Wakefulness, Cognitive Enhancement, AND Improved Mood?
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Old Drug, New Tricks?
Modafinil (also known by brand names including Modalert and Provigil) is a dopamine uptake inhibitor.
What does that mean? It means it won’t put any extra dopamine in your brain, but it will slow down the rate at which your brain removes naturally-occuring dopamine.
The result is that your brain will get to make more use of the dopamine it does have.
(dopamine is a neutrotransmitter that allows you to feel wakeful and happy, and perform complex cognitive tasks)
Modafinil is prescribed for treatment of excessive daytime sleepiness. Often that’s caused by shift work sleep disorder, sleep apnea, restless leg syndrome, or narcolepsy.
Read: Overview of the Clinical Uses, Pharmacology, and Safety of Modafinil
Many studies done on humans (rather than rats) have been military experiments to reduce the effects of sleep deprivation:
Click Here To See A Military Study On Modafinil!
They’ve found modafinil to be helpful, and more effective and more long-lasting than caffeine, without the same “crash” later. This is for two reasons:
1) while caffeine works by blocking adenosine (so you don’t feel how tired you are) and by constricting blood vessels (so you feel more ready-for-action), modafinil works by allowing your brain to accumulate more dopamine (so you’re genuinely more wakeful, and you get to keep the dopamine)
2) the biological half-life of modafinil is 12–15 hours, as opposed to 4–8 hours* for caffeine.
*Note: a lot of sources quote 5–6 hours for caffeine, but this average is misleading. In reality, we are each genetically predetermined to be either a fast caffeine metabolizer (nearer 4 hours) or a slow caffeine metabolizer (nearer 8 hours).
What’s a biological half-life (also called: elimination half-life)?
A substance’s biological half-life is the time it takes for the amount in the body to be reduced by exactly half.
For example: Let’s say you’re a fast caffeine metabolizer and you have a double-espresso (containing 100mg caffeine) at 8am.
By midday, you’ll have 50mg of caffeine left in your body. So far, so simple.
By 4pm you might expect it to be gone, but instead you have 25mg remaining (because the amount halves every four hours).
By 8pm, you have 12.5mg remaining.
When midnight comes and you’re tucking yourself into bed, you still have 6.25mg of caffeine remaining from your morning coffee!
Use as a nootropic
Many healthy people who are not sleep-deprived use modafinil “off-label” as a nootropic (i.e., a cognitive enhancer).
Read: Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: A systematic review
Important Note: modafinil is prescription-controlled, and only FDA-approved for sleep disorders.
To get around this, a lot of perfectly healthy biohackers describe the symptoms of sleep pattern disorder to their doctor, to get a prescription.
We do not recommend lying to your healthcare provider, and nor do we recommend turning to the online “grey market”.
Such websites often use anonymized private doctors to prescribe on an “informed consent” basis, rather than making a full examination. Those websites then dispense the prescribed medicines directly to the patient with no further questions asked (i.e. very questionable practices).
Caveat emptor!
A new mood-brightener?
Modafinil was recently tested head-to-head against Citalapram for the treatment of depression, and scored well:
See its head-to-head scores here!
How does it work? Modafinil does for dopamine what a lot of anti-depressants do for serotonin. Both dopamine and serotonin promote happiness and wakefulness.
This is very promising, especially as modafinil (in most people, at least) has fewer unwanted side-effects than a lot of common anti-depressant medications.
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It’s Not A Bloody Trend – by Kat Brown
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This one’s not a clinical book, and the author is not a clinician. However, it’s not just a personal account, either. Kat Brown is an award-winning journalist (with ADHD) and has approached this journalistically.
Not just in terms of investigative journalism, either. Rather, also with her knowledge and understanding of the industry, doing for us some meta-journalism and explaining why the press have gone for many misleading headlines.
Which in this case means for example it’s not newsworthy to say that people have gone undiagnosed and untreated for years and that many continue to go unseen; we know this also about such things as endometriosis, adenomyosis, and PCOS. But some more reactionary headlines will always get attention, e.g. “look at these malingering attention-seekers”.
She also digs into the common comorbidities of various conditions, the differences it makes to friendships, families, relationships, work, self-esteem, parenting, and more.
This isn’t a “how to” book, but there’s a lot of value here if a) you have ADHD, and/or b) you spend any amount of time with someone who does.
Bottom line: if you’d like to understand “what all the fuss is about” in one book, this is the one for ADHD.
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Daily, Weekly, Monthly: Habits Against Aging
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Dr. Anil Rajani has advice on restoring/retaining youthfulness. Two out of three of the sections are on skincare specifically, which may seem a vanity, but it’s also worth remembering that our skin is a very large and significant organ, and makes a big difference for the rest of our physical health, as well as our mental health. So, it’s worthwhile to look after it:
The recommendations
Daily: meditation practice
Meditation reduces stress, which reduction in turn protects telomere length, slowing the overall aging process in every living cell of the body.
Weekly: skincare basics
Dr. Rajani recommends a combination of retinol and glycolic acid. The former to accelerate cell turnover, stimulate collagen production, and reduce wrinkles; the latter, to exfoliate dead cells, allowing the retinol to do its job more effectively.
We at 10almonds would like to add: wearing sunscreen with SPF50 is a very good thing to do on any day that your phone’s weather app says the UV index is “moderate” or higher.
Monthly: skincare extras
Here are the real luxuries; spa visits, microneedling (stimulates collagen production), and non-ablative laser therapy. He recommends creating a home spa if possible for monthly skincare treatments, investing in high-quality devices for long-term benefits.
For more on all of these things, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Age & Aging: What Can (And Can’t) We Do About It?
- No-Frills, Evidence-Based Mindfulness
- The Evidence-Based Skincare That Beats Product-Specific Hype
Take care!
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Mental Health Courts Can Struggle to Fulfill Decades-Old Promise
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GAINESVILLE, Ga. — In early December, Donald Brown stood nervously in the Hall County Courthouse, concerned he’d be sent back to jail.
The 55-year-old struggles with depression, addiction, and suicidal thoughts. He worried a judge would terminate him from a special diversion program meant to keep people with mental illness from being incarcerated. He was failing to keep up with the program’s onerous work and community service requirements.
“I’m kind of scared. I feel kind of defeated,” Brown said.
Last year, Brown threatened to take his life with a gun and his family called 911 seeking help, he said. The police arrived, and Brown was arrested and charged with a felony of firearm possession.
After months in jail, Brown was offered access to the Health Empowerment Linkage and Possibilities, or HELP, Court. If he pleaded guilty, he’d be connected to services and avoid prison time. But if he didn’t complete the program, he’d possibly face incarceration.
“It’s almost like coercion,” Brown said. “‘Here, sign these papers and get out of jail.’ I feel like I could have been dealt with a lot better.”
Advocates, attorneys, clinicians, and researchers said courts such as the one Brown is navigating can struggle to live up to their promise. The diversion programs, they said, are often expensive and resource-intensive, and serve fewer than 1% of the more than 2 million people who have a serious mental illness and are booked into U.S. jails each year.
People can feel pressured to take plea deals and enter the courts, seeing the programs as the only route to get care or avoid prison time. The courts are selective, due in part to political pressures on elected judges and prosecutors. Participants must often meet strict requirements that critics say aren’t treatment-focused, such as regular hearings and drug screenings.
And there is a lack of conclusive evidence on whether the courts help participants long-term. Some legal experts, like Lea Johnston, a professor of law at the University of Florida, worry the programs distract from more meaningful investments in mental health resources.
Jails and prisons are not the place for individuals with mental disorders, she said. “But I’m also not sure that mental health court is the solution.”
The country’s first mental health court was established in Broward County, Florida, in 1997, “as a way to promote recovery and mental health wellness and avoid criminalizing mental health problems.” The model was replicated with millions in funding from such federal agencies as the Substance Abuse and Mental Health Services Administration and the Department of Justice.
More than 650 adult and juvenile mental health courts were operational as of 2022, according to the National Treatment Court Resource Center. There’s no set way to run them. Generally, participants receive treatment plans and get linked to services. Judges and mental health clinicians oversee their progress.
Researchers from the center found little evidence that the courts improve participants’ mental health or keep them out of the criminal justice system. “Few studies … assess longer-term impacts” of the programs “beyond one year after program exit,” said a 2022 policy brief on mental health courts.
The courts work best when paired with investments in services such as clinical treatment, recovery programs, and housing and employment opportunities, said Kristen DeVall, the center’s co-director.
“If all of these other supports aren’t invested in, then it’s kind of a wash,” she said.
The courts should be seen as “one intervention in that larger system,” DeVall said, not “the only resource to serve folks with mental health needs” who get caught up in the criminal justice system.
Resource limitations can also increase the pressures to apply for mental health court programs, said Lisa M. Wayne, executive director of the National Association of Criminal Defense Lawyers. People seeking help might not feel they have alternatives.
“It’s not going to be people who can afford mental health intervention. It’s poor people, marginalized folks,” she said.
Other court skeptics wonder about the larger costs of the programs.
In a study of a mental health court in Pennsylvania, Johnston and a University of Florida colleague found participants were sentenced to longer time under government supervision than if they’d gone through the regular criminal justice system.
“The bigger problem is they’re taking attention away from more important solutions that we should be investing in, like community mental health care,” Johnston said.
When Melissa Vergara’s oldest son, Mychael Difrancisco, was arrested on felony gun charges in Queens in May 2021, she thought he would be an ideal candidate for the New York City borough’s mental health court because of his diagnosis of autism spectrum disorder and other behavioral health conditions.
She estimated she spent tens of thousands of dollars to prepare Difrancisco’s case for consideration. Meanwhile, her son sat in jail on Rikers Island, where she said he was assaulted multiple times and had to get half a finger amputated after it was caught in a cell door.
In the end, his case was denied diversion into mental health court. Difrancisco, 22, is serving a prison sentence that could be as long as four years and six months.
“There’s no real urgency to help people with mental health struggles,” Vergara said.
Critics worry such high bars to entry can lead the programs to exclude people who could benefit the most. Some courts don’t allow those accused of violent or sexual crimes to participate. Prosecutors and judges can face pressure from constituents that may lead them to block individuals accused of high-profile offenses.
And judges often aren’t trained to make decisions about participants’ care, said Raji Edayathumangalam, senior policy social worker with New York County Defender Services.
“It’s inappropriate,” she said. “We’re all licensed to practice in our different professions for a reason. I can’t show up to do a hernia operation just because I read about it or sat next to a hernia surgeon.”
Mental health courts can be overly focused on requirements such as drug testing, medication compliance, and completing workbook assignments, rather than progress toward recovery and clinical improvement, Edayathumangalam said.
Completing the programs can leave some participants with clean criminal records. But failing to meet a program’s requirements can trigger penalties — including incarceration.
During a recent hearing in the Clayton County Behavioral Health Accountability Court in suburban Atlanta, one woman left the courtroom in tears when Judge Shana Rooks Malone ordered her to report to jail for a seven-day stay for “being dishonest” about whether she was taking court-required medication.
It was her sixth infraction in the program — previous consequences included written assignments and “bench duty,” in which participants must sit and think about their participation in the program.
“I don’t like to incarcerate,” Malone said. “That particular participant has had some challenges. I’m rooting for her. But all the smaller penalties haven’t worked.”
Still, other participants praised Malone and her program. And, in general, some say such diversion programs provide a much-needed lifeline.
Michael Hobby, 32, of Gainesville was addicted to heroin and fentanyl when he was arrested for drug possession in August 2021. After entry into the HELP Court program, he got sober, started taking medication for anxiety and depression, and built a stable life.
“I didn’t know where to reach out for help,” he said. “I got put in handcuffs, and it saved my life.”
Even as Donald Brown awaited his fate, he said he had started taking medication to manage his depression and has stayed sober because of HELP Court.
“I’ve learned a new way of life. Instead of getting high, I’m learning to feel things now,” he said.
Brown avoided jail that early December day. A hearing to decide his fate could happen in the next few weeks. But even if he’s allowed to remain in the program, Brown said, he’s worried it’s only a matter of time before he falls out of compliance.
“To try to improve myself and get locked up for it is just a kick in the gut,” he said. “I tried really hard.”
KFF Health News senior correspondent Fred Clasen-Kelly contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Glycemic Index vs Glycemic Load vs Insulin Index
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How To Actually Use Those Indices
Carbohydrates are essential for our life, and/but often bring about our early demise. It would be a very conveniently simple world if it were simply a matter of “enjoy in moderation”, but the truth is, it’s not that simple.
To take an extreme example, for the sake of clearest illustration: The person who eats an 80% whole fruit diet (and makes up the necessary protein and fats etc in the other 20%) will probably be healthier than the person who eats a “standard American diet”, despite not practising moderation in their fruit-eating activities. The “standard American diet” has many faults, and one of those faults is how it promotes sporadic insulin spikes leading to metabolic disease.
If your breakfast is a glass of orange juice, this is a supremely “moderate” consumption, but an insulin spike is an insulin spike.
Quick sidenote: if you’re wondering why eating immoderate amounts of fruit is unlikely to cause such spikes, but a single glass of orange juice is, check out:
Which Sugars Are Healthier, And Which Are Just The Same?
Glycemic Index
The first tool in our toolbox here is glycemic index, or GI.
GI measures how much a carb-containing food raises blood glucose levels, also called blood sugar levels, but it’s just glucose that’s actually measured, bearing in mind that more complex carbs will generally get broken down to glucose.
Pure glucose has a GI of 100, and other foods are ranked from 0 to 100 based on how they compare.
Sometimes, what we do to foods changes its GI.
- Some is because it changed form, like the above example of whole fruit (low GI) vs fruit juice (high GI).
- Some is because of more “industrial” refinement processes, such as whole grain wheat (medium GI) vs white flour and white flour products (high GI)
- Some is because of other changes, like starches that were allowed to cool before being reheated (or eaten cold).
Broadly speaking, a daily average GI of 45 is considered great.
But that’s not the whole story…
Glycemic Load
Glycemic Load, or GL, takes the GI and says “ok, but how much of it was there?”, because this is often relevant information.
Refined sugar may have a high GI, but half a teaspoon of sugar in your coffee isn’t going to move your blood sugar levels as much as a glass of Coke, say—the latter simply has more sugar in, and just the same zero fiber.
GL is calculated by (grams of carbs / 100) x GI, by the way.
But it still misses some important things, so now let’s look at…
Insulin Index
Insulin Index, which does not get an abbreviation (probably because of the potentially confusing appearance of “II”), measures the rise in insulin levels, regardless of glucose levels.
This is important, because a lot of insulin response is independent of blood glucose:
- Some is because of other sugars, some some is in response to fats, and yes, even proteins.
- Some is a function of metabolic base rate.
- Some is a stress response.
- Some remains a mystery!
Another reason it’s important is that insulin drives weight gain and metabolic disorders far more than glucose.
Note: the indices of foods are calculated based on average non-diabetic response. If for example you have Type 1 Diabetes, then when you take a certain food, your rise in insulin is going to be whatever insulin you then take, because your body’s insulin response is disrupted by being too busy fighting a civil war in your pancreas.
If your diabetes is type 2, or you are prediabetic, then a lot of different things could happen depending on the stage and state of your diabetes, but the insulin index is still a very good thing to be aware of, because you want to resensitize your body to insulin, which means (barring any urgent actions for immediate management of hyper- or hypoglycemia, obviously) you want to eat foods with a low insulin index where possible.
Great! What foods have a low insulin index?
Many factors affect insulin index, but to speak in general terms:
- Whole plant foods are usually top-tier options
- Lean and/or white meats generally have lower insulin index than red and/or fatty ones
- Unprocessed is generally lower than processed
- The more solid a food is, generally the lower its insulin index compared to a less solid version of the same food (e.g. baked potatoes vs mashed potatoes; cheese vs milk, etc)
But do remember the non-food factors too! This means where possible:
- reducing/managing stress
- getting frequent exercise
- getting good sleep
- practising intermittent fasting
See for example (we promise you it’s relevant):
Fix Chronic Fatigue & Regain Your Energy, By Science
…as are (especially recommendable!) the two links we drop at the bottom of that page; do check them out if you can
Take care!
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The Five Invitations – by Frank Ostaseski
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This book covers exactly what its subtitle promises, and encourages the reader to truly live life fully, something that Ostaseski believes cannot be done in ignorance of death.
Instead, he argues from his experience of decades working at a hospice, we must be mindful of death not only to appreciate life, but also to make the right decisions in life—which means responding well to what he calls, as per the title of this book, “the five invitations”.
We will not keep them a mystery; they are:
- Don’t wait; do the important things now
- Welcome everything; push away nothing
- Bring your whole self to the experience
- Find a place in the middle of things
- Cultivate a “don’t know” mind
Note, for example, that “do the important things now” requires knowing what is important. For example, ensuring a loved one knows how you feel about them, might be more important than scratching some item off a bucket list. And “push away nothing” does mean bad things too; rather, of course try to make life better rather than worse, but accept the lessons and learnings of the bad too, and see the beauty that can be found in contrast to it. Enjoying the fullness of life without getting lost in it; carrying consciousness through the highs and lows. And yes, approaching the unknown (which means not only death, but also the large majority of life) with open-minded curiosity and wonder.
The style of the book is narrative and personal, without feeling like a collection of anecdotes, but rather, taking the reader on a journey, prompting reflection and introspection along the way.
Bottom line: if you’d like to minimize the regrets you have in life, this book is a fine choice.
Click here to check out The Five Invitations, and answer with a “yes” to the call of life!
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Driving under the influence of marijuana: An explainer and research roundup
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Update 1: On May 16, 2024, the U.S. Department of Justice sent a proposed rule to the Federal Register to downgrade marijuana from a Schedule I to a Schedule III drug. This is the first step in a lengthy approval process that starts with a 60-day comment period.
Update 2: Two recent research studies were added to the “Studies on marijuana and driving” section of this piece on July 18, 2024.
As marijuana use continues to rise and state-level marijuana legalization sweeps the U.S., researchers and policymakers are grappling with a growing public safety concern: marijuana-impaired driving.
As of April 2023, 38 U.S. states had legalized medical marijuana and 23 had legalized its recreational use, according to the National Conference of State Legislatures. Recreational or medical marijuana measures are on the ballot in seven states this year.
The issue of marijuana-impaired driving has not been an easy one to tackle because, unlike alcohol, which has well-established thresholds of impairment, the metrics for marijuana’s effects on driving remain rather elusive.
“We don’t have that kind of deep knowledge right now and it’s not because of lack of trying,” says Dr. Guohua Li, professor of epidemiology and the founding director of the Center for Injury Science and Prevention at Columbia University.
“Marijuana is very different from alcohol in important ways,” says Li, who has published several studies on marijuana and driving. “And one of them is that the effect of marijuana on cognitive functions and behaviors is much more unpredictable than alcohol. In general, alcohol is a depressant drug. But marijuana could act on the central nervous system as a depressant, a stimulant, and a hallucinogenic substance.”
Efforts to create a breathalyzer to measure the level of THC, the main psychoactive compound found in the marijuana plant, have largely failed, because “the THC molecule is much bigger than ethanol and its behavior after ingestion is very different from alcohol,” Li says.
Currently, the two most common methods used to measure THC concentration to identify impaired drivers are blood and saliva tests, although there’s ongoing debate about their reliability.
Marijuana, a term interchangeably used with cannabis, is the most commonly used federally illegal drug in the U.S.: 48.2 million people, or about 18% of Americans reported using it at least once in 2019, according to the latest available data from the Centers for Disease Control and Prevention. Worldwide, 2.5% of the population consumes marijuana, according to the World Health Organization.
Marijuana is legal in several countries, including Canada, where it was legalized in 2018. Despite state laws legalizing cannabis, it remains illegal at the federal level in the U.S.
As states grapple with the contentious issue of marijuana legalization, the debate is not just about public health, potential tax revenues and economic interests. At the heart of the discussion is also the U.S. criminal justice system.
Marijuana is shown to have medicinal qualities and, compared with substances like alcohol, tobacco, and opioids, it has relatively milder health risks. However, it’s not risk-free, a large body of research has shown.
Marijuana consumption can lead to immediate effects such as impaired muscle coordination and paranoia, as well as longer-term effects on mental health and cognitive functions — and addiction. As its use becomes more widespread, researchers are trying to better understand the potential hazards of marijuana, particularly for younger users whose brains are in critical stages of development.
Marijuana and driving
The use of marijuana among drivers, passengers and pedestrians has increased steadily over the past two decades, Li says.
Compared with the year 2000, the proportion of U.S. drivers on the road who are under the influence of marijuana has increased by several folds, between five to 10 times, based on toxicology testing of people who died in car crashes, Li says.
A 2022 report from the National Transportation Safety Board finds alcohol and cannabis are the two most commonly detected drugs among drivers arrested for impaired driving and fatally injured drivers. Most drivers who tested positive for cannabis also tested positive for another potentially impairing drug.
“Although cannabis and many other drugs have been shown to impair driving performance and are associated with increased crash risk, there is evidence that, relative to alcohol, awareness about the potential dangers of driving after using other drugs is lower,” according to the report.
Indeed, many U.S. adults perceive daily marijuana use or exposure to its smoke safer than tobacco, even though research finds otherwise.
Several studies have demonstrated marijuana’s impact on driving.
Marijuana use can reduce the drivers’ ability to pay attention, particularly when they are performing multiple tasks, research finds. It also slows reaction time and can impair coordination.
“The combination is that you potentially have people who are noticing hazards later, braking slower and potentially not even noticing hazards because of their inability to focus on competing things on the road,” says Dr. Daniel Myran, an assistant professor at the Department of Family Medicine and health services researcher at the University of Ottawa.
In a study published in September in JAMA Network Open, Myran and colleagues find that from 2010 to 2021 the rate of cannabis-involved traffic injuries that led to emergency department visits in Ontario, Canada, increased by 475%, from 0.18 per 1,000 traffic injury emergency department visits in 2010 to 1.01 visits in 2021.
To be sure, cannabis-involved traffic injuries made up a small fraction of all traffic injury-related visits to hospital emergency departments. Out of 947,604 traffic injury emergency department visits, 426 had documented cannabis involvement.
Myran cautions the increase shouldn’t be solely attributed to marijuana legalization. It captures changing societal attitudes toward marijuana and acceptance of cannabis use over time in the lead-up to legalization. In addition, it may reflect an increasing awareness among health care providers about cannabis-impaired driving, and they may be more likely to ask about cannabis use and document it in medical charts, he says.
“When you look at the 475% increase in cannabis involvement in traffic injuries, rather than saying legalizing cannabis has caused the roads to be unsafe and is a public health disaster, it’s that cannabis use appears to be growing as a risk for road traffic injuries and that there seem to be more cannabis impaired drivers on the road,” Myran says. “Legalization may have accelerated this trend. Faced with this increase, we need to think about what are public health measures and different policy interventions to reduce harms from cannabis-impaired driving.”
Setting a legal limit for marijuana-impaired driving
Setting a legal limit for marijuana-impaired driving has not been easy. Countries like Canada and some U.S. states have agreed upon a certain level of THC in blood, usually between 1 to 5 nanograms per milliliter. Still, some studies have found those limits to be weak indicators of cannabis-impaired driving.
When Canada legalized recreational marijuana in 2018, it also passed a law that made it illegal to drive with blood THC levels of more than 2 nanograms. The penalties are more severe for blood THC levels above 5 nanograms. The blood test is done at the police station for people who are pulled over and are deemed to be drug impaired.
In the U.S., five states — Ohio, Illinois, Montana, Washington and Nevada — have “per se laws,” which set a specific amount of THC in the driver’s blood as evidence of impaired driving, according to the National Conference of State Legislatures. That limit ranges between 2 and 5 nanograms of THC per milliliter of blood.
Colorado, meanwhile, has a “permissible inference law,” which states that it’s permissible to assume the driver was under the influence if their blood THC level is 5 nanograms per milliliter or higher, according to NCSL.
Twelve states, most which have legalized some form of marijuana of use, have zero tolerance laws for any amount of certain drugs, including THC, in the body.
The remaining states have “driving under the influence of drugs” laws. Among those states, Alabama and Michigan, have oral fluid roadside testing program to screen drivers for marijuana and other drugs, according to NCSL.
In May this year, the U.S. Department of Transportation published a final rule that allows employers to use saliva testing for commercially licensed drivers, including truck drivers. The rule, which went into effect in June, sets the THC limit in saliva at 4 nanograms.
Saliva tests can detect THC for 8 to 24 hours after use, but the tests are not perfect and can results in false positives, leading some scientists to argue against using them in randomly-selected drivers.
In a 2021 report, the U.S. National Institute of Justice, the research and development arm of the Department of Justice, concluded that THC levels in bodily fluids, including blood and saliva “were not reliable indicators of marijuana intoxication.”
Studies on marijuana and driving
Over the past two decades, many studies have shown marijuana use can impair driving. However, discussions about what’s the best way to measure the level of THC in blood or saliva are ongoing. Below, we highlight and summarize several recent studies that address the issue. The studies are listed in order of publication date. We also include a list of related studies and resources to inform your audiences.
State Driving Under the Influence of Drugs Laws
Alexandra N. Origenes, Sarah A. White, Emma E. McGinty and Jon S. Vernick. Journal of Law, Medicine & Ethics, July 2024.Summary: As of January 2023, 33 states and D.C. had a driving under the influence of drugs law for at least one drug other than cannabis. Of those, 29 states and D.C. had a law specifically for driving under the influence of cannabis, in addition to a law for driving under the influence of other drugs. Four states had a driving under the influence of drug laws, excluding cannabis. Meanwhile, 17 states had no law for driving under the influence of drugs, including cannabis. “The 17 states lacking a DUID law that names specific drugs should consider enacting such a law. These states already have expressed their concern — through legislation — with drug-impaired driving. However, failure to name specific drugs is likely to make the laws more difficult to enforce. These laws may force courts and/or law enforcement to rely on potentially subjective indicators of impairment,” the authors write.
Associations between Adolescent Marijuana Use, Driving After Marijuana Use and Recreational Retail Sale in Colorado, USA
Lucas M. Neuroth, et al. Substance Use & Misuse, October 2023.Summary: Researchers use data from four waves (2013, 2015, 2017 and 2019) of the Healthy Kids Colorado Survey, including 47,518 students 15 and older who indicated that they drove. They find 20.3% of students said that they had used marijuana in the past month and 10.5% said they had driven under the influence of marijuana. They find that the availability of recreational marijuana in stores was associated with an increased prevalence of using marijuana one to two times in the past month and driving under the influence of marijuana at least once. “Over the study period, one in ten high school age drivers engaged in [driving after marijuana use], which is concerning given the high risk of motor vehicle-related injury and death arising from impaired driving among adolescents,” the authors write.
Are Blood and Oral Fluid Δ9-tetrahydrocannabinol (THC) and Metabolite Concentrations Related to Impairment? A Meta-Regression Analysis
Danielle McCartney, et al. Neuroscience & Biobehavioral Reviews, March 2022.Summary: Commonly used THC measurements may not be strong indicators of driving impairment. While there is a relationship between certain biomarkers like blood THC concentrations and impaired driving, this correlation is often weak. The study underscores the need for more nuanced and comprehensive research on this topic, especially as cannabis usage becomes more widespread and legally accepted.
The Effects of Cannabis and Alcohol on Driving Performance and Driver Behaviour: A Systematic Review and Meta-Analysis
Sarah M. Simmons, Jeff K. Caird, Frances Sterzer and Mark Asbridge. Addiction, January 2022.Summary: This meta-analysis of experimental driving studies, including driving simulations, confirms that cannabis impairs driving performance, contrary to some beliefs that it might enhance driving abilities. Cannabis affects lateral control and speed — typically increasing lane excursions while reducing speed. The combination of alcohol and marijuana appears worse than either alone, challenging the idea that they cancel each other out.
Cannabis Legalization and Detection of Tetrahydrocannabinol in Injured Drivers
Jeffrey R. Brubacher, et al. The New England Journal of Medicine, January 2022.Summary: Following the legalization of recreational marijuana in Canada, there was a notable increase in injured drivers testing positive for THC, especially among those 50 years of age or older. This rise in cannabis-related driving incidents occurred even with new traffic laws aiming to deter cannabis-impaired driving. This uptick began before legalization became official, possibly due to perceptions that cannabis use was soon-to-be legal or illegal but not enforced. The data suggests that while legalization has broad societal impacts, more comprehensive strategies are needed to deter driving under the influence of cannabis and raise public awareness about its risks.
Cannabis and Driving
Godfrey D. Pearlson, Michael C. Stevens and Deepak Cyril D’Souza. Frontiers in Psychiatry, September 2021.Summary: Cannabis-impaired driving is a growing public health concern, and studies show that such drivers are more likely to be involved in car crashes, according to this review paper. Drivers are less affected by cannabis than they are by alcohol or cocaine, but the problem is expected to escalate with increasing cannabis legalization and use. Unlike alcohol, THC’s properties make it challenging to determine direct impairment levels from testing results. Current roadside tests lack precision in detecting genuine cannabis-impaired drivers, leading to potential wrongful convictions. Moreover, there is a pressing need for research on the combined effects of alcohol and cannabis on driving, as well as the impact of emerging popular forms of cannabis, like concentrates and edibles. The authors recommend public awareness campaigns about the dangers of driving under the influence of cannabis, similar to those against drunk driving, to address misconceptions. Policymakers should prioritize science-based decisions and encourage further research in this domain.
Demographic And Policy-Based Differences in Behaviors And Attitudes Towards Driving After Marijuana Use: An Analysis of the 2013–2017 Traffic Safety Culture Index
Marco H. Benedetti, et al. BMC Research Notes, June 2021.Summary: The study, based on a U.S. survey, finds younger, low-income, low-education and male participants were more tolerant of driving after marijuana consumption. Notably, those in states that legalized medical marijuana reported driving after use more frequently, aligning with studies indicating a higher prevalence of THC detection in drivers from these states. Overall, while the majority perceive driving after marijuana use as dangerous, not all research agrees on its impairment effects. Existing studies highlight that marijuana impacts motor skills and executive functions, yet its direct correlation with crash risk remains debated, given the variations in individual tolerance and how long THC remains in the system.
Driving Under the Influence of Cannabis: A Framework for Future Policy
Robert M. Chow, et al.Anesthesia & Analgesia, June 2019.Summary: The study presents a conceptual framework focusing on four main domains: legalization, driving under the influence of cannabis, driver impairment, and motor vehicle accidents. With the growing legalization of cannabis, there’s an anticipated rise in cannabis-impaired driving cases. The authors group marijuana users into infrequent users who show significant impairment with increased THC blood levels, chronic users with minimal impairment despite high THC levels, and those with consistent psychomotor deficits. Current challenges lie in the lack of standardized regulation for drivers influenced by cannabis, primarily because of state-to-state variability and the absence of a federal statutory limit for blood THC levels. European nations, however, have established thresholds for blood THC levels, ranging from 0.5 to 50.0 micrograms per liter depending on whether blood or blood serum are tested. The authors suggest the combined use of alcohol and THC blood tests with a psychomotor evaluation by a trained professional to determine impairment levels. The paper stresses the importance of creating a structured policy framework, given the rising acceptance and use of marijuana in society.
Additional research
Cannabis-Involved Traffic Injury Emergency Department Visits After Cannabis Legalization and Commercialization
Daniel T. Myran, et al. JAMA Network Open, September 2023.Driving Performance and Cannabis Users’ Perception of Safety: A Randomized Clinical Trial
Thomas D. Marcotte, et al. JAMA Psychiatry, January 2022.Medicinal Cannabis and Driving: The Intersection of Health and Road Safety Policy
Daniel Perkins, et al. International Journal of Drug Policy, November 2021.Prevalence of Marijuana Use Among Trauma Patients Before and After Legalization of Medical Marijuana: The Arizona Experience
Michael Levine, et al. Substance Abuse, July 2021.Self-Reported Driving After Marijuana Use in Association With Medical And Recreational Marijuana Policies
Marco H. Benedetti, et al. International Journal of Drug Policy, June 2021.Cannabis and Driving Ability
Eric L. Sevigny. Current Opinion in Psychology, April 2021.The Failings of per se Limits to Detect Cannabis-Induced Driving Impairment: Results from a Simulated Driving Study
Thomas R. Arkell, et al. Traffic Injury Prevention, February 2021.Risky Driving Behaviors of Drivers Who Use Alcohol and Cannabis
Tara Kelley-Baker, et al. Transportation Research Record, January 2021.Direct and Indirect Effects of Marijuana Use on the Risk of Fatal 2-Vehicle Crash Initiation
Stanford Chihuri and Guohua Li. Injury Epidemiology, September 2020Cannabis-Impaired Driving: Evidence and the Role of Toxicology Testing
Edward C. Wood and Robert L. Dupont. Cannabis in Medicine, July 2020.Association of Recreational Cannabis Laws in Colorado and Washington State With Changes in Traffic Fatalities, 2005-2017
Julian Santaella-Tenorio, et al. JAMA Internal Medicine, June 2020.Marijuana Decriminalization, Medical Marijuana Laws, and Fatal Traffic Crashes in US Cities, 2010–2017
Amanda Cook, Gregory Leung and Rhet A. Smith. American Journal of Public Health, February 2020.Cannabis Use in Older Drivers in Colorado: The LongROAD Study
Carolyn G. DiGuiseppi, et al. Accident Analysis & Prevention, November 2019.Crash Fatality Rates After Recreational Marijuana Legalization in Washington and Colorado
Jayson D. Aydelotte, et al. American Journal of Public Health, August 2017.Marijuana-Impaired Driving: A Report to Congress
National Highway Traffic Safety Administration, July 2017Interaction of Marijuana And Alcohol on Fatal Motor Vehicle Crash Risk: A Case–Control Study
Stanford Chihuri, Guohua Li and Qixuan Chen. Injury Epidemiology, March 2017.US Traffic Fatalities, 1985–2014, and Their Relationship to Medical Marijuana Laws
Julian Santaella-Tenorio, et al. American Journal of Public Health, February 2017.Delays in DUI Blood Testing: Impact on Cannabis DUI Assessments
Ed Wood, Ashley Brooks-Russell and Phillip Drum. Traffic Injury Prevention, June 2015.Establishing Legal Limits for Driving Under the Influence of Marijuana
Kristin Wong, Joanne E. Brady and Guohua Li. Injury Epidemiology, October 2014.Cannabis Effects on Driving Skills
Rebecca L. Hartman and Marilyn A. Huestis. Clinical Chemistry, March 2014.Acute Cannabis Consumption And Motor Vehicle Collision Risk: Systematic Review of Observational Studies and Meta-Analysis
Mark Asbridge, Jill A. Hayden and Jennifer L. Cartwright. The BMJ, February 2012.Resources for your audiences
The following resources include explainers from federal agencies and national organizations. You’re free to use images and graphics from federal agencies.
- CDC’s main marijuana page.
- CDC’s marijuana data and statistics.
- Marijuana Drug Facts from the National Institute on Drug Abuse.
- Health Effects of Marijuana from the CDC.
- Learn About Marijuana Risks from the Substance Abuse and Mental Health Services Administration.
- Marijuana and Lung Health from the American Lung Association.
- Substance Use Disorder 101 from the U.S. Department of Health & Human Services.
- What You Need To Know About Marijuana Use and Driving from the CDC.
- Does marijuana use affect driving? from the National Institute on Drug Abuse.
- Drug-Impaired Driving from the National Highway Traffic Safety Administration.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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