Skip to main content

Advertisement

Log in

Cannabis and traffic collision risk: findings from a case-crossover study of injured drivers presenting to emergency departments

  • Original Article
  • Published:
International Journal of Public Health

Abstract

Objectives

This study examined whether acute cannabis use leads to an increased collision risk.

Methods

Participants were 860 drivers presenting to emergency departments in Toronto and Halifax, Canada, with an injury from a traffic collision, between April 2009 and July 2011. Cannabis and other drug use were identified either through blood sample or self-report. A case-crossover design was employed with two control conditions: a fixed condition measuring substance use during last time driving, and whether the driver typically uses cannabis prior to driving. Collision risk was assessed through conditional fixed-effects logistic regression models.

Results

Results revealed that 98 (11 %; 95 % CI: 9.0–13.1) drivers reported using cannabis prior to the collision. Regression results measuring exposure with blood and self-report data indicated that cannabis use alone was associated with a fourfold increased (OR 4.11; 95 % CI: 1.98–8.52) odds of a collision; a regression relying on self-report measures only found no significant association.

Conclusions

Main findings confirmed that cannabis use increases collision risk and reinforces existing policy and educational efforts, in many high-income countries, aimed at reducing driving under the influence of cannabis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Adamson SJ, Sellman JD (2003) A prototype screening instrument for cannabis use disorder: the cannabis use disorders identification test (CUDIT) in an alcohol dependent clinical sample. Drug Alcohol Rev 22:309–315

    Article  PubMed  Google Scholar 

  • Asbridge M, Poulin C, Donato A (2005) Driving under the influence of cannabis and motor vehicle collision risk: evidence from adolescents in Atlantic Canada. Accid Anal Prev 37(6):1025–1034

    Article  PubMed  Google Scholar 

  • Asbridge M, Hayden JA, Cartwright JL (2012) Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ 9(344):e536. doi:10.1136/bmj.e536

    Article  Google Scholar 

  • Bates MN, Blakely TA (1999) Role of cannabis in motor vehicle crashes. Epidemiol Rev 21:222–232

    Article  CAS  PubMed  Google Scholar 

  • Beirness DJ, Beasley EE (2011) Alcohol and drug use among drivers: British Columbia roadside survey 2010. Canadian Centre on Substance Abuse, Ottawa

    Google Scholar 

  • Bergamaschi MM, Karschner EL, Goodwin RS, Scheidweiler KB, Hirvonen J, Queiroz RH, Huestis MA (2013) Impact of prolonged cannabinoid excretion in chronic daily cannabis smokers’ blood on per se drugged driving laws. Clin Chem 59(3):519–526

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Bogstrand ST, Gjerde H, Normann PT, Rossow I, Ekeberg O (2012) Alcohol, psychoactive substances and non-fatal road traffic accidents—a case–control study. BMC Public Health 12:734

    Article  PubMed Central  PubMed  Google Scholar 

  • Borges G, Cherpitel C, Orozco R, Bond J, Ye Y, MacDonald S et al (2006) Multicenter study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuries. Bull World Health Org 84(6):453–460

    Article  PubMed Central  PubMed  Google Scholar 

  • Drummer OH, Gerostamoulos J, Batziris H, Chu M, Caplehorn JR, Robertson MD, Swann P (2003) The incidence of drugs in drivers killed in Australian road traffic crashes. Forensic Sci Int 134(2–3):154–162

    Article  PubMed  Google Scholar 

  • Dussault C, Brault M, Bouchard J, Lemire AM (2002) The contribution of alcohol and other drugs among fatally injured drivers in Quebec: some preliminary results. In: Mayhew DR, Dussault C (eds) Proceedings of the 16th international conference on alcohol, drugs and traffic safety. Société de l’Assurance Automobile du Québec, Quebec, pp 423–430

  • Elvik R (2012) Risk of road accident associated with the use of drugs: a systematic review and meta-analysis of evidence from epidemiological studies. Accid Anal Prev. doi:10.1016/j.aap.2012.06.017 (e-pub ahead of print)

  • European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2008) Drug use, impaired driving and traffic accidents: insights no 8. Office for Official Publications of the European Communities, Lisbon

    Google Scholar 

  • Fergusson DM, Horwood LJ, Boden JM (2008) Is driving under the influence of cannabis becoming a greater risk to driver safety than drink driving? Findings from a longitudinal study. Accid Anal Prev 40(4):1345–1350

    Article  PubMed  Google Scholar 

  • Gmel G (2010) Case-crossover designs for alcohol use: the potential for more than one bias. J Stud Alcohol Drugs 71:620–621

    Google Scholar 

  • Gmel G, Kuendig H, Rehm J, Schreyer N, Daeppen JB (2009) Alcohol and cannabis use as risk factors for injury—a case-crossover analysis in a Swiss hospital emergency department. BMC Public Health 9:40

    Article  PubMed Central  PubMed  Google Scholar 

  • Gonzalez-Wilhelm L (2007) Prevalence of alcohol and illicit drugs in blood specimens from drivers involved in traffic law offences. Systematic review of cross-sectional studies. Traffic Inj Prev 8(2):189–198

    Article  PubMed  Google Scholar 

  • Hall W, Degenhardt L (2009) Adverse health effects of non-medical cannabis use. Lancet 374:1383–1391

    Article  CAS  PubMed  Google Scholar 

  • 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 

  • Kalant H (2004) Adverse effects of cannabis on health: an update of the literature since 1996. Prog Neuropsychopharmacol Biol Psychiatry 28(5):849–863

    Article  CAS  PubMed  Google Scholar 

  • Karschner EL, Scwilke EW, Lowe RH, Darwin WD, Pope HG, Herning R et al (2009) Do Δ9-tetrahydrocannabinol concentrations indicate recent use in chronic cannabis users? Addiction 104(12):2041–2048

    Article  PubMed Central  PubMed  Google Scholar 

  • Laumon B, Gadegbeku B, Martin J-L, Biecheler MB, SAM Group (2005) Cannabis intoxication and fatal road crashes in France: population based case–control study. BMJ 331:1371–1377

    Article  PubMed Central  PubMed  Google Scholar 

  • Ledgerwood DM, Goldberger BA, Risk NK, Lewis CE, Price RK (2008) Comparison between self-report and hair analysis of illicit drug use in a community sample of middle-age men. Addict Behav 33(9):1131–1139

    Article  PubMed Central  PubMed  Google Scholar 

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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Loo RL, Chan Q, Brown IJ, Robertson CE, Stamler J, Nicholson JK et al (2012) A comparison of self-reported analgesic use and detection of urinary ibuprofen and acetaminophen metabolites by means of metabonomics: the INTERMAP study. Am J Epidemiol 175(4):348–358

    Article  PubMed Central  PubMed  Google Scholar 

  • MacDonald S, Anglin-Bodrug K, Mann RE, Erickson P, Hathaway A, Chipman M, Rylett M (2003) Injury risk associated with cannabis and cocaine use. Drug Alcohol Depend 72:99–115

    Article  CAS  PubMed  Google Scholar 

  • Maclure M (1991) The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 133:144–153

    CAS  PubMed  Google Scholar 

  • Maclure M, Mittleman MA (2000) Should we use case-crossover design? Annu Rev Public Health 21:193–221

    Article  CAS  PubMed  Google Scholar 

  • Marshall RJ, Jackson RT (1993) Analysis of case-crossover designs. Stat Med 12:2333–2341

    Article  CAS  PubMed  Google Scholar 

  • Mensch BS, Kandel DB (1988) Underreporting of substance use in a national longitudinal youth cohort individual and interviewer effects. Public Opin Q 52(1):100–124

    Article  Google Scholar 

  • Mura P, Kintz P, Ludes B, Gaulier JM, Marquet P, Martin-Dupont S et al (2003) Comparison of the prevalence of alcohol, cannabis and other drugs between 900 injured drivers and 900 control subjects: results of a French collaborative study. Forensic Sci Int 133:79–85

    Article  CAS  PubMed  Google Scholar 

  • Mura P, Chatelain C, Dumestre V, Gaulier JM, Ghysel MH, Lacroix C et al (2005) Use of drugs of abuse in less than 30-year-old drivers killed in a road crash in France: a spectacular increase for cannabis, cocaine and amphetamines. Forensic Sci Int 160:168–172

    Article  PubMed  Google Scholar 

  • Origer A, Schmit JC (2012) Prevalence of hepatitis B and C and HIV infections among problem drug users in Luxembourg: self-report versus serological evidence. J Epidemiol Community Health 66(1):64–68

    Article  PubMed  Google Scholar 

  • Perez-Reyes M, Hicks RE, Bumberry J, Jeffcoat AR, Cook CE (1988) Interaction between marihuana and ethanol: effects on psychomotor performance. Alcohol Clin Exp Res 12:268–276

    Article  CAS  PubMed  Google Scholar 

  • Pope H, Gruber A, Hudson J, Huestis M, Yurgelun-Todd D (2001) Neuropsychological performance in longterm cannabis users. Arch Gen Psychiatry 58:909–915

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  • Redelmeier DA, Tibshirani RJ (1997) Association between cellular–telephone calls and motor vehicle collisions. New Engl J Med 336:453–458

    Article  CAS  PubMed  Google Scholar 

  • Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M (1993) Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88:791–804

    Article  CAS  PubMed  Google Scholar 

  • Stoduto G, Vingilis E, Kapur BM, Sheu WJ, McLellan BA, Liban CB (1993) Alcohol and drug use among motor vehicle collision victims admitted to a regional trauma unit: demographic, injury, and crash characteristic. Accid Anal Prev 25:411–420

    Article  CAS  PubMed  Google Scholar 

  • Yu Y, Bond J, Cherpitel CJ, Stockwell T, MacDonald S, Rehm J (2013) Evaluating potential bias using the case-crossover usual frequency method to estimate risk of injury due to alcohol. Epidemiology 24(2):240–243

    Article  Google Scholar 

  • Zeisser C, Stockwell TR, Chikritzhs T, Cherpitel C, Ye Y, Gardner C (2013) A systematic review and meta-analysis of alcohol consumption and injury risk as a function of study design and recall period. Alcohol Clin Exp Res 37(Suppl 1):E1–E8

    Article  PubMed Central  PubMed  Google Scholar 

  • Zhu M, Zhao S, Rice TM, Coben JH (2010) Trend analysis of drug-related motor vehicle crashes in the United States. Inj Prev 16:A159

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Dr. Rakesh Kumar and Dr. Kirk MaGee for their contributions to the project. Funding for this research comes from an operating grant from the Canadian Institutes of Health Research (CIHR), and a grant from AUTO21, a member of the Networks of Centres of Excellence (NCE) program which is administered and funded by the Natural Sciences and Engineering Research Council (NSERC) of Canada, the Canadian Institutes of Health Research (CIHR) and the Social Sciences and Humanities Research Council (SSHRC) of Canada, in partnership with Industry Canada. Asbridge was supported by a Canadian Institutes for Health Research New Investigator Award. Rehm received salary and infrastructure support from the Ontario Ministry of Health and Long-Term Care. We wish to thank Esther Giesbrecht and the Clinical Laboratory Team at the Centre for Addiction and Mental Health for the analysis of blood samples.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mark Asbridge.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Asbridge, M., Mann, R., Cusimano, M.D. et al. Cannabis and traffic collision risk: findings from a case-crossover study of injured drivers presenting to emergency departments. Int J Public Health 59, 395–404 (2014). https://doi.org/10.1007/s00038-013-0512-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-013-0512-z

Keywords

Navigation