Car Crash Deaths Involving Cannabis on the Rise Between 2000 and 2018, the percentage of car crash deaths in the United States involving cannabis have doubled—and the percentage of deaths Synthetic cannabinoids have caused a large number of emergency presentations to hospitals for adverse cardiovascular events including numerous deaths, particularly for the more potent analogs acting on the CB<sub>1</sub> receptor. While smoked cannabis use is often associated with significant change …
Car Crash Deaths Involving Cannabis on the Rise
Between 2000 and 2018, the percentage of car crash deaths in the United States involving cannabis have doubled—and the percentage of deaths involving both cannabis and alcohol have more than doubled, according to a new study by a School of Public Health researcher.
Researchers from the School of Public Health, the School of Medicine, Boston Medical Center, and University of Victoria found that people who died in crashes involving cannabis had 50 percent greater odds of also having alcohol in their system.
Published in the American Journal of Public Health, these findings suggest that as states have loosened cannabis policies, cannabis and alcohol have increasingly been used together when driving.
Although the proportion of crash deaths involving alcohol has remained relatively constant over the last two decades, the proportion of crash deaths involving other substances, particularly cannabis, has increased, and little attention has been given to the connection between alcohol and cannabis use. Some have proposed that liberalizing cannabis policies could lead to a reduction in alcohol use, as individuals might substitute cannabis for alcohol. However, this study suggests the opposite—that cannabis and alcohol are increasingly being used together when it comes to impaired driving, and that cannabis increases the likelihood of alcohol use in crash deaths.
“There has been progress in reducing deaths from alcohol-impaired driving, but our study suggests that cannabis involvement might be undercutting these public health efforts,” says study senior author Timothy Naimi, adjunct professor at the Schools of Public Health and Medicine, and director of the Canadian Institute of Substance Use Research in Victoria, Canada. Currently, almost 40 percent of crash deaths in the US involve alcohol, and 30 percent of deaths involve alcohol above the legal limit for driving.
For the study, which was funded by the National Institute on Alcohol Abuse and Alcoholism, researchers analyzed 19 years of data from the Fatality Analysis Reporting System, a national database of fatal crashes on public roads. The percent of crash deaths involving cannabis more than doubled from 9 percent in 2000 to 21.5 percent in 2018, and the percent of deaths involving cannabis and alcohol also more than doubled from 4.8 percent to 10.3 percent. Cannabis was a risk factor for alcohol co-involvement, even at levels below the legal limit.
These results also show that cannabis-involved car crashes are more likely to involve the deaths of passengers as well as individuals younger than 35, compared to crash deaths not involving cannabis. A series of analyses were conducted to account for drug testing rates and alcohol policies, and the results remained consistent.
“Our testing methods for cannabis remain suboptimal and individuals can test positive for cannabis weeks after they have consumed it,” says study lead author Marlene Lira, an epidemiologist at BMC. “However, we can say that fatalities from crashes involving cannabis are more likely to have also involved alcohol, even if we don’t know the exact level of cannabis.” Most cannabis tests do not distinguish between any past use and acute intoxication, and implementing standardized thresholds is challenging due to tolerance from regular use.
”The bottom line is that we have a lot of work to do to reduce deaths and harms from impaired driving from alcohol, cannabis, and other substances,” says Lira.
In 2018, National Highway Traffic Safety Administration (NHTSA) began workgroups to mitigate the harms of drug-impaired driving in the midst of the overdose epidemic and cannabis legalization. NHTSA also commissioned the National Academies of Sciences, Engineering and Medicine to study alcohol-impaired driving whose report included the recommendation to reduce the legal alcohol limit to 0.05 percent, among other interventions. This study underscores that now, more than ever, these efforts are still needed.
Cannabis as a cause of death: A review
Synthetic cannabinoids have caused a large number of emergency presentations to hospitals for adverse cardiovascular events including numerous deaths, particularly for the more potent analogs acting on the CB1 receptor. While smoked cannabis use is often associated with significant changes in heart rate and cardiac output, amongst other physiological changes, it has been rarely considered in the forensic literature as a significant contributory or causal factor in sudden unexpected death. A review of case reports of admissions to hospitals for cardiovascular events was undertaken together with a review of epidemiological studies, and case reports of sudden death attributed, at least in part, to use of this drug. These publications show that use of cannabis is not without its risks of occasional serious medical emergencies and sudden death, with reports of at least 35 persons presenting with significant cardiovascular emergencies who had recently smoked a cannabis preparation. At least 13 deaths from a cardiovascular mechanism have been reported from use of this drug which is very likely to be an under-estimate of the true incidence of its contribution to sudden death. In addition, many cases of stroke and vascular arteritis have also been reported with the latter often involving a limb amputation. While it is a drug with widespread usage among the community with relatively few deaths when faced with a circumstance of very recent use (within a few hours), a positive blood concentration of THC and a possible cardiac-related or cerebrovascular cause of death this drug should be considered, at least, a contributory cause of death in cases of sudden or unexpected death.
Keywords: Arrhythmias; Cardiovascular disease; Forensic; Heart disease; Myocardial infarction; Stroke.
Copyright © 2019 Elsevier B.V. All rights reserved.
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