Amendment 64, Gold Dome, Politics

After Amendment 64: Addressing 'driving while stoned' in Colorado

The Colorado State University Futures Center has projected that 642,772 Coloradans will consume an average of 3.53 ounces of marijuana during 2014, the first year marijuana becomes commercially accessible to adult consumers.

Now, let’s do some projections to put these numbers into perspective.

It is generally accepted that an ounce of marijuana will yield 30 joints. So, if 642,772 Coloradans each roll 30 joints from their 3.53 ounces of marijuana, producing 105 joints, we can expect about 67,491,060 joints to be rolled in 2014. Based on reasonable assumptions, we’ll also have 67,491,060 occurrences of people getting high.

However, this projection of 67.5 million “highs” is possibly somewhat inaccurate. A joint is an inefficient THC (the psychoactive chemical in marijuana) delivery system. With higher levels of THC in today’s product, one might need not smoke an entire joint, or its equivalent, through alternative delivery methods, to get stoned. Such alternatives include pipes, bongs, vaporizers of all kinds, “e-joints” for vaporizing special extractions, edibles from granola to traditional brownies, candies, ice cream and oatmeal-raisin cookies, soda, elixirs, and salves. It is possible that one joint will actually equate to more than one “high.”

With, at a minimum, 67.5 million occurrences of Coloradans—not to mention visitors to the state because of “marijuana tourism”—getting stoned in 2014, it is sensible to ask how many of them will get into a vehicle and drive. Will people smoke marijuana before driving to movies or concerts, or going out to eat at a restaurant? Will they wait to find an appropriate place upon arrival at an entertainment venue? (Keep in mind that it’s illegal to smoke marijuana in public, although consuming an edible would be quite discreet.) Or, will they use a sober designated driver?

Of the 68 million “highs,” let’s assume 5 percent involve driving 30 to 90 minutes after smoking, perhaps the highest risk period for cannabis impairment. That adds up to 3,400,000 instances of driving while stoned in 2014.

The times have been a-changin’

Passed in 2012, Amendment 64 made cannabis legal for adults in Colorado. The General Assembly passed enabling laws during its 2013 session, state rule-making has been concluded, and local governments are grappling with the issue. The U.S. Department of Justice has said it won’t interfere in allowing recreational cannabis to be sold in Colorado, beginning January 1. However, the department said it will be monitoring several potential consequences of legal recreational marijuana, including incidences of people driving while stoned.

The debates over the legalization and regulation of cannabis in Colorado have been passionate. Whether legal access to marijuana engenders joy or terror, we now face a new challenge: to address the potentially serious issue of driving while stoned.

The abstract of a September 24, 2013 International Journal of Public Health article clearly states the concern:

OBJECTIVES: This study examined whether acute cannabis use leads to an increased collision risk.

METHODS: Participants were 860 drivers presenting to emergency departments in Toronto and Halifax, Canada, with an injury from a traffic collision, between April 2009 and July 2011. Cannabis and other drug use were identified either through blood sample or self-report. A case-crossover design was employed with two control conditions: a fixed condition measuring substance use during last time driving, and whether the driver typically uses cannabis prior to driving. Collision risk was assessed through conditional fixed-effects logistic regression models.

RESULTS: Results revealed that 98 (11 %; 95 % CI: 9.0-13.1) drivers reported using cannabis prior to the collision. Regression results measuring exposure with blood and self-report data indicated that cannabis use alone was associated with a fourfold increased (OR 4.11; 95 % CI: 1.98-8.52) odds of a collision; a regression relying on self-report measures only found no significant association.

CONCLUSIONS: Main findings confirmed that cannabis use increases collision risk and reinforces existing policy and educational efforts, in many high-income countries, aimed at reducing driving under the influence of cannabis.

This study, however, addresses the use of marijuana alone, and not in combination with other drug usage. Taking marijuana with illegal drugs, prescription drugs, and with the most popular legal drug, alcohol, increases impairment. The use of marijuana and alcohol together needs to be of a particular concern, not just because of increased impairment, but also because of the general lack of awareness about the potential of greater impairment while driving.

The pharmacodynamic profiles of alcohol and THC are not the same. They act very differently on the brain. When combined, the impairing effects are synergistic, the whole being greater than the sum of the parts. We cannot apply the “alcohol model” of impairment and expect it to address the potential “driving while stoned” problem. An individual’s tolerance and ability to compensate for the effects of alcohol and cannabis are vastly different.

A 2009 article in The American Journal on Addictions explicitly warns that “combining marijuana and alcohol…results in impairment even at doses which would be insignificant were they of either drug alone,” and that “the risk from driving under the influence of both alcohol and cannabis is greater than the risk of driving under the influence of either alone.”

In other words, THC and alcohol cause much greater impairment when used together, potentially at levels below the individual substances’ legal limits for impairment under established Colorado law.

Getting ahead of the problem

Colorado stands at the domestic and international forefront of legal access to marijuana. We have the opportunity to be the world model of intelligent, progressive thinking regarding concerns associated with access to legal pot. We have the opportunity to address potentially serious issues calmly and head-on, especially regarding driving after using both marijuana and alcohol. For more than a dozen years, Coloradans have legally used marijuana for medicinal purposes and have not faced a highway-safety apocalypse.

If solutions to the challenge of a potential rise in incidents of driving stoned associated with legal recreational marijuana use are to be effective, credible and realistic, they must be based on evidence and real science. Solutions must focus on actual impairment, not conventional wisdom or misinformation. Using scare tactics will serve no purpose beyond hindering sensible and wise thought.

Education is the key

The major public education advertising campaign called for by Gov. John Hickenlooper is a great idea. However, state government should not be the one directly doing the messaging, or it will be a colossal waste of taxpayers’ money. After more than seven decades of disseminating Reefer Madness nonsense to the American people about the dangers of marijuana, the credibility of any government-produced message will be severely undermined.

For adults to make safe, informed decisions, they need facts, not heresy or fantasy. It is misguided and counterproductive to underestimate the intelligence of Coloradans if the goal is to prevent people from driving while impaired by THC.

Credibility is crucial

We still hear dire warnings about marijuana being a “gateway drug,” meaning pot smoking inevitably leads to use of other drugs like cocaine and heroin. However, an increasing amount of research makes it increasingly evident that these warnings aren’t necessarily true. The label of “gateway drug,” an ever-increasing amount of research suggests, more properly should be used to describe nicotine and alcohol.

Colorado has approximately 1.6 million “Baby Boomers,” most of whom were told in junior high and high school that if they should ever use marijuana it would lead them to use harder drugs. Regardless of such dire warnings, a significant number of ‘Boomers used or experimented with marijuana while in college, after work, or while in the military. Overwhelmingly, they know that marijuana use did not lead them or friends to an untimely death from a heroin or cocaine overdose, to be found lying on the floor of some sleazy hotel room.

It might be noted that members of the Baby Boomer generation are now retiring. With their children raised, their careers behind them, not having to worry about health concerns from smoking (especially fear it could lead back to tobacco use), and marijuana being legally available at stores throughout the state, one has to wonder just how many ‘Boomers will revisit marijuana use.

While drug-overdose deaths are all too real, none of them are the direct result of smoking pot. And recent polling now shows the majority of Americans believe marijuana should be legalized.

Stick to the science

Because cannabis is federally a Schedule I controlled-substance, there is a paucity of U.S. research involving marijuana generally, and more specifically, its effects on driving. Worldwide, the story is different. Israel, for example, is heavily invested in cannabis medical research, including its potential use to treat Post-Traumatic Stress Disorder (PTSD). Further, there are a far number of studies from England and Canada on the issue of driving while stoned.

PubMed, a repository of biomedical research, currently lists over 18,000 studies with the keyword “marijuana.” Research isn’t lacking. It’s just that the skilled scientists in the United States haven’t been doing a lot of it. Much more domestic research is needed on marijuana. With the increasing popularity of medicinal uses for marijuana, states beginning to legalize it for recreational use (current reporting suggests at least 10 more states will be trying to do so via the ballot in 2014 and 2016, and maybe even a few others legislatively), and with the Department of Justice backing off enforcement in states where it’s legal, one has to expect American research will begin to rise substantially.

Targeted messaging

The most effective messaging is designed specifically for targeted demographics, especially based on age. Messages that may be convincing to one generation will not necessarily be effective with other generations. Our experience with drunk-driving education can help us in identifying strategies which will address this new challenge by analyzing what has worked and what has not worked.

We now have a real opportunity to produce messaging that will be effective and credible, not to mention, proactive. We need to be smart about it. For example, should Cheech and Chong do a public service announcement warning of the dangers of driving while stoned, the connection to Baby Boomers might be very effective, while the Gen-Ys and Millennials might ask, “Who are these old guys? What do they know about pot?”

Reporting on research from the University of Montreal and New York’s Ican School of Medicine, Science Daily recently noted, “The nature of the teenage brain makes users of cannabis amongst this population particularly at risk of developing addictive behaviors and suffering other long-term negative effects.”

Yet the news hasn’t reached enough of those affected. Prof. Didier Jutras-Aswad of the University of Montreal and Mount Sinai Hospital Dr. Yasmin Hurd have shown that cannabis is the most-used illicit drug among teenagers, “since it is perceived by many to be of little harm.”

Other research confirms the increasing perception of teens that marijuana is a “safe drug,” in addition to a growing number of high school seniors acknowledging they’ve used it prior to driving.

While ‘Boomers, Gen-Xers and Gen-Ys will respond more likely to honest, scientifically-based information on the dangers of driving while stoned, Millennials will need to be reached by strategies embracing cultural influences and behavior encouraged by peer pressure.

Embrace technology

TV and radio ads, distributing brochures on the dangers of driving while stoned, and informative package labeling all seem to be likely components of any such campaign. Of course, any educational endeavor these days must also include informational websites along with significant presence and interaction on social media.

How we access the Internet on a regular basis also offers opportunities. At least one currently available iPhone app evaluates a person’s ability to drive after using marijuana, or any licit or illicit substance. The app “CheckPlusBalance” uses a series of tests to determine one’s level of cognitive ability and balance, and can be an effective tool in helping to ascertain if a person is safely able to drive.

Other convenient and inexpensive tests of actual impairment will be developed, adding to the options for those who want to be responsible. (We already have a range of Breathalyzer attachments for smartphones which a person can use to generally determine one’s blood alcohol level, if used properly.)

Such technological advancements need to be encouraged, and people need to be motivated to use them as tools. Of course, the evaluation of such apps and devices is also necessary, with words of caution that driving is such a complex task that impairment cannot be determined simply by a quick and easy assessment.

To be successful in preventing individuals from driving while stoned and wreaking the kind of havoc we have seen from drunk driving, every individual must become personally responsible for not driving if they are impaired by marijuana (even more so if alcohol is also consumed). Threatening arrest has proven woefully ineffective as a deterrent. People need to know, understand, and appreciate what the risks really are, and how they can be personally responsible for choosing not to drive while impaired.

Time is now of the essence

With January rapidly approaching, educational efforts on the danger of driving while stoned, especially in combination with the use of alcohol, needs to begin very soon. Initial outreach to Colorado media should begin in mid-November prior to the time when coverage of the approaching holidays begin to dominate the media. Another media push should be made the week before the New Year.

Pot shops will open January 1. Free informational cards on driving while stoned should be provided to each of them so consumers will have access to this information when they come to shop.

Lastly, one needs to expect there will be very significant media coverage on the first sales of legal marijuana by national, and even international media, in Colorado. This should present a huge opportunity to also showcase that Colorado is committed to preventing stoned driving from becoming a deadly consequence of legal marijuana for recreational use.

Former State Senator Bob Hagedorn served 16 years in the Colorado state legislature (1993-2008). He sponsored the legislation creating the landmark “Persistent Drunk Driving Act” in 1999, the major provisions of which have now been adopted by 38 states. He chaired the Senate Health and Human Services Committee from 2005-2008.

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