In our recent article, Forensic Toxicology: A Primer, we described “stop testing” as a practice in forensic toxicology laboratories where “if the concentration of alcohol in a biological sample is above a set threshold (i.e., 0.08 g/dL), no further toxicological testing for drugs is conducted.” Due to the variability in prioritization of government funding of forensic toxicology laboratories (i.e., federal, state, county, city, regional, or private entities), significant differences exist in staffing, equipment, testing, and reporting capabilities among laboratories. The lack of standardization of testing, coupled with stop-testing practices naturally led to incomplete data on drug-impaired driving cases. This variance impacts all traffic safety partners in numerous ways, including case adjudication. Addressing lab variances and standardization would provide a more complete picture of what drug(s) an individual used and better support the judicial system and mental health practitioners who provide assessment and treatment plans. However, when forensic toxicology laboratories possess limited resources, they lack the opportunity to provide comprehensive toxicological testing, leading to an incomplete picture of substance use and abuse in the United States related to impaired driving.
February 26, 2025 Winter 2025
The Big Picture:The Importance of Comprehensive Toxicology Testing in Understanding and Addressing Mental Health in Courts
Amy Miles, Sabra Jones, Chris Heartsill, and Kristen Burke
Prevalence of Stop Limit Testing in U.S. Forensic Toxicology Laboratories
The Regional Toxicology Liaisons, in partnership with the Society of Forensic Toxicology’s Toxicology Resource Committee, recently sought to obtain data on government funded toxicology laboratories and stop limit testing practices. Of the approximately 100 laboratories contacted, 50% utilized stop testing practices or only tested for alcohol in driving under the influence of drugs (DUID)/operating under the influence cases. To further explore the impact of stop limit testing, the researchers at the Center for Forensic Science Research recently examined blood samples from over 2,500 DUID cases to determine the drugs missed during evaluation due to stop limit testing. Their findings revealed that in 2,514 suspected DUID cases in which only alcohol was initially identified, the “drug positivity was 79%, nearly double the 40% positive for alcohol.” Further, 23% of the reviewed cases revealed positive test results for both drugs and alcohol, and only 17% of the cases were positive for alcohol alone.
Mental Health, Substance Use Disorders, and Impaired Driving
The National Institute of Mental Health reports that more than one in five U.S. adults live with any mental illness (AMI) (59.3 million in 2022; 23.1% of the U.S. adult population). However, among the 15.4 million adults with Serious Mental Illness (SMI), only 10.2 million (66.7% of SMI, 17.2% AMI) received mental health treatment in the past year. A connection exists between mental and substance use disorders. Individuals with a mental disorder (i.e., anxiety, depression, post-traumatic stress disorder, etc.) may use drugs or alcohol as a form of self-medication. Further, “brain changes in people with mental disorders may enhance the rewarding effects of substances, making it more likely they will continue to use the substance.”
The 2023 National Survey on Drug Use and Health (NSDUH) found that 134.7 million people reported current alcohol use, with 61.4 million reporting binge alcohol use in the previous month.. “The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (28.7% or 9.8 million people), followed by adults aged 26 or older (22.7% or 50.6 million people), then by adolescents aged 12 to 17 (3.9% or 1.0 million people).” To highlight the public safety risk of the excessive use of drugs in the United States, in 2022, 15.6 million people (5.9%) reported driving under the influence of alcohol, a statistically significant increase from 13.4 million people (5.1%) who self-reported such use in 2021. Of the almost 50 million people diagnosed with any substance use disorder, 29.5 million reported alcohol use disorder and 27.2 million acknowledged a drug use disorder, with some individuals diagnosed with both alcohol and drugs use disorders. Unfortunately, in some instances, the first opportunity for help results from the interaction with the criminal justice system and not a preventative option.
Treatment Courts, Comprehensive Toxicological Testing, and Mental Health and Substance Use Disorder Assessment
Treatment courts and the treatment court team members (judge, prosecutor, defense attorney, treatment providers, probation officers, coordinators, law enforcement, peer support and others), can assist in identifying and addressing the issues underlying criminal behavior, such as drug or alcohol substance use disorders and/or mental illness. Treatment court participants have an opportunity to experience recovery from use disorder(s) to reduce future criminal activity. As an alternative to incarceration, treatment courts may “reduce the burden and costs of repeatedly processing low‐level, non‐violent offenders through the nation's courts, jails, and prisons while providing offenders an opportunity to receive treatment and education. Drug court participants are required to abstain from substance use, to be accountable for their behavior, and to fulfill the legal responsibilities of the offenses they have committed.” With a complete toxicology report available as part of the assessment in formulating a treatment plan an opportunity is available for early identification of all of the substances that an individual is abusing. Stop testing, though, potentially results in substances being overlooked and, thus, an incomplete picture of the individual’s use would be developed, and thus an opportunity would be missed. Failing to engage in early identification of drugs of abuse in an offender could also have serious consequences, such as unmonitored withdrawal. Further, comprehensive toxicological testing provides important data on drug trends and drug tolerance data which guides education and prevention efforts.
The Regional Toxicology Liaisons (RTL) are working with publicly funded laboratories in many parts of the country to identify their needs and assist with removing any barriers to comprehensive testing. Courts must be cognizant of the barriers U.S. forensic toxicology laboratories experience that prevent comprehensive testing, and that can affect the information available to courts and treatment teams. The impact of stop limit testing on the work of all traffic safety partners must factor into the evaluation as we continue to explore solutions to reduce the public health threat of impaired driving.
To learn more about the Regional Toxicology Liaison program, please visit: SOFT