Interventions to Prevent Drugged Driving: A Systematic Review

Harm reduction strategies for cannabis-related problems: a literature review and typology

Measures that seek to minimise the health and social consequences of substance use are an integral part of national drug strategies in many European countries. Against the backdrop of a high prevalence of cannabis use in the economically advanced countries, and increasing demand for treatment for cannabis-related problems, a range of harm reduction measures have been implemented by peers, statutory bodies and third-sector organisations. Based on a systematic review of the literature, the author describes these different forms of intervention, identifies innovative strategies and presents a simple typology that can be used when exploring existing measures or seeking to develop new policies. This typology covers different kinds of legal, socio-organisational and health-related interventions. All study designs were eligible for inclusion, with the exception of case reports, non-systematic reviews, editorials and news stories. Studies had to be published between 2011 and 2022, in English, and they had to refer to Europe, the Americas, Australia or New Zealand. A two-concept search was implemented using Embase.com and a number of other databases, combined with citation searches and manual website searching to improve coverage of research reports and advocacy documents. A total of 35 documents were deemed eligible, many of which rely on qualitative research methods.

Assessing the effectiveness of psychoeducational interventions on driving behavior: A systematic review and meta-analysis

This review aimed to quantitatively summarize the evidence concerning the effectiveness of psychoeducational interventions on driving behavior. A final pool of 138 studies, totaling approximately 97,000 participants, was included in the analyses and covered all types of driving behavior targeted by the interventions. Using a random effects model, significant results were found for almost all driving outcomes, both post-intervention and long-term. The strongest effect was for reducing distracted driving at post-intervention (d = 1.87 [1.12, 2.60], Z = 4.94, p < 0.001). The only non-significant effects were for reducing errors in the long term (d = 0.50 [-0.87, 1.86], Z = 0.71, p = 0.48) and driving under the influence at post-intervention (d = 0.35 [0.00, 0.71], Z = 1.96, p = 0.05). Concerning which type of intervention was more effective, feedback, training and motivational ones appear to work best. Educational interventions show only weak effects, while awareness interventions seem mostly ineffective. Overall, our results show that most interventions can reduce different types of driving behaviors, but there are specific aspects to be considered based on the targeted behavior.

Feasibility and acceptability of a web-intervention to prevent alcohol and cannabis-impaired driving among adolescents in driver education

Background

Adolescents increasingly view cannabis as a substance with limited harm. Their propensity to engage in risky driving, combined with their relative driving inexperience, places adolescents at heightened risk for harm resulting from impaired driving. Driver education provides an opportunity to help prevent and reduce these risks, yet few interventions address cannabis-impaired driving, especially impairment from simultaneous use of both cannabis and alcohol.

Methods

We adapted a single-session primary care brief intervention (CHAT) for driver education programs. First, we conducted two focus groups with adolescents aged 15-17 years (n = 6; n = 5) enrolled in driver education programs. Their feedback was integrated into a prototype of an online intervention called webCHAT that focuses on preventing alcohol and cannabis-impaired driving. Next, we recruited a new sample of adolescents who user tested webCHAT (n = 8) and provided qualitative and survey feedback. We analyzed qualitative data using classic content analysis and grouped themes according to the feasibility and acceptability of webCHAT.

Results

Participants suggested that webCHAT should have adolescent narrators in short, informal, and interactive videos. In satisfaction surveys (n = 8), 88% of participants would recommend webCHAT to a friend and 88% reported that they learned helpful skills regarding impaired driving. General acceptability was also reflected in interviews (n = 6; 100% would recommend the intervention to a friend, 100% indicated overall positive impressions, and 67% stated it was easy to use). Participants reported that it was helpful to learn about the negative effects of both cannabis and alcohol on driving behavior, voicing that webCHAT would help adolescents make more informed decisions.

Conclusions

Soliciting adolescent perspectives is critical when developing interventions targeting cannabis use because of increasingly permissive attitudes and perceptions of minimal risk associated with use. The current study highlights how feedback can help increase both the feasibility and acceptability of interventions.

Driving Under the Influence of Alcohol, Cannabis, and Delta-8 THC: Perceived Likelihood, Risk Perceptions, and Behaviors

Driving under the influence (DUI) of alcohol or cannabis poses public health risks. Little is known about DUI of Delta-8 THC, a newer cannabis product. Using 2022 survey data among 189 U.S. adults ages 18-25 (58.73% male, 59.26% non-Hispanic White), multivariable logistic regression examined substance-specific (alcohol, cannabis, Delta-8) DUI perceived likelihood and risk in relation to past-year DUI among those with past-year use of each. Overall, 72.49% reported past-year alcohol use, 50.53% cannabis, and 22.46% Delta-8. Among those reporting past-year use of each respective substance, 33.58% reported DUI of alcohol, 32.63% cannabis, and 57.14% Delta-8. On average, participants had the same DUI perceived likelihood ("somewhat unlikely") across substances and perceived alcohol DUI as riskiest. Higher alcohol DUI perceived likelihood and lower perceived risk were associated with alcohol-related DUI. Greater cannabis-related perceived likelihood (but not risk) was associated with cannabis-related DUI. Neither Delta-8 DUI perceived likelihood nor risk were associated with Delta-8 DUI. In sum, perceived DUI likelihood for alcohol, cannabis, or Delta-8 tended to be similar. Among those with past-year use of each, the proportion of DUI was highest for Delta-8. Interventions should target DUI-related perceived likelihood and promote protective behavioral strategies that reduce substance-specific DUI risk.

Driving under the influence of cannabis versus alcohol: A mixed-methods study examining perceptions and related risk behaviors among US and Israeli adults

BACKGROUND

Despite the dangers of driving under the influence (DUI), little is known about DUI substance-specific risk perceptions or risk factors for riding with drunk/drugged drivers (RDD).

METHODS

In this sequential exploratory mixed-methods study, we conducted: 1) multivariable analyses of cross-sectional survey data from 2222 US and Israeli adults to identify correlates of perceived cannabis- vs. alcohol-related DUI risks (linear regression) and past-month RDD involving alcohol-only, cannabis-only, or both (alcohol-cannabis) (multinomial logistic regression); and 2) deductive-inductive thematic analyses of qualitative interview data from 84 participants to identify themes elaborating on survey findings regarding DUI-related risk perceptions.

RESULTS

54.0 % reported past-month alcohol use, 16.7 % cannabis use, 4.2 % alcohol-only RDD, 5.5 % cannabis-only RDD, and 7.9 % alcohol-cannabis RDD. Being from the US, not having children at home, and cannabis non-use correlated with lower perceived cannabis vs. alcohol DUI risk. Lower perceived cannabis vs. alcohol DUI risk correlated with cannabis-only and alcohol-cannabis (vs. no) RDD, and with alcohol-cannabis (vs. cannabis-only) RDD. Alcohol use correlated with alcohol-only (vs. no) RDD and alcohol-cannabis (vs. cannabis-only) RDD. Cannabis use correlated with cannabis-only and alcohol-cannabis (vs. no) RDD, and with alcohol-cannabis (vs. alcohol-only) RDD. Being from the US correlated with alcohol-only (vs. alcohol-cannabis and none) RDD and cannabis-only (vs. alcohol-cannabis) RDD; being from Israel correlated with alcohol-cannabis (vs. no) RDD. Qualitative data indicated most participants perceived greater risk of DUI of alcohol vs. cannabis and desired more effective DUI-related prevention and regulatory efforts.

CONCLUSIONS

Prevention interventions targeting DUI- and RDD-related risk perceptions are needed, particularly for high-risk populations.

Perceptions and Attitudes Related to Driving after Cannabis Use in Canadian and US Adults

BACKGROUND

This study examined the risk perceptions related to driving after cannabis use (DACU) among Canadian and US adults who used cannabis in the past six months.

METHODS

Perceptions of danger, normative beliefs, perceived likelihood of negative consequences, and other driving-related variables were collected via online surveys in Canadian (n = 158; 50.0% female, 84.8% White, mean age = 32.73 years [SD = 10.61]) and US participants (n = 678; 50.9% female, 73.6% White, mean age = 33.85 years [SD = 10.12]). Driving cognitions and DACU quantity/frequency were compared between samples using univariate analyses of variance, and Spearman's (ρ) correlations were performed to examine associations between driving cognitions and DACU quantity/frequency.

RESULTS

The two samples did not significantly differ in self-reported level of cannabis use, lifetime quantity of DACU, or the number of times they drove within two hours of cannabis use in the past three months (Ps > .12). Compared to US participants, Canadians perceived driving within two hours of cannabis use as more dangerous (P < 0.001, ηp2 = 0.013) and reported more of their friends would disapprove of DACU (P = 0.03, ηp2 = 0.006). There were no differences in the number of friends who would refuse to ride with a driver who had used cannabis (P = 0.15) or the perceived likelihood of negative consequences (Ps > 0.07). More favorable perceptions were significantly correlated with greater lifetime DACU and driving within two hours of use (ρ = 0.25-0.53, Ps < 0.01).

CONCLUSIONS

These findings reveal differences in distal risk factors for DACU between Canada and the US and may inform prevention efforts focusing on perceptions of risk and social acceptance of DACU.

Measuring a motivational interviewing practice orientation in criminal justice practitioners: initial validation of the response style screening questionnaire

Introduction

The use of collaborative communication techniques by criminal justice practitioners has been identified as a component of core correctional practices (CCPs). Criminal justice agencies and programs are investing in motivational interviewing (MI) training for their staff with varying intensity, follow-up coaching, and expectations for integration into practice. The present article describes the development and initial validation of the Response Style Screening Questionnaire (RSSQ), a practitioner completed tool assessing an MI-consistent practice orientation. Over three studies, we examined the factor structure, reliability, and correlations between the scale and self-reported and behavioral validity indicators.

Method

Study 1 examined the factor structure of the RSSQ with a sample of 825 criminal justice practitioners. In Study 2, data from 350 probation officers completing the RSSQ alongside measures of work-orientation and attitudes was used to conduct a confirmatory factor analysis and an initial assessment of its construct validity. In Study 3, correlations between the RSSQ and audio recorded office visits of 33 probation officers coded for MI and relationship building skills examined the scale's criterion validity.

Results

In Study 1, an exploratory factor analysis with an oblique rotation yielded 18 items on four factors. In Study 2, four and five factor models were tested, with the 4-factor model of Study 1 yielding the best fit. Two of the 4 factor-derived subscales reflect styles inconsistent with MI: (1) Confrontational style, and (2) Sustain Talk style; while the remaining two reflect styles consistent with MI: (3) Eliciting style, and (4) Change Talk style. Confrontational style scores were correlated with a work-orientation reflecting probation as a law enforcement endeavor, while Eliciting and Change Talk scores were correlated with a behavior change and resource broker work-orientations. In Study 3, Confrontational and Sustain Talk style scores were negatively correlated with a variety of MI skills and CCPs displayed on audio recordings, while Change Talk style scores were positively correlated with use of such skills.

Discussion

Overall, the findings suggest the RSSQ is a potentially useful new practitioner self-report tool for assessing an MI practice orientation.

Perceived Safety, Not Perceived Legality, Mediates the Relationship Between Cannabis Legalization and Drugged Driving

Cannabis legalization has rapidly spread throughout the United States and is associated with multiple public health outcomes, including driving under the influence of cannabis (DUIC). To improve understanding of the relationship between legalization and DUIC, we tested two potential mediators of this relationship: perceived safety and perceived legality of driving high. We analyzed data from 1,236 current (past 30-day) cannabis users who were recruited from states with recreational, medical only, or no legal cannabis between 2016 and 2017 using address-based and social media samples. Using a generalized linear model and adjusting for cannabis legalization, demographics, living in a state with a cannabis-specific drugged driving law, frequency of cannabis use, and weights, we found that perceived safety (risk ratio [RR] = 2.60, 95% CI [1.88, 3.58]), but not perceived legality (RR = 0.96, 95% CI [0.67, 1.37]), was significantly associated with DUIC. Perceived safety mediated the relationship between legalization and DUIC (Coeff: -0.12, 95% CI [-0.23, -0.01]). Models stratified by frequency of cannabis use yielded results consistent with those of pooled models except that, for frequent users, cannabis-specific driving laws were associated with a significantly lower risk of DUIC (RR = 0.64, 95% CI [0.44, 0.92]). Agencies developing cannabis-focused drugged driving educational campaigns should consider the potential role of perceived safety of driving high in DUIC campaigns.

Can inhaled cannabis users accurately evaluate impaired driving ability? A randomized controlled trial

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.

Association of risky driving behavior with psychiatric disorders among Iranian drivers: A case-control study

PURPOSE

This study aimed to investigate the possible association between psychological disorders and risky driving behavior (RDB) in Iran.

METHODS

This case-control study conducted in Shiraz, Iran in 2021. The case group included drivers with psychological disorders and the control group included those without any disorders. The inclusion criteria for selecting patients were: active driving at the time of the study, being 18 - 65 years old, having a driving license, having a psychological disorder including depression, bipolar disorder, anxiety spectrum disorder, or psychotic disorder spectrum confirmed by a psychiatrist, and completing an informed consent form. The exclusion criterion was the existence of conditions that interfered with answering and understanding the questions. The inclusion criteria for selecting the healthy cases were: active driving at the time of the study, being 18 - 65 years old, having a driving license, lack of any past or present history of psychiatric problems, and completing an informed consent form. The data were gathered using a researcher-made checklist and Manchester driving behavior questionnaire. First, partition around medoids method was used to extract clusters of RDB. Then, backward logistic regression was applied to investigate the association between the independent variables and the clusters of RDB.

RESULTS

The sample comprised of 344 (153 with psychological disorder and 191 without confirmed psychological disorder) drivers. Backward elimination logistic regression on total data revealed that share of medical expenditure ≤ 10% of total household expenditure (OR = 3.27, 95% CI: 1.48 - 7.24), psychological disorder (OR = 3.08, 95% CI: 1.67 - 5.70), and substance abuse class (OR = 6.38, 95% CI: 3.55 - 11.48) were associated with high level of RDB.

CONCLUSION

Substance abuse, psychological illnesses, and share of medical costs from total household expenditure were found to be main predictors of RDB. Further investigations are necessary to explain the impact of different psychological illnesses on driving behavior.

Roadside screening tests for cannabis use: A systematic review

As more countries legalize recreational cannabis, roadside screening programs are imperative to detect and deter driving under the influence of cannabis. This systematic review evaluated roadside screening tests for cannabis use. We searched six databases (inception-March 2020) and grey literature sources for primary studies evaluating test characteristics of roadside screening tests for cannabis use compared to laboratory tests for cannabinoids in blood or oral fluid. The synthesis was focused on sensitivity and specificity of delta-9-tetrahydrocannabinol (THC) detection. 101 studies were included. Oral fluid tests were higher in specificity and lower in sensitivity compared to urine tests when evaluated against blood laboratory tests. Oral fluid tests were higher in sensitivity and similar in specificity compared to observational tests when evaluated against blood and oral fluid laboratory tests. Sensitivity was variable among oral fluid tests; two instrumented immunoassays (Draeger DrugTest 5000 [5 ng/mL THC cut-off] and Alere DDS 2 Mobile Test System) appeared to perform best, but definitive conclusions could not be drawn due to imprecise estimates. Specificities were similar. Overall, oral fluid tests showed the most promise for use in roadside screening for blood THC levels over legal limits; their continued development and testing are warranted. Urine tests are generally inadvisable, and observational tests require sensitivity improvements.

Drugged driving among U.S. adolescents, 2016-2019, USA

INTRODUCTION

Drugged driving, the operation of a vehicle under the influence of any illegal drugs and alcohol, is a growing problem, but remains understudied among adolescents. The purpose of this article is to estimate past-year driving under the influence of alcohol, marijuana, and other drugs among a large sample of U.S. adolescents and potential associations (e.g., age, race, metropolitan status, sex).

DESIGN

A cross-sectional secondary data analysis of the 2016-2019 National Survey on Drug Use and Health among 17,520 adolescents ages 16-17-years old was conducted. Weighted logistic regression models were built to determine potential associations to drugged driving.

RESULTS

An estimated 2.00% of adolescents drove under the influence of alcohol in the past year, 5.65% drove under the influence of marijuana in the past year, and an estimated 0.48% drove under the influence of other drugs other than marijuana in the past year. Differences were based on race, past-year drug use, and county status.

CONCLUSIONS

Drugged driving is a growing problem among adolescents and interventions are greatly needed to mitigate these behaviors among youth.

The Impact of Cannabis Decriminalization and Legalization on Road Safety Outcomes: A Systematic Review

INTRODUCTION

There is substantial debate concerning the impact of cannabis decriminalization and legalization on road safety outcomes.

METHODS

Seven databases were systematically searched: Embase, MEDLINE, and PsycINFO through Ovid as well as Web of Science Core Collection, SafetyLit, Criminal Justice Database (ProQuest), and Transport Research International Documentation (from inception to June 16, 2021). Eligible primary studies examined group-level cannabis decriminalization or legalization and a road safety outcome in any population.

RESULTS

A total of 65 reports of 64 observational studies were eligible, including 39 that applied a quasi-experimental design. Studies examined recreational cannabis legalization (n=50), medical cannabis legalization (n=22), and cannabis decriminalization (n=5). All studies except 1 used data from the U.S. or Canada. Studies found mixed impacts of legalization on attitudes, beliefs, and self-reported driving under the influence. Medical legalization, recreational legalization, and decriminalization were associated with increases in positive cannabis tests among drivers. Few studies examined impacts on alcohol or other drug use, although findings suggested a decrease in positive alcohol tests among drivers associated with medical legalization. Medical legalization was associated with reductions in fatal motor-vehicle collisions, whereas recreational legalization was conversely associated with increases in fatal collisions.

DISCUSSION

Increased cannabis positivity may reflect changes in cannabis use; however, it does not in itself indicate increased impaired driving. Subgroups impacted by medical and recreational legalization, respectively, likely explain opposing findings for fatal collisions. More research is needed concerning cannabis decriminalization; the impacts of decriminalization and legalization on nonfatal injuries, alcohol and other drugs; and the mechanisms by which legalization impacts road safety outcomes.

[PAPPS expert group: Lifestyle recommendations]

We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.