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Drugs and Driving

Published on Nov 05, 2016

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PRESENTATION OUTLINE

Drugs and Driving

Ian Mitchell, MD, CM, FRCP

Disclosures

  • Tilray
  • MD Briefcase
  • MCRCI
  • Doctors for Responsible Access
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Rights vs Impairment

What impairment level do we tolerate?
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Senior plus Pet

RR 1.89
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Per Se Laws

Driving Research

Epidemiological vs live cases
Culpability
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BC Drivers Survey (2012)

  • Alcohol 8.3%
  • Cannabis 5.4%
  • Amphetamines 1.7%
  • Opiates 1.1%
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Injured BC Drivers

  • Alcohol 17.8%
  • THC 7.3%
  • Diphenhydramine 4.7%
  • Benzodiazepines 4.0%
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BC Drinking and Driving

  • 2008 - 395 fatalities
  • 38.5% ETOH related
  • 52% reduction after new laws
21% decrease in total crashes, 52 % decrease in alcohol related crashes.
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Alcohol

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Cannabis

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Bicycle Study

https://www.ncbi.nlm.nih.gov/pubmed/26739323

Alcohol is linked to 28% of cycling fatalities
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Meta-meta-analysis
OR 1.2-1.4
Rogeberg & Elvik

Under a causal interpretation, this suggests that roughly 20–30% of traffic crashes involving cannabis use occur because of the cannabis use. By comparison, the comparable ‘average’ relative risk for accidents with fatalities after drinking alcohol has been estimated at 7.5, which would imply that approximately 85% of crashes involving alcohol occur because of alcohol.
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Simulator Study

Hartman, Huestis, et al.
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AAA
Fatalities doubled in WA*
Per se laws arbitrary

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Anecdotes

  • Saskatoon
  • Saanich Moms
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Rees & Anderson

The Substitution Effect

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  • Colorado
  • Washington
Colorado - 2015 Worst year since 2008, due to record motorcycle fatalities (no helmet or seatbelt laws).

Washington - 1.7% increase in fatalities. Decreased alcohol related, increased cannabis related.

MML & Opiates

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Multiple Substances

Scherer, Harrell & Romano
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712660/pdf/jsad.2015.76.916.p...
And Dr. Romano said that lowering the legal blood-alcohol concentration, or B.A.C., to 0.05 or even 0.02 percent would reduce risk far more effectively than any effort to curb stoned driving.
“I’m not saying marijuana is safe,” he said. “But to me it’s clear that lowering the B.A.C. should be our top priority. That policy would save more lives.”http://www.nytimes.com/2014/02/18/health/driving-under-the-influence-of-mar...

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Amphetamines

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Methamphetamine

OR 14?
Amphetamines can be impairing and do not generally reverse the effects of fatigue.

Zopiclone

The effects of zopiclone 7.5 mg at 10 hours is comparable to the effects of a mean blood alcohol concentration between 0.5 and 0.8 mg/mL, which has been associated with a 2- to 3-fold increase in the risk of becoming involved in a traffic accident.

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Tech Answers?

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Future?