Cannabis legalization and driving under the influence of cannabis and driving under the influence of alcohol among adult and adolescent drivers in Ontario, Canada (2001-2019)

Sameer Imtiaz; Yeshambel T Nigatu; Farihah Ali; Branka Agic; Tara Elton-Marshall; Huan Jiang; Jürgen Rehm; Sergio Rueda; Marcos Sanches; Robert M Schwartz; Kevin D Shield; Some Nibene Somé; Bundit Sornpaisarn; Samantha Wells; Christine M Wickens; Hayley A Hamilton

doi:10.1016/j.drugalcdep.2023.111060

Cannabis legalization and driving under the influence of cannabis and driving under the influence of alcohol among adult and adolescent drivers in Ontario, Canada (2001-2019)

Drug Alcohol Depend. 2024 Feb 1:255:111060. doi: 10.1016/j.drugalcdep.2023.111060. Epub 2023 Dec 14.

Authors

Sameer Imtiaz¹, Yeshambel T Nigatu², Farihah Ali², Branka Agic³, Tara Elton-Marshall⁴, Huan Jiang⁵, Jürgen Rehm⁶, Sergio Rueda⁷, Marcos Sanches⁸, Robert M Schwartz⁹, Kevin D Shield¹⁰, Some Nibene Somé¹¹, Bundit Sornpaisarn⁵, Samantha Wells¹², Christine M Wickens¹³, Hayley A Hamilton¹⁰

Affiliations

¹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada. Electronic address: sameer.imtiaz@camh.ca.
² Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
³ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Education Research, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
⁴ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada.
⁵ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada.
⁶ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, University of Toronto, Room 2374, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, Dresden 01187, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, B. 2, Moscow 119992, Russian Federation.
⁷ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, University of Toronto, Room 2374, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
⁸ Biostatistics Core, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H5, Canada.
⁹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada.
¹⁰ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
¹¹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, London, Ontario N6A 5C1, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
¹² Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, London, Ontario N6A 5C1, Canada; School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia.
¹³ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, 6th Floor, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 425-155 College Street, Toronto, Ontario M5T 1P8, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.

PMID: 38181618
DOI: 10.1016/j.drugalcdep.2023.111060

Abstract

Background: The impacts of cannabis legalization on driving under the influence of cannabis and driving under the influence of alcohol among adults and adolescents were examined in Ontario, Canada.

Methods: Data were sourced from adult (N=38,479) and adolescent (N=23,216) populations-based surveys (2001-2019). The associations between cannabis legalization and driving within an hour of using cannabis and driving within an hour of drinking two or more drinks of alcohol were quantified using logistic regression, with testing of multiplicative interactions between cannabis legalization and age and sex. All analyses were conducted separately for adults and adolescents and restricted to participants with a valid driver's license.

Results: Cannabis legalization was not associated with driving within an hour of using cannabis among adults (OR, 95% CI: 1.21, 0.69-2.11). However, a multiplicative interaction indicated that there was an increased likelihood of driving within an hour of using cannabis among adults ≥55 years of age (4.23, 1.85-9.71) pre-post cannabis legalization. Cannabis legalization was not associated with driving within an hour of using cannabis among adolescents (0.92, 0.72-1.16), or with driving within an hour of consuming two or more drinks of alcohol among adults (0.78, 0.51-1.20) or adolescents (0.87, 0.42-1.82).

Conclusions: An increased likelihood of driving under the influence of cannabis among adults ≥55 years of age was detected in the year following cannabis legalization, suggesting the need for greater public awareness and education and police monitoring and enforcement concerning driving under the influence of cannabis, particularly among older adults.

Keywords: Alcohol Drinking; Canada; Cannabis; Ethanol; Marijuana Use; Policy.

MeSH terms

Adolescent
Aged
Alcohol Drinking / epidemiology
Canada
Cannabinoid Receptor Agonists
Cannabis*
Driving Under the Influence*
Ethanol
Hallucinogens*
Humans
Legislation, Drug
Ontario / epidemiology

Substances

Ethanol
Hallucinogens
Cannabinoid Receptor Agonists