Cannabis and Driving: Developing Guidelines for Safety Policies

Federico      Manetti; Silvio      Chericoni; Anna      Marrocco; Matteo      Scopetti; Martina      Padovano; Alessandro      Santurro; Paola      Frati; Mario      Gabbrielli; Vittorio      Fineschi
doi:10.2174/1389201023666220616160459
Abstract

Introduction: The dynamism in the regulatory frameworks concerning the consumption of cannabinoids has placed their effects on cognitive and psychomotor skills at the center of the scientific debate. In consideration of the potential repercussions on public safety, particular attention has been focused on the impairment of driving skills, opening up the need to specifically regulate driving under the effects of cannabinoids.
Pharmacokinetics: Both native cannabinoids and metabolites show a long positivity at low concentrations in the biological fluids, especially in the case of chronic consumption. Qualitative positivity to cannabinoids does not itself prove the presence of detrimental effects, which require the presence of active substances at relevant concentrations.
Driving Skill Impairment: Multiple studies highlight a tetrahydrocannabinol (THC) concentration- based alteration of driving skills mainly affecting automatisms, whereas skills subjected to cognitive control are preserved up to higher dosages. The evidence relating to associations with other substances, chronic consumption and other cannabinoids, on the other hand, is still burdened by a high degree of uncertainty.
Regulation Policies: Different models can be adopted in the regulation of driving under the effects of cannabinoids: sanctions can be applied in case of qualitative positivity, cannabinoids concentration above a defined threshold, or in presence of a demonstrated state of cognitive alteration.
Conclusion: "Per se limit" with a quantitative THC cut-off between 3.5 and 5 ng/ml can currently be considered the most balanced choice. Finally, the analysis carried out allowed to identify pitfalls in both scientific and legislative fields for the improvement of safety policies.
Keywords: Cannabinoids, driving skill, zero tolerance, per se limit, impairment assessment, safety policies.
[1]

EMCDDA. European Drug Report 2017: Trends and Developments.  , 2017. Available from: http://www.emcdda.europa.eu/publications/edr/trends development s/2017 (Accessed on May 27, 2022)

[2]
EMCDDA. Statistical Bulletin 2018. 2018. Available from: https://www.emcdda.europa.eu/data/stats (Accessed on May 27, 2022).

[3]
Carliner, H.; Brown, Q.L.; Sarvet, A.L.; Hasin, D.S. Cannabis use, attitudes, and legal status in the U.S.: A review. Prev. Med.,  2017, 104, 13-23.
 [http://dx.doi.org/10.1016/j.ypmed.2017.07.008] [PMID:  28705601]

[4]
Caulkins, J.P.; Kilmer, B.; MacCoun, R.J.; Pacula, R.L.; Reuter, P. Design considerations for legalizing cannabis: Lessons inspired by analysis of California’s Proposition 19. Addiction,  2012, 107(5), 865-871.
 [http://dx.doi.org/10.1111/j.1360-0443.2011.03561.x] [PMID:  21985069]

[5]
van Ours, J.C. Legalizing recreational cannabis use: A promising journey into the unknown. World Psychiatry,  2020, 19(2), 196-197.
 [http://dx.doi.org/10.1002/wps.20743] [PMID:  32394555]

[6]
Carcieri, M. On the medicinal-recreational distinction in cannabis law. Denver Univ. Law Rev.,  2012, 89(4), 1011-1016.

[7]

 United Nations High Commissioner for Human Rights - Human Rights Council Study on the impact of the world drug problem on the enjoyment of human rights Available from:,  https://www.ohchr.org/en/hrbodies/hrc/regularsessions/session30/documents/a_hrc_30_65_e.docx  (Accessed on May 27, 2022)

[8]
Hall, W.D.; Renström, M.; Poznyak, V. Geneva: World Health Organization. The health and social effects of nonmedical cannabis use. Available from,  http://www.who.int/substance_abuse/publications/msb_ cannabis_report.pdf (Accessed on May 27, 2022).

[9]

EMCDDA. Cannabis and driving: Questions and answers for policymaking. Available from:,  https://www.emcdda.europa.eu/publications/joint-publications/cannabis-and-driving_en (Accessed May 27, 2022). 

[10]

EMCDDA. Driving Under the Influence of Drugs, Alcohol and   Medicines in Europe — findings from the DRUID project. Available from:, https://www.emcdda.europa.eu/publications/thematic-papers/druid_en (Accessed on May 27, 2022).

[11]
Hall, W. How should we respond to cannabis-impaired driving? Drug Alcohol Rev.,  2018, 37(1), 3-5.
 [http://dx.doi.org/10.1111/dar.12651] [PMID:  29345082]

[12]
Grotenhermen, F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin. Pharmacokinet.,  2003, 42(4), 327-360.
 [http://dx.doi.org/10.2165/00003088-200342040-00003] [PMID:  12648025]

[13]
Agurell, S.; Carlsson, S.; Lindgren, J.E.; Ohlsson, A.; Gillespie, H.; Hollister, L. Interactions of delta 1-tetrahydrocannabinol with cannabinol and cannabidiol following oral administration in man. Assay of cannabinol and cannabidiol by mass fragmentography. Experientia,  1981, 37(10), 1090-1092.
 [http://dx.doi.org/10.1007/BF02085029] [PMID:  6273208]

[14]
Gaston, T.E.; Friedman, D. Pharmacology of cannabinoids in the treatment of epilepsy. Epilepsy Behav,  2017, 70(Pt B), 313-3.
 [http://dx.doi.org/10.1016/j.yebeh.2016.11.016]

[15]
Kauert, G.F.; Ramaekers, J.G.; Schneider, E.; Moeller, M.R.; Toennes, S.W. Pharmacokinetic properties of delta9-tetrahydrocannabinol in serum and oral fluid. J. Anal. Toxicol.,  2007, 31(5), 288-293.
 [http://dx.doi.org/10.1093/jat/31.5.288] [PMID:  17579974]

[16]
McGilveray, I.J. Pharmacokinetics of cannabinoids. Pain Res. Manag.,  2005, 10(Suppl. A), 15A-22A.
 [http://dx.doi.org/10.1155/2005/242516] [PMID:  16237477]

[17]
Dinis-Oliveira, R.J. Metabolomics of Δ9-tetrahydrocannabinol: Implications in toxicity. Drug Metab. Rev.,  2016, 48(1), 80-87.
 [http://dx.doi.org/10.3109/03602532.2015.1137307] [PMID:  26828228]

[18]
Hunt, C.A.; Jones, R.T. Tolerance and disposition of tetrahydrocannabinol in man. J. Pharmacol. Exp. Ther.,  1980, 215(1), 35-44.
 [PMID:  6256518]

[19]
Devinsky, O.; Cilio, M.R.; Cross, H.; Fernandez-Ruiz, J.; French, J.; Hill, C.; Katz, R.; Di Marzo, V.; Jutras-Aswad, D.; Notcutt, W.G.; Martinez-Orgado, J.; Robson, P.J.; Rohrback, B.G.; Thiele, E.; Whalley, B.; Friedman, D. Cannabidiol: Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia,  2014, 55(6), 791-802.
 [http://dx.doi.org/10.1111/epi.12631] [PMID:  24854329]

[20]
White, C.M. A review of human studies assessing cannabidiol’s (CBD) therapeutic actions and potential. J. Clin. Pharmacol.,  2019, 59(7), 923-934.
 [http://dx.doi.org/10.1002/jcph.1387] [PMID:  30730563]

[21]
Lee, D.; Bergamaschi, M.M.; Milman, G.; Barnes, A.J.; Queiroz, R.H.; Vandrey, R.; Huestis, M.A. Plasma cannabinoid pharmacokinetics after controlled smoking and ad libitum cannabis smoking in chronic frequent users. J. Anal. Toxicol.,  2015, 39(8), 580-587.
 [http://dx.doi.org/10.1093/jat/bkv082] [PMID:  26378131]

[22]
Martin, J.H.; Schneider, J.; Lucas, C.J.; Galettis, P. Exogenous cannabinoid efficacy: merely a pharmacokinetic interaction? Clin. Pharmacokinet.,  2018, 57(5), 539-545.
 [http://dx.doi.org/10.1007/s40262-017-0599-0] [PMID:  28921125]

[23]
Ellis, G.M., Jr; Mann, M.A.; Judson, B.A.; Schramm, N.T.; Tashchian, A. Excretion patterns of cannabinoid metabolites after last use in a group of chronic users. Clin. Pharmacol. Ther.,  1985, 38(5), 572-578.
 [http://dx.doi.org/10.1038/clpt.1985.226] [PMID:  3902318]

[24]
Newmeyer, M.N.; Swortwood, M.J.; Barnes, A.J.; Abulseoud, O.A.; Scheidweiler, K.B.; Huestis, M.A. Free and glucuronide whole blood cannabinoids’ pharmacokinetics after controlled smoked, vaporized, and oral cannabis administration in frequent and occasional cannabis users: identification of recent cannabis intake. Clin. Chem.,  2016, 62(12), 1579-1592.
 [http://dx.doi.org/10.1373/clinchem.2016.263475] [PMID:  27899456]

[25]
Hassenberg, C.; Clausen, F.; Hoffmann, G.; Studer, A.; Schürenkamp, J. Investigation of phase II metabolism of 11-hydroxy-Δ-9-tetrahydrocannabinol and metabolite verification by chemical synthesis of 11-hydroxy-Δ-9-tetrahydrocannabinol-glucuronide. Int. J. Legal Med.,  2020, 134(6), 2105-2119.
 [http://dx.doi.org/10.1007/s00414-020-02387-w] [PMID:  32808050]

[26]
Bergamaschi, M.M.; Karschner, E.L.; Goodwin, R.S.; Scheidweiler, K.B.; Hirvonen, J.; Queiroz, R.H.; Huestis, M.A. Impact of prolonged cannabinoid excretion in chronic daily cannabis smokers’ blood on per se drugged driving laws. Clin. Chem.,  2013, 59(3), 519-526.
 [http://dx.doi.org/10.1373/clinchem.2012.195503] [PMID:  23449702]

[27]
Karschner, E.L.; Schwilke, E.W.; Lowe, R.H.; Darwin, W.D.; Pope, H.G.; Herning, R.; Cadet, J.L.; Huestis, M.A. Do Delta9-tetrahydrocannabinol concentrations indicate recent use in chronic cannabis users? Addiction,  2009, 104(12), 2041-2048.
 [http://dx.doi.org/10.1111/j.1360-0443.2009.02705.x] [PMID:  19804462]

[28]
Lucas, C.J.; Galettis, P.; Schneider, J. The pharmacokinetics and the pharmacodynamics of cannabinoids. Br. J. Clin. Pharmacol.,  2018, 84(11), 2477-2482.
 [http://dx.doi.org/10.1111/bcp.13710] [PMID:  30001569]

[29]
Ohlsson, A.; Lindgren, J.E.; Andersson, S.; Agurell, S.; Gillespie, H.; Hollister, L.E. Single-dose kinetics of deuterium-labelled cannabidiol in man after smoking and intravenous administration. Biomed. Environ. Mass Spectrom.,  1986, 13(2), 77-83.
 [http://dx.doi.org/10.1002/bms.1200130206] [PMID:  2937482]

[30]
Millar, S.A.; Stone, N.L.; Yates, A.S.; O’Sullivan, S.E. A Systematic review on the pharmacokinetics of cannabidiol in humans. Front. Pharmacol.,  2018, 9(9), 1365.
 [http://dx.doi.org/10.3389/fphar.2018.01365] [PMID:  30534073]

[31]
Consroe, P.; Laguna, J.; Allender, J.; Snider, S.; Stern, L.; Sandyk, R.; Kennedy, K.; Schram, K. Controlled clinical trial of cannabidiol in Huntington’s disease. Pharmacol. Biochem. Behav.,  1991, 40(3), 701-708.
 [http://dx.doi.org/10.1016/0091-3057(91)90386-G] [PMID:  1839644]

[32]
Boden, M.T.; Gross, J.J.; Babson, K.A.; Bonn-Miller, M.O. The interactive effects of emotional clarity and cognitive reappraisal on problematic cannabis use among medical cannabis users. Addict. Behav.,  2013, 38(3), 1663-1668.
 [http://dx.doi.org/10.1016/j.addbeh.2012.09.001] [PMID:  23254215]

[33]
Atakan, Z. Cannabis, a complex plant: Different compounds and different effects on individuals. Ther. Adv. Psychopharmacol.,  2012, 2(6), 241-254.
 [http://dx.doi.org/10.1177/2045125312457586] [PMID:  23983983]

[34]
De Aquino, J.P.; Sherif, M.; Radhakrishnan, R.; Cahill, J.D.; Ranganathan, M.; D’Souza, D.C. The psychiatric consequences of cannabinoids. Clin. Ther.,  2018, 40(9), 1448-1456.
 [http://dx.doi.org/10.1016/j.clinthera.2018.03.013] [PMID:  29678279]

[35]
Grotenhermen, F.; Leson, G.; Berghaus, G.; Drummer, O.H.; Krüger, H.P.; Longo, M.; Moskowitz, H.; Perrine, B.; Ramaekers, J.G.; Smiley, A.; Tunbridge, R. Developing limits for driving under cannabis. Addiction,  2007, 102(12), 1910-1917.
 [http://dx.doi.org/10.1111/j.1360-0443.2007.02009.x] [PMID:  17916224]

[36]
Del Balzo, G.; Gottardo, R.; Mengozzi, S.; Dorizzi, R.M.; Bortolotti, F.; Appolonova, S.; Tagliaro, F. “Positive” urine testing for cannabis is associated with increased risk of traffic crashes. J. Pharm. Biomed. Anal.,  2018, 151(151), 71-74.
 [http://dx.doi.org/10.1016/j.jpba.2017.12.059] [PMID:  29310049]

[37]
Johnson, M.B.; Kelley-Baker, T.; Voas, R.B.; Lacey, J.H. The prevalence of cannabis-involved driving in California. Drug Alcohol Depend.,  2012, 123(1-3), 105-109.
 [http://dx.doi.org/10.1016/j.drugalcdep.2011.10.023] [PMID:  22101027]

[38]
Pollini, R.A.; Romano, E.; Johnson, M.B.; Lacey, J.H. The impact of marijuana decriminalization on California drivers. Drug Alcohol Depend.,  2015, 150, 135-140.
 [http://dx.doi.org/10.1016/j.drugalcdep.2015.02.024] [PMID:  25765482]

[39]
Beirness, D.J.; Gu, K.W.; Lowe, N.J.; Woodall, K.L.; Desrosiers, N.A.; Cahill, B.; Porath, A.J.; Peaire, A. Cannabis, alcohol and other drug findings in fatally injured drivers in Ontario. Traffic Inj. Prev.,  2021, 22(1), 1-6.
 [http://dx.doi.org/10.1080/15389588.2020.1847281] [PMID:  33275453]

[40]
Asbridge, M.; Hayden, J.A.; Cartwright, J.L.  Acute cannabis consumption
  and motor vehicle collision risk: Systematic review of  observational studies and meta-analysis.  BMJ,  2012, 344(feb09 2), e536.
 [http://dx.doi.org/10.1136/bmj.e536] [PMID:  22323502]

[41]
Drummer, O.H.; Gerostamoulos, J.; Batziris, H.; Chu, M.; Caplehorn, J.; Robertson, M.D.; Swann, P. The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes. Accid. Anal. Prev.,  2004, 36(2), 239-248.
 [http://dx.doi.org/10.1016/S0001-4575(02)00153-7] [PMID:  14642878]

[42]
Laumon, B.; Gadegbeku, B.; Martin, J.L.; Biecheler, M.B.; Group, S.A.M. Cannabis intoxication and fatal road crashes in France: Population based case-control study. BMJ,  2005, 331(7529), 1371.
 [http://dx.doi.org/10.1136/bmj.38648.617986.1F] [PMID:  16321993]

[43]
Broyd, S.J.; van Hell, H.H.; Beale, C.; Yücel, M.; Solowij, N. Acute and chronic effects of cannabinoids on human cognition-A systematic review. Biol. Psychiatry,  2016, 79(7), 557-567.
 [http://dx.doi.org/10.1016/j.biopsych.2015.12.002] [PMID:  26858214]

[44]
Solowij, N.; Pesa, N. [Cognitive abnormalities and cannabis use Rev. Bras. Psiquiatr.,  2010, 32(Suppl. 1), S31-S40.
 [PMID:  20512268]

[45]
Fletcher, P.C.; Honey, G.D. Schizophrenia, ketamine and cannabis: Evidence of overlapping memory deficits. Trends Cogn. Sci.,  2006, 10(4), 167-174.
 [http://dx.doi.org/10.1016/j.tics.2006.02.008] [PMID:  16531099]

[46]
Ranganathan, M.; D’Souza, D.C. The acute effects of cannabinoids on memory in humans: A review.  Psychopharmacology (Berl.),  2006, 188(4), 425-444.
 [http://dx.doi.org/10.1007/s00213-006-0508-y] [PMID: 17019571]

[47]
D’Souza, D.C.; Perry, E.; MacDougall, L.; Ammerman, Y.; Cooper, T.; Wu, Y.T.; Braley, G.; Gueorguieva, R.; Krystal, J.H. The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: Implications for psychosis. Neuropsychopharmacology,  2004, 29(8), 1558-1572.
 [http://dx.doi.org/10.1038/sj.npp.1300496] [PMID:  15173844]

[48]
D’Souza, D.C.; Braley, G.; Blaise, R.; Vendetti, M.; Oliver, S.; Pittman, B.; Ranganathan, M.; Bhakta, S.; Zimolo, Z.; Cooper, T.; Perry, E. Effects of haloperidol on the behavioral, subjective, cognitive, motor, and neuroendocrine effects of Delta-9-tetrahydrocannabinol in humans. Psychopharmacology,  2008, 198(4), 587-603.
 [http://dx.doi.org/10.1007/s00213-007-1042-2] [PMID:  18228005]

[49]
Hunault, C.C.; Mensinga, T.T.; Böcker, K.B.; Schipper, C.M.; Kruidenier, M.; Leenders, M.E.; de Vries, I.; Meulenbelt, J. Cognitive and psychomotor effects in males after smoking a combination of tobacco and cannabis containing up to 69 mg delta-9-tetrahydrocannabinol (THC). Psychopharmacology,  2009, 204(1), 85-94.
 [http://dx.doi.org/10.1007/s00213-008-1440-0] [PMID:  19099294]

[50]
Kollins, S.H.; Schoenfelder, E.N.; English, J.S.; Holdaway, A.; Van Voorhees, E.; O’Brien, B.R.; Dew, R.; Chrisman, A.K. An exploratory study of the combined effects of orally administered methylphenidate and delta-9-tetrahydrocannabinol (THC) on cardiovascular function, subjective effects, and performance in healthy adults. J. Subst. Abuse Treat.,  2015, 48(1), 96-103.
 [http://dx.doi.org/10.1016/j.jsat.2014.07.014] [PMID:  25175495]

[51]
Morie, K.P.; Potenza, M.N. A mini-review of relationships between cannabis use and neural foundations of reward processing, inhibitory control and working memory. Front. Psychiatry,  2021, 12, 657371.
 [http://dx.doi.org/10.3389/fpsyt.2021.657371] [PMID:  33967859]

[52]
Cousijn, J.; Vingerhoets, W.A.; Koenders, L.; de Haan, L.; van den Brink, W.; Wiers, R.W.; Goudriaan, A.E. Relationship between working-memory network function and substance use: A 3-year longitudinal fMRI study in heavy cannabis users and controls. Addict. Biol.,  2014, 19(2), 282-293.
 [http://dx.doi.org/10.1111/adb.12111] [PMID:  24589297]

[53]
Cousijn, J.; Wiers, R.W.; Ridderinkhof, K.R.; van den Brink, W.; Veltman, D.J.; Goudriaan, A.E. Effect of baseline cannabis use and working-memory network function on changes in cannabis use in heavy cannabis users: A prospective FMRI study. Hum. Brain Mapp.,  2014, 35(5), 2470-2482.
 [http://dx.doi.org/10.1002/hbm.22342] [PMID:  24038570]

[54]
Fisk, J.E.; Montgomery, C. Real-world memory and executive processes in cannabis users and non-users. J. Psychopharmacol.,  2008, 22(7), 727-736.
 [http://dx.doi.org/10.1177/0269881107084000] [PMID:  18208908]

[55]
Morrison, P.D.; Zois, V.; McKeown, D.A.; Lee, T.D.; Holt, D.W.; Powell, J.F.; Kapur, S.; Murray, R.M. The acute effects of synthetic intravenous Delta9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychol. Med.,  2009, 39(10), 1607-1616.
 [http://dx.doi.org/10.1017/S0033291709005522] [PMID:  19335936]

[56]
Ramaekers, J.G.; Moeller, M.R.; van Ruitenbeek, P.; Theunissen, E.L.; Schneider, E.; Kauert, G. Cognition and motor control as a function of Delta9-THC concentration in serum and oral fluid: Limits of impairment. Drug Alcohol Depend.,  2006, 85(2), 114-122.
 [http://dx.doi.org/10.1016/j.drugalcdep.2006.03.015] [PMID:  16723194]

[57]
Ramaekers, J.G.; Kauert, G.; van Ruitenbeek, P.; Theunissen, E.L.; Schneider, E.; Moeller, M.R. High-potency marijuana impairs executive function and inhibitory motor control. Neuropsychopharmacology,  2006, 31(10), 2296-2303.
 [http://dx.doi.org/10.1038/sj.npp.1301068] [PMID:  16572123]

[58]
Ramaekers, J.G.; Kauert, G.; Theunissen, E.L.; Toennes, S.W.; Moeller, M.R. Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. J. Psychopharmacol.,  2009, 23(3), 266-277.
 [http://dx.doi.org/10.1177/0269881108092393] [PMID:  18719045]

[59]
Ramaekers, J.G.; Robbe, H.W.J.; O’Hanlon, J.F. Marijuana, alcohol and actual driving performance. Hum. Psychopharmacol.,  2000, 15(7), 551-558.
 [http://dx.doi.org/10.1002/1099-1077(200010)15:7<551:AID-HUP236>3.0.CO;2-P] [PMID:  12404625]

[60]
Ortiz-Peregrina, S.; Ortiz, C.; Castro-Torres, J.J.; Jiménez, J.R.; Anera, R.G. Effects of smoking cannabis on visual function and driving performance. A driving-simulator based study. Int. J. Environ. Res. Public Health,  2020, 17(23), 9033.
 [http://dx.doi.org/10.3390/ijerph17239033] [PMID:  33287427]

[61]
Ramaekers, J.G.; Berghaus, G.; van Laar, M.; Drummer, O.H. Dose related risk of motor vehicle crashes after cannabis use. Drug Alcohol Depend.,  2004, 73(2), 109-119.
 [http://dx.doi.org/10.1016/j.drugalcdep.2003.10.008] [PMID:  14725950]

[62]
Sewell, R.A.; Poling, J.; Sofuoglu, M. The effect of cannabis compared with alcohol on driving. Am. J. Addict.,  2009, 18(3), 185-193.
 [http://dx.doi.org/10.1080/10550490902786934] [PMID:  19340636]

[63]
Micallef, J.; Dupouey, J.; Jouve, E.; Truillet, R.; Lacarelle, B.; Taillard, J.; Daurat, A.; Authié, C.; Blin, O.; Rascol, O.; Philip, P.; Mestre, D. Cannabis smoking impairs driving performance on the simulator and real driving: A randomized, double-blind, placebo-controlled, crossover trial. Fundam. Clin. Pharmacol.,  2018, 32(5), 558-570.
 [http://dx.doi.org/10.1111/fcp.12382] [PMID:  29752828]

[64]
Hartman, R.L.; Brown, T.L.; Milavetz, G.; Spurgin, A.; Pierce, R.S.; Gorelick, D.A.; Gaffney, G.; Huestis, M.A. Cannabis effects on driving lateral control with and without alcohol. Drug Alcohol Depend.,  2015, 154, 25-37.
 [http://dx.doi.org/10.1016/j.drugalcdep.2015.06.015] [PMID:  26144593]

[65]
Fares, A.; Wickens, C.M.; Mann, R.E.; Di Ciano, P.; Wright, M.; Matheson, J.; Hasan, O.S.M.; Rehm, J.; George, T.P.; Samokhvalov, A.V.; Shuper, P.A.; Huestis, M.A.; Stoduto, G.; Brown, T.; Stefan, C.; Rubin-Kahana, D.S.; Le Foll, B.; Brands, B. Combined effect of alcohol and cannabis on simulated driving. Psychopharmacology,  2021, 239(5), 1263-1277.

[66]
Burt, T.S.; Brown, T.L.; Schmitt, R.; McGehee, D.; Milavetz, G.; Gaffney, G.R.; Berka, C. Perceived effects of cannabis and changes in driving performance under the influence of cannabis. Traffic Inj Prev,  2021, 22(sup1), S8-S13.
 [http://dx.doi.org/10.1080/15389588.2021.1933459]

[67]
Blows, S.; Ivers, R.Q.; Connor, J.; Ameratunga, S.; Woodward, M.; Norton, R. Marijuana use and car crash injury. Addiction,  2005, 100(5), 605-611.
 [http://dx.doi.org/10.1111/j.1360-0443.2005.01100.x] [PMID:  15847617]

[68]
Bondallaz, P.; Favrat, B.; Chtioui, H.; Fornari, E.; Maeder, P.; Giroud, C. Cannabis and its effects on driving skills. Forensic Sci. Int.,  2016, 268, 92-102.
 [http://dx.doi.org/10.1016/j.forsciint.2016.09.007] [PMID:  27701009]

[69]
Wickens, C.M.; Mann, R.E.; Brands, B.; Stoduto, G.; Matheson, J.; Sayer, G.; Burston, J.; Pan, J.F.; Di Ciano, P.; George, T.P.; Rehm, J.; Kenney, C.; Soule, D.; Huestis, M.A.; Le Foll, B. Influence of personality on acute smoked cannabis effects on simulated driving. Exp. Clin. Psychopharmacol., 2021.
 [http://dx.doi.org/10.1037/pha0000505] [PMID:  34291988]

[70]
Schuster, R.M.; Hoeppner, S.S.; Evins, A.E.; Gilman, J.M. Early onset marijuana use is associated with learning inefficiencies. Neuropsychology,  2016, 30(4), 405-415.
 [http://dx.doi.org/10.1037/neu0000281] [PMID:  26986749]

[71]
Gruber, S.A.; Sagar, K.A.; Dahlgren, M.K.; Racine, M.; Lukas, S.E. Age of onset of marijuana use and executive function. Psychol. Addict. Behav.,  2012, 26(3), 496-506.
 [http://dx.doi.org/10.1037/a0026269] [PMID:  22103843]

[72]
Dahlgren, M.K.; Sagar, K.A.; Smith, R.T.; Lambros, A.M.; Kuppe, M.K.; Gruber, S.A. Recreational cannabis use impairs driving performance in the absence of acute intoxication. Drug Alcohol Depend.,  2020, 208, 107771.
 [http://dx.doi.org/10.1016/j.drugalcdep.2019.107771] [PMID:  31952821]

[73]
Griffith-Lendering, M.F.; Huijbregts, S.C.; Mooijaart, A.; Vollebergh, W.A.; Swaab, H. Cannabis use and development of externalizing and internalizing behaviour problems in early adolescence: A TRAILS study. Drug Alcohol Depend.,  2011, 116(1-3), 11-17.
 [http://dx.doi.org/10.1016/j.drugalcdep.2010.11.024] [PMID:  21208753]

[74]
Fergusson, D.M.; Horwood, L.J.; Ridder, E.M. Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: Results of a 25-year longitudinal study. Drug Alcohol Depend.,  2007, 88(Suppl. 1), S14-S26.
 [http://dx.doi.org/10.1016/j.drugalcdep.2006.12.011] [PMID:  17292565]

[75]
La Russa, R.; Fineschi, V.; Di Sanzo, M.; Gatto, V.; Santurro, A.; Martini, G.; Scopetti, M.; Frati, P. Personalized medicine and adverse drug reactions: The experience of an Italian teaching hospital. Curr. Pharm. Biotechnol.,  2017, 18(3), 274-281.
 [http://dx.doi.org/10.2174/1389201018666170207124835] [PMID:  28176638]

[76]
McCartney, D.; Benson, M.J.; Suraev, A.S.; Irwin, C.; Arkell, T.R.; Grunstein, R.R.; Hoyos, C.M.; McGregor, I.S. The effect of cannabidiol on simulated car driving performance: A randomised, double-blind, placebo-controlled, crossover, dose-ranging clinical trial protocol. Hum. Psychopharmacol.,  2020, 35(5), e2749.
 [http://dx.doi.org/10.1002/hup.2749] [PMID:  32729120]

[77]
Arkell, T.R.; Vinckenbosch, F.; Kevin, R.C.; Theunissen, E.L.; McGregor, I.S.; Ramaekers, J.G. Effect of cannabidiol and Δ9-tetrahydrocannabinol on driving performance: A randomized clinical trial. JAMA,  2020, 324(21), 2177-2186.
 [http://dx.doi.org/10.1001/jama.2020.21218] [PMID:  33258890]

[78]
Gottschling, S.; Ayonrinde, O.; Bhaskar, A.; Blockman, M.; D’Agnone, O.; Schecter, D.; Suárez Rodríguez, L.D.; Yafai, S.; Cyr, C. Safety considerations in cannabinoid-based medicine. Int. J. Gen. Med.,  2020, 13, 1317-1333.
 [http://dx.doi.org/10.2147/IJGM.S275049] [PMID:  33299341]

[79]
Laprairie, R.B.; Bagher, A.M.; Kelly, M.E.; Denovan-Wright, E.M. Cannabidiol is a negative allosteric modulator of the cannabinoid CB1 receptor. Br. J. Pharmacol.,  2015, 172(20), 4790-4805.
 [http://dx.doi.org/10.1111/bph.13250] [PMID:  26218440]

[80]
Rock, E.M.; Bolognini, D.; Limebeer, C.L.; Cascio, M.G.; Anavi-Goffer, S.; Fletcher, P.J.; Mechoulam, R.; Pertwee, R.G.; Parker, L.A. Cannabidiol, a non-psychotropic component of cannabis, attenuates vomiting and nausea-like behaviour via indirect agonism of 5-HT(1A) somatodendritic autoreceptors in the dorsal raphe nucleus. Br. J. Pharmacol.,  2012, 165(8), 2620-2634.
 [http://dx.doi.org/10.1111/j.1476-5381.2011.01621.x] [PMID:  21827451]

[81]
Baker, D.; Pryce, G.; Croxford, J.L.; Brown, P.; Pertwee, R.G.; Huffman, J.W.; Layward, L. Cannabinoids control spasticity and tremor in a multiple sclerosis model. Nature,  2000, 404(6773), 84-87.
 [http://dx.doi.org/10.1038/35003583] [PMID:  10716447]

[82]
McGuire, P.; Robson, P.; Cubala, W.J.; Vasile, D.; Morrison, P.D.; Barron, R.; Taylor, A.; Wright, S. Cannabidiol (CBD) as an adjunctive therapy in schizophrenia: A multicenter randomized controlled trial. Am. J. Psychiatry,  2018, 175(3), 225-231.
 [http://dx.doi.org/10.1176/appi.ajp.2017.17030325] [PMID:  29241357]

[83]
Boggs, D.L.; Surti, T.; Gupta, A.; Gupta, S.; Niciu, M.; Pittman, B.; Schnakenberg Martin, A.M.; Thurnauer, H.; Davies, A.; D’Souza, D.C.; Ranganathan, M. The effects of cannabidiol (CBD) on cognition and symptoms in outpatients with chronic schizophrenia a randomized placebo controlled trial. Psychopharmacology,  2018, 235(7), 1923-1932.
 [http://dx.doi.org/10.1007/s00213-018-4885-9] [PMID:  29619533]

[84]
Leweke, F.M.; Piomelli, D.; Pahlisch, F.; Muhl, D.; Gerth, C.W.; Hoyer, C.; Klosterkötter, J.; Hellmich, M.; Koethe, D. Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl. Psychiatry,  2012, 2(3), e94.
 [http://dx.doi.org/10.1038/tp.2012.15] [PMID:  22832859]

[85]
Englund, A.; Morrison, P.D.; Nottage, J.; Hague, D.; Kane, F.; Bonaccorso, S.; Stone, J.M.; Reichenberg, A.; Brenneisen, R.; Holt, D.; Feilding, A.; Walker, L.; Murray, R.M.; Kapur, S. Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment. J. Psychopharmacol.,  2013, 27(1), 19-27.
 [http://dx.doi.org/10.1177/0269881112460109] [PMID:  23042808]

[86]
Morgan, C.J.; Schafer, G.; Freeman, T.P.; Curran, H.V. Impact of cannabidiol on the acute memory and psychotomimetic effects of smoked cannabis: Naturalistic study: Naturalistic study. Br. J. Psychiatry,  2010, 197(4), 285-290.
 [http://dx.doi.org/10.1192/bjp.bp.110.077503] [PMID:  20884951]

[87]
Morgan, C.J.; Gardener, C.; Schafer, G.; Swan, S.; Demarchi, C.; Freeman, T.P.; Warrington, P.; Rupasinghe, I.; Ramoutar, A.; Tan, N.; Wingham, G.; Lewis, S.; Curran, H.V. Sub-chronic impact of cannabinoids in street cannabis on cognition, psychotic-like symptoms and psychological well-being. Psychol. Med.,  2012, 42(2), 391-400.
 [http://dx.doi.org/10.1017/S0033291711001322] [PMID:  21798112]

[88]
Arkell, T.R.; Lintzeris, N.; Kevin, R.C.; Ramaekers, J.G.; Vandrey, R.; Irwin, C.; Haber, P.S.; McGregor, I.S. Cannabidiol (CBD) content in vaporized cannabis does not prevent tetrahydrocannabinol (THC)-induced impairment of driving and cognition. Psychopharmacology,  2019, 236(9), 2713-2724.
 [http://dx.doi.org/10.1007/s00213-019-05246-8] [PMID:  31044290]

[89]
Berthet, A.; De Cesare, M.; Favrat, B.; Sporkert, F.; Augsburger, M.; Thomas, A.; Giroud, C. A systematic review of passive exposure to cannabis. Forensic Sci. Int.,  2016, 269, 97-112.
 [http://dx.doi.org/10.1016/j.forsciint.2016.11.017] [PMID:  27883985]

[90]
Compton, W.M.; Volkow, N.D.; Lopez, M.F. Medical marijuana laws and cannabis use: Intersections of health and policy. JAMA Psychiatry,  2017, 74(6), 559-560.
 [http://dx.doi.org/10.1001/jamapsychiatry.2017.0723] [PMID:  28445570]

[91]
Downey, L.A.; King, R.; Papafotiou, K.; Swann, P.; Ogden, E.; Boorman, M.; Stough, C. Detecting impairment associated with cannabis with and without alcohol on the Standardized Field Sobriety Tests. Psychopharmacology,  2012, 224(4), 581-589.
 [http://dx.doi.org/10.1007/s00213-012-2787-9] [PMID:  22763669]

[92]
Porath, A.J.; Beirness, D.J. Predicting categories of drugs used by suspected drug-impaired drivers using the drug evaluation and classification program tests. Traffic Inj. Prev.,  2019, 20(3), 255-263.
 [http://dx.doi.org/10.1080/15389588.2018.1562178] [PMID:  30946603]

[93]
EMCDDA. A cannabis reader: Global issues and local experiences: Volume 1.  Available from: https://www.emcdda.europa.eu/publications/monographs/cannabis-volume1_en  (Accessed on May 27, 2022).

[94]
Zuurman, L.; Ippel, A.E.; Moin, E.; van Gerven, J.M. Biomarkers for the effects of cannabis and THC in healthy volunteers. Br. J. Clin. Pharmacol.,  2009, 67(1), 5-21.
 [http://dx.doi.org/10.1111/j.1365-2125.2008.03329.x] [PMID:  19133057]

[95]
Hartman, R.L.; Richman, J.E.; Hayes, C.E.; Huestis, M.A. Drug Recognition Expert (DRE) examination characteristics of cannabis impairment. Accid. Anal. Prev.,  2016, 92, 219-229.
 [http://dx.doi.org/10.1016/j.aap.2016.04.012] [PMID:  27107471]

[96]
Borro, M.; Gentile, G.; Cipolloni, L.; Foldes-Papp, Z.; Frati, P.; Santurro, A.; Lionetto, L.; Simmaco, M. Personalised healthcare: The DiMA clinical model. Curr. Pharm. Biotechnol.,  2017, 18(3), 242-252.
 [http://dx.doi.org/10.2174/1389201018666170208125131] [PMID:  28183244]

[97]
Di Sanzo, M.; Cipolloni, L.; Borro, M.; La Russa, R.; Santurro, A.; Scopetti, M.; Simmaco, M.; Frati, P. Clinical applications of personalized medicine: A new paradigm and challenge. Curr. Pharm. Biotechnol.,  2017, 18(3), 194-203.
 [http://dx.doi.org/10.2174/1389201018666170224105600] [PMID:  28240172]

[98]
Santurro, A.; Vullo, A.M.; Borro, M.; Gentile, G.; La Russa, R.; Simmaco, M.; Frati, P.; Fineschi, V. Personalized medicine applied to forensic sciences: New advances and perspectives for a tailored forensic approach. Curr. Pharm. Biotechnol.,  2017, 18(3), 263-273.
 [http://dx.doi.org/10.2174/1389201018666170207141525] [PMID:  28176637]

[99]
Chow, R.M.; Marascalchi, B.; Abrams, W.B.; Peiris, N.A.; Odonkor, C.A.; Cohen, S.P. Driving under the influence of cannabis: A framework for future policy. Anesth. Analg.,  2019, 128(6), 1300-1308.
 [http://dx.doi.org/10.1213/ANE.0000000000003575] [PMID:  31094805]

[100]
Manetti, F.; Scopetti, M.; Santurro, A.; Consoloni, L.; D’Errico, S. Widespread septic embolization in injection drug use mitro-aortic infective endocarditis as a remote cause of death. Int. J. Legal Med.,  2020, 134(4), 1345-1351.
 [http://dx.doi.org/10.1007/s00414-020-02309-w] [PMID:  32367331]
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DOI https://dx.doi.org/10.2174/1389201023666220616160459	Print ISSN 1389-2010
Publisher Name Bentham Science Publisher	Online ISSN 1873-4316
Current Pharmaceutical Biotechnology

Cannabis and Driving: Developing Guidelines for Safety Policies

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Current Pharmaceutical Biotechnology

Cannabis and Driving: Developing Guidelines for Safety Policies

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