Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis: A Randomized Clinical Trial.
Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis: A Randomized Clinical Trial.
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DOI：
10.1001/jamapsychiatry.2023.2345
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发表时间：
2023-09-01
期刊：
影响因子：
25.8
通讯作者：
Fitzgerald, Robert L.
中科院分区：
文献类型：
--
作者：
Marcotte, Thomas D.;Umlauf, Anya;Grelotti, David J.;Sones, Emily G.;Mastropietro, Kyle F.;Suhandynata, Raymond T.;Huestis, Marilyn A.;Grant, Igor;Fitzgerald, Robert L.
这项随机临床试验调查了执法人员现场清醒测试的准确性，以评估吸食大麻的个人的功能损害和驾驶表现。现场清醒试验(FST)在识别急性Δ-9-四氢大麻酚(THC)损伤方面的准确性如何？在这项对184名大麻使用者随机分为THC和安慰剂的随机临床试验中，执法人员分别将81.0%和49.2%的人归类为FST受损，并怀疑99.2%的FST受损参与者接受了THC。驾驶模拟器的性能与选定的FST有关。在这项研究中，FST在暴露于THC和安慰剂的参与者之间有所区别；然而，组间FST损害的大量重叠以及怀疑由THC引起的FST损害的高频率表明，如果没有其他指标，仅有FST可能不足以识别THC特定的驾驶损害。随着医用和娱乐用大麻合法化的增加，公共卫生需要进行有效和公正的评估，以确定司机是否因接触Δ9-四氢大麻酚而受损。现场清醒测试(FST)是以执法人员为基础的黄金标准评估的关键组成部分，但关于它们在检测一个人是否受到THC影响方面的有效性，对照研究尚无定论。检查FST在大麻暴露和驾驶损伤方面的分类准确性(通过驾驶模拟确定)。这项双盲、安慰剂对照的平行随机临床试验于2017年2月至2019年6月在加州大学圣地亚哥分校大麻医学研究中心进行。参与者年龄在21岁至55岁之间，并在过去一个月中使用过大麻。对2021年8月至2023年4月的数据进行了分析。参与者被随机分为1：1：1安慰剂(0.02%THC)、5.9%THC大麻或13.4%THC随意吸食大麻。主要终点是执法人员在吸烟后4个时间点确定FST损害。其他措施包括官员估计参与者是否属于THC组或安慰剂组，以及驾驶模拟器数据。警察没有观察驾驶表现。这项研究包括184名参与者(117名[63.6%]男性；平均[SD]年龄，30[8.3]岁)，他们在过去30天内平均(SD)16.7(9.8)天；121人接受THC治疗，63人服用安慰剂。在吸烟后70分钟，警察将98名(81.0%)THC组参与者和31名(49.2%)安慰剂组参与者归类为FST受损(差异31.8%；95%可信区间16.4-47.2%；P <； .001)。THC组在27个单独的FST成分中的8个(29.6%)和所有FST总分上的表现明显低于安慰剂组。然而，安慰剂组没有按照指示完成8(IQR，5-11)FST成分的中位数。在128名被归类为FST受损的参与者中，有127人(99.2%)怀疑接受了THC。驾驶模拟器的表现与选择的FST结果显著相关(例如，单腿支架上的≥2线索与模拟器上的损伤相关：优势比，3.09；95%可信区间，1.63-5.88；P <； .001)。这项随机临床试验发现，当由训练有素的官员实施FST时，服用THC和安慰剂的人之间的FST有所不同，驾驶能力与一些FST的结果有关。然而，服用安慰剂的参与者未能充分执行FST的比率很高，而且FST表现不佳被怀疑是由于THC相关的损害的频率很高，这表明如果没有其他指标，FST可能不足以指示司机中THC特有的损害。ClinicalTrials.gov标识：NCT02849587
This randomized clinical trial investigates the accuracy of field sobriety tests administered by law enforcement officers to assess functional impairment and driving performance among individuals who have smoked cannabis. How accurate are field sobriety tests (FSTs) in identifying acute Δ9-tetrahydrocannabinol (THC) impairment? In this randomized clinical trial of 184 cannabis users randomized to THC or placebo, law enforcement officers classified 81.0% and 49.2%, respectively, as FST impaired, and officers suspected that 99.2% of FST-impaired participants received THC. Driving simulator performance was associated with select FSTs. In this study, FSTs differentiated between THC- and placebo-exposed participants; however, the substantial overlap of FST impairment between groups and the high frequency at which FST impairment was suspected to be due to THC suggest that absent other indicators, FSTs alone may be insufficient to identify THC-specific driving impairment. With increasing medicinal and recreational cannabis legalization, there is a public health need for effective and unbiased evaluations for determining whether a driver is impaired due to Δ9-tetrahydrocannabinol (THC) exposure. Field sobriety tests (FSTs) are a key component of the gold standard law enforcement officer–based evaluations, yet controlled studies are inconclusive regarding their efficacy in detecting whether a person is under the influence of THC. To examine the classification accuracy of FSTs with respect to cannabis exposure and driving impairment (as determined via a driving simulation). This double-blind, placebo-controlled parallel randomized clinical trial was conducted from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California, San Diego. Participants were aged 21 to 55 years and had used cannabis in the past month. Data were analyzed from August 2021 to April 2023. Participants were randomized 1:1:1 to placebo (0.02% THC), 5.9% THC cannabis, or 13.4% THC cannabis smoked ad libitum. The primary end point was law enforcement officer determination of FST impairment at 4 time points after smoking. Additional measures included officer estimation as to whether participants were in the THC or placebo group as well as driving simulator data. Officers did not observe driving performance. The study included 184 participants (117 [63.6%] male; mean [SD] age, 30 [8.3] years) who had used cannabis a mean (SD) of 16.7 (9.8) days in the past 30 days; 121 received THC and 63, placebo. Officers classified 98 participants (81.0%) in the THC group and 31 (49.2%) in the placebo group as FST impaired (difference, 31.8 percentage points; 95% CI, 16.4-47.2 percentage points; P < .001) at 70 minutes after smoking. The THC group performed significantly worse than the placebo group on 8 of 27 individual FST components (29.6%) and all FST summary scores. However, the placebo group did not complete a median of 8 (IQR, 5-11) FST components as instructed. Of 128 participants classified as FST impaired, officers suspected 127 (99.2%) as having received THC. Driving simulator performance was significantly associated with results of select FSTs (eg, ≥2 clues on One Leg Stand was associated with impairment on the simulator: odds ratio, 3.09; 95% CI, 1.63-5.88; P < .001). This randomized clinical trial found that when administered by highly trained officers, FSTs differentiated between individuals receiving THC vs placebo and driving abilities were associated with results of some FSTs. However, the high rate at which the participants receiving placebo failed to adequately perform FSTs and the high frequency that poor FST performance was suspected to be due to THC-related impairment suggest that FSTs, absent other indicators, may be insufficient to denote THC-specific impairment in drivers. ClinicalTrials.gov Identifier: NCT02849587
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DOI：
10.1016/j.aap.2021.106326
发表时间：
2021-09
期刊：
Accident; analysis and prevention
影响因子：
--
作者：
Brooks-Russell A;Brown T;Friedman K;Wrobel J;Schwarz J;Dooley G;Ryall KA;Steinhart B;Amioka E;Milavetz G;Sam Wang G;Kosnett MJ
通讯作者：
Kosnett MJ
影响因子：
3.4
作者：
Downey, Luke A.;King, Rebecca;Stough, Con
通讯作者：
Stough, Con
影响因子：
4.2
作者：
Cooper, Ziva D.;Haney, Margaret
通讯作者：
Haney, Margaret
影响因子：
120.7
作者：
Arkell, Thomas R.;Vinckenbosch, Frederick;Ramaekers, Johannes G.
通讯作者：
Ramaekers, Johannes G.
影响因子：
5.9
作者：
Hasin D;Walsh C
通讯作者：
Walsh C