1
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Dutra LM, Gourdet C, Farrelly MC, Bradfield B. Perceived Safety, Not Perceived Legality, Mediates the Relationship Between Cannabis Legalization and Drugged Driving. HEALTH EDUCATION & BEHAVIOR 2023; 50:718-727. [PMID: 35822623 DOI: 10.1177/10901981221109137] [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] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Lauren M Dutra
- RTI International, Research Triangle Park, NC, USA
- RTI International, Berkeley, CA, USA
| | - C Gourdet
- RTI International, Research Triangle Park, NC, USA
| | - M C Farrelly
- RTI International, Research Triangle Park, NC, USA
| | - B Bradfield
- RTI International, Research Triangle Park, NC, USA
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2
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Lulek CF, Maulik M, Mitra S, Guindon J, Morgan DJ, Henderson-Redmond AN. Sex differences in acute delta-9-tetrahydrocannabinol (Δ 9-THC) response and tolerance as a function of mouse strain. Psychopharmacology (Berl) 2023; 240:1987-2003. [PMID: 37516707 PMCID: PMC10471687 DOI: 10.1007/s00213-023-06421-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 07/31/2023]
Abstract
Cannabinoids are increasingly used to alleviate pain; however, tolerance to their antinociceptive effects, including those of delta-9-tetrahydrocannabinol (Δ9-THC), may limit their therapeutic utility. With more women than men using medical cannabis for pain relief, it is crucial to understand how sex influences cannabinoid-mediated antinociception and tolerance. Though studies in rats consistently find females are more sensitive to the acute antinociceptive effects of cannabinoids, our work with mice consistently finds the converse. The present study examined whether our observed sex differences in Δ9-THC-induced antinociception and tolerance are consistent across multiple mouse strains or are strain-dependent. Male and female C57BL/6J (B6), DBA/2, AKR, and CBA/J mice were assessed for differences in acute Δ9-THC-induced antinociception and hypothermia prior to and following seven days of once-daily Δ9-THC administration. Consistent with our previous findings, male B6 mice were more sensitive to the acute antinociceptive effects of Δ9-THC than female littermates, an effect which dissipated with age. B6 males had decreased cannabinoid expression in the PAG compared to females. While DBA and CBA female mice showed increased Δ9-THC-antinociception compared to male littermates at 30 and 10 mg/kg Δ9-THC, respectively, these differences were less pronounced at higher doses, revealing that dose of Δ9-THC may also be important. Overall, CBA mice were more sensitive to Δ9-THC-induced antinociception while AKR mice were less responsive. These studies highlight the therapeutic potential of Δ9-THC in pain management and underscore the importance of considering not only Δ9-THC dose as a function of sex, but potentially genetic differences when evaluating their clinical utility.
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Affiliation(s)
- Courtney F Lulek
- Department of Biomedical Sciences, Marshall University, Huntington, WV, 25755, USA
| | - Malabika Maulik
- Department of Biomedical Sciences, Marshall University, Huntington, WV, 25755, USA
| | - Swarup Mitra
- Department of Biomedical Sciences, Marshall University, Huntington, WV, 25755, USA
| | - Josée Guindon
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Daniel J Morgan
- Department of Biomedical Sciences, Marshall University, Huntington, WV, 25755, USA
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3
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Piscura MK, Henderson-Redmond AN, Barnes RC, Mitra S, Guindon J, Morgan DJ. Mechanisms of cannabinoid tolerance. Biochem Pharmacol 2023; 214:115665. [PMID: 37348821 PMCID: PMC10528043 DOI: 10.1016/j.bcp.2023.115665] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Cannabis has been used recreationally and medically for centuries, yet research into understanding the mechanisms of its therapeutic effects has only recently garnered more attention. There is evidence to support the use of cannabinoids for the treatment of chronic pain, muscle spasticity, nausea and vomiting due to chemotherapy, improving weight gain in HIV-related cachexia, emesis, sleep disorders, managing symptoms in Tourette syndrome, and patient-reported muscle spasticity from multiple sclerosis. However, tolerance and the risk for cannabis use disorder are two significant disadvantages for cannabinoid-based therapies in humans. Recent work has revealed prominent sex differences in the acute response and tolerance to cannabinoids in both humans and animal models. This review will discuss evidence demonstrating cannabinoid tolerance in rodents, non-human primates, and humans and our current understanding of the neuroadaptations occurring at the cannabinoid type 1 receptor (CB1R) that are responsible tolerance. CB1R expression is downregulated in tolerant animals and humans while there is strong evidence of CB1R desensitization in cannabinoid tolerant rodent models. Throughout the review, critical knowledge gaps are indicated and discussed, such as the lack of a neuroimaging probe to assess CB1R desensitization in humans. The review discusses the intracellular signaling pathways that are responsible for mediating CB1R desensitization and downregulation including the action of G protein-coupled receptor kinases, β-arrestin2 recruitment, c-Jun N-terminal kinases, protein kinase A, and the intracellular trafficking of CB1R. Finally, the review discusses approaches to reduce cannabinoid tolerance in humans based on our current understanding of the neuroadaptations and mechanisms responsible for this process.
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Affiliation(s)
- Mary K Piscura
- Department of Biomedical Sciences, Marshall University, Huntington, WV 25755, USA; Department of Biomedical Sciences, Edward Via College of Osteopathic Medicine, Auburn, AL 36832, USA
| | | | - Robert C Barnes
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Swarup Mitra
- Department of Biomedical Sciences, Marshall University, Huntington, WV 25755, USA
| | - Josée Guindon
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Daniel J Morgan
- Department of Biomedical Sciences, Marshall University, Huntington, WV 25755, USA.
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4
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Schnakenberg Martin AM, Flynn LT, Sefik E, Luddy C, Cortes-Briones J, Skosnik PD, Pittman B, Ranganathan M, D'Souza DC. Preliminary study of the interactive effects of THC and ethanol on self-reported ability and simulated driving, subjective effects, and cardiovascular responses. Psychopharmacology (Berl) 2023; 240:1235-1246. [PMID: 37045988 DOI: 10.1007/s00213-023-06356-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/15/2023] [Indexed: 04/14/2023]
Abstract
RATIONALE Drug- and alcohol-related motor vehicle accidents are a leading cause of morbidity and mortality worldwide. Compared to alcohol, less is known about the effects of cannabis on driving and even less about their combined effects. OBJECTIVE To characterize the combined and separate effects of ethanol and tetrahydrocannabinol (THC) on perceived ability to drive, subjective effects, and simulated driving. METHODS In a within-subject (crossover), randomized, placebo-controlled, double-blind, 2 × 2 design, the effects of oral THC (10 mg [dronabinol] or placebo) and low-dose intravenous ethanol (clamped at BAC 0.04% or placebo) on perceived ability to drive, simulated driving (standard deviation of lateral position [SDLP]), subjective effects (e.g., "high"), and physiological effects (e.g., heart rate) were studied in healthy humans (n = 18). RESULTS Subjects reported reductions in perceived ability to drive (THC < ethanol < combination) which persisted for ~ 6 h (placebo = ethanol, THC < combination). Ethanol and THC produced synergistic effects on heart rate, significant differences compared to either drug alone on perceived ability to drive and feeling states of intoxication (e.g., high), as well increases in SDLP compared to placebo. CONCLUSIONS Perceived ability to drive is reduced under the influence of THC against the backdrop of blood alcohol levels that are below the legal limit. People should be aware that the effects of oral THC on driving may persist for up to six hours from administration. Findings are relevant to the increasingly common practice of combining alcohol and cannabinoids and the effects on driving.
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Affiliation(s)
- Ashley M Schnakenberg Martin
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 05615, USA
| | - L Taylor Flynn
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 05615, USA
| | - Esra Sefik
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 05615, USA
| | - Christina Luddy
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 05615, USA
| | - Jose Cortes-Briones
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 05615, USA
| | - Patrick D Skosnik
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 05615, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Mohini Ranganathan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 05615, USA
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 05615, USA.
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5
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Trends in Canadian Cannabis Consumption Over Time: A Two-step Meta-analysis of Canadian Household Survey Data. CANADIAN JOURNAL OF ADDICTION 2022. [DOI: 10.1097/cxa.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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6
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Simmons SM, Caird JK, Sterzer F, Asbridge M. The effects of cannabis and alcohol on driving performance and driver behaviour: a systematic review and meta-analysis. Addiction 2022; 117:1843-1856. [PMID: 35083810 DOI: 10.1111/add.15770] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Cannabis and alcohol are frequently detected in fatal and injury motor vehicle crashes. While epidemiological meta-analyses of cannabis and alcohol have found associations with an increase in crash risk, convergent evidence from driving performance measures is insufficiently quantitatively characterized. Our objectives were to quantify the magnitude of the effect of cannabis and alcohol-alone and in combination-on driving performance and behaviour. METHODS Systematic review and meta-analysis. We systematically searched Academic Search Complete, CINAHL, Embase, Scopus, Google Scholar, MEDLINE, PsycINFO, SPORTDiscus and TRID. Of the 616 studies that underwent full-text review, this meta-analysis represents 57 studies and 1725 participants. We extracted data for hazard response time, lateral position variability, lane deviations or excursions, time out of lane, driving speed, driving speed variability, speed violations, time speeding, headway, headway variability and crashes from experimental driving studies (i.e. driving simulator, closed-course, on-road) involving cannabis and/or alcohol administration. We reported meta-analyses of effect sizes using Hedges' g and r. RESULTS Cannabis alone was associated with impaired lateral control [e.g. g = 0.331, 95% confidence interval (CI) = 0.212-0.451 for lateral position variability; g = 0.198, 95% CI = 0.001-0.395 for lane excursions) and decreased driving speed (g = -0.176, 95% CI = -0.298 to -0.053]. The combination of cannabis and alcohol was associated with greater driving performance decrements than either drug in isolation [e.g. g = 0.480, 95% CI = 0.096-0.865 for lateral position variability (combination versus alcohol); g = 0.525, 95% CI = 0.049-1.002 for time out of lane (versus alcohol); g = 0.336, 95% CI = 0.036-0.636 for lateral position variability (combination versus cannabis; g = 0.475, 95% CI = 0.002-0.949 for time out of lane (combination versus cannabis)]. Subgroup analyses indicated that the effects of cannabis on driving performance measures were similar to low blood alcohol concentrations. A scarcity of data and study heterogeneity limited the interpretation of some measures. CONCLUSIONS This meta-analysis indicates that cannabis, like alcohol, impairs driving, and the combination of the two drugs is more detrimental to driving performance than either in isolation.
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Affiliation(s)
- Sarah M Simmons
- Department of Psychology, University of Calgary, Alberta, Canada
| | - Jeff K Caird
- Department of Psychology, University of Calgary, Alberta, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Alberta, Canada
| | - Frances Sterzer
- Department of Psychology, University of Calgary, Alberta, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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7
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Dutra LM, Farrelly M, Gourdet C, Bradfield B. Cannabis legalization and driving under the influence of cannabis in a national U.S. Sample. Prev Med Rep 2022; 27:101799. [PMID: 35656220 PMCID: PMC9152797 DOI: 10.1016/j.pmedr.2022.101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 11/24/2022] Open
Abstract
A national survey sampled current cannabis users. Users in medical cannabis states were less likely to report driving high. Users in recreational states were less likely to report driving high. Likelihood of driving high varied by frequency of cannabis use.
The relationship between cannabis legalization and traffic safety remains unclear. Physiological measures of cannabis impairment remain imperfect. This analysis used self-report data to examine the relationship between cannabis legalization and driving under the influence of cannabis (DUIC)1. Using a cross-sectional national sample (2016–2017) of 1,249 past–30-day cannabis users, we regressed self-reported DUIC (driving within three hours of “getting high”) on cannabis legalization (recreational and medical (recreational), medical only (medical), or no legal cannabis), adjusting for demographics, days of use (past 30 days), days of use*legal status, calibration weights, and geographic clustering. The risk of DUIC in recreational (risk ratio [RR] = 0.41, 95% confidence interval (CI):0.23–0.72) and medical (RR = 0.39, 95% CI:0.20–0.79) states was lower than in states without legal cannabis, with one exception. Among frequent cannabis users (≥20 days per month), there was a significantly lower risk of DUIC for those living in recreational states (RR = 0.70, 95% CI: 0.49–0.99), but not for those living in medical states (RR = 0.87, 95% CI: 0.60–1.24), compared to users living in states without legal cannabis. The risk of self-reported DUIC was lower in recreational and medical cannabis states compared to states without legal cannabis. The only exception was for frequent users in medical states, for whom there was no difference in risk compared to frequent users living in states without legal cannabis.
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8
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Fares A, Wickens CM, Mann RE, Di Ciano P, Wright M, Matheson J, Hasan OSM, Rehm J, George TP, Samokhvalov AV, Shuper PA, Huestis MA, Stoduto G, Brown T, Stefan C, Rubin-Kahana DS, Le Foll B, Brands B. Combined effect of alcohol and cannabis on simulated driving. Psychopharmacology (Berl) 2022; 239:1263-1277. [PMID: 33544195 DOI: 10.1007/s00213-021-05773-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/21/2021] [Indexed: 12/21/2022]
Abstract
RATIONALE With alcohol and cannabis remaining the most commonly detected drugs in seriously and fatally injured drivers, there is a need to understand their combined effects on driving. OBJECTIVES The present study examined the effects of combinations of smoked cannabis (12.5% THC) and alcohol (target BrAC 0.08%) on simulated driving performance, subjective drug effects, cardiovascular measures, and self-reported perception of driving ability. METHODS In this within-subjects, double-blind, double-dummy, placebo-controlled, randomized clinical trial, cannabis users (1-7 days/week) aged 19-29 years attended four drug administration sessions in which simulated driving, subjective effects, cardiovascular measures, and whole blood THC and metabolite concentrations were assessed following placebo alcohol and placebo cannabis (<0.1% THC), alcohol and placebo cannabis, placebo alcohol and active cannabis, and alcohol and active cannabis. RESULTS Standard deviation of lateral position in the combined condition was significantly different from the placebo condition (p < 0.001). Standard deviation of lateral position was also significantly different from alcohol and cannabis alone conditions in the single task overall drive (p = 0.029 and p = 0.032, respectively), from the alcohol alone condition in the dual task overall drive (p = 0.022) and the cannabis alone condition in the dual task straightaway drive (p = 0.002). Compared to the placebo condition, the combined and alcohol conditions significantly increased reaction time. Subjective effects in the combined condition were significantly greater than with either of the drugs alone at some time points, particularly later in the session. A driving ability questionnaire showed that participants seemed unaware of their level of impairment. CONCLUSION Combinations of alcohol and cannabis increased weaving and reaction time, and tended to produce greater subjective effects compared to placebo and the single drug conditions suggesting a potential additive effect. The fact that participants were unaware of this increased effect has important implications for driving safety.
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Affiliation(s)
- Andrew Fares
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Christine M Wickens
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 425 - 155 College Street, Toronto, Ontario, M5T 1P8, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Patricia Di Ciano
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Madison Wright
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Justin Matheson
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Jurgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,World Health Organization/Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, M5S 1A8, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, Moscow, Russian Federation, 119992
| | - Tony P George
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,Biobehavioural Addictions and Concurrent Disorders Research Laboratory, Addictions Division, CAMH, 33 Ursula Franklin Street, Suite 1910A, Toronto, Ontario, M5S 2S1, Canada
| | - Andriy V Samokhvalov
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Paul A Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA, 19107, USA
| | - Gina Stoduto
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Timothy Brown
- National Advanced Driving Simulator, University of Iowa, 2401 Oakdale Blvd, Iowa City, IA, 52242, USA
| | - Cristiana Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Dafna Sara Rubin-Kahana
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario, M5G 1V7, Canada
| | - Bruna Brands
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada. .,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada. .,Controlled Substances and Cannabis Branch, Health Canada, Ottawa, Ontario, Canada.
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9
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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] [Key Words] [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.
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Affiliation(s)
- Alberto Blandino
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Rosy Cotroneo
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Stefano Tambuzzi
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Domenico Di Candia
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Umberto Genovese
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Riccardo Zoja
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
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10
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Arkell TR, Kevin RC, Vinckenbosch F, Lintzeris N, Theunissen E, Ramaekers JG, McGregor IS. Sex differences in acute cannabis effects revisited: Results from two randomized, controlled trials. Addict Biol 2022; 27:e13125. [PMID: 34936167 PMCID: PMC9286641 DOI: 10.1111/adb.13125] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/14/2021] [Accepted: 12/02/2021] [Indexed: 01/31/2023]
Abstract
Some evidence suggests that males and females may differ in their responses to acute cannabis effects, including subjective drug effects and behavioural effects, and cannabinoid pharmacokinetics. This is significant given current changes to cannabis-related policies and, in consequence, increased cannabis accessibility. The present study combines data from two randomized controlled trials to investigate possible differences among males (n = 21) and females (n = 19) in the acute effects of vaporized cannabis containing 13.75 mg Δ9-tetrahydrocannabinol (THC), with and without cannabidiol (CBD; 13.75 mg). To control for differences in the timing of assessments, peak (or peak change from baseline) scores were calculated for a range of measures including subjective drug effects, cognitive performance, cardiovascular effects, and plasma concentrations of THC, CBD, and their respective primary metabolites. While THC elicited robust and significant changes in all but one outcome measure relative to placebo, relatively few sex differences were observed after controlling for BMI and plasma THC concentrations. Relative to females, males performed better overall on a divided attention task (DAT) and had higher peak plasma concentrations of 11-nor-9-carboxy-THC (11-COOH-THC). Males and females did not differ with respect to plasma concentrations of any other analyte, subjective drug effects, or cardiovascular measures. These data indicate an absence of systematic sex differences in acute cannabis effects given a moderate dose of vaporized cannabis. They do not preclude the possibility that sex differences may emerge with higher THC doses or with other commonly used routes of administration (e.g., orally administered oils or edibles).
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Affiliation(s)
- Thomas R. Arkell
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Richard C. Kevin
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Faculty of Science, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | | | - Nicholas Lintzeris
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- Drug and Alcohol ServicesSouth East Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Eef Theunissen
- Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Johannes G. Ramaekers
- Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Iain S. McGregor
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Faculty of Science, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
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11
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Khan RN, Maner-Smith K, A. Owens J, Barbian ME, Jones RM, R. Naudin C. At the heart of microbial conversations: endocannabinoids and the microbiome in cardiometabolic risk. Gut Microbes 2022; 13:1-21. [PMID: 33896380 PMCID: PMC8078674 DOI: 10.1080/19490976.2021.1911572] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cardiometabolic syndrome encompasses intertwined risk factors such as hypertension, dyslipidemia, elevated triglycerides, abdominal obesity, and other maladaptive metabolic and inflammatory aberrations. As the molecular mechanisms linking cardiovascular disease and metabolic disorders are investigated, endocannabinoids have emerged as molecules of interest. The endocannabinoid system (ECS) of biologically active lipids has been implicated in several conditions, including chronic liver disease, osteoporosis, and more recently in cardiovascular diseases. The gut microbiome is a major regulator of inflammatory and metabolic signaling in the host, and if disrupted, has the potential to drive metabolic and cardiovascular diseases. Extensive studies have unraveled the impact of the gut microbiome on host physiology, with recent reports showing that gut microbes exquisitely control the ECS, with significant influences on host metabolic and cardiac health. In this review, we outline how modulation of the gut microbiome affects host metabolism and cardiovascular health via the ECS, and how these findings could be exploited as novel therapeutic targets for various metabolic and cardiac diseases.
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Affiliation(s)
- Ramsha Nabihah Khan
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA
| | - Kristal Maner-Smith
- Emory Integrated Metabolomics and Lipidomics Core, Emory University, Atlanta, Georgia, USA
| | - Joshua A. Owens
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA
| | - Maria Estefania Barbian
- Division of Neonatology, Department of Pediatrics, Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA
| | - Rheinallt M. Jones
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA
| | - Crystal R. Naudin
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA,CONTACT Crystal R. Naudin Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University School of Medicine, 615 Michael Street, Atlanta, GA30322, United States of America
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12
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Zhu L, Pei W, DiCiano P, Brands B, Wickens CM, Foll BL, Kwong B, Parashar M, Sivananthan A, Mahadevan R. Physiologically-based pharmacokinetic model for predicting blood and tissue tetrahydrocannabinol concentrations. Comput Chem Eng 2021. [DOI: 10.1016/j.compchemeng.2021.107461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Abstract
As more states in the U.S legalize recreational and medicinal cannabis, rates of driving under the influence of this drug are increasing significantly. Aspects of this emerging public health issue potentially pit science against public policy. The authors believe that the legal cart is currently significantly ahead of the scientific horse. Issues such as detection procedures for cannabis-impaired drivers, and use of blood THC levels to gauge impairment, should rely heavily on current scientific knowledge. However, there are many, often unacknowledged research gaps in these and related areas, that need to be addressed in order provide a more coherent basis for public policies. This review focuses especially on those areas. In this article we review in a focused manner, current information linking cannabis to motor vehicle accidents and examine patterns of cannabis-impairment of driving related behaviors, their time courses, relationship to cannabis dose and THC blood levels, and compare cannabis and alcohol-impaired driving patterns directly. This review also delves into questions of alcohol-cannabis combinations and addresses the basis for of per-se limits in cannabis driving convictions. Finally, we distinguish between areas where research has provided clear answers to the above questions, areas that remain unclear, and make recommendations to fill gaps in current knowledge.
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Affiliation(s)
- Godfrey D. Pearlson
- Department of Psychiatry, Olin Neuropsychiatry Research Center, Institute of Living, Hartford Healthcare Corporation, Hartford, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States
| | - Michael C. Stevens
- Department of Psychiatry, Olin Neuropsychiatry Research Center, Institute of Living, Hartford Healthcare Corporation, Hartford, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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14
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Ortiz-Peregrina S, Ortiz C, Anera RG. Aggressive Driving Behaviours in Cannabis Users. The Influence of Consumer Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3911. [PMID: 33917856 PMCID: PMC8068208 DOI: 10.3390/ijerph18083911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
This study analysed dangerous driving behaviours in twenty young occasional cannabis users through objective and self-reported data, studying the relationship between the two aspects. Visual function was assessed in a baseline session and after smoking cannabis, as well as speed-related behaviour in a driving simulator. The participants responded to questionnaires on sociodemographic factors, their consumption profile, and the incidence of dangerous behaviours (Dula Dangerous Driving Index; DDDI). After cannabis use, the results revealed a significant deterioration in visual function. In terms of speed management, they showed significantly greater acceleration force in the two different sections of the route, and they drove significantly faster. Our correlations indicate that males and heavier users display more risky speed management. Likewise, the heavier cannabis users admitted to increased dangerous driving behaviour, and an accident in the preceding year was associated with a trend towards aggressive driving behaviour according to the DDDI questionnaire. The findings of this study suggest that cannabis users adopt dangerous behaviours when driving, despite the effect this drug has on certain important functions, such as vision. The results suggest a need for awareness-raising and information campaigns.
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Affiliation(s)
| | - Carolina Ortiz
- Laboratory of Vision Sciences and Applications, Department of Optics, University of Granada, 18071 Granada, Spain; (S.O.-P.); (R.G.A.)
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15
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Alvarez L, Colonna R, Kim S, Chen C, Chippure K, Grewal J, Kimm C, Randell T, Leung V. Young and under the influence: A systematic literature review of the impact of cannabis on the driving performance of youth. ACCIDENT; ANALYSIS AND PREVENTION 2021; 151:105961. [PMID: 33421731 DOI: 10.1016/j.aap.2020.105961] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/20/2020] [Accepted: 12/19/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Young drivers ages 15-24 continue to constitute a high-risk population for fatal motor vehicle collisions (MVCs) compared to all other age groups. Driving under the influence of cannabis is an important contributor to the high rates of MVCs among youth. Understanding the specific impact of cannabis on the driving performance outcomes of young drivers can inform injury prevention, education, and intervention strategies. OBJECTIVES This systematic literature review (SLR) aims to determine the Class (I- highest to IV-lowest) of evidence and level of confidence (A-high to U-insufficient) in the effects of cannabis on the driving performance of young drivers. METHODS Registered in PROSPERO (#CRD42020180541), this SLR searched seven data bases and appraised the quality and confidence in the evidence using an established research methodology. RESULTS Class II evidence suggests that THC is likely to reduce mean speed, headway distance, and reaction time; and increase lane and steering wheel position variability among young drivers (Level B, moderate confidence). CONCLUSIONS This study shows that there is a moderate to low level of confidence on the impact of cannabis on the specific driving performance outcomes of young drivers. A need remains for Class I and II studies that focus on the specific effects on young drivers, distinguish between the biological and socially constructed variables of sex and gender, and includes larger and more representative samples.
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Affiliation(s)
- Liliana Alvarez
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada.
| | - Robert Colonna
- Health and Rehabilitation Sciences Graduate Program, Western University, London, Canada
| | - Sean Kim
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Caron Chen
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Katherine Chippure
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Jasleen Grewal
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Chris Kimm
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Travis Randell
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Victoria Leung
- Schulich School of Medicine and Dentistry, Western University, London, Canada
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16
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McCartney D, Arkell TR, Irwin C, McGregor IS. Determining the magnitude and duration of acute Δ 9-tetrahydrocannabinol (Δ 9-THC)-induced driving and cognitive impairment: A systematic and meta-analytic review. Neurosci Biobehav Rev 2021; 126:175-193. [PMID: 33497784 DOI: 10.1016/j.neubiorev.2021.01.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/24/2020] [Accepted: 01/04/2021] [Indexed: 02/04/2023]
Abstract
The increasing legal availability of cannabis has important implications for road safety. This systematic review characterised the acute effects of Δ9-THC on driving performance and driving-related cognitive skills, with a particular focus on the duration of Δ9-THC-induced impairment. Eighty publications and 1534 outcomes were reviewed. Several measures of driving performance and driving-related cognitive skills (e.g. lateral control, tracking, divided attention) demonstrated impairment in meta-analyses of "peak" Δ9-THC effects (p's<0.05). Multiple meta-regression analyses further found that regular cannabis users experianced less impairment than 'other' (mostly occasional) cannabis users (p = 0.003) and that the magnitude of oral (n = 243 effect estimates [EE]) and inhaled (n = 481 EEs) Δ9-THC-induced impairment depended on various factors (dose, post-treatment time interval, the performance domain (skill) assessed) in other cannabis users (p's<0.05). The latter model predicted that most driving-related cognitive skills would 'recover' (Hedges' g=-0.25) within ∼5-hs (and almost all within ∼7-hs) of inhaling 20 mg of Δ9-THC; oral Δ9-THC-induced impairment may take longer to subside. These results suggest individuals should wait at least 5 -hs following inhaled cannabis use before performing safety-sensitive tasks.
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Affiliation(s)
- Danielle McCartney
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia.
| | - Thomas R Arkell
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
| | - Christopher Irwin
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Iain S McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
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17
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Brands B, Di Ciano P, Mann RE. Cannabis, Impaired Driving, and Road Safety: An Overview of Key Questions and Issues. Front Psychiatry 2021; 12:641549. [PMID: 34489746 PMCID: PMC8416748 DOI: 10.3389/fpsyt.2021.641549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/01/2021] [Indexed: 12/19/2022] Open
Abstract
The road safety impact of cannabis has been a topic of much discussion and debate over the years. These discussions have been revitalized in recent years by initiatives in several jurisdictions to legalize non-medical cannabis. Canada became the second country to legalize non-medical cannabis use in October, 2018, preceded by Uruguay in December 2013. Road safety concerns were key issues in the Canadian government's deliberations on the issue. In this paper, we identify several key questions related to the impact of cannabis on road safety, and provide a consideration of the relevant literature on these questions. These questions cover several perspectives. From an epidemiological perspective, perhaps the central question is whether cannabis use contributes to the chances of being involved in a collision. The answer to this question has evolved in recent years as the ability to conduct the relevant studies has evolved. A related question is the extent to which cannabis plays an important role in road safety, and recent research has made progress in estimating the collisions, injuries, and deaths that may be attributed to cannabis use. Several questions relate to the behavioral and pharmacological effects of cannabis. One central question is whether cannabis affects driving skills in ways that can increase the chances of being involved in a collision. Another important question is whether the effects of the drug on the driving behavior of medical users is similar to, or different from, the effects on non-medical users and whether there are sex differences in the pharmacological and behavioral effects of cannabis. Other important questions are the impact of tolerance to the effects of cannabis on road safety as well as different routes of administration (e.g., edibles, vaped). It remains unclear if there is a dose-response relationship of cannabis to changes in driving. These and other key questions and issues are identified and discussed in this paper.
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Affiliation(s)
- Bruna Brands
- Health Canada, Ottawa, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Patricia Di Ciano
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health, Toronto, ON, Canada
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18
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Rudisill TM, Smith GS. Risk factors associated with driving under the influence of drugs in the USA. Inj Prev 2020; 27:514-520. [PMID: 33303559 DOI: 10.1136/injuryprev-2020-044015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Driving under the influence of drugs (DUID) is a burgeoning public health concern in the USA. Because little is known about individuals who engage in DUID, the purpose of this study was to analyse potential sociodemographic characteristics and behavioural risk factors associated with the behaviour. METHODS Self-reported data from drivers ≥18 years of age who ever used drugs and participated in the 2018 National Survey on Drug Use and Health were used. Characteristics of those who reported to engage and not engage in DUID were compared via frequencies, percentages and logistic regression analyses, which accounted for the multistage survey design. RESULTS Among eligible respondents, 10.4% (weighted n=117 275 154) reported DUID. DUID was higher among those aged 18-25 year (34%), males (65%), unmarried individuals (61%), lesbian/gay/bisexuals (13%), those whom abused or were drug dependent (45%), engaged in numerous risky lifestyle behaviours (12%) and those taking medication for a mental health issue (22%). Nearly 20% and 6% of respondents engaged in DUID abused or were dependent on marijuana or methamphetamine, respectively. The adjusted odds of DUID were greatest among those 18-25 years of age (OR 3.7; 95% CI 2.8 to 5.0), those never/not married (OR 1.8; 95% CI 1.5 to 2.2), those who abused or were drug dependent (OR 4.0; 95% CI 3.5 to 4.7), exhibited riskier lifestyle behaviours (OR 8.0; 95% CI 5.9 to 11.0), were employed (OR 1.3; 95% CI 1.1 to 1.6) or lesbian/gay/bisexuals (OR 1.4; 95% CI 1.1 to 1.7). CONCLUSIONS DUID was common among some population sub-groups who may benefit from intervention.
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Affiliation(s)
| | - Gordon S Smith
- Epidemiology, West Virginia University, Morgantown, West Virginia, USA
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19
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Lloyd SL, Lopez-Quintero C, Striley CW. Sex differences in driving under the influence of cannabis: The role of medical and recreational cannabis use. Addict Behav 2020; 110:106525. [PMID: 32711286 DOI: 10.1016/j.addbeh.2020.106525] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Existing evidence suggest that cannabis may impair driving and is the most prevalent drug identified in drivers. Males exhibit an excess risk for driving under the influence of drugs or alcohol compared to females. We assessed sex differences in the association between the reason for cannabis use (medical, recreational, or both) and driving under the influence of cannabis (DUIC). METHODS A sample of 17,405 past 12-month cannabis users (18 + years old) were analyzed from the 2016-17 National Survey on Drug Use and Health. Multivariable logistic regression was used to assess the interaction of sex and reason for cannabis use on DUIC using predicted probabilities. RESULTS Among cannabis users in the sample, 88.1% used for recreational reasons, 7.8% used for medical reasons, and 4.1% used for medical and recreational reasons. The probability of DUIC was as low as 20% among female medical only users, and as high as 40% among male combined medical and recreational users. Females showed more similar probabilities of DUIC across reasons of use (range 20% to 25%s) than males (range 28% to 40%). The difference in the probability of DUIC between combined medical and recreational users and recreational only users was significantly greater among males than among females (Δ 0.1, p < 0.05). CONCLUSIONS The observed effects of sex and reasons for cannabis use on DUIC suggests a need for targeted educational interventions, particularly among males reporting combined medical and recreational marijuana use.
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20
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Miller RE, Brown TL, Lee S, Tibrewal I, Gaffney GG, Milavetz G, Hartman RL, Gorelick DA, Compton R, Huestis MA. Impact of cannabis and low alcohol concentration on divided attention tasks during driving. TRAFFIC INJURY PREVENTION 2020; 21:S123-S129. [PMID: 33035082 DOI: 10.1080/15389588.2020.1814956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess divided-attention performance when driving under the influence of cannabis with and without alcohol. Three divided-attention tasks were performed following administration of placebo, cannabis, and/or alcohol. METHODS Healthy adult cannabis users participated in 6 sessions, receiving combinations of cannabis (placebo/low-THC/high-THC) and alcohol (placebo/active) in randomized order, separated by washout periods of ≥1 week. At 0.5 hours post-dosing, participants performed simulator drives in the University of Iowa National Advanced Driving Simulator (NADS-1), a full vehicle cab simulator with a 360° horizontal field of view and motion base that provides realistic feedback. Drives contained repeated instances of three tasks: a side-mirror task (reaction to a triangle appearing in the side-mirrors), an artist-search task (select a specified artist from a navigable menu on the vehicle's console), and a message-reading task (read aloud a message displayed on the console). Blood THC and breath alcohol concentration (BrAC) were interpolated using individual power curves from samples collected approximately 0.17, 0.42, 1.4, and 2.3 hours post-dose. Driving measures during tasks were compared to equal-duration control periods occurring just prior to the task. Performance shifts, task completion, and lane departures were modeled relative to blood THC and BrAC using mixed-effects regression models. RESULTS Each 1 µg/L increase in blood THC concentration predicted increased odds of failing to complete the artist-search task (OR: 1.05, 95% CI: 1.01-1.11, p = 0.046), increased odds of selecting at least one incorrect response (OR: 1.05, 95% CI: 1.00-1.09, p = 0.041), declines in speed during the side-mirror task (0.005 m/s, 95% CI: 0.001-0.009, p = 0.023), and longer lane departure durations during the artist-search task (0.74% of task-period, 95% CI: 0.12-1.36 p = 0.020). BrAC (approximately 0.05%) was not associated with task performance, though each 0.01 g/210 L increase predicted longer departure durations during the side-mirror task (1.41% of task-period, 95% CI: 0.08-2.76, p = 0.040) and increased standard deviation of lane position in the message-reading task (0.61 cm, 95% CI: 0.14-1.08, p = 0.011). CONCLUSIONS With increasing medical and legal cannabis use, understanding the impact of acute cannabis use on driving performance, including divided-attention, is essential. These data indicate that impaired divided-attention performance is a safety concern.
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Affiliation(s)
- Ryan E Miller
- aDepartment of Mathematics and Statistics, Grinnell College, Grinnell, Iowa (currently at Xavier University, Cincinnati, Ohio)
| | - Timothy L Brown
- bNational Advanced Driving Simulator, University of Iowa, Iowa City, Iowa
| | | | | | - Gary G Gaffney
- bNational Advanced Driving Simulator, University of Iowa, Iowa City, Iowa
- dDepartment of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Gary Milavetz
- bNational Advanced Driving Simulator, University of Iowa, Iowa City, Iowa
- eCollege of Pharmacy, University of Iowa, Iowa City, Iowa
| | - Rebecca L Hartman
- fChemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, Maryland (currently at Monroe County Office of the Medical Examiner, Rochester, New York)
| | - David A Gorelick
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, Maryland (currently at Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland)
| | - Richard Compton
- hBehavioral Safety Research, National Highway Traffic Safety Administration, Washington, DC, (currently Traffic Safety Research, North Potomac, Maryland)
| | - Marilyn A Huestis
- iChemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, Maryland (currently at Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania)
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21
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McCartney D, Benson MJ, Suraev AS, Irwin C, Arkell TR, Grunstein RR, Hoyos CM, McGregor IS. The effect of cannabidiol on simulated car driving performance: A randomised, double-blind, placebo-controlled, crossover, dose-ranging clinical trial protocol. Hum Psychopharmacol 2020; 35:e2749. [PMID: 32729120 DOI: 10.1002/hup.2749] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Interest in the use of cannabidiol (CBD) is increasing worldwide as its therapeutic effects are established and legal restrictions moderated. Unlike Δ9 -tetrahydrocannabinol (Δ9 -THC), CBD does not appear to cause cognitive or psychomotor impairment. However, further assessment of its effects on cognitively demanding day-to-day activities, such as driving, is warranted. Here, we describe a study investigating the effects of CBD on simulated driving and cognitive performance. METHODS Thirty healthy individuals will be recruited to participate in this randomised, double-blind, placebo-controlled crossover trial. Participants will complete four research sessions each involving two 30-min simulated driving performance tests completed 45 and 210 min following oral ingestion of placebo or 15, 300, or 1,500 mg CBD. Cognitive function and subjective drug effects will be measured, and blood and oral fluid sampled, at regular intervals. Oral fluid drug testing will be performed using the Securetec DrugWipe® 5S and Dräger DrugTest® 5000 devices to determine whether CBD increases the risk of "false-positive" roadside tests to Δ9 -THC. Noninferiority analyses will test the hypothesis that CBD is no more impairing than placebo. CONCLUSION This study will clarify the risks involved in driving following CBD use and assist in ensuring the safe use of CBD by drivers.
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Affiliation(s)
- Danielle McCartney
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Melissa J Benson
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Anastasia S Suraev
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Irwin
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Thomas R Arkell
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, New South Wales, Australia
| | - Camilla M Hoyos
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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Ramaekers JG, Mason NL, Theunissen EL. Blunted highs: Pharmacodynamic and behavioral models of cannabis tolerance. Eur Neuropsychopharmacol 2020; 36:191-205. [PMID: 32014378 DOI: 10.1016/j.euroneuro.2020.01.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/22/2019] [Accepted: 01/12/2020] [Indexed: 02/07/2023]
Abstract
Acute exposure to cannabis comes with neurocognitive impairment, leading to increased risk of human error and injury. Evidence however indicates that such acute effects are less prominent in chronic users, suggesting cannabis tolerance. Models of cannabis tolerance stress the importance of neurobiological or behavioral adaptations following repeated cannabis exposure. The pharmacodynamic model relates neuroadaptive changes in the brain to a blunted response to cannabis. Downregulation of CB1 receptors in chronic cannabis users has been associated with a normalization of dopaminergic output from the ventral tegmental area to the mesolimbic circuit, and a reduction of impairment during acute cannabis exposure. Such neuroadaptions are absent in occasional users, who show strong increments of dopamine and glutamate levels in the striatum, a loss of functional connectivity within the mesolimbic circuit and neurocognitive impairments when exposed to cannabis. Evidence for a behavioral model of cannabis tolerance that poses that users can have volitional control to overcome functional impairment during cannabis intoxication is relatively weak, and at best shows limited control over a limited number of behavioral functions. Cannabis tolerance is most likely to occur in users that consume high doses of cannabis continuously, at a high pace, for a prolonged period of time. Knowledge on frequency, dose and duration of cannabis use that is needed to achieve, maintain or lessen tolerance however is very limited, but will be of importance in the context of cannabis therapeutics and in legal settings when evaluating the impact of cannabis exposure on human function.
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Affiliation(s)
- J G Ramaekers
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, the Netherlands.
| | - N L Mason
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, the Netherlands
| | - E L Theunissen
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, the Netherlands
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Dahlgren MK, Sagar KA, Smith RT, Lambros AM, Kuppe MK, Gruber SA. Recreational cannabis use impairs driving performance in the absence of acute intoxication. Drug Alcohol Depend 2020; 208:107771. [PMID: 31952821 PMCID: PMC9036916 DOI: 10.1016/j.drugalcdep.2019.107771] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Across the nation, growing numbers of individuals are exploring the use of cannabis for medical or recreational purposes, and the proportion of cannabis-positive drivers involved in fatal crashes increased from 8 percent in 2013 to 17 percent in 2014, raising concerns about the impact of cannabis use on driving. Previous studies have demonstrated that cannabis use is associated with impaired driving performance, but thus far, research has primarily focused on the effects of acute intoxication. METHODS The current study assessed the potential impact of cannabis use on driving performance using a customized driving simulator in non-intoxicated, heavy, recreational cannabis users and healthy controls (HCs) without a history of cannabis use. RESULTS Overall, cannabis users demonstrated impaired driving relative to HC participants with increased accidents, speed, and lateral movement, and reduced rule-following. Interestingly, however, when cannabis users were divided into groups based on age of onset of regular cannabis use, significant driving impairment was detected and completely localized to those with early onset (onset before age 16) relative to the late onset group (onset ≥16 years old). Further, covariate analyses suggest that impulsivity had a significant impact on performance differences. CONCLUSIONS Chronic, heavy, recreational cannabis use was associated with worse driving performance in non-intoxicated drivers, and earlier onset of use was associated with greater impairment. These results may be related to other factors associated with early exposure such as increased impulsivity.
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Affiliation(s)
- M. Kathryn Dahlgren
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Marijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelly A. Sagar
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Marijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rosemary T. Smith
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Marijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Ashley M. Lambros
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Marijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Madeline K. Kuppe
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Marijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Staci A. Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Marijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Corresponding author at: Cognitive and Clinical Neuroimaging Core, McLean Hospital, 115 Mill Street, Belmont, 021478, MA USA. (S.A. Gruber)
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24
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Matheson J, Sproule B, Di Ciano P, Fares A, Le Foll B, Mann RE, Brands B. Sex differences in the acute effects of smoked cannabis: evidence from a human laboratory study of young adults. Psychopharmacology (Berl) 2020; 237:305-316. [PMID: 31637452 DOI: 10.1007/s00213-019-05369-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/22/2019] [Indexed: 02/01/2023]
Abstract
RATIONALE Animal studies have found robust sex differences in the pharmacokinetics and pharmacodynamics of Δ9-tetrahydrocannabinol (THC). However, the human evidence remains equivocal, despite findings that women may experience more severe consequences of cannabis use than men. OBJECTIVES The objective of this secondary analysis was to examine sex differences in THC pharmacokinetics and in acute subjective, physiological, and cognitive effects of smoked cannabis in a sample of regular cannabis users (use 1-4 days per week) aged 19-25 years. METHODS Ninety-one healthy young adults were randomized to receive active (12.5% THC; 17 females, 43 males) or placebo (< 0.1% THC; 9 females, 21 males) cannabis using a 2:1 allocation ratio. Blood samples to quantify concentrations of THC, 11-OH-THC, and 11-Nor-carboxy-THC (THC-COOH), as well as measures of subjective drug effects, vital signs, and cognition were collected over a period of 6 h following ad libitum smoking of a 750-mg cannabis cigarette. RESULTS Females smoked less of the cannabis cigarette than males (p = 0.008) and had a lower peak concentration of THC and THC-COOH than males (p ≤ 0.01). Blood THC concentrations remained lower in females even when adjusting for differences in estimated dose of THC inhaled. There was very little evidence of sex differences in visual analog scale (VAS) ratings of subjective drug effects, mood, heart rate, blood pressure, or cognitive effects of cannabis. CONCLUSIONS Females experienced the same acute effects of smoked cannabis as males at a lower observed dose, highlighting the need for more research on sex differences in the pharmacology of THC, especially when administered by routes in which titrating to the desired effect is more difficult (e.g., cannabis edibles).
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Affiliation(s)
- Justin Matheson
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada.
| | - Beth Sproule
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada
- Pharmacy Department, Centre for Addiction and Mental Health, 1001 Queen Street, Toronto, Ontario, M6J 1H4, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Patricia Di Ciano
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Andrew Fares
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario, M5G 1V7, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Bruna Brands
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada
- Controlled Substances Directorate, Health Canada, Ottawa, Ontario, Canada
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25
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Sex and Gender Interactions on the Use and Impact of Recreational Cannabis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020509. [PMID: 31947505 PMCID: PMC7014129 DOI: 10.3390/ijerph17020509] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 02/06/2023]
Abstract
Cannabis is the second most frequently used substance in the world and regulated or legalized for recreational use in Canada and fourteen US states and territories. As with all substances, a wide range of sex and gender related factors have an influence on how substances are consumed, their physical, mental and social impacts, and how men and women respond to treatment, health promotion, and policies. Given the widespread use of cannabis, and in the context of its increasing regulation, it is important to better understand the sex and gender related factors associated with recreational cannabis use in order to make more precise clinical, programming, and policy decisions. However, sex and gender related factors include a wide variety of processes, features and influences that are rarely fully considered in research. This article explores myriad features of both sex and gender as concepts, illustrates their impact on cannabis use, and focuses on the interactions of sex and gender that affect three main areas of public interest: the development of cannabis use dependence, the impact on various routes of administration (ROA), and the impact on impaired driving. We draw on two separate scoping reviews to examine available evidence in regard to these issues. These three examples are described and illustrate the need for more comprehensive and precise integration of sex and gender in substance use research, as well as serious consideration of the results of doing so, when addressing a major public health issue such as recreational cannabis use.
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26
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Brands B, Mann RE, Wickens CM, Sproule B, Stoduto G, Sayer GS, Burston J, Pan JF, Matheson J, Stefan C, George TP, Huestis MA, Rehm J, Le Foll B. Acute and residual effects of smoked cannabis: Impact on driving speed and lateral control, heart rate, and self-reported drug effects. Drug Alcohol Depend 2019; 205:107641. [PMID: 31678833 DOI: 10.1016/j.drugalcdep.2019.107641] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although driving under the influence of cannabis is increasingly common among young adults, little is known about residual effects on driver behavior. This study examined acute and residual effects of smoked cannabis on simulated driving performance of young cannabis users. METHODS In this double-blind, placebo-controlled, parallel-group randomized clinical trial, cannabis users (1-4 days/week) aged 19-25 years were randomized with a 2:1 allocation ratio to receive active (12.5% THC) or placebo (0.009% THC) cannabis in a single 750 mg cigarette. A median split (based on whole-blood THC concentrations at the time of driving) was used to divide the active group into low and high THC groups. Our primary outcome was simulated driving performance, assessed 30 min and 24 and 48 h after smoking. Secondary outcomes included blood THC concentrations, subjective drug effects, and heart rate. RESULTS Ninety-six participants were randomized, and 91 were included in the final analysis (30 high THC, 31 low THC, 30 placebo). Mean speed (but not lateral control) significantly differed between groups 30 min after smoking cannabis (p ≤ 0.02); low and high THC groups decreased their speed compared to placebo. Heart rate, VAS drug effect and drug high increased significantly immediately after smoking cannabis and declined steadily after that. There was little evidence of residual effects in any of the measures. CONCLUSION Acutely, cannabis caused decreased speed, increased heart rate, and increases in VAS drug effect and drug high. There was no evidence of residual effects on these measures over the two days following cannabis administration.
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Affiliation(s)
- Bruna Brands
- Controlled Substances Directorate, Health Canada, Ottawa, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S3H7, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada.
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T3M7, Canada
| | - Christine M Wickens
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T3M7, Canada
| | - Beth Sproule
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S3M2, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T1R8, Canada; Pharmacy, Centre for Addiction and Mental Health, 1001 Queen Street, Toronto, Ontario, M6J1H4, Canada
| | - Gina Stoduto
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada
| | - Gillian S Sayer
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S3H7, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada
| | - Jillian Burston
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S3H7, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada
| | - Jie Fei Pan
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S3H7, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada
| | - Justin Matheson
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S3H7, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada
| | - Cristiana Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J1H4, Canada
| | - Tony P George
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T1R8, Canada; Addictions Division, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J1H4, Canada
| | - Marilyn A Huestis
- The Lambert Center for the Study of Medicinal Cannabis and Hemp, Thomas Jefferson University, 1020 Walnut Street Philadelphia, PA 19107, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T3M7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T1R8, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S3H7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T1R8, Canada; Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S2S1, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario, M5G 1V7, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Room 2374, Toronto, Ontario, M5S 1A8, Canada
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27
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Ginsburg BC. Strengths and limitations of two cannabis-impaired driving detection methods: a review of the literature. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:610-622. [DOI: 10.1080/00952990.2019.1655568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Brett C. Ginsburg
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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28
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Bahji A, Stephenson C. International Perspectives on the Implications of Cannabis Legalization: A Systematic Review & Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173095. [PMID: 31454942 PMCID: PMC6747067 DOI: 10.3390/ijerph16173095] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/15/2019] [Accepted: 08/23/2019] [Indexed: 12/16/2022]
Abstract
The legality, recreational and medical use of cannabis varies widely by country and region but remains largely prohibited internationally. In October 2018, Canada legalized the recreational use of cannabis—a move many viewed as controversial. Proponents of legalization have emphasized the potential to eradicate the marijuana black market, improve quality and safety control, increase tax revenues, improve the availability of medical cannabis, and lower gang-related drug violence. Conversely, opponents of legalization have stressed concerns about cannabis’ addictive potential, second-hand cannabis exposure, potential exacerbation of underlying and established mental illnesses, as well as alterations in perception that affect safety, particularly driving. This systematic review synthesizes recent international literature on the clinical and public health implications of cannabis legalization.
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Affiliation(s)
- Anees Bahji
- Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada.
- Department of Psychiatry, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Callum Stephenson
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
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29
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Wickens CM, Watson TM, Mann RE, Brands B. Exploring perceptions among people who drive after cannabis use: Collision risk, comparative optimism and normative influence. Drug Alcohol Rev 2019; 38:443-451. [PMID: 30896069 DOI: 10.1111/dar.12923] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/22/2018] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS While the perceived risks of driving under the influence of cannabis (DUIC) have been a focus of recent drug-driving research, relevant concepts from the social cognition literature have rarely been applied to inform understanding of DUIC. This study aims to expand knowledge of perceived collision risk and social influences associated with DUIC and driving after other substance use. DESIGN AND METHODS Semi-structured interviews were conducted with 20 participants of a remedial program for impaired drivers. Thematic analysis began with two independent coders. Early discussion of emergent themes resulted in the identification of applicable social cognition concepts, resulting in selective coding and interpretation. RESULTS Many participants identified DUIC as less risky than driving under the influence of alcohol or other drugs. Mixed perceptions regarding the dangerousness of DUIC were expressed, with some participants denying increased collision risk except among novice cannabis users. Comparative optimism bias was also expressed by participants who perceived themselves as less likely than others to be involved in a collision when DUIC. In view of normative influence, friends were generally seen as more accepting of DUIC than family, and there were indications that the opinions of others who use cannabis were regarded as more credible than the opinions of those who do not use the drug. DISCUSSION AND CONCLUSIONS Comparative optimism bias and normative influence may contribute to perceived risks associated with DUIC and may, therefore, be useful concepts to employ to increase the effectiveness of public health and road safety initiatives.
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Affiliation(s)
- Christine M Wickens
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tara Marie Watson
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Bruna Brands
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Controlled Substances Directorate, Health Canada, Ottawa, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
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Scherer M, Canham S, Voas RB, Furr-Holden CD. Intercorrelation of Alcohol and Other Drug Use Disorders among a National Sample of Drivers. J Psychoactive Drugs 2018; 50:143-150. [PMID: 28846058 PMCID: PMC6117115 DOI: 10.1080/02791072.2017.1366605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.
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Affiliation(s)
- Michael Scherer
- a Associate Research Scientist, Pacific Institute for Research and Evaluation , Calverton , MD , USA
| | - Sarah Canham
- b Research Associate, Department of Gerontology , Simon Fraser University , Vancouver , BC , Canada
| | - Robert B Voas
- c Senior Research Scientist, Pacific Institute for Research and Evaluation , Calverton , MD , USA
| | - C Debra Furr-Holden
- d Endowed Professor, Department of Epidemiology and Biostatics , Michigan State University , Flint , MI , USA
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Behnood A, Mannering FL. The effects of drug and alcohol consumption on driver injury severities in single-vehicle crashes. TRAFFIC INJURY PREVENTION 2017; 18:456-462. [PMID: 27893281 DOI: 10.1080/15389588.2016.1262540] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE It is well known that alcohol and drugs influence driving behavior by affecting the central nervous system, awareness, vision, and perception/reaction times, but the resulting effect on driver injuries in car crashes is not fully understood. The purpose of this study was to identify factors affecting the injury severities of unimpaired, alcohol-impaired, and drug-impaired drivers. METHOD The current article applies a random parameters logit model to study the differences in injury severities among unimpaired, alcohol-impaired, and drug-impaired drivers. Using data from single-vehicle crashes in Cook County, Illinois, over a 9-year period from January 1, 2004, to December 31, 2012, separate models for unimpaired, alcohol-impaired, and drug-impaired drivers were estimated. A wide range of variables potentially affecting driver injury severity was considered, including roadway and environmental conditions, driver attributes, time and location of the crash, and crash-specific factors. RESULTS The estimation results show significant differences in the determinants of driver injury severities across groups of unimpaired, alcohol-impaired, and drug-impaired drivers. The findings also show that unimpaired drivers are understandably more responsive to variations in lighting, adverse weather, and road conditions, but these drivers also tend to have much more heterogeneity in their behavioral responses to these conditions, relative to impaired drivers. In addition, age and gender were found to be important determinants of injury severity, but the effects varied significantly across all drivers, particularly among alcohol-impaired drivers. CONCLUSIONS The model estimation results show that statistically significant differences exist in driver injury severities among the unimpaired, alcohol-impaired, and drug-impaired driver groups considered. Specifically, we find that unimpaired drivers tend to have more heterogeneity in their injury outcomes in the presence potentially adverse weather and road surface conditions. This makes sense because one would expect unimpaired drivers to apply their full knowledge/judgment range to deal with these conditions, and the variability of this range across the driver population (with different driving experiences, etc.) should be great. In contrast, we find, for the most part, that alcohol-impaired and drug-impaired drivers have far less heterogeneity in the factors that affect injury severity, suggesting an equalizing effect resulting from the decision-impairing substance.
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Affiliation(s)
- Ali Behnood
- a Lyles School of Civil Engineering, Purdue University , West Lafayette , Indiana
| | - Fred L Mannering
- b Department of Civil and Environmental Engineering , University of South Florida , Tampa , Florida
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Cannabis and its effects on driving skills. Forensic Sci Int 2016; 268:92-102. [DOI: 10.1016/j.forsciint.2016.09.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/07/2016] [Accepted: 09/10/2016] [Indexed: 01/15/2023]
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Abstract
Background Tetrahydrocannabinol (Δ9-THC), the primary ingredient in marijuana, exerts its effects across several neurological and biological systems that interact with the endocrine system. Thus, differential effects of Δ9-THC are likely to exist based on sex and hormone levels. Methods We reviewed the existing literature to determine sex-based effects of Δ9-THC on neural structure and functioning. Results The literature demonstrates differences in male and female marijuana users on brain structure, reward processing, attention, motor coordination, and sensitivity to withdrawal. However, inconsistencies exist in the literature regarding how marijuana affects men and women differentially, and more work is needed to understand these mechanisms. While extant literature remains inconclusive, differentiation between male and female marijuana users is likely due to neurological sexual dimorphism and differential social factors at play during development and adulthood. Conclusions Sex has important implications for marijuana use and the development of cannabis use disorders and should be considered in the development of prevention and treatment strategies.
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Affiliation(s)
- Ariel Ketcherside
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 W. Mockingbird Lane, Dallas, TX 75235 USA
| | - Jessica Baine
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 W. Mockingbird Lane, Dallas, TX 75235 USA
| | - Francesca Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, 2200 W. Mockingbird Lane, Dallas, TX 75235 USA
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Hartman RL, Brown TL, Milavetz G, Spurgin A, Pierce RS, Gorelick DA, Gaffney G, Huestis MA. Cannabis effects on driving longitudinal control with and without alcohol. J Appl Toxicol 2016; 36:1418-29. [DOI: 10.1002/jat.3295] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Rebecca L. Hartman
- Chemistry and Drug Metabolism, Intramural Research Program; National Institute on Drug Abuse, NIH; 251 Bayview Boulevard Street, 200 Rm 05A721 Baltimore MD USA
| | - Timothy L. Brown
- National Advanced Driving Simulator; University of Iowa; 2401 Oakdale Boulevard Iowa City IA USA
| | - Gary Milavetz
- College of Pharmacy; University of Iowa; Iowa City IA USA
| | - Andrew Spurgin
- College of Pharmacy; University of Iowa; Iowa City IA USA
| | | | - David A. Gorelick
- Department of Psychiatry; University of Maryland School of Medicine; Baltimore MD USA
| | - Gary Gaffney
- Carver College of Medicine; University of Iowa; Iowa City IA USA
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, Intramural Research Program; National Institute on Drug Abuse, NIH; 251 Bayview Boulevard Street, 200 Rm 05A721 Baltimore MD USA
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35
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Wagner EJ. Sex differences in cannabinoid-regulated biology: A focus on energy homeostasis. Front Neuroendocrinol 2016; 40:101-9. [PMID: 26800649 PMCID: PMC4783283 DOI: 10.1016/j.yfrne.2016.01.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/31/2015] [Accepted: 01/19/2016] [Indexed: 11/18/2022]
Abstract
Considerable strides have been made over the past 20 years in our understanding of the ligands, receptor subtypes, signal transduction mechanisms and biological actions comprising the endocannabinoid system. From the ever-expanding number of studies that have been conducted during this time, it has become increasingly clear that sex differences are the cornerstone of cannabinoid-regulated biology. Available evidence has demonstrated that these sex differences endure in the absence of gonadal steroids, and are modulated by the acute, activational effects of these hormones. This review focuses on select aspects of sexually differentiated, cannabinoid-regulated biology, with a particular emphasis on the control of energy balance. It is anticipated that it will lend impactful insight into the pervasive and diverse disparities in how males and females respond to cannabinoids--from the organismal level down to the molecular level. Additionally, it will furnish a newfound appreciation for the need to recalibrate our thinking in terms of how cannabinoids are used as therapeutic adjuvants for a broad range of clinical disorders and associated comorbidities, including body wasting and obesity.
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Affiliation(s)
- Edward J Wagner
- Department of Basic Medical Sciences, College of Osteopathic Medicine, Western University of Health Sciences, 309 E. Second Street, Pomona, CA 91766, United States.
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36
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Hartman RL, Brown TL, Milavetz G, Spurgin A, Pierce RS, Gorelick DA, Gaffney G, Huestis MA. Cannabis effects on driving lateral control with and without alcohol. Drug Alcohol Depend 2015; 154:25-37. [PMID: 26144593 PMCID: PMC4536116 DOI: 10.1016/j.drugalcdep.2015.06.015] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effects of cannabis, the most commonly encountered non-alcohol drug in driving under the influence cases, are heavily debated. We aim to determine how blood Δ(9)-tetrahydrocannabinol (THC) concentrations relate to driving impairment, with and without alcohol. METHODS Current occasional (≥1×/last 3 months, ≤3days/week) cannabis smokers drank placebo or low-dose alcohol, and inhaled 500mg placebo, low (2.9%)-THC, or high (6.7%)-THC vaporized cannabis over 10min ad libitum in separate sessions (within-subject design, 6 conditions). Participants drove (National Advanced Driving Simulator, University of Iowa) simulated drives (∼0.8h duration). Blood, oral fluid (OF), and breath alcohol samples were collected before (0.17h, 0.42h) and after (1.4h, 2.3h) driving that occurred 0.5-1.3h after inhalation. We evaluated standard deviations of lateral position (lane weave, SDLP) and steering angle, lane departures/min, and maximum lateral acceleration. RESULTS In N=18 completers (13 men, ages 21-37years), cannabis and alcohol increased SDLP. Blood THC concentrations of 8.2 and 13.1μg/L during driving increased SDLP similar to 0.05 and 0.08g/210L breath alcohol concentrations, the most common legal alcohol limits. Cannabis-alcohol SDLP effects were additive rather than synergistic, with 5μg/L THC+0.05g/210L alcohol showing similar SDLP to 0.08g/210L alcohol alone. Only alcohol increased lateral acceleration and the less-sensitive lane departures/min parameters. OF effectively documented cannabis exposure, although with greater THC concentration variability than paired blood samples. CONCLUSIONS SDLP was a sensitive cannabis-related lateral control impairment measure. During drive blood THC ≥8.2μg/L increased SDLP similar to notably-impairing alcohol concentrations. Despite OF's screening value, OF variability poses challenges in concentration-based effects interpretation.
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Affiliation(s)
- Rebecca L. Hartman
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, 251 Bayview Boulevard Ste 200 Rm 05A721, Baltimore, MD, USA,Program in Toxicology, University of Maryland Baltimore, 660 West Redwood Street, Baltimore, MD, USA
| | - Timothy L. Brown
- National Advanced Driving Simulator, University of Iowa, 2401 Oakdale Boulevard, Iowa City, IA, USA
| | - Gary Milavetz
- College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Andrew Spurgin
- College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | | | - David A. Gorelick
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, 251 Bayview Boulevard Ste 200 Rm 05A721, Baltimore, MD, USA,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gary Gaffney
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, 251 Bayview Boulevard Ste 200 Rm 05A721, Baltimore, MD, USA
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Lewis TF, Wahesh E. Perceived Norms and Marijuana Use at Historically Black Colleges and Universities. JOURNAL OF COLLEGE COUNSELING 2015. [DOI: 10.1002/jocc.12010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Todd F. Lewis
- Department of Counseling and Educational Development; University of North Carolina at Greensboro
- Now at Counselor Education Department; North Dakota State University
| | - Edward Wahesh
- Department of Counseling and Educational Development; University of North Carolina at Greensboro
- Now at Department of Education and Counseling; Villanova University
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38
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Salomonsen-Sautel S, Min SJ, Sakai JT, Thurstone C, Hopfer C. Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado. Drug Alcohol Depend 2014; 140:137-44. [PMID: 24831752 PMCID: PMC4068732 DOI: 10.1016/j.drugalcdep.2014.04.008] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Legal medical marijuana has been commercially available on a widespread basis in Colorado since mid-2009; however, there is a dearth of information about the impact of marijuana commercialization on impaired driving. This study examined if the proportions of drivers in a fatal motor vehicle crash who were marijuana-positive and alcohol-impaired, respectively, have changed in Colorado before and after mid-2009 and then compared changes in Colorado with 34 non-medical marijuana states (NMMS). METHODS Thirty-six 6-month intervals (1994-2011) from the Fatality Analysis Reporting System were used to examine temporal changes in the proportions of drivers in a fatal motor vehicle crash who were alcohol-impaired (≥0.08 g/dl) and marijuana-positive, respectively. The pre-commercial marijuana time period in Colorado was defined as 1994-June 2009 while July 2009-2011 represented the post-commercialization period. RESULTS In Colorado, since mid-2009 when medical marijuana became commercially available and prevalent, the trend became positive in the proportion of drivers in a fatal motor vehicle crash who were marijuana-positive (change in trend, 2.16 (0.45), p<0.0001); in contrast, no significant changes were seen in NMMS. For both Colorado and NMMS, no significant changes were seen in the proportion of drivers in a fatal motor vehicle crash who were alcohol-impaired. CONCLUSIONS Prevention efforts and policy changes in Colorado are needed to address this concerning trend in marijuana-positive drivers. In addition, education on the risks of marijuana-positive driving needs to be implemented.
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Affiliation(s)
- Stacy Salomonsen-Sautel
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Sung-Joon Min
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045
| | - Joseph T. Sakai
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045
| | - Christian Thurstone
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045,Denver Health and Hospital Authority, Denver, CO, 80204
| | - Christian Hopfer
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045
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Scherer M, Voas RB, Furr-Holden D. Marijuana as a predictor of concurrent substance use among motor vehicle operators. J Psychoactive Drugs 2013; 45:211-7. [PMID: 24175485 DOI: 10.1080/02791072.2013.804230] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the adverse effects associated with marijuana abuse and dependence, marijuana is becoming more common-place in activities such as driving. Previous literature has discussed the high rates of cocaine, opioid and benzodiazepine use among users of marijuana, but no research has addressed the rates of concurrent use among drivers meeting abuse or dependence criteria. Each of these substances may produce effects detrimental to driving safety which may be compounded by concurrent substance use. This research examines rates of marijuana use, abuse, and dependence among an active sample of drivers (N = 7,734) in the 2007 National Roadside Survey. Mean age of participants was 36.89 years, and the majority were male (60.1%) and identified as White (59.2%). Participants who used marijuana but did not meet diagnostic criteria for abuse (n = 165) or dependence (n = 112) were significantly more likely to test positive for all substances than were those who did not use marijuana. Further, those that met criteria for marijuana abuse or dependence were more likely than those who did not meet criteria to test positive for THC, cocaine, and benzodiazepines and THC, cocaine, and opioids, respectively. The current research has implications for policy development and drugged driving interventions.
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Affiliation(s)
- Michael Scherer
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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41
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Abstract
BACKGROUND Cannabis is the most prevalent illicit drug identified in impaired drivers. The effects of cannabis on driving continue to be debated, making prosecution and legislation difficult. Historically, delays in sample collection, evaluating the inactive Δ(9)-tetrahydrocannabinol (THC) metabolite 11-nor-9-carboxy-THC, and polydrug use have complicated epidemiologic evaluations of driver impairment after cannabis use. CONTENT We review and evaluate the current literature on cannabis' effects on driving, highlighting the epidemiologic and experimental data. Epidemiologic data show that the risk of involvement in a motor vehicle accident (MVA) increases approximately 2-fold after cannabis smoking. The adjusted risk of driver culpability also increases substantially, particularly with increased blood THC concentrations. Studies that have used urine as the biological matrix have not shown an association between cannabis and crash risk. Experimental data show that drivers attempt to compensate by driving more slowly after smoking cannabis, but control deteriorates with increasing task complexity. Cannabis smoking increases lane weaving and impaired cognitive function. Critical-tracking tests, reaction times, divided-attention tasks, and lane-position variability all show cannabis-induced impairment. Despite purported tolerance in frequent smokers, complex tasks still show impairment. Combining cannabis with alcohol enhances impairment, especially lane weaving. SUMMARY Differences in study designs frequently account for inconsistencies in results between studies. Participant-selection bias and confounding factors attenuate ostensible cannabis effects, but the association with MVA often retains significance. Evidence suggests recent smoking and/or blood THC concentrations 2-5 ng/mL are associated with substantial driving impairment, particularly in occasional smokers. Future cannabis-and-driving research should emphasize challenging tasks, such as divided attention, and include occasional and chronic daily cannabis smokers.
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Affiliation(s)
- Rebecca L. Hartman
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
- Program in Toxicology, Graduate Program in Life Sciences, University of Maryland Baltimore, Baltimore, MD
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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Craft RM, Marusich JA, Wiley JL. Sex differences in cannabinoid pharmacology: a reflection of differences in the endocannabinoid system? Life Sci 2012; 92:476-81. [PMID: 22728714 DOI: 10.1016/j.lfs.2012.06.009] [Citation(s) in RCA: 193] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/18/2012] [Accepted: 05/31/2012] [Indexed: 11/16/2022]
Abstract
Marijuana is the most widely used illicit drug in the U.S., and marijuana use by women is on the rise. Women have been found to be more susceptible to the development of cannabinoid abuse and dependence, have more severe withdrawal symptoms, and are more likely to relapse than men. The majority of research in humans suggests that women are more likely to be affected by cannabinoids than men, with reports of enhanced and decreased performance on various tasks. In rodents, females are more sensitive than males to effects of cannabinoids on tests of antinociception, motor activity, and reinforcing efficacy. Studies on effects of cannabinoid exposure during adolescence in both humans and rodents suggest that female adolescents are more likely than male adolescents to be deleteriously affected by cannabinoids. Sex differences in response to cannabinoids appear to be due to activational and perhaps organizational effects of gonadal hormones, with estradiol identified as the hormone that contributes most to the sexually dimorphic effects of cannabinoids in adults. Many, but not all sexually dimorphic effects of exogenous cannabinoids can be attributed to a sexually dimorphic endocannabinoid system in rodents, although the same has not yet been established firmly for humans. A greater understanding of the mechanisms underlying sexually dimorphic effects of cannabinoids will facilitate development of sex-specific approaches to treat marijuana dependence and to use cannabinoid-based medications therapeutically.
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Affiliation(s)
- Rebecca M Craft
- Department of Psychology, Washington State University, Pullman, WA, USA
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Anderson BM, Rizzo M, Block RI, Pearlson GD, O'Leary DS. Sex, drugs, and cognition: effects of marijuana. J Psychoactive Drugs 2011; 42:413-24. [PMID: 21305906 DOI: 10.1080/02791072.2010.10400704] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Despite the knowledge that many drugs affect men and women differently, few studies exploring the effects of marijuana use on cognition have included women. Findings from both animal and human studies suggest marijuana may have more marked effects in women. This study examined sex differences in the acute effects of marijuana on cognition in 70 (n=35 male, 35 female) occasional users of marijuana. Tasks were chosen to tap a wide variety of cognitive domains affected by sex and/or marijuana including attention, cognitive flexibility, time estimation, and visuospatial processing. As expected, acute marijuana use impaired performance on selective and divided attention, time estimation, and cognitive flexibility. While there did not appear to be sex differences in marijuana's effects on cognition, women requested to discontinue the smoking session more often than men, likely leading to an underestimation of differences. Further study of psychological differences in marijuana's effects on men and women following both acute and residual effects of marijuana is warranted.
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Affiliation(s)
- Beth M Anderson
- Olin Neuropsychiatry Research Center, 200 Retreat Avenue-Whitehall Bldg, Hartford Hospital Institute of Living, Hartford, CT 06106, USA.
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