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Berry JL, Brooks-Russell A, Beuning CN, Limbacher SA, Lovestead TM, Jeerage KM. Cannabinoids detected in exhaled breath condensate after cannabis use. J Breath Res 2024; 18:041002. [PMID: 39008974 PMCID: PMC11264354 DOI: 10.1088/1752-7163/ad6347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/15/2024] [Indexed: 07/17/2024]
Abstract
Cannabinoids can be detected in breath after cannabis use, but different breath matrices need to be explored as studies to date with filter-based devices that collect breath aerosols have not demonstrated that breath-based measurements can reliably identify recent cannabis use. Exhaled breath condensate (EBC) is an unexplored aqueous breath matrix that contains condensed volatile compounds and water vapor in addition to aerosols. EBC was collected from participants both before and at two time points (0.7 ± 0.2 h and 1.7 ± 0.3 h) after observed cannabis use. Eleven different cannabinoids were monitored with liquid chromatography tandem mass spectrometry. Five different cannabinoids, including Δ9-tetrahydrocannabinol (THC), were detected in EBC collected from cannabis users. THC was detected in some EBC samples before cannabis use, despite the requested abstinence period. THC was detected in all EBC samples collected at 0.7 h post use and decreased for all participants at 1.7 h. Non-THC cannabinoids were only detected after cannabis use. THC concentrations in EBC samples collected at 0.7 h showed no trend with sample metrics like mass or number of breaths. EBC sampling devices deserve further investigation with respect to modes of cannabis use (e.g, edibles), post use time points, and optimization of cannabinoid recovery.
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Affiliation(s)
- Jennifer L Berry
- Applied Chemical and Materials Division, National Institute of Standards and Technology, 325 Broadway, Boulder, CO, United States of America
| | - Ashley Brooks-Russell
- Colorado School of Public Health, University of Colorado Anschutz Medical, 13001 E. 17th Place, Aurora, CO, United States of America
| | - Cheryle N Beuning
- Applied Chemical and Materials Division, National Institute of Standards and Technology, 325 Broadway, Boulder, CO, United States of America
| | - Sarah A Limbacher
- Colorado School of Public Health, University of Colorado Anschutz Medical, 13001 E. 17th Place, Aurora, CO, United States of America
| | - Tara M Lovestead
- Applied Chemical and Materials Division, National Institute of Standards and Technology, 325 Broadway, Boulder, CO, United States of America
| | - Kavita M Jeerage
- Applied Chemical and Materials Division, National Institute of Standards and Technology, 325 Broadway, Boulder, CO, United States of America
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Vael VEC, Bijlenga D, Schinkelshoek MS, van der Sluiszen NNJJM, Remmerswaal A, Overeem S, Ramaekers JG, Vermeeren A, Lammers GJ, Fronczek R. Skin temperature as a predictor of on-the-road driving performance in people with central disorders of hypersomnolence. J Sleep Res 2024; 33:e14045. [PMID: 37720977 DOI: 10.1111/jsr.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
Excessive daytime sleepiness is the core symptom of central disorders of hypersomnolence (CDH) and can directly impair driving performance. Sleepiness is reflected in relative alterations in distal and proximal skin temperature. Therefore, we examined the predictive value of skin temperature on driving performance. Distal and proximal skin temperature and their gradient (DPG) were continuously measured in 44 participants with narcolepsy type 1, narcolepsy type 2 or idiopathic hypersomnia during a standardised 1-h driving test. Driving performance was defined as the standard deviation of lateral position (SDLP) per 5 km segment (equivalent to 3 min of driving). Distal and proximal skin temperature and DPG measurements were averaged over each segment and changes over segments were calculated. Mixed-effect model analyses showed a strong, quadratic association between proximal skin temperature and SDLP (p < 0.001) and a linear association between DPG and SDLP (p < 0.021). Proximal skin temperature changes over 3 to 15 min were predictive for SDLP. Moreover, SDLP increased over time (0.34 cm/segment, p < 0.001) and was higher in men than in women (3.50 cm, p = 0.012). We conclude that proximal skin temperature is a promising predictor for real-time assessment of driving performance in people with CDH.
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Affiliation(s)
- Veronique E C Vael
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
- Leiden University Medical Centre, Department of Neurology, Leiden, The Netherlands
| | - Denise Bijlenga
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
- Leiden University Medical Centre, Department of Neurology, Leiden, The Netherlands
| | - Mink S Schinkelshoek
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
- Leiden University Medical Centre, Department of Neurology, Leiden, The Netherlands
| | - Nick N J J M van der Sluiszen
- Maastricht University, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands
| | - Aniek Remmerswaal
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Sebastiaan Overeem
- Kempenhaeghe, Centre for Sleep Medicine, Heeze, The Netherlands
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, The Netherlands
| | - Johannes G Ramaekers
- Maastricht University, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands
| | - Annemiek Vermeeren
- Maastricht University, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands
| | - Gert Jan Lammers
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
- Leiden University Medical Centre, Department of Neurology, Leiden, The Netherlands
| | - Rolf Fronczek
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
- Leiden University Medical Centre, Department of Neurology, Leiden, The Netherlands
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Zamarripa CA, Spindle TR, Panlilio LV, Strickland JC, Feldman JD, Novak MD, Epstein DH, Dunn KE, McCurdy CR, Sharma A, Kuntz MA, Mukhopadhyay S, Raju KSR, Rogers JM, Smith KE. Effects of kratom on driving: Results from a cross-sectional survey, ecological momentary assessment, and pilot simulated driving Study. TRAFFIC INJURY PREVENTION 2024; 25:594-603. [PMID: 38497810 PMCID: PMC11149710 DOI: 10.1080/15389588.2024.2327827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Despite widespread kratom use, there is a lack of knowledge regarding its effects on driving. We evaluated the self-reported driving behaviors of kratom consumers and assessed their simulated-driving performance after self-administering kratom products. METHODS We present results from: 1) a remote, national study of US adults who regularly use kratom, and 2) an in-person substudy from which we re-recruited participants. In the national study (N = 357), participants completed a detailed survey and a 15-day ecological momentary assessment (EMA) that monitored naturalistic kratom use. For the remote study, outcomes were self-reported general and risky driving behaviors, perceived impairment, and driving confidence following kratom administration. For the in-person substudy, 10 adults consumed their typical kratom products and their driving performance on a high-fidelity driving simulator pre- and post-kratom administration was evaluated. RESULTS Over 90% of participants surveyed self-reported driving under the influence of kratom. Most reported low rates of risky driving behavior and expressed high confidence in their driving ability after taking kratom. This was consistent with EMA findings: participants reported feeling confident in their driving ability and perceived little impairment within 15-180 min after using kratom. In the in-person substudy, there were no significant changes in simulated driving performance after taking kratom. CONCLUSIONS Using kratom before driving appears routine, however, self-reported and simulated driving findings suggest kratom effects at self-selected doses among regular kratom consumers do not produce significant changes in subjective and objective measures of driving impairment. Research is needed to objectively characterize kratom's impact on driving in regular and infrequent consumers.
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Affiliation(s)
- C Austin Zamarripa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tory R Spindle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leigh V Panlilio
- Real-World, Assessment, Prediction, Treatment Unit, Intramural Research Program, National Institute on Drug Abuse, Baltimore, Maryland, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey D Feldman
- Real-World, Assessment, Prediction, Treatment Unit, Intramural Research Program, National Institute on Drug Abuse, Baltimore, Maryland, USA
| | - Matthew D Novak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David H Epstein
- Real-World, Assessment, Prediction, Treatment Unit, Intramural Research Program, National Institute on Drug Abuse, Baltimore, Maryland, USA
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher R McCurdy
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Michelle A Kuntz
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Sushobhan Mukhopadhyay
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Kanumuri Siva Rama Raju
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Jeffrey M Rogers
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Kirsten E Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Brooks-Russell A, Wrobel J, Brown T, Bidwell LC, Wang GS, Steinhart B, Dooley G, Kosnett MJ. Effects of acute cannabis inhalation on reaction time, decision-making, and memory using a tablet-based application. J Cannabis Res 2024; 6:3. [PMID: 38308382 PMCID: PMC10837858 DOI: 10.1186/s42238-024-00215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/13/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Acute cannabis use has been demonstrated to slow reaction time and affect decision-making and short-term memory. These effects may have utility in identifying impairment associated with recent use. However, these effects have not been widely investigated among individuals with a pattern of daily use, who may have acquired tolerance. The purpose of this study was to examine the impact of tolerance to cannabis on the acute effects as measured by reaction time, decision-making (gap acceptance), and short-term memory. METHODS Participants (ages 25-45) completed a tablet-based (iPad) test battery before and approximately 60 min after smoking cannabis flower. The change in performance from before to after cannabis use was compared across three groups of cannabis users: (1) occasional use (n = 23); (2) daily use (n = 31); or (3) no current use (n = 32). Participants in the occasional and daily use group self-administered ad libitum, by smoking or vaping, self-supplied cannabis flower with a high concentration of total THC (15-30%). RESULTS The occasional use group exhibited decrements in reaction time (slowed) and short-term memory (replicated fewer shapes) from before to after cannabis use, as compared to the no-use group. In the gap acceptance task, daily use participants took more time to complete the task post-smoking cannabis as compared to those with no use or occasional use; however, the level of accuracy did not significantly change. CONCLUSIONS The findings are consistent with acquired tolerance to certain acute psychomotor effects with daily cannabis use. The finding from the gap acceptance task which showed a decline in speed but not accuracy may indicate a prioritization of accuracy over response time. Cognitive and psychomotor assessments may have utility for identifying impairment associated with recent cannabis use.
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Affiliation(s)
- Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17Th Place, Aurora, CO, 80045, USA.
| | - Julia Wrobel
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tim Brown
- Driving Safety Research Institute, University of Iowa, Iowa City, IA, USA
| | - L Cinnamon Bidwell
- Institute of Cognitive Science, University of Colorado, Boulder, CO, USA
| | - George Sam Wang
- Department of Pediatrics, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin Steinhart
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory Dooley
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Michael J Kosnett
- Department of Medicine, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Di Ciano P, Rajji TK, Hong L, Zhao S, Byrne P, Elzohairy Y, Brubacher JR, McGrath M, Brands B, Chen S, Wang W, Hasan OSM, Wickens CM, Kaduri P, Le Foll B. Cannabis and Driving in Older Adults. JAMA Netw Open 2024; 7:e2352233. [PMID: 38236599 PMCID: PMC10797455 DOI: 10.1001/jamanetworkopen.2023.52233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
Importance Epidemiological studies have found that cannabis increases the risk of a motor vehicle collision. Cannabis use is increasing in older adults, but laboratory studies of the association between cannabis and driving in people aged older than 65 years are lacking. Objective To investigate the association between cannabis, simulated driving, and concurrent blood tetrahydrocannabinol (THC) levels in older adults. Design, Setting, and Participants Using an ecologically valid counterbalanced design, in this cohort study, regular cannabis users operated a driving simulator before, 30 minutes after, and 180 minutes after smoking their preferred legal cannabis or after resting. This study was conducted in Toronto, Canada, between March and November 2022 with no follow-up period. Data were analyzed from December 2022 to February 2023. Exposures Most participants chose THC-dominant cannabis with a mean (SD) content of 18.74% (6.12%) THC and 1.46% (3.37%) cannabidiol (CBD). Main outcomes and measures The primary end point was SD of lateral position (SDLP, or weaving). Secondary outcomes were mean speed (MS), maximum speed, SD of speed, and reaction time. Driving was assessed under both single-task and dual-task (distracted) conditions. Blood THC and metabolites of THC and CBD were also measured at the time of the drives. Results A total of 31 participants (21 male [68%]; 29 White [94%], 1 Latin American [3%], and 1 mixed race [3%]; mean [SD] age, 68.7 [3.5] years), completed all study procedures. SDLP was increased and MS was decreased at 30 but not 180 minutes after smoking cannabis compared with the control condition in both the single-task (SDLP effect size [ES], 0.30; b = 1.65; 95% CI, 0.37 to 2.93; MS ES, -0.58; b = -2.46; 95% CI, -3.56 to -1.36) and dual-task (SDLP ES, 0.27; b = 1.75; 95% CI, 0.21 to 3.28; MS ES, -0.47; b = -3.15; 95% CI, -5.05 to -1.24) conditions. Blood THC levels were significantly increased at 30 minutes but not 180 minutes. Blood THC was not correlated with SDLP or MS at 30 minutes, and SDLP was not correlated with MS. Subjective ratings remained elevated for 5 hours and participants reported that they were less willing to drive at 3 hours after smoking. Conclusions and relevance In this cohort study, the findings suggested that older drivers should exercise caution after smoking cannabis.
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Affiliation(s)
- Patricia Di Ciano
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tarek K. Rajji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Hong
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sampson Zhao
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Byrne
- Ontario Ministry of Transportation, Toronto, Ontario, Canada
| | | | - Jeffrey R. Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael McGrath
- Ontario Ministry of Transportation, Toronto, Ontario, Canada
| | - Bruna Brands
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Health Canada, Ottawa, Ontario, Canada
| | - Sheng Chen
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wei Wang
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Omer S. M. Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Christine M. Wickens
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Pamela Kaduri
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry and Mental Health, Muhimbill University of Health and Allied Sciences, Tanzania
| | - Bernard Le Foll
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
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Godbole S, Leroux A, Brooks-Russell A, Subramanian PS, Kosnett MJ, Wrobel J. A Study of Pupil Response to Light as a Digital Biomarker of Recent Cannabis Use. Digit Biomark 2024; 8:83-92. [PMID: 38682092 PMCID: PMC11052563 DOI: 10.1159/000538561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/23/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Given the traffic safety and occupational injury prevention implications associated with cannabis impairment, there is a need for objective and validated measures of recent cannabis use. Pupillary light response may offer an approach for detection. Method Eighty-four participants (mean age: 32, 42% female) with daily, occasional, and no-use cannabis use histories participated in pupillary light response tests before and after smoking cannabis ad libitum or relaxing for 15 min (no use). The impact of recent cannabis consumption on trajectories of the pupillary light response was modeled using functional data analysis tools. Logistic regression models for detecting recent cannabis use were compared, and average pupil trajectories across cannabis use groups and times since light test administration were estimated. Results Models revealed small, significant differences in pupil response to light after cannabis use comparing the occasional use group to the no-use control group, and similar statistically significant differences in pupil response patterns comparing the daily use group to the no-use comparison group. Trajectories of pupillary light response estimated using functional data analysis found that acute cannabis smoking was associated with less initial and sustained pupil constriction compared to no cannabis smoking. Conclusion These analyses show the promise of pairing pupillary light response and functional data analysis methods to assess recent cannabis use.
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Affiliation(s)
- Suneeta Godbole
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Leroux
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Prem S. Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, Sue Anschutz-Rodgers Eye Center, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael J. Kosnett
- Department of Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Julia Wrobel
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
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Wang GS, Kosnett M, Subramanian P, Wrobel J, Ma M, Brown T, Bidwell LC, Brooks-Russell A. Accuracy and replicability of identifying eyelid tremor as an indicator of recent cannabis smoking. Clin Toxicol (Phila) 2024; 62:10-18. [PMID: 38421358 PMCID: PMC11019859 DOI: 10.1080/15563650.2024.2310154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Cannabis intoxication may increase the risk of motor vehicle crashes. However, reliable methods of assessing cannabis intoxication are limited. The presence of eyelid tremors is among the signs of cannabis use identified under the Drug Evaluation and Classification Program of the International Association of Chiefs of Police. Our objectives were to assess the accuracy and replicability of identifying eyelid tremor as an indicator of recent cannabis smoking using a blinded, controlled study design. METHODS Adult subjects (N = 103) were recruited into three groups based on their cannabis use history: daily, occasional, and no current cannabis use. Participants' closed eyelids were video recorded for 30 seconds by infrared videography goggles before and at a mean ± standard deviation time of 71.4 ± 4.6 minutes after the onset of a 15-minute interval of ad libitum cannabis flower smoking or vaping. Three observers with expertise in neuro-ophthalmology and medical toxicology were trained on exemplar videos of eyelids to reach a consensus on how to grade eyelid tremor. Without knowledge of subjects' cannabis use history or time point (pre- or post-smoking), observers reviewed each video for eyelid tremor graded as absent, slight, moderate, or severe. During subsequent data analysis, this score was further dichotomized as a consensus score of absent (absent/slight) or present (moderate/severe). RESULTS Kappa and intraclass correlation coefficient statistics demonstrated moderate agreement among the coders, which ranged from 0.44-0.45 and 0.58-0.61, respectively. There was no significant association between recent cannabis use and the observers' consensus assessment that eyelid tremor was present, and cannabis users were less likely to have tremors (odds ratio: 0.75; 95 percent confidence interval: 0.25, 2.40). The assessment of eyelid tremor as an indicator of recent cannabis smoking had a sensitivity of 0.86, specificity of 0.18, and accuracy of 0.64. DISCUSSION Eyelid tremor has fair sensitivity but poor specificity and accuracy for identification of recent cannabis use. Inter-rater reliability for assessment of eyelid tremor was moderate for the presence and degree of tremor. The weak association between recent cannabis use and eyelid tremor does not support its utility in identifying recent cannabis use. LIMITATIONS Videos were recorded at only one time point after cannabis use. Adherence to abstinence could not be strictly supervised. Due to regulatory restrictions, we were unable to control the cannabis product used or administer a fixed Δ9-tetrahydrocannabinol dose. Participants were predominately non-Hispanic and White. CONCLUSIONS In a cohort of participants with a range of cannabis use histories, acute cannabis smoking was not associated with the presence of eyelid tremor, regardless of cannabis use history, at 70 minutes post-smoking. Additional research is needed to identify the presence of eyelid tremor accurately, determine the relationship between cannabis dose and timeline in relation to last cannabis use to eyelid tremor, and determine how it should be, if at all, utilized for cannabis Drug Recognition Evaluator examinations.
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Affiliation(s)
- George Sam Wang
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | - Michael Kosnett
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Prem Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, Sue Anschutz-Rodgers University of Colorado Eye Center, Aurora, CO, USA
| | - Julia Wrobel
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Ming Ma
- Department of Biostatistics, Medpace, Denver, CO, USA
| | - Tim Brown
- Driving Safety Research Institute, College of Engineering, University of Iowa, Iowa City, Iowa, USA
| | - L Cinnamon Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Hartley S, Simon N, Cardozo B, Larabi IA, Alvarez JC. Can inhaled cannabis users accurately evaluate impaired driving ability? A randomized controlled trial. Front Public Health 2023; 11:1234765. [PMID: 38074719 PMCID: PMC10703156 DOI: 10.3389/fpubh.2023.1234765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Aims To study the effect of inhaled cannabis on self-assessed predicted driving ability and its relation to reaction times and driving ability on a driving simulator. Participants and methods 30 healthy male volunteers aged 18-34: 15 chronic (1-2 joints /day) and 15 occasional (1-2 joints/week) consumers. Self-assessed driving confidence (visual analog scale), vigilance (Karolinska), reaction time (mean reciprocal reaction time mRRT, psychomotor vigilance test), driving ability (standard deviation of lane position SDLP on a York driving simulator) and blood concentrations of delta-9-tétrahydrocannabinol (THC) were measured before and repeatedly after controlled inhalation of placebo, 10 mg or 30 mg of THC mixed with tobacco in a cigarette. Results Cannabis consumption (at 10 and 30 mg) led to a marked decrease in driving confidence over the first 2 h which remained below baseline at 8 h. Driving confidence was related to THC dose and to THC concentrations in the effective compartment with a low concentration of 0.11 ng/ml for the EC50 and a rapid onset of action (T1/2 37 min). Driving ability and reaction times were reduced by cannabis consumption. Driving confidence was shown to be related to driving ability and reaction times in both chronic and occasional consumers. Conclusions Cannabis consumption leads to a rapid reduction in driving confidence which is related to reduced ability on a driving simulator. Clinical trial registration ClinicalTrials.gov, identifier: NCT02061020.
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Affiliation(s)
- Sarah Hartley
- Sleep Unit, Physiology Department, AP-HP GHU Paris-Saclay, Raymond Poincaré Hospital, Garches, France
| | - Nicolas Simon
- Department of Clinical Pharmacology, Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, CAP-TV, Marseille, France
| | - Bibiana Cardozo
- Department of Clinical Pharmacology, Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, CAP-TV, Marseille, France
| | - Islam Amine Larabi
- Plateform MasSpecLab, Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, GHU AP-HP.Paris-Saclay, Paris-Saclay University, UVSQ, Inserm U-1018, CESP, Team MOODS, Garches, France
| | - Jean Claude Alvarez
- Plateform MasSpecLab, Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, GHU AP-HP.Paris-Saclay, Paris-Saclay University, UVSQ, Inserm U-1018, CESP, Team MOODS, Garches, France
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Marcotte TD, Umlauf A, Grelotti DJ, Sones EG, Mastropietro KF, Suhandynata RT, Huestis MA, Grant I, Fitzgerald RL. Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:914-923. [PMID: 37531115 PMCID: PMC10398547 DOI: 10.1001/jamapsychiatry.2023.2345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/04/2023] [Indexed: 08/03/2023]
Abstract
Importance With increasing medicinal and recreational cannabis legalization, there is a public health need for effective and unbiased evaluations for determining whether a driver is impaired due to Δ9-tetrahydrocannabinol (THC) exposure. Field sobriety tests (FSTs) are a key component of the gold standard law enforcement officer-based evaluations, yet controlled studies are inconclusive regarding their efficacy in detecting whether a person is under the influence of THC. Objective To examine the classification accuracy of FSTs with respect to cannabis exposure and driving impairment (as determined via a driving simulation). Design, Setting, and Participants This double-blind, placebo-controlled parallel randomized clinical trial was conducted from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California, San Diego. Participants were aged 21 to 55 years and had used cannabis in the past month. Data were analyzed from August 2021 to April 2023. Intervention Participants were randomized 1:1:1 to placebo (0.02% THC), 5.9% THC cannabis, or 13.4% THC cannabis smoked ad libitum. Main Outcome and Measures The primary end point was law enforcement officer determination of FST impairment at 4 time points after smoking. Additional measures included officer estimation as to whether participants were in the THC or placebo group as well as driving simulator data. Officers did not observe driving performance. Results The study included 184 participants (117 [63.6%] male; mean [SD] age, 30 [8.3] years) who had used cannabis a mean (SD) of 16.7 (9.8) days in the past 30 days; 121 received THC and 63, placebo. Officers classified 98 participants (81.0%) in the THC group and 31 (49.2%) in the placebo group as FST impaired (difference, 31.8 percentage points; 95% CI, 16.4-47.2 percentage points; P < .001) at 70 minutes after smoking. The THC group performed significantly worse than the placebo group on 8 of 27 individual FST components (29.6%) and all FST summary scores. However, the placebo group did not complete a median of 8 (IQR, 5-11) FST components as instructed. Of 128 participants classified as FST impaired, officers suspected 127 (99.2%) as having received THC. Driving simulator performance was significantly associated with results of select FSTs (eg, ≥2 clues on One Leg Stand was associated with impairment on the simulator: odds ratio, 3.09; 95% CI, 1.63-5.88; P < .001). Conclusions and Relevance This randomized clinical trial found that when administered by highly trained officers, FSTs differentiated between individuals receiving THC vs placebo and driving abilities were associated with results of some FSTs. However, the high rate at which the participants receiving placebo failed to adequately perform FSTs and the high frequency that poor FST performance was suspected to be due to THC-related impairment suggest that FSTs, absent other indicators, may be insufficient to denote THC-specific impairment in drivers. Trial Registration ClinicalTrials.gov Identifier: NCT02849587.
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Affiliation(s)
- Thomas D. Marcotte
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Anya Umlauf
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - David J. Grelotti
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Emily G. Sones
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Kyle F. Mastropietro
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Raymond T. Suhandynata
- Center for Medicinal Cannabis Research, Department of Pathology, University of California, San Diego
- Center for Medicinal Cannabis Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego
| | - Marilyn A. Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Igor Grant
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Robert L. Fitzgerald
- Center for Medicinal Cannabis Research, Department of Pathology, University of California, San Diego
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Mills L, Freeman J, Rowland B. Australian daily cannabis users' use of police avoidance strategies and compensatory behaviours to manage the risks of drug driving. Drug Alcohol Rev 2023; 42:1577-1586. [PMID: 37323052 DOI: 10.1111/dar.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Daily use of cannabis is increasing in Australia, yet there is limited understanding of the driving behaviours within this cohort, including how they perceive and manage the risks of being apprehended for drug driving and involved in a crash after consumption. METHODS An online survey was completed by 487 Australians who reported daily cannabis use (30% medically prescribed patients, 58% male). RESULTS Current drug driving (i.e., driving within 4 h of consuming cannabis each week) was reported by 86% of participants. Future drug driving was anticipated by 92% of the sample. While most participants (93%) disagreed that their risk of crash increased following cannabis use, participants reported that they would drive more carefully (89%), leave greater headway (79%) and/or drive slower (51%) following cannabis consumption. Half of the sample (53%) perceived the risk of apprehension for drug driving to be likely to some extent. Strategies to reduce the likelihood of being detected were used by 25% of participants, and included using Facebook police location sites (16%), driving on back roads (6%) and/or consuming substances to mask the presence of drugs (13%). The regression analysis revealed that individuals who reported more occasions of cannabis use per day, and who perceived that cannabis does not reduce driving ability, reported a greater extent of current drug driving. DISCUSSION AND CONCLUSIONS Interventions and education which aim to challenge this perception that 'cannabis does not reduce driving ability' may prove important for reducing drug driving among the most frequent consumers of cannabis.
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Affiliation(s)
- Laura Mills
- Road Safety Research Collaboration, University of the Sunshine Coast, Sippy Downs, Australia
| | - James Freeman
- Road Safety Research Collaboration, University of the Sunshine Coast, Sippy Downs, Australia
| | - Bevan Rowland
- Road Safety Research Collaboration, University of the Sunshine Coast, Sippy Downs, Australia
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11
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Kosnett MJ, Ma M, Dooley G, Wang GS, Friedman K, Brown T, Henthorn TK, Brooks-Russell A. Blood cannabinoid molar metabolite ratios are superior to blood THC as an indicator of recent cannabis smoking. Clin Toxicol (Phila) 2023; 61:355-362. [PMID: 37293900 PMCID: PMC10481452 DOI: 10.1080/15563650.2023.2214697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Cannabis use is a growing concern in transportation and workplace incidents. Because Δ9-tetrahydrocannabinol is detectable after acute psychoactive effects have resolved, it has limitations as an indicator of recent usage or potential impairment. METHODS In an observational study of driving and psychomotor performance, we measured whole blood Δ9-tetrahydrocannabinol plus its metabolites 11-hydroxy-Δ9-tetrahydrocannabinol and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol by liquid chromatography with tandem mass spectrometry at baseline and 30 min after starting a 15-minute interval of smoking cannabis in 24 occasional and 32 daily cannabis smokers. We calculated two blood cannabinoid molar metabolite ratios: 1) [Δ9-tetrahydrocannabinol] to [11-nor-9-carboxy-Δ9-tetrahydrocannabinol] and 2) ([Δ9-tetrahydrocannabinol] + [11-hydroxy-Δ9-tetrahydrocannabinol]) to [11-nor-9-carboxy-Δ9-tetrahydrocannabinol]. We compared these to blood [Δ9-tetrahydrocannabinol] alone as indicators of recent cannabis smoking. RESULTS Median Δ9-tetrahydrocannabinol concentrations increased from 0 ( 0.38). By comparison, a cut-point for Δ9-tetrahydrocannabinol of 5.3 µg/L yielded 88% specificity, 73% sensitivity, and 80% accuracy. CONCLUSIONS In occasional and daily users, the blood cannabinoid molar metabolite ratios were superior to whole blood Δ9-tetrahydrocannabinol as indicators of recent cannabis smoking. We recommend measurement and reporting of Δ9-tetrahydrocannabinol, 11-hydroxy-Δ9-tetrahydrocannabinol, and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol, and their molar metabolite ratios in forensic and safety investigations.
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Affiliation(s)
- Michael J. Kosnett
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ming Ma
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gregory Dooley
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - George Sam Wang
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kyle Friedman
- Rocky Mountain Poison and Drug Safety, Denver Health, Denver, CO, United States
| | - Timothy Brown
- Driving Safety Research Institute, University of Iowa, Iowa City, IA, United States
| | - Thomas K. Henthorn
- Department of Anesthesiology and Pharmaceutical Sciences, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO United States
| | - Ashley Brooks-Russell
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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12
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Rague JM, Ma M, Dooley G, Sam Wang G, Friedman K, Henthorn TK, Brooks-Russell A, Kosnett MJ. The minor cannabinoid cannabigerol (CBG) is a highly specific blood biomarker of recent cannabis smoking. Clin Toxicol (Phila) 2023; 61:363-369. [PMID: 36939145 PMCID: PMC10428941 DOI: 10.1080/15563650.2023.2173076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/02/2023] [Accepted: 01/22/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION The determination of recent cannabis use is of forensic interest in the investigation of automotive crashes, workplace incidents and other mishaps. Because Δ9-tetrahydrocannabinol may persist in blood after psychoactive effects of intoxication resolve, particularly in regular users, short-lived minor cannabinoids such as cannabigerol have merited examination as adjunct indicators of recent cannabis inhalation. METHODS As part of an observational cohort study, whole blood cannabinoids including cannabigerol were measured in whole blood by liquid chromatography with tandem mass spectrometry at baseline, and 30 minutes after initiation of a 15-minute supervised interval of ad libitum cannabis smoking in occasional (1-2 days/week over the past 30 days) (n = 24) and daily cannabis smokers (n = 32). Per protocol, subjects self-reported abstention from inhaling cannabis (>8 h) or ingesting cannabis (>12 h) prior to baseline measurement. RESULTS At baseline, none of the occasional users had detectable cannabigerol (limit of detection = 0.2 µg/L), whereas cannabigerol was detectable post-smoking in 7 of 24 (29%). Among daily cannabis users, 2 of 32 (6%) had detectable cannabigerol at baseline, increasing to 21 of 32 (66%) post-smoking. The odds ratio for recent cannabis smoking associated with a detectable cannabigerol was 27 (95% confidence interval: 6.6, 110.3). In this mixed cohort of occasional and daily cannabis users, receiver operator characteristic curve analysis indicated that whole blood cannabigerol concentration of ≥ 0.2 µg/L had 96% specificity, 50% sensitivity, and 73% accuracy for identifying a 15-minute interval of ad libitum cannabis smoking initiated 30 minutes earlier. Post smoking blood Δ9-tetrahydrocannabinol (median = 5.6 µg/L in occasional users, 21.3 µg/L in daily users) was significantly correlated with post-smoking cannabigerol (P < 0.0001). CONCLUSION Whole blood cannabigerol may have forensic utility as a highly specific albeit insensitive biomarker of recent cannabis smoking.
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Affiliation(s)
- John M. Rague
- Rocky Mountain Poison and Drug Safety, Denver Health, Denver, CO, United States
| | - Ming Ma
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gregory Dooley
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - George Sam Wang
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kyle Friedman
- Rocky Mountain Poison and Drug Safety, Denver Health, Denver, CO, United States
| | - Thomas K. Henthorn
- Department of Anesthesiology and Pharmaceutical Sciences, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO United States
| | - Ashley Brooks-Russell
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michael J. Kosnett
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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13
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Steinhart B, Brooks-Russell A, Kosnett MJ, Subramanian PS, Wrobel J. A Video Segmentation Pipeline for Assessing changes in Pupil Response to Light After Cannabis Consumption. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.17.533144. [PMID: 36993434 PMCID: PMC10055178 DOI: 10.1101/2023.03.17.533144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Due to long-standing federal restrictions on cannabis-related research, the implications of cannabis legalization on traffic and occupational safety are understudied. Accordingly, there is a need for objective and validated measures of acute cannabis impairment that may be applied in public safety and occupational settings. Pupillary response to light may offer an avenue for detection that outperforms typical sobriety tests and THC concentrations. We developed a video processing and analysis pipeline that extracts pupil sizes during a light stimulus test administered with goggles utilizing infrared videography. The analysis compared pupil size trajectories in response to a light for those with occasional, daily, and no cannabis use before and after smoking. Pupils were segmented using a combination of image pre-processing techniques and segmentation algorithms which were validated using manually segmented data and found to achieve 99% precision and 94% F-score. Features extracted from the pupil size trajectories captured pupil constriction and rebound dilation and were analyzed using generalized estimating equations. We find that acute cannabis use results in less pupil constriction and slower pupil rebound dilation in the light stimulus test.
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Affiliation(s)
- Benjamin Steinhart
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael J. Kosnett
- Department of Medicine, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Prem S. Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, Sue Anschutz-Rodgers Eye Center, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Julia Wrobel
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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14
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Cheng JYK, Hui JWS, Chan WS, So MH, Hong YH, Leung WT, Ku KW, Yeung HS, Lo KM, Fung KM, Ip CY, Dao KL, Cheung BKK. Interpol review of toxicology 2019-2022. Forensic Sci Int Synerg 2022; 6:100303. [PMID: 36597440 PMCID: PMC9799715 DOI: 10.1016/j.fsisyn.2022.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Bobbie Kwok-keung Cheung
- Corresponding author. Government Laboratory, 7/F, Homantin Government Offices, 88 Chung Hau Street, Ho Man Tin, Kowloon, SAR, Hong Kong, China. http://www.govtlab.gov.hk/
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15
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Brooks-Russell A, Holdman R, Whitehill JM. Approaches to Measuring Cannabis Use in Injury Research: Beyond Drug Detection. CURR EPIDEMIOL REP 2022. [DOI: 10.1007/s40471-022-00314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Stringer RJ. Waiting for the Stop Sign to Turn Green: Contemporary Issues on Drug and Alcohol Impaired Driving Policy. AMERICAN JOURNAL OF CRIMINAL JUSTICE : AJCJ 2022; 47:735-748. [PMID: 36407840 PMCID: PMC9648432 DOI: 10.1007/s12103-022-09705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Impaired driving has been a considerable social problem in the U.S. for decades, but efforts to reduce it have stalled after the initial reductions in the 1980's. As a result, legislators continue to develop more polices aimed at deterring impaired driving. Although alcohol has historically been the focus of these efforts, recently there has been increased concern about marijuana impaired driving policies as well. However, alcohol and marijuana impaired driving differ in many ways. This paper explores the costs and benefits of new zero-tolerance policies such as the reduction of the per-se Blood Alcohol Concentration (BAC) level from .08 to .05 for alcohol and the establishment of similar per-se limits for marijuana. These policies are not based on actual impairment and reflect a net widening effect that will criminalize unimpaired drivers, divert criminal justice resources away from the most problematic impaired drivers, and will have little impact on impaired driving crashes. As such, they have the potential to do more harm than good.
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17
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Yates CF, Huang JY, Protti DA. Tonic Endocannabinoid Levels Modulate Retinal Signaling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12460. [PMID: 36231760 PMCID: PMC9566182 DOI: 10.3390/ijerph191912460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
The endocannabinoid (eCB) system is critically involved in the modulation of synaptic transmission in the central nervous system, playing an important role in the control of emotional responses, neurodevelopment and synaptic plasticity among other functions. The eCB system is also present in the retina, with studies indicating changes in function after application of cannabinoid receptor agonists, antagonists and in knockout models. Whether eCBs are tonically released in the retina and their physiological functions is, however, still unknown. We investigated the role of the eCB system in the modulation of response strength of retinal ganglion cells (RGCs) to light stimulation, their receptive field organization, contrast sensitivity and excitability properties by performing whole-cell patch-clamp recordings in mouse RGCs before and after bath application of URB597, an inhibitor of the enzyme that degrades the eCB anandamide. Our results show that URB597 application leads to a reduction in the strength of synaptic inputs onto RGCs but paradoxically increases RGC excitability. In addition, URB597 was shown to modulate receptive field organization and contrast sensitivity of RGCs. We conclude that tonically released eCBs modulate retinal signaling by acting on traditional cannabinoid receptors (CB1R/CB2R) as well as on non-cannabinoid receptor targets. Thus, a thorough understanding of the effects of drugs that alter the endogenous cannabinoid levels and of exogenous cannabinoids is necessary to fully comprehend the impact of their medical as well as recreational use on vision.
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Affiliation(s)
- Charles F. Yates
- School of Medical Sciences (Neuroscience), The University of Sydney, Sydney, NSW 2006, Australia
- Department of Neurosurgery, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
| | - Jin Y. Huang
- School of Medical Sciences (Education Innovation), The University of Sydney, Sydney, NSW 2006, Australia
| | - Dario A. Protti
- School of Medical Sciences (Neuroscience), The University of Sydney, Sydney, NSW 2006, Australia
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18
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Miller R, Brown T, Wrobel J, Kosnett MJ, Brooks-Russell A. Influence of cannabis use history on the impact of acute cannabis smoking on simulated driving performance during a distraction task. TRAFFIC INJURY PREVENTION 2022; 23:S1-S7. [PMID: 35686998 PMCID: PMC10108575 DOI: 10.1080/15389588.2022.2072492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 06/12/2023]
Abstract
Objective: This research explores the driving performance of people who use cannabis daily or occasionally during distraction tasks performed following acute cannabis use.Methods: Healthy adults aged 25 to 45 years with different cannabis usage histories were recruited to participate in a within-subjects controlled experiment using a car-based driving simulator. Participants were classified as having daily use (n = 31), occasional use (1 or 2 times per week; n = 24), or no-use (n = 30). Participants completed a practice drive followed by four 5-10 minute driving scenarios during the baseline period. Participants then smoked self-procured cannabis flower ad libitum for up to 15 minutes. Thirty minutes later, they completed four additional 5-10 minute scenarios. Scenarios were paired according to difficulty and randomized across the baseline and post-use periods. Each scenario contained between 0 and 3 repetitions of a distraction task where the participant was prompted by an audio message to select an app from a 4 × 5 grid displayed on a mounted tablet, a step that would require briefly looking away from the roadway. Measures of driving performance (lane departures, standard deviation of lateral position) were assessed during the five-second period following the audio trigger and analyzed using generalized linear mixed models.Results: Those with a pattern of occasional use were significantly more likely to experience a lane departure during distraction periods after acute cannabis use relative to baseline (OR = 3.71, p = 0.04, CI = 1.04, 13.17), while those with daily use did not exhibit a similar increase (OR = 1.56, p = 0.43, CI = 0.52, 4.64). Changes in departure risk were significantly greater for the occasional use group compared to no-use (p = 0.02), but not for the daily use group compared to no-use (p = 0.18). However, following acute use, those who use daily exhibited decreases in speed relative to baseline in comparison to the changes observed in the no-use group (p = 0.02), while differences between occasional and no-use did not reach statistical significance (p = 0.052). Differences in standard deviation of lateral position were not statistically significant, likely due to the short duration of tasks.Conclusions: These results find the largest potential safety concerns associated with a pattern of occasional use, who displayed an increase in lane departures after acute cannabis smoking. Those in the daily use group decreased their speed, which may be interpreted as compensation for drug effects. Further research is needed to understand the effects during longer and more complex secondary tasks.
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Affiliation(s)
- Ryan Miller
- Department of Mathematics, Xavier University, Cincinnati, Ohio
| | - Tim Brown
- National Advance Driving Simulator, University of Iowa
| | - Julia Wrobel
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael J. Kosnett
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Medicine, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ashley Brooks-Russell
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Blandino A, Cotroneo R, Tambuzzi S, Di Candia D, Genovese U, Zoja R. Driving under the influence of drugs: Correlation between blood psychoactive drug concentrations and cognitive impairment. A narrative review taking into account forensic issues. Forensic Sci Int Synerg 2022; 4:100224. [PMID: 35330981 PMCID: PMC8938866 DOI: 10.1016/j.fsisyn.2022.100224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022]
Abstract
Driving under the influence of alcohol has been shown to increase the risk of involvement in road traffic collisions (RTCs) however, less is known about the effects of illicit drugs, and a clear correlation between drug concentrations and RTC risk is still debated. The goal of this narrative review is to assess the current literature regarding the most detected psychoactive drugs in RTC (ethanol, amphetamines, cannabis, opioids and cocaine), in relation to driving performance. Evidence on impaired driving due to psychoactive substances, forensic issues relating to the assessment of the impact of drugs, blood cut-off values proposed to date as well as scientific basis for proposed legislative limits are discussed. At present there is no unequivocal evidence demonstrating a clear dose/concentration dependent impairment in many substances. Per se and zero tolerance approaches seem to have negative effect on drugged driving fatalities. However, the weight of these approaches needs further investigation. Driving under the influence of psychotropic substances has become a widespread phenomenon. Only a few substances have been reported to have a clear dose/concentration dependent impairment. Statistically significant differences should not be considered as clinically significant per se There is wide variability in legislative cut-offs. Detection limits seems to be the most public safety-oriented legislative approach.
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