title: Differential physiological and behavioral cues observed in individuals smoking botanical marijuana versus synthetic cannabinoid drugs.
abstract: BACKGROUND
  Synthetic cannabinoid use has increased in many states, and medicinal and/or recreational marijuana use has been legalized in some states. These changes present challenges to law enforcement drug recognition experts (DREs) who determine whether drivers are impaired by synthetic cannabinoids or marijuana, as well as to clinical toxicologists who care for patients with complications from synthetic cannabinoids and marijuana. Our goal was to compare what effects synthetic cannabinoids and marijuana had on performance and behavior, including driving impairment, by reviewing records generated by law enforcement DREs who evaluated motorists arrested for impaired driving.
  
  
  METHODS
  Data were from a retrospective, convenience sample of de-identified arrest reports from impaired drivers suspected of using synthetic cannabinoids (n = 100) or marijuana (n = 33). Inclusion criteria were arrested drivers who admitted to using either synthetic cannabinoids or marijuana, or who possessed either synthetic cannabinoids or marijuana; who also had a DRE evaluation at the scene; and whose blood screens were negative for alcohol and other drugs. Exclusion criteria were impaired drivers arrested with other intoxicants found in their drug or alcohol blood screens. Blood samples were analyzed for 20 popular synthetic cannabinoids by using liquid chromatography-tandem mass spectrometry. Delta-9-tetrahydrocannabinol (THC) and THC-COOH were quantified by gas chromatography-mass spectrometry. Statistical significance was determined by using Fisher's exact test or Student's t-test, where appropriate, to compare the frequency of characteristics of those in the synthetic cannabinoid group versus those in the marijuana group.
  
  
  RESULTS
  16 synthetic cannabinoid and 25 marijuana records met selection criteria; the drivers of these records were arrested for moving violations. Median age for the synthetic cannabinoid group (n = 16, 15 males) was 20 years (IQR 19-23 years). Median age for the marijuana group (n = 25, 21 males) was 20 years (IQR 19-24 years) (p = 0.46). In the synthetic cannabinoid group, 94% (15/16) admitted to using synthetic cannabinoids. In the marijuana group, 96% (24/25) admitted to using marijuana. Blood was available for testing in 96% (24/25) of the marijuana group; 21 of these 24 had quantitative levels of THC (mean + SD = 10.7 + 5 ng/mL) and THC-COOH (mean + SD = 57.8 + 3 ng/mL). Blood was available for testing in 63% (10/16) of the synthetic cannabinoid group, with 80% (8/10) of these positive for synthetic cannabinoids. Those in the synthetic cannabinoid group were more frequently confused (7/16 [44%] vs. 0/25 [0%], p ≤ 0.003) and disoriented (5/16 [31%] vs. 0/25 [0%], p ≤ 0.003), and more frequently had incoherent, slurred speech (10/16 [63%] vs. 3/25 [12%], p = 0.0014) and horizontal gaze nystagmus (8/16 [50%] vs. 3/25 [12%], p = 0.01) than those in the marijuana group.
  
  
  CONCLUSIONS
  Drivers under the influence of synthetic cannabinoids were more frequently impaired with confusion, disorientation, and incoherent, slurred speech than drivers under the influence of marijuana in this population evaluated by DREs.
authors.affiliation: a Arizona Poison and Drug Information Center, The University of Arizona College of Pharmacy , Tucson , AZ , USA ;
authors.forename: Peter B
authors.initials: PB
authors.lastname: Chase
authors.affiliation: b Tucson Police Department , Tucson , AZ , USA ;
authors.forename: Jeff
authors.initials: J
authors.lastname: Hawkins
authors.affiliation: c Department of Emergency Medicine , The University of Arizona College of Medicine , Tucson , AZ , USA ;
authors.forename: Jarrod
authors.initials: J
authors.lastname: Mosier
authors.affiliation: d LCMS Laboratories , Tucson , AZ , USA ;
authors.forename: Ernest
authors.initials: E
authors.lastname: Jimenez
authors.affiliation: a Arizona Poison and Drug Information Center, The University of Arizona College of Pharmacy , Tucson , AZ , USA ;
authors.forename: Keith
authors.initials: K
authors.lastname: Boesen
authors.affiliation: e NMS Labs , Willow Grove , PA , USA.
authors.forename: Barry K
authors.initials: BK
authors.lastname: Logan
authors.affiliation: a Arizona Poison and Drug Information Center, The University of Arizona College of Pharmacy , Tucson , AZ , USA ;|c Department of Emergency Medicine , The University of Arizona College of Medicine , Tucson , AZ , USA ;
authors.forename: Frank G
authors.initials: FG
authors.lastname: Walter
mesh_terms: D001334:Automobile Driving; D002186:Cannabinoids / Q000097:blood / Q000138:chemical synthesis / Q000302:isolation & purification / Q000494:pharmacology*; D002188:Cannabis; D002853:Chromatography, Liquid; D003221:Confusion / Q000139:chemically induced / Q000523:psychology; D003415:Crime; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D008385:Marijuana Smoking / Q000009:adverse effects / Q000097:blood / Q000523:psychology*; D009759:Nystagmus, Pathologic / Q000139:chemically induced; D010936:Plant Extracts / Q000097:blood / Q000302:isolation & purification / Q000494:pharmacology*; D011237:Predictive Value of Tests; D011619:Psychotropic Drugs / Q000097:blood / Q000138:chemical synthesis / Q000302:isolation & purification / Q000494:pharmacology*; D012189:Retrospective Studies; D013028:Space Perception / Q000187:drug effects; D013065:Speech Intelligibility / Q000187:drug effects; D015813:Substance Abuse Detection / Q000379:methods*; D053719:Tandem Mass Spectrometry; D055815:Young Adult
chemical_list: D002186:Cannabinoids; D010936:Plant Extracts; D011619:Psychotropic Drugs
keywords: Driving under the influence; drug recognition experts; drugs of abuse; impairment