Impairment due to cannabis and ethanol: clinical signs and additive effects
Article first published online: 10 MAR 2010
© 2010 The Authors. Journal compilation © 2010 Society for the Study of Addiction
Volume 105, Issue 6, pages 1080–1087, June 2010
How to Cite
Bramness, J. G., Khiabani, H. Z. and Mørland, J. (2010), Impairment due to cannabis and ethanol: clinical signs and additive effects. Addiction, 105: 1080–1087. doi: 10.1111/j.1360-0443.2010.02911.x
- Issue published online: 6 MAY 2010
- Article first published online: 10 MAR 2010
- Submitted 6 May 2009; initial review completed 2 July 2009; final version accepted 2 December 2009
- clinical test for impairment;
- drugged driving;
Aims Studies have shown that the impairing effects of Δ-9-tetrahydrocannabinol (THC) are dose-related. Cannabis intake increases the risk of traffic accidents. The purpose of this study was to see how different clinical tests and observations were related to blood THC concentrations and to determine whether the combined influence of THC and ethanol was different from either drug alone.
Design A retrospective cross-sectional forensic database study.
Setting Drivers apprehended by the police suspected of driving under the influence of alcohol other drugs.
Participants We investigated 589 cases positive for THC only. In addition, 894 cases with THC and ethanol were included. A comparison was made with 3480 drivers with only ethanol in their blood and 79 drivers who tested negative.
Measurements Data were analytical results of blood samples and the 27 clinical tests and observations included in the Norwegian clinical test for impairment (CTI).
Findings No relationship was found between blood THC concentration and most of the CTI tests. Blood THC concentration was, however, related to conjunctival injection, pupil dilation and reaction to light and to the overall risk of being judged impaired. When THC and ethanol were detected together the risk of being judged impaired was increased markedly.
Conclusions This study demonstrates that cannabis impairs driving ability in a concentration-related manner. The effect is smaller than for ethanol. The effect of ethanol and cannabis taken simultaneously is additive. Conjunctival injection, dilated pupils and slow pupil reaction are among the few signs to reveal THC influence.