Friday, 25 September 2015

Driving under the influence

Driving Under the Influence of Marijuana Versus Driving and Dying Under the Influence of Marijuana: A Comparison of Blood Concentrations of Δ9-Tetrahydrocannabinol, 11-Hydroxy-Δ9-Tetrahydrocannabinol, 11-Nor-9-Carboxy-Δ9-Tetrahydrocannabinol and Other Cannabinoids in Arrested Drivers Versus Deceased Drivers. Lemos NP, San Nicolas AC, Volk JA, Ingle EA, Williams CM. J Anal Toxicol. 2015;39(8):588-601.

Cannabis intoxication in living and deceased drivers is an important medico-legal topic, but only a limited number of studies examine cannabinoids in living and deceased humans. This study compares cannabinoid concentrations (in ng/mL) in driving under the influence of drug (DUID) drivers with blood cannabinoids to those in drivers who died while driving with cannabinoids in their post-mortem (PM) peripheral blood. From 2010 to 2013, there were 318 cannabis-positive DUID cases (mean, median THC: 4.9, 3); 88 had cannabis-only in their bloods (mean, median THC: 5.8, 4). In 23 DUID cases, Huestis' Predictive Models with 95% confidence intervals were applied and evaluated, demonstrating that the actual case time points in all 23 cases fell within the predicted time ranges. Among deceased drivers, 19 had cannabis-positive toxicology (mean, median THC: 11.7, 4.5) and 8 had cannabis-only (mean, median THC: 20.3, 19.5). Motorcyclists and bicyclists comprised the majority of deceased vehicle operators, with bicyclists averaging the highest mean and median THC concentrations overall. The analysis of variance between living and deceased drivers' cannabinoid concentrations showed that THC-OH and THC-COOH concentrations are not statistically different between the two groups, but that THC concentrations are statistically different, making it difficult to directly correlate PM with antemortem THC concentrations between living and deceased drivers.
Drug driving is can be an issue for anyone taking medical cannabis and driving and is probably an issue in the US where people are welded to their cars and also have high availability to medical marijuana. This study tries to see if deaths from driving had any effect relating to drug levels. There are probably too few to make any real conclusions.

It seems that people dying under the influence are cyclists and motorbike riders, and as cannabis is well known to influence balance....Moral of the story don't ride a bike stoned.

Freidel M, Tiel-Wilck K, Schreiber H, Prechtl A, Essner U, Lang M.Drug-resistant MS spasticity treatment with Sativex(®) add-on and driving ability.Acta Neurol Scand. 2015;131(1):9-16.

OBJECTIVE:The aim of the present observational study was to determine the effects of a delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) oromucosal spray (Sativex(®) spray), brand name Sativex(®), indicated for drug-resistant MS spasticity, on the driving ability of treated MS patients.
METHODS:The study was conducted over a period of 4-6 weeks. Thirty-three MS patients with moderate to severe treatment-resistant spasticity and planned to begin add-on treatment with Sativex(®) were enrolled at three specialized MS centres in Germany. A set of five driving test procedures from a validated computerized test battery was used to evaluate the driving ability of eligible patients. Tests were performed by patients at baseline and repeated after 4-6 weeks of treatment with Sativex(®) oromucosal spray. According to German normative data, the test thresholds achieved by the general population served as a reference to allow for a fitness/unfitness to drive classification.
RESULTS:Patients showed comparable driving test results at baseline and at final visits. Only two patients changed classification shifting from 'unfit' to drive to 'fit' and vice versa. The mean severity of spasticity, as self-reported by the patients, improved with statistical significance.Sativex(®) was generally well tolerated.
CONCLUSIONS:Treatment of MS patients with Sativex(®) does not negatively impact on driving ability and may improve moderate to severe treatment-resistant MS spasticity.

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