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Medical Marijuana and Driving: a Review

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Abstract

Medical marijuana remains a highly debated treatment regimen despite removal of state penalties against care providers prescribing the drug and patients treated with the drug in many areas of the USA. The utility of marijuana in specific medical conditions has been studied at length, but its effects on driving performance and risk of motor vehicle collision remain unclear. As with other medications that affect psychomotor function, the healthcare provider should be informed of the potential risks of driver safety prior to prescribing this psychotropic drug to give appropriate anticipatory guidance for appropriate use. The goal of this narrative review is to assess the current literature regarding marijuana as it relates to driving performance and traffic safety. With a foundation in the pharmacology of cannabinoids, we consider the limitations of testing cannabinoid and metabolite concentration. In addition, we will review studies on driving performance and epidemiological studies implicating marijuana in motor vehicle collisions. The increasing prevalence of medical marijuana laws in the USA suggests that clinicians should be aware of marijuana’s influence on public safety. Patients should abstain from driving for 8 h if they achieve a subjective “high” from self-treatment with smoked marijuana and should be aware of the cumulative effects of alcohol and other psychoactive xenobiotics.

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References

  1. Institute of Medicine (1999) Marijuana and medicine: assessing the science base. The National Academies Press

  2. Watson SJ, Benson JA Jr, Joy JE (2000) Marijuana and medicine: assessing the science base: a summary of the 1999 Institute of Medicine report. Arch Gen Psychiatry 57(6):547–552

    Article  CAS  PubMed  Google Scholar 

  3. Ferrara SD, Zancaner S, Giorgetti R (1994) Low blood alcohol concentrations and driving impairment. A review of experimental studies and international legislation. Int J Legal Med 106(4):169–177

    Article  CAS  PubMed  Google Scholar 

  4. Movig KL, Mathijssen MP, Nagel PH et al (2004) Psychoactive substance use and the risk of motor vehicle accidents. Accid Anal Prev 36(4):631–636

    Article  CAS  PubMed  Google Scholar 

  5. Strand MC, Fjeld B, Arnestad M, Morland J (2013) Can patients receiving opioid maintenance therapy safely drive? A systematic review of epidemiological and experimental studies on driving ability with a focus on concomitant methadone or buprenorphine administration. Traffic Inj Prev 14(1):26–38

    Article  PubMed  Google Scholar 

  6. Asbridge M, Hayden JA, Cartwright JL (2012) Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ 344:e536

    Article  PubMed Central  PubMed  Google Scholar 

  7. Deitch R (2007) Hemp—American history revisited, vital resource to contentious weed. Algora Publishing, New York, pp 7–10

    Google Scholar 

  8. Musto DF (1972) The marihuana tax act of 1937. Arch Gen Psychiatry 26(2):101–108

    Article  CAS  PubMed  Google Scholar 

  9. Aldington S, Harwood M, Cox B et al (2008) Cannabis use and risk of lung cancer: a case-control study. Eur Respir J Off J Eur Soc Clin Respir Physiol 31(2):280–286

    CAS  Google Scholar 

  10. Tashkin DP (2005) Smoked marijuana as a cause of lung injury. Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio. Univ Napoli Secondo Ateneo 63(2):93–100

    CAS  Google Scholar 

  11. Meier MH, Caspi A, Ambler A et al (2012) Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences of the United States of America

  12. Solowij N (2006) Cannabis and cognitive functioning. Cambridge [u.a.]: Cambridge Univ. Press

  13. Hall W (1994) The health and psychological consequences of cannabis use. Australian Government Publicaiton Service

  14. Hollister LE (1998) Health aspects of cannabis: revisited. Int J Neuropsychopharmacol 1(1):71–80

    Article  CAS  PubMed  Google Scholar 

  15. Robbe HWJ, O'Hanlon JF (1993) Marijuana and actual driving performance. U.S. Department of Transportation, National Highway Traffic Safety Administration

  16. Gerberich SG, Sidney S, Braun BL, Tekawa IS, Tolan KK, Quesenberry CP (2003) Marijuana use and injury events resulting in hospitalization. Ann Epidemiol 13(4):230–237

    Article  PubMed  Google Scholar 

  17. Li MC, Brady JE, DiMaggio CJ, Lusardi AR, Tzong KY, Li G (2012) Marijuana use and motor vehicle crashes. Epidemiol Rev 34(1):65–72

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Gaoni Y, Mechoulam R (1964) Isolation, structure, and partial synthesis of an active constituent of hashish. J Am Chem Soc 86(8):1646–1647

    Article  CAS  Google Scholar 

  19. Matsuda LA, Lolait SJ, Brownstein MJ, Young AC, Bonner TI (1990) Structure of a cannabinoid receptor and functional expression of the cloned cDNA. Nature 346(6284):561–564

    Article  CAS  PubMed  Google Scholar 

  20. Iversen L (2003) Cannabis and the brain. Brain J Neurol 126(Pt 6):1252–1270

    Article  Google Scholar 

  21. O'Leary DS, Block RI, Flaum M et al (2000) Acute marijuana effects on rCBF and cognition: a PET study. Neuroreport 11(17):3835–3841

    Article  PubMed  Google Scholar 

  22. O'Leary DS, Block RI, Koeppel JA et al (2007) Effects of smoking marijuana on focal attention and brain blood flow. Hum Psychopharmacol 22(3):135–148

    Article  PubMed  Google Scholar 

  23. Mathew RJ, Wilson WH, Humphreys DF, Lowe JV, Wiethe KE (1992) Regional cerebral blood flow after marijuana smoking. J Cereb Blood Flow Metab Off J Int Soc Cereb Blood Flow Metab 12(5):750–758

    Article  CAS  Google Scholar 

  24. Grotenhermen F (2003) Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet 42(4):327–360

    Article  CAS  PubMed  Google Scholar 

  25. Menetrey A, Augsburger M, Favrat B et al (2005) Assessment of driving capability through the use of clinical and psychomotor tests in relation to blood cannabinoids levels following oral administration of 20 mg dronabinol or of a cannabis decoction made with 20 or 60 mg Delta9-THC. J Anal Toxicol 29(5):327–338

    Article  CAS  PubMed  Google Scholar 

  26. Kreuz DS, Axelrod J (1973) Delta-9-tetrahydrocannabinol: localization in body fat. Science 179(4071):391–393

    Article  CAS  PubMed  Google Scholar 

  27. Huestis MA (2007) Human cannabinoid pharmacokinetics. Chem Biodivers 4(8):1770–1804

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Abrams DI, Vizoso HP, Shade SB, Jay C, Kelly ME, Benowitz NL (2007) Vaporization as a smokeless cannabis delivery system: a pilot study. Clin Pharmacol Ther 82(5):572–578

    Article  CAS  PubMed  Google Scholar 

  29. Carter GT, Weydt P, Kyashna-Tocha M, Abrams DI (2004) Medicinal cannabis: rational guidelines for dosing. IDrugs Investig Drugs J 7(5):464–470

    CAS  Google Scholar 

  30. Lemberger L, Crabtree RE, Rowe HM (1972) 11-hydroxy-9-tetrahydrocannabinol: pharmacology, disposition, and metabolism of a major metabolite of marihuana in man. Science 177(4043):62

    Article  CAS  PubMed  Google Scholar 

  31. Wall ME, Perez-Reyes M (1981) The metabolism of delta 9-tetrahydrocannabinol and related cannabinoids in man. J Clin Pharmacol 21(8 suppl):178S–189S

    Article  CAS  PubMed  Google Scholar 

  32. Schwope DM, Karschner EL, Gorelick DA, Huestis MA (2011) Identification of recent cannabis use: whole-blood and plasma free and glucuronidated cannabinoid pharmacokinetics following controlled smoked cannabis administration. Clin Chem 57(10):1406–1414

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Foltin RW, Evans SM (1993) Performance effects of drugs of abuse: a methodological survey. Hum Psychopharmacol Clin Exp Hum Psychopharmacol Clin Exp 8(1):9–19

    Article  Google Scholar 

  34. Dornbush RL, Fink M, Freedman AM (1971) Marijuana, memory, and perception. Am J Psychiatry 128(2):194–197

    CAS  PubMed  Google Scholar 

  35. Borg J, Gershon S, Alpert M (1975) Dose effects of smoked marihuana on human cognitive and motor functions. Psychopharmacologia 42(3):211–218

    Article  CAS  PubMed  Google Scholar 

  36. Block RI, Wittenborn JR (1986) Marijuana effects on the speed of memory retrieval in the letter-matching task. Int J Addict 21(2):281–285

    CAS  PubMed  Google Scholar 

  37. Liguori A, Gatto CP, Robinson JH (1998) Effects of marijuana on equilibrium, psychomotor performance, and simulated driving. Behav Pharmacol 9(7):599–609

    Article  CAS  PubMed  Google Scholar 

  38. Kurzthaler I, Hummer M, Miller C et al (1999) Effect of cannabis use on cognitive functions and driving ability. J Clin Psychiatry 60(6):395–399

    Article  CAS  PubMed  Google Scholar 

  39. Bergaus G, Guo B (1995) Medicines and driver fitness—findings from a meta-analysis of experimental studies as basic information to patients, physicians and experts. Paper presented at: alcohol, Drugs, and Traffic Safety-T95: Proceedings of the 13th International Conference on Alcohol, Drugs and Traffic Safety; Adelaide, Australia

    Google Scholar 

  40. Grotenhermen F, Leson G, Berghaus G et al (2007) Developing limits for driving under cannabis. Addiction 102(12):1910–1917

    Article  PubMed  Google Scholar 

  41. Moeller MR, Doerr G, Warth S (1992) Simultaneous quantitation of delta-9-tetrahydrocannabinol (THC) and 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH) in serum by GC/MS using deuterated internal standards and its application to a smoking study and forensic cases. J Forensic Sci 37:969–983

    CAS  PubMed  Google Scholar 

  42. Huestis MA, Henningfield JE, Cone EJ (1992) Blood cannabinoids. I. Absorption of THC and formation of 11-OH-THC and THCCOOH during and after smoking marijuana. J Anal Toxicol 16(5):276–282

    Article  CAS  PubMed  Google Scholar 

  43. Ramaekers JG, Moeller MR, van Ruitenbeek P, Theunissen EL, Schneider E, Kauert G (2006) Cognition and motor control as a function of Delta9-THC concentration in serum and oral fluid: limits of impairment. Drug Alcohol Depend 85(2):114–122

    Article  CAS  PubMed  Google Scholar 

  44. Manno JE, Manno BR, Kemp PM et al (2001) Temporal indication of marijuana use can be estimated from plasma and urine concentrations of delta9-tetrahydrocannabinol, 11-hydroxy-delta9-tetrahydrocannabinol, and 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid. J Anal Toxicol 25(7):538–549

    Article  CAS  PubMed  Google Scholar 

  45. Daldrup T (1998) Cannabis im Strassenverkehr—final report to the Ministry of the State of North Rhine-Westphalia. 1998. http://www.uni-duesseldorf.de/daldrup/file/cannabisbericht.pdf. Accessed 2 Aug 2013

  46. Yesavage JA, Leirer VO, Denari M, Hollister LE (1985) Carry-over effects of marijuana intoxication on aircraft pilot performance: a preliminary report. Am J Psychiatry 142(11):1325–1329

    CAS  PubMed  Google Scholar 

  47. Leirer VO, Yesavage JA, Morrow DG (1989) Marijuana, aging, and task difficulty effects on pilot performance. Aviat Space Environ Med 60(12):1145–1152

    CAS  PubMed  Google Scholar 

  48. Ramaekers JG, Berghaus G, van Laar M, Drummer OH (2004) Dose related risk of motor vehicle crashes after cannabis use. Drug Alcohol Depend 73(2):109–119

    Article  CAS  PubMed  Google Scholar 

  49. Sewell RA, Poling J, Sofuoglu M (2009) The effect of cannabis compared with alcohol on driving. Am J Addict Am Acad Psychiat Alcohol Addict 18(3):185–193

    Google Scholar 

  50. van Laar MW, Volkerts ER, van Willigenburg AP (1992) Therapeutic effects and effects on actual driving performance of chronically administered buspirone and diazepam in anxious outpatients. J Clin Psychopharmacol 12(2):86–95

    PubMed  Google Scholar 

  51. Ramaekers JG, Robbe HW, O'Hanlon JF (2000) Marijuana, alcohol and actual driving performance. Hum Psychopharmacol 15(7):551–558

    Article  PubMed  Google Scholar 

  52. Downey LA, King R, Papafotiou K et al (2012) The effects of cannabis and alcohol on simulated driving: influences of dose and experience. Accid Anal Prev 50:879–886

    Article  PubMed  Google Scholar 

  53. Marks DF, MacAvoy MG (1989) Divided attention performance in cannabis users and non-users following alcohol and cannabis separately and in combination. Psychopharmacology (Berlin) 99(3):397–401

    Article  CAS  Google Scholar 

  54. Sutton LR (1983) The effects of alcohol, marihuana and their combination on driving ability. J Stud Alcohol 44(3):438–445

    CAS  PubMed  Google Scholar 

  55. Sexton BF TR, Brook-Carter N, Jackson PG, Wright K, Stark MM, Englehart K (2000) The influence of cannabis on driving. In: department of Environment Transport and the Regions, Road Safety Division, ed. Transport Research Laboratory, Crowthorne, Berkshire, p p110

    Google Scholar 

  56. Delgado J (2007) Marijuana. In: Shannon MW, Borron SW, Burns MJ (eds) Haddad and Winchester’s clinical management of poisoning and drug overdose, 7th edn. Saunders Elsevier, Philadelphia, pp 747–754

    Chapter  Google Scholar 

  57. Brookoff D, Cook CS, Williams C, Mann CS (1994) Testing reckless drivers for cocaine and marijuana. N Engl J Med 331(8):518–522

    Article  CAS  PubMed  Google Scholar 

  58. Beirness DJ, Davis CG (2006) Driving under the influence of cannabis: analysis drawn from the 2004 Canadian addiction survey. Canadian Centre on Substance Abuse, Ottawa

    Google Scholar 

  59. Jones AW, Holmgren A, Kugelberg FC (2008) Driving under the influence of cannabis: a 10-year study of age and gender differences in the concentrations of tetrahydrocannabinol in blood. Addiction 103(3):452–461

    Article  PubMed  Google Scholar 

  60. National Highway Traffic Safety Administration. Traffic safety facts 2010. In: U.S. Department of Transportation, Washington, D.C. http://www-nrd.nhtsa.dot.gov/Pubs/811659.pdf. Accessed 2 Aug 2013

  61. Vakulin A, Baulk SD, Catcheside PG et al (2007) Effects of moderate sleep deprivation and low-dose alcohol on driving simulator performance and perception in young men. Sleep 30(10):1327–1333

    CAS  PubMed Central  PubMed  Google Scholar 

  62. Williams AF, Peat MA, Crouch DJ, Wells JK, Finkle BS (1985) Drugs in fatally injured young male drivers. Public health reports, Washington, D.C, 1974 100(1)

    Google Scholar 

  63. Terhune KW, Ippolito CA, Hendricks DL, Michalovic YG, Bogema, SC, Santinga P, Blomber R, Preusser DF (1992) The incidence and role of drugs in fatally injured drivers. U.S. Department of Transportation National Highway Traffic Safety Administration, Washington, D.C

  64. Lowenstein SR, Koziol-McLain J (2001) Drugs and traffic crash responsibility: a study of injured motorists in Colorado. J Trauma 50(2):313–320

    Article  CAS  PubMed  Google Scholar 

  65. Drummer OH, Gerostamoulos J, Batziris H et al (2004) The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes. Accid Anal Prev 36(2):239–248

    Article  PubMed  Google Scholar 

  66. Heishman SJ, Huestis MA, Henningfield JE, Cone EJ (1990) Acute and residual effects of marijuana: profiles of plasma THC levels, physiological, subjective, and performance measures. Pharmacol Biochem Behav 37(3):561–565

    Article  CAS  PubMed  Google Scholar 

  67. Chait LD, Perry JL (1994) Acute and residual effects of alcohol and marijuana, alone and in combination, on mood and performance. Psychopharmacology (Berlin) 115:340–349

    Article  CAS  Google Scholar 

  68. Huestis MA (2002) Cannabis (marijuana)—effects on human behavior and performance. For Sci Rev 14:15

    Google Scholar 

  69. Hollister LE, Gillespie HK, Ohlsson A, Lindgren J-E, Wahlen A, Agurell S (1981) Do plasma concentrations of delta-9-tetrahydrocannabinol reflect the degree of intoxication? Clin Pharm 21(S1):171S–177S

    Article  CAS  Google Scholar 

  70. Lemberger L, Weiss JL, Watanabe AM, Galanter IM, Wyatt RJ, Cardon PV (1972) Delta-9-Tetrahydrocannabinol temporal correlation of the psychologic effects and blood levels after various routes of administration. N Engl J Med 286(13):685–688

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA

    Mark J. Neavyn, Eike Blohm, Kavita M. Babu & Steven B. Bird

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  1. Mark J. Neavyn
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Neavyn, M.J., Blohm, E., Babu, K.M. et al. Medical Marijuana and Driving: a Review. J. Med. Toxicol. 10, 269–279 (2014). https://doi.org/10.1007/s13181-014-0393-4

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