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S3E3 - Cause Agnostic

What is impairment?  What does it mean to drive a car impaired?  Kirk and Trevor talk to PJ Barclay CEO of DriveABLE (@DriveABLE).  DriveABLE has tools that look a impairment and cognition.  But the impairment can be from opioid pain medication, muscle relaxant, lack of sleep, alcohol or cannabis.  Legalization of recreational cannabis in Canada changed many things.  Let's talk about impairment and how everyone can stay safe on the roads. 

Sunday, 10 March 2019 14:21

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Episode Transcript

PJ:  Yeah thanks Trevor. Well as you mentioned my name is PJ Buckley and I'm the president and CEO of an organization called DriveAble which is an organization that focuses on impairment risk by primary looking at people's cognitive performance.

So we use our solutions to help licensing authority sharing Canada and hospital groups down in the United States with information about Medicare risk drivers. We support organizations who have commercial fleets who are indeed proactive about their drivers and ensuring that their drivers are safe. And then other pieces that we are looking at is definitely with the advent of cannabis legalization. We are working on solutions that deal with impairments that are associated with cannabis and other substances that have any impairing effects on one's cognition.

Trevor:  Thank you. That's fantastic. And we we will get to cannabis because you know that's the main reason why our what our listeners are interested in. But your background is interesting you didn't come out from sort of a health care or neurology background. How did you get involved with DriveAble?

PJ:  That's correct. I think firstly from my accent I'm originally from South Africa and I've been in Canada for just on seven years. By trade, I'm actually an auditor a Chartered Accountant and my world started out in in business and had the opportunity when I around 2014 to hit up an advisory practice, here in Edmonton, through my previous organization Deloitte and that was sort of focused on working with organizations to really focus on their finance functions, help with the their processes help with technical support and through that I had the opportunity to meet some of the primary investors within this within this organization and DriveAble and they were at that stage still very much focused towards supporting the Medicaid risk community and starting to move into the commercial the commercial route. But what is interesting about the timing was that that is when Colorado had just legalized recreational cannabis and the question that started to come out how we effectively measure an impairment and the opportunity seemed to be clear at the time that one couldn't rely on those per se measures. Saliva swabs or urine but one had to look at performance metrics. And I just felt the science was incredibly fascinating and had incredible power to be applied in these kind of scenarios. So through the process and through the interest and my passion to actually see the science succeed it fortunately for me worked out to be a good fit with the company. And that's why we've picked the pieces up and we are now on an exciting journey to deal with issues.

Trevor:  Yeah and it sounds like you're really quite familiar with the cannabis space. I've got a note here that in 2016 you were on a Federal task force about cannabis legalization in Canada. What kind of things did you guys discuss on that task force pre-legalization.

PJ:  Yes I had the opportunity to go with my development team and the scientists within the organization and that particular part of the committee was focusing on the issues of impairment and driving and DriveAble given its name in Canada it's been one of the primary solutions used to assist driving impairment was invited to be at the table. So the work that we had done in the past had opened doors for us what we could do in the future. But we got to sit at that task force and their primary focus was starting to look at how are we going to deal with the issue. The very real risk of there being impaired drivers as they legalize recreational cannabis. There was definitely an expectation that this was something that was a risk that needed to be addressed and that's what we got at the table so we got to present who we are and we also got to present our solution on the way we feel that cognitive performance analyzing one's cognitive skills that are critical for safe driving pay a very real part in being in the toolbox to assist impairment risk.

Trevor: Well I think that segues nicely into so flipping through the Web site you guys have a number of tools on how to assess how well somebody is driving. And I like the quote on here that you're looking for things that are cause agnostic assessments so what are some of the tools that you guys use and what do you mean by cause agnostic assessments.

PJ: Yeah “Cause Agnostic” is an interesting one because I think there is a there is a large focus on finding a solution to identify cannabis impairment. And I think one of the dangerous things over there is while we know that cannabis impairs or at least THC impairs is the the cognitive components of the brain critical for safe driving. The reality is that it's not just cannabis. I think that there are many things out there that can impact one's ability to drive and by that and also operate within the safety sensitive environment. So we're not focused on is it cannabis. We're focused on is this person able to perform the task that is being required of them whether it be driving or whether it be operating in a safety sensitive environment regardless of what's in this system. You know it could be cocaine it could be cannabis it could be a person is just fatigued or they are uncontrolled pain medication which has been prescribed to them by their doctor. So the focus can't be necessarily on what's in your system.  Our focus. And while that is still something that one wants to see our focus is to say is this person actually impaired in performing the task that you asking them to perform regardless of what's in this system.

Trevor: No thank you. I think that's two of those hit close to my heart like the fatigue thing like when my early 20s I fell asleep behind the wheel and rolled the vehicle and thankfully was uninjured but scared my parents half to death so you know fatigue is definitely something that we don't talk about enough behind the wheel and as a pharmacist every day I give out you know benzodiazepines and painkillers and muscle relaxants that you know I put a little sticker on the bottle saying you know don't operate heavy machinery but it's always kind of in the back of my mind. How safe is this, how safe is this person. You know if they take one of these and go jump from their car and drive home. Is that a good idea. So how do we how would your tools work let's say on a person that I've given muscle relaxants to it and we're trying to decide if they're safe too safe to drive.

PJ: So essentially the what the tool would look like is for for real simplistic sake. It would be on an iPad sort of a tablet application. And what are to be is a series of neuropsych tasks. And what the neuropsych tasks do for example what we'd asked them to do is just track a box moving across the screen. We would ask them to navigate a box through a dotted line we would be testing things like their reaction time we would be testing things like their field of vision their and their ability to process different stimuli, executive function will be a couple of things that we will be tested through these tasks and what we'd be able to do is through these through these tasks we actually start to assess the cognitive components of the brain that are critical for safe driving. And just a part on this is that when we look at driving it's well accepted within the community that one also looks at a person's ability to drive and how they operate in other safety sensitive environments speak just because of the overlay and the complexity of cognition required for driving overlays very well into what would be required of them in other safety sensitive environments. But what you'd be able to do is through these tasks we are able to assess and evaluate the performance of those cognitive components and then see how they work together to execute a safe task. Now why I say together is because one doesn't just require a strong reaction time to be able to drive or to work in a safe environment. But what you require is the brain to work in all its components together to execute the safe task. And I think there are a number of tools that says you know let's just check your reaction time and while reaction time is important. It's no more important than a person having a safe executive function. And what we do is we look at how they work together in unison to execute a safe task be it driving or in a safety sensitive environment.

Trevor: That's great. So let's move to cannabis in a medicinal form. So honestly in that way it's not a lot different than you know the person I have on Tylenol 3s every day or who's taken benzodiazepine for their anxiety. Usually people who are taking cannabis medicinally are dosing it everyday so we'll call them chronic users. What would we what could we do to make sure of you know a chronic user of cannabis say medicinally is safe to drive or I guess like you said work in a work in an environment where they have to be alert.

PJ: Yes. It's a very real question and what we've noticed is that there has been a significant amount of interest from Licensed Producers in this question as well. One of the Licensed Producers that we work with is Emblem Cannabis to actually start to answer this question because all of these operations are focused on the social responsibility to ensure the safe use of their products. But the way in which this is this is being piloted is through various pain clinics where this medical cannabis has been administered is as this is being administered, what there is also is a tracking of the cognitive performance to assess their risk be it exposure in driving or operating the safety sensitive environments and through that what we're able to do is will the license producers. Is been able to tailor the dosages so if he had assume a scenario in which you had a let's say three candidates all on the same strain of cannabis because we know that there is varying degrees in which cannabis impairs you could you could have it mean I could have it and you could be impaired and I wouldn't impaired. But what the what the what the tool is able to do is to say you know Trevor you are more exposed to risk versus P.J. you are not. And through that you are able to tailor the amount of the dosage so that people are still able to operate in their daily environment safely.

Now you know you start to see and think the listeners also start to see that this isn't just a cannabis issue this is a whole bunch of other medications that could have an impairing effect you could see a world in the future in which prescriptions are more tailored to that individual and that individual’s tolerance to accept that that medication within their system.

Trevor: No that's great we talk about personalized medicine in pharmacy all the time and you're right. You know we could have somebody on a huge dose of opioids and they could be just fine. But you take someone like me who we is we calls opioid naïve or I don't use opioids. The first dose would probably impair me from you know being able to not fall asleep in front of a book. So yeah that sounds like a great a great tool. Now how about our. We'll call them recreational or occasional users. So it makes sense to me as a pharmacist if we sort of have somebody on a stable dose of cannabis that you know we can eventually get that dose to where they know how it affects them and everything is pretty stable. But you know if I'm a recreational user who you know I use cannabis on weekends but not during the week how can we. How can we help them decide if they're safe to drive after you know I go out that night I have two joints and I'm trying to decide if I should drive home or or what I'm able to do. What can what can we do for the occasional or the recreational user?

PJ: Well one of the things that I think is really just a challenge associated specifically with cannabis is how it has those varying degrees of effects on different individuals. So whether you're male or female whether you are large or small whether you've taken it together with alcohol there's many different effects that could impact an individual very differently. So to have a one size fits all fits all approach for everybody is just not going to work and it's just not realistic. I think what's also going to be a challenge is in the world of developing tools that will empower recreational users with information about their ability to perform various tasks is going to be difficult just given that people find themselves in different environments.  Just think if one person is using our assessment tool in a noisy night club versus one person using on their couch the environmental factors could impact that result quite significantly as well.  I think what's going to have to happen in the future. And as more research comes behind recreational products is that the producers that are producing the recreational products are going to have to develop a greater level of information and data behind the products of what they are more likely to do. And I think the onus will then again once that information is there the onus will be on the individual who's using it to understand what the potential risks of that particular type of product that they're using could have on them and what they should or shouldn't do. So, it's kind of a very long round wait for me to say that I don't think that there's necessarily a solution for everybody in the public just because of the different natures of it but it's going to come down to the building up of evidence related to a particular product and then the user empowering themselves with the with what that data is saying that they could make the right choice.

Trevor:  So right now. Legally you know so well we'll get away from scientifically what we think's going on with impairment. But onto legally. So legally it's sort of being treated the same as alcohol and there's many people argue you know what it affects body completely different than alcohol so it shouldn't be treated but that's legally what's going on. How about you know you guys been looking into cannabis and impairment a lot lately. What do you guys think of the , well the Drager test 5000 and the idea of putting a blood level on THC to  determine impairment does that does that make sense or does that have any problems with it.

PJ: On its own. I would say yes. I think that and to be fair I think on its own for us it would be it would not be appropriate just to use our tool on its own. I think the world looking at a single tool to determine impairments is probably naive. And rather what should happen is that we should be the community should be working on building up an effective toolbox that is used for the right application. And I mean to speak to the saliva. We understand as to why they actually looking at saliva at the moment because it is really sort of the most likely or closest to recent use which could translate to more likely to be impaired. And that's why people have gone the law enforcement have gone the route of looking at saliva. But you also know that from some of the products that have come in capsule form none of the THC residue is actually remains in the in the mouth. So you wouldn't necessarily pick it up on a saliva test. What if it goes down into the stomach and that's where it is metabolized. Now you need to start looking at how you how are you actually going to be picking it up and relying purely on a per se measure. We know that that doesn't translate to a measure of impairment. This is where a the assessing the person's performance and establishing their risk of impairment is an important step. And once you establish that risk of impairments now asking what has caused that impairment whether it be cannabis whether it be fatigue or some other medication is probably a more practical approach and prudent approach to actually really manage this issue of looking at impairments.

Trevor: So.  Well we'll throw the other one that everybody loves to hate. PJ What do you guys think of what the standard field sobriety test how our effective is that for impairment especially related to cannabis.

PJ: I've got to be honest that the. I actually really believe that the standard field sobriety test has its place and the initially I think before even getting into the space. I used to be part of the community that would laugh at the one-legged stand or the walking on the walk on a straight line. But the reality is that the standard field sobriety test has its place and it's an important step to establish they had reason to suspect. One thing I think that the listeners need to know is that that standard field sobriety test is written into law and has been accepted in from a global standpoint for some time. But just like our tool that field sobriety test has its place in establishing a reason to suggest that a person is impaired and that would create the platform for a for a performance-based test which could create a platform for a per se measure. So again, it's working towards understanding. There is an ecosystem of tests they're built out of protocol to actively manage the risk. So I would say you know as a person that used to joke about it I definitely have worked closely with law enforcement I've come to appreciate where it fits and what it is able to do and how that sort of answers that first question of reason to suspect to move on to some other to some other pieces. I think it's also from our side as we've stood it's understood the lay of the land if you will. It would be naive for us to also expect you know as people come to a cause that we just put a put them through a cognitive test. What I do believe is that they would still be a place for the field sobriety test to suggest that a person is impaired. You then provide a pretty solid metric behind of performance metrics from a cognitive side and then that leads on to saying OK let's understand why this person is showing a risk of impairment.

Trevor: No fair enough. And I think that leads nicely into this let's talk about some of your actual tools and what would happen if I was in there. So, we've got the DCAT the DriveAble Cognitive Assessment Tool. So what's that is that the iPad thing you're talking about is that slightly different.

PJ: It is slightly different. So, in the beginning I alluded to the work that we do with the with the medical community and the DCAT is used with our support and licensing authorities here in Canada and the doctors down in the United States. That's something that you would find in their doctor's offices where they actually run these assessments to get more information about a person's risk of impairments from medical conditions or from medication whatever that may be. When we focus in from the from the tablet application is that is something which we call our care efforts a cognitive assessment real time evaluation and that is the that essentially takes the best elements of a DCAT as well as new research to take mobilize really the cognitive science and take it to the field whether it be on the road side whether it be in on a construction site for a for a person who's working in a crane. It really sort of mobilizes the science so that's something a bit different from what the DCAT is. But that's very much the tool that we are working on fitting into to deal with this issue of impairment.

Trevor: Thank you. And a little off topic but I thought it was interesting so let's say I had a trucking company guys your company actually does on road evaluations as well as sort of the cognitive and vitals assessment to ahead of time. Right.

PJ: That's correct. Yes, so what we do is we give the people the opportunity to actually demonstrate their functional ability to drive and what that on road evaluation also allows is us to pick up various areas where people could have trainable points. So we're not just looking at things that could present an impairment risk but when they actually goes through our full protocol for a commercial driver they would actually be in a position to identify some of the trainable errors that could be remediated with an appropriate training program.

Trevor: This is all fascinating and unfortunate I think we're running a little short on time. So P.J. any sort of final thoughts about where you think impairment testing and how we can keep people safe before they get on the roads where you think it's going. And you know what. The DriveAble tools might be able to do to help keep people safer especially when it comes to cannabis.

PJ: Yes. I think it's a very exciting space. I think that the the question of impairments sort of existed long before the legalization of cannabis but what cannabis with the legalization of cannabis and specifically the recreational use of cannabis has done is it got people to start to ask what is impairment and how we appropriately measure it. And I think that's one of the greatest things that came out of October 17th is that people have started to say you know the ways in which we used to look at impairment are not necessarily appropriate and we need to be looking at new ways and embracing new technologies to truly measure impairments on a tailored individual tailored individual level. So, where that leaves us is we part of a growing community that is actively looking at the question of impairment beyond just cannabis. We do believe that in the future the world will experience a performance-evaluations real time performance-evaluations, that would give an insight into the risk of impairments and that would allow people to proactively respond and I think even you know to to my point earlier about what the general public would be able to have at their fingertips the amount of research and the amount of data that is coming out. I don't see it being off the cards that in the future the general public will be able to within the comfort of their own homes be assessing am I able to, am I able to drive, am I able to go to work today and that will allow them to make a proactive decision before anything catastrophic could potentially happen. So I just think it's an amazing environment to be in at the moment incredibly excited. I get the privilege to work with a number of research organizations law enforcement agencies as well as industry partners that are actively looking at this question that is just sort of had a lots up above it to say let's try and tackle this issue and let's do it the right way embracing and what we have now as well as what we'll have in the future.

Trevor: Oh that's great. PJ yeah no I'm really looking forward to now as a pharmacist when I sort of see a impairment score from a pain clinic that's using some of the DriveAble tools and more and I think more what we're looking forward to is that when there is an app out there too for me to assess you know am I able to drive no matter what caused, am I too tired of ever had too much to drink did I smoke too much cannabis are my sleeping pills not a not appropriate to take. Before I went out I think yeah down the road when we get to see that tool I think it'll be very well received and more importantly keep everyone safe on the road. So thank you PJ that's been fantastic.