Limitations of Drug Fatality Dataonlinepubs.trb.org/onlinepubs/webinars/190613.pdf · • FARS drug...

Limitations of Drug Fatality Data

Thursday, June 13, 20192:00-3:30 PM ET

TRANSPORTATION RESEARCH BOARD

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Purpose

To discuss limitations of fatality crash data reporting, specifically regarding drug-involved driving.

Learning Objectives

At the end of this webinar, you will be able to:

• Identify the limitations of FARS drug-involved driving data

• Describe practices in forensic toxicology testing for drugs and identify the differences between laboratories across the country

• Describe upcoming improvements to data reporting

Limitations of Drug Fatality DataTARA KELLEY-BAKER, PH.D.

TRB COMMITTEE CHAIR, ALCOHOL AND OTHER DRUGS IN TRANSPORTATION DATA AND INFORMATION GROUP LEADER, AAA FOUNDATION FOR TRAFFIC SAFETY

TRB WEBINAR, JUNE 13, 2019

Drug Driving Fatalities on the Rise!

Growing number of fatal crashes linked to drug use

More Drivers Killed Under the Influence of Drugs Than Alcohol

Drug Driving Leads to More Fatal Crashes than Drunk Driving

Drugged Driving Deaths Spike With Spread of Legal Marijuana, Opioid Abuse

Drugged Driving Surpasses Drunken Driving Among Drivers Killed in Crashes

MEDIA

Conferences

Scientific Journals

State agencies, private corporation foundations….

But there is a problem…..

We don’t actually know this to be true.

8Drugs and Driving is a Complex Issue

Assuming alcohol-Impaired driving is a good model for understanding and addressing drugs and driving

“Drugs” There are hundreds of drugs > different effects on body > different effects on driving behaviors

Stimulants will stimulate nervous system, depressants will depress nervous system

Drugs metabolize differently across people Onset of effect; peak time differ across people

Drugs testing differences By drug> by lab

9Why is this Important? Big focus today on drugs and driving

Priorities are being established; policies getting developed; laws getting enacted; enforcement strategies implemented, and funds are spent

States, federal agencies, courts, advocacy groups, researchers – all looking for information to asses the situation and determine priorities …and using the information that is readily available

Often, national level data, such as the Fatality Analysis Reporting System (FARS) (and state-level) drug data is used without understanding the limitations

11Why is Understanding Drug Fatality Data Important?

We need information and potential solutions to be based on good – reliable - data

We don’t want to cast doubt on the quality of other data

12Personal Experience

As part of the TRB Alcohol and Other Drugs Committee Have expressed concerns about conference presentations and research journal

articles on drug-impaired driving As a researcher and proposal reviewer…

Question the work of scientists and applicants As part of safety organization….

Continually educating and cautioning clubs, the general public, etc.

An Overview of NHTSA’s Fatality Analysis Reporting

System (FARS)Drug Data Reporting

TrisAnn JodonFARS Program Analyst

National Center for Statistics and Analysis, NHTSA

Fatality Analysis Reporting System (FARS)

• Initiated in 1975 by the U. S. Department of Transportation’s National Highway Traffic Safety Administration

• Tasked with developing and maintaining an annual national census of traffic crashes:• Occurring on a public traffic way• Involving at least one motor vehicle in transport• Resulting in at least one fatal injury sustained as a result of the crash

• Death of the fatally injured party occurring within 720 hours of the crash

3NHTSA Organization for Data Collection

• Administered through Cooperative Agreements with State agencies:• State Patrol• State Highway Safety Offices• Department of Transportation• Department of Motor Vehicles

• 52 Individual FARS data collection and reporting units• 50 states• District of Columbia• Puerto Rico

4FARS Core Data Elements• CRASH LEVEL – location and environmental description of crash scene and

EMS involvement• VEHICLE LEVEL – vehicle description, ownership, and use• DRIVER LEVEL – operator licensing, history and contributing factors

(including impairment)• PRECRASH LEVEL – environmental, behavioral and situational description

just prior to the first harmful event for a particular vehicle/driver – geared toward crash prevention

• PERSON LEVEL – describes demographics, restraint systems use, status of drug and alcohol use, and injury status

• NON-MOTORIST LEVEL (as needed) – person level descriptors for pedestrians, cyclists, et. al.

5Distribution of FARS Data Elements• CRASH LEVEL – 32 data elements• VEHICLE LEVEL – 36 data elements• DRIVER LEVEL – 24 data elements• PRECRASH LEVEL – 23 data elements• PERSON LEVEL – 26 data elements – include Drug Test Status, Specimen,

Result• NON-MOTORIST LEVEL (as needed) – 26 data elements PLUS

pedestrian/bicyclist crash typing module – include Drug Test Status, Specimen, Result

Over 6,000,000 data points collected per annual FARS fileApproximately 85,000 data points related to persons tested for drugs

FARS Toxicology Reporting: Subjects 6

• FARS anticipates alcohol and/or drug testing for a subset of persons involved in fatal motor vehicle incidents depending on their role in the crash and their injury severity• All drivers regardless of injury severity• All fatally injured occupants/passengers of the motor vehicles

• Testing not expected for surviving occupants/passengers• All fatally injured non-motorists

• Testing not expected for surviving non-motorists

• Toxicology data elements for surviving occupants/passengers and non-motorists default to “not tested” in FARS unless the case materials provide information indicating testing

Drug Testing Rates in FARS 7

• 2 in 3 fatally injured drivers drug tested• 1 in 5 surviving drivers drug tested• 2 in 5 fatally injured occupants/passengers drug tested• 3 in 5 fatally injured non-motorists drug tested

FARS Drug Toxicology Reporting: Data Fields 8

FARS Drug Toxicology Reporting: Data Fields 9

Prior to 2018:

Since 2018:

10FARS Drug Toxicology Reporting: Data Fields

• FARS currently reports:• Drug Test Status – disposition of

drug testing• Drug Specimen – able to report

results for multiple specimens• Drug Test Result – only reports the

presence of a substance

• FARS does not currently report:• Specimen collection date/time• Vital status of person at time of

specimen collection• Type of analysis: Screening vs

Confirmatory• Method of analysis performed• Quantitation values• Reporting limits/thresholds• Substances on the drug test panel• Negative results by specific drug

11FARS Drug Toxicology Reporting: Data Sources

• FARS acquires drug testing dispositions and results through various sources• Primary Sources

• Full toxicology report as generated by the testing laboratory• Secondary Sources

• Summary of toxicology findings reported by coroner/medical examiner• Summary of state crime laboratory report added to police crash report by law enforcement officer

• Tertiary Sources• Officer notes drug result findings as informed by a secondary source

• FARS does not currently differentiate among sources when reporting the presence of a drug

• The drug specimen type may or may not be known to FARS depending on the data source

12FARS Drug Toxicology Reporting: Interpretation

• FARS drug data answers only the most basic questions:• Was it reported to the state FARS unit that drug testing was

administered?• What type of specimen was reported as having been used for that drug

test?• Were drugs detected or not detected?

• If detected, what substance was reported as having been present?

• Attempts to make inferences by extrapolating the current parameters of FARS drug data will yield unreliable conclusions

Thank you

[email protected]

13

Limitations of Drug Fatality Data The Toxicology Perspective

Amy MilesDirector of Forensic Toxicology

Wisconsin State Laboratory of HygieneUW School of Medicine and Public Health

Laboratory Accreditation

• American Board of Forensic Toxicology (ABFT)• American Society of Crime Laboratory Directors

(ASCLD)

ANABANSI National Accreditation Board

ISO

Alcohol and Drug Testing

Confirmation and

QuantitationDrug ScreeningAlcohol

ALCOHOL: GC, HEADSPACE, FID DUAL

COLUMNBAC >0.100DRE/MVD

Immunoassay: Cocaine, Opiates, Benzodiazepines, Barbiturates,

Carboxy-THC, Amphetamines, PCP Buprenorphine, Fentanyl,

Oxycodone, Methadone, LSD

Confirmation by HPLC, LC/MS/MS or GC/MSD

and Quantitation

Basic Drug Screen: Amphetamines, Antidepressants,

Sedative/Hypnotics, OTC Meds, Narcotic Analgesics and others

Confirmation by HPLC, LC/MS/MS or GC/MSD

and Quantitation

Triage Testing

• Based on BAC result– Greater than a certain BAC (i.e 0.08 g/100mL),

remaining testing may not occur• Per Se drug laws may limit testing

– Per se limit for delta-9-THC may mean testing end once confirmed

• End result of triage testing – Underreporting of individuals positive for drugs while

driving– Incomplete information for addiction assessment

Screening vs Confirmation

Screening• Presumptive results• Used to direct the testing• Immunoassay is general (for

some drug classes)• MS screening is broader

than immunoassay• Qualitative

Confirmation• Definitive identity of drugs• May determine further

testing• MS is most common

confirmation technique, can use HPLC UV, etc.

• Quantify the drug(s)

One Size Does Not Fit All

• Lab policies vary from state to state– Statutes may define testing– Sample matrices differ (blood vs urine)

• Lab policies vary within the state– States may have multiple labs under different

agencies– Public vs Private Labs– Instrumentation variations and resource limitations

Recommendations for DUID Labs

Recommendations for DUID LabsTier I Drugs

• THC (Carboxy-THC)• Methamphetamine /

Amphetamine• MDMA / MDA• Cocaine/BE• Carisoprodol / Meprobamate• Zolpidem• Alprazolam (alpha-hydroxy)• Lorazepam• Diazepam / Nordiazepam• Oxazepam• Temazepam

• Codeine• 6-Acetylmorphine• Buprenorphine /

Norbuprenorphine• Fentanyl• Hydrocodone• Hydromorphone• Methadone• Morphine• Oxycodone• Oxymorphone• Tramadol / O-

desmethyltramadol

• Testing workflows differ between states and labs

• Need to identify barriers in each state to achieve similar testing in labs– Once states synchronize within, then between

state comparisons may begin

• Labs performing DUID and Motor Vehicle Fatalities casework should strive to meet Tier I

Summary

Amy Miles

Director of Forensic ToxicologyWisconsin State Laboratory of Hygiene

UW School of Medicine and Public Health

[email protected]

Understanding the Limitations of Drug Test Information, Testing

Practices, and Reporting in Fatal Crashes

Amy BerningOffice of Behavioral Safety Research

National Highway Traffic Safety Administration

FARS Drug Data is not FARS Alcohol Data

• Not in quantity; not in quality

• States and NHTSA have reported on alcohol-related fatalities for 50 years

• Procedures and testing methods are well-established

• There is an established imputation method to estimate BACs for drivers when no sample obtained

Presence is (often) not Impairment

• When looking at crash-involved “impaired driving” data… Always determine where data originates, and exactly what it means – do not generalize beyond.

• FARS drug data provides information about drug presence; not whether the driver was impaired by a drug. We only know the drug was in the system at the time of testing. We do not know about impairment.

• Some substances, such as cannabinoids (marijuana), can be detected in blood long after any impairment, including weeks after use.

• Thus, knowing a driver tested positive for a drug does not necessarily indicate the person was impaired by the drug at the time of the crash. (Or that the driver “caused” crash.)

Differences in Drug Testing Procedures

• There are no consistent policies or procedures between, or sometimes even within, States for drug testing. This relates to laws that dictate who within a crash must be tested, enforcement practices, lab drug testing procedures, and how drug-positive cases are reported.

There are variations with: Who is tested (fatally-injured, surviving) What drugs are tested Thresholds of drug testing Reporting

• Laws vary, and practices vary, including based on real-world scenarios of conditions at a crash scene, ability to obtain drug testing, and costs of drug panels.

Variations in Drug Result Reporting

• Once a drug test is conducted, and a result is known, it still needs to be reported to a FARS state analyst to be included in the FARS database.

• Drug testing may occur in • Toxicology lab• Medical Examiner’s facility• Coroner’s facility• Hospital

• If there is not a reporting system in place, the drug test results may never make it to the FARS analyst.

• Drug-positive drivers may be reported, but not drug-negative drivers.

Implications of Variations in Testing, Reporting

• A jurisdiction that tests more drivers is likely to have a higher number of drivers determined to be drug-positive.

• A jurisdiction with more funds one year can test more drivers, and for a larger panel of drugs, is likely to have a higher number of drivers determined to be drug-positive.

• A driver who is tested for a greater number of drugs (than another driver), is more likely to be reported positive for a drug, compared to a driver tested for fewer substances.

• A toxicology lab that can detect the presence of drugs at lower thresholds than another lab, or compared to an past year, will yield higher numbers of drug-positive drivers.

• A jurisdiction that submits all drug test results is more likely to report a higher number of drug-positive drivers than a jurisdiction that does not send results forward.

This All Means…

Rising numbers do not necessarily (but may) mean an increased number of drug-positive (for some drugs) drivers on the road (in some places).

Remember:Determine where data originate, what it can mean, and what it cannot mean – do not generalize beyond.

March 13

March 14March 15

The Chicago River2015

NHTSA Research Study on FARS

• Examining the data process from start to finishcrash event > drug results entered into FARS

• Talking to people involved at all stags of the process: officers who conduct crash investigations, toxicologists, FARS analysts, etc.

• Obtained a sample of 1,000 FARS cases, across states, that involved a drug test, and reviewed information on drug testing and results.

Amy Berning, NHTSAResearch Psychologist

Office of Behavioral Safety Research National Highway Traffic Safety Administration

[email protected]

Link to Limitations Research Note

http://www.nhtsa.gov/staticfiles/nti/pdf/812072-UnderstandLimitsDrugTest-ResearchNote.pdf

1Police Accident Report

Drug Results Via Police Report 2

Toxicology Report 3

4Uniform Traffic Crash Report

“Unknown” Drug Test

Type Alcohol Test Given

98

Alcohol TestResults

Unk

Type DrugTest Given

98

Drug TestResults

99

LEGENDLocation Category Code Description Location Category Code Description

Report Header Unit Type 1 Passenger car Driver Liability Ins. Policy Code

0 Not Set

Driver Alcohol Test Type

6 No Test Given


98 Other

Driver Drug Test Result 97 Not applicable

Driver Drug Test Result 99 Unknown

Driver Drug Test Type 4 No test given

Driver Drug Test Type 98 Other

6Blood Test Given, but Results “Not Applicable”


1

Alcohol TestResults

Unk

Type DrugTest Given

1

Drug TestResults

97



0 Not Set


1 Blood test

Driver Drug Test Result 97 Not applicable

Driver Drug Test Type 1 Blood test

7“Positive” ResultsType Alcohol Test Given

1

Alcohol TestResults

0.007

Type DrugTest Given

1

Drug TestResults

1


Report Header Unit Type 1 Passenger car

Driver Liability Ins. Policy Code

0 Not Set


1 Blood test

Driver Drug Test Result 1 Positive


8“Negative” Results


1

Alcohol TestResults

0.000

Type DrugTest Given

1

Drug TestResults

2



0 Not Set


1 Blood test

Driver Drug Test Result 2 Negative


9No Test Given

Sobriety/ Officer Opinion

Alcohol:

Drugs:

No

No


6

Alcohol Test Results

N/A

Type Drug Test Given

4

Drug TestResults

97


Report Header

Unit Type 1 Passenger car

Driver Liability Ins. Policy Code

0 Not Set


6 No test given


98 Other

Driver Drug Test Result

97 Not Applicable

Driver Drug Test Result

99 Unknown

Driver Drug Test Type 4 No test given

Driver Drug Test Type 98 Other

10Interpreting the Police Narrative

11Crash Report, “Positive for Other Drugs”

Crash Report “Positive for Other Drugs”

12Additional Methods of Toxicology Reporting

14

It was entered in FARS as “drug positive” and the drug was coded as “other

Caffeine-related crash becomes a drug-related crash

Fatal Injury (K) 2 Test Given 996 Other Drug

15

N O P Q R SDeath Location

How Did Injury Occur Mechanism Code

Cause of Death according to DC

Contributory Toxicology

Off Road Something happened that caused one motorized vehicle to hit another object

MVA, Driver

Blunt force trauma

Femoral Blood: Caffeine Positive mcg/mL

Caffeine-related crash becomes a Negative Result

It was entered in FARS as “Tested, No Drugs Found/Negative”

Fatal Injury (K) 2 Test Given 0 Tested, No Drugs Found/Negative

16

The Drug Result Entered in FARS was via DRE Exam (only)

(5) Unit Occupants Type Last Name First Middle Suffix Date of Birth (mm/dd/yyy) Sex 01 01 D Hit

& Run Doe Jane A 01/23/1945 M

CMV

(6) Address City State Zip Telephone (Use Area Code) 1234 Somewhere Dr Aplaceburg ML 892054 (123) 456-7891

(7) Driver License Number State Class Endorsement(s) Restriction(s) Inj. Sev. Type of Injury Driv./Ped. Cond. OP Use XXXXXXXXXXXX ML D 2 3 04 04

(8) Ejected Extracted Test (% BAC) Transported by To Medical Facility License Plate Number State Month Year Air Bag

2 1 1 4 0. REFUSED ABC4567 ML 01 2345

OFFICER SUMMARY: UPON ARRIVAL, I OBSERVED THE ABOVE MENTIONED CRASH SCENE AT 677 DRIVINGROAD. I SPOKE WITH DRIVER OF UNIT 1, JANE A DOE WHO GAVE THE ABOVE MENTIONED STATEMENTS. DOE APPEARED AGITATED AND CONFRONTATIONAL. INSIDE DOE’S VEHICLE, I COULD SMELL THE ODOR ASSOCIATED WITH ALCOHOL AND I OBSERVED ONE (1) CAN OF BEER IN THE FLOOR BOARD NEAR THE DRIVERS SEAT. I SPOKE WITH JOHN SMITH, DRIVER OF UNIT 2, WHO GAVE THE ABOVE MENTIONED STATEMENTS. OFFICER JONES CONDUCTED SFST (STANDARD FIELD SOBRIETY TESTS) ON DOE WHO CONTINUED TO BE AGITATED AND CONFRONTATIONAL. (SEE OFFICER JONES’S SUPPLEMENTAL) DUE TO THE RESULTS OF THE SFST, DOE REQUESTED A BREATH TEST TO PROVE SHE WAS NOT INTOXICATED. OFFICER JONES CONDUCTED A PBT (PORTABLE BREATH TEST) ON DOE. THE PBT PROVIDED A 0.00 BLOOD ALCOHOL CONTENT (BAC). DOE REFUSED A BLOOD TEST; HOWEVER, CONSENTED TO A DRUG RECOGNITION EXPERT (DRE) TEST. A DRE TEST WAS CONDUCTED BY OFFICER JONES.

Chemical Test0 N/A1 Blood2 Breath3 Blood/Breath

4 Test Refused5 None Given6 Other

(5) Unit Occupants Type Last Name First Middle Suffix Date of Birth (mm/dd/yyy) Sex

01

01

D

Hit

& Run

Doe

Jane

A

01/23/1945

M

CMV

(6) Address City State Zip Telephone (Use Area Code)

1234 Somewhere Dr

Aplaceburg

ML

892054

(123) 456-7891

(7) Driver License Number State Class Endorsement(s) Restriction(s) Inj. Sev. Type of Injury Driv./Ped. Cond. OP Use

XXXXXXXXXXXX

ML

D

2

3

04

04

(8) Ejected Extracted Test (% BAC) Transported by To Medical Facility License Plate Number State Month Year

Air

Bag

2

1

1

4

0.

REFUSED

ABC4567

ML

01

2345

OFFICER SUMMARY:

UPON ARRIVAL, I OBSERVED THE ABOVE MENTIONED CRASH SCENE AT 677 DRIVINGROAD. I SPOKE WITH DRIVER OF UNIT 1, JANE A DOE WHO GAVE THE ABOVE MENTIONED STATEMENTS. DOE APPEARED AGITATED AND CONFRONTATIONAL.

INSIDE DOE’S VEHICLE, I COULD SMELL THE ODOR ASSOCIATED WITH ALCOHOL AND I OBSERVED ONE (1) CAN OF BEER IN THE FLOOR BOARD NEAR THE DRIVERS SEAT.

I SPOKE WITH JOHN SMITH, DRIVER OF UNIT 2, WHO GAVE THE ABOVE MENTIONED STATEMENTS.

OFFICER JONES CONDUCTED SFST (STANDARD FIELD SOBRIETY TESTS) ON DOE WHO CONTINUED TO BE AGITATED AND CONFRONTATIONAL. (SEE OFFICER JONES’S SUPPLEMENTAL)

DUE TO THE RESULTS OF THE SFST, DOE REQUESTED A BREATH TEST TO PROVE SHE WAS NOT INTOXICATED. OFFICER JONES CONDUCTED A PBT (PORTABLE BREATH TEST) ON DOE. THE PBT PROVIDED A 0.00 BLOOD ALCOHOL CONTENT (BAC).

DOE REFUSED A BLOOD TEST; HOWEVER, CONSENTED TO A DRUG RECOGNITION EXPERT (DRE) TEST. A DRE TEST WAS CONDUCTED BY OFFICER JONES.

17

Screening Test (only) is Conducted / Not Confirmation(can lead to false positives)

Month / Year January 2016TRAFFIC

COLLISION DATEDATE OF DEATH BLOOD

ALCOHOLDRUG SCREEN

1/2/16 1/3/16 None Cocaine1/4/16 1/5/16 0.111 Cocaine, Meth

1/16/16 1/16/16 None None1/16/16 1/16/16 None None1/16/16 1/16/16 None THC1/22/16 1/22/16 0.203 None

18

Result Reported as “Negative” but Sample Was Insufficient for Analysis

Evidence: On 1/23/2016 the laboratory received the following evidence from the Evidence Provider for this Case via US Mail

4567-1010101-123 Sealed alcohol collection kit containing five tube(s) containing hospital specimens labeled “LABEL FOR 123A SAMPLE”

4567-1010101-123A two tubes containing hospital specimens collected at 1/23/2016 01:234567-1010101-123B two tubes containing hospital blood collected at 1/23/2016 03:454567-1010101-123C one tube containing hospital plasma collected at 1/23/2016 01:234567-1010101-123D three tubes containing hospital plasma collected at 1/23/2016 03:45

Results and Conclusions:Drug Screen Results by: Immunoassay

Abbreviations:GC/MS = Gas chromatography/Mass SpectrometryLC/MS/MS = Liquid Chromatography/Mass Spectrometry/Mass Spectrometry

Subm#: Drug Screen Classification Result123A QNS

Due to insufficient specimen analysis not possibleNegative

123B QNSDue to insufficient specimen analysis not possible

Negative

123C QNSDue to insufficient specimen analysis not possible

Negative

123D QNSDue to insufficient specimen analysis not possible

Negative

19

Officers are Requested to Choose “Up to 4” Types of Drugs to Test

0 1

STATE LOGO

Vehicle No. 01 02 03… X X X X X X X X X XCASE NO.

SUPPLEMENTAL ALCOHOL OR DRUG TEST RESULTS DRIVER

Last Name

D O E

First Name

J O N

MI

A

Alcohol Test Results

Alcohol Test Result 9 9

Drug Test Indication

P – Positive

N – Negative

98 – Results Pending (Add Results Later)

99 – Unknown

PDrug Results choose up to 4

01 – Marijuana

02 – Cocaine

03 – Opiate

04 – Amphetamine

05 – PCP

06 – Other Controlled Substance

07 – Other Drug (excludes post crash drugs)

0 11st choice2nd choice

3rd choice

4th choice

0 6

Ryan C. Smith, Ph.D.Research Scientist; Group Lead

Impaired Driving Research, Evaluation, & AnalysisVirginia Tech Transportation Institute

[email protected](804) 815-5040

20Questions?

Future Directions in FARS Drug Data Reporting

TrisAnn JodonFARS Program Analyst

National Center for Statistics and Analysis, NHTSA

FARS Drug Data: Goals

• Drug involved fatal crashes is a burgeoning field of study

• FARS data acquisition and reporting processes aim to:• Describe drug involvement in fatal crashes in greater depth and accuracy• Improve the reliability of FARS drug data• Increase the usefulness of FARS drug data to users of the data

FARS Drug Data Reporting: Work in Progress• Expertise gained in FARS’ alcohol reporting does not translate effectively to

drug data reporting• FARS approach to developing more robust, reliable drug data involves:

• Identifying issues and gaps in the current drug data reported in FARS• Refining current reporting capabilities through an expanded drug list• Defining paths to acquire improved, primary source drug data• Addressing obstacles to acquiring primary source drug data• Improving interpretation of primary source drug toxicology documents by FARS

analysts• Expanding the scope of FARS drug data reporting through new data elements• Developing a means to warehouse more robust FARS drug data

3

4Identify Issues and Gaps: Ongoing Efforts• Ongoing collaboration between NHTSA’s Office of Data Acquisition and

Office of Behavioral Research• Engagement with toxicology community in academic, forensic and medical

settings and toxicology fellows• Multi-disciplinary panels engaging in recommendations for drug reporting

standards• Focused review of FARS data acquisition operations for drug data involving

both fatally injured persons and surviving drivers

5Refining Current Reporting Capabilities• Expanding list of drugs reported by name in FARS

• Moving from a 3-digit to a 4-digit naming convention to expand the number of drugs and metabolites listed in the FARS Drug Results attributes

• Defining paths to acquire improved, primary source drug data• Surveying State FARS unit to identify the documents used to source drug data and the agencies

supplying source documents to FARS• Identifying areas where secondary and tertiary data sources are supplying FARS drug data in lieu of

primary data sources• Addressing obstacles to acquiring primary source drug data• Improving interpretation of primary source drug toxicology documents by FARS

analysts• Using training sessions at the annual FARS System-wide Training event• Leveraging site visits to individual State FARS units to train on documents specific to that state

6Building to Future Drug Data Collection: Ideas

• Expand the scope of FARS drug data reporting through new data elements• Identify salient descriptors corresponding to robust drug data

• Develop a means to warehouse more robust FARS drug data• Explore IT alternatives to current FARS drug data warehousing to:

• Accommodate expanded array of data elements• Contextualize the timing of the specimen collection relative to crash date and

time• Describe types of analysis employed• Identify reporting thresholds for results• Report quantitated values• List all drugs tested and identify negative results as well as positive values

7Spheres of Influence: Obstacles to Outcomes• No current standards in place for drug testing and reporting from toxicology

laboratories – including drug panels and reporting thresholds• The list of available drugs continually evolves – particularly synthetics• State statutes mandating drug testing vary• Compliance with existing State statutes mandating drug testing varies• Administrative decisions may be taken at the jurisdictional level to dismiss

drug testing requests when the threshold to adjudicate impairment based on BAC findings is met

• Intermittent cooperation between agencies generating drug toxicology reports and State FARS unit – often due to a lack of awareness

• Drug toxicology reporting delays related to extended adjudication processes

8Expectations: Measured Approach• Incremental changes to FARS drug data acquisition and data warehousing

process year over year – FARS data collection cycles on a calendar year basis• Dynamic process between FARS data acquisition processes and progress

towards standardization within the field of toxicology• Relationships between the State FARS unit and toxicology drug data

providers varies in complexity – flow of data lacks certainty• IT developments require extensive planning and funding to execute

effectively

FARS is moving in the right direction, at a pace that cannot be rushed.

Thank you

[email protected]

9

Today’s Speakers• Tara Casanova Powell, Casanova Powell Consulting,

[email protected]• Tara Kelley-Baker, AAA Foundation for Traffic

Safety, [email protected]• TrisAnn Jodon, NHTSA, [email protected]• Amy Miles, Wisconsin State University Laboratory

of Hygiene, [email protected]• Amy Berning, NHTSA, [email protected]• Ryan Smith, Virginia Tech Transportation Institute,

[email protected]

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]

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inroSlide Number 1The Transportation Research Board has met the standards and requirements of the Registered Continuing Education Providers Program. Credit earned on completion of this program will be reported to RCEP. A certificate of completion will be issued to participants that have registered and attended the entire session. As such, it does not include content that may be deemed or construed to be an approval or endorsement by RCEP.Slide Number 3

baker-kelleyLimitations of Drug Fatality DataSlide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6But there is a problem…..Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12

Jodan Deck1Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13

MILESLimitations of Drug Fatality Data �The Toxicology PerspectiveLaboratory AccreditationAlcohol and Drug TestingTriage TestingScreening vs ConfirmationOne Size Does Not Fit AllRecommendations for DUID LabsRecommendations for DUID Labs�Tier I DrugsSummaryAmy Miles��Director of Forensic Toxicology�Wisconsin State Laboratory of Hygiene�UW School of Medicine and Public Health

Berning June 2019� ��Understanding the Limitations of Drug Test Information, Testing Practices, and Reporting in Fatal Crashes�FARS Drug Data is not FARS Alcohol Data�Presence is (often) not ImpairmentDifferences in Drug Testing ProceduresVariations in Drug Result ReportingImplications of Variations in Testing, ReportingThis All Means… Slide Number 8NHTSA Research Study on FARS ��Amy Berning, NHTSA�Research Psychologist�Office of Behavioral Safety Research �National Highway Traffic Safety Administration�[email protected]

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Limitations of Drug Fatality Dataonlinepubs.trb.org/onlinepubs/webinars/190613.pdf · • FARS drug...

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Transcript of Limitations of Drug Fatality Dataonlinepubs.trb.org/onlinepubs/webinars/190613.pdf · • FARS drug...