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Stellpflug SJ, Stolbach A, Ghorayeb J, Magraken E, Twohey E, Lapoint J, deWeber K. Cannabis in combat sports: position statement of the Association of Ringside Physicians. PHYSICIAN SPORTSMED 2024; 52:432-443. [PMID: 38949963 DOI: 10.1080/00913847.2024.2375788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/30/2024] [Indexed: 07/03/2024]
Abstract
and ARP Position Statement: Based on the available body of scientific evidence and with the goals of promoting safety of combat sports athletes and striving for the advancement of clean sport, the Association of Ringside Physicians recommends the following regarding cannabis:• Use of marijuana or synthetic cannabinoids by combat sports athletes is discouraged due to unproven benefits and many known adverse effects. Acute use can impair cognition and complex motor function, which likely leads to reduced performance in combat sports. Chronic use can increase risk for heart and lung disease, several cancers, schizophrenia, and can reduce testosterone in men and impair fertility. Benefits from cannabis in most contexts, including athletic performance, have not been proven.• Use of topical purified CBD is neither encouraged nor discouraged.• Since acute cannabis intoxication can impair complex cognitive and motor function, any athlete suspected of acute intoxication at the time of competition - based on clinical judgment - should be banned from that competition.• Wide-scale regulation of cannabis based on quantitative testing has limited usefulness in combat sports, for the following reasons:∘ Cannabis is not ergogenic and is likely ergolytic.∘ Concentrations in body fluids correlate poorly with clinical effects and timing of use.∘ Access to testing resources varies widely across sporting organizations.
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Affiliation(s)
| | - Andrew Stolbach
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joe Ghorayeb
- University of Medicine and Health Sciences, New York, NY, USA
| | | | - Eric Twohey
- Mayo Clinic Department of Physical Medicine and Rehabilitation, Rochester, MN, USA
| | - Jeff Lapoint
- Southern California Permanente Medical Group, San Diego Medical Center, Department of Emergency Medicine, San Diego, CA, USA
| | - Kevin deWeber
- SW Washington Sports Medicine Fellowship, Vancouver, WA, USA
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Schranz A, Verthein U, Manthey J. Road safety implications of the partial legalisation of cannabis in Germany: protocol for a quasi-experimental study. BMJ Open 2024; 14:e084611. [PMID: 38871660 DOI: 10.1136/bmjopen-2024-084611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Germany is reforming its legal approach to cannabis, allowing the possession and cultivation of cannabis for recreational purposes. The objective of this study is to investigate the impact of the policy reform on (1) The prevalence of cannabis use in the general population and (2) Driving under the influence of cannabis (DUIC) among regular users. METHODS AND ANALYSIS A quasi-experimental research design will be employed, with repeated cross-sectional surveys on self-reported DUIC and cannabis use conducted at three measurement points in Germany (intervention group) and Austria (control group) over a 2-year observation period (2023-2025). Data will be collected from approximately 50 000 individuals aged between 18 years and 64 years. To minimise reporting biases in the measurement of DUIC, we will use direct and indirect assessments via crosswise model and motor vehicle accident data from official statistics. In a difference-in-difference framework, regression analyses and interrupted time series analysis will be carried out for hypothesis testing. ETHICS AND DISSEMINATION Participants will be informed about voluntary participation, data protection laws and the option to delete data on request. Ethical approval was obtained from the Local Psychological Ethics Committee of the Centre for Psychosocial Medicine in Hamburg, Germany (reference number: 0686). Findings will be disseminated through scientific networks and will be key for a comprehensive evaluation of the cannabis law reform. The findings will facilitate the design and implementation of road safety measures.
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Affiliation(s)
- Anna Schranz
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Manthey
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
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Neuroth LM, Benedetti MH, Brooks-Russell A, Li L, Zhu M. Associations between Adolescent Marijuana Use, Driving after Marijuana Use and Recreational Retail Sale in Colorado, USA. Subst Use Misuse 2023; 59:235-242. [PMID: 37877210 DOI: 10.1080/10826084.2023.2267123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE We investigated associations between the retail distribution of recreational marijuana in Colorado and (i) past 30-day marijuana use and (ii) driving after marijuana use (DAMU) among a representative sample of public high school students using four waves of data from a state surveillance system. METHODS Past 30-day marijuana use was assessed among all sampled students (n = 85,336). DAMU was assessed among students 15 years or older who indicated driving (n = 47,518). Modified Poisson regression with robust variance estimates was used to estimate prevalence ratios (PR) comparing the pre-distribution (2013) and post-distribution (2015, 2017, 2019) periods for marijuana-related behaviors. Frequency of behavioral engagement was assessed using a multinomial approach. RESULTS An estimated 20.3% of students engaged in past 30-day marijuana use and 10.5% of student drivers engaged in DAMU. Retail distribution of recreational marijuana was not significantly associated with the prevalence of any marijuana use or DAMU. However, it was associated with 1.16 (95% CI: 1.04-1.29) times the prevalence of using marijuana one or two times in the last 30 days, 1.27 (1.03, 1.55) times the prevalence of DAMU one time, and 0.82 (0.69, 0.98) times the prevalence of DAMU six or more times. No significant associations were observed for the remaining frequency categories. CONCLUSIONS Approximately 1 in 10 students who drive reported DAMU. Varying prevalence in the frequency of past 30-day marijuana use and DAMU was observed following the retail distribution of recreational marijuana in Colorado. Care should be taken to properly educate adolescent drivers regarding the dangers of DAMU.
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Affiliation(s)
- Lucas M Neuroth
- The Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marco H Benedetti
- The Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ashley Brooks-Russell
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado, USA
| | - Li Li
- Department of Epidemiology and Health Statistics, Xiangya College of Public Health, Central South University, Changsha, Hunan, China
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Motao Zhu
- The Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Sevigny EL, Greathouse J, Medhin DN. Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1362. [PMID: 37915420 PMCID: PMC10616541 DOI: 10.1002/cl2.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms. Objectives This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps. Search Methods We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020. Selection Criteria The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws. Data Collection and Analysis Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2. Main Results The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality. Authors’ Conclusions More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.
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Affiliation(s)
- Eric L. Sevigny
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Jared Greathouse
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Danye N. Medhin
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
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Fataar F, Driezen P, Owusu-Bempah A, Hammond D. Patterns of problematic cannabis use in Canada pre- and post-legalisation: Differences by neighbourhood deprivation, individual socioeconomic factors and race/ethnicity. Drug Alcohol Rev 2023; 42:1534-1546. [PMID: 37137866 DOI: 10.1111/dar.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The legalisation of cannabis in Canada in 2018, and subsequent increase in prevalence of use, has generated interest in understanding potential changes in problematic patterns of use, including by socio-demographic factors such as race/ethnicity and neighbourhood deprivation level. METHODS This study used repeat cross-sectional data from three waves of the International Cannabis Policy Study web-based survey. Data were collected from respondents aged 16-65 prior to cannabis legalisation in 2018 (n = 8704), and post-legalisation in 2019 (n = 12,236) and 2020 (n = 12,815). Respondents' postal codes were linked to the INSPQ neighbourhood deprivation index. Multinomial regression models examined differences in problematic use by socio-demographic and socio-economic factors and over time. RESULTS No evidence of a change in the proportion of those aged 16-65 in Canada whose cannabis use would be classified as 'high risk' was noted from before cannabis legalisation (2018 = 1.5%) to 12 or 24 months after legalisation (2019 = 1.5%, 2020 = 1.6%; F = 0.17, p = 0.96). Problematic use differed by socio-demographic factors. For example, consumers from the most materially deprived neighbourhoods were more likely to experience 'moderate' vs 'low risk' compared to those living outside deprived neighbourhoods (p < 0.01 for all). Results were mixed for race/ethnicity and comparisons for high risk were limited by small sample sizes for some groups. Differences across subgroups were consistent from 2018 to 2020. DISCUSSION AND CONCLUSIONS The risk of problematic cannabis use does not appear to have increased in the 2 years following cannabis legalisation in Canada. Disparities in problematic use persisted, with some racial minority and marginalised groups experiencing higher risk.
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Affiliation(s)
- Fathima Fataar
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Pete Driezen
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | | | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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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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Wennberg E, Windle SB, Filion KB, Thombs BD, Gore G, Benedetti A, Grad R, Ells C, Eisenberg MJ. Roadside screening tests for cannabis use: A systematic review. Heliyon 2023; 9:e14630. [PMID: 37064483 PMCID: PMC10102219 DOI: 10.1016/j.heliyon.2023.e14630] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/20/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
As more countries legalize recreational cannabis, roadside screening programs are imperative to detect and deter driving under the influence of cannabis. This systematic review evaluated roadside screening tests for cannabis use. We searched six databases (inception-March 2020) and grey literature sources for primary studies evaluating test characteristics of roadside screening tests for cannabis use compared to laboratory tests for cannabinoids in blood or oral fluid. The synthesis was focused on sensitivity and specificity of delta-9-tetrahydrocannabinol (THC) detection. 101 studies were included. Oral fluid tests were higher in specificity and lower in sensitivity compared to urine tests when evaluated against blood laboratory tests. Oral fluid tests were higher in sensitivity and similar in specificity compared to observational tests when evaluated against blood and oral fluid laboratory tests. Sensitivity was variable among oral fluid tests; two instrumented immunoassays (Draeger DrugTest 5000 [5 ng/mL THC cut-off] and Alere DDS 2 Mobile Test System) appeared to perform best, but definitive conclusions could not be drawn due to imprecise estimates. Specificities were similar. Overall, oral fluid tests showed the most promise for use in roadside screening for blood THC levels over legal limits; their continued development and testing are warranted. Urine tests are generally inadvisable, and observational tests require sensitivity improvements.
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González-Sala F, Tortosa-Pérez M, Peñaranda-Ortega M, Tortosa F. Effects of Cannabis Legalization on Road Safety: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4655. [PMID: 36901669 PMCID: PMC10001957 DOI: 10.3390/ijerph20054655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Legalizing medical and recreational cannabis and decriminalizing this substance may have unanticipated effects on traffic safety. The present study aimed to assess the impact of cannabis legalization on traffic accidents. METHODS A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration of the articles included in the Web of Science (WoS) and Scopus databases. The number of papers included in the review was 29. RESULTS The results show that in 15 papers, there is a relationship between the legalization of medical and/or recreational cannabis and the number of traffic accidents, while in 5 papers, no such relationship is observed. In addition, nine articles indicate a greater number of risk behaviors related to driving after consumption, identifying young, male, and alcohol consumption together with cannabis as the risk profile. CONCLUSIONS It can be concluded that the legalization of medical and/or recreational cannabis has negative effects on road safety when considering the number of jobs that affect the number of fatalities.
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Affiliation(s)
- Francisco González-Sala
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Valencia, 46010 Valencia, Spain
| | - Macarena Tortosa-Pérez
- Departamento de Psicología, Universidad Internacional de Valencia-VIU, 46002 Valencia, Spain
| | - María Peñaranda-Ortega
- Departamento de Psicología Básica y Metodología, Universidad de Murcia, 30100 Murcia, Spain
| | - Francisco Tortosa
- Instituto de Investigación en Tráfico y Seguridad Vial-INTRAS, Universidad de Valencia, 46010 Valencia, Spain
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Windle SB, Socha P, Nazif-Munoz JI, Harper S, Nandi A. The Impact of Cannabis Decriminalization and Legalization on Road Safety Outcomes: A Systematic Review. Am J Prev Med 2022; 63:1037-1052. [PMID: 36167602 DOI: 10.1016/j.amepre.2022.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There is substantial debate concerning the impact of cannabis decriminalization and legalization on road safety outcomes. METHODS Seven databases were systematically searched: Embase, MEDLINE, and PsycINFO through Ovid as well as Web of Science Core Collection, SafetyLit, Criminal Justice Database (ProQuest), and Transport Research International Documentation (from inception to June 16, 2021). Eligible primary studies examined group-level cannabis decriminalization or legalization and a road safety outcome in any population. RESULTS A total of 65 reports of 64 observational studies were eligible, including 39 that applied a quasi-experimental design. Studies examined recreational cannabis legalization (n=50), medical cannabis legalization (n=22), and cannabis decriminalization (n=5). All studies except 1 used data from the U.S. or Canada. Studies found mixed impacts of legalization on attitudes, beliefs, and self-reported driving under the influence. Medical legalization, recreational legalization, and decriminalization were associated with increases in positive cannabis tests among drivers. Few studies examined impacts on alcohol or other drug use, although findings suggested a decrease in positive alcohol tests among drivers associated with medical legalization. Medical legalization was associated with reductions in fatal motor-vehicle collisions, whereas recreational legalization was conversely associated with increases in fatal collisions. DISCUSSION Increased cannabis positivity may reflect changes in cannabis use; however, it does not in itself indicate increased impaired driving. Subgroups impacted by medical and recreational legalization, respectively, likely explain opposing findings for fatal collisions. More research is needed concerning cannabis decriminalization; the impacts of decriminalization and legalization on nonfatal injuries, alcohol and other drugs; and the mechanisms by which legalization impacts road safety outcomes.
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Affiliation(s)
- Sarah B Windle
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Institute for Health and Social Policy, School of Population and Global Health, McGill University, Montreal, Quebec, Canada.
| | - Peter Socha
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - José Ignacio Nazif-Munoz
- Programmes d'études et de recherche en toxicomanie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Institute for Health and Social Policy, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Institute for Health and Social Policy, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
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Ropero Miller JD, Mullen LD, Speaker PJ. The sentinel role of forensic toxicology laboratories to identify and act upon diverse drug threats by addressing toxicology and economic demands. Forensic Sci Int Synerg 2022; 5:100292. [PMID: 36419757 PMCID: PMC9677077 DOI: 10.1016/j.fsisyn.2022.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Paul J. Speaker
- John Chambers College of Business & Economics, West Virginia University, United States
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Dempsey SK, Gray TR, Kelly AT, Stout P, Lee D. A Comparison of High Drug Concentrations in Impaired Driving and Postmortem Casework in Harris County, Texas. J Anal Toxicol 2022; 46:817-824. [PMID: 35639908 DOI: 10.1093/jat/bkac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/29/2022] [Accepted: 05/26/2022] [Indexed: 11/14/2022] Open
Abstract
Drug-impaired driving is a growing public safety issue. Addressing impairment due to drugs other than ethanol can be challenging for forensic toxicologists as many factors need to be considered including the type of drug(s), drug-drug interaction, the dose(s), and the individual's physiological condition and drug use history. Interpretation of blood drug test results is additionally difficult as drug concentrations in impaired driving cases may overlap levels typically viewed as toxic. This study compares blood concentrations of drugs in impaired driving cases to those in postmortem cases in Houston, Texas from 2014 to 2020. Blood drug concentrations from driving while intoxicated (DWI) or driving under the influence of drugs (DUID) cases submitted to Houston Forensic Science Center (HFSC) and Harris County Institute of Forensic Sciences (HCIFS) were compared to postmortem blood test results from HCIFS. Eight DWI/DUID cases had drugs that exceeded impaired driving concentrations reported in literature. These drugs included fentanyl (220 ng/mL), oxycodone (680 ng/mL), hydrocodone (310 and 490 ng/mL), clonazepam (330 ng/mL), methamphetamine (3500 and 7100 ng/mL), and THC (160 ng/mL). For oxycodone and hydrocodone, the presented DWI/DUID cases exceeded 91% and 96% of postmortem concentrations, respectively. The 7100 ng/mL methamphetamine DWI/DUID result was greater than 98% of postmortem cases. The presented DWI/DUID concentrations were higher than all but one postmortem case for clonazepam and higher than all postmortem cases for THC. This study demonstrates extremely high drug concentrations in DWI/DUID casework blur the line between therapeutic/recreational and toxic concentrations.
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Affiliation(s)
- Sara K Dempsey
- Dallas County Southwestern Institute of Forensic Sciences, 2355 N. Stemmons Fwy, Dallas, Texas 75207 USA
| | - Teresa R Gray
- Harris County Institute of Forensic Sciences, 1861 Old Spanish Trail, Houston, Texas 77054 USA
| | - Anna T Kelly
- Harris County Institute of Forensic Sciences, 1861 Old Spanish Trail, Houston, Texas 77054 USA
| | - Peter Stout
- Houston Forensic Science Center, Inc., 500 Jefferson St., 13th Floor, Houston, Texas 77002 USA
| | - Dayong Lee
- Houston Forensic Science Center, Inc., 500 Jefferson St., 13th Floor, Houston, Texas 77002 USA
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Hasan R, Watson B, Haworth N, Oviedo-Trespalacios O. A systematic review of factors associated with illegal drug driving. ACCIDENT; ANALYSIS AND PREVENTION 2022; 168:106574. [PMID: 35152044 DOI: 10.1016/j.aap.2022.106574] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Drug driving is a serious problem worldwide that can increase the risk of road crashes. This systematic review seeks to identify factors associated with drug driving (i.e., driving after consuming drugs other than alcohol) to highlight gaps in existing knowledge and inform the design of more effective countermeasures. A search of the literature was conducted for the period January 1, 2005 to July 31, 2021 using six different databases. The search protocol followed PRISMA guidelines and was registered in PROSPERO (#CRD42021234616). Studies that met inclusion criteria compared drug drivers with either non-drug drivers, alcohol-only drivers or drug drivers from an earlier time period, to identify factors specifically associated with drug driving, rather than common to all drivers. Two hundred and nineteen publications met the inclusion criteria and were included within the review. Based on the findings, a logic model was developed that presents the factors associated with drug driving. Various sociodemographic, psychosocial and legal factors emerged as the main factors associated with illegal drug driving. At the sociodemographic and psychological levels, drug drivers were more likely to be single, young males who often drive after using cannabis and who score high on sensation-seeking and impulsivity scales. The key social factor found to be associated with drug driving was peer acceptance/disapproval of the behaviour. At the legal level, the review suggested that the effectiveness of current enforcement approaches to drug driving vary among jurisdictions around the world due to differences in the level of perceived certainty of apprehension and the chances of punishment avoidance. Future research into the anticipated and actual rewards for drug driving is needed to inform the development of more effective countermeasures.
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Affiliation(s)
- Razi Hasan
- Queensland University of Technology (QUT), Centre for Accident Research and Road Safety- Queensland (CARRS-Q), K Block, 130 Victoria Park Road, Kelvin Grove, QLD 4059, Australia
| | - Barry Watson
- Queensland University of Technology (QUT), Centre for Accident Research and Road Safety- Queensland (CARRS-Q), K Block, 130 Victoria Park Road, Kelvin Grove, QLD 4059, Australia
| | - Narelle Haworth
- Queensland University of Technology (QUT), Centre for Accident Research and Road Safety- Queensland (CARRS-Q), K Block, 130 Victoria Park Road, Kelvin Grove, QLD 4059, Australia
| | - Oscar Oviedo-Trespalacios
- Queensland University of Technology (QUT), Centre for Accident Research and Road Safety- Queensland (CARRS-Q), K Block, 130 Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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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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Benedetti MH, Li L, Neuroth LM, Humphries KD, Brooks-Russell A, Zhu M. Demographic and policy-based differences in behaviors and attitudes towards driving after marijuana use: an analysis of the 2013-2017 Traffic Safety Culture Index. BMC Res Notes 2021; 14:226. [PMID: 34082823 PMCID: PMC8176701 DOI: 10.1186/s13104-021-05643-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Marijuana policies in the United States have become more permissive, motivating research on demographic and policy-based differences in behaviors and attitudes towards driving after marijuana use. The Traffic Safety Culture Index is an annual survey with national scope and multiple measures relevant to driving after marijuana use. We tabulated responses to questions about driving after marijuana use from the Traffic Safety Culture Index based on demographic factors, recreational and medical marijuana policies, and per-se marijuana laws. RESULTS Male, younger, lower-income, and lower-education respondents self-reported driving after marijuana use more than their demographic counterparts, more often reported such behavior to be personally acceptable, and exhibited lower support per-se laws. Drivers in states that legalized medical marijuana self-reported driving after marijuana use slightly more than drivers in states where both medical and recreational were illegal. Support for per-se laws was higher among those in states that legalized recreational marijuana and in states with per-se laws. Demographic differences in our outcomes were consistent and cohesive. On the other hand, we found no predominant pattern suggesting that those in states with liberal marijuana policies were more tolerant of driving after marijuana use.
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Affiliation(s)
- Marco H Benedetti
- The Center for Injury Research and Policy, Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, RB3-WB5217, Columbus, OH, 43215, USA
| | - Li Li
- The Center for Injury Research and Policy, Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, RB3-WB5217, Columbus, OH, 43215, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Lucas M Neuroth
- The Center for Injury Research and Policy, Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, RB3-WB5217, Columbus, OH, 43215, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Kayleigh D Humphries
- The Center for Injury Research and Policy, Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, RB3-WB5217, Columbus, OH, 43215, USA
| | - Ashley Brooks-Russell
- Department of Community and Behavioral Health, Colorado School of Public Health, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
| | - Motao Zhu
- The Center for Injury Research and Policy, Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, RB3-WB5217, Columbus, OH, 43215, USA. .,Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA. .,Department of Pediatrics, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA.
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15
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Oldfield K, Evans S, Braithwaite I, Newton-Howes G. Don’t make a hash of it! A thematic review of the literature relating to outcomes of cannabis regulatory change. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1901855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Karen Oldfield
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
- School of Biological Sciences, Victoria University of Wellington (VUW), Wellington, New Zealand
- Medical Cannabis Research Collaborative (MCRC) NZ, Wellington, New Zealand
| | - Sean Evans
- Addiction Services, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Irene Braithwaite
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
- School of Biological Sciences, Victoria University of Wellington (VUW), Wellington, New Zealand
- Medical Cannabis Research Collaborative (MCRC) NZ, Wellington, New Zealand
| | - Giles Newton-Howes
- Medical Cannabis Research Collaborative (MCRC) NZ, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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16
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Straub HL, Mou J, Drennan KJ, Pflugeisen BM. Maternal Marijuana Exposure and Birth Weight: An Observational Study Surrounding Recreational Marijuana Legalization. Am J Perinatol 2021; 38:65-75. [PMID: 31430821 DOI: 10.1055/s-0039-1694793] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to study the relationship between prenatal marijuana and infant birth weight using natural cohorts established before, during and after the 20-month lapse between legalization and legal recreational sales in Washington State. STUDY DESIGN Over 5 years, 5,343 pregnant women with documented urine drug screen (UDS) results delivered at Tacoma General Hospital or Good Samaritan Hospital. Maternal medical data were extracted for three delivery cohorts established based on before (T1), during (T2), and after legalization (T3) of recreational marijuana and legalized availability. Univariate and multivariate models were created to study marijuana exposure on infants' birth weight. RESULTS Marijuana exposure increased the risk of low birth weight (LBW; odds ratio [OR] = 1.42, 95% confidence interval [CI]: 1.01-2.01). This was more pronounced in full-term babies (OR = 1.72, 95% CI: 1.10-2.69), and was independently associated with a higher risk for small for gestational age (SGA; OR = 1.51, 95% CI: 1.49-1.53). The associations between marijuana exposure and SGA were maintained in cohort-specific models (OR = 1.53, 95% CI: 1.01-2.32 for T2, and OR = 1.43, 95% CI: 1.01-2.02 for T3, respectively). CONCLUSION Marijuana exposure verified by UDS was associated with LBW and SGA. However, recreational marijuana legalization and availability did not have direct impact on newborns' risk of LBW or SGA.
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Affiliation(s)
- Heather L Straub
- Division of Maternal-Fetal Medicine, University of Colorado, Aurora, Colorado
| | - Jin Mou
- MultiCare Institute for Research and Innovation, Tacoma, Washington
| | - Kathryn J Drennan
- Division of Maternal-Fetal Medicine, University of Colorado, Aurora, Colorado.,Division of Maternal-Fetal Medicine, University of Rochester, Rochester, New York
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17
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Self-reported driving after marijuana use in association with medical and recreational marijuana policies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 92:102944. [PMID: 33268196 DOI: 10.1016/j.drugpo.2020.102944] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND A common concern surrounding increasingly permissive marijuana policies in the US is that they will lead to more dangerous behavior, including driving after marijuana use. Although there is considerable research on the effects of marijuana policies on behaviours, few studies have examined self-reported driving after marijuana use. In this study, we use data from the Traffic Safety Culture Index (TSCI) to model self-reported past-year driving after marijuana use in association with medical and recreational marijuana policies. METHODS We analysed individual responses to annual administrations of TSCI from years 2013-2017 using a multiple logistic regression model. Our outcome variable was self-reported past-year driving after marijuana use (at least once vs. never), and our primary explanatory variable was the respondents' state medical marijuana (MM) and recreational marijuana (RM) policy. Additional explanatory variables include policies that specify thresholds for marijuana-intoxicated driving, year, and demographic factors. RESULTS Drivers in states that legalized MM but not RM had marginally higher odds of self-reporting driving after marijuana use compared to drivers in states where both RM and MM were illegal (adjusted OR 1.29; 95% CI 0.98, 1.70; p = 0.075). However, we found little evidence that drivers in states that legalized both RM and MM had higher odds of driving after marijuana use compared to drivers in states where both RM and MM were illegal (adjusted OR 1.06; 95% CI 0.71, 1.56; p = 0.784). Per-se or THC threshold laws were associated with lower self-reported driving after marijuana use (adjusted OR 0.74; 95% CI 0.57, 0.95; p = 0.018). CONCLUSION Although we found some evidence of an association between MM legalization and self-reported driving after marijuana use, our results provide only mixed support for the hypothesis that permissive marijuana policies are associated with higher odds of self-reported driving after marijuana use.
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18
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Fink DS, Stohl M, Sarvet AL, Cerda M, Keyes KM, Hasin D. Medical marijuana laws and driving under the influence of marijuana and alcohol. Addiction 2020; 115:1944-1953. [PMID: 32141142 PMCID: PMC7483706 DOI: 10.1111/add.15031] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/14/2019] [Accepted: 03/03/2020] [Indexed: 11/26/2022]
Abstract
AIMS Medical marijuana law (MML) enactment in the United States has been associated with increased cannabis use but lower traffic fatality rates. We assessed the possible association of MML and individual-level driving under the influence of cannabis (DUIC) and also under the influence of alcohol (DUIA). DESIGN AND SETTING Three cross-sectional U.S. adult surveys: The National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the NESARC-III (2012-2013). PARTICIPANTS The total n was 118 497: 41 764, 41 184, and 35 549 from NLAES, NESARC, and NESARC-III, respectively. MEASUREMENTS Across the three surveys, similar questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule assessed DUIC and DUIA. Ever-MML states enacted MML between 1991-1992 and 2012-2013 (overall period). Early-MML states enacted MML between 1991-1992 and 2001-2002 (early period). Late-MML states enacted MML between 2001-2002 and 2012-2013 (late period). MML effects on change in DUIC and DUIA prevalence were estimated using a difference-in-differences specification to compare changes in MML and other states. FINDINGS From 1991-1992 to 2012-2013, DUIC prevalence nearly doubled (from 1.02% to 1.92%), increasing more in states that enacted MML than other states (difference-in-differences [DiD] = 0.59%; 95% CI = 0.06%-1.12%). Most change in DUIC prevalence occurred between 2001-2002 and 2012-2013. DUIC prevalence increased more in states that enacted MML 2001-2002 to 2012-2013 than in never-MML states (DiD = 0.77%; 95% CI = -0.05%-1.59%), and in two early-MML states, California (DiD = 0.82; 95% CI = 0.06-1.59) and Colorado (DiD = 1.32; 95% CI = 0.11-2.53). In contrast, DUIA prevalence appeared unrelated to MML enactment. CONCLUSIONS Medical marijuana law enactment in US states appears to have been associated with increased prevalence of driving under the influence of cannabis, but not alcohol.
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Affiliation(s)
- David S. Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Malki Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | - Aaron L. Sarvet
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard, Boston, MA, USA
| | - Magdalena Cerda
- Department of Population Health, New York University, New York, NY, USA
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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19
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Carpino M, Langille D, Ilie G, Asbridge M. Cannabis-related driving and passenger behaviours among high school students: a cross-sectional study using survey data. CMAJ Open 2020; 8:E754-E761. [PMID: 33234582 PMCID: PMC7721252 DOI: 10.9778/cmajo.20200081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many youth report driving under the influence of cannabis (DUIC) and riding with a cannabis-impaired driver (RWCD), and many perceive that cannabis causes limited impairment. We examined associations of perceived risk of regular cannabis use with DUIC and RWCD, exploring differences by sex and rural setting. METHODS In a cross-sectional study, we examined DUIC and RWCD among high school students in grades 11 and 12 who participated in the 2016-2017 Canadian Student Tobacco, Alcohol and Drugs Survey. Private and public schools across 9 Canadian provinces were included. New Brunswick and the 3 territories were not included. Multinomial logistic regression models generated adjusted and unadjusted models for the associations. RESULTS A total of 52 103 students in grades 7-12, from 117 school boards and 699 schools, participated in the survey. The survey response rate was 76.2% (n = 52 103/68 415). In total, 14 520 students in grades 11 and 12 participated in the survey. Greater perceived risk of regular cannabis use was associated with reduced risk of DUIC and RWCD in a dose-response manner. Students perceiving that regular cannabis use posed great risk had an adjusted relative risk (RR) of 0.06 (95% confidence interval [CI] 0.04-0.10) of DUIC in the past 30 days compared with students perceiving that regular use posed no risk. Students perceiving that regular cannabis use posed great risk had an adjusted RR of 0.09 (95% CI 0.07-0.12) of RWCD in the past 30 days compared with students perceiving no such risk. Associations were consistent for male and female students and for those living in urban and rural areas. INTERPRETATION Students perceiving minimal risk from cannabis use reported greater engagement in cannabis-related risky driving behaviours. Given the importance of youth perceptions in shaping driving and passenger behaviours, efforts must be made to disseminate appropriate information regarding cannabis-related driving risks to high school students.
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Affiliation(s)
- Melissa Carpino
- Departments of Community Health and Epidemiology (Carpino, Langille, Ilie, Asbridge), Urology (Ilie) and Emergency Medicine (Asbridge), Dalhousie University, Halifax, NS
| | - Donald Langille
- Departments of Community Health and Epidemiology (Carpino, Langille, Ilie, Asbridge), Urology (Ilie) and Emergency Medicine (Asbridge), Dalhousie University, Halifax, NS
| | - Gabriela Ilie
- Departments of Community Health and Epidemiology (Carpino, Langille, Ilie, Asbridge), Urology (Ilie) and Emergency Medicine (Asbridge), Dalhousie University, Halifax, NS
| | - Mark Asbridge
- Departments of Community Health and Epidemiology (Carpino, Langille, Ilie, Asbridge), Urology (Ilie) and Emergency Medicine (Asbridge), Dalhousie University, Halifax, NS
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20
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Scheim AI, Maghsoudi N, Marshall Z, Churchill S, Ziegler C, Werb D. Impact evaluations of drug decriminalisation and legal regulation on drug use, health and social harms: a systematic review. BMJ Open 2020; 10:e035148. [PMID: 32958480 PMCID: PMC7507857 DOI: 10.1136/bmjopen-2019-035148] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To review the metrics and findings of studies evaluating effects of drug decriminalisation or legal regulation on drug availability, use or related health and social harms globally. DESIGN Systematic review with narrative synthesis. DATA SOURCES We searched MEDLINE, Embase, PsycINFO, Web of Science and six additional databases for publications from 1 January 1970 through 4 October 2018. INCLUSION CRITERIA Peer-reviewed articles or published abstracts in any language with quantitative data on drug availability, use or related health and social harms collected before and after implementation of de jure drug decriminalisation or legal regulation. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened titles, abstracts and articles for inclusion. Extraction and quality appraisal (modified Downs and Black checklist) were performed by one reviewer and checked by a second, with discrepancies resolved by a third. We coded study-level outcome measures into metric groupings and categorised the estimated direction of association between the legal change and outcomes of interest. RESULTS We screened 4860 titles and 221 full-texts and included 114 articles. Most (n=104, 91.2%) were from the USA, evaluated cannabis reform (n=109, 95.6%) and focussed on legal regulation (n=96, 84.2%). 224 study outcome measures were categorised into 32 metrics, most commonly prevalence (39.5% of studies), frequency (14.0%) or perceived harmfulness (10.5%) of use of the decriminalised or regulated drug; or use of tobacco, alcohol or other drugs (12.3%). Across all substance use metrics, legal reform was most often not associated with changes in use. CONCLUSIONS Studies evaluating drug decriminalisation and legal regulation are concentrated in the USA and on cannabis legalisation. Despite the range of outcomes potentially impacted by drug law reform, extant research is narrowly focussed, with a particular emphasis on the prevalence of use. Metrics in drug law reform evaluations require improved alignment with relevant health and social outcomes.
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Affiliation(s)
- Ayden I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nazlee Maghsoudi
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Zack Marshall
- Social Work, McGill University, Montreal, Quebec, Canada
| | - Siobhan Churchill
- Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Carolyn Ziegler
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, Ontario, Canada
- Medicine, University of California San Diego, La Jolla, California, USA
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21
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Levine M, Jontz A, Dabrowski P, Claudius IA, Kreisler R, Yee N, LoVecchio F. Prevalence of marijuana use among trauma patients before and after legalization of medical marijuana: The Arizona experience. Subst Abus 2020; 42:366-371. [DOI: 10.1080/08897077.2020.1784359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Medical Toxicology, Banner University Medical Center, Phoenix, Phoenix, Arizona, USA
| | - Ashley Jontz
- Department of Surgery, Division of Trauma Surgery, Banner University Medical Center, Phoenix, Phoenix, Arizona, USA
| | - Paul Dabrowski
- Department of Surgery, Division of Trauma Surgery, Banner University Medical Center, Phoenix, Phoenix, Arizona, USA
| | - Ilene A. Claudius
- Department of Emergency Medicine, Harbor UCLA Medical Center, University of California, Los Angeles, Torrance, California, USA
| | - Rachael Kreisler
- College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - Noa Yee
- School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Frank LoVecchio
- Department of Medical Toxicology, Banner University Medical Center, Phoenix, Phoenix, Arizona, USA
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22
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Brubacher JR, Chan H, Staples JA. Cannabis-impaired driving and Canadian youth. Paediatr Child Health 2020; 25:S21-S25. [PMID: 32581627 DOI: 10.1093/pch/pxaa017] [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: 11/08/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
Acute cannabis use results in inattention, delayed information processing, impaired coordination, and slowed reaction time. Driving simulator studies and epidemiologic analyses suggest that cannabis use increases motor vehicle crash risk. How much concern should we have regarding cannabis associated motor vehicle collision risks among younger drivers? This article summarizes why young, inexperienced drivers may be at a particularly high risk of crashing after using cannabis. We describe the epidemiology of cannabis use among younger drivers, why combining cannabis with alcohol causes significant impairment and why cannabis edibles may pose a heightened risk to traffic safety. We provide recommendations for clinicians counselling younger drivers about cannabis use and driving.
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Affiliation(s)
- Jeff R Brubacher
- Faculty of Medicine, Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia
| | - Herbert Chan
- Faculty of Medicine, Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia
| | - John A Staples
- Faculty of Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia
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23
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Earle AM, Napper LE, LaBrie JW, Brooks-Russell A, Smith DJ, de Rutte J. Examining interactions within the theory of planned behavior in the prediction of intentions to engage in cannabis-related driving behaviors. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:374-380. [PMID: 30681931 PMCID: PMC6658360 DOI: 10.1080/07448481.2018.1557197] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Objective: As marijuana use becomes more available to college students through increasing legal reform, this paper seeks to examine intentions for driving under the influence of cannabis (DUIC) and riding with a high driver (RWHD) through the lens of the theory of planned behavior (TPB) and assess potential interactions between personal attitudes, subjective norms, perceived behavioral control (PBC), and sex. Participants: Undergraduate college students (N = 311) completed online surveys in September, 2013. Method: Participants self-reported their attitudes toward DUIC, subjective norms, PBC, past DUIC and RWHD, and intentions to DUIC and RWHD. Results: Participants' attitudes toward DUIC, subjective norms, and PBC were strongly associated with intentions to DUIC and RWHD bivariately. In regression models, attitudes and PBC were both positively and significantly related to intentions to DUIC and RWHD. Conclusions: DUIC and RWHD are concerns for college populations. Targeting personal attitudes and perceived behavioral control via interventions may reduce these behaviors.
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Affiliation(s)
- Andrew M. Earle
- Department of Psychology, Loyola Marymount University, Los Angeles, CA 90045
| | - Lucy E. Napper
- Lehigh University, Department of Psychology, Health, Medicine, & Society Program, 17 Memorial Drive East, Chandler-Ullmann Hall, Bethlehem, PA 18015
| | - Joseph W. LaBrie
- Department of Psychology, Loyola Marymount University, Los Angeles, CA 90045
| | | | - Daniel J. Smith
- Department of Psychology, Loyola Marymount University, Los Angeles, CA 90045
| | - Jennifer de Rutte
- Department of Psychology, Loyola Marymount University, Los Angeles, CA 90045
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24
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Lake S, Kerr T, Werb D, Haines-Saah R, Fischer B, Thomas G, Walsh Z, Ware MA, Wood E, Milloy MJ. Guidelines for public health and safety metrics to evaluate the potential harms and benefits of cannabis regulation in Canada. Drug Alcohol Rev 2020; 38:606-621. [PMID: 31577059 DOI: 10.1111/dar.12971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 01/20/2023]
Abstract
ISSUES Canada recently introduced a public health-based regulatory framework for non-medical cannabis. This review sought to identify a comprehensive set of indicators to evaluate the public health and safety impact of cannabis regulation in Canada, and to explore the ways in which these indicators may be expected to change in the era of legal non-medical cannabis. APPROACH Five scientific databases were searched to compile a list of cannabis-related issues of interest to public health and safety. A set of indicators was developed based on topics and themes that emerged. Preliminary evidence from other jurisdictions in the USA and Canada that have legalised medical and/or non-medical cannabis (e.g. Colorado, Washington) was summarised for each indicator, wherever possible. KEY FINDINGS In total, 28 indicators were identified under five broad themes: public safety; cannabis use trends; other substance use trends; cardiovascular and respiratory health; and mental health and cognition. Preliminary trends from other legalised jurisdictions reveal little consensus regarding the effect of cannabis legalisation on public health and safety harms and an emerging body of evidence to support potential benefits (e.g. reductions in opioid use and overdose). IMPLICATIONS In addition to indicators of commonly discussed challenges (e.g. cannabis-related hospitalisations, cannabis-impaired driving), this review led to the recommendation of several indicators to monitor for possible public health and safety improvements. CONCLUSION In preparing a comprehensive public health and safety monitoring and evaluation system for cannabis regulation, this review underscores the importance of not only measuring the possible risks but also the potential benefits.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - Dan Werb
- Department of Medicine, University of California San Diego, La Jolla, USA.,International Centre for Science in Drug Policy, St. Michael's Hospital, Toronto, Canada
| | - Rebecca Haines-Saah
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Gerald Thomas
- Alcohol, Tobacco, Cannabis and Gambling Policy and Prevention, British Columbia Ministry of Health, Victoria, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, Canada
| | - Mark A Ware
- Departments of Family Medicine and Anesthesia, McGill University, Montréal, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
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Hammond D, Goodman S, Wadsworth E, Rynard V, Boudreau C, Hall W. Evaluating the impacts of cannabis legalization: The International Cannabis Policy Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102698. [PMID: 32113149 DOI: 10.1016/j.drugpo.2020.102698] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 01/30/2023]
Abstract
An increasing number of jurisdictions have legalized non-medical cannabis use, including Canada in October 2018 and several US states starting in 2012. The policy measures implemented within these regulated markets differ with respect to product standards, labelling and warnings, public education, retail policies, marketing, and price/taxation. The International Cannabis Policy Study (ICPS) seeks to evaluate the impacts of these policy measures as well as the broader population-level impact of cannabis legalization using a quasi-experimental research design. The objective of this paper is to describe the ICPS conceptual framework, methods, and baseline estimates of cannabis use. The ICPS is a prospective cohort survey conducted with national samples of 16-65-year-olds in Canada and the US. Data are collected via an online survey using the Nielsen Consumer Insights Global Panel. Primary survey domains include: prevalence and patterns of cannabis use; purchasing and price; consumption and product types; commercial retail environment; problematic use and risk behaviours; cannabis knowledge and risk perceptions; and policy-relevant outcomes including exposure to health warnings, public educational campaigns, and advertising and promotion. The first annual wave was conducted in Aug-Oct 2018 with 27,169 respondents in three geographic 'conditions': Canada (n = 10,057), US states that had legalized non-medical cannabis (n = 7,398) and US states in which non-medical cannabis was prohibited (n = 9,714). The ICPS indicates substantial differences in cannabis use in jurisdictions with different regulatory frameworks for cannabis. Future waves of the study will examine changes over time in cannabis use and its effects associated with legalization in Canada and additional US states.
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Affiliation(s)
- David Hammond
- School of Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Samantha Goodman
- School of Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Elle Wadsworth
- School of Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Vicki Rynard
- School of Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Christian Boudreau
- Department of Statistics and Actuarial Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Wayne Hall
- Centre for Youth Substance Abuse, University of Queensland, 17 Upland Road, St Lucia, Queensland 4067, Australia.
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26
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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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Elevated Demand and Proportionate Substance-related Reinforcement are Associated with Driving after Cannabis Use. CANADIAN JOURNAL OF ADDICTION 2019. [DOI: 10.1097/cxa.0000000000000062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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28
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Chow RM, Marascalchi B, Abrams WB, Peiris NA, Odonkor CA, Cohen SP. Driving Under the Influence of Cannabis: A Framework for Future Policy. Anesth Analg 2019; 128:1300-1308. [PMID: 31094805 DOI: 10.1213/ane.0000000000003575] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Marijuana is the most widely consumed illicit substance in the United States, and an increasing number of states have legalized it for both medicinal and recreational purposes. As it becomes more readily available, there will be a concurrent rise in the number of users and, consequently, the number of motor vehicle operators driving under the influence. This article examines the cognitive and psychomotor effects of cannabis, as well as current policy concerning driving under the influence of drugs. The authors performed a MEDLINE search on the epidemiology of cannabis use, its cognitive and psychomotor effects, and policies regarding driving under the influence of drugs. Twenty-eight epidemiological studies, 16 acute cognitive and psychomotor studies, 8 chronic cognitive and psychomotor studies, and pertinent state and federal laws and policies were reviewed. These search results revealed that marijuana use is associated with significant cognitive and psychomotor effects. In addition, the legalization of marijuana varies from state to state, as do the laws pertaining to driving under the influence of drugs. Marijuana is a commonly found illicit substance in motor vehicle operators driving under the influence of drugs. Current evidence shows that blood levels of tetrahydrocannabinol do not correlate well with the level of impairment. In addition, although acute infrequent use of cannabis typically leads to cognitive and psychomotor impairment, this is not consistently the case for chronic heavy use. To establish the framework for driving under the influence of cannabis policy, we must review the current published evidence and examine existing policy at state and federal levels.
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Affiliation(s)
- Robert M Chow
- From the Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Winfred B Abrams
- Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nathalie A Peiris
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles A Odonkor
- Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Steven P Cohen
- Department of Anesthesiology, Neurology and Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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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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30
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Chung C, Salottolo K, Tanner A, Carrick MM, Madayag R, Berg G, Lieser M, Bar-Or D. The impact of recreational marijuana commercialization on traumatic injury. Inj Epidemiol 2019; 6:3. [PMID: 30714081 PMCID: PMC6360194 DOI: 10.1186/s40621-019-0180-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The medical legalization of marijuana has been shown to result in an increased risk of motor vehicle injuries. In Colorado, commercialization of recreational marijuana (initiation of retail sales) occurred on January 1, 2014, resulting in the rapid proliferation of its availability. The objective of this study was to determine whether the proportion of injured patients testing positive for marijuana and other drugs changed two years before and two years after commercialization of recreational marijuana in Colorado. METHODS This retrospective multi-institutional cohort study included all patients admitted with a traumatic injury to six trauma centers (three centers in Colorado and three centers in states without permissive marijuana laws) from 2012 to 2015. The primary outcome was the rate (%) of a positive urine drug screen (UDS) for marijuana. Generalized linear regression models were used to examine the rate of change over time in the pre-commercialization period relative to the post- commercialization period (via an interaction effect), separately for states with and without recreational marijuana legalization. RESULTS There were 40,591 trauma admissions. In Colorado, the rate of marijuana detected with UDS decreased over time pre-commercialization; this trend reversed post-commercialization, when marijuana detection rates increased significantly over time (interaction p = 0.004). At non-Colorado hospitals, the rate over time of marijuana detection was significantly reduced post-commercialization relative to the pre-commercialization period (p < 0.001). CONCLUSION There was an overall increased rate over time of marijuana detected among trauma patients at Colorado hospitals but not at non-Colorado hospitals, suggesting an increased use of marijuana or an increased risk of injury while using marijuana following the commercialization of recreational marijuana in Colorado.
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Affiliation(s)
- Christine Chung
- Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA
| | - Kristin Salottolo
- Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA.,Trauma Research Department, Penrose-St Francis Health Services, Colorado Springs, CO, USA.,Trauma Research Department, Medical City Plano, Plano, TX, USA.,Trauma Research Department, St. Anthony Hospital, Lakewood, CO, USA.,Trauma Research Department, Wesley Medical Center, Wichita, KS, USA.,Trauma Research Department, Research Medical Center, MO, Kansas City, US, USA
| | - Allen Tanner
- Trauma Research Department, Penrose-St Francis Health Services, Colorado Springs, CO, USA
| | | | - Robert Madayag
- Trauma Research Department, St. Anthony Hospital, Lakewood, CO, USA
| | - Gina Berg
- Trauma Research Department, Wesley Medical Center, Wichita, KS, USA
| | - Mark Lieser
- Trauma Research Department, Research Medical Center, MO, Kansas City, US, USA
| | - David Bar-Or
- Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA. .,Trauma Research Department, Penrose-St Francis Health Services, Colorado Springs, CO, USA. .,Trauma Research Department, Medical City Plano, Plano, TX, USA. .,Trauma Research Department, St. Anthony Hospital, Lakewood, CO, USA. .,Trauma Research Department, Wesley Medical Center, Wichita, KS, USA. .,Trauma Research Department, Research Medical Center, MO, Kansas City, US, USA.
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Law enforcement practices in the first two states in U.S. to legalize recreational marijuana. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 61:38-43. [PMID: 30388568 DOI: 10.1016/j.drugpo.2018.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/09/2018] [Accepted: 08/29/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a lack of research regarding law enforcement practices where recreational marijuana sales are legal. Given that legalization of recreational marijuana is expanding, lessons learned from areas with existing legalization can help inform future practices. This pilot study is an evaluation of enforcement of marijuana laws in the first two states in the U.S. to legalize sales of recreational marijuana, Colorado and Washington, several years post legalization. METHODS We surveyed a random sample of local law enforcement agencies in the two states (25 agencies per state). We also attempted to survey the state-level marijuana enforcement agency but only Washington responded. Surveys focused on youth marijuana use, youth access to marijuana, and impaired driving but included other topics. Chi-square tests assessed differences between states (p < .05). RESULTS All local agencies reported underage use was somewhat or very common in their jurisdictions. Thirty percent of local agencies conducted enforcement targeting underage use/possession. Twenty percent of agencies overall conducted underage compliance checks at licensed stores, with more agencies conducting checks in Colorado (32%) than Washington (8%; p = .03). Most agencies in both states reported marijuana-impaired driving was somewhat or very common in their jurisdictions. One local agency in each state specifically targeted marijuana-impaired driving. The state-level agency in Washington reported that their agency is the one primarily responsible for enforcing marijuana retail laws and they conducted routine underage compliance checks at all licensed marijuana stores three times per year. CONCLUSION Our findings indicate that marijuana enforcement can be improved regarding sales/provision to underage youth and impaired driving in these states, particularly given that underage use and impaired driving are perceived to be common. Larger studies with additional jurisdictions and types of agencies (e.g., highway patrol) are warranted.
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Berg CJ. A Socioecological Perspective Regarding Risk Factors for Driving Under the Influence of Marijuana Among Young Adults. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2018; 12:1178221818805084. [PMID: 30349281 PMCID: PMC6194923 DOI: 10.1177/1178221818805084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/13/2018] [Indexed: 11/16/2022]
Abstract
Young adults are at high risk for using marijuana, driving under the influence (DUI) of marijuana, and fatalities or serious injuries from motor vehicle crashes related to DUI of marijuana. Within the context of increased legalization of marijuana use and shifting social norms, these public health concerns are particularly prominent. Drawing from a socioecological perspective, this commentary summarizes the literature indicating the importance of multilevel influences on DUI of marijuana among young adults. Indeed, prior research has indicated that risk for DUI of marijuana is associated with policy-level factors such as state and local policies related to marijuana, community-level factors including marijuana access (eg, legalized retail, black market), interpersonal influences including social norms, and intrapersonal factors such as risk perceptions of marijuana use and DUI. This literature should inform future research and practice aiming to develop, test, and implement multilevel interventions and develop messaging strategies aimed at curtailing DUI of marijuana.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health; Winship Cancer Institute; Emory University, Atlanta, GA, USA
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33
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Has the Legalisation of Medical and Recreational Cannabis Use in the USA Affected the Prevalence of Cannabis Use and Cannabis Use Disorders? CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0224-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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34
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Ferrari D, Manca M, Premaschi S, Banfi G, Locatelli M. Toxicological investigation in blood samples from suspected impaired driving cases in the Milan area: Possible loss of evidence due to late blood sampling. Forensic Sci Int 2018; 288:211-217. [DOI: 10.1016/j.forsciint.2018.04.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/24/2018] [Accepted: 04/19/2018] [Indexed: 12/15/2022]
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Alcañiz M, Guillen M, Santolino M. Prevalence of drug use among drivers based on mandatory, random tests in a roadside survey. PLoS One 2018; 13:e0199302. [PMID: 29920542 PMCID: PMC6007923 DOI: 10.1371/journal.pone.0199302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/05/2018] [Indexed: 11/18/2022] Open
Abstract
Background In the context of road safety, this study aims to examine the prevalence of drug use in a random sample of drivers. Methods A stratified probabilistic sample was designed to represent vehicles circulating on non-urban roads. Random drug tests were performed during autumn 2014 on 521 drivers in Catalonia (Spain). Participation was mandatory. The prevalence of drug driving for cannabis, methamphetamines, amphetamines, cocaine, opiates and benzodiazepines was assessed. Results The overall prevalence of drug use is 16.4% (95% CI: 13.9; 18.9) and affects primarily younger male drivers. Drug use is similarly prevalent during weekdays and on weekends, but increases with the number of occupants. The likelihood of being positive for methamphetamines is significantly higher for drivers of vans and lorries. Conclusions Different patterns of use are detected depending on the drug considered. Preventive drug tests should not only be conducted on weekends and at night-time, and need to be reinforced for drivers of commercial vehicles. Active educational campaigns should focus on the youngest age-group of male drivers.
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Affiliation(s)
- Manuela Alcañiz
- Department of Econometrics, Riskcenter-IREA, University of Barcelona, Barcelona, Spain
| | - Montserrat Guillen
- Department of Econometrics, Riskcenter-IREA, University of Barcelona, Barcelona, Spain
| | - Miguel Santolino
- Department of Econometrics, Riskcenter-IREA, University of Barcelona, Barcelona, Spain
- * E-mail:
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Kerr WC, Ye Y, Subbaraman MS, Williams E, Greenfield TK. Changes in Marijuana Use Across the 2012 Washington State Recreational Legalization: Is Retrospective Assessment of Use Before Legalization More Accurate? J Stud Alcohol Drugs 2018; 79:495-502. [PMID: 29885159 PMCID: PMC6005249 DOI: 10.15288/jsad.2018.79.495] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/01/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate changes in marijuana use prevalence and user characteristics across the 2012 recreational legalization in Washington State. Differences in change estimates between retrospective and contemporaneous pre-legalization measures are compared and considered in relation to potential social acceptability and illegality effects on reporting. METHOD Four representative surveys of the Washington State population 18 years and older were conducted by telephone, two in 2014 and two in 2015, which are combined by year for analyses (N = 3,451). Respondents reported their current past-year use frequency and retrospective frequency of use in 2012 before the election in which legalization was passed. They also provided demographic information and details of alcohol use, including simultaneous use with marijuana. RESULTS A small and not statistically significant increase of 1.2 percentage points in past-year use prevalence, from 24.3% (22.3-26.5) to 25.6% (23.6-27.6), was found when combining the surveys. No statistically significant change was found in the prevalence of simultaneous use with alcohol, which decreased from 12.9% (11.3-14.7) to 12.6% (11.0-14.4). In contrast, estimates from the National Survey on Drug Use and Health (NSDUH) indicate substantially increased prevalence, from 15.5% (13.8-17.3) in 2010-2012 to 19.1% (16.9-21.4) in 2013-2014, although this change is not statistically significant. Other findings of interest from the Washington State surveys include new users after legalization tending to be older, White, and moderate drinkers who do not use marijuana simultaneously with alcohol. CONCLUSIONS A retrospective pre-legalization measure showed only a small increase in marijuana use prevalence in contrast to larger changes found in prospectively assessed use in the NSDUH. Changes in the social acceptability and legal status of marijuana after legalization may have increased reporting of pre-legalization use compared with concurrent assessments.
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Affiliation(s)
- William C. Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | | | - Edwina Williams
- Alcohol Research Group, Public Health Institute, Emeryville, California
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Berg CJ, Daniel CN, Vu M, Li J, Martin K, Le L. Marijuana Use and Driving Under the Influence among Young Adults: A Socioecological Perspective on Risk Factors. Subst Use Misuse 2018; 53:370-380. [PMID: 28777692 PMCID: PMC6088242 DOI: 10.1080/10826084.2017.1327979] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Given increases in marijuana use and driving under the influence (DUI), it is critical to identify those at risk in order to inform intervention efforts. OBJECTIVES We used a socioecological framework to examine correlates of level of marijuana use and DUI in the past month among young adult marijuana users. METHODS We recruited 1567 participants aged 18-34 years via Facebook ads targeting tobacco and marijuana users in August 2014 to complete an online survey assessing marijuana use and DUI, as well as related multilevel factors. Analyses focused on 649 participants reporting past 30-day marijuana use. RESULTS The sample was an average age of 24.48 (SD = 5.10), 43.9% female, and 76.4% White and used marijuana an average of 17.86 (SD = 11.29) days in the past month. Notably, 48.4% reported driving after marijuana use at least once in the past month, and 74.0% were passengers. Multivariable regression indicated that greater use was associated with: being older; being male; greater symptoms of dependence; residing in a state with recreational marijuana legalized; having a medical marijuana card; having parents and more friends who use; higher coping motives; lower perceived harm to health; and less concern about driving after marijuana use (adjusted R-squared = 0.294). Correlates of driving after using marijuana in the past month included: being younger; more frequent use; having more friends who use; higher enhancement motives; and less concern about driving after using (Nagelkerke R-squared = 0.442). Conclusions/Importance: Interventions and campaigns should address social norms and risk perceptions regarding marijuana use, particularly as it relates to DUI.
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Affiliation(s)
- Carla J Berg
- a Department of Behavioral Sciences and Health Education , Emory University School of Public Health , Atlanta , Georgia , USA
| | - Carmen N Daniel
- a Department of Behavioral Sciences and Health Education , Emory University School of Public Health , Atlanta , Georgia , USA
| | - Milkie Vu
- a Department of Behavioral Sciences and Health Education , Emory University School of Public Health , Atlanta , Georgia , USA
| | - Jingjing Li
- a Department of Behavioral Sciences and Health Education , Emory University School of Public Health , Atlanta , Georgia , USA
| | - Kathleen Martin
- a Department of Behavioral Sciences and Health Education , Emory University School of Public Health , Atlanta , Georgia , USA
| | - Lana Le
- a Department of Behavioral Sciences and Health Education , Emory University School of Public Health , Atlanta , Georgia , USA
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Choi NG, DiNitto DM, Marti CN. Older Adults Driving Under the Influence: Associations With Marijuana Use, Marijuana Use Disorder, and Risk Perceptions. J Appl Gerontol 2017; 38:1687-1707. [DOI: 10.1177/0733464817745379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite increasing marijuana use among the 50+ age group, little research has been done on marijuana’s impact on older adults’ driving under the influence (DUI). Using the 2013 to 2014 National Survey on Drug Use and Health data, this study examined the association of older adults’ self-reported DUI with marijuana use, marijuana abuse/dependence, and marijuana risk perception. The findings show that one third of past-year marijuana users aged 50+ reported past-year DUI, two thirds of which involved drugs. Those with marijuana abuse/dependence were 2.6 times more likely than those without the disorder to report DUI, controlling for alcohol abuse/dependence, other illicit drug use, and sociodemographic and health/mental health statuses. As safe driving is key to prolonging independence in late life, clinicians need to educate older adults about the risk of marijuana use, alone and with other substances, on their driving capacity and provide age-appropriate treatment for marijuana use disorder.
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Valen A, Bogstrand ST, Vindenes V, Gjerde H. Increasing use of cannabis among arrested drivers in Norway. TRAFFIC INJURY PREVENTION 2017; 18:801-806. [PMID: 28448164 DOI: 10.1080/15389588.2017.1321114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The availability of cannabis in Norway seems to have increased according to seizures by customs and police. On the other hand, national population surveys have not found any increase in self-reported use of cannabis. This investigation aimed at studying trends in cannabis use among suspected drug-impaired drivers apprehended by the police in Norway. METHODS A time series observational study of cannabis use among all drivers tested for drugs during 2000-2015 was performed. Descriptive analyses of trends in frequencies and combined use of cannabis with other drugs or alcohol for different age groups and gender were conducted. RESULTS Tetrahydrocannabinol (THC) is the main psychoactive substance in cannabis and was detected in blood samples from 18,767 suspected drug-impaired drivers. The annual number of THC findings increased during the years 2000-2015 for all age groups. For cannabis-only users, young drivers aged 20-29 years dominated during the whole period, whereas for multidrug-cannabis users the median age increased steadily during 2000-2015. After 2009, the annual increase in THC findings escalated; THC-only findings increased the most. CONCLUSIONS Increasing numbers of THC-positive drivers were found among all age groups and genders; the strongest trend was observed between 2009-2015 for young drivers testing positive only for THC.
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Affiliation(s)
- Anja Valen
- a Department of Forensic Sciences , Oslo University Hospital , Oslo , Norway
- b Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Stig Tore Bogstrand
- a Department of Forensic Sciences , Oslo University Hospital , Oslo , Norway
- c Lovisenberg University College , Oslo , Norway
| | - Vigdis Vindenes
- a Department of Forensic Sciences , Oslo University Hospital , Oslo , Norway
- b Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Hallvard Gjerde
- a Department of Forensic Sciences , Oslo University Hospital , Oslo , Norway
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Fischer B, Russell C, Sabioni P, van den Brink W, Le Foll B, Hall W, Rehm J, Room R. Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations. Am J Public Health 2017; 107:e1-e12. [PMID: 28644037 PMCID: PMC5508136 DOI: 10.2105/ajph.2017.303818] [Citation(s) in RCA: 256] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. OBJECTIVES To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. SEARCH METHODS We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. SELECTION CRITERIA We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. DATA COLLECTION AND ANALYSIS We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process. MAIN RESULTS For most recommendations, there was at least "substantial" (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use-related health risks is abstinence, (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years), (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)-ratio cannabis products, (4) abstain from using synthetic cannabinoids, (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods, (6) avoid deep or other risky inhalation practices, (7) avoid high-frequency (e.g., daily or near-daily) cannabis use, (8) abstain from cannabis-impaired driving, (9) populations at higher risk for cannabis use-related health problems should avoid use altogether, and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use). AUTHORS' CONCLUSIONS Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use-related health risks should be evaluated. Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.
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Affiliation(s)
- Benedikt Fischer
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Cayley Russell
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Pamela Sabioni
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wim van den Brink
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Bernard Le Foll
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wayne Hall
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Jürgen Rehm
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robin Room
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Watson TM, Mann RE. International approaches to driving under the influence of cannabis: A review of evidence on impact. Drug Alcohol Depend 2016; 169:148-155. [PMID: 27810658 DOI: 10.1016/j.drugalcdep.2016.10.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are knowledge gaps regarding the effectiveness of different approaches designed to prevent and deter driving under the influence of cannabis (DUIC). Policymakers are increasingly interested in evidence-based responses to DUIC as numerous jurisdictions worldwide have legally regulated cannabis or are debating such regulation. We contribute a comprehensive review of international literature on countermeasures that address DUIC, and identify where and how such measures have been evaluated. METHODS The following databases were systematically searched from 1995 to present: Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts, and Criminal Justice Abstracts. Hand searching of relevant documents, internet searches for grey literature, and review of ongoing email alerts were conducted to capture any emerging literature and relevant trends. RESULTS Numerous international jurisdictions have introduced a variety of measures designed to deter DUIC. Much interest has been generated regarding non-zero per se laws that set fixed legal limits for tetrahydrocannabinol and/or its metabolites detected in drivers. Other approaches include behavioural impairment laws, zero-tolerance per se laws, roadside drug testing, graduated licensing system restrictions, and remedial programs. However, very few evaluations have appeared in the literature. CONCLUSIONS Although some promising results have been reported (e.g., roadside testing), it is premature to draw firm conclusions regarding the broader impacts of general deterrent approaches to DUIC. This review points to the need for a long-term commitment to rigorously evaluate, using multiple methods, the impact of general and specific deterrent DUIC countermeasures.
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Affiliation(s)
- Tara Marie Watson
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, 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.
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Lee D, Bergamaschi MM, Milman G, Barnes AJ, Queiroz RHC, Vandrey R, Huestis MA. Plasma Cannabinoid Pharmacokinetics After Controlled Smoking and Ad libitum Cannabis Smoking in Chronic Frequent Users. J Anal Toxicol 2016; 39:580-7. [PMID: 26378131 DOI: 10.1093/jat/bkv082] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
More Americans are dependent on cannabis than any other illicit drug. The main analytes for cannabis testing include the primary psychoactive constituent, Δ(9)-tetrahydrocannabinol (THC), equipotent 11-hydroxy-THC (11-OH-THC) and inactive 11-nor-9-carboxy-THC (THCCOOH). Eleven adult chronic frequent cannabis smokers resided on a closed research unit with unlimited access to 5.9% THC cannabis cigarettes from 12:00 to 23:00 during two ad libitum smoking phases, followed by a 5-day abstinence period in seven participants. A single cigarette was smoked under controlled topography on the last day of the smoking and abstinence phases. Plasma cannabinoids were quantified by two-dimensional gas chromatography-mass spectrometry. Median plasma maximum concentrations (Cmax) were 28.3 (THC), 3.9 (11-OH-THC) and 47.0 μg/L (THCCOOH) 0.5 h after controlled single cannabis smoking. Median Cmax 0.2-0.5 h after ad libitum smoking was higher for all analytes: 83.5 (THC), 14.2 (11-OH-THC) and 155 μg/L (THCCOOH). All 11 participants' plasma samples were THC and THCCOOH-positive, 58.3% had THC ≥5 μg/L and 79.2% were 11-OH-THC-positive 8.1-14 h after last cannabis smoking. Cannabinoid detection rates in seven participants 106-112 h (4-5 days) after last smoking were 92.9 (THC), 35.7 (11-OH-THC) and 100% (THCCOOH), with limits of quantification of 0.5 μg/L for THC and THCCOOH, and 1.0 μg/L for 11-OH-THC. These data greatly expand prior research findings on cannabinoid excretion profiles in chronic frequent cannabis smokers during ad libitum smoking. Smoking multiple cannabis cigarettes led to higher Cmax and AUC compared with smoking a single cigarette. The chronic frequent cannabis smokers exhibited extended detection windows for plasma cannabinoids, reflecting a large cannabinoid body burden.
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Affiliation(s)
- Dayong Lee
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA
| | - Mateus M Bergamaschi
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, SP 14040-903, Brazil
| | - Garry Milman
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA
| | - Allan J Barnes
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA
| | - Regina H C Queiroz
- School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, SP 14040-903, Brazil
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Marilyn A Huestis
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA
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Vearrier D, Vearrier L, McKeever R, Okaneku J, LaSala G, Goldberger D, McCloskey K. Issues in driving impairment. Dis Mon 2016; 62:72-116. [DOI: 10.1016/j.disamonth.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Correlates of Marijuana Drugged Driving and Openness to Driving While High: Evidence from Colorado and Washington. PLoS One 2016; 11:e0146853. [PMID: 26800209 PMCID: PMC4723241 DOI: 10.1371/journal.pone.0146853] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/21/2015] [Indexed: 11/22/2022] Open
Abstract
Aims A potential unintended consequence of legalizing recreational marijuana is increased marijuana-related driving impairment. Some states where recreational marijuana is legal have begun implementing interventions to mitigate driving under the influence (DUI) of marijuana, including media campaigns to increase knowledge about DUI laws. However, little is known about the associations between knowledge of DUI laws and marijuana DUI behavior. In this study, we provide new data from a survey of marijuana users in Colorado and Washington to examine associations between marijuana drugged driving and two potential behavioral precursors of marijuana DUI. We also explore other factors that may influence marijuana DUI. Methods Data are from an online survey of marijuana users in Colorado and Washington. Respondents who reported any marijuana use in the past 30 days (n = 865) served as the analytic sample. We examined prevalence of two behavioral outcomes: (1) any driving of a motor vehicle while high in the past year and (2) driving a motor vehicle within 1 hour of using marijuana 5 or more times in the past month. Additional outcomes measuring willingness to drive while high were also assessed. Logistic regressions were used to estimate each outcome as a function of two multi-item scales measuring knowledge of the legal consequences of driving high and perceptions that driving while high is not safe. Additional covariates for potential confounders were included in each model. Results Prevalence of past-year driving while under the influence of marijuana was 43.6% among respondents. The prevalence of driving within 1 hour of using marijuana at least 5 times in the past month was 23.9%. Increased perception that driving high is unsafe was associated with lower odds of past-year marijuana DUI (OR = 0.31, P < 0.01) and lower past-month odds of driving 5 or more times within 1 hour of using marijuana (OR = 0.26, P < 0.01). Increased knowledge of marijuana DUI laws was also associated with lower odds of each of these outcomes (OR = 0.63, P < 0.01, OR = 0.69, P = 0.02, respectively). Post-estimation Wald tests confirmed the negative associations with marijuana DUI were greater in magnitude for safety perceptions than knowledge of DUI laws. Increased perceptions that driving while high is unsafe was associated with significantly lower willingness to drive after using marijuana while increased knowledge of marijuana DUI laws was not associated with these outcomes. Conclusions Despite recent interventions targeting public awareness of the legal consequences of marijuana DUI, our results suggest that knowledge of these laws is a weaker predictor of DUI behavior than perceptions that driving high is unsafe. In addition, safety perceptions predict decreased openness to driving high while knowledge of DUI laws was not associated with openness. These findings suggest that interventions for reducing the incidence of marijuana DUI are likely to be more successful by targeting safety perceptions related to marijuana DUI rather than knowledge of DUI laws. We caution that because these data are limited to an online convenience sample, results may not be generalizable beyond our sample.
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Huestis MA. Deterring driving under the influence of cannabis. Addiction 2015; 110:1697-8. [PMID: 26264558 DOI: 10.1111/add.13041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 07/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA.
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Huestis MA. Cannabis-Impaired Driving: A Public Health and Safety Concern. Clin Chem 2015; 61:1223-5. [DOI: 10.1373/clinchem.2015.245001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
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Andrews R, Murphy KG, Nahar L, Paterson S. Cannabinoid Concentrations Detected in Fatal Road Traffic Collision Victims Compared with a Population of Other Postmortem Cases. Clin Chem 2015; 61:1256-64. [DOI: 10.1373/clinchem.2015.240846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/29/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Acute cannabis consumption nearly doubles the risk of motor vehicle collision resulting in injury or death. Limited data have been published regarding the concentrations of cannabinoids associated with fatal road traffic collisions (RTCs), and these have not previously been compared to a population of other postmortem cases.
METHODS
We conducted analysis for cannabinoids [Δ9-tetrahydrocannabinol (THC), 11-hydroxy-THC, 11-nor-THC-9-carboxylic acid, cannabidiol, and cannabinol], drugs, and alcohol on consecutive fatal RTC cases (100) and non-RTC cases (114) from coroners' jurisdictions in London and southeast England and compared the data.
RESULTS
The incidence of cannabinoids detected in non-RTC and RTC cases was similar (25% vs 21%, P = 0.44), but THC was detected more frequently (90% vs 59%, P = 0.01) and at significantly higher concentrations in the cannabinoid-positive RTC cases than the non-RTC cases (P = 0.01). The distribution of non-RTC and RTC cases over 4 categories of THC concentration was significantly different (P = 0.004). There was no significant difference in the concentrations of other cannabinoids detected between the 2 groups. Cannabinoids were detected in more fatal RTC cases (21) than alcohol >80 mg/dL (17). Detection of other drugs was low compared to cannabis and alcohol.
CONCLUSIONS
These first data on the concentrations of cannabinoids in the postmortem blood of fatal RTC victims compared with a population of other routine coroners' cases highlight the importance of specifically measuring THC concentrations in the blood to aid interpretation of postmortem cases where cannabis may be implicated.
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Affiliation(s)
- Rebecca Andrews
- Toxicology Unit, Imperial College London, London, UK, W6 8RP
| | - Kevin G Murphy
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Limon Nahar
- Toxicology Unit, Imperial College London, London, UK, W6 8RP
| | - Sue Paterson
- Toxicology Unit, Imperial College London, London, UK, W6 8RP
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Peterson BL, Couper FJ. Concentrations of AB-CHMINACA and AB-PINACA and Driving Behavior in Suspected Impaired Driving Cases. J Anal Toxicol 2015; 39:642-7. [DOI: 10.1093/jat/bkv091] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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