A randomized, placebo-controlled, double-blind, pilot study of cannabis-related driving impairment assessed by driving simulator and self-report

Aims: In the context of increasing cannabis use, understanding how cannabis affects specific driving behaviors is crucial in mitigating risks and ensuring road safety. Design and setting: The current study included 38 adults aged 18–40 years, administered a single 0.5 g acute dose of vaporized cannabis (5.9% Tetrahydrocannabinol (THC), 13% THC or placebo) in a randomized, within-subject, double-blind, counterbalanced design. Throughout each of the three, 8-h assessment days, at 4 time points, participants underwent simulated driving tests, including lane-keeping, car following, and overtaking tasks, capturing 19 behavioral metrics. An SPSS linear mixed model assessed the main effects of dose, time, and dose×time. Findings: During lane-keeping, participants exhibited reduced steering reversal rates up to 5.5h following 13% THC and 3.5h for 5.9%. For car following, participants showed reduced pedal peak-to-peak deviation and reversal rates, persisting for 1–3h post-dose (only at 13% THC). During overtaking, following 13% THC, subjects demonstrated a shorter median gap to passed cars, lower time-to-potential collision, and more time in the oncoming lane. Drug effects on driving metrics improved gradually, to varying degrees over time. Approximately 66% of participants reported willingness to drive, despite subjective awareness of being impaired and objectively worse driving performance. Conclusions: Our study reveals for the first time long-lasting cannabis-induced impairments across multiple driving behaviors, that extend beyond the typical 3-h window explored in most previous research. The observed discrepancy between participants' willingness to drive and their actual impairment highlights an important public safety concern. In addition, the lack of correlation between cannabinoid metabolite concentrations and driving performance challenges the reliability of blood THC levels as impairment indicators, emphasizing the need for a multifaceted approach to assessing cannabis-impaired driving risk.