Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis.
OBJECTIVE
To determine whether the acute consumption of cannabis (cannabinoids) by drivers increases the risk of a motor vehicle collision.


METHODS
Systematic review of observational studies, with meta-analysis.


METHODS
We did electronic searches in 19 databases, unrestricted by year or language of publication. We also did manual searches of reference lists, conducted a search for unpublished studies, and reviewed the personal libraries of the research team. Review methods We included observational epidemiology studies of motor vehicle collisions with an appropriate control group, and selected studies that measured recent cannabis use in drivers by toxicological analysis of whole blood or self report. We excluded experimental or simulator studies. Two independent reviewers assessed risk of bias in each selected study, with consensus, using the Newcastle-Ottawa scale. Risk estimates were combined using random effects models.


RESULTS
We selected nine studies in the review and meta-analysis. Driving under the influence of cannabis was associated with a significantly increased risk of motor vehicle collisions compared with unimpaired driving (odds ratio 1.92 (95% confidence interval 1.35 to 2.73); P=0.0003); we noted heterogeneity among the individual study effects (I(2)=81). Collision risk estimates were higher in case-control studies (2.79 (1.23 to 6.33); P=0.01) and studies of fatal collisions (2.10 (1.31 to 3.36); P=0.002) than in culpability studies (1.65 (1.11 to 2.46); P=0.07) and studies of non-fatal collisions (1.74 (0.88 to 3.46); P=0.11).


CONCLUSIONS
Acute cannabis consumption is associated with an increased risk of a motor vehicle crash, especially for fatal collisions. This information could be used as the basis for campaigns against drug impaired driving, developing regional or national policies to control acute drug use while driving, and raising public awareness.
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V7. mark.asbridge@dal.ca
Mark
M
Asbridge
Jill A
JA
Hayden
Jennifer L
JL
Cartwright
D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000208:Acute Disease; D001334:Automobile Driving / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D015982:Bias; D002186:Cannabinoids / Q000009:adverse effects*; D002188:Cannabis; D015986:Confounding Factors, Epidemiologic; D003625:Data Collection; D004305:Dose-Response Relationship, Drug; D013759:Dronabinol / Q000097:blood; D006801:Humans; D008385:Marijuana Smoking / Q000453:epidemiology* / Q000331:legislation & jurisprudence; D012307:Risk Factors
D002186:Cannabinoids; D013759:Dronabinol