Bupenorphine in Wisconsin Drivers: Concerns for Impairment?

Opinions vary on whether buprenorphine can cause impairment in drivers. Relatively little information on the observed effects of buprenorphine, outside a laboratory or a controlled driving course, exist in the literature. The Wisconsin State Laboratory of Hygiene monitored the detection of buprenorphine and its pharmacologically active metabolite, norbuprenorphine (NBUP), in Wisconsin drivers over a 2-year period. A total of 204 individuals (78 females and 126 males) were driving under the influence of buprenorphine and/or NBUP. Concentrations in whole blood (ng/mL) ranged (mean) from 0.6 to 14 (2.0) and 0.5 to 20 (2.1) for buprenorphine and NBUP, respectively. Poly-substance use is extremely prevalent in Wisconsin operating while intoxicated casework, so prevalent that only four of the previously described cases had buprenorphine and/or NBUP as the only drug(s) detected. This paper summarizes and highlights the case histories and observed impairments of those four cases. Law enforcement (LE) made contact with three of the four subjects due to either a crash or poor/reckless driving. Police reports and observations made by LE, including drug recognition expert (DRE) evaluations, were collected. Physical and behavioral observations made by LE varied and included a combination of narcotic analgesic, central nervous system depressant- and stimulant-like effects. Impaired balance and lack of coordination during the administration of the Standardized Field Sobriety Tests were documented by the arresting officers and/or the DRE. While the number of buprenorphine-only cases reported here is limited, the results demonstrate the complex paradigm associated with forensic interpretation of buprenorphine in driving under the influence of drugs casework and the frequency of poly-substance administration in Wisconsin drivers.

Drugged Driving in Wisconsin: Oral Fluid Versus Blood.

A pilot project was conducted in Dane County, Wisconsin, to evaluate the frequency of individuals driving under the influence of drugs (DUID). Evidentiary blood specimens, collected from subjects arrested for Operating While Intoxicated (OWI), were compared to oral fluid (OF) results obtained with the Alere DDS2®, a handheld screening device. The project objectives were to evaluate (i) the Alere DDS2® for use by police officers in the field, (ii) the frequency of individuals DUID and drugs combined with alcohol among OWI cases, (iii) the differences between detecting drugs in OF and in blood, and (iv) the effect of the laboratory drug testing cancellation policy (LCP) when the blood alcohol concentration (BAC) exceeds 0.100 g/100 mL. Following the arrest and collection of blood, subjects were asked to voluntarily participate in the project and provide an OF specimen. The OF was presumptively screened with the Alere DDS2® for six drug categories including (ng/mL) amphetamine (50), benzodiazepines (temazepam, 20), cocaine (benzoylecgonine, 30), methamphetamine (50), opioids (morphine, 40) and THC (delta-9-THC, 25). Results obtained with the OF screening instrument were not confirmed. A total of 104 subjects (22 female, 82 male), ages 18-72, were included in the project. Blood specimens were tested by gas chromatography-headspace (GCHS-FID) for volatiles, enzyme immunoassay (Siemens Viva-E Drug Testing System), and an alkaline basic drug screen with gas chromatography-mass spectrometry (GCMS) analysis. To compensate for differences between the EIA and the Alere DDS2® drug categories, results from the enzyme immunoassay and the alkaline basic drug screen were combined for purposes of comparing OF to blood. Seventy-six of 104 (73%) subjects arrested for OWI were driving under the influence of alcohol; 71 of the 76 had a BAC exceeding 0.10 g/100 mL. Subjects with a BAC exceeding the LCP, screened positive for drugs in both OF (n = 29) and blood (n = 28). Overall, one or more positive drug screening result was observed in 57 (55%) and 50 (48%) subjects for OF and blood specimens, respectively. THC was the most frequently detected drug category in both OF (n = 46) and whole blood (n = 44). Drug Recognition Expert (DRE) evaluations were performed on 18 subjects. In general, the Alere DDS2® results were consistent with the combined screening results observed in evidentiary blood specimens. This project was limited in scope as a second OF specimen was not collected for confirmation of drugs, however it did demonstrate that nearly 40% of the subjects with concentrations of alcohol exceeding 0.10 g/100 mL, screened positive for one or more drug categories in both OF and blood. The Alere DDS2® portable OF screening instrument may be useful in assisting law enforcement with identifying individuals driving under the influence of drugs and establishing probable cause at roadside for making DUID arrests.