State of Knowledge of Drug-Impaired Driving

Jones, R. K. (Ralph K.); Shinar, David; Walsh, J. M. · 2003 · ROSA P / United States. National Highway Traffic Safety Administration

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Summary

This report, commissioned by the National Highway Traffic Safety Administration (NHTSA) and conducted by the Mid-America Research Institute, reviews the state of scientific knowledge regarding drug-impaired driving. Published in 2003, the study synthesizes literature from 1981 to 2001, covering both U.S. and international research. The review addresses four primary domains: the detection and measurement of drugs in drivers, experimental research on drug effects on driving performance, epidemiologic studies of drug prevalence and crash risk, and existing countermeasures. The authors aimed to update previous reviews to inform public policy and identify gaps in current understanding. The methodology involved a comprehensive literature search using specialized libraries, databases such as TRIS and MEDLINE, and expert consultations. Documents underwent a two-level screening process to ensure scientific validity, requiring clear objectives, appropriate statistical techniques, and sound conclusions. The review categorized drugs into classes including narcotics, central nervous system (CNS) depressants, stimulants, cannabis, antidepressants, and antihistamines. It examined laboratory assays, point-of-contact testing technologies, and clinical assessments used in enforcement. Key findings indicate that while laboratory technologies like gas chromatography-mass spectrometry have become more affordable, forensic resources remain insufficient for widespread prosecution. Point-of-contact testing devices offer promise for immediate screening but require further integration. Experimentally, narcotics, long-life benzodiazepines, barbiturates, and first-generation antihistamines showed high potential for significant impairment, whereas CNS stimulants and second-generation antihistamines showed low potential. Cannabis demonstrated moderate impairment potential. Epidemiologically, cannabis was the most prevalent drug found in fatally injured drivers, with a mean positive rate of 14%, compared to 5% or less for other drugs. However, the report highlights a critical limitation: unlike alcohol, current chemical tests cannot reliably determine if a driver was actually impaired at the time of a crash, as drug presence does not equate to causation. Crash risk factors were estimated at approximately 2.0 for benzodiazepines and cannabis, and 1.5 for narcotics. The report concludes that significant gaps remain in understanding drug-crash causality and the effects of chronic drug use. It recommends enhancing forensic capabilities, integrating point-of-contact testing, and conducting rigorous research to establish precise drug-crash risk factors. The authors urge the development of an integrated federal program to address drug-impaired driving, including improved legislation, enforcement strategies, and technological advancements, noting that no evaluations currently exist regarding the impact of countermeasures on crash rates.

Key finding

Cannabis is the most prevalent drug detected in fatally injured drivers, with positive test rates ranging from 7% to 37% and a mean of 14%, significantly higher than other drug classes which average 5% or less.

Methodology

review

Provenance

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Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.

Topics

Ranked by relevance to this paper. Hover a topic for its definition.

• prescription meds
• polydrug
• illicit drugs
• cannabis
• opioids
• drowsy as impairment

Information type

What kind of knowledge this paper contributes, grouped by family — independent of topic (what it is about) and method (how it was studied).

• Empirical Findings: observational prevalence
• Methodological Resource: validation psychometrics