Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

A variety of related literature and studies incorporated in this study are put

forward to see the relationship of the identified variables. This chapter presents an

overview of previous research about the study in regards to road accidents by drug

and drunk driving and the implementation of Mandatory drug testing and alcohol-

level checking among bus drivers. The discussion is organized based on the topics

which are the focus of the study.

Status of Global and Local Road Accidents

Road safety is one of the most substantial entity in public health. Aside from the

fact that it may involve human’s life, it can also affect socio-economic progress.

Vehicle accident can cause slow movement of traffic that may lead to

unproductiveness of an individual or even firm and other business (Asor, et al., 2018).

Vehicle accident cannot always be considered as accident but rather a collision,

because accident is an undesirable and unexpected event without apparent cause.

According to an article by SmartMotorist (2011) stated that the four factors affecting

road accidents are equipment failure, roadway design and no proper signage in the

road, poor roadway maintenance and driver behavior.

Every year, millions more road victims are added to the current toll of over 50

million killed and hundreds of millions injured since the first road death 125 years ago

last August – a disaster that continues day in and day out in all countries of the world

(UN, 2022). Lookin at the numbers of death by road accidents for the past years, you

can easily conclude that the number of incidents are alarming, considering that the
 11

issue has not yet been resolved up to this day, and is still predicted to increase as

countries are developing in a fast pace and the number of people who use vehicles are

keep on adding up every year. Each year, 1.35 million people are killed on roadways

around the world. Every day, almost 3,700 people are killed globally in crashes

involving cars, buses, motorcycles, bicycles, trucks, or pedestrians. More than half of

those killed are pedestrians, motorcyclists, or cyclists. Crash injuries are estimated to

be the eighth leading cause of death globally for all age groups and the leading cause

of death for children and young people 5–29 years of age. More people now die in

crashes than from HIV/AIDS (CDC, 2021).

About 85% of anniversary deaths are occurring in developing countries. (Vague)

Males especially those between 15 and 44 years old is the extremely affected group of

people with traffic accidents. Traffic accidents expenditure of countries is 1 to 2% of

their total national products. Even although only 52% of vehicles in the world are,

recorded in developing countries, 80% of road traffic deaths take place in these

countries (WHO, 2013).

In the Philippines, with a total of 29.67 million vehicles registered with the Land

Transportation Office, saw an increasing trend in road accidents. In Metro Manila

alone that consists of 16 cities and 1 municipality, with a population of 13.9M and

6.68M registered vehicles, the number of road accidents doubled from 63,072 in 2007

to 116,906 in 2018, resulting in a yearly average of 566 fatalities based on Metro

Manila Accident Reporting and Analysis System report on situation on road accidents

in the Philippines (MMARAS, 2018). This led the Philippine Department of Health

(DOH) tagged that road accidents as major leading causes of death overtaking other

health and deadly diseases, including dengue, in the list of causes of deaths

([Link], 2020). Also reported in MMARAS (2019) was the classification of

accidents in Metro Manila into Fatal with 372 cases, NonFatal with 20, 466 cases and

Damage to Property with 100,933 cases. The most common nature of road accidents

was collision with the following types: side-swipe, rear-end, angle impact, hit and run,

multiple collision, self-accident, hit parked vehicle, head on and hit object. The most

leading road accident cause was human interface errors, such as, lack of experience

on driving, unfamiliar road signs and locations, fell asleep, lost control and drive

under the influence of alcohol. Another cause was due to mechanical defects, namely:

electrical problem, loose brake, loose propeller, exploded tire and flat tire

([Link], 2020). Other factors that led to casualties to pedestrians, drivers and

passengers included environmental related and road issues and vehicle traffic

involving driver’s over speeding, driving under the influence of alcohol, not good in

overtaking, improper turning of the wheel and even pedestrian’s jaywalking.

Road Accidents by Drunk Driving

It has been known that alcohol use impairs driving skills and increases accident

risk. It has been found that while driving under the influence of alcohol, the risk of

having an accident causing injury or death increases exponentially (Zhao, X., Zhang,

X., & Rong, J., 2014). In Europe, drinking driving is thought to be responsible for

10,000 deaths each year. Alcohol-impaired driving accidents contribute to

approximately 31% of all traffic fatalities in the USA. In China, it was revealed that

about 34.1% of road accidents were alcohol related. Drunk driving has a high

probability to lead to serious accidents. Even with a small amount of alcohol

assumption, drivers are twice likely to be involved in traffic accidents than sober

drivers (Li et al., 2012).As a result, numerous nations have been working on solutions

to drunk driving for a very long time, including public awareness campaigns,
 13

education campaigns, and strict drunk driving laws. Laws against driving after

intoxication have been passed, and offenders face severe penalties.

The range of BAC legal limits is between 0.01% and 0.08%. For instance, in

Sweden, Israel, Korea, and Australia, the limit is 0.02%; in Canada, England, Mexico,

and the United States, it is 0.08%; and in Sweden, it is 0.05%. In China, driving while

intoxicated is considered to be drink driving, and the offender will face consequences.

Additionally, driving while intoxicated is illegal and is defined as having a BAC of

0.08 percent or higher (Zha0, et al., 2014).

According to the European Commission, 25% of all deaths on the road in the EU

are alcohol-related. Worldwide, of the estimated 1.25 million annual road deaths,

273,000 are thought to have involved at least one drunk driver (Uddin, 2022).

Moreover, National Highway Traffic Safety Administration reported that over the 10-

year period from 2010 to 2019, more than 10,000 people died each year in drunk

driving car accidents (Masterson,2023). In NHTSA's roundup statistics about driving

includes; In 2017, 32% of all drivers involved in fatal crashes while driving at night

were drunk. Almost twice as many alcohol-related and fatal car crashes occur during

the weekend. In 2017, there were four male, alcohol-impaired drivers for every one

female alcohol-impaired driver out on the road. And in 2019, there were 50,930

drivers in fatal car crashes, and an estimated 19% of the drivers were alcohol-

impaired (NHTSA, 2019).

In the Philippines, 12,000 road users die annually due to road crashes and almost

one-third are alcohol-related crashes (Lu, J. L., Herbosa, T. J., & Lu, S. F., 2022).

About 25 percent of which are related to the harmful consumption of alcohol.

Moreover, many Filipinos remain unaware of the risks of drinking then driving—
 14

and that the effects of alcohol could kick in once the motorist is on the road (MB,

2022).

Road Accidents by Drug Driving

Drugged driving has become a safety issue of increasing public concern in the

United States and many other countries (Brady and Li, 2013; Dupont et al., 2012;

Legrand et al., 2013). According to the 2018 National Survey on Drug Use and Health

(NSDUH), in 2018, 20.5 million people aged 16 or older drove under the influence of

alcohol in the past year and 12.6 million drove under the influence of illicit drugs.

And the survey also showed that men are more likely than women to drive under the

influence of drugs or alcohol. A higher percentage of adults aged 21 to 25 drive after

taking drugs or drinking than do young adults aged 16 to 20 or adults 26 or older

(NIDA, 2019). In addition, after alcohol, marijuana is the drug most often found in the

blood of drivers involved in crashes. Tests for detecting marijuana in drivers measure

the level of delta-9-tetrahydrocannabinol (THC), marijuana’s mind-altering

ingredient, in the blood. But the role that marijuana plays in crashes is often unclear.

THC can be detected in body fluids for days or even weeks after use, and it is often

combined with alcohol. The vehicle crash risk associated with marijuana in

combination with alcohol, cocaine, or benzodiazepines appears to be greater than that

for each drug by itself.

A 2018 report from the Governors Highway Safety Association (2016) show that

43.6% of drivers in FARS (Fatality Analysis Reporting System) with known drug test

results were drug-positive. Over half of drug-positive drivers were positive for two or

more drugs and 40.7% of drug-positive drivers were also positive for alcohol.

Marijuana was the most common drug among fatally-injured drivers -- its prevalence

has increased in recent years as well as the prevalence of opioids.

In 2019, of fatally injured drivers with known drug tests, 50.0 percent were

positive for drugs – legal and illegal. Alcohol use in combination with drug use

increases impairment. In 2019, the National Survey of Drug Use and Health found

that 36.3 percent of those reporting that they drove under the influence of drugs

within the past year also reported that they drove under the influence of alcohol in the

same time period. While generally understood as unsafe, research is emerging on the

specific dangers of driving under the influence of drugs and in combination with

alcohol (SafeTREC, 2022).

Mandatory Drug Testing and Alcohol Level Checking

The drug policy in the Philippines is written as the Comprehensive Dangerous

Drugs Act of 2002 or Republic Act 9165. Unlike drug policies in other countries, the

law includes policies on drug testing. Aside from mandatory drug testing for specific

situations, the law states further that two testing methods should be employed—a

screening test, and a confirmatory test to be performed if the former yields a

presumptive positive result. Over 1000 drugs of abuse screening laboratories are

scattered all over the Philippines, but only seven can perform confirmatory testing

using either gas chromatography-mass spectrometry (GC-MS) or liquid

chromatography-mass spectrometry (LC-MS) technologies. In the last 30 years, more

sophisticated analytical technologies like liquid chromatography-tandem mass

spectrometry (LC-MS/MS) and high-resolution mass spectrometry such as liquid

chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF/MS) have

been developed not only to confirm what has been detected on screening tests, but

also to determine the presence of new psychoactive substances that are not usually

detected in drug screening. New matrices are also being utilized for the detection of

drugs. The drug testing policy in the Philippines will have to keep up with the
 16

changing drug trends and drug testing innovations in the world to truly address the

current administration's war on drugs. With the adoption of new drug testing methods

using modern analytical platforms, the cut-offs used for drug testing interpretation

should be updated.

Article 3 of the law addresses testing for dangerous drugs. Authorized drug

testing is mandatory for the following: applicants for firearms license and permit to

carry firearms outside of residence, military and law enforcement officers, candidates

for public office, and persons charged with criminal offenses who will be serving time

for more than six years. Authorized drug testing is also required for students in

secondary and tertiary schools depending on school policy and for workers in

government offices based on the drug free workplace program in the specific office as

well (Comprehensive Dangerous Drugs Act, 2002; Philippine Drug Enforcement

Agency [PDEA], n.d.). The clause requiring applicants for a driver's license to have a

drug test was repealed by the Anti-Drunk and Drugged Driving Act of 2003 (Mendez,

2013). An authorized drug test is one that is performed in a government forensic

laboratory or any other drug testing laboratory that has been accredited by the

Department of Health through the Health Facilities and Services Regulatory Bureau.

The law provides further that two testing methods should be employed for authorized

drug testing—a screening test and a confirmatory test. The confirmatory test would be

performed if the screening test yields a presumptive positive result. The implementing

rules and regulations for the law tasked the Department of Health to accredit and

monitor these drug testing centers (PDEA, n.d.).

With the continuous increase of death due to drugged and drunk driving, the

Philippines had imposed a Mandatory Drug Testing and Alcohol Level Checking.

This implementation solely target the PUV (Public Utility Vehicle) drivers in the
 17

Philippines, as they are one of the most used types of transportation in the country.

One of the latest reports in the Philippine News Agency, drugged drivers have been

blamed for the increasing number of road traffic accidents (Caliwan, 2019). The Land

Transportation Office said that they would heighten its nationwide terminal inspection

and quick random drug tests on drivers of Public Utility Vehicles to prevent drunk or

drugged driving among motorists. In a statement sent to reporters, the LTO said its

Law Enforcement Service-Anti-Drunk and Drugged Driving Enforcement Unit

recorded a total of 558 road crash incidents from January to August 2022. August saw

the highest number with 128 incidents, during which a total of 476 drivers tested

positive for alcoholic intoxication. The office's data also showed 17 fatalities and 281

injuries were also recorded in that span of time. The LTO said the thrust is meant to

prevent future incidents by preventing drivers under the influence of alcohol or illegal

drugs from driving vehicles by confiscating their driver’s license and requiring them

to undergo drug rehabilitation (Philstar, 2022). This emphasized the LTO’s aim in

reducing more possibilities of fatalities due to unlawful and irresponsible PUV

drivers.

OPLAN HARABAS. The Philippine Drug Enforcement Agency (PDEA)

conducts "Oplan Harabas" which aims to curb vehicular accidents caused by drivers

under the influence of illegal drugs (PNA, 2022). The Oplan Harabas initiative is in

accordance with Republic Act (RA) 10856 or Anti Drugged Driving Act of 2013,

known as "An Act Penalizing Persons Driving Under the Influence of Alcohol,

Dangerous Drugs, and Similar Substances, and for Other Purposes. In a press release,

the Land Transportation Franchising and Regulatory Board-Davao Region (LTFRB-

Davao) said that their office, in coordination with the Land Transportation Office

(LTO), and the Philippine Drug Enforcement Agency (PDEA) conducted a surprise
 18

drug screening dubbed as "Oplan Harabas" on Friday morning, October 28.

According to PDEA, the individuals who tested positive during the initial screening

will still be subjected to confirmatory testing. If found positive following the results

of the confirmatory tests by PDEA, their licenses would be withheld. It will also be

PDEA that will clear those who will test negative (Llemit, 2022). And based on

PDEA monitoring from January 2013 to January 2019, a total of 11,609 drivers, bus

conductors, and dispatchers were arrested for violation of RA 9165, or the

Comprehensive Dangerous Drugs Act of 2002 (Caliwan, 2019).

Establishing a response network that brings together different agencies and

organizations is also critical so that there is synergy in the efforts to combat the social

and health hazards of drug abuse. Ideally, the network can be effectively run by a

government-mandated center that would coordinate interagency programs to educate

the public on the psychosocial roots of drug use and abuse, assist in conducting

comprehensive drug surveillance, disseminate information on current drug trends,

coordinate drug law enforcement, oversee standardized drug testing, implement

effective drug rehabilitation programs, and assist in designing impactful drug control

and regulation policy (Dioquino, 2022).