired driving problems, notwithstanding the availability of mass transportation or the proximity of users to illicit markets. To the extent that drugs, including prescription drugs, are readily available and easily obtainable, whether through illicit markets on or off the street, through legitimate or illegitimate (usually recreational) prescription markets or through other means (e.g., Internet-based purchasing, nightclub transactions, concert distribution, discreet markets, and medical marijuana outlets), the risk of increased drug-impaired driving is higher when and where drugs are readily available. Certain drugs or drug categories may be more risky than others,25 although a number of factors affect the level of impairment, including dosage, frequency of use, and use of other substances.
Open-air drive-by drug markets (those to which users drive up and purchase drugs without getting out of their cars) are of particular concern because potential users are already in vehicles as drugs are being purchased, and those buyers may return for additional drugs within a matter of minutes or hours, depending on the particular substance. In addition, jurisdictions that have difficulty controlling access to legal prescriptions or that have particularly high rates of prescription drug use within their populations (e.g., jurisdictions that mainly include elderly persons or that include large groups of mentally ill patients who are medicated) might create substantial public safety challenges. Finally, jurisdictions with relaxed drug laws (e.g., allowing the use of medical marijuana or decriminalizing the use of marijuana) might also have higher rates of drug-impaired driving.
Image1: Drive-by drug purchases, such as the one pictured here, are of particular concern as users are already in vehicles.
Drug use can affect users’ perceptions of the risks associated with substance use, can alter decisions and influence behaviors and can decrease user concerns with apprehension. Despite evidence to the contrary, some marijuana users26 and users of other drugs27 perceive minimal risk associated with driving following substance use, and perceptions of risk seem to vary across different drugs and drug use patterns.28 As a result, some drug users are more likely and more willing to drive while impaired, and their willingness to do so can affect other drug users, who may then be inclined to drive following their own drug use at some point in the future. To the extent that drug-impaired drivers successfully make it to their destinations and avoid being apprehended by police, their willingness to continue to use drugs while driving increases risks for other drivers as well.
Using multiple drugs simultaneously or using drugs in combination with alcohol significantly impedes driving performance,29 which is a particularly important concern in situations or places where alcohol and drugs are readily available and consumed simultaneously (such as nightclubs, parties, raves, and concerts). For example, nightclub attendees in Australia reported both recent drug use and a likelihood of driving home with someone who is drug impaired and, possibly alcohol impaired as well.30 Although some rave attendees have reported higher levels of concern with impaired drivers,31 young people, in particular, are willing to accept rides from drugged drivers.32 In addition, a prior experience of driving while drug impaired increases the likelihood of doing so again; it also increases the chances of accepting rides with others who are drug impaired.33
The information provided above is only a generalized description of drug-impaired driving. You must combine the basic facts with a more specific understanding of your local problem. Analyzing the local problem carefully will help you design a more effective response strategy.
In addition to criminal justice agencies, the following groups have an interest in the drug-impaired driving problem and should be consulted when gathering information about the problem and responding to it.
The following are some critical questions you should ask in analyzing your local problem of drug-impaired driving, even if the answers are not always readily available. Your answers to these and other questions will help you choose the most appropriate set of responses later on.
Measurement allows you to determine to what degree your efforts have succeeded, and suggests how you might modify your responses if they are not producing the intended results.
Ideally, you should take measures of your problem before you implement responses, to determine how serious the problem is, and after you implement them, to determine whether your responses have been effective. You should take all measures in both the target area and the surrounding area. For more detailed guidance on measuring effectiveness, see Problem-Solving Tools Guide No. 1, Assessing Responses to Problems: An Introductory Guide for Police Problem-Solvers and Problem-Solving Tools Guide No. 10, Analyzing Crime Displacement and Diffusion.
The following are potentially useful measures of the effectiveness of responses to drug-impaired driving. Process measures demonstrate the extent to which the responses were properly implemented. Outcome measures demonstrate the extent to which the responses reduced the level or severity of the problem.
Your analysis of your local problem should give you a better understanding of the factors contributing to it. Once you have analyzed your local problem and established a baseline for measuring effectiveness, you should consider possible responses for addressing the problem.
The following response strategies provide a foundation of ideas for addressing your particular problem. These strategies are drawn from a variety of research studies, government initiatives and police reports. Several of these strategies may apply to your community problem.
It is critical that you tailor responses to local circumstances and that you can justify each response on the basis of reliable analysis of accurate data. In most cases, an effective strategy will involve implementing several different responses. Law enforcement responses alone are seldom effective in reducing or solving the problem.
Do not limit yourself to considering what police can do: carefully consider whether others in your community share responsibility for the problem and can help police better respond to it. The responsibility of responding, in some cases, may need to be shifted toward those who have the capacity to implement more effective responses. (For more detailed information on shifting and sharing responsibility, see Response Guide No. 3, Shifting and Sharing Responsibility for Public Safety Problems).
For further information on managing the implementation of response strategies, see Problem-Solving Tools Guide No. 7, Implementing Responses to Problems.
Generally, any enforcement, intervention or prevention programs that attempt to minimize or delay onset of illicit substance use can also help reduce incidents of drug-impaired driving.α
In addressing drug-impaired driving, you would do well to begin by examining your local strategies for responding to drunk driving and considering using parts of that framework as a starting point for responding to drug-impaired driving.β The lessons we have learned about drunk driving can directly inform many of our responses to drug-impaired driving. For example, first-time drunk-driving offenders can likely be influenced and persuaded to desist, but repeat offenders’ behavior is far more difficult to change, and they are at increased risk of continued offending.34 Therefore, you should consider adopting different sets of responses that address first-time drug-impaired drivers and repeat offenders.35
α For further information on addressing the broader issues related to drug use, readers are encouraged to review the POP Guides on Drug Dealing in Open-Air Drug Markets (No.31), Drug Dealing in Privately Owned Apartment Complexes (No.4), Clandestine Methamphetamine Labs (No.16), Rave Parties (No.14), and Prescription Fraud (No.24).
β See Problem-Specific Guide No. 36, Drunk Driving for further information.
1. Implementing per se (also known as “zero-tolerance”) laws. Many jurisdictions have implemented per se laws in which a specified level of an illicit drug found in the body of a driver is, in and of itself, defined as an offense. Within the context of illegal drugs, zero-tolerance laws include those that set the limit of illicit drugs at the minimal drug detection level. Therefore, under zero-tolerance laws, it may not be necessary to prove that drivers were actually impaired but only to demonstrate that they had a detectable amount of an illegal drug in their body while driving.36 Other states, and some scientists, have an interest in identifying reasonable detection levels that suggest impairment by some substances (including marijuana).37 Nevertheless, zero-tolerance laws, while not necessarily improving the enforcement of the laws, appear to improve prosecution rates in some states.38 Broader adoption of zero-tolerance laws has been carefully studied and recommended.39 However, actual enforcement of zero-tolerance laws may be challenging, because police officers may still need to use the premise of perceived impairment as the justification for a traffic stop. Therefore, per se and zero-tolerance laws may ultimately focus attention primarily on drivers who are substantially impaired, as opposed to the larger population of drivers who have illicit substances in their bodies.40 Furthermore, per se and zero-tolerance laws may not include drug-impaired drivers who are using prescription or over-the-counter medications (because possession, as determined by a laboratory or field test of those drugs, may not be illegal, in and of itself).
2. Developing drug-impaired driver courts. Drug-impaired driver courts, generally modeled on drug courts, have been developed and implemented in South Dakota and in Erie/Niagara, New York.41 These specialized courts have been used to respond to first-time offenders, but they mostly target high-risk and repeat offenders and are focused on managing substance abuse problems, one of which is drug-impaired driving. Because initial evaluations and reviews of these kinds of intervention efforts are promising, like the evaluation and review of drug court effectiveness overall, much broader adoption of drug-impaired driver courts should be encouraged, given the cost of trying offenders in drug courts compared with the cost of their incarceration,42 especially for serious recidivists.43
3. Implementing or improving on-site, point-of-contact (field) drug-testing devices and protocols. A number of drug-screening devices are available for use in the field. One initial evaluation suggested that Los Angeles police officers were quite effective at field testing, although there was some room for improvement.44 However, a larger study that examined a wide variety of testing methods across a broad array of substances suggested that no devices can yet be recommended.45 As a result, continued development of drug-testing devices that ensure accuracy, reliability and usability is necessary.
4. Standardizing lab- and field-testing protocols. Uniformity in lab and field drug-testing standards and protocols is also important. Professional organizations such as the American Board of Forensic Toxicology (ABFT), the American Society of Crime Laboratory Directors/ Laboratory Accreditation Board (ASLD/LAB) and other similar entities should continue to take the lead in aligning laboratory standards internationally and ensuring consistency in lab processes and protocols.46 Standardization of testing protocols can also assist police in preparing cases that can be efficiently prosecuted and that can withstand legal and judicial scrutiny.
5. Suspending, restricting, or revoking driving privileges. Motor vehicle departments typically have administrative and legal protocols in place for restricting, suspending or revoking driving privileges for impaired drivers, and these responses have been effective.47 The same protocols could be (and in some jurisdictions already are) applied to drug-impaired drivers. It seems clear, however, that relying solely on these measures has not been effective - especially for persistent drinkers. It likely follows that these approaches, if implemented as a primary response, would be equally ineffective for persistent drug users, including users of intravenous drugs who are frequently convicted of drug-impaired driving.48 First-time drug-impaired driving offenders, however, may be more effectively influenced to change their behavior by various methods of restricting driving privileges. And some evidence suggests that “use and lose” laws, which include those that authorize driver-licensing actions against persons found to be using, or in possession of, illicit drugs, and against underage persons found to be drinking, purchasing or in possession of alcoholic beverages, improve public safety and reduce subsequent traffic violations overall.49
Many departments use officers trained as drug recognition experts at sobriety checkpoints such as the one pictured here.
Photo Credit: Wikipedia Commons (http://commons.wikimedia.org/wiki/File:Sobriety_checkpoint_easthaven_ct.jpg)
7. Training police officers to be drug recognition experts. Many police departments have trained some officers as drug recognition experts. These experts rely on a standardized process for assessing whether a suspect is drug impaired.53 The use of this systematic approach has assisted many prosecutors in prosecuting drug-impaired driving offenders, although the reliability of the process and the admissibility of the evidence have been subjected to substantial legal challenges.54 Evaluations of the effectiveness of this response have been mixed, but they tend to indicate that officers are reasonably accurate in identifying drug-impaired drivers.55 The National Highway Traffic Safety Administration (NHTSA) has published useful guidance on how to improve the investigation and prosecution of drug-impaired driving cases.56
9. Mandating drug treatment for all drug-impaired drivers. It is unlikely that all first-time drug-impaired drivers were apprehended the first time they drove while impaired. Furthermore, repeat offenders have demonstrated a persistent use of drugs and a willingness to drive while impaired; they have also demonstrated an unwillingness or inability to change either behavior. By and large, it is reasonable to conclude that most convicted drug-impaired drivers are drug users during periods when they are not driving. Drug treatment, including court-mandated treatment or compelled treatment by other means (e.g., drug courts or other drug diversion programs), is often effective at reducing (and sometimes eliminating) drug use and at managing the consequences associated with drug abuse.61 Treatment should be more intensive and last longer for repeat drug-impaired driving offenders (who are likely persistent drug users); even so, treatment has been effective at reducing subsequent collision risk for cocaine and alcohol users.62 Treatment is often less costly than many other criminal justice sanctions, including incarceration; therefore, it should be required for any convicted drug-impaired driver. Treatment, either concurrent with or in lieu of punishment, can be effective, but punishment without treatment is less likely to deter repeat drug-impaired driving.
10. Using electronic-monitoring devices to closely track repeat drug-impaired driving offenders. Offenders who are arrested or convicted more than once for drug-impaired driving merit closer monitoring and supervision by the criminal justice system than first-time offenders. Recent advances in electronic monitoring have suggested that this approach is a cost-effective method of community supervision both before and after convictions.63 Electronic monitors affixed to convicted drug-impaired drivers or their vehicles would allow police to track offenders continuously, to determine whether they are on foot or in a car, and to assess whether they are near such places as drug markets and drug houses. Together with driving restrictions, an electronic-monitoring program that includes a drug-use-monitoring device that can detect illicit substance use occurring within the offender’s home or while he or she is driving to or from work would create an effective technological method of preventing continued drug use and of reducing rates of recidivism among convicted drug-impaired drivers.
γ See Response Guide No. 6, Crime Prevention Publicity Campaigns, for further information.
Repeatedly publicizing laws and legal sanctions may deter drug-impaired driving.
Photo Credit: Colorado Department of Transportation
12. Mandating drug-impaired driving education and prevention programs for high-risk drivers. Any new driver should be exposed to educational materials that focus attention on preventing drug-impaired driving. These types of programs should also target older drivers who are prescribed potentially impairing medications (which can be identified when the drivers renew licenses or, better yet, when they are prescribed); first-time and persistent substance abusers who may be at increased risk of offending; and other identified at-risk populations (e.g., those with drug-related arrests, nontraffic convictions and persistent traffic infractions at younger ages, as well as first-time drug-impaired drivers). These programs must move beyond merely providing factual information about the hazards associated with drug-impaired driving, an approach which may not be particularly effective.67
Prevention programs will be more effective if they emphasize increased swiftness and certainty of apprehension, nonlegal sanctions such as shame and loss of friends, concern for others, and awareness of personal-injury risks.68 Furthermore, programs that seek to correct inaccurate perceptions of the risks associated with various forms of drug-impaired driving, including marijuana-impaired driving and driving under the influence of marijuana and alcohol combined, should be developed and adopted.69
13. Educating and engaging physicians and pharmacists regarding prescription drug abuse and drug-impaired driving. Given that a substantial proportion of drug-impaired driving is linked to prescription drugs and prescription drug abuse, doctors and pharmacists (and their assistants) need to be fully informed of, educated about and engaged in responding to this problem. One potential program that focuses on physician support for designated drivers could be considered and adopted.70 A comparable program, supported by pharmaceutical companies and perhaps local transportation companies, could also be considered and adopted: designated drivers would be made available to those who are picking up or continuously using prescription drugs known to impair driving ability. Guides for developing such programs are available.71
14. Encouraging physicians and pharmacists to educate their patients about the link between the use of certain prescription drugs and impaired driving. Point-of-sale education programs are a viable method of reaching the general population and specific at-risk populations using prescription drugs, such as the elderly and the mentally impaired. These types of warning programs might have a meaningful impact because they are delivered proactively from a medical professional rather than reactively from a law enforcement officer or a court. Such programs should seek to identify drugs that are potentially impairing, to explain the consequences of using these substances before driving and to articulate the laws and punishments (including rate increases in automobile liability insurance) that apply to drug-impaired driving.72 Progressive programs might also include readily available transportation alternatives, home delivery of potentially impairing substances, clearly readable warning labels on containers, and other such methods for ensuring that substance users are effectively reached and are likely to understand the risks and consequences associated with driving while medicated.
15. Confining convicted drug-impaired drivers to their homes in the absence of close monitoring (electronic or otherwise). Home confinement, while possibly minimizing some subsequent offending, does not necessarily address the problem of substance abuse, and persistent drug users are unlikely to abstain in the absence of additional coercive or restrictive measures. Use of electronic monitoring as a method of enforcing home confinement is a preferred option, particularly if the offender understands the surveillance capability of the monitoring device and if swift, certain and severe sanctions are in place for noncompliance with, or other violations of, confinement conditions. Home confinement, combined with mandatory treatment and electronic monitoring, has been tested with drug offenders and has generated some positive results.73
16. Developing ignition interlocking devices and requiring convicted drug-impaired drivers to install them. Use of ignition interlocking devices, properly installed and maintained for a sufficient amount of time, has been effective in deterring some first-time and repeat drunk drivers from reoffending.74 Nevertheless, there have been some disadvantages to this approach. Some offenders do not own cars (and the impoundment of which may be part of their punishment - See No. 8 above); others may not install the devices even if ordered to do so; and ongoing monitoring may present substantial resource challenges for criminal justice systems. Those challenges would need to be considered if technological advances allow for drug testing by ignition interlocking devices in the future. At present, such devices are neither widely available nor validated as useful.
17. Developing and implementing devices that monitor drug use. Current technology allows for ongoing monitoring of the amount of alcohol in the blood. Similar technology may be developed for ongoing drug monitoring and testing of sweat, blood, urine, or saliva. At this point, such technology is in the early stages of development, although there are some preliminary indications that sweat-testing patches might prove useful in the future.75 If you are part of the criminal justice system in your jurisdiction, you should be aware of new scientific and technological developments regarding the technology of remote drug-monitoring devices. Such technology might also be used in conjunction with electronic-monitoring technology, which would allow police to track offenders and test them for drugs at all times and wherever they go.
18. Incarcerating drug-impaired drivers. Incarcerating convicted drug-impaired drivers, particularly repeat offenders and those prosecuted for deaths associated with crashes, obviously prevents offenders from driving during confinement and can deter them from further drug-impaired driving once released, but the deterrent impact on all drivers may be less than anticipated. Much of the deterrence literature suggests that swift and certain responses, rather than severe consequences alone, are likely to deter future offending, particularly if offenders know clearly how they are expected to behave in the future and the consequences for failing to do so. For offenders who are unresponsive to alternative sanctions, to substance abuse treatment (either compelled or voluntary), or to other responses, long-term incarceration is a viable, although expensive, strategy for ensuring increased public safety for some period of time.76
19. Substantially increasing fines for drug-impaired driving offenses. In many countries, increasing fines has historically had minimal effects on recidivism rates among drunk drivers or as a general deterrent to drunk driving. Often the fines are not paid, and many jurisdictions lack the resources to enforce payments unless the offender comes into contact with the criminal justice system in the future. Hence, there is little reason to believe that this approach would have a meaningful impact on drug-impaired drivers. However, Australia and Sweden have adopted fine systems that are closely linked to offenders’ income levels and to the seriousness of the offense, and within those systems, fines have been more effective in reducing recidivism rates.77 Nevertheless, the magnitude of the fine relative to the offender’s resources and the seriousness of the offense may not have been equitably balanced in many countries. Therefore, fine systems may need further exploration as one potential response to drug-impaired driving.
The table below summarizes the responses to drug-impaired driving, the mechanism by which they are intended to work, the conditions under which they might work best, and some factors to consider before implementing a particular response. It is critical that you tailor responses to local circumstances and that you can justify each response on the basis of reliable analyses. In most cases, an effective strategy will involve implementing several different responses. Law enforcement responses alone are seldom effective in reducing or solving the problem.
|#||Response||How It Works||Works Best If…||Considerations|
|General Considerations for an Effective Response Strategy|
per se (aka "zerotolerance")
drivers to arrest
|....states or countries
are interested in
policies and are not
as concerned about
the inadequacies of
|Some drivers who
are not actually
impaired will still be
on the location
and local laws; false
positives may affect
a small minority
of drivers; legality
of enforcement of
these laws may be
not be included
use and offending;
offenders in an
effort to prevent
at high risk for
recidivism or have
had more than one
arrest for driving
courts can require
significant time and
courts are often cost
effective in the long
and ensures that
drug testing occurs
near the time and
place of the offense,
validity of test
|....the devices are
|There are a number
and still evolving,
so police agencies
will need to keep
pace with ongoing
technology is still
in development and
may not accurately
assess newer drugs
or certain categories
that can withstand
how to handle
testing samples and
have the resources to
such protocols are
by threat of
drive a vehicle
and courts have
the resources to
and those with
are less likely to be
deterred and will
often continue to
drive while impaired
|Increases risk of
high-risk times and
places; raises public
awareness of drugimpaired
|....police are able to
patterns at high-risk
times and places
likely to hinder
can be resource
officers to be drug
ensures that suspects
are treated fairly but
|....scale of drugimpaired
is sufficiently large
to justify training
to admission of
will consume court
and officer time;
training costs can be
|Restricting Vehicle Access|
or vehicle license
plates of drugimpaired
from driving their
own vehicle or
of being stopped by
police for driving
without a license
may surface, as
well as concerns
for first offenders);
costs associated with
might be substantial
|Reducing Drug Use|
treatment for all
of recidivism by
for illicit drugs
by drug type and
|Treatment does not
have to occur in
lieu of punishment,
may be less effective;
treatment costs are
to closely track
risk of drug
and drug use
may be expensive,
but ongoing costs
requires staff time to
them, if necessary
|Education and Prevention Responses|
directed at the
and targeting highrisk
to dangers and
|....targeted to highrisk
drug users, the
elderly, and in
have relaxed drug
message is deemed
credible by intended
points and sponsors
may be more
effective; costs may
be substantial and
for high-risk drivers
that reach at-risk
populations or that
may be required
for certain at-risk
ensures that those
the risks and
focus on nonlegal
about the risks
driving, and are
will need to be
different risk groups
such as repeat
offenders, the elderly
abuse and drugimpaired
|Ensures that those
who prescribe drugs
are fully aware of
are engaged in
recognize their own
and work with
that focus on
driving, and these
programs might be
readily adopted or
expanded to address
the consequences of
use while driving
the link between
the use of certain
delivers the message
outside of the
system, which may
be more appropriate
for some groups and
more effective for
and pharmacists and
provide a variety
of options for safe
delivery and use of
can hinder driving
companies will need
to be active partners
the risks associated
in educating users
about those risks
|Responses with Limited or Unknown Effectiveness|
to their homes
in the absence of
through fear of
certain and swift;
drug treatment is
also made available
restrictions are too
easily violated absent
of impaired driving
such drivers from
operating their own
vehicle while drug
is reliable and valid
|Technology of such
devices is still in
and testing stages;
have access to other
devices that monitor
from using drugs
illicitly out of
fear of detection
a valid argument
against others who
encourage drug use
is reliable and
if monitoring is
vigilant and results
in swift and certain
such devices is still
and will not be
for some time;
will likely delay
will need to be
from driving while
through fear of
is also swift
|This response may
be the best available
option for persistent
offenders who are
not responsive to
other forms of
|Intended to deter
through aversion to
income levels and
of offense and
|Fines are often not
paid, and follow-up
enforcement is often
 Lacey et al. (2009).
 National Highway Traffic Safety Administration (2010).
 Substance Abuse and Mental Health Services Administration (2010).
 O'Malley and Johnston (2007).
 Lacey et al. (2009).
 O'Kane, Tutt, and Bauer (2002).
 Bernhoft et al. (2005).
 Beasley, Beirness, and Porath-Waller (2011).
 Poulsen (2010).
 Elliott, Woolacott, and Braithwaite (2009).
 Officer (2009). But see Beasley, Beirness, and Porath-Waller (2011) for a somewhat different age distribution among Canadian offenders and victims.
 O'Malley and Johnston (2007).
 Begg, Langley, and Stephenson (2003).
 Karjalainen et al. (2011).
 Fergusson, Horwood, and Boden (2008).
Lenne et al. (2001).
 Li et al. (2011).
 Bingham, Shope, and Zhu (2008); Brookoff et al. (1994); Hausken, Skurtveit, and Christophersen (2004); Ramaekers (2003).
 Jones, Shinar, and Walsh (2003).
National Highway Traffic Safety Administration (2012b).
 Normand, Lempert, and O'Brien (1994).
 Kelly, Darke, and Ross (2004).
 Abramson and Haines (2012).
 Couper and Logan (2004).
 Lenne et al. (2001).
 Aitken, Kerger, and Crofts (2000).
 Kelly, Darke, and Ross (2004).
 National Highway Traffic Safety Administration (2009).
 Degenhardt et al. (2006).
 Cartwright and Asbridge (2011).
 Calafat et al. (2009).
 Cartwright and Asbridge (2011).
 White (2003).
 Kerrigan (2004).
 DuPont (2011).
 Grotenhermen et al. (2005).
 Lacey, Brainard, and Snitow (2010).
 Walsh Group (2002).
 Voas (2006).
 Loudenburg, Drube, and Leonardson (2010); Cissner (2009).
 Eibner et al. (2006).
 Caulkins and DuPont (2010).
 Hersch, Crouch, and Cook (2000).
 Farrell, Kerrigan, and Logan (2007).
 National Highway Traffic Safety Administration (1996).
 Darke, Kelly, and Ross (2004).
 Ulmer, Shabanova, and Preusser (2001).
 Boorman and Owens (2009).
 Freeman et al. (2008).
 McKnight and Voas (2001).
 International Association of Chiefs of Police (n.d.).
 Talpins and Hayes (2004).
 Smith et al. (2002).
 National Highway Traffic Safety Administration (2004).
 DeYoung (1997).
 Leaf and Preusser (2011).
 Sweedler and Stewart (n.d.).
 Whittle (2000).
 Shaffer (2011).
 Macdonald et al. (2008).
 Bonta, Wallace-Capretta, and Rooney (2000).
 Mothers Against Drunk Driving (2005).
 Office of National Drug Control Policy (2011).
 Lacey et al. (2009).
 Davey et al. (2008).
 Watling et al. (2010).
 Fergusson and Horwood (2001).
 Hanson (2012).
 National Highway Traffic Safety Administration (2012a).
 Couper and Logan (2004).
 Jolin and Stipak (1992).
 Fulkerson (2003).
 Skopp et al. (1996).
 White and Gasperin (2006).
 Nichols and Ross (1990).
Abramson, Mark A., and Holly B. Haines. 2012. “Medical Provider Liability to Non- Patient Third Parties for Negligent Medical Care and Prescribing Practices.” Available at www.arbd.com/medical-provider-liability-to-non-patient-third-parties-for-negligent-medical-care-and-prescribing-p.
Aitken, Campbell, Michael Kerger, and Nick Crofts. 2000. “Drivers Who Use Illicit Drugs: Behaviour and Perceived Risks.” Drugs: Education, Prevention and Policy 7 (1): 39 - 50.
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