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Safety Recommendation Details

Safety Recommendation H-12-033
Details
Synopsis: The National Transportation Safety Board (NTSB) has long been concerned about alcohol-impaired driving, which accounts for approximately one-third of all US highway fatalities. Between 1982 and 1994, the percentage of fatally injured drivers with a blood alcohol concentration (BAC) greater than or equal to 0.08 decreased from 49 to 33 percent. However, since that time, there has been no further decline in the percentage, and efforts are needed to address this lack of progress. The NTSB has issued more than 120 safety recommendations on impaired driving since 1968, and “Addressing Alcohol-Impaired Driving” is on the NTSB’s Most Wanted List. The National Highway Traffic Safety Administration (NHTSA) estimates that alcohol-impaired driving in the United States continues to kill over 10,000 people yearly and to injure many more despite numerous federal, state, and local efforts. The NTSB is also concerned about the growing problem of drug use by drivers. According to NHTSA, from 2005 to 2009, the proportion of fatally injured drivers who tested positive for drugs (illicit, prescription, and over-the-counter) rose from 13 to 18 percent. According to NHTSA’s 2007 National Roadside Survey, 16.3 percent of weekend nighttime drivers tested positive for drugs. The growing prevalence of drugged driving has also captured the attention of the White House Office of National Drug Control Policy, which cites the following principle in its 2011 National Drug Control Strategy: “Preventing drugged driving must become a national priority on par with preventing drunk driving.” In May 2012, the NTSB held a forum to identify the most effective, scientifically based actions needed to “reach zero” accidents resulting from substance-impaired driving. Numerous impaired driving countermeasures were discussed at the forum, including laws, enforcement strategies, adjudication programs, substance treatment programs, ignition interlocks, passive alcohol detection systems, and educational campaigns. Presenters discussed the merits and drawbacks of various countermeasures, as well as the challenges to reducing impaired driving. Reductions in accidents and injuries attributable to impaired driving are the ultimate measures of success. However, inadequate data collection and reporting in many states continue to limit our ability to understand and address the problem of impaired driving and to measure the effectiveness of countermeasures.
Recommendation: TO THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION: Develop and disseminate to appropriate state officials a common standard of practice for drug toxicology testing, including (1) the circumstances under which tests should be conducted, (2) a minimum set of drugs for which to test, and (3) cutoff values for reporting the results.
Original recommendation transmittal letter: PDF
Overall Status: Open - Acceptable Response
Mode: Highway
Location: Washington, DC, United States
Is Reiterated: Yes
Is Hazmat: No
Is NPRM: No
Accident #: DCA12SS003
Accident Reports:
Report #: None
Accident Date: 5/15/2012
Issue Date: 11/21/2012
Date Closed:
Addressee(s) and Addressee Status: NHTSA (Open - Acceptable Response)
Keyword(s):

Safety Recommendation History
From: NTSB
To: NHTSA
Date: 7/1/2019
Response: We note that you continue to develop the recommended standard of practice for drug toxicology testing. We are encouraged by your plans to publish a request for comments in the Federal Register to receive public input on the scope and use of the guidance, and we urge you to process this information expediently. Pending our receipt and review of the disseminated guidance, Safety Recommendation H-12-33 remains classified OPEN--ACCEPTABLE RESPONSE.

From: NTSB
To: NHTSA
Date: 6/20/2019
Response: The National Transportation Safety Board (NTSB) has reviewed the National Highway Traffic Safety Administration’s (NHTSA) request for public comment on a proposed collection of information, which was published in 84 Federal Register 17233 on April 24, 2019. NHTSA intends to perform a toxicology evaluation of blood specimens obtained from seriously or fatally injured people involved in motor vehicle crashes who are taken to a small group of trauma centers and morgues. Specifically, the request asks for public comment on the following: (i) Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility; (ii) The accuracy of the agency’s estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used; (iii) How to enhance the quality, utility, and clarity of the information to be collected; and (iv) How to minimize the burden of the collection of information on those who are to respond, including the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submissions of responses. The NTSB finds the proposed collection of information to be necessary, proper, and useful; the methodology to be valid; the quality and clarity of the proposed collected information to be appropriate; and the collection techniques to be suitable. For the reasons provided below, the NTSB supports NHTSA’s research efforts to better understand the prevalence of alcohol and other drug use among motor vehicle crash victims admitted to selected trauma centers and morgues. As a result of its investigation of a 1983 fatal aviation crash in which two cargo pilots were each found to have used substances that impaired their decision-making and flying abilities, the NTSB issued the following safety recommendation to the Federal Aviation Administration (FAA): A-84-93 Establish at the Civil Aeromedical Institute the capability to perform state of the art toxicological tests on the blood, urine, and tissue of pilots involved in fatal accidents to determine the levels of both licit and illicit drugs at both therapeutic and abnormal levels. In response, the FAA established its Forensic Sciences Laboratory in Oklahoma City, Oklahoma. For more than three decades, this laboratory has performed extensive toxicological tests on every fatally injured pilot involved in a civil aviation accident in the United States. Consequently, we have a better understanding of drug use trends among these pilots. However, fatally injured drivers are not currently evaluated for alcohol and other drug use as completely as fatally injured pilots. For example, in 2017, according to the NHTSA Fatality Analysis Reporting System annual report file, only 57 percent of fatally injured drivers were tested for drugs other than alcohol. The tests that were performed varied by state and jurisdiction, including which drugs were tested for, how the test was performed, what type of specimen was tested, and what level of drug was considered “positive.” The NTSB has made several recommendations regarding driver drug testing over the years. In 2012, the NTSB held a forum to identify the most effective, scientifically based actions needed to reduce substance-impaired driving crashes. As a result of that forum, the NTSB issued the following safety recommendation to NHTSA: H-12-33 Develop and disseminate to appropriate state officials a common standard of practice for drug toxicology testing, including (1) the circumstances under which tests should be conducted, (2) a minimum set of drugs for which to test, and (3) cutoff values for reporting the results. In its November 21, 2012, letter to NHTSA issuing Safety Recommendation H-12-33, the NTSB noted that— Although collecting consistent postaccident drug data alone will not solve the problem, it will give researchers and policymakers a better understanding of the prevalence of drug use among drivers, as well as provide tools with which to assess the risks associated with various substances. And, importantly, it will provide a reliable and valid marker of the effectiveness of laws, enforcement, education, and other countermeasures to address drugged driving. In 2018, NHTSA established a toxicology data collection expert working group to improve overall understanding of the national scope and prevalence of drug-impaired driving. The working group is developing draft standards for the forensic toxicology community to follow to encourage the standardization of drug testing across jurisdictions. This request for public comment shows NHTSA is taking another step to better evaluate the use of alcohol, over-the-counter and prescription medications, and other drugs by individuals involved in serious or fatal motor vehicle crashes. The NTSB believes this work is crucial to NHTSA’s proper performance of its agency functions, particularly addressing the safety hazards caused by driver impairment. The NTSB notes the blood specimens will be left over from those already drawn and used for medical care and that demographic data will be deidentified. Consequently, there will be no evident burden placed on the public or the individuals involved in the research. The NTSB fully supports NHTSA’s research efforts to better understand the prevalence of different drugs used among the seriously and fatally injured motor vehicle crash victims taken to the trauma centers and morgues participating in the work. Thank you for the opportunity to provide comments.

From: NHTSA
To: NTSB
Date: 4/18/2019
Response: -From Jonathan Morrison, Chief Counsel: NHTSA, along with other federal agencies and senior toxicologists, is working on guidance for drug toxicology testing for drug-impaired driving. This guidance is expected to include information on the circumstances under which tests should be conducted, a minimum set of drugs for which to test, test procedures to use, and appropriate cutoff values, by drug. NHTSA anticipates publishing a request for information in the Federal Register Notice in late spring 2019 to request public comment on the need for this guidance, topics it should address, and means to facilitate adoption of this guidance. NHTSA requests that this recommendation be listed as Open, Acceptable Response.

From: NTSB
To: NHTSA
Date: 11/20/2018
Response: From NTSB Highway Accident Report, “Pickup Truck Centerline Crossover Collision with Medium-Size Bus on US Highway 83, Concan, Texas, March 29, 2017.” Report Number HAR-18-02. Adopted on October 16, 2018 and published on November 20, 2018: 2.4.3.2 Drug Toxicology Testing. Postcrash drug toxicology testing is inconsistent among the states. There is currently no national guidance on a minimum set of drugs that should be tested for, recommended methods for drug testing, or reporting thresholds for crash databases. Collecting consistent postcrash drug data will provide policymakers with a better understanding of the prevalence of drug use among drivers, as well as the tools with which to assess the risks associated with various substances. National guidance would provide a more reliable marker of the effectiveness of laws, enforcement, education, and other countermeasures in addressing drug-impaired driving. As a result of the NTSB forum on “reaching zero” crashes from substance-impaired driving, we recommended that NHTSA (NTSB 2013): Develop and disseminate to appropriate state officials a common standard of practice for drug toxicology testing, including (1) the circumstances under which tests should be conducted, (2) a minimum set of drugs for which to test, and (3) cutoff values for reporting the results. (H-12-33) NHTSA has informed the NTSB that it is developing a recommended standard of practice for drug toxicology testing. In 2016, NHTSA provided support for the review and update of a set of recommendations developed by the National Safety Council–Alcohol, Drugs, and Impairment Division for toxicological investigation of drug-impaired driving cases and motor vehicle fatalities (Logan and others 2018). In 2018, NHTSA formed an expert working group focused on toxicology and data collection (see also section 2.4.3.5). Safety Recommendation H-12-33 is classified “Open—Acceptable Response.” 2.4.3.3 GHSA Actions. The GHSA recently updated its guidance to assist states in managing the drug-impaired driving problem (GHSA 2017). The guidance covers laws, enforcement, adjudication, toxicology testing procedures, education, and data collection. A recent GHSA report examines the impact of marijuana and opioid use on driving and crash causation, and recommends state actions to address drug-impaired driving (GHSA 2018). Although the NTSB is pleased with these GHSA initiatives, state actions should be closely monitored to identify the most effective practices and countermeasures. 2.4.3.4 AAA-Sponsored Research. Section 2.3.5 (drug impairment) discusses the dangers of DUID, including the impairing effects of many prescription medications. The AAA Foundation for Traffic Safety, through the Virginia Tech Transportation Institute, sponsored a major research project on drug-impaired driving countermeasures. The project report, Countermeasures Against Prescription and Over-the-Counter Drug-Impaired Driving, is scheduled for release in October 2018. As another resource for states, researchers, and practitioners, the report discusses drug-impaired driving countermeasures in four major areas: pharmacy and medical, data recording and toxicology, law enforcement and judicial, and education and advertising. 2.4.3.5 National Leadership. Many states and local jurisdictions have developed legislation and policy and implemented countermeasures to address the increasing prevalence of drug-impaired driving. Moreover, highway safety organizations such as GHSA and AAA have developed related reports and recommended specific countermeasures. Again, however, it is critical that the effectiveness of state laws and countermeasures be closely monitored to identify and disseminate best practices. In January 2018, NHTSA introduced an initiative to combat drug-impaired driving. Responding to the national opioid epidemic and the decriminalization of marijuana in many states, NHTSA announced that a top priority of the agency was to ensure that “U.S. roads, communities and families are safe from impaired drivers.” A March 2018 call-to-action campaign brought together key stakeholders, safety partners, data and policy experts, law enforcement and criminal justice professionals, toxicologists, and drug experts. Summit participants agreed on the urgent need for a coordinated plan to address the drug-impaired driving problem. NHTSA committed to seeking additional input through a series of regional meetings and to working closely with stakeholders in developing an action plan. When states develop highway safety plans, they frequently refer to Countermeasures That Work: A Highway Safety Countermeasure Guide for State Highway Safety Offices to address critical safety issues, such as combating impaired driving (NHTSA 2018). Although the guide contains extensive information on countermeasures to reduce alcohol-impaired driving (including prevention, intervention, communication, and outreach campaigns), it includes relatively few science-based safety countermeasures to address drug-impaired driving. Through continued collaboration with stakeholders, NHTSA could provide a valuable resource to states by identifying those countermeasures proven to be the most effective in reducing drug-impaired driving. 2.4.3.5 Safety Recommendations. The NTSB concludes that because the use of legal and illicit drugs by drivers is increasing, national leadership is needed to help prevent drug-impaired driving crashes by identifying best practices, effective science-based safety countermeasures, and drug testing protocols. Therefore, the NTSB recommends that NHTSA evaluate best practices and countermeasures found to be the most effective in reducing fatalities, injuries, and crashes involving drug-impaired drivers and provide additional guidance to the states on drug-impaired driving in Countermeasures That Work: A Highway Safety Countermeasure Guide for State Highway Safety Offices. Because more consistent postcrash data are needed to monitor the effectiveness of laws, enforcement, education, and countermeasures, the NTSB also reiterates Safety Recommendation H-12-33 to NHTSA.

From: NTSB
To: NHTSA
Date: 11/13/2017
Response: Your staff has informed us that you are developing the recommended standard of practice for drug toxicology testing. Pending our receipt and review of the disseminated guidance, Safety Recommendation H-12-33 is classified OPEN--ACCEPTABLE RESPONSE.

From: NTSB
To: NHTSA
Date: 6/3/2013
Response: From the safety report Reaching Zero: Actions to Eliminate Alcohol Impaired Driving (NTSB/SR-13/01, adopted May 13, 2013, notation 8482): Since the 2012 forum, the NTSB has taken additional steps to address the problem of impaired driving. In November 2012, the NTSB identified eliminating substance-impaired driving as one of 10 transportation safety areas on its Most Wanted List. By expanding the safety area from alcohol-impaired driving to substance-impaired driving, the NTSB recognized the need to address the growing problem of drug-impaired driving, of which alcohol-impaired driving is a substantial component. Although this report is focused on reducing alcohol-impaired driving, the NTSB has made numerous recommendations to address drug-impaired driving, and it continues to seek means of addressing this problem. Also in November 2012, as one outcome of the May 2012 forum, the NTSB made six recommendations calling for improvements to BAC testing and reporting in crashes, common standards for postcrash drug tests, and better tracking of place of last drink (POLD) data (NTSB 2012a, standalone recommendation letter). These recommendations recognize the criticality of obtaining robust data to determine the scope of safety issues, track changes over time, and assess the effectiveness of countermeasures. Specifically, the NTSB recommended that NHTSA take the following actions: H-12-32 Develop and disseminate to the 50 states, the Commonwealth of Puerto Rico, and the District of Columbia blood alcohol concentration (BAC) testing and reporting guidelines based on the 2012 report State Blood Alcohol Concentration Testing and Reporting for Drivers Involved in Fatal Crashes: Current Practices, Results, and Strategies, 1997–2009. H-12-33 Develop and disseminate to appropriate state officials a common standard of practice for drug toxicology testing, including (1) the circumstances under which tests should be conducted, (2) a minimum set of drugs for which to test, and (3) cutoff values for reporting the results. The NTSB also made the following recommendations to the 45 states that have low reporting rates for BAC testing,18 the Commonwealth of Puerto Rico, and the District of Columbia: H-12-34 Increase your collection, documentation, and reporting of blood alcohol concentration (BAC) test results by taking the following actions, as needed, to improve testing and reporting rates: (1) enact legislation, (2) issue regulations, and (3) improve procedures used by law enforcement agencies or testing facilities. H-12-35 Once the National Highway Traffic Safety Administration has developed the blood alcohol concentration (BAC) testing and reporting guidelines recommended in Safety Recommendation H-12-32, incorporate the guidelines into a statewide action plan to achieve BAC reporting rates of at least 80 percent of fatally injured drivers and at least 60 percent of surviving drivers involved in fatal crashes. To the 50 states, the Commonwealth of Puerto Rico, and the District of Columbia, the NTSB recommended the following action: H-12-36 Require law enforcement agencies to collect place of last drink (POLD) data as part of any arrest or accident investigation involving an alcohol-impaired driver. To the International Association of Chiefs of Police and the National Sheriffs’ Association, the NTSB recommended the following action: H-12-37 Inform your members of the value of collecting place of last drink (POLD) data as part of any arrest or accident investigation involving an alcohol-impaired driver. Safety Recommendations H-12-32 and -33 are in “Open—Acceptable Response” status, and Safety Recommendations H-12-34 through -36 are in “Open—Await Response” status. Safety Recommendation H-12-37 is in “Open—Acceptable Response” status to the International Association of Chiefs of Police and in “Open—Await Response” status to the National Sheriffs’ Association. Because the NTSB continues to consider that improvements to BAC testing and reporting following accidents, common standards for postaccident drug tests, and better tracking of POLD data are necessary, it reiterates Safety Recommendations H-12-32 through -37. In December 2012, the NTSB held a Board Meeting on wrong-way driving collisions, during which the Board called on NHTSA and the Automotive Coalition for Traffic Safety, Inc., (ACTS)19 to accelerate implementation of the Driver Alcohol Detection System for Safety (DADSS). DADSS refers to passive vehicle-based systems that would identify driver alcohol use by touch or by measuring a driver’s exhaled breath; they then would prevent vehicle operation by drivers above the legal limit (NTSB 2012c, wrong-way report). Specifically, the NTSB recommended that NHTSA take the following action: H-12-43 Work with the Automotive Coalition for Traffic Safety, Inc., to accelerate widespread implementation of Driver Alcohol Detection System for Safety (DADSS) technology by (1) defining usability testing that will guide driver interface design and (2) implementing a communication program that will direct driver education and promote public acceptance. The NTSB also recommended that the 33 states that do not mandate the use of interlocks for all DWI offenders, the Commonwealth of Puerto Rico, and the District of Columbia take the following action: H-12-45 Enact laws to require the use of alcohol ignition interlock devices for all individuals convicted of driving while intoxicated (DWI) offenses. Chapter 5 discusses these recommendations concerning technologies that prevent a person from driving a vehicle while impaired.

From: NTSB
To: NHTSA
Date: 3/28/2013
Response: We are encouraged that NHTSA is working with the ONDCP to develop an effective drug impairment testing program and that NHTSA is evaluating the workplace drug testing program currently used by the states as a framework for an expanded program for driver testing. As discussed at the January 28, 2013, meeting, although the scope of the expanded testing is a challenge that needs to be addressed, the established workplace program includes the elements recommended in Safety Recommendation H-12-33, and existing resources could be used in support of a new driver testing program. We are further encouraged that the ONDCP is developing an oral fluids testing device that will support improved collection of impairment data and the establishment of more accurate cutoff percentages for a larger number of drugs. We commend NHTSA for its proactive partnership with the ONDCP and look forward to receiving periodic updates on the development of the drug testing program for drivers. Pending completion of these actions, Safety Recommendation H-12-33 is classified OPEN—ACCEPTABLE RESPONSE.

From: NHTSA
To: NTSB
Date: 1/29/2013
Response: -From David L. Strickland, Administrator: While we believe that this recommendation is directionally correct, we are concerned that such an initiative by NHTSA may be duplicative of work already underway by other Federal agencies. We work closely with the Office of National Drug Control Policy (ONDCP) on drugged driving issues, and base our activities on the directions outlined in the President's National Drug Control Strategy. The Drug Control Strategy includes attention to the problem of drugged driving and has previously recommended that agencies in the Department of Health and Human Services pursue the development of standards for drug testing. Since recommendation H-12-33 may be duplicative of these ongoing efforts, we have scheduled a meeting with your staff and the ONDCP in late January 2013, to review plans. Until this meeting takes place and the roles of participating agencies in addressing this issue are resolved, we request this recommendation be classified as Open- Alternative Action.