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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.
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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
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Gjerde H, Bogstrand ST, Jamt REG, Vindenes V. Crash-involved THC-positive drivers in Norway have a high frequency of polysubstance use. Drug Alcohol Depend 2023; 244:109800. [PMID: 36774807 DOI: 10.1016/j.drugalcdep.2023.109800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Tetrahydrocannabinol (THC) is the most frequently detected drug in blood samples from apprehended drug driving suspects in Norway. This investigation aimed to study the extent of polysubstance use among apprehended crash-involved drivers with THC concentrations above the legal limit and explore the importance of THC in polysubstance cases. METHODS We selected all drug driving cases where blood samples had been submitted for forensic toxicology testing after involvement in road traffic crashes during 2013-2020, except drivers who were fatally injured. RESULTS Twenty percent (n = 2133) of the 10,520 apprehended crash-involved drivers had concentrations of THC in their blood above the legal limit of 1.3 ng/mL, and 84 % of those also had concentrations of alcohol or other drugs above the legal limits; 61 % for sedatives, 38 % for stimulants, 33 % for alcohol, and 10 % for opioids. The most frequent substance combination was cannabis together with sedatives and stimulants (22.9 %; n = 488). Polysubstance use was least common among drivers under 24 years. The proportion of drivers with THC > 5 ng/mL was highest if the blood sample was collected within 90 min after the crash, and when only THC was detected. There was a statistically significant inverse association between THC > 5 ng/mL and concentrations of alcohol or amphetamines at the highest sanction level. CONCLUSIONS Most apprehended crash-involved THC-positive drivers also tested positive for other psychoactive substances. Drivers with high blood THC concentrations had less often high concentrations of other substances; cannabis might then have been a more important contributor to impairment.
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Affiliation(s)
- Hallvard Gjerde
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.
| | - Stig Tore Bogstrand
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Nursing and Health Promotion, Acute and Critical Illness, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ragnhild Elén Gjulem Jamt
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Vigdis Vindenes
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway; Department of Forensic Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Fischer B, Robinson T, Bullen C, Curran V, Jutras-Aswad D, Medina-Mora ME, Pacula RL, Rehm J, Room R, van den Brink W, Hall W. Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103381. [PMID: 34465496 DOI: 10.1016/j.drugpo.2021.103381] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Tessa Robinson
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Chris Bullen
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand
| | - Valerie Curran
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Maria Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico; Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosalie Liccardo Pacula
- Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Wim van den Brink
- Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia; National Addiction Centre, Institute of Psychiatry, Kings College London, United Kingdom
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4
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The why behind the high: determinants of neurocognition during acute cannabis exposure. Nat Rev Neurosci 2021; 22:439-454. [PMID: 34045693 DOI: 10.1038/s41583-021-00466-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/08/2022]
Abstract
Acute cannabis intoxication may induce neurocognitive impairment and is a possible cause of human error, injury and psychological distress. One of the major concerns raised about increasing cannabis legalization and the therapeutic use of cannabis is that it will increase cannabis-related harm. However, the impairing effect of cannabis during intoxication varies among individuals and may not occur in all users. There is evidence that the neurocognitive response to acute cannabis exposure is driven by changes in the activity of the mesocorticolimbic and salience networks, can be exacerbated or mitigated by biological and pharmacological factors, varies with product formulations and frequency of use and can differ between recreational and therapeutic use. It is argued that these determinants of the cannabis-induced neurocognitive state should be taken into account when defining and evaluating levels of cannabis impairment in the legal arena, when prescribing cannabis in therapeutic settings and when informing society about the safe and responsible use of cannabis.
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Aggressive Driving Behaviours in Cannabis Users. The Influence of Consumer Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083911. [PMID: 33917856 PMCID: PMC8068208 DOI: 10.3390/ijerph18083911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
This study analysed dangerous driving behaviours in twenty young occasional cannabis users through objective and self-reported data, studying the relationship between the two aspects. Visual function was assessed in a baseline session and after smoking cannabis, as well as speed-related behaviour in a driving simulator. The participants responded to questionnaires on sociodemographic factors, their consumption profile, and the incidence of dangerous behaviours (Dula Dangerous Driving Index; DDDI). After cannabis use, the results revealed a significant deterioration in visual function. In terms of speed management, they showed significantly greater acceleration force in the two different sections of the route, and they drove significantly faster. Our correlations indicate that males and heavier users display more risky speed management. Likewise, the heavier cannabis users admitted to increased dangerous driving behaviour, and an accident in the preceding year was associated with a trend towards aggressive driving behaviour according to the DDDI questionnaire. The findings of this study suggest that cannabis users adopt dangerous behaviours when driving, despite the effect this drug has on certain important functions, such as vision. The results suggest a need for awareness-raising and information campaigns.
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Scheunemann A, Elsner K, Germerott T, Hess C, Röhrich J. Simultaneous quantification of 18 different phytocannabinoids in serum using a highly sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1173:122685. [PMID: 33882447 DOI: 10.1016/j.jchromb.2021.122685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/22/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
The potential therapeutic effects of various phytocannabinoids and the availability of multiple cannabis-based medicines make it desirable to have an analytical method that simultaneously quantifies a wide range of cannabinoids in blood, beyond delta-9-tetrahydrocannabinol and its metabolites. A liquid chromatography tandem mass spectrometry (LC-MS/MS) method for quantification of 18 phytocannabinoids and cannabinoid metabolites in serum was developed and validated. The method enables simultaneous detection of delta-9-tetrahydrocannabinol, cannabidiol, cannabinol, cannabigerol, cannabichromene, cannabicyclol, tetrahydrocannabivarin and cannabidivarin and their acidic precursors tetrahydocannabinolic acid A, cannabidiolic acid, cannabinolic acid, cannabigerolic acid, cannabichromenic acid, cannabicyclolic acid, tetrahydrocannabivarinic acid and cannabidivarinic acid as well as the delta-9-tetrahydrocannabinol metabolites 11-hydroxy-tetrahydrocannabinol and 11-nor-9-carboxy-tetrahydrocannabinol. Limits of detection ranged from 0.0004 to 1 ng/mL and limits of quantification ranged from 0.004 to 2 ng/mL. Calibration curves of all analytes were linear over the whole calibration range. Recovery rates of 52 to 86% were obtained for all analytes except for cannabicyclol (49%), 11-nor-9-carboxy-tetrahydrocannabinol (46%), cannabichromenic acid (44%) and cannabidivarinic acid (36%). Acceptable bias and precision data were demonstrated for all analytes. The method was successfully applied to 55 forensic serum samples, obtained from the Institute of Legal Medicine Mainz.
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Affiliation(s)
- A Scheunemann
- Institute of Legal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 3, 55131 Mainz, Germany.
| | - K Elsner
- Institute of Legal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 3, 55131 Mainz, Germany
| | - T Germerott
- Institute of Legal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 3, 55131 Mainz, Germany
| | - C Hess
- Institute of Legal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 3, 55131 Mainz, Germany
| | - J Röhrich
- Institute of Legal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 3, 55131 Mainz, Germany
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Brands B, Di Ciano P, Mann RE. Cannabis, Impaired Driving, and Road Safety: An Overview of Key Questions and Issues. Front Psychiatry 2021; 12:641549. [PMID: 34489746 PMCID: PMC8416748 DOI: 10.3389/fpsyt.2021.641549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/01/2021] [Indexed: 12/19/2022] Open
Abstract
The road safety impact of cannabis has been a topic of much discussion and debate over the years. These discussions have been revitalized in recent years by initiatives in several jurisdictions to legalize non-medical cannabis. Canada became the second country to legalize non-medical cannabis use in October, 2018, preceded by Uruguay in December 2013. Road safety concerns were key issues in the Canadian government's deliberations on the issue. In this paper, we identify several key questions related to the impact of cannabis on road safety, and provide a consideration of the relevant literature on these questions. These questions cover several perspectives. From an epidemiological perspective, perhaps the central question is whether cannabis use contributes to the chances of being involved in a collision. The answer to this question has evolved in recent years as the ability to conduct the relevant studies has evolved. A related question is the extent to which cannabis plays an important role in road safety, and recent research has made progress in estimating the collisions, injuries, and deaths that may be attributed to cannabis use. Several questions relate to the behavioral and pharmacological effects of cannabis. One central question is whether cannabis affects driving skills in ways that can increase the chances of being involved in a collision. Another important question is whether the effects of the drug on the driving behavior of medical users is similar to, or different from, the effects on non-medical users and whether there are sex differences in the pharmacological and behavioral effects of cannabis. Other important questions are the impact of tolerance to the effects of cannabis on road safety as well as different routes of administration (e.g., edibles, vaped). It remains unclear if there is a dose-response relationship of cannabis to changes in driving. These and other key questions and issues are identified and discussed in this paper.
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Affiliation(s)
- Bruna Brands
- Health Canada, Ottawa, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Patricia Di Ciano
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health, Toronto, ON, Canada
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Beirness DJ, Gu KW, Lowe NJ, Woodall KL, Desrosiers NA, Cahill B, Porath AJ, Peaire A. Cannabis, alcohol and other drug findings in fatally injured drivers in Ontario. TRAFFIC INJURY PREVENTION 2020; 22:1-6. [PMID: 33275453 DOI: 10.1080/15389588.2020.1847281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of cannabis, alcohol and other drug use in drivers of motor vehicles who died in crashes in the Canadian province of Ontario from January 2016 through December 2018 along with the characteristics of these drivers and some of the circumstances of the crash in which they were involved. METHODS Toxicological tests were performed on blood samples obtained from 921 driver fatalities for whom postmortem blood samples were submitted to the Center of Forensic Sciences for analysis. The results were coded into a database along with basic demographic and crash characteristics and examined for prominent characteristics and patterns. RESULTS Overall, among the 921 cases examined, 495 (53.7%) tested positive for alcohol, cannabis (tetrahydrocannabinol or THC), or another psychoactive drug. The number of cases that tested positive for THC (251) exceeded the number of cases that tested positive for alcohol (241) as well as the number that tested positive for a drug other than THC (235). In 38% of positive cases, more than one substance was detected. Alcohol and THC were most commonly detected among males; females most frequently tested positive for a drug other than THC, notably medications with depressant effects. Alcohol-involved driver fatalities were most common on weekends and most likely involved single vehicle crashes. Driver fatalities that tested positive for THC or another drug were more evenly distributed throughout the week and were more likely to have been in multi-vehicle crashes. CONCLUSIONS The present study highlights the use of cannabis and other drugs by drivers. The patterns of crashes and the characteristics of drivers involved indicate that the characteristics of driver fatalities involving cannabis and/or other drug use differ from those of alcohol and require new, innovative approaches targeting high-risk times, groups and behaviors. Continued monitoring of the toxicological findings from blood samples obtained from drivers killed in motor vehicle crashes will be a key element in efforts to reduce the impact of drug use by drivers on road safety.
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Affiliation(s)
| | - Kai Wen Gu
- Centre of Forensic Sciences , Toronto , Canada
| | | | | | | | | | - Amy J Porath
- Canadian Centre on Substance Use and Addiction , Ottawa , Canada
| | - Amy Peaire
- Centre of Forensic Sciences , Toronto , Canada
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Nazif-Munoz JI, Oulhote Y, Ouimet MC. The association between legalization of cannabis use and traffic deaths in Uruguay. Addiction 2020; 115:1697-1706. [PMID: 32003494 DOI: 10.1111/add.14994] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/01/2019] [Accepted: 01/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS While cannabis use has been found to impair motor vehicle driving, the association between cannabis legalization and motor vehicle fatalities is unclear. In Uruguay in December 2013, cannabis for recreational purposes was legalized. This study assessed the association between implementation of this law and changes in traffic fatality rates. DESIGN Interrupted time-series analysis of traffic fatality rates of light motor vehicle drivers and motorcyclists in urban and rural settings. Changes are reported as step and trend effects against modeled trends in the absence of legalization. SETTING Uruguay, Montevideo and four rural provinces (Colonia, Florida, Río Negro and San José) from 1 January 2012 to 31 December 2017. Cases and measurement Weekly traffic fatalities of light motor vehicle drivers and motorcyclists per type of vehicle. Data were gathered from the National Road Safety Agency of Uruguay and the Ministry of Transport and Public Works, respectively. RESULTS Cannabis legalization was associated with a 52.4% immediate increase [95% confidence interval (CI) = 11.6, 93.3, P = 0.012] in the light motor vehicle driver's fatality rate. However, no significant change in the motorcyclists' fatality rate was observed. In Montevideo the legislation was associated with an absolute increase in its light motor vehicle driver's fatality rate by 0.06 (95% CI = 0.01, 0.11, P = 0.025), but no significant associations were observed in rural settings. CONCLUSIONS In Uruguay, the 2013 legislation legalizing recreational cannabis consumption may have been associated with an increase in fatal motor vehicle crashes, particularly in light motor-vehicle drivers and urban settings.
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Affiliation(s)
- Jose Ignacio Nazif-Munoz
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada.,T. H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Youssef Oulhote
- School of Public Health, University of Massachusetts, Amherst, MA, USA
| | - Marie Claude Ouimet
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
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Ramaekers JG, Mason NL, Theunissen EL. Blunted highs: Pharmacodynamic and behavioral models of cannabis tolerance. Eur Neuropsychopharmacol 2020; 36:191-205. [PMID: 32014378 DOI: 10.1016/j.euroneuro.2020.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/22/2019] [Accepted: 01/12/2020] [Indexed: 02/07/2023]
Abstract
Acute exposure to cannabis comes with neurocognitive impairment, leading to increased risk of human error and injury. Evidence however indicates that such acute effects are less prominent in chronic users, suggesting cannabis tolerance. Models of cannabis tolerance stress the importance of neurobiological or behavioral adaptations following repeated cannabis exposure. The pharmacodynamic model relates neuroadaptive changes in the brain to a blunted response to cannabis. Downregulation of CB1 receptors in chronic cannabis users has been associated with a normalization of dopaminergic output from the ventral tegmental area to the mesolimbic circuit, and a reduction of impairment during acute cannabis exposure. Such neuroadaptions are absent in occasional users, who show strong increments of dopamine and glutamate levels in the striatum, a loss of functional connectivity within the mesolimbic circuit and neurocognitive impairments when exposed to cannabis. Evidence for a behavioral model of cannabis tolerance that poses that users can have volitional control to overcome functional impairment during cannabis intoxication is relatively weak, and at best shows limited control over a limited number of behavioral functions. Cannabis tolerance is most likely to occur in users that consume high doses of cannabis continuously, at a high pace, for a prolonged period of time. Knowledge on frequency, dose and duration of cannabis use that is needed to achieve, maintain or lessen tolerance however is very limited, but will be of importance in the context of cannabis therapeutics and in legal settings when evaluating the impact of cannabis exposure on human function.
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Affiliation(s)
- J G Ramaekers
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, the Netherlands.
| | - N L Mason
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, the Netherlands
| | - E L Theunissen
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, the Netherlands
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Brown T, Banz B, Li K, Camenga D, Vaca F, Gaffney G, Milavetz G. Variability of baseline vehicle control among sober young adult cannabis users: A simulator-based exploratory study. TRAFFIC INJURY PREVENTION 2019; 20:S145-S148. [PMID: 31674851 DOI: 10.1080/15389588.2019.1661676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: The objective of this study was to compare the variability in vehicle control for sober young adult drivers (18-23 years old) who either use cannabis but are not acutely exposed or do not use cannabis.Methods: The data analyzed in the study were from 4 prospective driving simulation studies (completed at the National Advanced Driving Simulator at the University of Iowa) that examined vehicle control metrics in cannabis users and nonusers across high-fidelity simulated urban, interstate, and rural driving environments. Data were collected for segments of consistent driving environments including urban driving, urban curves, interstate, interstate curves, dark rural, and rural straight. Dependent measures included measures of lateral and longitudinal vehicle control.Results: Thirty out of 72 (12 users and 18 nonusers) met the age requirements for inclusion in the analysis. Between the cohorts, we identified differences in lateral and longitudinal driving performance. For lateral control there were no observed effects on variability in lane keeping. Cannabis users exhibited lower frequency steering and fewer and less variable steering reversals compared to nonusers. For longitudinal control, cannabis users drove slower than nonusers and more accelerator pedal holds and a lower accelerator pedal reversal rate were observed.Conclusions: Young adult drivers who use cannabis in our study drove slower and produced significantly less frequent steering and accelerator pedal inputs than drivers who did not use cannabis. This suggests that lasting effects of cannabis use persist and may lead to detrimental driving behaviors even after intoxication has subsided. These findings have implications for legislation in support of legalizing cannabis because sober cannabis-using drivers may still be a public health concern. Further study is needed to evaluate whether these differences persist even with longer term abstinence and whether differences are found in other age demographics.
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Affiliation(s)
- Timothy Brown
- National Advanced Driving Simulator, The University of Iowa, Iowa City, Iowa
| | - Barbara Banz
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Kaigang Li
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
| | - Deepa Camenga
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Federico Vaca
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Gary Gaffney
- Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Gary Milavetz
- College of Pharmacy, The University of Iowa, Iowa City, Iowa
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Abstract
Abstract
Traffic medicine is an important part within the scope of concerns of forensic medicine. We are dealing with consequences of traffic accidents – fatal or survived – but this problem overlaps the borders of our specialization. Sustained injuries are the focus of various fields of medicine and in combination with alcohol and illicit drugs abuse this issue is growing. The following review has an ambition to bring more light into the problem concerning the effect of alcohol and cannabis (which is the most common illicit drug used worldwide) on driving abilities.
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Sobolesky PM, Smith BE, Hubbard JA, Stone J, Marcotte TD, Grelotti DJ, Grant I, Fitzgerald RL. Validation of a liquid chromatography-tandem mass spectrometry method for analyzing cannabinoids in oral fluid. Clin Chim Acta 2019; 491:30-38. [PMID: 30615854 PMCID: PMC10885733 DOI: 10.1016/j.cca.2019.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
A liquid chromatography tandem mass spectrometry method was developed for quantifying ten cannabinoids in oral fluid (OF). This method utilizes OF collected by the Quantisal™ device and concurrently quantifies cannabinol (CBN), cannabidiol (CBD), Δ9-tetrahydrocannabinol (THC), 11-hydroxy-Δ9-THC (11-OH-THC), 11-nor-9-carboxy-Δ9-THC (THC-COOH), 11-nor-9-carboxy-Δ9-THC glucuronide (THC-COOH-gluc), Δ9-THC glucuronide (THC-gluc), cannabigerol (CBG), tetrahydrocannabiverin (THCV), and Δ9-tetrahydrocannabinolic acid A (THCA-A). Solid phase extraction was optimized using Oasis Prime HLB 30 mg 96-well plates. Cannabinoids were separated by liquid chromatography over a BEH C18 column and detected by a Waters TQ-S micro tandem mass spectrometer. The lower limits of quantification (LLOQ) were 0.4 ng/mL for CBN, CBD, THC, 11-OH-THC, THC-gluc, and THCV; and 1.0 ng/mL for THC-COOH, THC-COOH-gluc, CBG and THCA-A. Linear ranges extended to 2000 ng/mL for THC and 200 ng/mL for all other analytes. Inter-day analytical bias and imprecision at three levels of quality control (QC) was within ±15%. Mean extraction efficiencies ranged from 26.0-98.8%. Applicability of this method was tested using samples collected from individuals randomly assigned to smoke either a joint containing <0.1%, 5.9%, or 13.4% THC content. This method was able to identify and calculate the concentration of 6 of 10 cannabinoids validated in this method.
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Affiliation(s)
- Philip M Sobolesky
- Department of Pathology, Center for Advanced Laboratory Medicine, University of California, San Diego Health, San Diego, CA, USA.
| | - Breland E Smith
- Department of Pathology, Center for Advanced Laboratory Medicine, University of California, San Diego Health, San Diego, CA, USA; Insource Diagnostics, Monrovia, CA, USA
| | - Jacqueline A Hubbard
- Department of Pathology, Center for Advanced Laboratory Medicine, University of California, San Diego Health, San Diego, CA, USA
| | - Judy Stone
- Department of Pathology, Center for Advanced Laboratory Medicine, University of California, San Diego Health, San Diego, CA, USA
| | - Thomas D Marcotte
- Department of Psychiatry, Center for Medicinal Cannabis Research, University of California San Diego, San Diego, CA, USA
| | - David J Grelotti
- Department of Psychiatry, Center for Medicinal Cannabis Research, University of California San Diego, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, Center for Medicinal Cannabis Research, University of California San Diego, San Diego, CA, USA
| | - Robert L Fitzgerald
- Department of Pathology, Center for Advanced Laboratory Medicine, University of California, San Diego Health, San Diego, CA, USA
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Impact of Cannabis Use on Road Traffic Collisions and Safety at Work: Systematic Review and Meta-analysis. CANADIAN JOURNAL OF ADDICTION 2019. [DOI: 10.1097/cxa.0000000000000046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Rogeberg O. A meta-analysis of the crash risk of cannabis-positive drivers in culpability studies-Avoiding interpretational bias. ACCIDENT; ANALYSIS AND PREVENTION 2019; 123:69-78. [PMID: 30468948 DOI: 10.1016/j.aap.2018.11.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/17/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Culpability studies, a common study design in the cannabis crash risk literature, typically report odds-ratios (OR) indicating the raised risks of a culpable accident. This parameter is of unclear policy relevance, and is frequently misinterpreted as an estimate of the increased crash risk, a practice that introduces a substantial "interpretational bias". METHODS A Bayesian statistical model for culpability study counts is developed to provide inference for both culpable and total crash risks, with a hierarchical effect specification to allow for meta-analysis across studies with potentially heterogeneous risk parameter values. The model is assessed in a bootstrap study and applied to data from 13 published culpability studies. RESULTS The model outperforms the culpability OR in bootstrap analyses. Used on actual study data, the average increase in crash risk is estimated at 1.28 (1.16-1.40). The pooled increased risk of a culpable crash is estimated as 1.42 (95% credibility interval 1.11-1.75), which is similar to pooled estimates using traditional ORs (1.46, 95% CI: 1.24-1.72). The attributable risk fraction of cannabis impaired driving is estimated to lie below 2% for all but two of the included studies. CONCLUSIONS Culpability ORs exaggerate risk increases and parameter uncertainty when misinterpreted as total crash ORs. The increased crash risk associated with THC-positive drivers in culpability studies is low.
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Jacobina OMP, Ventura CAA. PERCEPTION OF STUDENTS OF A PUBLIC UNIVERSITY ON THE RISK AND DRIVING OF AN AUTOMOTIVE VEHICLE UNDER THE EFFECT OF ALCOHOL AND MARIJUANA. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-cicad-23-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: to investigate the relationship between risk perception and behaviors related to the driving of motor vehicle under the effect of alcohol and/or marijuana of students of a public university between 18 and 29 years; investigating the relationship between driving under influence, students' social network, and driving-related behaviors under the influence of alcohol and/or marijuana. Method: a transversal questionnaire was applied to 383 students. Inferential and descriptive statistics were used for data analysis, processed by SPSS. Results: are students who have used alcohol and marijuana; 37.1% presented problematic use of alcohol and 22.0% of marijuana. Regarding the correlations, the variables related to the use of marijuana were those that presented greater significance. The lower the perceived risk, the greater the possibility of hitchhiking with those who have used marijuana, that is, there is a strong association between taking a ride with someone who has driven under marijuana and the perception of risk of being detected, receiving sanction or suffer any harm (p<0.01). Conclusion: It is clear that in Brazil the emphasis on alcohol use prevention policies should also address issues related to marijuana use and student social networks.
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Hall W. How should we respond to cannabis-impaired driving? Drug Alcohol Rev 2018; 37:3-5. [PMID: 29345082 DOI: 10.1111/dar.12651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/04/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.,National Addiction Centre, King's College London, London, UK
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Rogeberg O, Elvik R, White M. Correction to: 'The effects of cannabis intoxication on motor vehicle collision revisited and revised' (2016). Addiction 2018; 113:967-969. [PMID: 29359364 DOI: 10.1111/add.14140] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/12/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Ole Rogeberg
- Ragnar Frisch Centre for Economic Research, Oslo, Norway
| | - Rune Elvik
- Institute of Transport Economics, Norwegian Centre for Transport Research, Oslo, Norway
| | - Michael White
- School of Psychology, University of Adelaide, South Australia
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Abstract
Lab studies have shown that marijuana can severely impair driving skills. Epidemiological studies, however, have been inconclusive regarding the contribution of marijuana use to crash risk. In the United States, case-control studies based on the merging of comparable crash Fatality Analysis Reporting System (FARS) and non-crash National Roadside Survey (NRS) data have been applied to assess the contribution of drugs to crash risk, but these studies have yielded confusing, even contradictory results. We hypothesize that such a divergence of results emanates from limitations in the databases used in these studies, in particular that of the FARS. The goal of this effort is to examine this hypothesis, and in doing so, illuminate the pros and cons of using these databases for drugged-driving research efforts. We took advantage of two relatively recent cannabis crash risk studies that, despite using similar databases (the FARS and the NRS) and following similar overall approaches, yielded opposite results (Li, Brady, & Chen, 2013; Romano, Torres-Saavedra, Voas, & Lacey, 2014). By identifying methodological similarities and differences between these efforts, we assessed how the limitations of the FARS and NRS databases contributed to contradictory and biased results. Because of its limitations, we suggest that the FARS database should neither be used to examine trends in drug use nor to obtain precise risk estimates. However, under certain conditions (e.g., based on data from jurisdictions that routinely test for drugs, with as little variation in testing procedures as possible), the FARS database could be used to assess the contribution of drugs to fatal crash risk relative to other sources of risk such as alcohol.
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Corrigendum. Addiction 2017; 112:185. [PMID: 27936509 DOI: 10.1111/add.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rogeberg O, Elvik R. Response: Cannabis intoxication, recent use and road traffic crash risks. Addiction 2016; 111:1495-8. [PMID: 27324455 DOI: 10.1111/add.13443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/04/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ole Rogeberg
- Frisch Centre for Economic Research, Gaustadalléen 21, Oslo, 0349, Norway.
| | - Rune Elvik
- Institute of Transport Economics, Oslo, Norway
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