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Abstract
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The health claims that have been made for cannabidiol, or CBD, are almost as numerous as the types of products that contain the compound--1 of the 2 main cannabinoids in cannabis.
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Despite its widespread use, evidence of CBD's safety and effectiveness is lacking, except in the treatment of seizures in patients with 2 rare epilepsy syndromes and tuberous sclerosis complex.
In addition, little is known about how people who consume CBD fare behind the wheel. Much of the research into cannabis's effect on driving performance has focused on the whole plant and its other main cannabinoid, tetrahydrocannabinol, or THC, which produces euphoria.
"There is still a notion among researchers and, particularly, the general public" that CBD counteracts the psychoactive effects of THC, said psychologist Johannes Ramaekers, PhD, of the University of Maastricht in the Netherlands, coauthor of a new study in this issue of JAMA that investigated how vaporized CBD and THC affected driving performance.
One or 2 studies "have suggested that maybe if you smoke cannabis strains that are high in CBD it will diminish the impairing effects of THC," Ramaekers said. However, subsequent studies have not been able to replicate that finding, he said. Even so, "I do see these claims on the internet quite often."
Demand for CBD use appears to be soaring, whether in newer high-CBD cannabis strains, touted for their "relaxing, nonintoxicating effects," or in ubiquitous edibles, tinctures, oils, and topical preparations. Internet searches for the cannabinoid have increased substantially in all states since 2014, according to a recent research letter in JAMA Network Open. People swear by CBD for everything from acne to erectile dysfunction to ulcerative colitis, another recent study in JAMA Network Open found.
Meanwhile, 33 states and the District of Columbia have legalized medical use of marijuana; 13 states allow the use of high-CBD-low-THC products for specific indications; and 11 states and the District of Columbia permit recreational marijuana use. In addition, on Election Day in November, voters in 2 more states approved measures to legalize medical marijuana, while voters in 4 more states approved measures to regulate recreational use of marijuana.
With so many states permitting medical or recreational marijuana use, driving under the influence of cannabis appears to be a growing trend, although drugged driving is illegal in every state. Among fatally injured drivers who were tested for drugs, the percentage positive for cannabinoids rose from 8% in 2007 to 18% in 2016, according to the National Highway Traffic Safety Administration.
Marijuana use has been associated with an increase in traffic fatalities in Colorado but not in Washington State, according to a recent study in JAMA Internal Medicine. In 2012, those 2 states became the first to allow recreational use.
Eleven states, one of which--Michigan--allows recreational marijuana use, have zero-tolerance driving laws for certain drugs, including THC, according to the National Conference of State Legislatures.
But what about CBD? As University of California, San Diego, psychologist Thomas Marcotte, PhD, noted in an interview, CBD itself is psychoactive, given its apparent antianxiety effects. Adverse events observed in human CBD studies have included sedation and somnolence, according to a recent review article coauthored by toxicologist Marilyn Huestis, PhD, former chief of the Chemistry and Drug Metabolism Section of the National Institute on Drug Abuse.
"The reason that I wrote it was because everybody and their brother was taking CBD," Huestis, now associated with Thomas Jefferson University's Institute of Emerging Health Professions, said in an interview. "I wrote the paper for people to realize that there are adverse effects with everything." She and her coauthors concluded that "Patients should be advised that their ability to drive or operate machinery could be impaired while under CBD treatment."...
Keywords: Cannabis impaired driving
Language: en |