Working to Reform Marijuana Laws

CannabisandDriving:
AScientificandRationalReview (2011Update)

PaulArmentano DeputyDirector NORML|NORMLFoundation September12,2011

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Policydebatesregardingmarijuanalawreforminvariablyraisethequestion:"Howdoessociety addressconcernsregardingcannabisconsumptionanddriving?"Thesubjectisworthyofserious discussion.NORML'sBoardofDirectorsaddressedthisissuebyratifyinga"nodriving"clausetothe organization's"PrinciplesofResponsibleCannabisUse"[1]stating,"Althoughcannabisissaidbymost expertstobesaferwithmotoriststhanalcoholandmanyprescriptiondrugs,responsiblecannabis consumersneveroperatemotorvehiclesinanimpairedcondition." Nevertheless,questionsremainregardingthedegreetowhichcannabisintoxicationimpairsactual drivingperformance.Unlikealcohol,whichisknowntoincreasedrivers'risktakingbehaviorandisa primarycontributorinonroadaccidents,marijuana'sacuteimpactonpsychomotorskillsissubtle anditsrealworldimpactinautomobilecrashesisinconclusive. DruggedDriving:TrueThreatOrFalsePanic? Surveydataindicatesthatapproximately112millionAmericans(46percentoftheUSpopulation) haveexperimentedwiththeuseofillicitsubstances.[2]Ofthese,morethan20million(8.3percentof thepopulation)selfidentifyas"current"or"monthly"usersofillicitdrugs,[3]andmorethan10 millionAmericanssaythatthey'veoperatedamotorvehiclewhileundertheinfluenceofanillicit substanceinthepastyear.[4]Thesetotals,whilefarfromnegligible,suggestthattheprevalenceof illicitdruguseamongUSdriversisfarlessthantheprevalenceofalcoholamongthissame population.[5] Todate,"[The]roleof[illicit]drugsasacausalfactorintrafficcrashesinvolvingdrugpositivedrivers isstillnotwellunderstood."[6]Whilesomestudieshaveindicatedthatillicitdruguseisassociated withanincreasedriskofaccident,arelationshiphasnotyetbeenclearlyestablishedregardingthe useofpsychoactivesubstancesandcrashseverity.[7]Somereviewsoftrafficfatalitydataindicate that,ingeneral,driverswiththepresenceofillicitdrugsintheirsystempossessanenhancedfatality riskcomparedtosoberdrivers.However,thisriskisfarlowerthanthefatalityriskassociatedwith driverswhooperateavehiclewiththepresenceofalcoholintheirsystemaboveornearthelegal limitforintoxication.[8]Accordingtoonereviewoftheliterature:"Theriskofalldrugpositivedrivers comparedtodrugfreedriversissimilartodriverswithabloodalcoholconcentrationof0.05%.The riskisalsosimilartodriversaboveage60comparedtoyoungerdrivers[aroundage35]."[9] Marijuanaisthemostcommonillicitsubstanceconsumedbypersonswhoreportdrivingafterdrug use.[10]Epidemiologicalresearchalsoindicatesthatcannabisisthemostprevalentillicitdrug detectedinfatallyinjureddriversandmotorvehiclecrashvictims.[11]Reasonsforthisfactare twofold.One,cannabisisbyfarthemostwidelyusedillicitdrugamongtheUSpopulation,with nearlyoneoutoftwoAmericansadmittinghavingtriedit.[12]Two,marijuanaisthemostreadily detectableillicitdrugintoxicologicaltests.Marijuana'sprimarypsychoactivecompound,THC,may accumulateandbedetectedinbloodforseveralhoursinoccasionalusers;insomechronicusers, THCmaybepresentinbloodforaperiodofdaysafterpastuse,[1315]longafteranyperformance impairingeffectshavewornoff.[16]Inaddition,nonpsychoactivebyproductsofcannabis,knownas
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metabolites,maybedetectedintheurineofregularusersfordaysorweeksafterpastuse.[17](Other commonillicitsubstances,suchascocaineormethamphetamine,donotpossesssuchlonghalf lives.)Therefore,thesubstance'sprevalenceintoxicologicalevaluationsofUSdriversdoesnot necessarilyindicatethatitisafrequentorsignificantcausalfactorinautoaccidents.Infact,states thathaveexperiencedasignificantincreaseinthetotalnumberofauthorizedmedicalcannabis usershaveingeneralexperiencednoproportionalcorrespondingriseintrafficfatalities,andmost haveexperiencedadeclineinoverallfatalaccidents.[18] CruisingOnCannabis:ClarifyingTheDebate Whileitiswellestablishedthatalcoholconsumptionincreasesaccidentrisk,evidenceof marijuana'sculpabilityinonroaddrivingaccidentsandinjuryisfarlessclear.Althoughacute cannabisintoxicationfollowinginhalationhasbeenshowntomildlyimpairpsychomotorskills,this impairmentisseldomsevereorlonglasting.[1920](Bycontrast,virtuallynopublishedresearchexists assessingtheoralingestionofcannabisediblesonpsychomotorperformance).Inclosedcourseand drivingsimulatorstudies,marijuana'sacuteeffectsonpsychomotorperformanceincludeminor impairmentsintracking(eyemovementcontrol)andreactiontime(breaklatency),aswellas variationinlateralpositioning(weaving),headway(driversundertheinfluenceofcannabistendto followlesscloselytothevehicleinfrontofthem),andspeed(driverstendtodecreasespeed followingcannabisinhalation).[21]Notably,theseimpairmentsinperformancearemorelikelytobe manifestedindriversimulatorteststhaninassessmentsofactualonroadbehavior,wherechanges inperformanceareconsistentlynominal.[22]Forexample,A2001studyevaluatingtheimpactof marijuanaintoxicationondrivingproficiencyoncitystreetsamongsixteensubjectsreported essentiallynodifferencesinsubjects'drivingperformanceaftercannabisadministration, concluding:"PerformanceasratedontheDrivingProficiencyScaledidnotdifferbetween treatments.ItwasconcludedthattheeffectsoflowdosesofTHC...onhigherleveldrivingskillsas measuredinthepresentstudyareminimal."[23]Similarly,a1993trialfundedbytheUnitedStates NationalHighwayTrafficAssociation(NTHSA)evaluatedsubjects'drivingperformanceafter cannabisinhalationinhighdensityurbantraffic.Investigatorsreported,"Marijuana...didnot significantlychangemeandrivingperformance."[24] Ingeneral,cannabisinducedvariationsindrivingbehavior,whenpresent,arelessconsistentor pronouncedthantheimpairmentsexhibitedbysubjectsundertheinfluenceofalcohol.[25]Unlike subjectsimpairedbyalcohol,individualsundertheinfluenceofcannabistendtobeawareoftheir impairmentandtrytocompensateforitaccordingly,eitherbydrivingmorecautiously[26]orby expressinganunwillingnesstodrivealtogether.[27]Further,numerousstudiesreportthat experiencedcannabisusersdeveloptolerancetomanyofthechangesincognitiveorpsychomotor performanceassociatedwithacutecannabisintoxication.[2830]Mostrecently,a2010doubleblind, placebocontrolledstudyof21heavycannabisusersassessedtheimpactofalcoholorTHC inhalationonmeasuresofperceptualmotorcontrol(criticaltrackingtask),dualtaskprocessing (dividedattentiontask),motorinhibition(stopsignaltask),andcognition(TowerofLondon). Authorsreported:"Alcoholsignificantlyimpairedcriticaltracking,dividedattention,andstopsignal
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performance.THCgenerallydidnotaffecttaskperformance."Theyconcluded,"[T]hepresentstudy generallyconfirmsthatheavycannabisusersdeveloptolerancetotheimpairingeffectsofTHCon neurocognitivetaskperformance."[31] Asaresult,cannabisinducedvariationsinperformancedonottypicallyappeartoplayasignificant roleinonroadtrafficaccidentswhentheTHClevelspresentinadriver'sbloodarelowand/or cannabisisnotconsumedincombinationwithalcohol.[3233]Forexample,a1993NationalHighway TrafficSafetyAdministrationreviewoftheroleofdruguseinfatalaccidentsreported,"[T]hereis littleifanyevidencetoindicatethatdriverswhohaveusedmarijuanaaloneareanymorelikelyto causeseriousaccidentsthandrugfreedrivers."[34]AmorerecentassessmentbyBlowsand colleaguesnotedthatselfreportedrecentuseofcannabis(withinthreehoursofdriving)wasnot significantlyassociatedwithcarcrashinjuryafterinvestigatorscontrolledforspecificcofounders (e.g.,seatbeltuse,sleepiness,etc.)[35]A2004observationalcasecontrolstudypublishedinthe journalAccident,AnalysisandPreventionreportedthatonlydriversundertheinfluenceofalcohol orbenzodiazepinesexperienceanincreasedcrashriskcomparedtodrugfreecontrols.Investigators didobserveincreasedrisksthoughtheywerenotstatisticallysignificantamongdriversusing amphetamines,cocaineandopiates,butfound,"Noincreasedriskforroadtraumawasfoundfor driversexposedtocannabis."[36] Alimitednumberofmorerecentstudiesandreviewshavepostulatedapositiveassociation betweenpresumedrecent,dosedependentcannabisexposureandagraduallyincreasedriskof vehicleaccident.[3739]However,thiselevatedriskwasbelowtheriskassociatedwithdriverswhohad consumedevensmallquantitiesofalcohol. A2007casecontrolstudypublishedintheCanadianJournalofPublicHealthreviewed10yearsof USautofatalitydata.InvestigatorsfoundthatUSdriverswithbloodalcohollevelsof0.05%alevel wellbelowthelegallimitforintoxicationwerethreetimesaslikelytohaveengagedinunsafe drivingactivitiespriortoafatalcrashascomparedtoindividualswhotestedpositivefor marijuana.[40]A2005reviewofautoaccidentfatalitydatafromFrancereportedsimilarresults, findingthatdriverswhotestedpositiveforanyamountofalcoholhadafourtimesgreaterriskof havingafatalaccidentthandiddriverswhotestedpositiveformarijuanaintheirblood.[41]Inthe latterstudy,evendriverswithlowlevelsofalcoholpresentintheirblood(below0.05%) experiencedagreaterelevatedriskascomparedtodriverswhotestedpositiveforhigher concentrationsofcannabis(above5ng/ml).Bothstudiesnotedthatoverallfewtrafficaccidents appearedtobeattributedtodriver'soperatingavehiclewhileimpairedbycannabis. Followingthepublicationofthesepapers,variousinvestigatorshaveattemptedtoassociatespecific THCbloodlevelstodriverimpairment.[4243]However,therearemanyreasonswhysuchan associationshouldbeinterpretedwithextremecaution.First,peakTHCbloodlevelsfollowing inhalationdonotconsistentlycorrespondwithlevelsofpeakimpairment.[44](Infact,subjectswho inhaleTHCtypicallyascertaintheirhighestTHCbloodlevelswithinminutes,wellbeforethedrugs
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impairingeffectshavereachedtheirpeak.)Asaresult,itisvirtuallyimpossibletomakeinferences regardingasubject'simpairmentbaseduponthepresenceofTHCaloneinasinglesample.[4546] Second,cannabis'effectonpsychomotorperformancevarieswidelyamongindividualsubjects, particularlyamongthosewhoarecannabisexperiencedversusthosewhoarenaive.Asaresultof theseextremevariations,evenexpertswhoareonrecordinsupportofestimatedblood/THC impairmentstandardsacknowledgethatsuchthresholds"arenotnecessarilyapplicabletoeachand everydriveranindividual."[47] Third,recentstudiesofchroniccannabisconsumersindicatethatresiduallevelsofTHCmaybe presentinbloodwithoutassociatedimpairmentofperformanceforseveraldaysafterpastuse.[4849] ThisaccumulationofTHCinchronicconsumers"leadstocannabinoidconcentrationsinsober phasesthatresembleconcentrationsfoundinoccasionalusersafteracutecannabisuse,"[50]thus makingtheuniversalapplicationofaspecificblood/THCimpairmentstandardinappropriate. Finally,atthistimethereisnopracticalmethodforlawenforcementofficersatthescenetocollect bloodsamplesfromsuspectedDUIcannabisdriversinatimelymanner.Thisdelayincollection (whichmaytypicallybeaslongasseveralhours),combinedwiththeTHC'scomplexand inconsistentpharmacokinetics,makeitimpossibletoinferwhether,ortowhatextent,asubject waspreviouslyimpairedbasedsolelyonapositivebloodtestresult.[51] Forthesereasons,NORMLdoesnotendorsetheimpositionofperselawsfordriverswhotest positiveforTHCinthebloodwithoutadditionaldemonstrableevidenceofpsychomotor impairment.Inparticular,NORMLopposestheimpositionofsocalled'zerotolerance'perse standards,whichlegallydefineamotoristimpairedifheorshetestspositiveforthepresenceof anyamountofTHCorTHCmetaboliteintheirbloodorurine.[52] DefiningARational'DruggedDriving'Policy Theabovereviewillustratestheneedforfurthereducationandunderstandingregardingtheeffects ofcannabisupondrivingbehavior.Whileitsadverseimpactonpsychomotorskillsislesssevere thantheeffectsofalcohol,drivingundertheacuteinfluenceofcannabisstillmayposeanelevated riskofaccidentincertainsituations,especiallyamonginexperiencedcannabisconsumers.However, becausemarijuana'spsychomotorimpairmentissubtleandshortlived,consumerscangreatly reducethisriskbyrefrainingfromdrivingforaperiodofseveralhoursimmediatelyfollowingtheir cannabisuse. Bycontrast,motoristsshouldneverbeencouragedtooperateavehiclewhilesmokingcannabis. Driversshouldalsobeadvisedthatengaginginthesimultaneoususeofbothcannabisandalcohol caninsomeinstancessignificantlyincreasetheirriskofaccidentcomparedtotheconsumptionof eithersubstancealone.[53]Pastuseofcannabis,asdefinedbythedetectionsolelyofinactive cannabismetabolitesintheurineofdrivers,isnotassociatedwithanincreasedaccidentrisk.[54]
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Educationalorpublicservicecampaignstargetingdruggeddrivingbehaviorshouldparticularlybe aimedtowardtheyoungerdrivingpopulationage18to25asthisgroupismostlikelyuse cannabis[55]andreporthavingoperatedamotorvehicleshortlyafterconsumingpot.[56]Inaddition, thispopulationmayhavelessdrivingexperience,maybemorepronetoengageinrisktaking behavior,andmaybemorenavetopot'spsychoactivityascomparedtoolder,moreexperienced populationswhoaremorelikelytobetoleranttothedrug'sperformanceimpairingeffects.This youngerpopulationalsoreportsagreaterlikelihoodforhavingdrivenafterusingcannabisin combinationswithotherillicitdrugsoralcohol.[57]Suchaneducationalcampaign[58]was implementednationwideinCanadabytheCanadianPublicHealthAssociationandcouldreadilybe replicatedintheUnitedStates.Arguably,suchacampaignwouldenjoyenhancedcredibilityif coordinatedbyaprivatepublichealthassociationortrafficsafetyorganization,suchasthe AmericanPublicHealthAssociationortheAAAAutomobileClub,asopposedtothefederalOfficeof NationalDrugControlPolicywhosepreviouspublicservicecampaignshavedemonstratedlimited influenceamongyoungeraudiences.[59]Mostrecently,theColoradoDepartmentofTransportation launcheditsown'druggeddrivingawareness'campaignatthestatewidelevel.[60] Finally,increasedeffortsshouldbemadewithinthelawenforcementcommunitytotrainofficers andDREs(drugrecognitionexperts)tobetteridentifydriverswhomaybeoperatingavehiclewhile impairedbymarijuana.ChangesmayalsobeadoptedtoroadsideStandardizedFieldSobrietyTest makingtheseevaluationsmoresensitivetodriverswhomaybeundertheinfluenceofcannabis. Preliminaryscientificevaluationsofthesetestsincontrolledconditionshaveshownthatsubjects' performanceduringmodifiedSFSTsmaybepositivelyassociatedwithdoserelatedlevelsof marijuanaimpairment.[61] Thoughthedevelopmentofroadsidecannabisspecificdetectiontesting(similartoanalcohol breathalyzertest)isstillinitsinfancy,anargumentmaybemadefortheprovisionaluseofsuch testsbyspeciallytrainedmembersoflawenforcement.Inaddition,thedevelopmentofpointof collectioncannabissensitivetechnologytorapidlyidentifythepresenceofTHCindrivers,suchasa roadsidesalivatest,wouldprovideutilitytolawenforcementintheireffortstobetteridentify suspectedintoxicateddrivers.Thedevelopmentofsuchtechnologywouldalsoincreasepublic supportforthetaxationandregulationofcannabisbyhelpingtoassuageconcernsthatliberalizing marijuanapoliciescouldpotentiallyleadtoanincreaseinincidencesofdruggeddriving.[62]Such concernsareasignificantimpedimenttotheenactmentofmarijuanalawreform,andarguably mustbesufficientlyaddressedbeforeamajorityofthepublicwillembraceanypublicpolicythat proposesregulatingadultcannabisuselikealcohol. ###
PaulArmentanoistheDeputyDirectorofNORMLandtheNORMLFoundation.Mr.Armentanoisanationallyrecognized expertinthefieldofmarijuanapolicy,health,pharmacology,andpharmacokinetics.Hehasattendedvarious internationalconferencesonthesubjectofcannabisandtoxicology,includingthosesponsoredbytheSocietyofForensic

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Toxicologists(SOFT),theAmericanAcademyofForensicSciences(AAFS),andTheInternationalCouncilonAlcohol,Drugs &TrafficSafety(ICADTS).Hehascoordinatedcampaignandlobbyingeffortsinnumerousstatespertainingtodrugged drivingandhewasanindependentconsultantontheCanadianPublicHealthAssociation's"PotandDriving"campaign, aprojecttoincreaseawarenessamongyoungCanadiansage14to18abouttherisksofcannabisimpaireddriving.Mr. Armentanohasauthoredpeerreviewedpapersonthesubjectofmarijuana,driving,andpublicpolicy,includingmost recently'DrivingUndertheInfluence,'whichappearsinThePotBook:ACompleteGuidetoCannabisIt'sRolein Medicine,Politics,Science,andCulture(editor:JulieHolland,M.D.,ParkStreetPress,2010).Hemaybecontactedviae mailat:paul@norml.org. Footnotes [1]AdoptedbyNORML'sBoardofDirectors,February3,1996.ReadallofNORML's"PrinciplesofResponsibleUse" [2]USDepartmentofJustice,BureauofJusticeStatistics.DrugandCrimeFacts:DrugUseAmongtheGeneral Population.OnlinedocumentaccessedNovember24,2007. [3]USDepartmentofHealthandHumanServices,SubstanceandMentalHealthServicesAssociation,OfficeofApplied Studies.2006NationalSurveyonDrugUseandHealth:NationalResults.OnlinedocumentaccessedNovember24, 2007. [4]Ibid. [5]USDepartmentofTransportation,NationalHighwayTrafficSafetyAdministration.StateofKnowledgeofDrugged Driving:FINALREPORT.September2003. [6]Ibid. [7]Sminketal.2005.Druguseandtheseverityoftrafficaccident.Accident,AnalysisandPrevention37:427433. [8]FranjoGrotenhermen.DrugsandDriving:ReviewfortheNationalTreatmentAgency,UK.NovaInstitut(Germany). November2007. [9]Ibid. [10]USDepartmentofHealthandHumanServices,SubstanceandMentalHealthServicesAssociation,OfficeofApplied Studies.DrivingAfterDrugorAlcoholUse,1998.OnlinedocumentaccessedNovember24,2007. [11]USDepartmentofTransportation.2003.op.cit. [12]October2324,2002CNN/TimepollconductedbyHarrisInteractive. [13]Skoppetal.2003.Serumcannabinoidlevels24to48hoursaftercannabissmoking.ArchivesofCriminology (Germany)212:8395. [14]Toennesetal.2008.Comparisonofcannabinoidpharmacokineticpropertiesinoccasionalandheavyuserssmoking amarijuanaorplacebojoint.JournalofAnalyticalToxicology32:470477."Heavyusersmightexhibitmeasurable

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cannabinoidconcentrationsinblood,evenifthelastcannabisusewasmorethan24hoursago.Thisisdueto redistributionfromdeepcompartmentsandtotheprolongedeliminationofTHC." [15]Karschneretal.2009.DoDelta9tetrahydrocannabinolconcentrationsindicaterecentuseinchroniccannabis users?Addiction104:20412048."SubstantialwholebloodTHCconcentrationspersistmultipledaysafterdrug discontinuationinheavychroniccannabisusers." [16]Ronenetal.2007.EffectsofTHCondrivingperformance,physiologicalstateandsubjectivefeelingsrelativeto alcohol.Accident,AnalysisandPrevention40:926934."NoTHCeffectswereobservedafter24honanyofthe measures." [17]MusshoffandMadea.2006.Reviewofbiologicalmatrices(urine,blood,andhair)asindicatorsofrecentorongoing cannabisuse.TherapeuticDrugMonitor28:155163. [18]NationalHighwayTrafficSafetyAdministration,FatalitiesandFatalityRatesByState,19942009.Onlinedocument accessSeptember6,2011. [19]AccordingtotheUSDepartmentofTransportation,NationalHighwayTrafficSafetyAdministration.Stateof KnowledgeofDruggedDriving:FINALREPORT.op.cit.,"Experimentalresearchontheeffectsofcannabis...indicat[e] thatanyeffects...dissipatequicklyafteronehour." [20]Accordingtothe2004NationalHighwayTrafficSafetyAdministrationfactsheet,DrugsandHumanPerformance, peakacuteeffectsaretypicallyreachedwithin10to30minutesafterinhalation. [21]USDepartmentofTransportation.NationalHighwayTrafficSafetyAdministration.StateofKnowledgeofDrugged Driving:FINALREPORT.op.cit.Othersummariesinclude:Ramaekersetal.2006.Cognitionandmotorcontrolasa functionofDelta9THCconcentrationinserumandoralfluid:Limitsofimpairment.DrugandAlcoholDependence85: 114122;DavidHadorn."AReviewofCannabisandDrivingSkills,"In:TheMedicinalUsesofCannabisandCannabinoids. (eds:Guyetal).PharmaceuticalPress,2004;CanadianSenateSpecialCommitteeonIllegalDrugs,Cannabis:Summary Report:OurPositionforaCanadianPublicPolicy.2002.(Seespecifically:Chapter8:"DrivingUndertheInfluenceof Cannabis");AlisonSmiley."Marijuana:OnRoadandDrivingSimulatorStudies,"In:TheHealthEffectsofCannabis.(eds. Kalantetal)CanadianCentreforAddictionandMentalHealth,1999. [22]USDepartmentofTransportation,NationalHighwayTrafficSafetyAdministration.MarijuanaandActualDriving Performance:FinalReport.November1993."ItappearsperformanceismoreaffectedbyTHCinlaboratory(settings) than(in)actualdrivingtests." [23]LamersandRamaekers.2001.Visualsearchandurbandrivingundertheinfluenceofmarijuanaandalcohol.Human Psychopharmacology16:393401. [24]USDepartmentofTransportation,NationalHighwayTrafficSafetyAdministration.MarijuanaandActualDriving Performance:FinalReport.op.cit. [25]DavidHadorn.2004.op.cit.andUSDepartmentofTransportation.2003.op.cit. [26]AccordingtotheUSDepartmentofTransportationNationalHighwayTrafficSafetyAdministration.Stateof KnowledgeofDruggedDriving:FINALREPORT.op.cit.,"TheextensivestudiesbyRobbeandO'Hanlon(1993),revealed

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thatundertheinfluenceofmarijuana,driversareawareoftheirimpairment,andwhentheexperimentaltaskallowsit, theytendtoactuallydecreasespeed,avoidpassingothercars,andreduceotherrisktakingbehaviors." [27]Menetreyetal.2005.Assessmentofdrivingcapabilitythroughtheuseofclinicalandpsychomotortestsinrelation tobloodcannabinoidlevelsfollowingoraladministrationof20mgdronabinolorofacannabisdecoctionmadewith20 and60mgdelta9THC.JournalofAnalyticalToxicology29:327338. [28]D'Souzaetal.2008.Bluntedpsychotomimeticandamnesticeffectsofdelta9tetrahydrocannabinolinfrequent usersofcannabis.Neuropsychopharmacology33:25052016."Thesedatasuggestthatfrequentusersofcannabisare eitherinherentlybluntedintheirresponseto,and/ordeveloptolerancetothepsychotomimetic,perceptualaltering, amnestic,endocrine,andothereffectsofcannabinoids." [29]Ramaekersetal.2009.NeurocognitiveperformanceduringacuteTHCintoxicationinheavyandoccasionalcannabis users.JournalofPsychopharmacology23:266277."THCdidnotaffecttheperformanceofheavycannabisusersexcept inthestopsignaltask,i.e.stopreactiontimeincreased,particularlyathighTHCconcentrations.Groupcomparisonsof overallperformanceinoccasionalandheavyusersdidnotrevealanypersistentperformancedifferencesduetoresidual THCinheavyusers.Thesedataindicatethatcannabisusehistorystronglydeterminesthebehaviouralresponseto singledosesofTHC." [30]Hartetal.2010.Neurophysiologicalandcognitiveeffectsofmarijuanainfrequentusers.2010.Pharmacology, BiochemistryandBehavior96:333341."Insummary,thecurrentdatasuggestthatfrequentmarijuanausersmayshow fewerbehavioralsignsofdisruptionduringintoxicationthaninfrequentusers,evenwhendifficultmemorytasksare usedtoassesscognitiveperformance....Thesedataemphasizetheimportanceoftakingintoaccountthedruguse historiesofresearchparticipantsandexaminingmultiplemeasureswheninvestigatingmarijuanarelatedeffectson cognitivefunctioning." [31]Ramaekersetal.2010.ToleranceandcrosstolerancetoneurocognitiveeffectsofTHCandalcoholinheavy cannabisusers.Psychopharmacology214:391401. [32]UnitedKingdomDepartmentofEnvironment,TransportandtheRegions,RoadSafetyDivisionCannabisand Driving:AReviewoftheLiteratureandCommentary.OnlinedocumentaccessedNovember24,2007."Overall,we concludethattheweightoftheevidenceindicatesthat...thereisnoevidencethatconsumptionofcannabisalone increasestheriskofculpabilityfortrafficcrashfatalitiesorinjuriesforwhichhospitalizationoccurs,andmayreduce thoserisks." [33]GregoryChesherandMarieLongo."CannabisandAlcoholinMotorVehicleAccidents,"In:Cannabisand Cannabinoids:Pharmacology,Toxicology,andTherapeuticPotential.(eds.Grotenhermenetal.)HaworthPress,2002. [34]USDepartmentofTransportation,NationalHighwayTrafficSafetyAdministration.MarijuanaandActualDriving Performance:FinalReport.op.cit. [35]Blowsetal.2004.Marijuanauseandcarcrashinjury.Addiction100:605611. [36]Movigetal.2004.Psychoactivesubstanceuseandtheriskofmotorvehicleaccidents.AccidentAnalysisand Prevention36:631636.

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[37]Drummeretal.2004.TheinvolvementofdrugsindriverskilledinAustralianroadtrafficcrashes.Accident,Analysis andPrevention36:239248."DriverswithTHCintheirbloodhadasignificantlyhigherlikelihoodofbeingculpablethan drugfreedrivers.FordriverswithbloodTHCconcentrationsof5ng/mlorhighertheoddsratiowasgreaterandmore statisticallysignificant." [38]Laumonetal.2005.CannabisintoxicationandfatalroadcrashesinFrance:apopulationbasecasecontrolstudy. BritishMedicalJournal331:13711377. [39]Sewelletal.2009.Theeffectofcannabiscomparedwithalcoholondriving.TheAmericanJournalonAddictions18: 185193."Casecontrolstudiesareinconsistent,butsuggestthatwhilelowconcentrationsofTHCdonotincreasethe rateofaccidents,andmayevendecreasethemserumconcentrationsofTHChigherthan5ng/mLareassociatedwith anincreasedriskofaccidents." [40]Bedardetal.2007.Theimpactofcannabisondriving.CanadianJournalofPublicHealth98:611. [41]Laumonetal.2005.CannabisintoxicationandfatalroadcrashesinFrance:apopulationbasecasecontrolstudy. op.cit. [42]Ramaekers.CommentaryonCannabisandCrashRisk:ConcentrationEffectRelation.In:TransportationResearch CircularEC096:DrugsandTraffic.2006. [43]Grotenhermenetal.2007.Developingperselimitsfordrivingundercannabis.Addiction102:19101917. [44]Ramaekersetal.Doserelatedriskofmotorvehiclecrashesaftercannabisuse:anupdate.In:Drugs,Driving,and TrafficSafety(eds.Vesteretal.)WorldHealthOrganization,2009."Individualdriverscanvarywidelyintheirsensitivity forTHCinducedimpairmentasevincedbytheweakcorrelationsbetweenTHCinserumandmagnitudeofperformance impairment." [45]USDepartmentofTransportation,NationalHighwayTrafficSafetyAdministration.MarijuanaandActualDriving Performance:FinalReport.op.cit."Oneoftheprogram'sobjectiveswastodeterminewhetheritispossibletopredict drivingimpairmentbyplasmaconcentrationsofTHCand/oritsmetabolite,THCCOOH,insinglesamples.Theansweris veryclear:itisnot.PlasmaofdriversshowingsubstantialimpairmentinthesestudiescontainedbothhighandlowTHC concentrations;anddriverswithhighplasmaconcentrationsshowedsubstantial,butalsonoimpairment,andeven someimprovement." [46]Elliotetal.MarijuanaDUIWorkgroup:RecommendationtotheDrugPolicyTaskForceandColoradoCommissionon CriminalandJuvenileJustice.2011."WhereasBAC(BloodAlcoholContent)canbeaccuratelymeasuredandcorrelated withbehavioralimpairment,thismaynotbethecasewithcannabis...Alcoholiswatersoluble;cannabisisstoredinthe fatandismetabolizeddifferently,makingadirectcorrelationwithbehaviordifficulttomeasure." [47]Ramaekersetal.2006.CognitionandmotorcontrolasafunctionofDelta9THCconcentrationinserumandoral fluid:Limitsofimpairment.op.cit. [48]Toennesetal.2008.Comparisonofcannabinoidpharmacokineticpropertiesinoccasionalandheavyuserssmoking amarijuanaorplacebojoint.op.cit.

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[49]Karschneretal.2009.DoDelta9tetrahydrocannabinolconcentrationsindicaterecentuseinchroniccannabis users?op.cit. [50]Toennesetal.2008.Comparisonofcannabinoidpharmacokineticpropertiesinoccasionalandheavyuserssmoking amarijuanaorplacebojoint.op.cit. [51]Willeetal.2010.Conventionalandalternativematricesfordrivingundertheinfluenceofcannabis.Bioanalysis2: 791806."[I]nDUIDcases,thedelaybetweentheaccidentandthefinalblooddrawcanbelongandbackextrapolation isnotanoptionduetothecomplexpharmacokineticprofileofTHC." [52]Accordingtothe2011WhiteHouseDrugControlStrategy,ActionItems:1.5.A:EncourageStatestoAdoptPerSe DrugImpairmentLaws:"Fifteenstateshavepassedlawsclarifyingthatthepresenceofanyillegaldruginadriver'sbody isperseevidenceofimpaireddriving.ONDCPwillworktoexpandtheuseofthisstandardtootherstatesandexplore otherwaystoincreasetheenforcementofexistingDUIDlaws."AstatebystatesummaryofDUIlawsisavailablefrom NORML. [53]Ramaekersetal.2004.Doserelatedriskofmotorvehiclecrashesaftercannabisuse.DrugandAlcoholDependence 73:109119."ExperimentalstudieshaveshownalcoholandTHCcombinedcanproducesevereperformance impairmentevenwhengivenatlowdoses.Thecombinedeffectofalcoholandcannabisonperformanceandcrashrisk appearedadditiveinnature,i.e.theeffectsofalcoholandcannabiscombinedwerealwayscomparabletothesumof theeffectsofalcoholandTHCwhengivenalone." [54]Ibid. [55]USDepartmentofJustice,BureauofJusticeStatistics.op.cit. [56]USDepartmentofHealthandHumanServices,SubstanceandMentalHealthServicesAssociation,OfficeofApplied Studies.1998.op.cit. [57]Ibid. [58]CanadianPublicHealthAssociation."ThePotandDrivingCampaign." [59]USGovernmentAccountabilityOffice.ONDCPMediaCampaign:Contractor'sNationalEvaluationDidNotFindthat theYouthAntiDrugMediaCampaignWasEffectiveinReducingYouthDrugUse:ReporttotheSubcommitteeon Transportation,Treasury,theJudiciary,HousingandUrbanDevelopment,andRelatedAgencies,Committeeon Appropriations,U.S.Senate.August25,2006. [60]http://www.coloradodot.info/programs/alcoholandimpaireddriving [61]Papafotiouetal.2005.AnevaluationofthesensitivityoftheStandardisedFieldSobrietyTests(SFSTs)todetect impairmentduetomarijuanaintoxication.Psychopharmacology180:107114. [62]Loobyetal.2007.Roadsidesobrietytestsandattitudestowardaregulatedcannabismarket.HarmReduction Journal.OnlinedocumentaccessedNovember24,2007.

The National Organization for the Reform of Marijuana Laws (www.norml.org)

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