Statement on Cannabis Regulation and Risk of Injury

The American College of Surgeons (ACS) Committee on Trauma (COT), through its Subcommittee on Injury Prevention and Control, developed the following Statement on Cannabis Regulation and Risk of Injury to educate surgeons and other medical professionals on the significance of cannabis and its effect on safety and the risk of injury. The ACS Board of Regents approved the statement at its October 2017 meeting in San Diego, CA.

The ACS recognizes the following:

• Cannabis is among the most commonly abused substances in the US, and its use has increased over the past decade, while active components have increased almost sixfold in content and potency over the last three decades. Cannabis is also one of the most commonly detected intoxicants in driving-related incidents.^1-4
• More than 25 states have enacted laws legalizing marijuana to some degree.^1,3
• Cannabis impairs the ability to perform tasks associated with driving in a dose-dependent fashion for several hours after using a cannabis-containing product.^5,6
• Cannabis-associated motor vehicle operation has increased fivefold over the past quarter-century, especially in states where its use has been legalized or decriminalized.^7,8
• Current methods for determining cannabis-related intoxication are challenging and difficult to utilize at the point of need, and may not accurately determine impairment.^5,9-12
• Since 1970, cannabis and cannabinoid-containing compounds have been listed by the Drug Enforcement Administration as a Schedule I Controlled Substance with “no currently acceptable medical use” and the Food and Drug Administration has not approved marijuana as a safe and effective drug for any indication.¹³

The ACS therefore supports the following:

• Educating the public about safe driving habits and the risks of recent cannabis use, including co-use with alcohol, medications, or any illicit substances¹⁴
• Funding research to determine appropriate medical cannabis use and restriction for use in conjunction with motor vehicle operation¹⁵
• Developing evidence-based legislation to deter driving while intoxicated in conjunction with reliable point-of-care tests to accurately identify cannabis intoxication or impairment
• Encouraging the comprehensive care of the injured patient, including attention to the use of substances that impair judgment and dexterity, including cannabis
• Researching the effectiveness of brief interventions to reduce cannabis-intoxicated driving¹⁶

References

1. Center for Behavioral Health Statistics and Quality (2016). Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H.51). Available at: www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf. Accessed January 17, 2018.
2. ElSohly MA, Ross SA, Mehmedic Z, Arafat R, Banaham BF 3rd. Potency trends of delta-9-THC and other cannabinoids in confiscated marijuana from 1980–1997. J Forens Sci. 2004;45(1):24-30.
3. Ramaekers JG, Berghaus G, van Laar MW, Drummer OH. Dose related risk of motor vehicle crashes after cannabis use: An update. In: Drugs, Driving and Traffic Safety. Basel, Switzerland: Birkhauser; 2009:477-499.
4. Downey LA, King R, Papafotiou K, et al. The effects of cannabis and alcohol on simulated driving: Influences of dose and experience. Accid Anal Prev. 2013;50:879-886.
5. 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.
6. Dubois S, Mullen N, Weaver B, Bedard M. The combined effects of alcohol and cannabis on driving: Impact on crash risk. Forensic Sci Int. 2015;248:94-100.
7. Couper FJ, Peterson BL. The prevalence of marijuana in suspected impaired driving cases in Washington state. J Anal Toxicol. 2014;38(8):569-574.
8. Salomonsen-Sautel S, Min SJ, Sakai JT, Thurstone C, Hopfer C. Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado. Drug and Alcohol Depend. 2014;140:137-144.
9. Ramaekers JG, Berghaus G, van Laar M, Drummer OH. Dose related risk of motor vehicle crashes after cannabis use. Drug and Alcohol Depend. 2004;73(2):109-119.
10. Ronen A, Gershon P, Drobiner H, et al. Effects of THC on driving performance, physiological state and subjective feelings relative to alcohol. Accid Anal Prev. 2008;40(3):926-934.
11. Hartman RL, Huestis MA. Cannabis effects on driving skills. Clin Chem. 2013;59(3):478-492.
12. Bramness JG, Khiabani HZ, Morland J. Impairment due to cannabis and ethanol: Clinical signs and additive effects. Addiction. 2010;105(6):1080-1087.
13. State marijuana laws in 2016 map. Governing.com. 2016. Available at: www.governing.com/gov-data/state-marijuana-laws-map-medical-recreational.html. Accessed December 19, 2017.
14. Sewell RA, Poling J, Sofuoglu M. The effect of cannabis compared with alcohol on driving. Am J Addictions. 2009;18(3):185-193.
15. Drug Enforcement Administration. Denial of Petition to Initiate Proceedings to Reschedule Marijuana, 81 Fed. Reg 53688. (August 12, 2016) (to be codified at 21 C.F.R. pts. 156).
16. Schermer CR, Moyers TB, Miller WR, Bloomfield LA. Trauma center brief interventions for alcohol disorders decrease subsequent driving under the influence arrests. J Trauma Acute Care Surg. 2006;60(1):29-34.