Cited by 88Forensic Toxicology and Drug AnalysisTraffic and Road SafetyCannabis and Cannabinoid Research

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Cannabis Legalization and Detection of Tetrahydrocannabinol in Injured Drivers

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Brubacher, Jeffrey R., Chan, Herbert, Erdelyi, Shannon, Staples, John A., Asbridge, Mark, Mann, Robert E.·2022·New England Journal of Medicine

DOI 10.1056/nejmsa2109371

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Abstract

BACKGROUND: The effect of cannabis legalization in Canada (in October 2018) on the prevalence of injured drivers testing positive for tetrahydrocannabinol (THC) is unclear. METHODS: We studied drivers treated after a motor vehicle collision in four British Columbia trauma centers, with data from January 2013 through March 2020. We included moderately injured drivers (those whose condition warranted blood tests as part of clinical assessment) for whom excess blood remained after clinical testing was complete. Blood was analyzed at the provincial toxicology center. The primary outcomes were a THC level greater than 0, a THC level of at least 2 ng per milliliter (Canadian legal limit), and a THC level of at least 5 ng per milliliter. The secondary outcomes were a THC level of at least 2.5 ng per milliliter plus a blood alcohol level of at least 0.05%; a blood alcohol level greater than 0; and a blood alcohol level of at least 0.08%. We calculated the prevalence of all outcomes before and after legalization. We obtained adjusted prevalence ratios using log-binomial regression to model the association between substance prevalence and legalization after adjustment for relevant covariates. RESULTS: During the study period, 4339 drivers (3550 before legalization and 789 after legalization) met the inclusion criteria. Before legalization, a THC level greater than 0 was detected in 9.2% of drivers, a THC level of at least 2 ng per milliliter in 3.8%, and a THC level of at least 5 ng per milliliter in 1.1%. After legalization, the values were 17.9%, 8.6%, and 3.5%, respectively. After legalization, there was an increased prevalence of drivers with a THC level greater than 0 (adjusted prevalence ratio, 1.33; 95% confidence interval [CI], 1.05 to 1.68), a THC level of at least 2 ng per milliliter (adjusted prevalence ratio, 2.29; 95% CI, 1.52 to 3.45), and a THC level of at least 5 ng per milliliter (adjusted prevalence ratio, 2.05; 95% CI, 1.00 to 4.18). The largest increases in a THC level of at least 2 ng per milliliter were among drivers 50 years of age or older (adjusted prevalence ratio, 5.18; 95% CI, 2.49 to 10.78) and among male drivers (adjusted prevalence ratio, 2.44; 95% CI, 1.60 to 3.74). There were no significant changes in the prevalence of drivers testing positive for alcohol. CONCLUSIONS: After cannabis legalization, the prevalence of moderately injured drivers with a THC level of at least 2 ng per milliliter in participating British Columbia trauma centers more than doubled. The increase was largest among older drivers and male drivers. (Funded by the Canadian Institutes of Health Research.).

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Additional file 3 of Attitudes toward driving after cannabis use: a systematic review
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Authors: Brubacher, J. R., Chan, H., Erdelyi, S., Staples, J. A., Asbridge, M., & Mann, R. E.
Affiliations: Dalhousie University (CA)
ORCID: Brubacher, Jeffrey R.
Staples, John A.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2022-01-13
Volume: 386
Issue: 2
Pages: 148-156
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmsa2109371
OpenAlex: W4205133903
Cited by: 88
References: 31
Citations by year: 2026: 13 · 2025: 25 · 2024: 18 · 2023: 24 · 2022: 8
FWCI: 12.80
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Institute of Population and Public Health (375264)
Topics: Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
Physical Sciences › Engineering › Safety, Risk, Reliability and Quality › Traffic and Road Safety
Health Sciences › Medicine › Pharmacology (medical) › Cannabis and Cannabinoid Research
Keywords: cannabis legalization, tetrahydrocannabinol, injured drivers, traffic accidents, blood alcohol concentration, drug-impaired driving, substance use prevalence, older drivers, Canadian cannabis policy, trauma centers, toxicology testing, British Columbia, road safety, substance use disorder treatment access
MeSH terms: Accidents, Traffic, Marijuana Use, Adult, Alcohol Drinking, Ethanol, British Columbia, Cannabis, Female, Humans, Legislation, Drug, Male, Middle Aged, Dronabinol, Age Distribution

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Cannabis Legalization and Detection of Tetrahydrocannabinol in Injured Drivers

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