Driving Performance and Cannabis Users' Perception of Safety: A Randomized Clinical Trial.
Driving Performance and Cannabis Users' Perception of Safety: A Randomized Clinical Trial.
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DOI：
10.1001/jamapsychiatry.2021.4037
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发表时间：
2022-03-01
期刊：
影响因子：
25.8
通讯作者：
Fitzgerald RL
中科院分区：
文献类型：
--
作者：
Marcotte TD;Umlauf A;Grelotti DJ;Sones EG;Sobolesky PM;Smith BE;Hoffman MA;Hubbard JA;Severson J;Huestis MA;Grant I;Fitzgerald RL
这项随机临床试验研究了大麻对驾驶的影响的程度和时间过程，不同四氢大麻酚含量的大麻的影响，可能的耐受性影响以及自我感知损伤的准确性。哪些因素与吸食大麻对驾驶的影响以及使用者对驾驶能力的看法有关？在这项随机临床试验中，191名经常吸食安慰剂或5.9%或13.4% Δ9-四氢大麻酚（THC）香烟的大麻使用者，THC组的模拟器驾驶恶化，但这与THC含量，使用历史或血液THC浓度无关。驾驶障碍的感知在1小时30分钟时下降，尽管驾驶没有客观改善;平均而言，在4.5小时时，与安慰剂组的表现没有区别。当有经验的大麻使用者控制自己的摄入量时，人们不能根据产品THC含量或血液浓度来推断损害，而表现与自我感知损害之间的脱节是一个重要的公共安全信息。扩大大麻医疗化和合法化增加了了解与急性驾驶障碍相关因素的紧迫性。在常规大麻使用者的大样本中，确定吸食不同Δ9-四氢大麻酚（THC）含量的大麻产生的驾驶障碍的程度和时间过程、使用历史的影响以及感知障碍与观察到的驾驶障碍之间的一致性。表现。这项双盲、安慰剂对照平行随机临床试验于2017年2月至2019年6月在加州圣地亚哥大学药用大麻研究中心进行。这项研究招募了大麻使用者，并在2020年4月至2021年9月期间进行了分析。安慰剂或5.9%或13.4% THC大麻，可自由吸食。主要终点是综合驾驶评分（CDS），包括吸烟前和吸烟后多个时间点评估的关键驾驶模拟器变量。其他措施包括驾驶障碍和大麻使用史的自我感知。在191名大麻使用者中，118名（61.8%）为男性，平均（SD）年龄为29.9（8.3）岁，过去一个月的平均（SD）使用天数为16.7（9.8）。参与者被随机分配到安慰剂组（63 [33.0%]），5.9% THC（66 [34.6%]）和13.4% THC（62 [32.5%]）。与安慰剂组相比，THC组在30分钟时的综合驾驶评分显著下降（Cohen d = 0.59 [95% CI，0.28-0.90]; P < .001）和1小时30分钟（Cohen d = 0.55 [95%CI，0.24-0.86]; P < .001），3小时30分钟时存在临界差异（Cohen d = 0.29 [95% CI，-0.02至0.60]; P = .07），4小时30分钟时无差异（Cohen d = -0.03 [95% CI，-0.33至0.28]; P = .87）。在过去的6个月里，基于THC含量（似然比χ24 = 3.83; P = 0.43）或使用强度（数量×频率）（似然比χ24 = 1.41; P = 0.49）的复合驱动力评分没有差异，尽管吸烟后血液THC浓度在使用强度最高的人中更高。尽管吸烟后立即开车犹豫不决，但越来越多的参与者（81 [68.6%]）报告说，尽管吸烟后的表现没有从最初的水平提高，但他们在1小时30分钟时就准备好了开车。经常使用者随意吸食大麻导致模拟驾驶减少。然而，当有经验的使用者控制自己的摄入量时，不能根据香烟的THC含量，行为耐受性或THC血液浓度来推断驾驶障碍。参与者越来越愿意在1小时30分钟内驾驶，这可能表明他们对驾驶安全有错误的认识。在吸烟后的几个小时内，许多用户的驾驶性能明显变差，但在大多数人中，4小时30分钟后似乎就解决了。需要进一步研究个体生物学差异，大麻使用史和管理方法对驾驶性能的影响。ClinicalTrials.gov标识符：NCT 02849587
This randomized clinical trial studies the magnitude and time course of effects of cannabis on driving, effect of cannabis with different tetrahydrocannabinol amounts, possible tolerance effects, and accuracy of self-perception of impairment. What factors are related to the impact of smoked cannabis on driving and the users’ perception of driving ability? In this randomized clinical trial of 191 regular cannabis users who smoked ad libitum placebo or 5.9% or 13.4% Δ9-tetrahydrocannabinol (THC) cigarettes, simulator driving worsened in the THC group, but this was unrelated to THC content, use history, or blood THC concentration. Perception of driving impairment decreased at 1 hour 30 minutes, despite no objective improvement in driving; on average, performance was indistinguishable from the placebo group at 4.5 hours. When experienced cannabis users control their own intake, one cannot infer impairment based on the product THC content or blood concentrations, and the disconnect between performance and self-perceived impairment is an important public safety message. Expanding cannabis medicalization and legalization increases the urgency to understand the factors associated with acute driving impairment. To determine, in a large sample of regular cannabis users, the magnitude and time course of driving impairment produced by smoked cannabis of different Δ9-tetrahydrocannabinol (THC) content, the effects of use history, and concordance between perceived impairment and observed performance. This double-blind, placebo-controlled parallel randomized clinical trial took place from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California San Diego. Cannabis users were recruited for this study, and analysis took place between April 2020 and September 2021. Placebo or 5.9% or 13.4% THC cannabis smoked ad libitum. The primary end point was the Composite Drive Score (CDS), which comprised key driving simulator variables, assessed prior to smoking and at multiple time points postsmoking. Additional measures included self-perceptions of driving impairment and cannabis use history. Of 191 cannabis users, 118 (61.8%) were male, the mean (SD) age was 29.9 (8.3) years, and the mean (SD) days of use in the past month was 16.7 (9.8). Participants were randomized to the placebo group (63 [33.0%]), 5.9% THC (66 [34.6%]), and 13.4% THC (62 [32.5%]). Compared with placebo, the THC group significantly declined on the Composite Drive Score at 30 minutes (Cohen d = 0.59 [95% CI, 0.28-0.90]; P < .001) and 1 hour 30 minutes (Cohen d = 0.55 [95% CI, 0.24-0.86]; P < .001), with borderline differences at 3 hours 30 minutes (Cohen d = 0.29 [95% CI, –0.02 to 0.60]; P = .07) and no differences at 4 hours 30 minutes (Cohen d = –0.03 [95% CI, –0.33 to 0.28]; P = .87). The Composite Drive Score did not differ based on THC content (likelihood ratio χ24 = 3.83; P = .43) or use intensity (quantity × frequency) in the past 6 months (likelihood ratio χ24 = 1.41; P = .49), despite postsmoking blood THC concentrations being higher in those with the highest use intensity. Although there was hesitancy to drive immediately postsmoking, increasing numbers (81 [68.6%]) of participants reported readiness to drive at 1 hour 30 minutes despite performance not improving from initial postsmoking levels. Smoking cannabis ad libitum by regular users resulted in simulated driving decrements. However, when experienced users control their own intake, driving impairment cannot be inferred based on THC content of the cigarette, behavioral tolerance, or THC blood concentrations. Participants’ increasing willingness to drive at 1 hour 30 minutes may indicate a false sense of driving safety. Worse driving performance is evident for several hours postsmoking in many users but appears to resolve by 4 hours 30 minutes in most individuals. Further research is needed on the impact of individual biologic differences, cannabis use history, and administration methods on driving performance. ClinicalTrials.gov Identifier: NCT02849587
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