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An effective framework for allowing patients who use medical cannabis to drive is one that prioritises road safety while also recognising the importance of driving for freedom of movement and quality of life, write Dr Thomas Arkell and Associate Professor Vicki Kotsirilos AM.
People who take cannabis containing delta-9-tetrahydrocannabinol (THC) for medicinal reasons are not allowed to drive, which can significantly affect their quality of life by restricting their freedom of movement.
Australia first introduced a regulatory framework allowing patients to legally access medical cannabis in 2016. Since then, the rate of prescribing has rapidly increased.
The approvals for access to medical cannabis via the Special Access Scheme Category B (SAS-B) alone exceeded 375 000, as of May 2023.
The SAS-B scheme allows health practitioners to apply for a permit to prescribe unapproved products to individual patients.
The majority of these prescriptions (~200 000) were for chronic pain, and most products prescribed were orally administered oils.
There have also been over 30 000 applications for patient access from 2035 prescribers via the Authorised Prescriber pathway.
Under current presence laws, which prohibit driving with a proscribed drug (in this case, cannabis containing THC) in one’s system, patients using medical cannabis products containing THC are banned from driving in each state with the exception of Tasmania.
These laws are enforced via roadside drug testing (RDT) that looks for the presence of THC and other drugs in oral fluid.
Although RDT is carried out in all Australian states and territories, Tasmania is the only jurisdiction where patients have a medical defence if they happen to test positive to THC and have a valid prescription for medical cannabis.
In Tasmania, driving with any detectable amount of THC is an offence, unless the product was obtained and administered in accordance with the Poisons Act 1971.
This restriction on driving has been the focus of several recent proposed legislative amendments.
In New South Wales, a Road Transport Amendment (Medicinal Cannabis – Exemptions from Offences) Bill was proposed in 2021 but rejected in 2022 due to concerns with perceived increase risk of road safety risk.
A similar bill – the Road Safety Amendment (Medicinal Cannabis) Bill 2023 — is now before the Victorian parliament and appears to have the support of the Premier.
What does the evidence say about medical cannabis and driving?
It is important to distinguish recreational cannabis laws and risks to driving compared with the prescribing of medical cannabis products containing THC prescribed by doctors for medical reasons.
Recreational cannabis contains unknown concentrations of THC with the aim to obtain a “high” from higher levels. This is not the aim with Medical Cannabis products.
Most of the international research on cannabis and driving is specific to THC. Cannabidiol (CBD), a non-psychoactive compound that is often found in medical cannabis, does not impair driving, and there is no restriction on driving for patients who are using CBD-only medical cannabis.
There is considerable dispute on the actual crash risk associated with driving with THC in one’s system. For example, a rapid review of the literature by Monash University concluded that “there is global consensus that the use of THC results in a range of impairments specific to driving, with these impairments being associated with an increase in crash risk”.
A separate Australian review also concluded that THC increases crash risk but noted that the magnitude of the increase is modest.
One of the most comprehensive reviews on the topic was conducted by members of the International Council on Alcohol, Drugs and Traffic Safety.
In 2021, over 20 experts from 11 different counties formed a Cannabis and Driving Working Group to address concerns around increasing cannabis use and implications for traffic safety.
The working group have since published a series of publicly available fact sheets that review the scientific evidence on cannabis and driving.
In one of these fact sheets, the working group reviewed the limited evidence that currently exists on the impact of medical cannabis (not recreational cannabis) on driving, quoting studies that show a nil impact or a reduction in fatal crashes in jurisdictions introducing medical-only access pathways.
In contrast, in jurisdictions where recreational cannabis was legalised or decriminalised, THC was associated with an increase in fatalities for some groups.
The quality of this evidence for the legalisation of recreational cannabis is generally good, as these studies use government data on crashes and hospital admissions, but it may be sometime yet before we have a clear picture of how changing cannabis laws have truly affected road safety.
It is important to distinguish recreational cannabis laws and risks to driving compared with the prescribing of medical cannabis products containing THC prescribed by doctors for medical reasons.
Ultimately, the working group concluded that “medical cannabis consumers should not be subject to THC zero-tolerance laws that make it illegal to drive with any detectable level of THC, as is the case with some other types of impairing medications, but they should still be subject to impaired driving laws.”
What would a patient exemption look like in practice?
A patient exemption from RDT for THC detection and the associated presence offence is not tantamount to giving patients the liberty to drive while impaired.
Any such change could bring medical cannabis (only when prescribed and used as directed) into line with other medications that can also impair driving, such as benzodiazepines and opioids, both of which appear to actually increase crash risk more than cannabis.
Patients would still remain vulnerable to impaired driving laws and the associated offence of driving under the influence.
Several international jurisdictions have already implemented policies enabling medical cannabis patients to drive so long as they are unimpaired.
New Zealand, for instance, recently passed legislation allowing oral fluid testing, but a medical defence is available to drivers who have taken medical cannabis in accordance with their prescription and are not demonstrating impairment during driving, such as lane weaving or failing to adhere to road rules.
Oral fluid testing was also recently introduced in Canada, but police must first have a reasonable suspicion, based on objectively discernible facts (eg, red eyes, speech patterns) that a driver is affected by a drug.
Other countries, including Norway, Germany, Ireland and the United Kingdom, also exempt patients from cannabis-impaired driving charges so long as they are unimpaired and were using their medication as prescribed.
What are some of the challenges to implementing a patient exemption?
There are several challenges that need acknowledging. For instance:
- what happens if a patient is combining prescribed medical cannabis with illicit cannabis?
- And how would police test for impairment if a driver does have a prescription but is demonstrably impaired?
The first of these two issues could be effectively managed through diligence at the point of prescription.
Doctors can and should inquire about previous cannabis and other drug use before prescribing medical cannabis.
If there are indications that a patient has a history of drug dependence or concurrent cannabis use, doctors might consider prescribing a CBD-only product without any THC or refusing access to medical cannabis.
Doctors can also use SafeScript and other real-time prescribing tools to identify patients who are currently prescribed other drugs of dependency (eg, benzodiazepines and opioids), and patients who might be “doctor shopping”.
SafeScript provides immediate alerts to the medical practitioner when trying to prescribe medical cannabis containing THC on top of other drugs of dependence. This is a very useful tool.
As outlined further below, a patient exemption might exclude certain groups of patients who already have an elevated crash risk, such as young drivers and people using inhaled products with high amounts of THC and/or alcohol.
The second issue, which relates to the determination of impairment, especially at a crash site, is one for which we already have a template.
Police can conduct what is known as a field sobriety assessment; this involves assessing a person’s balance, coordination, and overall behaviour.
Police can also look for signs of intoxication (eg, red eyes, speech patterns) and recent cannabis use (eg, smell of cannabis in the car).
If a police officer has a reasonable suspicion that a driver is impaired and intoxicated, then this may warrant an RDT for presence of THC, other illicit drugs, and alcohol in the body.
Research is currently looking at ways to improve the detection of impairment.
For instance, studies are looking at whether driver state monitoring systems might be able to identify alcohol and drug-related impairment in real time.
Driver monitoring systems devices help drivers, including across other areas of transportation such as aviation and rail, to provide real-time assessment of their capacity to perform the driving task.
Driver state monitoring systems are already widely implemented in modern vehicles to monitor fatigue and distraction, and they are mandatory for all new vehicles in the European Union.
What safeguards could be implemented to manage the risks?
Warnings about safe driving would potentially follow the same approach that doctors use when advising patients how to minimise the risk of impairment with any other potentially impairing medication.
For example, a label warning on the medical cannabis product can warn patients to avoid driving or using machinery if they experience sedation or drowsiness.
There are multiple safeguards that can be put in place from the point of prescription onwards to help minimise the risk of impairment associated with the use of THC-based products.
Examples derived from our own personal clinical experience include:
- Require patients to sign a consent form acknowledging the risk of side effects and contraindications to driving (eg, sedation, drowsiness) with THC-related products.
- Warn patients they cannot drive if impaired, just as we advise patients to not drive if impaired with pharmaceuticals such as benzodiazepines and opioids.
- Prescribe CBD-based products, which are non-intoxicating, first before considering the inclusion of THC, which can be intoxicating depending on the dose. Medicinal cannabis products contain a range of concentrations from CBD alone or CBD dominant, to a combination of CBD and THC of various ratios, to THC dominant products.
- Work from the principle of “start low, go slow”, titrating doses upwards slowly to use the lowest possible dose of THC, and avoiding THC altogether where contraindicated.
- Trial orally administered, low dose THC products before prescribing products for inhalation, as oral products can be dosed more precisely.
- Instruct patients to avoid driving for the first two to four weeks when initiating treatment with a THC-containing product, and avoid driving for at least 48 hours after each dose increment where the risk of impairment can increase (here, here and here).
- Instruct the patient to avoid driving for four to six hours after using inhaled products, and for eight to ten hours after ingesting oral products.
- Advise patients to avoid concomitant use of alcohol, other drugs of dependency, and illicit drugs that are known to increase the risk of impairment when used with THC-based medical cannabis products.
- Ensure prescribers have the authority to assess patients and prohibit driving if they believe a patient is unfit to drive.
It would also be wise to set parameters around which patients should be given an exemption, such as bus drivers, truck drivers, drivers in certain age groups more at risk of being involved in a crash, and drivers who already have alcohol or other drugs in their system.
The Victorian State Government has formulated useful recommendations based on existing driving guidelines that prescribers can consider when deciding on a patient’s fitness to drive.
Conclusion
At present, patients who take medical cannabis containing THC cannot legally drive in any Australian jurisdiction except for Tasmania.
An effective framework for allowing patients who take medical cannabis to drive is one that prioritises road safety while also recognising the importance of driving for freedom of movement and quality of life.
We believe it is possible to strike this balance, by drawing upon existing frameworks in other jurisdictions, providing warnings as doctors do with prescriptive drugs of dependency, and by establishing a set of risk-mitigating safeguards.
Dr Thomas Arkell is a Research Fellow at Swinburne University of Technology. His research focuses on the behavioural pharmacology of cannabis, including its effects on driving and cognitive function.
Associate Professor Vicki Kotsirilos AM is a medical practitioner, and Australia’s first Authorised GP Medicinal Cannabis Prescriber. Associate Professor Vicki Kotsirilos also served on the Medicinal Cannabis and Safe Driving Working Group, Department of Justice Victorian Ministerial Government committee from December 2020 to March 2021.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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I am sorry, but penalising drivers for mere presence, without impairment testing, is wrong on multiple levels.In that case, why not apply it to alcohol and driving ? Apparently Australia is the only country that has this law.It can be argued that drug usage is being penalised under the guise of a driving law.I am all for safe driving practices, but this is utterly absurd and draconian. We told a friend from New York about this law and he said it would be seriously challenged if implemented there.He was quite shocked.
What about Alcohol which kills thousands each year yet they drive and kill and their license is not suspended. How about the hundreds of suicides each year that include alcohol. There should be equal penalties by offense. How about driving after taking prescription medication? Are going to keep them from driving as well?
So if someone were to take a prescribed thc/cbd product via a TGA approved vaporizer at the end of the day when all tasks were complete. If that person went to bed, by the time they woke they would no longer be under the influence but they will present a positive result and then be fined and loss of licence. Do the laws need to catch up with the medical prescriptions that continue to rise every year? This process, if followed correctly and not abused, is proving effective to many, and are we just going to clog the courts up a bit more.
I just don’t know.
I think that published research conducted by Sydney University itself, which is linked to on this very website (https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/full/10.1002/dta.2687) speaks volumes for how bad our current roadside Oral Fluid testing is in terms of accuracy:
Detection of Δ9 THC in oral fluid following vaporized cannabis with varied cannabidiol (CBD) content: An evaluation of two point-of-collection testing devices – Drug Testing & Analysis Volume11(10) October 2019
Pages 1486-1497
“…With a 10 ng/mL confirmatory cut-off, 5% of Securetec DrugWipe® 5s test results were FALSE POSITIVES and 16% FALSE NEGATIVES. For the Dräger DrugTest® 5000, 10% of test results were FALSE POSITIVES and 9% FALSE NEGATIVES. Neither the DW5s nor the DT5000 demonstrated the recommended >80% sensitivity, specificity and accuracy.”
Yes that’s right, up to 1 in 10 people tested can/will give a false roadside saliva test for THC, meaning they’ll be treated like a criminal and be denied driving their car for 24 hours; resulting in who knows what ‘complications’ such as possibly losing their job, losing custody of their children, losing a relationship or even losing their life via suicide if they happen to be depressed or emotionally unstable.
The question NOT being asked is:
Why hasn’t Canada and the USA rushed to use the same technology when they legalised recreational & medical cannabis consumption?
I think the answer’s very clear to that question!
Our laws need to change IMO.
I have seen multiple patients who are being prescribed “medical” Cannabis who now struggle to walk.They are clearly unfit to drive. Likely they are combining it with other drugs illicit or legal. Or perhaps some people just get such a bad reaction.
I have been forced to cease practice due to my prescribing of opiates for chronic pain on the advice of specialists.I believe AHPRA feels the risks outweigh the benefit. But many patients do at least get a reduction in their pain, which is why they are approved by the TGA and why pain specialists recommend them.With carefully controlled and monitored dosages, some patients are able to resume both driving and paid employment.Of course,if they are ineffective or are being abused they must be ceased.
No Medical Cannabis company have been able to provide for me a single clinical trial which shows that cannabis works for chronic pain. Indeed I have seen multiple trials which show that it is no better than a placebo. I suggest that chronic pain suffers who are to be denied opiates and are going to be treated with a placebo should at least be given one that does not prevent them from driving. The AHPRA approved “training”which I was forced to undertake suggested massage or acupuncture.
Being tertiary educated in biological science and chemistry (which doesn’t make me right, but rather more experienced in science journal interpretation) as well as trying my best to read the vast growing quantity of research papers on cannabis; here’s two points I’d like to make:
Roadside sobriety testing is absolute non-sense or I should say non-science (why it is not allowed as court evidence in any USA state, despite officers in numerous states being allowed to conduct it with ‘consent’). Think about it: how can even an accurate measurement of someones ability to track with their eyes, or balance on one leg or walk a line etc. EVER actually indicate that they’re intoxicated as opposed to say being fatigued or simply less coordinated on an individual neurological basis. Only the same testing done on the same individual on a prior occasion (as a control) could demonstrate ‘impairment’ using such tests.
I hate to be critical of someone else’s comment above, however the apparently well qualified Michael Kennedy’s statement “Salivary tests for THC will remain +ve for hours after oral administration even when the blood concentration is quite low” is completely wrong. In fact numerous published trials in peer-reviewed journals, including at least one funded by Cozart (whose RapiScan oral fluid test is used by Australian police) actually showed negative test responses in subjects who were VERY intoxicated from orally consumed THC.
Not only is that incredibly ironic in the case of the Cozart study which was published to demonstrate the efficacy of their testing device (it did produce positive readings for smoked and vaped THC as well as briefly after oral consumption), but the science clearly shows that THC does not appear to pass from blood/serum into the saliva, but rather is deposited there only while consuming it – which makes perfect sense since THC is highly Lipophilic (fat soluble) and saliva is a water based matrix. Compare that to another drug tested for in saliva, methamphetamine, which is a highly polar molecule and hence Hydrophilic (water soluble) – it actually concentrates in saliva at many times the concentration found in blood/serum.
And to those people who say there’s a correlation between blood/serum THC levels and intoxication, they’re right HOWEVER there is no direct correlation like with Ethanol (‘alcohol’) blood conc’s and intoxication. So since THC rapidly drops in blood/serum concentration while people are still demonstrably intoxicated occurs and in other cases a person with a degree of tolerance can have ‘high’ (well above 5ng/ml) blood levels yet show little intoxication in testing, makes the situation very complex.
To top it all off the laws in Australia have ZERO TOLERANCE for both blood/serum and saliva levels of THC i.e. absolutely ANY THC in a persons saliva or blood/serum (only tested in cases of road accidents) means they will be charged with intoxicated driving – which is both morally wrong and absolute non-science.
Our laws need to change.
Thank you for your comments and thoughts. Some valid points here and some issues that certainly warrant further discussion.
We need to remember that the current legal prohibition on driving as operationalised via RDT is a legacy framework that was introduced in the context of illicit cannabis use. It was never intended to apply to medical cannabis. What we are proposing here is not a radical shift by any means, but rather a rethinking of whether this RDT framework is truly suitable for patients who have been prescribed medical cannabis to manage a refractory condition.
We already have a framework for managing driving under the influence of drugs, including prescription medications, which is paired with an offence that is distinct from the offence of driving with the presence of an illicit drug in one’s system. The NSW government website (https://www.nsw.gov.au/driving-boating-and-transport/demerits-penalties-and-offences/offences/alcohol-and-drug-offences/drink-and-drug-driving-penalties) clearly outlines the difference between these two offences:
Drug driving offence: Police can charge you with a drug driving offence if a roadside drug test detects illegal drugs in your system. The roadside drug test takes a saliva sample. The test can occur at roadside random drug testing, or if you are stopped by police.
Driving under the influence: You can be charged with Driving under the Influence (DUI) if you are driving while affected by illegal or prescription drugs or alcohol. Drugs are detected through blood and urine tests which are ordered if a police officer has reasonable suspicion that a driver is under the influence of a drug or drugs.
The Victorian government website (https://www.vicroads.vic.gov.au/safety-and-road-rules/road-rules/penalties/drug-driving-penalties) similarly explains these differences.
The latter offence is entirely appropriate for patients prescribed medical cannabis, while the former – I would argue – is not. As we note in the article, other countries with medical cannabis laws follow the approach associated with the DUI offence, whereby testing for THC in a biological matrix – be that blood, oral fluid or urine – can be considered appropriate *where* police have a “reasonable suspicion that a driver is under the influence of a drug or drugs”.
Hi there, i lost my license at the end of last yr. Second afence. Went to court and pleaded my case that it was for medical reasons and that i do not drive wen impaired and stated that i was a daily user due to health and have a build up thc in my fat cells .
Was facing 6month disqualification.
He reduced it to 1mth disqualification and $900 fine.
Wen i got my paper work it was $1300 fine and i have to prove that im not addicted to cannabis in order to get my license back.
I still dont have a license to date coz im NOT beening subject to the stress and humiliation.
If i could get a medical card that would make me exempt from this and SAPOL did an impairment test rather than stick test to make it fair.
Wow so much ignorance and misinformation in one place, most of it appears to be “Reefer Madness” hangover …
Cannabis is a brilliant medicine, and a much safer substance generally speaking than many other prescribed medications. Responsible users do not drive whilst impaired.
I drove trucks and busses and operated machinery for years whilst using prescribed opiates and other medications at times for acute and later chronic pain, carefully managing dosages to avoid impairment when working or driving. I removed opiates (prescribed for years for chronic pain) from my life recently using prescribed cannabis.
I manage my doses with road safety as a top priority. You see I was also, for many years, a first responder to serious road trauma, and industrial accidents. Millions of Australians use cannabis, whether for medicinal or other reasons, and the numbers alone indicate that we don’t all drive around maggotted. Alcohol is by far the biggest drug contributing to roadside trauma, and more besides.
The mere presence of THC or metabolites thereof in saliva, as per our Australian roadside drug testing procedure, is not indicative of impairment.
Basically, it comes down to the individual’s level of tolerance, years of usage, and experience. If they are using it medicinally, then chances are they are able to pass their drivers test, university exams, ride a bike, play sports and do anything a person prescribed nearly any other pain-killer medication can. There’s no way I’d trust a someone during the first year of medication, but after 5? You wouldn’t even be able to tell. A long term user who is still active feels less impact than 0.5mg of valium.
Editor,
In the Australian context, such benefits of cannabis that have been suggested to assuage specific “medical conditions” requires THC (rather than CBD) as the dominant component. It is not the reverse. The conditions are (varied consensus): a specific paediatric epilepsy; some variable ease of the gastro-intestinal side-effects of chemotherapy and in AIDS (inferred rather than in HIV positivity alone); some variable ease of the protean symptoms in advanced Multiple Sclerosis. There is at best little, and only of moderate quality (even then) evidence to support THC as the preferred initial drug for symptom management. I postulate that driving a vehicle may be problematic and/or impaired from and by such “medical conditions”, and thus may have reasons other than the intake of cannabinoids alone.
The problem of self-dosing and tolerance, leading to uncontrolled intake has been touched upon. A relevant component for the engagement of the public discussion? Given, that initial access is based on a lack of any evidence of any benefit.
I refer to the TGA guide (notably from 2017), as a place to start, again at the beginning.
As a CBD user i can state i am impaired for for 4 to 6 hours after use. If you take prescribed double dose over 24hrs that puts driving a vehicle an act of sheer stupidity. There are definite consequences of using this drug. If you have to use this drug, you are obviously have chronic health issues
to manage and this should be affecting your lifestyle choices and abilities to do obviously tasks such as holding a job etc. It’s a catch 22 situation. The •05 standard as with alcohol impairment is an example of how to set a standard for users of CBD. This seems elementary to me.
This is a complex issue and a number of variables need to be considered. For example:
The interpretation of a blood concentration of THC following fatal accident involving a motor vehicle is complicated by large elevations, and later falls, after death
There is no doubt that THC impairs psychomotor performance but a “cut off” concentration similar to alcohol would be almost an impossible exercise
THC + etoh seriously impairs driving performance
CBD alone does not appear to have an effect on driving performance
The amount of THC present in some CBD formulations can result in a +ve drug test in sport
Salivary tests for THC will remain +ve for hours after oral administration even when the blood concentration is quite low
Some wonderful critiques of the article presented above. I appreciate that chronic pain is horrible, either from physiological or psychological causes. So are the consequences of motor vehicle accident. I would not clear someone for a safety critical role knowing they are on a potential CNS depressant. Period. However if they were an experienced driver who drove for less than 1 hour at a time within close proximity to their home on 50 kmh streets, they may have a case. DO they make restricted licenses like this in Australia? But if they were involved in an accident and had THC/CBD on board, I bet I’d get hammered by the prosecution, and could expect a HCCC case from an angry relative if anyone died.
An intelligent and rational approach to a problem for people with medical conditions amenable to treatment with medical cannabis, may of whom do not take it because they cannot risk losing their licence.
People needing treatment for chronic pain are often the same people who have mobility issues.
Thanks for addressing this issue so comprehensively.
Sensible, logical, compassionate and commonsense! What does it take for policy change?
This is one of the negative social aspects of Australian Medicinal Cannabis policy that needs to be addressed by decision makers.
Thanks Tom and Vicki for your sensible thoughts which will be up for discussion at UIC2023 Australian Medicinal Cannabis Symposium next month.
With 1000’s of patients already prescribed medicinal cannabis for medical purposes, the issue of driving and reducing impairment whilst taking the products needs to be debated in public. Patients want to get on with their lives and study or go to work etc. Patients do not want to feel impaired. The authors are not suggesting patients taking medicinal cannabis should be driving if impaired. The main points of this article is how to reduce the risk of impairment by avoiding THC prescribing or if needed, in tiny doses, and what sort of guidelines can be put in place if the laws are passed to permit driving whilst taking prescribed [not recreational] medicinal cannabis that contains THC [not CBD]. The points raised are similar to when doctors prescribe the many drugs such as antihistamines, benzodiazepines and opioids yet 1000’s and 1000’s of patients are permitted to drive whilst taking these medications. When prescribing these drugs, patients are warned not to drive if feeling impaired.
Like alcohol, a blood test for THC cut off is a way forward but requires a robust evidence based discussion, and can be difficult to distinguish from recreational cannabis use which I do not support.
Editor,
With apologies to the authors, but is the entire issue not being addressed from a perspective that ignores essential aspects, such as evidence-base, logical and permitted uncertain ethical conduct? The evidence (refer British Pain Society) is that Cannabinoids do not address, manage or treat pain – it is possible that it may address the person. The authors have informed that prescriptions are predominantly made for pain. Inference is made to “unapproved” medications of uncertain quality, limited standardization with acknowledged likely contamination – noting the multiple variants of cannabinoids with varied reactivity – separate to THC. I acknowledge that the authors seek to lessen harm to individuals, and to society, given the society’s circumstance that created the impasse outlined in their article – but why does it need to be so?
Further Questions: Why is it that the “system” permits the enabling of “care” that lacks medical evidence for care and benefit? That the health care system promotes the distribution of unsafe contaminants for “therapy”? Places no constraint on practitioners (therein an unreliable aspect) who readily prescribe a possibly harmful “drug” without professional (moral or ethical) consequence?
Serum THC, unlike urine and oral fluid, is closely related to impairment. Its is recognised from a host of studies that levels over 5 ng/ml are associated with significant impairment. Indeed countries such as Canada have introduced legislation to this effect. The product information on Dronabinol a pure oral THC medication, in a study of 12 healthy male volunteers who took 10 mg THC orally twice a day for 16 days, not an unusual dosage, had mean serum THC levels of 7.8 ng/ml. The case rests.
The authors’ basic premise of “also recognising the importance of driving for freedom of movement and quality of life” applies equally to drunk drivers. Motor vehicle accidents account for high death tolls, massive costs of trauma care including longterm NDIS, and almost 100% of serious spinal injuries. The victim may not be the impaired driver, but the person they hit. That’s why P platers have a zero alcohol requirement, or why commercial pilots have a 24 hr ban on preflight alcohol.
Anything which may sedate, and where the known effect includes an impairment of judgement about one’s own fitness to drive, needs to be banned for drivers.
Patients are already trying to legitimise their cannabis addiction by obtaining just one “medicinal cannabis” script and naively claiming driving rights in the process, without any motivation to moderate their use. Plenty of patients accelerate their use of THC through prescription. If people are so sick from terminal medical conditions that they need medicinal cannabis then chances are they aren’t able to drive anyway, and I’m not referring to the patients with “soft” indications such as anxiety or insomnia.
The argument presented would be a lot stronger if there were compelling evidence that cannabis was actually an effective treatment for pain! The experience in America would suggest we should be cautious and ill bet the state trauma centres would disagree with the conclusions in this article. Pain Specialist Victoria.
Why not establish a safe threshold serum THC level for driving impairment as already applies to alcohol
Dangerous and slippery slope. It should go more “the other way” – patients taking opioids and gabapentinoids or other sedating drugs – especially higher doses – should not be driving. Specialist Pain Medicine Physician.
This article presents arguments in favor of permitting patients who use medical cannabis containing THC to drive- article also raises important points, but it also contains inconsistencies and requires critical appraisal for overall improvement.
Lack of comprehensive evidence: The authors acknowledge that there is considerable dispute and limited evidence regarding the crash risk associated with driving under the influence of THC. While they mention studies that suggest a nil impact or a reduction in fatal crashes in jurisdictions with medical-only access pathways, they fail to provide a comprehensive review of the existing evidence. It is crucial to consider all available research and conduct further studies to establish a clear understanding of the impact of medical cannabis on driving safety.
Comparisons to other impairing medications: The authors argue that medical cannabis patients should be treated similarly to patients using other impairing medications such as benzodiazepines and opioids. However, comparing medical cannabis to these medications is not entirely appropriate, as the effects of THC on driving are different from those of sedative medications. Each substance has its own unique characteristics and risks, and they should be evaluated individually in the context of driving safety.
Challenges with patient exemptions: The authors discuss challenges associated with implementing patient exemptions, such as patients combining prescribed medical cannabis with illicit cannabis or determining impairment in drivers with prescriptions. These challenges raise serious concerns about the feasibility and effectiveness of implementing patient exemptions. It is essential to establish robust protocols and guidelines to address these challenges before considering any changes to existing regulations.
Risk management and safeguards: The authors suggest various safeguards to manage the risks associated with driving under the influence of medical cannabis, such as requiring patients to sign consent forms, warning labels on products, and prescribing CBD-based products first. While these measures may help mitigate some risks, they do not guarantee the absence of impairment or address the complexities of assessing impairment in real-time situations. Furthermore, it is unclear how these safeguards would be enforced and monitored effectively.
Potential exclusion of high-risk groups: The authors propose setting parameters to exclude certain groups of patients from exemptions, such as bus drivers, truck drivers, and drivers in specific age groups. While this approach may seem reasonable, it raises questions about fairness and the potential for discrimination. Establishing criteria for exclusion should be based on solid scientific evidence and should be implemented with caution to avoid unintended consequences.
In summary, while the authors present arguments for allowing medical cannabis patients to drive, there are significant inconsistencies and gaps in their reasoning. The existing evidence on the impact of THC on driving safety is limited and conflicting. Before considering any changes to current regulations, a more comprehensive understanding of the risks and benefits associated with driving under the influence of medical cannabis is necessary. Future research and robust guidelines are needed to ensure the safety of both patients and other vulnerable road users including child and older pedestrians and cyclists.