P-PG/RTD(2006)4 EN

Driving and alcohol, drugs and medicine: concerted European action needed

Driving under the influence of drugs other than alcohol has been a subject of increasing concern to the authorities in recent years. While alcohol is still the substance most frequently detected in drivers, whether responsible for fatal road accidents or not, illegal drugs and psychoactive medicines have also made a noticeable appearance in the statistics.

Epidemiological data are scarce, however, and where they exist they are difficult to compare because of the lack of uniformity in the study protocols and the survey and analysis methods used. Recent studies conducted in France and Scandinavia, in particular, have attempted to shed light on the situation in those parts of the world. And the European Commission will be launching a vast research programme called "Druid" in autumn 2006.

Available information on the subject was presented at the Seminar organised on 10 and 11 July in Strasbourg by the Council of Europe's Pompidou Group. Fifty-odd participants – government experts, researchers, judges, lawyers, doctors and police officers – shared their experiences and examined means of co-operating and exchanging ideas at the European level to tackle what threatens to become a real scourge, particularly among young people.

Alcohol and cannabis together considerably increase the risk of fatal accidents

"Alcohol remains a serious road safety problem, but its effects are far greater when it is combined with cannabis or other drugs", said psychologist Wolf Rüdiger Nickel, President-Elect of the International Council on Alcohol, Drugs and Traffic Safety (ICADTS) and general rapporteur for the seminar. According to the French SAM survey carried out by the Direction Générale des Stupéfiants (DGS – drugs directorate) and the Observatoire Français des Drogues et des Toxicomanies (OFDT), "driving under the influence of narcotic substances increases the risk of causing a (fatal) accident" and "being under the influence of narcotic substances at the time of the accident increases the risk of death (for the driver)".

2270 of the 6000 fatal accidents recorded annually on French roads are purportedly due to the effects of alcohol, and no fewer than 230 to THC. 3 drivers out of 100 are believed to drive under the influence of cannabis, which is thought to be responsible for 2.5 % of fatal accidents. Particularly exposed are young males (14-24 years old) driving two-wheeled vehicles at night during the week-end. The study also reveals, however, that the added risk increases considerably with the presence of both THC and alcohol in the blood. Driving under the influence of both cannabis and alcohol multiplies the fatal accident risk to a young motorcyclist by 170, for example.

Similar findings were made in Scandinavia, where survey results show that alcohol and drugs play a significant role in fatal accidents. The study goes even further, concluding that drugs, particularly benzodiazepines, seem to have almost as great, if not as great an influence as alcohol. The situation seems to be changing fast, as a similar survey conducted in Norway in 1989-1990 found that the effects of drugs on drivers were behind 20% of fatal accidents, compared with 40% in 2002.

"The simultaneous abuse of alcohol and drugs increases the dangers", Joël Valmain of the European Commission's Road Safety Unit confirmed. This phenomenon has disastrous effects, especially among young people: "every year in Europe, 2000 young people kill themselves in road accidents in the small hours of Sunday morning, driving home from clubs or parties", he deplored.

Research: when will we have reliable screening tests?

The experts at the seminar deplored the lack of reliable roadside tests for detecting the presence of psychotropic substances, particularly cannabis. Current saliva tests are only 50% reliable when it comes to testing for THC (compared with 85 to 90 % for other drugs). Only blood tests are really reliable, but they have one major drawback – their cost.

Rapidly changing consumption habits, with the arrival of new drugs, for example, and the abuse of legal substances such as medicinal drugs, also hinder the development of reliable screening tests. Where and how should the tests be carried out?  Random or systematic testing is a bone of contention: when should blood tests be carried out if the urine or saliva test is negative but the suspicion great?

The Tispol representative, Cor Kuijten, emphasised the need to train the police to detect drivers under the influence by observing their behaviour. The test would then be carried out on a random, "instinctive" basis, as it is for alcohol. Here again, however, leaving aside the ethical issues raised by the participants, the cost alone of such training programmes is prohibitive.

National legislations and penalties: considerable dispatities subsist

Legal proceedings against drivers under the influence of drugs remain rare, the sentences pronounced vary and the difficulties encountered in proving guilt are great. The participants agreed to conclude that it was essential to develop more effective domestic legislation.

The studies carried out by the EMCDDA reveal substantial differences between legislations and the penalties incurred in different European countries. Many European states do not carry out roadside tests to detect the presence of alcohol and psychotropic substances in drivers, and fewer than 50 % report the existence of legislation on the subject.

Offender rehabilitation: essential for social cohesion

One of the most common penalties is withdrawal of the driver's licence for a certain period, or for good in the event of repeat offences. Participants expressed numerous reservations about this measure, which should not be considered a miracle solution.

According to Wolf R. Nickerl, "banning drivers for life serves no purpose as they just carry on driving without a licence, so the cure is worse than the ill".

We must identify the problem and develop a multidisciplinary solution, not one of exclusion in a world where motor vehicles are vectors of integration, several speakers pointed out. This means that the main concern is to rehabilitate the offender and avoid recidivism.

In this respect the role of the prescribing doctor was highlighted, who "is in a privileged position, because he has a unique relationship with the patient based on trust, to give him useful information and advice in addition to health care". Charles Mercier-Guyon, a French GP and Secretary of the Road Safety Medical Council, considered that doctors should be ready to join the other players, prevention associations and state services to bring a certain social "pressure" to bear on the individuals concerned.

The different countries seem to agree that there is no "global" solution, but rather individual strategies, depending on the driver. In Germany and Austria young people caught driving under the influence of drugs can join support groups where they talk about their problems and receive help. For six weeks they agree to undergo random screening tests at any time of the day or night and for any reason. If they do not take any drugs during the six-week period, they can sit their driving test again. Recidivism remains high, however. There are other solutions, such as the "autolock", a device that prevents the car from starting if the driver's breath contains too much alcohol, and which could be adapted to certain drugs.

Finally, drivers should be better informed about the combined dangers of drink and drugs. We know that strict road safety measures are unpopular with the general public, which does not make it any easier for governments. So information campaigns certainly have a major role to play in the future.

More exchanging of information and harmonisation at the European level

In order to provide comparative studies and statistics at European level, the Pompidou Group, the Council of Europe body responsible for drug prevention, and interested national agencies were invited to contribute more to the collection and dissemination of information.

A vast research programme called "Druid" will also be launched this autumn by the European Commission. Represented at the Seminar, the programme should provide for a number of the needs and concerns voiced by the experts in various fields. Its aim is to optimise policies to prevent drivers from drinking and taking drugs or other legal or illegal psychotropic substances. It should also teach us more about the effects of the different psychotropic substances on driving, encourage epidemiological studies, improve testing and screening techniques and help evaluate preventive and repressive policies.