臺灣地區影響精神物質減損駕駛能力評估

Driving Under Influence of Psychoactive Substance in Taiwan

毒、藥物與酒精等影響精神物質（Psychoactive Substance）影響駕駛能力之評估與探討對於交通事故之影響駕駛能力及偵查過程相當重要。交通事故傷害的法醫鑑定，除死因確認及排除自然疾病與交通事故的關係（帶病駕駛）外，尋找酒精、毒藥物影響駕駛能力及安全性，如人為、環境及機械之因素，為研判事故發生經過、原因及結果，確認駕駛者與交通事故所衍生的安全預防的基礎。交通駕駛者肇事時遭受酒精（酒駕）、濫用藥物（毒駕）或治療藥物（藥駕）影響為當今主要議題。採用呼氣（BrAC）及血中酒精濃度（BAC）檢測方法整合為標準作業流程中如現場行為反應測試（FST）及歐美各國配合各類影響精神物質使用口腔液篩檢的標準操作步驟，使能嚴謹的達到司法審判的要求。除了酒精影響駕駛外，近年來交通事故發生原因，有關毒品危害防制條例中各類一、二級毒品包括安非他命類、嗎啡類、 MDMA、大麻與古柯鹼等及三級以上管制藥物中愷他命（Ketamine）、苯二氮平類（Benzodiazepines；BZD）安眠鎮靜劑治療藥物已逐年增加，多重影響精神物質併用會導致道路安全風險大幅增高，影響精神物質如何減損及影響駕駛能力（Driving Under Influence；DUI；臺灣稱「不能安全駕駛」）之法律認定，已經成為法醫鑑定與司法審判之重要議題。本文依據歐美先進國家各類影響駕駛安全之數據來綜合推判、研擬我國各類影響精神物質造成國人駕駛能力減損者（impaired driver）導致「不能安全駕駛」，違反《刑法185 條之3》法律責任及規範。除參考先進國家對於單一影響精神物質濃度使用情況下各類物質閾值之外，在多重藥物或併用酒精濃度高於20mg/dL 的情況下，研判毒、藥駕之各類血中化學物濃度閾值之調降亦為考量重點。除了運用世界各國、毒藥駕文獻數據及政策擬定，包括駕駛現場、現場行為反應測試，唾液收集及唾液篩驗各類毒品，並經確認制定各影響精神物質閾值等及零容忍度（Zero tolerance）之政策，據以研擬各類影響精神物質造成不安全駕駛之審判依據，並應用各類毒藥物的藥物動力學，藉此便於詮釋、駕駛肇事者精神描繪（Psychological Profiling）、駕駛能力極限（Limitation of driving impairment）和駕駛者的精神狀態等，可為探討事故原因及闡明事實真相的重要依據，並提供為日後司法審判與反毒宣導的參考。

Understanding the impact of drugs, alcohol and medicine effect on the person under the influence is an important aspect of the traffic accident investigation. Attribution of responsibilities such as human factors, environmental factors and machinery factors in order to conclude the cause of the accidents and safety improvement measures are the purposes of each traffic accident investigation. In addition to alcohol-related traffic accident (approaching 10%), psychoactive substance (PS) impaired drivers (around 5%) are also on the rise making drug control an important modern-day concern. Establishing the threshold of each PS is of immediate interest for judiciary purpose in Taiwan (Criminal Code Article 185-3). Alcohol is removed from the body by a combination of mechanisms including xenobiotic metabolism and saturated metabolite secretion. Breath alcohol content (BrAC) and blood alcohol content (BAC) are the standard legal examination process used in forensic toxicology. Besides alcohol-impaired driving, the misuse illicit drugs of schedule I and II controlled drugs - including amphetamine, morphine, MDMA, cannabis, and cocaine; and sedative-hypnotic drugs such as diazepam have been increasing throughout the years. How the alcohol and PS affect the safety of driving has become an important topic for forensic examination and judicial adjudication. Using a variety of data from international allies to analyze and accredit the impaired driver under the uses of the PS become the important issue to affirm the traffic safety and regulation (Taiwan's Criminal Code Article 185-3, not safety driving crime). Poly-drug use by driver and the road safety risk with driving after consuming drugs and alcohol is extremely high. A lower limit should be set for certain drugs where they are found in combination with alcohol. These lower drug limits of many illicit and over-the-counter drugs are recommended when BAC above 20 or 50 mg/dL is detected. For future adjudication, it is critical to explore the cause of the accident and to clarify the incident to exclude DUI of psychoactive substances' pharmacodynamics and pharmacokinetics, that is needed to facilitate the accurate interpretation of the driver's mental state.