1
|
Hjelmeland K, Middelkoop G, Mørland J, Høiseth G. The relationship between clinical impairment and blood drug concentration: Comparison between the most prevalent traffic relevant drug groups. Forensic Sci Int 2024; 363:112180. [PMID: 39141931 DOI: 10.1016/j.forsciint.2024.112180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
AIM The aim of the present study was to investigate the relationship between blood concentrations of four different drug classes; ethanol, benzodiazepines, amphetamines and tetrahydrocannabinol (THC) and driver impairment as assessed by a clinical test of impairment (CTI). METHODS Data was retrieved from a national database on CTI assessments and accompanying blood drug concentrations from apprehended drivers. All drug concentrations in blood were quantified using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS), and compared to the results of the CTI which were categorized as either "not impaired", "mildly impaired", "moderately impaired", or "considerably impaired". RESULTS A total number of 15 514 individual mono drug-cases collected over 9 years was included. 89 % were men and the median age was 34 years. In addition, 3 684 individual cases with similar age and gender distribution where no drugs were detected, were included as a reference group. For ethanol and benzodiazepines the percentage of clinically impaired cases increased markedly from lower to higher concentration windows, from 60 % to 97 % for ethanol and from 38 % to 76 % for benzodiazepines. The corresponding increase for amphetamines and THC was modest, from 43 % to 58 % for amphetamines and from 41 % to 55 % for THC. The correlation between drug concentration and degree of impairment was high for ethanol (Spearman´s rho=0.548, p<0.001) and relatively high for benzodiazepines (Spearman´s rho=0.377, p<0.001), but low for amphetamines (Spearman´s rho=0.078, p<0.001) and THC (Spearman´s rho=0.100, p<0.001). CONCLUSION The percentage of impaired drivers increased with increasing blood drug concentration for all four drug classes, most pronounced for ethanol and benzodiazepines and much less for amphetamines and THC. The median blood drug concentration increased with increasing magnitude of impairment for ethanol and benzodiazepines, while this was much less pronounced for amphetamines and THC. The ranges of drug concentrations, however, were wide for all four drug classes in all impairment categories as assessed by individual clinical examination.
Collapse
Affiliation(s)
- Knut Hjelmeland
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway.
| | - Gerrit Middelkoop
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway.
| | - Jørg Mørland
- Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo 0213, Norway; Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1039 Blindern, Oslo 0315, Norway.
| | - Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway; Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1039 Blindern, Oslo 0315, Norway; Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 23 Vinderen, Oslo 0319, Norway.
| |
Collapse
|
2
|
Brown T, Kruse C, Schmitt R, Gaffney G, Milavetz G. Assessing the impact of cannabis use on freeway driving performance and practices: A comparative analysis with placebo and alcohol-influenced driving. TRAFFIC INJURY PREVENTION 2024:1-10. [PMID: 39303060 DOI: 10.1080/15389588.2024.2393215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE The objectives of this study were 1) to identify the effects cannabis has on driving performance and individual motor practices when on the freeway compared to placebo and 2) to bring context to the effects of cannabis on driving by comparing effect sizes to those of alcohol. METHODS Data for analysis was collected from a study of fifty-three participants with a history of tetrahydrocannabinol (THC) cannabis use who completed three visits in randomized order (placebo (0% THC), 6.18% THC, and 10.5% THC). Data for the alcohol analysis was from a subset of eighteen of these participants with a history of recent alcohol use that completed a fourth alcohol visit that targeted a .05 g/210L breath alcohol content (BrAC) during the drive. Comparisons were made using an analysis of variance approach with the SAS General Linear Models Procedure. Cohen's d effect sizes were calculated for the cannabis and alcohol conditions relative to placebo for both the full sample and alcohol subset. RESULTS Standard deviation of lane position (SDLP) for cannabis significantly increased compared to placebo and the effect size was comparable to that of alcohol at .05 BrAC. Lane departures for cannabis significantly increased relative to placebo as did the time out of the lane. Cannabis use resulted in an increased amount of time at 10% or more below the speed limit for the 6.18% THC condition. Relative to alcohol, cannabis produced more time at slower speeds and less time at speeds more than 10% above the speed limit. CONCLUSIONS Multiple factors of lateral and longitudinal vehicle control on the freeway showed statistical significance. Drivers under the influence of cannabis exhibited higher rates of driving errors but also showed more cautious behaviors such as generally lower speeds on the freeway. Compared with alcohol, effect sizes varied. For longitudinal control, there were larger effect sizes for alcohol with speed effects in opposite directions, but relatively equivalent effect sizes for lateral control and driving errors associated with lane keeping.
Collapse
Affiliation(s)
- Timothy Brown
- University of Iowa Driving Safety Research Institute, Iowa City, Iowa
| | - Cole Kruse
- College of Liberal Arts and Sciences, University of Iowa, Iowa City, Iowa
| | - Rose Schmitt
- University of Iowa Driving Safety Research Institute, Iowa City, Iowa
| | - Gary Gaffney
- University of Iowa Driving Safety Research Institute, Iowa City, Iowa
| | - Gary Milavetz
- College of Pharmacy, University of Iowa, Iowa City, Iowa
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Asbridge M, Brubacher J. Cannabis and Alcohol Involvement in Motor Vehicle Crashes: Reflections in the Era of Legalization. Am J Public Health 2024; 114:550-552. [PMID: 38635944 PMCID: PMC11079830 DOI: 10.2105/ajph.2024.307657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Mark Asbridge
- Mark Asbridge is with the Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. Jeff Brubacher is with the Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeff Brubacher
- Mark Asbridge is with the Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. Jeff Brubacher is with the Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
5
|
Wrathall M, Cristiano N, Walters D, Cullen G, Hathaway A. Examining the impact of legalization on the prevalence of driving after using cannabis: A comparison of rural and non-rural parts of Canada. TRAFFIC INJURY PREVENTION 2024; 25:571-578. [PMID: 38572920 DOI: 10.1080/15389588.2024.2333908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The purpose of this study was to examine the likelihood of driving after using cannabis, and of being a passenger with someone who is driving after using cannabis, in rural areas and non-rural areas before and after legalization. METHODS A multi-wave analysis of Canada's National Cannabis Survey was conducted using logistic regression with interactions to predict the prevalence of driving after using cannabis, and of being a passenger with someone who is driving after using cannabis, in relation to place of residence (rural or non-rural) and in the weeks and months before and after legalization. Three time points were compared: pre-legalization, two months following legalization and 1 year after legalization. RESULTS At the national level, there are no significant differences between the predicted estimates of driving after using cannabis for those who live in rural and non-rural areas. However, when examining the impact of legalization, we found a significant increase in driving after using cannabis among rural residents directly following legalization. Furthermore, it was observed that this increase in driving after using cannabis returns to pre-legalization rates one year after legalization. By contrast, in the weeks and months following legalization, driving after using cannabis decreased among those living in non-rural areas, and slowly increased soon thereafter. No significant differences were observed, in either time period or group, in the prevalence of being a passenger with someone who is driving after using cannabis. CONCLUSIONS The finding of significantly higher risk of driving after use of cannabis soon after legalization in rural areas suggests a need for more attention to address immediate concerns for public safety. The increased potential for traffic injuries and deaths in other jurisdictions contemplating legalization supports the call for more and better targeted prevention efforts in rural communities that have far too often been overlooked and under-served.
Collapse
Affiliation(s)
- Meghan Wrathall
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
| | - Nick Cristiano
- Department of Policing and Community Well-Being, Trent University Durham, Oshawa, Ontario, Canada
| | - David Walters
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
| | - Greggory Cullen
- Department of Economics, Justice, and Policy Studies, Mount Royal University, Calgary, Alberta, Canada
| | - Andrew Hathaway
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
6
|
Scherer JN, Vasconcelos M, Dalanhol CS, Govoni B, Dos Santos BP, Borges GR, de Gouveia GC, Viola PP, Carlson RLR, Martins AF, Costa JL, Huestis MA, Pechansky F. Reliability of roadside oral fluid testing devices for ∆ 9 -tetrahydrocannabinol (∆ 9 -THC) detection. Drug Test Anal 2024. [PMID: 38440942 DOI: 10.1002/dta.3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
Driving under the influence of cannabis (DUIC) is increasing worldwide, and cannabis is the most prevalent drug after alcohol in impaired driving cases, emphasizing the need for a reliable traffic enforcement strategy. ∆9 -tetrahydrocannabinol (THC) detection in oral fluid has great potential for identifying recent cannabis use; however, additional data are needed on the sensitivities, specificities, and efficiencies of different oral fluid devices for detecting cannabinoids at the roadside by police during routine traffic safety enforcement efforts. At the roadside, 8945 oral fluid THC screening tests were performed with four devices: AquilaScan®, Dräger DrugTest®, WipeAlyser Reader®, and Druglizer®. A total of 530 samples screened positive for THC (5.9%) and were analyzed by liquid chromatography-tandem mass spectrometry at multiple cutoff concentrations (2 ng/mL, 10 ng/mL, and manufacturers' recommended device cutoffs) to investigate device performance. Results varied substantially, with sensitivities of 0%-96.8%, specificities of 89.8%-98.5%, and efficiencies of 84.3%-97.8%. The Dräger DrugTest® outperformed the other devices with a 96.8% sensitivity, 97.1% specificity, and 97.0% efficiency at a 5-ng/mL LC-MS/MS confirmation cutoff. The WipeAlyser Reader® had good performance with a 91.4% sensitivity, 97.2% specificity, and 96.4% efficiency. AquilaScan® and Druglizer® had unacceptable performance for cannabinoid detection, highlighted by sensitivity <13%. The choice of roadside oral fluid testing device must offer good analytical performance for cannabinoids because of its high prevalence of use and impact on road safety.
Collapse
Affiliation(s)
- Juliana Nichterwitz Scherer
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
| | - Mailton Vasconcelos
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Bruna Govoni
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Bruno Pereira Dos Santos
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Gabriela Ramos Borges
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Patrícia Pacheco Viola
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Aline Franco Martins
- Campinas Poison Control Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Jose Luiz Costa
- Campinas Poison Control Center, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Severna Park, Maryland, USA
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| |
Collapse
|
7
|
Manning B, Arkell TR, Hayley AC, Downey LA. A semi-naturalistic open-label study examining the effect of prescribed medical cannabis use on simulated driving performance. J Psychopharmacol 2024; 38:247-257. [PMID: 38332655 PMCID: PMC10944578 DOI: 10.1177/02698811241229524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Despite increasing medical cannabis use, research has yet to establish whether and to what extent products containing delta-9-tetrahydrocannabinol (THC) impact driving performance among patients. Stable doses of prescribed cannabinoid products during long-term treatment may alleviate clinical symptoms affecting cognitive and psychomotor performance. AIM To examine the effects of open-label prescribed medical cannabis use on simulated driving performance among patients. METHODS In a semi-naturalistic laboratory study, 40 adults (55% male) aged between 23 and 80 years, consumed their own prescribed medical cannabis product. Driving performance outcomes including standard deviation of lateral position (SDLP), the standard deviation of speed (SDS), mean speed and steering variability were evaluated using the Forum8 driving simulator at baseline (pre-dosing), 2.5 h and 5 -h (post-dosing). Perceived driving effort (PDE) was self-reported after each drive. Oral fluid and whole blood samples were collected at multiple timepoints and analysed for THC via liquid chromatography-mass spectrometry. RESULTS A significant main effect of time was observed for mean speed (p = 0.014) and PDE (p = 0.020), with patients displaying modest stabilisation of vehicle control, increased adherence to speed limits and reductions in PDE post-dosing, relative to baseline. SDLP (p = 0.015) and PDE (p = 0.043) were elevated for those who consumed oil relative to flower-based products. Detectable THC concentrations were observed in oral fluid at 6-h post-dosing (range = 0-24 ng/mL). CONCLUSIONS This semi-naturalistic study suggests that the consumption of medical cannabis containing THC (1.13-39.18 mg/dose) has a negligible impact on driving performance when used as prescribed.
Collapse
Affiliation(s)
- Brooke Manning
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Thomas R Arkell
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Amie C Hayley
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Institute for Breathing and Sleep (IBAS), Austin Health, Melbourne, VIC, Australia
| | - Luke A Downey
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Institute for Breathing and Sleep (IBAS), Austin Health, Melbourne, VIC, Australia
| |
Collapse
|
8
|
Xu J, Fard M, Zhang N, Davy JL, Robinson SR. Interrelatedness of steering and lateral position parameters: Recommendations for the assessment of driving performance. JOURNAL OF SAFETY RESEARCH 2024; 88:275-284. [PMID: 38485369 DOI: 10.1016/j.jsr.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/07/2023] [Accepted: 11/17/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Loss of attention leads to less steady driving within the lane and is one of the main causes of road accidents. To improve road safety, vehicle-based parameters such as steering wheel angle and lateral position are used to objectively assess driving performance, especially in monotonous driving tasks. METHOD The present driving simulator study investigated the extent to which eight commonly used parameters are independent indicators of driving performance. Fifteen participants undertook a monotonous highway driving task for 1 h. Four steering angle parameters were examined: average steering angle (ASA), standard deviation of steering angle (SDSA), steering angle range (SAR), and steering reversal rate (SRR); as well as four lateral position parameters: mean lateral position (MLP), standard deviation of lateral position (SDLP), lateral position range (LPR), and the out-of-lane duration. Measurements were averaged across 2-minute epochs. Repeated measures correlation analysis evaluated the similarity between each parameter, and the variance inflation factor test evaluated the multicollinearity of all the parameters. RESULTS The results demonstrated that some parameters are highly correlated and should not be used together to assess driving performance. It is recommended that the optimal combination is ASA and SAR to assess steering angle, and SDLP and out-of-lane to assess lateral position. Out-of-lane, as a factor directly contributing to road safety, is recommended because it has the least correlation with other parameters. PRACTICAL APPLICATIONS If implemented, these recommendations may improve the assessment of driving performance in future studies.
Collapse
Affiliation(s)
- Jinhui Xu
- School of Engineering, RMIT University, Australia
| | | | - Neng Zhang
- School of Engineering, RMIT University, Australia
| | - John L Davy
- School of Science, RMIT University, Australia
| | | |
Collapse
|
9
|
Lalwani K, Martin J, Barton E, Frazier G, Abel W. Drug driving: a secondary analysis of factors associated with driving under the influence of cannabis in Jamaica. BMJ Open 2024; 14:e078437. [PMID: 38262644 PMCID: PMC11148678 DOI: 10.1136/bmjopen-2023-078437] [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: 01/25/2024] Open
Abstract
OBJECTIVES To determine cannabis use patterns, the predictive sociodemographic correlates of driving under the influence of cannabis (DUIC) and the association between risk perception and cannabis dependence among vehicle drivers in Jamaica. DESIGN Secondary data analysis. SETTING Used the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS 1060 vehicle drivers extracted from the population sample of 4623. PRIMARY AND SECONDARY OUTCOME MEASURES Analysis used Pearson's χ2 test and logistic regression. ORs and 95% CIs were recorded. A p<0.05 was considered statistically significant. RESULTS More than 10% of Jamaican drivers admitted to DUIC in the past year. Approximately 43.3% of drivers who currently use cannabis reported DUIC only. Evidently, 86.8% of drivers who DUIC were heavy cannabis users. Approximately 30% of drivers with moderate to high-risk perception of smoking cannabis sometimes or often were dependent on cannabis. Notwithstanding, drivers with no to low-risk perception of smoking cannabis sometimes or often were significantly likelier to be dependent (p<0.001 and p<0.001, respectively). Logistic regression highlighted male drivers (OR 4.14, 95% CI 1.59 to 14.20, p=0.009) that were 34 years and under (OR 2.97, 95% CI 1.71 to 5.29, p<0.001) and were the head of the household (OR 2.22, 95% CI 1.10 to 4.75, p=0.031) and operated a machine as part of their job (OR 1.87, 95% CI 1.09 to 3.24, p=0.023) were more likely to DUIC, while those who were married (OR 0.42, 95% CI 0.22 to 0.74, p=0.004) and had achieved a tertiary-level education (OR 0.26, 95% CI 0.06 to 0.76, p=0.031) were less likely. CONCLUSIONS Two in five Jamaican drivers, who currently smoke cannabis, drive under its influence, with over 85% engaging in heavy use. Public health implications necessitate policy-makers consider mobile roadside drug testing and amending drug-driving laws to meet international standards.
Collapse
Affiliation(s)
- Kunal Lalwani
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Jamaica
| | - Jacqueline Martin
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Jamaica
| | - Everard Barton
- Department of Medicine, The University of the West Indies, Mona, Jamaica
| | - Gralyn Frazier
- Department of Economics, Western Michigan University, Kalamazoo, Michigan, USA
| | - Wendel Abel
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Jamaica
| |
Collapse
|
10
|
Di Ciano P, Rajji TK, Hong L, Zhao S, Byrne P, Elzohairy Y, Brubacher JR, McGrath M, Brands B, Chen S, Wang W, Hasan OSM, Wickens CM, Kaduri P, Le Foll B. Cannabis and Driving in Older Adults. JAMA Netw Open 2024; 7:e2352233. [PMID: 38236599 PMCID: PMC10797455 DOI: 10.1001/jamanetworkopen.2023.52233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
Importance Epidemiological studies have found that cannabis increases the risk of a motor vehicle collision. Cannabis use is increasing in older adults, but laboratory studies of the association between cannabis and driving in people aged older than 65 years are lacking. Objective To investigate the association between cannabis, simulated driving, and concurrent blood tetrahydrocannabinol (THC) levels in older adults. Design, Setting, and Participants Using an ecologically valid counterbalanced design, in this cohort study, regular cannabis users operated a driving simulator before, 30 minutes after, and 180 minutes after smoking their preferred legal cannabis or after resting. This study was conducted in Toronto, Canada, between March and November 2022 with no follow-up period. Data were analyzed from December 2022 to February 2023. Exposures Most participants chose THC-dominant cannabis with a mean (SD) content of 18.74% (6.12%) THC and 1.46% (3.37%) cannabidiol (CBD). Main outcomes and measures The primary end point was SD of lateral position (SDLP, or weaving). Secondary outcomes were mean speed (MS), maximum speed, SD of speed, and reaction time. Driving was assessed under both single-task and dual-task (distracted) conditions. Blood THC and metabolites of THC and CBD were also measured at the time of the drives. Results A total of 31 participants (21 male [68%]; 29 White [94%], 1 Latin American [3%], and 1 mixed race [3%]; mean [SD] age, 68.7 [3.5] years), completed all study procedures. SDLP was increased and MS was decreased at 30 but not 180 minutes after smoking cannabis compared with the control condition in both the single-task (SDLP effect size [ES], 0.30; b = 1.65; 95% CI, 0.37 to 2.93; MS ES, -0.58; b = -2.46; 95% CI, -3.56 to -1.36) and dual-task (SDLP ES, 0.27; b = 1.75; 95% CI, 0.21 to 3.28; MS ES, -0.47; b = -3.15; 95% CI, -5.05 to -1.24) conditions. Blood THC levels were significantly increased at 30 minutes but not 180 minutes. Blood THC was not correlated with SDLP or MS at 30 minutes, and SDLP was not correlated with MS. Subjective ratings remained elevated for 5 hours and participants reported that they were less willing to drive at 3 hours after smoking. Conclusions and relevance In this cohort study, the findings suggested that older drivers should exercise caution after smoking cannabis.
Collapse
Affiliation(s)
- Patricia Di Ciano
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tarek K. Rajji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Hong
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sampson Zhao
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Byrne
- Ontario Ministry of Transportation, Toronto, Ontario, Canada
| | | | - Jeffrey R. Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael McGrath
- Ontario Ministry of Transportation, Toronto, Ontario, Canada
| | - Bruna Brands
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Health Canada, Ottawa, Ontario, Canada
| | - Sheng Chen
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wei Wang
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Omer S. M. Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Christine M. Wickens
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Pamela Kaduri
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry and Mental Health, Muhimbill University of Health and Allied Sciences, Tanzania
| | - Bernard Le Foll
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| |
Collapse
|
11
|
Davis W, Miller BP, Amlung M. Perceptions and Attitudes Related to Driving after Cannabis Use in Canadian and US Adults. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:114-123. [PMID: 38258863 DOI: 10.1177/29767342231208521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND This study examined the risk perceptions related to driving after cannabis use (DACU) among Canadian and US adults who used cannabis in the past six months. METHODS Perceptions of danger, normative beliefs, perceived likelihood of negative consequences, and other driving-related variables were collected via online surveys in Canadian (n = 158; 50.0% female, 84.8% White, mean age = 32.73 years [SD = 10.61]) and US participants (n = 678; 50.9% female, 73.6% White, mean age = 33.85 years [SD = 10.12]). Driving cognitions and DACU quantity/frequency were compared between samples using univariate analyses of variance, and Spearman's (ρ) correlations were performed to examine associations between driving cognitions and DACU quantity/frequency. RESULTS The two samples did not significantly differ in self-reported level of cannabis use, lifetime quantity of DACU, or the number of times they drove within two hours of cannabis use in the past three months (Ps > .12). Compared to US participants, Canadians perceived driving within two hours of cannabis use as more dangerous (P < 0.001, ηp2 = 0.013) and reported more of their friends would disapprove of DACU (P = 0.03, ηp2 = 0.006). There were no differences in the number of friends who would refuse to ride with a driver who had used cannabis (P = 0.15) or the perceived likelihood of negative consequences (Ps > 0.07). More favorable perceptions were significantly correlated with greater lifetime DACU and driving within two hours of use (ρ = 0.25-0.53, Ps < 0.01). CONCLUSIONS These findings reveal differences in distal risk factors for DACU between Canada and the US and may inform prevention efforts focusing on perceptions of risk and social acceptance of DACU.
Collapse
Affiliation(s)
- William Davis
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brandon P Miller
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA
| | - Michael Amlung
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA
| |
Collapse
|
12
|
Hartley S, Simon N, Cardozo B, Larabi IA, Alvarez JC. Can inhaled cannabis users accurately evaluate impaired driving ability? A randomized controlled trial. Front Public Health 2023; 11:1234765. [PMID: 38074719 PMCID: PMC10703156 DOI: 10.3389/fpubh.2023.1234765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Aims To study the effect of inhaled cannabis on self-assessed predicted driving ability and its relation to reaction times and driving ability on a driving simulator. Participants and methods 30 healthy male volunteers aged 18-34: 15 chronic (1-2 joints /day) and 15 occasional (1-2 joints/week) consumers. Self-assessed driving confidence (visual analog scale), vigilance (Karolinska), reaction time (mean reciprocal reaction time mRRT, psychomotor vigilance test), driving ability (standard deviation of lane position SDLP on a York driving simulator) and blood concentrations of delta-9-tétrahydrocannabinol (THC) were measured before and repeatedly after controlled inhalation of placebo, 10 mg or 30 mg of THC mixed with tobacco in a cigarette. Results Cannabis consumption (at 10 and 30 mg) led to a marked decrease in driving confidence over the first 2 h which remained below baseline at 8 h. Driving confidence was related to THC dose and to THC concentrations in the effective compartment with a low concentration of 0.11 ng/ml for the EC50 and a rapid onset of action (T1/2 37 min). Driving ability and reaction times were reduced by cannabis consumption. Driving confidence was shown to be related to driving ability and reaction times in both chronic and occasional consumers. Conclusions Cannabis consumption leads to a rapid reduction in driving confidence which is related to reduced ability on a driving simulator. Clinical trial registration ClinicalTrials.gov, identifier: NCT02061020.
Collapse
Affiliation(s)
- Sarah Hartley
- Sleep Unit, Physiology Department, AP-HP GHU Paris-Saclay, Raymond Poincaré Hospital, Garches, France
| | - Nicolas Simon
- Department of Clinical Pharmacology, Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, CAP-TV, Marseille, France
| | - Bibiana Cardozo
- Department of Clinical Pharmacology, Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, CAP-TV, Marseille, France
| | - Islam Amine Larabi
- Plateform MasSpecLab, Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, GHU AP-HP.Paris-Saclay, Paris-Saclay University, UVSQ, Inserm U-1018, CESP, Team MOODS, Garches, France
| | - Jean Claude Alvarez
- Plateform MasSpecLab, Department of Pharmacology and Toxicology, Raymond Poincaré Hospital, GHU AP-HP.Paris-Saclay, Paris-Saclay University, UVSQ, Inserm U-1018, CESP, Team MOODS, Garches, France
| |
Collapse
|
13
|
Waddell JT, Merrill JE, Okey SA, Woods-Gonzalez R, Corbin WR. Subjective effects of simultaneous alcohol and cannabis versus alcohol-only use: A qualitative analysis. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:906-917. [PMID: 36757980 PMCID: PMC10409872 DOI: 10.1037/adb0000908] [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] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Theoretical models of addictive behavior suggest that subjective effects serve as a mechanism through which substance use disorders develop. However, little is known about the subjective effects of simultaneous alcohol and cannabis use, particularly whether simultaneous use (a) heightens specific subjective effects or (b) is related to unique subjective effects relative to single-substance effects. The present study used formative, qualitative data analysis to examine patterns of responses within open-answer text response data on subjective effects of simultaneous use. METHOD College students who simultaneously use alcohol and cannabis (N = 443; 68.2% female) were asked to describe how alcohol effects differ on simultaneous alcohol and cannabis use versus alcohol-only use days. RESULTS Conventional content analysis revealed nine concepts related to simultaneous (vs. alcohol-only) use subjective effects including as follows: (a) increased/decreased impairment, (b) low arousal/relaxation, (c) balancing/replacement effects, (d) "cross-faded" effects, (e) little-to-no differences, (f) altered sensation and perception, (g) increased negative affective states, (h) increased appetite, and (i) increased/decreased negative consequences. Increased impairment (N = 191) and increased relaxation (N = 110) were the most often endorsed subjective effects, followed by decreased impairment (N = 55), balancing/replacement effects (N = 50) and cross-faded/enhancement effects (N = 44). CONCLUSIONS Subjective effects from simultaneous use largely map onto domains of single-substance alcohol and cannabis effects (e.g., relaxation, sociability, cognitive/behavioral impairment), but also include distinct domains related to simultaneous use (e.g., balancing/replacement effects, altered sensation and perception). Future quantitative research is needed to validate measures of subjective effects from simultaneous use and their relations with use behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
|
14
|
Fink DS, Malte C, Cerdá M, Mannes ZL, Livne O, Martins SS, Keyhani S, Olfson M, McDowell Y, Gradus JL, Wall MM, Sherman S, Maynard CC, Saxon AJ, Hasin DS. Trends in Cannabis-positive Urine Toxicology Test Results: US Veterans Health Administration Emergency Department Patients, 2008 to 2019. J Addict Med 2023; 17:646-653. [PMID: 37934524 PMCID: PMC10766071 DOI: 10.1097/adm.0000000000001197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
OBJECTIVES This study aimed to examine trends in cannabis-positive urine drug screens (UDSs) among emergency department (ED) patients from 2008 to 2019 using data from the Veterans Health Administration (VHA) health care system, and whether these trends differed by age group (18-34, 35-64, and 65-75 years), sex, and race, and ethnicity. METHOD VHA electronic health records from 2008 to 2019 were used to identify the percentage of unique VHA patients seen each year at an ED, received a UDS, and screened positive for cannabis. Trends in cannabis-positive UDS were examined by age, race and ethnicity, and sex within age groups. RESULTS Of the VHA ED patients with a UDS, the annual prevalence positive for cannabis increased from 16.42% in 2008 to 27.2% in 2019. The largest increases in cannabis-positive UDS were observed in the younger age groups. Male and female ED patients tested positive for cannabis at similar levels. Although the prevalence of cannabis-positive UDS was consistently highest among non-Hispanic Black patients, cannabis-positive UDS increased in all race and ethnicity groups. DISCUSSION The increasing prevalence of cannabis-positive UDS supports the validity of previously observed population-level increases in cannabis use and cannabis use disorder from survey and administrative records. Time trends via UDS results provide additional support that previously documented increases in self-reported cannabis use and disorder from surveys and claims data are not spuriously due to changes in patient willingness to report use as it becomes more legalized, or due to greater clinical attention over time.
Collapse
Affiliation(s)
- David S Fink
- From the New York State Psychiatric Institute, New York, NY (DSF, ZLM, OL, MMW, DSH); Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA (CM, CCM, AJS); Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA (CM, YM, AJS); New York University, New York, NY (MC, SS); Columbia University Mailman School of Public Health, New York, NY (SSM, DSH); San Francisco VA Health System, San Francisco, CA (SK); University of California at San Francisco, San Francisco, CA (SK); Columbia University Irving Medical Center, New York, NY (MO, MMW, DSH); Boston University School of Public Health, Boston, MA (JLG); VA Manhattan Harbor Healthcare, New York, NY (SS); University of Washington, Seattle, WA (CCM); and University of Washington School of Medicine, Seattle, WA (AJS)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ortiz-Peregrina S, Oviedo-Trespalacios O, Ortiz C, Anera RG. Self-Regulation of Driving Behavior Under the Influence of Cannabis: The Role of Driving Complexity and Driver Vision. HUMAN FACTORS 2023; 65:1506-1524. [PMID: 34601949 DOI: 10.1177/00187208211047799] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study analyzed the self-regulation behaviors of drivers under the influence of cannabis and its relationship with road complexity and some driver traits, including visual deterioration. BACKGROUND Cannabis is the illicit drug most often detected in drivers; its use results in significant negative effects in terms of visual function. Self-regulation behaviors involve the mechanisms used by drivers to maintain or reduce the risk resulting from different circumstances or the driving environment. METHODS Thirty-one young, occasional cannabis users were assessed both in a baseline session and after smoking cannabis. We evaluated the visual function (visual acuity and contrast sensitivity) and driver self-regulation variables of both longitudinal and lateral control as the speed adaptation and standard deviation of lateral position (SDLP). RESULTS Visual function was significantly impaired after cannabis use. Recreational cannabis use did not result in self-regulation, although some road features such as curved roads did determine self-regulation. Male participants adopted mean faster driving speeds with respect to the speed limit. Driver age also determined better lateral control with lower SDLPs. In addition, visual impairment resulting from cannabis use (contrast sensitivity) was linked with self-regulation by changes in longitudinal and lateral control. CONCLUSION Contrast sensitivity could be a good indicator of individual visual status to help determine how drivers self-regulate their driving both in normal conditions and while under the influence of cannabis. APPLICATION The findings provide new insights about driver self-regulation under cannabis effects and are useful for policy making and awareness campaigns.
Collapse
|
16
|
Aitken B, Hayley AC, Ford TC, Geier L, Shiferaw BA, Downey LA. Driving impairment and altered ocular activity under the effects of alprazolam and alcohol: A randomized, double-blind, placebo-controlled study. Drug Alcohol Depend 2023; 251:110919. [PMID: 37611483 DOI: 10.1016/j.drugalcdep.2023.110919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/03/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Alprazolam, also known by trade-name Xanax, is regularly detected along with alcohol in blood samples of drivers injured or killed in traffic collisions. While their co-consumption is principally legal, policy guidelines concerning fitness-to-drive are lacking and methods to index impairment are underdeveloped. METHODS In this randomized, double-blind, placebo-controlled, crossover trial, we examined whether legally permissible levels of alcohol [target 0.04% blood alcohol concentration (BAC)], alprazolam (1mg), and their combination impacts driving performance, and whether driving impairment can be indexed by ocular activity. Participants completed a test battery consisting of a 40-minute simulated highway drive with ocular parameters assessed simultaneously, the Karolinska Sleepiness Scale, and a confidence to drive assessment following four separate treatment combinations. The predictive efficacy of ocular parameters to identify alcohol and alprazolam-related driving impairment was also examined. RESULTS Among 21 healthy, fully licensed drivers (37% female, mean age 28.43, SD ± 3.96), driving performance was significantly impacted by alprazolam, alcohol, and their combination. Linear regression models revealed that the odds of an out-of-lane event occurring increased five-fold under the influence alprazolam alone and when combined with alcohol. An increase in gaze transition entropy (GTE) demonstrated the strongest association with the odds of an out-of-lane event occurring in the same minute, with both microsleeps and fixation rate achieving moderate accuracy across treatments. CONCLUSIONS Alprazolam and alcohol, alone and in combination, impaired select aspects of vehicle control over time. GTE, microsleeps, and fixation rate show potential as real-time indicators of driving impairment and crash risk associated with alcohol and alprazolam consumption.
Collapse
Affiliation(s)
- Blair Aitken
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Amie C Hayley
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria, Australia; Institute for Breathing and Sleep (IBAS), Austin Hospital, Heidelberg, Victoria, Australia
| | - Talitha C Ford
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria, Australia; Cognitive Neuroscience Unit, Deakin University, Geelong, Victoria, Australia
| | - Lauren Geier
- Forensic Science South Australia, Adelaide, Australia
| | - Brook A Shiferaw
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria, Australia; Institute for Breathing and Sleep (IBAS), Austin Hospital, Heidelberg, Victoria, Australia; Seeing Machines, Fyshwick, Australian Capital Territory (ACT), Australia
| | - Luke A Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria, Australia; Institute for Breathing and Sleep (IBAS), Austin Hospital, Heidelberg, Victoria, Australia.
| |
Collapse
|
17
|
Marcotte TD, Umlauf A, Grelotti DJ, Sones EG, Mastropietro KF, Suhandynata RT, Huestis MA, Grant I, Fitzgerald RL. Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:914-923. [PMID: 37531115 PMCID: PMC10398547 DOI: 10.1001/jamapsychiatry.2023.2345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/04/2023] [Indexed: 08/03/2023]
Abstract
Importance With increasing medicinal and recreational cannabis legalization, there is a public health need for effective and unbiased evaluations for determining whether a driver is impaired due to Δ9-tetrahydrocannabinol (THC) exposure. Field sobriety tests (FSTs) are a key component of the gold standard law enforcement officer-based evaluations, yet controlled studies are inconclusive regarding their efficacy in detecting whether a person is under the influence of THC. Objective To examine the classification accuracy of FSTs with respect to cannabis exposure and driving impairment (as determined via a driving simulation). Design, Setting, and Participants This double-blind, placebo-controlled parallel randomized clinical trial was conducted from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California, San Diego. Participants were aged 21 to 55 years and had used cannabis in the past month. Data were analyzed from August 2021 to April 2023. Intervention Participants were randomized 1:1:1 to placebo (0.02% THC), 5.9% THC cannabis, or 13.4% THC cannabis smoked ad libitum. Main Outcome and Measures The primary end point was law enforcement officer determination of FST impairment at 4 time points after smoking. Additional measures included officer estimation as to whether participants were in the THC or placebo group as well as driving simulator data. Officers did not observe driving performance. Results The study included 184 participants (117 [63.6%] male; mean [SD] age, 30 [8.3] years) who had used cannabis a mean (SD) of 16.7 (9.8) days in the past 30 days; 121 received THC and 63, placebo. Officers classified 98 participants (81.0%) in the THC group and 31 (49.2%) in the placebo group as FST impaired (difference, 31.8 percentage points; 95% CI, 16.4-47.2 percentage points; P < .001) at 70 minutes after smoking. The THC group performed significantly worse than the placebo group on 8 of 27 individual FST components (29.6%) and all FST summary scores. However, the placebo group did not complete a median of 8 (IQR, 5-11) FST components as instructed. Of 128 participants classified as FST impaired, officers suspected 127 (99.2%) as having received THC. Driving simulator performance was significantly associated with results of select FSTs (eg, ≥2 clues on One Leg Stand was associated with impairment on the simulator: odds ratio, 3.09; 95% CI, 1.63-5.88; P < .001). Conclusions and Relevance This randomized clinical trial found that when administered by highly trained officers, FSTs differentiated between individuals receiving THC vs placebo and driving abilities were associated with results of some FSTs. However, the high rate at which the participants receiving placebo failed to adequately perform FSTs and the high frequency that poor FST performance was suspected to be due to THC-related impairment suggest that FSTs, absent other indicators, may be insufficient to denote THC-specific impairment in drivers. Trial Registration ClinicalTrials.gov Identifier: NCT02849587.
Collapse
Affiliation(s)
- Thomas D. Marcotte
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Anya Umlauf
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - David J. Grelotti
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Emily G. Sones
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Kyle F. Mastropietro
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Raymond T. Suhandynata
- Center for Medicinal Cannabis Research, Department of Pathology, University of California, San Diego
- Center for Medicinal Cannabis Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego
| | - Marilyn A. Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Igor Grant
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Robert L. Fitzgerald
- Center for Medicinal Cannabis Research, Department of Pathology, University of California, San Diego
| |
Collapse
|
18
|
Forbes CR, Spence KA, Garg NK, Darzi ER. Electrochemical Oxidation of Δ 9-Tetrahydrocannabinol at Nanomolar Concentrations. J Org Chem 2023; 88:11358-11362. [PMID: 37467382 DOI: 10.1021/acs.joc.3c01101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
With increasing marijuana legalization, there is a growing need for technology that can determine if an individual is impaired due to recent marijuana usage. The electrochemical oxidation of Δ9-THC to form its corresponding quinones can be used as a framework to develop an electrochemical sensor for Δ9-THC. This study describes an electrochemical oxidation of Δ9-THC that uses a copper anode, a platinum cathode, and an atmosphere of oxygen. The oxidation is feasible at nanomolar concentrations, which approaches the reactivity that is necessary for developing a real-world marijuana breathalyzer. Moreover, we show that vaporized Δ9-THC can be captured directly in an electrolyte medium and subjected to electrochemical oxidation, thus paving the way for use in future technology development.
Collapse
Affiliation(s)
- Christina R Forbes
- ElectraTect Inc., 850 N. 5th Street, Suite 406, Phoenix, Arizona 85004, United States
| | - Katie A Spence
- Department of Chemistry and Biochemistry, University of California, Los Angeles, California 90095, United States
| | - Neil K Garg
- Department of Chemistry and Biochemistry, University of California, Los Angeles, California 90095, United States
| | - Evan R Darzi
- ElectraTect Inc., 850 N. 5th Street, Suite 406, Phoenix, Arizona 85004, United States
| |
Collapse
|
19
|
Fitzgerald RL, Umlauf A, Hubbard JA, Hoffman MA, Sobolesky PM, Ellis SE, Grelotti DJ, Suhandynata RT, Huestis MA, Grant I, Marcotte TD. Driving Under the Influence of Cannabis: Impact of Combining Toxicology Testing with Field Sobriety Tests. Clin Chem 2023; 69:724-733. [PMID: 37228223 PMCID: PMC10320013 DOI: 10.1093/clinchem/hvad054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cannabis is increasingly used both medically and recreationally. With widespread use, there is growing concern about how to identify cannabis-impaired drivers. METHODS A placebo-controlled randomized double-blinded protocol was conducted to study the effects of cannabis on driving performance. One hundred ninety-one participants were randomized to smoke ad libitum a cannabis cigarette containing placebo or delta-9-tetrahydrocannabinol (THC) (5.9% or 13.4%). Blood, oral fluid (OF), and breath samples were collected along with longitudinal driving performance on a simulator (standard deviation of lateral position [SDLP] and car following [coherence]) over a 5-hour period. Law enforcement officers performed field sobriety tests (FSTs) to determine if participants were impaired. RESULTS There was no relationship between THC concentrations measured in blood, OF, or breath and SDLP or coherence at any of the timepoints studied (P > 0.05). FSTs were significant (P < 0.05) for classifying participants into the THC group vs the placebo group up to 188 minutes after smoking. Seventy-one minutes after smoking, FSTs classified 81% of the participants who received active drug as being impaired. However, 49% of participants who smoked placebo (controls) were also deemed impaired at this same timepoint. Combining a 2 ng/mL THC cutoff in OF with positive findings on FSTs reduced the number of controls classified as impaired to zero, 86 minutes after smoking the placebo. CONCLUSIONS Requiring a positive toxicology result in addition to the FST observations substantially improved the classification accuracy regarding possible driving under the influence of THC by decreasing the percentage of controls classified as impaired.
Collapse
Affiliation(s)
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, Center for Medicinal Cannabis Research, San Diego, CA, United States
| | | | | | | | - Shannon E Ellis
- Department of Cognitive Sciences, University of California San Diego, La Jolla, CA, United States
| | - David J Grelotti
- Department of Psychiatry, University of California San Diego, Center for Medicinal Cannabis Research, San Diego, CA, United States
| | | | - Marilyn A Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, United States
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, Center for Medicinal Cannabis Research, San Diego, CA, United States
| | - Thomas D Marcotte
- Department of Psychiatry, University of California San Diego, Center for Medicinal Cannabis Research, San Diego, CA, United States
| |
Collapse
|
20
|
Schwarz C, Ahmad O, Brown T, Gaspar J, Wagner G, McGehee DV, Potel M. The Long and Winding Road: 25 Years of the National Advanced Driving Simulator. IEEE COMPUTER GRAPHICS AND APPLICATIONS 2023; 43:121-128. [PMID: 37432778 DOI: 10.1109/mcg.2023.3277228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
The National Advanced Driving Simulator is a high-fidelity motion-base simulator owned by the National Highway Transportation Safety Administration and managed and operated by the University of Iowa. Its 25-year history has intersected with some of the most significant developments in automotive history, such as advanced driver assistance systems like stability control and collision warning systems, and highly automated vehicles. The simulator is an application of immersive virtual reality that uses multiprojection instead of head-mounted displays. A large-excursion motion system provides realistic acceleration and rotation cues to the driver. Due to its level of immersion and realism, drivers respond to events in the simulator the same way they would in their own vehicle. We document the history and technology behind this national facility.
Collapse
|
21
|
Boyle HK, Singh S, López G, Carey KB, Jackson KM, Merrill JE. A qualitative examination of positive and negative consequences young adults experience from simultaneous alcohol and cannabis use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:639-650. [PMID: 36301269 PMCID: PMC10133411 DOI: 10.1037/adb0000886] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Alcohol and cannabis are two of the most commonly used substances among young adults, and most individuals who use both substances use them simultaneously, that is, on the same occasion such that their effects overlap. Given the high prevalence of simultaneous alcohol and cannabis use, it is important to understand the relationship between simultaneous use and consequences. This study presents a qualitative examination of positive and negative consequences of simultaneous use. METHOD We conducted individual interviews among 36 young adults who engage in simultaneous use (23 women, 12 men, 1 trans man). Interviews included open-ended questions examining negative and positive consequences of simultaneous use and how simultaneous use differed from single substance use (alcohol only use, cannabis only use). Interviews were analyzed using applied thematic analysis. RESULTS Young adults reported numerous negative and positive consequences of simultaneous use, many overlapping with single substance use. Yet, they also reported unique combinations of positive consequences not experienced by single substance use. Young adults discussed patterns of use that were sometimes approached intentionally (e.g., quantity of substances used, order) that influenced consequences. CONCLUSIONS Together these findings provide further insight into young adults' simultaneous use experiences. Next steps should include quantitative exploratory research to identify and determine the frequency of specific consequences experienced during simultaneous use and examine the relationship between simultaneous use consequences and particular patterns of use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Holly K Boyle
- Center for Alcohol and Addiction Studies, Brown University
| | - Samyukta Singh
- Center for Alcohol and Addiction Studies, Brown University
| | - Gabriela López
- Center for Alcohol and Addiction Studies, Brown University
| | - Kate B Carey
- Center for Alcohol and Addiction Studies, Brown University
| | | | | |
Collapse
|
22
|
Manning B, Hayley AC, Catchlove S, Shiferaw B, Stough C, Downey LA. Effect of CannEpil ® on simulated driving performance and co-monitoring of ocular activity: A randomised controlled trial. J Psychopharmacol 2023; 37:472-483. [PMID: 37129083 PMCID: PMC10184186 DOI: 10.1177/02698811231170360] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Medicinal cannabis products containing Δ9-tetrahydrocannabinol (THC) are increasingly accessible. Yet, policy guidelines regarding fitness to drive are lacking, and cannabinoid-specific indexations of impairment are underdeveloped. AIMS To determine the impact of a standardised 1 mL sublingual dose of CannEpil®, a medicinal cannabis oil containing 100 mg cannabidiol (CBD) and 5 mg THC on simulated driving performance, relative to placebo and whether variations in vehicle control can be indexed by ocular activity. METHODS A double-blind, within-subjects, randomised, placebo-controlled, crossover trial assessed 31 healthy fully licensed drivers (15 male, 16 female) aged between 21 and 58 years (M = 38.0, SD = 10.78). Standard deviation of lateral position (SDLP), standard deviation of speed (SDS) and steering variability were assessed over time and as a function of treatment during a 40 min simulated drive, with oculomotor parameters assessed simultaneously. Oral fluid and plasma were collected at 30 min and 2.5 h. RESULTS CannEpil did not significantly alter SDLP across the full drive, although increased SDLP was observed between 20 and 30 min (p < 0.05). CannEpil increased SDS across the full drive (p < 0.05), with variance greatest at 20-30 min (p < 0.001). CannEpil increased fixation duration (p < 0.05), blink rate (trend p = 0.051) and decreased blink duration (p < 0.001) during driving. No significant correlations were observed between biological matrices and performance outcomes. CONCLUSIONS CannEpil impairs select aspects of vehicle control (speed and weaving) over time. Alterations to ocular behaviour suggest that eye tracking may assist in determining cannabis-related driver impairment or intoxication. Australian and New Zealand Clinician Trials Registry, https://anzctr.org.au(ACTRN12619000932167).
Collapse
Affiliation(s)
- Brooke Manning
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Amie C Hayley
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- International Council for Alcohol, Drugs, and Traffic Safety
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia
| | - Sarah Catchlove
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Brook Shiferaw
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Seeing Machines, Melbourne, VIC, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Luke A Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia
| |
Collapse
|
23
|
Osilla KC, D'Amico EJ, Smart R, Rodriguez A, Nameth K, Hummer J. Study design to evaluate a web-intervention to prevent alcohol and cannabis-impaired driving and use among adolescents in driver education. Addict Sci Clin Pract 2023; 18:17. [PMID: 36964608 PMCID: PMC10037905 DOI: 10.1186/s13722-023-00373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Alcohol and cannabis are the most commonly used substances among adolescents in the U.S. The consequences related to using both substances together are significantly higher relative to use of either substance alone. Teens' propensity to engage in risky driving behaviors (e.g., speeding, rapid lane changes, and texting) and their relative inexperience with the timing and duration of cannabis' effects puts them at heightened risk for experiencing harms related to driving under the influence. Use of alcohol and cannabis peak at age 16, the legal age teens may apply for a provisional driver's license in some states. Targeting novice teen drivers prior to licensure is thus an ideal time for prevention efforts focused on reducing alcohol and/or cannabis initiation, use, and impaired driving. METHODS The current study proposes to evaluate the efficacy of webCHAT among 15.5 to 17-year-old adolescents (n = 150) recruited at driver education programs. WebCHAT is a single session online intervention that aims to prevent alcohol and cannabis use and risky driving behaviors. We will recruit adolescents enrolled in driver education programs, and stratify based on whether they used cannabis and/or alcohol in the past 3 months (60% screening negative and 40% screening positive). All participants will receive usual driver education and half will also receive webCHAT. We will test whether webCHAT in addition to usual driver education reduces alcohol and/or cannabis initiation or use and reduces risky driving attitudes and behaviors (intent to drive after drinking/using, riding as a passenger with someone who drank/used) compared to teens in usual driver education over a 6-month period. We will also explore whether variables such as beliefs and perceived norms serve as explanatory mechanisms for our outcomes. DISCUSSION The study has the potential to promote public welfare by decreasing adolescent initiation and use of cannabis and alcohol and reducing risky driving behaviors that can have substantial monetary, personal, and social costs. The study recruits adolescents who are at risk for substance use as well as those who are not and it is delivered remotely during a teachable moment when adolescents receive driver education. Trial registration This study was registered with ClinicalTrials.gov on July 13, 2021 (NCT04959461). https://clinicaltrials.gov/ct2/show/NCT04959461.
Collapse
Affiliation(s)
- Karen Chan Osilla
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA.
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407‑2138, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407‑2138, USA
| | | | - Katherine Nameth
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA
| | - Justin Hummer
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407‑2138, USA
| |
Collapse
|
24
|
Di Ciano P, Brands B, Fares A, Wright M, Stoduto G, Byrne P, McGrath M, Hasan OSM, Le Foll B, Wickens CM. The Utility of THC Cutoff Levels in Blood and Saliva for Detection of Impaired Driving. Cannabis Cannabinoid Res 2023. [PMID: 36730769 DOI: 10.1089/can.2022.0187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: Δ9-Tetrahydrocannabinol (THC) is the psychoactive component in cannabis and a relationship of THC to driving impairment is expected. Despite this, there are discrepant findings with respect to the relationship of blood THC to driving. This study investigated the relationship of blood, urine, and saliva THC/THC-COOH levels to "weaving," as measured by a driving simulator. Methods: Participants smoked cannabis alone or with alcohol. THC/THC-COOH levels in blood, urine, and saliva were correlated with standard deviation of lateral position (SDLP), measuring "weaving." In addition, SDLP after cannabis and/or alcohol were compared with SDLP after placebo when THC/THC-COOH levels were above or below specified thresholds in blood (5 ng/mL), urine (50 ng/mL), or saliva (25 ng/mL). Results: A clear linear relationship between blood THC concentration and SDLP was not observed based on calculation of Spearman coefficients. When compared with placebo, SDLP was significantly increased after cannabis and cannabis combined with alcohol when THC in the blood was above the legal limit. SDLP was increased in drug conditions when saliva cutoffs were above the legal limit. Conclusions: The findings of this study suggest that specified thresholds for THC in blood and saliva may be able to detect driving impairment, but future studies are needed. ClinicalTrials.gov ID: NCT03106363.
Collapse
Affiliation(s)
- Patricia Di Ciano
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Bruna Brands
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Controlled Substances Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Andrew Fares
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Madison Wright
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Gina Stoduto
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Patrick Byrne
- Research and Evaluation Office, Ontario Ministry of Transportation, Toronto, Ontario, Canada
| | - Michael McGrath
- Research and Evaluation Office, Ontario Ministry of Transportation, Toronto, Ontario, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Medical Sciences Building, Toronto, Ontario, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Christine M Wickens
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Stringer RJ. Waiting for the Stop Sign to Turn Green: Contemporary Issues on Drug and Alcohol Impaired Driving Policy. AMERICAN JOURNAL OF CRIMINAL JUSTICE : AJCJ 2022; 47:735-748. [PMID: 36407840 PMCID: PMC9648432 DOI: 10.1007/s12103-022-09705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Impaired driving has been a considerable social problem in the U.S. for decades, but efforts to reduce it have stalled after the initial reductions in the 1980's. As a result, legislators continue to develop more polices aimed at deterring impaired driving. Although alcohol has historically been the focus of these efforts, recently there has been increased concern about marijuana impaired driving policies as well. However, alcohol and marijuana impaired driving differ in many ways. This paper explores the costs and benefits of new zero-tolerance policies such as the reduction of the per-se Blood Alcohol Concentration (BAC) level from .08 to .05 for alcohol and the establishment of similar per-se limits for marijuana. These policies are not based on actual impairment and reflect a net widening effect that will criminalize unimpaired drivers, divert criminal justice resources away from the most problematic impaired drivers, and will have little impact on impaired driving crashes. As such, they have the potential to do more harm than good.
Collapse
|
26
|
Fink DS, Shmulewitz D, Mannes ZL, Stohl M, Livne O, Wall M, Hasin DS. Construct validity of DSM-5 cannabis use disorder diagnosis and severity levels in adults with problematic substance use. J Psychiatr Res 2022; 155:387-394. [PMID: 36182768 PMCID: PMC9590423 DOI: 10.1016/j.jpsychires.2022.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/02/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
The DSM-5 definition of cannabis use disorder (CUD) differs from DSM-IV by combining abuse and dependence criteria (without the legal criterion) and including withdrawal and craving criteria. Information on construct validity of the DSM-5 CUD diagnosis and severity levels is lacking. This study examines the associations between DSM-5 CUD and severity classification and a set of concurrent validators. Adults with problematic substance use were recruited from two settings: a research setting in an urban medical center and a suburban inpatient addiction treatment program. Participants who reported past-year cannabis use (n = 392) were included in this study and completed a semi-structured, clinician-administered diagnostic interview. Regression models estimated the associations between binary DSM-5 CUD and severity levels with a set of validators, including cannabis use variables, psychopathology, and functional impairment. DSM-5 CUD and all severity levels were associated with cannabis use validators, including number of days used, self-reporting that cannabis use was a major problem, and greater cannabis craving. DSM-5 CUD and severe CUD were associated with other psychiatric disorders and social impairment. Findings add information about the validity of DSM-5 CUD diagnosis and severity levels, with severe CUD receiving the strongest support from its association with validators across all domains, as distinct from the mild and moderate CUD measures that were associated with cannabis-specific validators alone. Severe CUD is likely to require more intensive treatment to bolster physical, psychiatric, and social functioning, whereas the mild and moderate severity thresholds provide useful information for identifying less severe disorders for prevention and brief intervention.
Collapse
Affiliation(s)
- David S Fink
- New York State Psychiatric Institute, New York, NY, USA
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Zachary L Mannes
- New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Malka Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | - Ofir Livne
- New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melanie Wall
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| |
Collapse
|
27
|
Dempsey SK, Rodgers CL, Stout P, Lee D. Evaluation of suspected drug-facilitated sexual assault cases in the city of Houston from 2014 to 2020. J Forensic Sci 2022; 67:2394-2400. [PMID: 36219514 DOI: 10.1111/1556-4029.15146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
Drug-facilitated sexual assault is a form of sexual violence against an individual incapacitated by alcohol and/or drugs consumed voluntarily or covertly administered. The purpose of this study was to evaluate toxicological results and the associated demographics of sexual assault-related cases submitted to Houston Forensic Science Center from 2014 to 2020. In total, 1240 samples (1230 cases) were tested during the six-year period that consisted of blood, urine, or both specimens. Blood was analyzed for ethanol by dual-column headspace gas chromatography with flame ionization detection. Drug screen analysis was performed preferably on urine specimens using enzyme-linked immunosorbent assay. Positive screening results were confirmed upon request only due to laboratory policy. A total of 22% (n = 176) of requested samples were confirmed positive. Ethanol was the most prevalent substance detected, present in 17% of the samples (n = 212), followed by 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH) (n = 118). The combination of ethanol and THC-COOH was the most frequent one found (n = 17) in cases positive for two or more drugs (n = 101). Demographic data showed the majority of DFSA victims were white (25%) females (72%) with an average age of 27 years old (n = 348). Almost 90% of cases where the presence of drugs was confirmed resulted in no charges being made, either due to lack of suspect information or unknown reasons by the laboratory.
Collapse
Affiliation(s)
- Sara K Dempsey
- Dallas County Southwestern Institute of Forensic Sciences, Dallas, Texas, USA
| | | | - Peter Stout
- Houston Forensic Science Center, Inc., Houston, Texas, USA
| | - Dayong Lee
- Houston Forensic Science Center, Inc., Houston, Texas, USA
| |
Collapse
|
28
|
Huang D, Forbes CR, Garg NK, Darzi ER. A Cannabinoid Fuel Cell Capable of Producing Current by Oxidizing Δ 9-Tetrahydrocannabinol. Org Lett 2022; 24:6705-6710. [PMID: 36094349 DOI: 10.1021/acs.orglett.2c02289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the development of a current-producing H-Cell that relies on the oxidation of Δ9-tetrahydrocannabinol (THC), which is the primary psychoactive ingredient in marijuana. We found through systematic investigation of several variables that power densities could be improved 5-fold. Moreover, a real-time signal in a rudimentary THC sensor was observed at varying concentrations of THC. Given the growing societal interest in the detection of THC, our studies lay the foundation for the development of a marijuana breathalyzer.
Collapse
Affiliation(s)
- Di Huang
- ElectraTect, Inc. 850 N. Fifth Street, Suite 406, Phoenix, Arizona 85004, United States
| | - Christina R Forbes
- ElectraTect, Inc. 850 N. Fifth Street, Suite 406, Phoenix, Arizona 85004, United States
| | - Neil K Garg
- Department of Chemistry and Biochemistry, University of California, Los Angeles, California 90095, United States
| | - Evan R Darzi
- ElectraTect, Inc. 850 N. Fifth Street, Suite 406, Phoenix, Arizona 85004, United States
| |
Collapse
|
29
|
Zamarripa CA, Novak MD, Weerts EM, Vandrey R, Spindle TR. The effects of oral and vaporized cannabis alone, and in combination with alcohol, on driving performance using the STISIM driving simulator: A two-part, double-blind, double-dummy, placebo-controlled, randomized crossover clinical laboratory protocol. Front Pharmacol 2022; 13:964749. [PMID: 36147331 PMCID: PMC9486093 DOI: 10.3389/fphar.2022.964749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
The legalization of cannabis for medicinal and non-medicinal purposes, and the corresponding increase in diversity of cannabis products, has resulted an urgent need for cannabis regulatory science. Among the most pressing needs is research related to impairment due to cannabis exposure, especially on driving performance. The present project was designed to evaluate the impact of oral and vaporized cannabis, when administered alone or in combination with alcohol, on simulated driving performance (STISIM driving simulator), cognitive/psychomotor ability, and field sobriety performance. Healthy adults will complete two, double-blind, double-dummy, placebo-controlled, randomized crossover clinical laboratory studies, one with oral cannabis (16 men/16 women) and the second with vaporized cannabis (16 men/16 women). In each study, participants will complete seven experimental sessions during which acute doses of placebo or high Δ9-THC cannabis containing 0, 10, or 25 mg Δ9-THC will be administered both alone and in combination with placebo or alcohol-containing beverages (target breath alcohol concentrations, BAC, of 0.0% or 0.05%). A positive control session (i.e., alcohol at target BAC of 0.08% with placebo cannabis) will also be completed. Simulated driving performance tests (available for download; see Methods), field sobriety assessments, subjective drug effect questionnaires, a mobile device impairment test (DRUID app), and collection of whole blood specimens will be completed repeatedly during each session. Linear mixed models will be used to test for differences across experimental conditions and a priori planned comparisons will be used to determine differences between conditions of interest (e.g., cannabis alone vs cannabis with alcohol). This research is designed to extend prior studies of cannabis and alcohol on driving performance by using oral and vaporized routes of cannabis administration. By increasing understanding of impairment associated with co-use of alcohol and these novel forms of cannabis, this research could inform impairment detection standards for cannabis and alcohol and have important implications for law enforcement, public policy decisions regarding accessibility of these substances, and education of the general population who may use cannabis and/or alcohol. Lastly, this manuscript provides interested researchers with access to the simulated driving scenarios and data extraction tools developed for this study as a means of facilitating future cross-study comparisons, which is important given the heterogeneity in methods used across laboratories in prior research.
Collapse
Affiliation(s)
| | | | | | | | - Tory R. Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
30
|
Trends in Canadian Cannabis Consumption Over Time: A Two-step Meta-analysis of Canadian Household Survey Data. CANADIAN JOURNAL OF ADDICTION 2022. [DOI: 10.1097/cxa.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
31
|
Keyes KM, Kaur N, Kreski NT, Chen Q, Martins SS, Hasin D, Olfson M, Mauro PM. Temporal trends in alcohol, cannabis, and simultaneous use among 12th-grade U.S. adolescents from 2000 to 2020: Differences by sex, parental education, and race and ethnicity. Alcohol Clin Exp Res 2022; 46:1677-1686. [PMID: 36125706 PMCID: PMC9635013 DOI: 10.1111/acer.14914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/14/2022] [Accepted: 07/16/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Simultaneous use of alcohol and cannabis to enhance each other's effect can cause potential harm. Time trends are diverging in adolescent use of alcohol, which is declining, and cannabis, which is increasing among certain subgroups. However, little is known about trends in their simultaneous and non-simultaneous use. Racial and socioeconomic disparities are emerging in cannabis use, which may portend consequences to public health. METHODS The 2000 to 2020 Monitoring the Future surveys included approximately 38,000 U.S. 12th-grade students with information on simultaneous use and pertinent demographic factors. A 5-level alcohol/cannabis measure included past-year simultaneous use (i.e., alcohol and cannabis use at the same time), non-simultaneous alcohol and cannabis use, alcohol-use-only, cannabis-use-only, and no use. Multinomial logistic regressions estimated associations (adjusted relative risk ratios; aRRR) with time period (2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2020). Models were adjusted and included interactions with sex, race/ethnicity, and parental education. RESULTS Between 2000 and 2020, simultaneous alcohol/cannabis use among 12th graders decreased from 24.4% to 18.7%. From 2015 to 2020 compared to 2000 to 2004, the odds of simultaneous use (adjusted relative risk ratio (aRRR) vs. no use = 0.57, 95% CI [0.50, 0.66]) and alcohol-use-only (aRRR = 0.55, 95% CI [0.49, 0.61]) decreased, while cannabis-use-only odds increased (aRRR = 2.59, 95% CI [1.87, 3.59]). Notably, the prevalence of cannabis-use-only more than doubled from 2011 to 2019. The odds of simultaneous use, alcohol-use-only, and non-simultaneous use of alcohol and cannabis declined more rapidly among males than females, whereas the odds for cannabis-use-only increased faster for females than males. Increases in cannabis-use-only were faster for non-white adolescents. CONCLUSION Simultaneous use of alcohol and cannabis is declining among U.S. adolescents, but the decline is slower among females than males. Declines in simultaneous use are largely concomitant with historical declines in alcohol use, indicating that a continued focus on reducing alcohol use among adolescents and young adults has extended benefits to other adolescent substance use. However, cannabis use without any reported past-year alcohol use more than doubled in the last decade, a concerning trend.
Collapse
Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Navdep Kaur
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Noah T Kreski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, New York, USA
| | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, New York, USA
| | - Pia M Mauro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| |
Collapse
|
32
|
Comparison of the effects of alcohol and cannabis on visual function and driving performance. Does the visual impairment affect driving? Drug Alcohol Depend 2022; 237:109538. [PMID: 35717788 DOI: 10.1016/j.drugalcdep.2022.109538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/23/2022] [Accepted: 06/09/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Alcohol and cannabis are the most widely consumed psychoactive substances worldwide. This study compared the effects of alcohol and cannabis on visual function and driving performance, as well as self-perceived effects. Also, the relationship between visual effects under the influence and driving performance was studied. METHODS Sixty-four young drivers, with a history of alcohol and/or cannabis use were included. Of these, 33 were allocated to the alcohol group and 31 to the cannabis group. All participants were evaluated in a baseline session. The alcohol group underwent two sessions: after drinking 300 ml and 450 ml of red wine (A1 and A2). The cannabis group attended one session after smoking cannabis (C). Visual function was evaluated at the contrast sensitivity, stereoacuity, and intraocular straylight level. Participants drove a driving simulator. A general score (overall visual score, OVS; overall driving performance score, ODPS) was obtained for both visual functioning and driving performance. RESULTS The evaluation of visual function demonstrated a significant impairment in OVS for all conditions studied (A1, p = 0.005; A2, p < 0.001; C, p < 0.001) with respect to the baseline session. General driving performance (ODPS) demonstrated a significant worsening for the A2 condition (p = 0.003). Finally, a significant relationship between driving performance and visual function was found (rho=0.163, p = 0.039 and χ2 = 4.801, p = 0.028). CONCLUSIONS Cannabis and alcohol use negatively impact visual function. However, driving performance was only significantly affected by the higher alcohol dose. This impairment in visual function was significantly associated with worse driving performance.
Collapse
|
33
|
Simmons SM, Caird JK, Sterzer F, Asbridge M. The effects of cannabis and alcohol on driving performance and driver behaviour: a systematic review and meta-analysis. Addiction 2022; 117:1843-1856. [PMID: 35083810 DOI: 10.1111/add.15770] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Cannabis and alcohol are frequently detected in fatal and injury motor vehicle crashes. While epidemiological meta-analyses of cannabis and alcohol have found associations with an increase in crash risk, convergent evidence from driving performance measures is insufficiently quantitatively characterized. Our objectives were to quantify the magnitude of the effect of cannabis and alcohol-alone and in combination-on driving performance and behaviour. METHODS Systematic review and meta-analysis. We systematically searched Academic Search Complete, CINAHL, Embase, Scopus, Google Scholar, MEDLINE, PsycINFO, SPORTDiscus and TRID. Of the 616 studies that underwent full-text review, this meta-analysis represents 57 studies and 1725 participants. We extracted data for hazard response time, lateral position variability, lane deviations or excursions, time out of lane, driving speed, driving speed variability, speed violations, time speeding, headway, headway variability and crashes from experimental driving studies (i.e. driving simulator, closed-course, on-road) involving cannabis and/or alcohol administration. We reported meta-analyses of effect sizes using Hedges' g and r. RESULTS Cannabis alone was associated with impaired lateral control [e.g. g = 0.331, 95% confidence interval (CI) = 0.212-0.451 for lateral position variability; g = 0.198, 95% CI = 0.001-0.395 for lane excursions) and decreased driving speed (g = -0.176, 95% CI = -0.298 to -0.053]. The combination of cannabis and alcohol was associated with greater driving performance decrements than either drug in isolation [e.g. g = 0.480, 95% CI = 0.096-0.865 for lateral position variability (combination versus alcohol); g = 0.525, 95% CI = 0.049-1.002 for time out of lane (versus alcohol); g = 0.336, 95% CI = 0.036-0.636 for lateral position variability (combination versus cannabis; g = 0.475, 95% CI = 0.002-0.949 for time out of lane (combination versus cannabis)]. Subgroup analyses indicated that the effects of cannabis on driving performance measures were similar to low blood alcohol concentrations. A scarcity of data and study heterogeneity limited the interpretation of some measures. CONCLUSIONS This meta-analysis indicates that cannabis, like alcohol, impairs driving, and the combination of the two drugs is more detrimental to driving performance than either in isolation.
Collapse
Affiliation(s)
- Sarah M Simmons
- Department of Psychology, University of Calgary, Alberta, Canada
| | - Jeff K Caird
- Department of Psychology, University of Calgary, Alberta, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Alberta, Canada
| | - Frances Sterzer
- Department of Psychology, University of Calgary, Alberta, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
34
|
Dutra LM, Farrelly M, Gourdet C, Bradfield B. Cannabis legalization and driving under the influence of cannabis in a national U.S. Sample. Prev Med Rep 2022; 27:101799. [PMID: 35656220 PMCID: PMC9152797 DOI: 10.1016/j.pmedr.2022.101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 11/24/2022] Open
Abstract
A national survey sampled current cannabis users. Users in medical cannabis states were less likely to report driving high. Users in recreational states were less likely to report driving high. Likelihood of driving high varied by frequency of cannabis use.
The relationship between cannabis legalization and traffic safety remains unclear. Physiological measures of cannabis impairment remain imperfect. This analysis used self-report data to examine the relationship between cannabis legalization and driving under the influence of cannabis (DUIC)1. Using a cross-sectional national sample (2016–2017) of 1,249 past–30-day cannabis users, we regressed self-reported DUIC (driving within three hours of “getting high”) on cannabis legalization (recreational and medical (recreational), medical only (medical), or no legal cannabis), adjusting for demographics, days of use (past 30 days), days of use*legal status, calibration weights, and geographic clustering. The risk of DUIC in recreational (risk ratio [RR] = 0.41, 95% confidence interval (CI):0.23–0.72) and medical (RR = 0.39, 95% CI:0.20–0.79) states was lower than in states without legal cannabis, with one exception. Among frequent cannabis users (≥20 days per month), there was a significantly lower risk of DUIC for those living in recreational states (RR = 0.70, 95% CI: 0.49–0.99), but not for those living in medical states (RR = 0.87, 95% CI: 0.60–1.24), compared to users living in states without legal cannabis. The risk of self-reported DUIC was lower in recreational and medical cannabis states compared to states without legal cannabis. The only exception was for frequent users in medical states, for whom there was no difference in risk compared to frequent users living in states without legal cannabis.
Collapse
|
35
|
Romm KF, Patterson B, Wang Y, Wysota CN, Bar-Zeev Y, Levine H, Berg CJ. Drivers and Passengers in Vehicles Driven Under the Influence of Alcohol or Marijuana: Behavior Profiles and Risk Factors Among Young Adults in a Longitudinal Study. J Stud Alcohol Drugs 2022; 83:342-351. [PMID: 35590174 PMCID: PMC9135000 DOI: 10.15288/jsad.2022.83.342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/29/2021] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE Little research has examined psychosocial influences differentially associated with driving under the influence of alcohol and marijuana (DUIA/DUIM) or of being a passenger in a vehicle driven by someone under the influence of alcohol or marijuana (PVA/PVM). METHOD Using 2019 survey data among 2,375 young adults (M age = 24.66, 57.7% female, 51.2% in states with legal marijuana retail) in a longitudinal study examining vaping retail, we conducted latent class analysis (LCA) to identify classes of DUI-related behaviors and multinomial logistic regression to identify correlates of classes (e.g., individual, interpersonal, policy related). RESULTS A total of 22.6% reported past-month DUIA, 24.1% DUIM, 29.7% PVA, and 27.7% PVM. Of those reporting DUIA, 41.4% reported DUIM, 71.8% PVA, and 40.7% PVM. Of those reporting DUIM, 47.7% reported DUIA, 49.6% PVA, and 83.8% PVM. LCA indicated four classes: alcohol and marijuana risk takers (5.9%), all of whom reported DUIA and DUIM, 81.2% PVA, and 89.2% PVM; marijuana risk takers (14.2%), 45.1% DUIM, 100% PVM, 7.8% PVA, and 0% DUIA; alcohol risk takers (24.1%), 40.1% DUIA, 98.6% PVA, 2.6% DUIM, and 33.8% PVM; and low risk takers (55.8%), 8.7% DUIA, 4.5% DUIM, and 0% PVA/PVM. Relative to the other classes, alcohol and marijuana risk takers were more likely male, heterosexual, and White, and alcohol and marijuana risk takers reported greater depressive symptoms. Influences of parent/peer alcohol versus marijuana use were specific to the respective DUI risk behaviors. No differences emerged for legal marijuana retail. CONCLUSIONS Findings regarding those at particular risk, social influences, and situations under which DUI-related behaviors occur should inform future interventions and research.
Collapse
Affiliation(s)
- Katelyn F. Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Brooke Patterson
- Global Health Design, Monitoring & Evaluation, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Christina N. Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem – Hadassah Medical Centre, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem – Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| |
Collapse
|
36
|
Fares A, Wickens CM, Mann RE, Di Ciano P, Wright M, Matheson J, Hasan OSM, Rehm J, George TP, Samokhvalov AV, Shuper PA, Huestis MA, Stoduto G, Brown T, Stefan C, Rubin-Kahana DS, Le Foll B, Brands B. Combined effect of alcohol and cannabis on simulated driving. Psychopharmacology (Berl) 2022; 239:1263-1277. [PMID: 33544195 DOI: 10.1007/s00213-021-05773-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/21/2021] [Indexed: 12/21/2022]
Abstract
RATIONALE With alcohol and cannabis remaining the most commonly detected drugs in seriously and fatally injured drivers, there is a need to understand their combined effects on driving. OBJECTIVES The present study examined the effects of combinations of smoked cannabis (12.5% THC) and alcohol (target BrAC 0.08%) on simulated driving performance, subjective drug effects, cardiovascular measures, and self-reported perception of driving ability. METHODS In this within-subjects, double-blind, double-dummy, placebo-controlled, randomized clinical trial, cannabis users (1-7 days/week) aged 19-29 years attended four drug administration sessions in which simulated driving, subjective effects, cardiovascular measures, and whole blood THC and metabolite concentrations were assessed following placebo alcohol and placebo cannabis (<0.1% THC), alcohol and placebo cannabis, placebo alcohol and active cannabis, and alcohol and active cannabis. RESULTS Standard deviation of lateral position in the combined condition was significantly different from the placebo condition (p < 0.001). Standard deviation of lateral position was also significantly different from alcohol and cannabis alone conditions in the single task overall drive (p = 0.029 and p = 0.032, respectively), from the alcohol alone condition in the dual task overall drive (p = 0.022) and the cannabis alone condition in the dual task straightaway drive (p = 0.002). Compared to the placebo condition, the combined and alcohol conditions significantly increased reaction time. Subjective effects in the combined condition were significantly greater than with either of the drugs alone at some time points, particularly later in the session. A driving ability questionnaire showed that participants seemed unaware of their level of impairment. CONCLUSION Combinations of alcohol and cannabis increased weaving and reaction time, and tended to produce greater subjective effects compared to placebo and the single drug conditions suggesting a potential additive effect. The fact that participants were unaware of this increased effect has important implications for driving safety.
Collapse
Affiliation(s)
- Andrew Fares
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Christine M Wickens
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 425 - 155 College Street, Toronto, Ontario, M5T 1P8, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Patricia Di Ciano
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Madison Wright
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Justin Matheson
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Jurgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,World Health Organization/Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, M5S 1A8, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, Moscow, Russian Federation, 119992
| | - Tony P George
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,Biobehavioural Addictions and Concurrent Disorders Research Laboratory, Addictions Division, CAMH, 33 Ursula Franklin Street, Suite 1910A, Toronto, Ontario, M5S 2S1, Canada
| | - Andriy V Samokhvalov
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Paul A Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA, 19107, USA
| | - Gina Stoduto
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Timothy Brown
- National Advanced Driving Simulator, University of Iowa, 2401 Oakdale Blvd, Iowa City, IA, 52242, USA
| | - Cristiana Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Dafna Sara Rubin-Kahana
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.,Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health, Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario, M5G 1V7, Canada
| | - Bruna Brands
- Department of Pharmacology and Toxicology, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada. .,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada. .,Controlled Substances and Cannabis Branch, Health Canada, Ottawa, Ontario, Canada.
| |
Collapse
|
37
|
Romm KF, Patterson B, Wang Y, Wysota CN, Bar-Zeev Y, Levine H, Berg CJ. Drivers and Passengers in Vehicles Driven Under the Influence of Alcohol or Marijuana: Behavior Profiles and Risk Factors Among Young Adults in a Longitudinal Study. J Stud Alcohol Drugs 2022; 83:342-351. [PMID: 35590174 PMCID: PMC9135000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/29/2021] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE Little research has examined psychosocial influences differentially associated with driving under the influence of alcohol and marijuana (DUIA/DUIM) or of being a passenger in a vehicle driven by someone under the influence of alcohol or marijuana (PVA/PVM). METHOD Using 2019 survey data among 2,375 young adults (M age = 24.66, 57.7% female, 51.2% in states with legal marijuana retail) in a longitudinal study examining vaping retail, we conducted latent class analysis (LCA) to identify classes of DUI-related behaviors and multinomial logistic regression to identify correlates of classes (e.g., individual, interpersonal, policy related). RESULTS A total of 22.6% reported past-month DUIA, 24.1% DUIM, 29.7% PVA, and 27.7% PVM. Of those reporting DUIA, 41.4% reported DUIM, 71.8% PVA, and 40.7% PVM. Of those reporting DUIM, 47.7% reported DUIA, 49.6% PVA, and 83.8% PVM. LCA indicated four classes: alcohol and marijuana risk takers (5.9%), all of whom reported DUIA and DUIM, 81.2% PVA, and 89.2% PVM; marijuana risk takers (14.2%), 45.1% DUIM, 100% PVM, 7.8% PVA, and 0% DUIA; alcohol risk takers (24.1%), 40.1% DUIA, 98.6% PVA, 2.6% DUIM, and 33.8% PVM; and low risk takers (55.8%), 8.7% DUIA, 4.5% DUIM, and 0% PVA/PVM. Relative to the other classes, alcohol and marijuana risk takers were more likely male, heterosexual, and White, and alcohol and marijuana risk takers reported greater depressive symptoms. Influences of parent/peer alcohol versus marijuana use were specific to the respective DUI risk behaviors. No differences emerged for legal marijuana retail. CONCLUSIONS Findings regarding those at particular risk, social influences, and situations under which DUI-related behaviors occur should inform future interventions and research.
Collapse
Affiliation(s)
- Katelyn F. Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Brooke Patterson
- Global Health Design, Monitoring & Evaluation, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Christina N. Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem – Hadassah Medical Centre, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem – Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| |
Collapse
|
38
|
Moore CF, Stiltner JW, Davis CM, Weerts EM. Translational models of cannabinoid vapor exposure in laboratory animals. Behav Pharmacol 2022; 33:63-89. [PMID: 33136615 PMCID: PMC8079522 DOI: 10.1097/fbp.0000000000000592] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cannabis is one of the most frequently used psychoactive substances in the world. The most common route of administration for cannabis and cannabinoid constituents such as Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is via smoking or vapor inhalation. Preclinical vapor models have been developed, although the vaporization devices and delivery methods vary widely across laboratories. This review examines the emerging field of preclinical vapor models with a focus on cannabinoid exposure in order to (1) summarize vapor exposure parameters and other methodological details across studies; (2) discuss the pharmacological and behavioral effects produced by exposure to vaporized cannabinoids; and (3) compare behavioral effects of cannabinoid vapor administration with those of other routes of administration. This review will serve as a guide for past and current vapor delivery methods in animals, synergize findings across studies, and propose future directions for this area of research.
Collapse
Affiliation(s)
- Catherine F. Moore
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey W. Stiltner
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Catherine M. Davis
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elise M. Weerts
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
39
|
Dolan SB, Spindle TR, Vandrey R, Johnson MW. Behavioral economic interactions between cannabis and alcohol purchasing: Associations with disordered use. Exp Clin Psychopharmacol 2022; 30:159-171. [PMID: 33001691 PMCID: PMC8209692 DOI: 10.1037/pha0000397] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
As cannabis policy changes, there is an urgent need to understand interactions between cannabis and alcohol couse. An online sample of 711 adult past-month cannabis and alcohol users completed both single-item hypothetical purchasing tasks for cannabis and alcohol and cross-commodity purchasing tasks assessing adjusting-price cannabis with concurrently available, fixed-price alcohol, and vice versa. Participants provided information about cannabis and alcohol use patterns, and completed the Alcohol and Cannabis Use Disorder Identification Tests (AUDIT and CUDIT, respectively). Group data showed that cannabis and alcohol served as complements (as the price of the adjusting-price commodity increased, consumption of both commodities decreased). However, individual data showed substantial variability with nontrivial proportions showing patterns of complementarity, substitution, and independence. More negative slopes (greater complementarity) for fixed-price cannabis and alcohol were both associated with greater self-reported drug consumption and CUDIT and AUDIT scores. The negative relation between cross-price slope and CUDIT/AUDIT score indicates that individuals who treat cannabis and alcohol more as complements are more likely to experience disordered use. Based on these cross-commodity purchasing data, when both cannabis and alcohol are concurrently available at low prices, both may be used at high levels, whereas limiting consumption of one commodity (e.g., through increased price) may reduce consumption of the other. These data show the importance of examining individual participant analyses of behavioral economic drug interactions and suggest that manipulation of cost (e.g., through taxes) or cosale restrictions are potential public health regulatory mechanisms for reducing alcohol and cannabis use and couse behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Sean B Dolan
- Department of Psychiatry and Behavioral Sciences
| | | | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences
| | | |
Collapse
|
40
|
Blandino A, Cotroneo R, Tambuzzi S, Di Candia D, Genovese U, Zoja R. Driving under the influence of drugs: Correlation between blood psychoactive drug concentrations and cognitive impairment. A narrative review taking into account forensic issues. Forensic Sci Int Synerg 2022; 4:100224. [PMID: 35330981 PMCID: PMC8938866 DOI: 10.1016/j.fsisyn.2022.100224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022]
Abstract
Driving under the influence of alcohol has been shown to increase the risk of involvement in road traffic collisions (RTCs) however, less is known about the effects of illicit drugs, and a clear correlation between drug concentrations and RTC risk is still debated. The goal of this narrative review is to assess the current literature regarding the most detected psychoactive drugs in RTC (ethanol, amphetamines, cannabis, opioids and cocaine), in relation to driving performance. Evidence on impaired driving due to psychoactive substances, forensic issues relating to the assessment of the impact of drugs, blood cut-off values proposed to date as well as scientific basis for proposed legislative limits are discussed. At present there is no unequivocal evidence demonstrating a clear dose/concentration dependent impairment in many substances. Per se and zero tolerance approaches seem to have negative effect on drugged driving fatalities. However, the weight of these approaches needs further investigation.
Collapse
Affiliation(s)
- Alberto Blandino
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Rosy Cotroneo
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Stefano Tambuzzi
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Domenico Di Candia
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Umberto Genovese
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Riccardo Zoja
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| |
Collapse
|
41
|
Roehler DR, Hoots BE, Holland KM, Baldwin GT, Vivolo-Kantor AM. Trends and characteristics of cannabis-associated emergency department visits in the United States, 2006-2018. Drug Alcohol Depend 2022; 232:109288. [PMID: 35033959 PMCID: PMC9885359 DOI: 10.1016/j.drugalcdep.2022.109288] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cannabis policies are rapidly changing in the United States, yet little is known about how this has affected cannabis-associated emergency department (ED) visits. METHODS We studied trends in cannabis-associated ED visits and identified differences by visit characteristics. Cannabis-associated ED visits from 2006 to 2018 were identified from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project's (HCUP) Nationwide Emergency Department Sample (NEDS). JoinPoint analysis was used to identify trends from 2006 to 2014, prior to medical coding changes in 2015, and Z-tests were used to compare annual rate changes from 2016 to 2018. Changes in rates from 2017 to 2018 were examined by visit characteristics. RESULTS From 2006-2014, the rate of cannabis-associated ED visits increased, on average, 12.1% annually (p < 0.05), from 12.3 to 34.7 visits per 100,000 population. The rate increased 17.3% from 2016 to 2017 (p < 0.05) and 11.1% from 2017 to 2018 (p < 0.05). From 2017-2018, rates of visits increased for both males (8.7%; p < 0.05) and females (15.9%; p < 0.05). Patients 0-14 years and 25 years and older had significant rate increases from 2017 to 2018 as did the Midwest region (36.8%; p < 0.05), the Northeast (9.2%; p < 0.05), and the South (4.5%; p < 0.05). CONCLUSIONS Cannabis-associated ED visits are on the rise and subgroups are at increased risk. Some potential explanations for increases in cannabis-associated ED visits include increased availability of cannabis products, increased use, and diversity of products available in marketplaces. Strategies are needed to prevent youth initiation, limit potentially harmful use among adults, and ensure safe storage where cannabis use is legal.
Collapse
Affiliation(s)
- Douglas R. Roehler
- Correspondence to: Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, MS: S106-8, 4770 Buford Highway NE, Atlanta, GA 30341, United States., (D.R. Roehler)
| | | | | | | | | |
Collapse
|
42
|
Marcotte TD, Umlauf A, Grelotti DJ, Sones EG, Sobolesky PM, Smith BE, Hoffman MA, Hubbard JA, Severson J, Huestis MA, Grant I, Fitzgerald RL. Driving Performance and Cannabis Users' Perception of Safety: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:201-209. [PMID: 35080588 PMCID: PMC8792796 DOI: 10.1001/jamapsychiatry.2021.4037] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Expanding cannabis medicalization and legalization increases the urgency to understand the factors associated with acute driving impairment. OBJECTIVE To determine, in a large sample of regular cannabis users, the magnitude and time course of driving impairment produced by smoked cannabis of different Δ9-tetrahydrocannabinol (THC) content, the effects of use history, and concordance between perceived impairment and observed performance. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled parallel randomized clinical trial took place from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California San Diego. Cannabis users were recruited for this study, and analysis took place between April 2020 and September 2021. INTERVENTIONS Placebo or 5.9% or 13.4% THC cannabis smoked ad libitum. MAIN OUTCOMES AND MEASURES The primary end point was the Composite Drive Score (CDS), which comprised key driving simulator variables, assessed prior to smoking and at multiple time points postsmoking. Additional measures included self-perceptions of driving impairment and cannabis use history. RESULTS Of 191 cannabis users, 118 (61.8%) were male, the mean (SD) age was 29.9 (8.3) years, and the mean (SD) days of use in the past month was 16.7 (9.8). Participants were randomized to the placebo group (63 [33.0%]), 5.9% THC (66 [34.6%]), and 13.4% THC (62 [32.5%]). Compared with placebo, the THC group significantly declined on the Composite Drive Score at 30 minutes (Cohen d = 0.59 [95% CI, 0.28-0.90]; P < .001) and 1 hour 30 minutes (Cohen d = 0.55 [95% CI, 0.24-0.86]; P < .001), with borderline differences at 3 hours 30 minutes (Cohen d = 0.29 [95% CI, -0.02 to 0.60]; P = .07) and no differences at 4 hours 30 minutes (Cohen d = -0.03 [95% CI, -0.33 to 0.28]; P = .87). The Composite Drive Score did not differ based on THC content (likelihood ratio χ24 = 3.83; P = .43) or use intensity (quantity × frequency) in the past 6 months (likelihood ratio χ24 = 1.41; P = .49), despite postsmoking blood THC concentrations being higher in those with the highest use intensity. Although there was hesitancy to drive immediately postsmoking, increasing numbers (81 [68.6%]) of participants reported readiness to drive at 1 hour 30 minutes despite performance not improving from initial postsmoking levels. CONCLUSIONS AND RELEVANCE Smoking cannabis ad libitum by regular users resulted in simulated driving decrements. However, when experienced users control their own intake, driving impairment cannot be inferred based on THC content of the cigarette, behavioral tolerance, or THC blood concentrations. Participants' increasing willingness to drive at 1 hour 30 minutes may indicate a false sense of driving safety. Worse driving performance is evident for several hours postsmoking in many users but appears to resolve by 4 hours 30 minutes in most individuals. Further research is needed on the impact of individual biologic differences, cannabis use history, and administration methods on driving performance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02849587.
Collapse
Affiliation(s)
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego
| | - David J. Grelotti
- Department of Psychiatry, University of California San Diego, San Diego
| | - Emily G. Sones
- Department of Psychiatry, University of California San Diego, San Diego
| | - Philip M. Sobolesky
- Department of Pathology, University of California San Diego, San Diego,Department of Pathology and Laboratory Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Breland E. Smith
- Department of Pathology, University of California San Diego, San Diego,LetsGetChecked Labs, Monrovia, California
| | - Melissa A. Hoffman
- Department of Pathology, University of California San Diego, San Diego,Vividion Therapeutics, San Diego, California
| | - Jacqueline A. Hubbard
- Department of Pathology, University of California San Diego, San Diego,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Marilyn A. Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego
| | | |
Collapse
|
43
|
Karoly HC, Milburn MA, Brooks-Russell A, Brown M, Streufert J, Bryan AD, Lovrich NP, DeJong W, Cinnamon Bidwell L. Effects of High-Potency Cannabis on Psychomotor Performance in Frequent Cannabis Users. Cannabis Cannabinoid Res 2022; 7:107-115. [PMID: 33998859 PMCID: PMC8864436 DOI: 10.1089/can.2020.0048] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Recently increased access to cannabis products in the United States has been associated with increased rates of driving after cannabis use. Although numerous studies indicate that cannabis impairs psychomotor and neurocognitive functions that can affect driving ability, the determination of cannabis-impaired driving risk is complicated by the extent to which frequent cannabis users develop tolerance to THC's subjective, cognitive, and psychomotor effects, and by the fact that there is no validated behavioral or biological marker of recent cannabis use or cannabis-related impairment. This study examined the psychomotor impairment-related effects experienced by frequent cannabis users in Colorado after naturalistic consumption of smoked cannabis, both immediately and 1 h postuse. Results were then validated in a smaller replication sample from Washington state. Methods: In the primary Colorado study, participants (n=70) used the DRUID® mobile app, a brief measure of psychomotor and cognitive domains that are sensitive to the effects of cannabis. First, participants used DRUID to establish a sober baseline impairment score. During a second appointment, they used DRUID at three time points: preuse, immediately after acutely using cannabis, and 1 h postuse. In the Washington replication sample, participants (n=39) used DRUID before acute cannabis consumption and then every half hour for 2.5 h. Results: In both studies, peak DRUID impairment effects were seen immediately after cannabis use, with recovery of performance at 1 h postuse. Specifically, significant quadratic effects of time emerged for both studies (Colorado study: (β=-0.935, SE=0.204, p<0.001); Washington study: β=3.0299, SE=1.3085, p<0.01). Domain-specific effects were tested in the larger Colorado study and were observed for reaction time within a complex divided attention task and a postural-stability balance task. Conclusions: These findings demonstrate that psychomotor impairment emerges immediately after acute cannabis use even in regular users, but decreases significantly 1 h postuse. These results underscore the potential utility of the DRUID app for assessing acute cannabis-related psychomotor impairment. Further research is needed to explore whether the DRUID app and/or the specific psychomotor functions it assesses might serve as a tool for measuring cannabis-related driving impairment. Clinical trials registration number for the Colorado Study: NCT03522103.
Collapse
Affiliation(s)
- Hollis C. Karoly
- Institute for Cognitive Science, University of Colorado, Boulder, Colorado, USA.,*Address correspondence to: Hollis C. Karoly, PhD, Institute of Cognitive Science, University of Colorado, 1777 Exposition Drive, Boulder, CO 80309, USA,
| | | | - Ashley Brooks-Russell
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Brown
- Advanced Integrative Medical Science Institute, Seattle, Washington, USA.,SMJ Consulting, Seattle, Washington, USA
| | | | - Angela D. Bryan
- Institute for Cognitive Science, University of Colorado, Boulder, Colorado, USA.,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
| | - Nicholas P. Lovrich
- Department of Criminal Justice and Criminology, Washington State University, Pullman, Washington, USA
| | - William DeJong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - L. Cinnamon Bidwell
- Institute for Cognitive Science, University of Colorado, Boulder, Colorado, USA.,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
| |
Collapse
|
44
|
Choo EK, Nishijima D, Trent S, Eichelberger A, Ye Y, Audett A, Brasel K, Kazmierczak S, Cherpitel CJ. Cannabis presentations to the emergency department after MVC in the era of legalization for recreational use. JOURNAL OF SAFETY RESEARCH 2022; 80:341-348. [PMID: 35249614 DOI: 10.1016/j.jsr.2021.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/22/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The objectives of this study were to examine cannabis and alcohol use among injured patients presenting to emergency departments (ED) in cannabis-legal states to capture an expanded profile of cannabis use and evaluate differences in motor-vehicle collision (MVC) characteristics among those using cannabis alone and in combination with alcohol. METHODS This was a cross-sectional study of ED visits by drivers in MVC who presented to one of three study sites. Event-related and usual drug and alcohol use information were obtained using a detailed interviewer-administered computerized questionnaire. We also obtained data from blood and breathalyzer tests and the electronic medical record. We examined frequency and types of acute and past-year cannabis and alcohol use and crash mechanisms and characteristics. Our primary method of determining substance use was self-report; we used biosamples secondarily. RESULTS Eight percent of drivers reported cannabis use in the 8 h prior to MVC, alone or in combination with alcohol; however, a higher proportion (18%) were positive by biosample. High-risk crash features were common in MVCs associated with cannabis, as they were for alcohol use and co-use of cannabis and alcohol; however, patients injured seriously enough to require admission were less likely to report cannabis use (7% vs. 9%) and more likely to report alcohol use (16% vs. 10%). CONCLUSIONS Cannabis use was common among patients presenting after MVC in this sample of cannabis-legal states. Practical Applications: Differences between self-report and biosample data for cannabis and alcohol use were significant and supports the need to use both means of assessing acute use.
Collapse
Affiliation(s)
- Esther K Choo
- Oregon Health & Science University, Portland, OR, United States.
| | | | - Stacy Trent
- Denver Health Medical Center, Department of Emergency Medicine, Denver, CO, United States
| | | | - Yu Ye
- Alcohol Research Group, Emeryville, CA, United States
| | - Ariane Audett
- Oregon Health & Science University, Portland, OR, United States
| | - Karen Brasel
- Oregon Health & Science University, Portland, OR, United States
| | | | | |
Collapse
|
45
|
Burt TS, Brown TL, Schmitt R, McGehee D, Milavetz G, Gaffney G, Berka C. Perceived effects of cannabis: Generalizability of changes in driving performance. TRAFFIC INJURY PREVENTION 2022; 23:S8-S13. [PMID: 36622373 DOI: 10.1080/15389588.2022.2128787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The objective of this analysis was to determine the generalizability of the relationship between different samples of a driver's perceived state after cannabis use and related performance while operating a motor vehicle. METHODS Data were collected from 52 subjects in a study examining the effects of cannabis on driving performance. Data were analyzed using the SAS GLM Select procedure, using stepwise selection, with subjective effects, dosing condition (placebo vs. 6.18% delta-9-tetrahydrocannabinol [THC]), and driving context as independent measures. Correlation matrices of measures of driving performance against subjective responses and dosing condition used Pearson's and Spearman's test statistics, respectively. Results were compared to a prior study from a sample of 10 subjects. RESULTS Subjective perceptions of acute cannabis impairment remain significant predictors of driving performance and explain individual variability in driving performance degradation as well as the data, beyond that which can be explained by acute use of cannabis alone. However, the significant subjective predictors of driving performance differ between the current and prior studies. To better understand these differences, correlations between subjective effects and performance measures were evaluated, which revealed that most correlations matched directionally (e.g., an increase in "good drug effect" was correlated with an increase in standard deviation of lane position [SDLP]). When there was a mismatch, 1 or more correlations were insignificant. Dosing condition and "stoned" were perfectly consistent; "high" and "sedated" contained 1 mismatch; and "anxious," "good drug effect" and "restless" contained 3 or more mismatches. CONCLUSIONS The results indicate that across both studies, differences in the perceived effects of cannabis are reflected in changes in both lateral and longitudinal control beyond the acute effects of cannabis, which may help explain individual variability in response to acute intoxication. However, the generalizability of these findings is lacking, as shown by inconsistencies in when and where subjective effects were significant. Other factors such as frequency of use, usage type, the evolving profile of a cannabis user, as well as other individual differences should be considered to explain this additional variability.
Collapse
Affiliation(s)
- Thomas S Burt
- National Advanced Driving Simulator, University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, Iowa
| | - Timothy L Brown
- National Advanced Driving Simulator, University of Iowa, Iowa City, Iowa
| | - Rose Schmitt
- National Advanced Driving Simulator, University of Iowa, Iowa City, Iowa
| | - Daniel McGehee
- National Advanced Driving Simulator, University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, Iowa
| | - Gary Milavetz
- College of Pharmacy, University of Iowa, Iowa City, Iowa
| | - Gary Gaffney
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Chris Berka
- Advanced Brain Monitoring, Carlsbad, California
| |
Collapse
|
46
|
Traccis F, Presciuttini R, Pani PP, Sinclair JMA, Leggio L, Agabio R. Alcohol-medication interactions: A systematic review and meta-analysis of placebo-controlled trials. Neurosci Biobehav Rev 2021; 132:519-541. [PMID: 34826511 DOI: 10.1016/j.neubiorev.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/20/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
Alcohol and other xenobiotics may limit the therapeutic effects of medications. We aimed at investigating alcohol-medication interactions (AMI) after the exclusion of confounding effects related to other xenobiotics. We performed a systematic review and meta-analysis of controlled studies comparing the effects induced by alcohol versus placebo on pharmacodynamic and/or pharmacokinetic parameters of approved medications. Certainty in the evidence of AMI was assessed when at least 3 independent studies and at least 200 participants were available. We included 107 articles (3097 participants): for diazepam, cannabis, opioids, and methylphenidate, we found significant AMI and enough data to assign the certainty of evidence. Alcohol consumption significantly increases the peak plasma concentration of diazepam (low certainty; almost 290 participants), cannabis (high certainty; almost 650 participants), opioids (low certainty; 560 participants), and methylphenidate (moderate certainty; 290 participants). For most medications, we found some AMI but not enough data to assign them the certainty grades; for some medications, we found no differences between alcohol and placebo in any outcomes evaluated. Our results add further evidence for interactions between alcohol and certain medications after the exclusion of confounding effects related to other xenobiotics. Physicians should advise patients who use these specific medications to avoid alcohol consumption. Further studies with appropriate control groups, enough female participants to investigate sex differences, and elderly population are needed to expand our knowledge in this field. Short phrases suitable for indexing terms.
Collapse
Affiliation(s)
- Francesco Traccis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.
| | - Riccardo Presciuttini
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.
| | - Pier Paolo Pani
- Health Social Services Public Health Trust Sardinia, Cagliari, Italy.
| | | | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Basic Research, National Institutes of Health, Baltimore and Bethesda, MD, United States; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, United States; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States; Division of Addiction Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Neuroscience, Georgetown University, Washington, DC, United States.
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.
| |
Collapse
|
47
|
Znoj H, Genrich G, Zeller C, Koroma D. Cannabis use, attitudes, regulation and health: Survey data from an urban population of users and non-users. J Public Health Res 2021; 11. [PMID: 34814651 PMCID: PMC8958447 DOI: 10.4081/jphr.2021.2575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Although illegal in most countries, cannabis remains the most common illicit drug in Switzerland and worldwide. While there is growing evidence on adverse effects of cannabis use, most users do not report any problems or negative consequences. In the face of a sustained high prevalence of cannabis use and the recent legalization waves in different parts of the world, it is important to know how cannabis is perceived in the general population and how current users regulate their own use. The present study aims to investigate users’ and non-users’ attitudes towards cannabis regulations and towards current users. Additionally, self-rated health measures as well as protective behavioral strategies and other cannabis related variables were assessed. Design and methods: We collected data from 380 current users and 659 non-users who were recruited by invitation letter or online media platforms. The data was analyzed using basic descriptive statistical procedures. Results: Results revealed that both groups favor moderate cannabis regulation measures over prohibition and no regulation at all. On average, they report the same subjective health. Protective strategies are often used and are associated with better health and lower severity of dependence in cannabis users. Conclusions: Taken together, results indicate that safe use of cannabis is possible for most users, while there is a group of users at risk of 15-20%, which may benefit from control by regulatory measures. Significance for public health In the face of recent legalization waves in different parts of the world and the current public discourse on a possible legalization in Switzerland, it is important to know how cannabis is perceived in the general population and how current users regulate their own use. The manuscript contributes to the literature by showing that in Switzerland, users and non-users prefer a moderate regulation of cannabis over prohibition. Further, support is shown for recent findings that highlight the protective effect of behavioral strategies (measured by the Protective Behavioral Strategies for Marijuana, Pedersen et al.1) on adverse effects of marijuana, such as perceived dependence.
Collapse
Affiliation(s)
- Hansjörg Znoj
- Department of Health Psychology and Behavioural Medicine, Institute of Psychology, University of Bern.
| | - Gregor Genrich
- Department of Health Psychology and Behavioural Medicine, Institute of Psychology, University of Bern.
| | - Céline Zeller
- Department of Old Age Psychiatry and Psychotherapy, University Hospital for Mental Health, Bern.
| | - Dennis Koroma
- Department of Health Psychology and Behavioural Medicine, Institute of Psychology, University of Bern.
| |
Collapse
|
48
|
McCartney D, Arkell TR, Irwin C, Kevin RC, McGregor IS. Are blood and oral fluid Δ 9-tetrahydrocannabinol (THC) and metabolite concentrations related to impairment? A meta-regression analysis. Neurosci Biobehav Rev 2021; 134:104433. [PMID: 34767878 DOI: 10.1016/j.neubiorev.2021.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022]
Abstract
Blood and oral fluid Δ9-tetrahydrocannabinol (THC) concentrations are often used to identify cannabis-impaired drivers. We used meta-analytic techniques to characterise the relationships between biomarkers of cannabis use, subjective intoxication, and impairment of driving and driving-related cognitive skills. Twenty-eight publications and 822 driving-related outcomes were reviewed. Each outcome was measured in concert with one or more biomarkers of cannabis/THC use and/or subjective intoxication. Higher blood THC and 11-OH-THC concentrations, oral fluid THC concentrations and subjective ratings of intoxication were associated with greater impairment in 'other' (mostly occasional) cannabis users (p's<0.05). Blood 11-COOH-THC concentrations were associated with impairment after inhaling, but not orally ingesting, cannabis/THC. However t these 'biomarker-performance' relationships (R) were only very weak (blood THCpost-ingestion: -0.08; blood THCpost-inhalation: -0.10; blood 11-OH-THCpost-ingestion: -0.13), weak (blood 11-OH-THCpost-inhalation: -0.24; oral fluid THCpost-inhalation: -0.36; subjective intoxication: -0.29) or moderate (blood 11-COOH-THCpost-inhalation: -0.43) in strength. No significant biomarker-performance relationships were observed in 'regular' (weekly or more often) cannabis users (p's>0.10), although the analyses were less robust. Blood and oral fluid THC concentrations are relatively poor indicators of cannabis/THC-induced impairment.
Collapse
Affiliation(s)
- Danielle McCartney
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia.
| | - Thomas R Arkell
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Christopher Irwin
- Menzies Health Institute Queensland and School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Richard C Kevin
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
| | - Iain S McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
| |
Collapse
|
49
|
Zhu L, Pei W, DiCiano P, Brands B, Wickens CM, Foll BL, Kwong B, Parashar M, Sivananthan A, Mahadevan R. Physiologically-based pharmacokinetic model for predicting blood and tissue tetrahydrocannabinol concentrations. Comput Chem Eng 2021. [DOI: 10.1016/j.compchemeng.2021.107461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
50
|
Lira MC, Heeren TC, Buczek M, Blanchette JG, Smart R, Pacula RL, Naimi TS. Trends in Cannabis Involvement and Risk of Alcohol Involvement in Motor Vehicle Crash Fatalities in the United States, 2000‒2018. Am J Public Health 2021; 111:1976-1985. [PMID: 34709858 PMCID: PMC8630490 DOI: 10.2105/ajph.2021.306466] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To assess cannabis and alcohol involvement among motor vehicle crash (MVC) fatalities in the United States. Methods. In this repeated cross-sectional analysis, we used data from the Fatality Analysis Reporting System from 2000 to 2018. Fatalities were cannabis-involved if an involved driver tested positive for a cannabinoid and alcohol-involved based on the highest blood alcohol concentration (BAC) of an involved driver. Multinomial mixed-effects logistic regression models assessed cannabis as a risk factor for alcohol by BAC level. Results. While trends in fatalities involving alcohol have remained stable, the percentage of fatalities involving cannabis and cannabis and alcohol increased from 9.0% in 2000 to 21.5% in 2018, and 4.8% in 2000 to 10.3% in 2018, respectively. In adjusted analyses, fatalities involving cannabis had 1.56 (95% confidence interval [CI] = 1.48, 1.65), 1.62 (95% CI = 1.52, 1.72), and 1.46 (95% CI = 1.42, 1.50) times the odds of involving BACs of 0.01% to 0.049%, 0.05% to 0.079%, and 0.08% or higher, respectively. Conclusions. The percentage of fatalities involving cannabis and coinvolving cannabis and alcohol doubled from 2000 to 2018, and cannabis was associated with alcohol coinvolvement. Further research is warranted to understand cannabis- and alcohol-involved MVC fatalities. (Am J Public Health. 2021;111(11):1976-1985. https://doi.org/10.2105/AJPH.2021.306466).
Collapse
Affiliation(s)
- Marlene C Lira
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Timothy C Heeren
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Magdalena Buczek
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Jason G Blanchette
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Rosanna Smart
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Rosalie Liccardo Pacula
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Timothy S Naimi
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| |
Collapse
|