title: Frequency and irregularity of heart rate in drivers suspected of driving under the influence of cannabis.
abstract: BACKGROUND
  Delta 9-tetrahydrocannabinol (THC) is the major active component of cannabis. Cardiovascular effects of THC have previously been reported: tachycardia after intake, but also bradycardia at higher doses. The purpose of this study was, firstly, to investigate the frequency and irregularity of heart rate in a group of cannabis users in their natural surroundings. We also compared THC-positive drivers with a regular pulse with THC-positive drivers with an irregular pulse.
  
  
  METHODS
  The division of Forensic Toxicology and Drug Abuse (DFTDA) at the Norwegian Institute of Public Heath analyzes blood samples from all drivers suspected of driving under the influence of drugs. We studied pulse rate and regularity in 502 THC-positive drivers who tested negative for other substances. As a control group, we randomly selected 125 drug-negative cases from the database of the DFTDA; no alcohol, narcotics, or medicinal drugs of abuse were detected.
  
  
  RESULTS
  The Delta9-THC-positive drivers had a higher mean pulse rate than the control group [82.8 beats/min (SD 16.3) versus 75.6 beats/min (SD 9.2)] and more cases with tachycardia were detected in the Delta9-THC-positive group (19.4% versus 1.6%). There was only one driver with an irregular heart beat in the control group, while there were nine among the Delta9-THC-positive drivers. The drivers with an irregular pulse were over-represented amongst those with the lowest blood Delta9-THC concentrations.
  
  
  CONCLUSIONS
  This report represents a large study of subjects in a real-life situation and includes observations on pulse frequency, regularity, and blood Delta9-THC concentration. A substantial fraction of Delta9-THC-positive drivers had tachycardia, but there was no correlation between blood Delta9-THC concentration and pulse rate in the present study. We had no further diagnostic information on the cause of the pulse irregularities, but our results indicate that occasional users of cannabis tend to have irregular heart rates at low THC concentrations and at low pulse rates.
authors.affiliation: Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse, Post Office Box 4404 Nydalen, 0403 Oslo Norway. hassan.khiabani@legemiddelverket.no
authors.forename: Hassan Z
authors.initials: HZ
authors.lastname: Khiabani
authors.forename: Jørg
authors.initials: J
authors.lastname: Mørland
authors.forename: Jørgen G
authors.initials: JG
authors.lastname: Bramness
mesh_terms: D000328:Adult; D001334:Automobile Driving; D002188:Cannabis / Q000009:adverse effects*; D016022:Case-Control Studies; D013759:Dronabinol / Q000097:blood / Q000494:pharmacology; D005260:Female; D006213:Hallucinogens / Q000097:blood / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D015813:Substance Abuse Detection / Q000379:methods; D013610:Tachycardia / Q000139:chemically induced*
chemical_list: D006213:Hallucinogens; D013759:Dronabinol