Interventions to Prevent Drugged Driving: A Systematic Review
Author(s): Razaghizad, Windle, Gore, Benedetti, Ells, Grad, Filion, Eisenberg
Slidedeck Presentation:
Abstract:
Background:
Literature suggests that cannabis legalization may increase fatal motor vehicle collisions. However, evidence on the effectiveness of interventions to prevent drugged driving is limited.
Aims:
The objective of this systematic review was to therefore evaluate and compare the effectiveness of interventions for the prevention of drugged driving based on measures of drugged driving knowledge, attitudes, behaviors, and traffic-related outcomes among adults and youth.
Methods:
MEDLINE, PsycINFO, Web of Science, EMBASE, SafetyLit, Criminal Justice Database, Transport Research International Documentation, bibliographies, and relevant grey literature were searched systematically through May 2020. Randomized and non-randomized studies of preventive interventions measuring drugged driving outcomes were included. Evidence certainty was judged per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines to designate quality ratings very low to high.
Results:
The search identified 11 randomized controlled trials and 17 non-randomized studies conducted predominantly among youth (ages 15-25 years; N=33,711 of 37,117 active research participants). In the public, cannabis packaging with health warnings increases knowledge about drugged driving effects (high certainty); roadside drug testing can reduce drugged driving among cannabis users (moderate certainty); media campaigns may increase deterrent attitudes and knowledge (low certainty); and state sanctions including traffic offense criminalization, license withdrawal, and per se drugged-driving laws may have little or no effect on fatalities or injuries (very low to low certainty). For adolescents, young adults, and previous offenders, motivational interviewing can prevent drugged driving and driver education programs can increase knowledge (moderate certainty); while drug abuse prevention, substance abuse treatment, and driver rehabilitation may prevent drugged driving (very low certainty).
Discussion:
Although previous research on the impact of drugged driving has implicitly relied on studies of drink driving prevention, the prevention of drugged driving brings unique challenges. Particularly for cannabis-impaired driving, perceptions of risk are substantively lower than for drink driving; research participants commonly report feeling more cautious, and negligible fear of police involvement when driving impaired. Addressing social norms is likely to be an important aspect for prevention as surveys have shown that cannabis-impaired driving is associated with having more friends who use the substance. State-level media campaigns have already implemented a socioecological approach. These campaigns aim to respectively address cannabis- and drug-impaired driving through changing social attitudes. Whether drug-specific, youth-targeted, or broad preventive strategies are most effective and feasible remains to be determined by future interrupted time-series analyses. Standardized the collection and reporting of drugged driving related data represents a productive avenue to improve prospective research.
Conclusions:
Overall, there is evidence to support interventions that may improve drugged driving knowledge, attitudes, and behaviors among adolescents and young adults. However, data are more limited concerning the impact of such interventions on measures of drugged driving-related morbidity and mortality. Further investigation that implements the current analytical framework for drugged driving prevention is urgently required to address these gaps in knowledge. Potential avenues for future research include interventions and public education campaigns that emphasize social norms and perceived risks regarding drugged driving predominantly among youth.