title: Interaction of marijuana and alcohol on fatal motor vehicle crash risk: a case-control study.
abstract: BACKGROUND
  Concurrent use of marijuana and alcohol in drivers is of increasing concern but its role in crash causation has not been well understood.
  
  
  METHODS
  Using a case-control design, we assessed the individual and joint effects of marijuana and alcohol use on fatal crash risk. Cases (n = 1944) were drivers fatally injured in motor vehicle crashes in the United States at specific times in 2006, 2007 and 2008. Controls (n = 7719) were drivers who participated in the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers.
  
  
  RESULTS
  Overall, cases were significantly more likely than controls to test positive for marijuana (12.2% vs. 5.9%, p < 0.0001), alcohol (57.8% vs. 7.7%, p < 0.0001) and both marijuana and alcohol (8.9% vs. 0.8%, p < 0.0001). Compared to drivers testing negative for alcohol and marijuana, the adjusted odds ratios of fatal crash involvement were 16.33 [95% confidence interval (CI): 14.23, 18.75] for those testing positive for alcohol and negative for marijuana, 1.54 (95% CI: 1.16, 2.03) for those testing positive for marijuana and negative for alcohol, and 25.09 (95% CI: 17.97, 35.03) for those testing positive for both alcohol and marijuana.
  
  
  CONCLUSIONS
  Alcohol use and marijuana use are each associated with significantly increased risks of fatal crash involvement. When alcohol and marijuana are used together, there exists a positive synergistic effect on fatal crash risk on the additive scale.
authors.affiliation: Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA.|Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Stanford
authors.initials: S
authors.lastname: Chihuri
authors.affiliation: Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA. GL2240@cumc.columbia.edu.|Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. GL2240@cumc.columbia.edu.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. GL2240@cumc.columbia.edu.
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Qixuan
authors.initials: Q
authors.lastname: Chen
keywords: Accidents; Alcohol; Case–control studies; Drug interaction; Marijuana; Motor vehicles; Safety; Traffic