CANADIAN CANNABIS CRAZE (AND CONUNDRUM) Dr. Melissa Snider-Adler Chief Medical Review Officer DriverCheck Inc. Addiction Medicine Physician
AGENDA THC IMPAIRMENT A deep dive into THC vs. CBD Signs and Symptoms of cannabis use MEDICAL CANNABIS: ACMPR Assessment of safety concerns with cannabis for medical purposes DRUG TESTING SUBSTANCE USE DISORDER
LEGAL CANNABIS IN THE WORKPLACE ACMPR medical marijuana Recreational cannabis Legal on October 17, 2018
AUDIENCE QUESTION Did people using cannabis in the 60s, 70s, and 80s get high (or impaired) with their use?
WHAT IS CANNABIS? Anything derived from cannabis plant Over 100+ different cannabinoids Delta-9-tetrahydrocannabinol = THC Cannabidiol = CBD Influences Endocannabinoid system (CB1, CB2) o o o o Appetite Mood Memory Pain sensation
CANNABIDIOL - CBD Not itself psychoactive Available in an OIL form Presence of THC in ALL AVAILABLE Will still test positive Low THC so less impairing but cannot state NO IMPAIRMENT
DABS shatter honeycomb crumble 60-95% THC
EDIBLES not yet
2017 Cannabis Use Stats 44.7% Past year use of cannabis 20-24 years (non-medical) 64% 18.4% Past year use 25 and older (non-medical) 18% 34% use cannabis for medical or recreational purposes Use more often than 1/month (all past year users) Daily use of cannabis (all past year users) Canadian Cannabis Survey 2017 9215 respondents telephone and then survey through mobile phones
2017 Cannabis Use and Work 23% Full time/part-time workers use cannabis 39% Driven under the influence of cannabis (within 2 hrs) 39% Passenger with driver under influence of cannabis (within 2 hrs) 21.5% Used cannabis to get high before or at work (last year) 7.7% Use cannabis to get high before or at work weekly or daily Canadian Cannabis Survey 2017 9215 respondents telephone and then survey through mobile phones
How does marijuana impair? Euphoria and relaxation Time distortion Difficulty with divided attention Cognitive impairments memory & learning
Impacts on Workplace Safety Divided Attention The ability for change focus Managing more than one important task In emergency situations this impacts safety Cognitive Impairments Executive function Working memory Planning/organizing Initiation Emotional control Inhibition
3 TYPES OF IMPAIRMENT Acute Effects After-effects/residual Withdrawals
EDIBLE vs. SMOKED CANNABIS Edible takes 30 90 minutes to take effect Effects last considerably longer Effects from smoking/vaping are very quick (minutes) Acute effects wear off faster with smoked cannabis Residual impairments are the same (the length of time it takes the brain to return to normal state after blood levels drop) Withdrawal impairments are the same Risk of Cannabis Use Disorder slightly higher with smoked drugs
Clinical Signs Red eyes Dry mouth Nystagmus Anxiety Increased appetite Impaired motor coordination Increased heart rate Irritability, rage, anger (withdrawals) APPEARS NORMAL!
Marijuana and Pilot Performance Experienced pilots trained on a flight simulator Given one joint of marijuana (3.65%) Tested before, and 0.25, 4,8,24, 48 hours after Significant impairment seen up to 24 hours 7/9 showed impairment at 24 hours ONLY ONE HAD AWARENESS OF THE DRUG S EFFECTS Leirer, V.O., Yesavage, JA., Morrow, DG., Marijuana Carry-Over Effects on Aircraft Pilot Performance. Aviat Space Enciron Med. 1991 Mar;62(3):221-7
LEARNING FROM OUR NEIGHBOURS Colorado Department of Public Safety Marijuana Legalization in Colorado: Early Findings Washington Traffic Safety Commission Marijuana Use, Alcohol Use, and Driving in Washington State
Positive testing and MVA fatalities Increase of 230% 2006 to 2012 From 2013 to 2014 continue increase of 70% testing positive for delta-9-thc in blood
WASHINGTON 1/5 daytime drivers tested positive for THC on blood or oral fluid in 2016 This was 1/10 prior to recreational sales of cannabis Fatal crash increase in positive tests for THC Fatal crash 15% yearly increase in testing positive for 2 or more drugs NOW SURPASSES ALCOHOL POSITIVE TESTS
Safety Summary Cannabis use prior to driving increases the risk of being involved in a motor vehicle accident - substantial evidence of a statistical association The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research Washington (DC): National Academies Press (US); 2017 Jan 12 Doubles car crash risk
The Growth of Medical Cannabis in Canada
The numbers speak volumes Medical Cannabis Users Over 400,000 296,702 AB 112,207 ON 123,983 477 37,000 2002 2013 2018 2024
CANNABIS IS NOT A PRESCRIPTION
Typical Prescription
Patient's Given Name and Surname: Patient's Date of Birth (DD/MM/YYYY): Daily quantity of dried marihuana to be used by the patient: grams/day The period of use is day(s) or week(s) or month(s). Note: The period of use cannot exceed one year Health care practitioner's given name and surname: Profession: Health care practitioner's business address:
Medical Cannabis Assessment
What do companies do? Employee safety Impairment Accommodation No use
Medical Cannabis Review Program Employee consent Ensure it is ACMPR Letter to authorizing physician Letter to treating physician Review of specific use Letter to employer with recommendations regarding safety sensitive work
Drug testing today
DRUG TESTING COMPARISON ORAL FLUID Short window of use THC parent (delta-9- THC) Positive test means recent use Recent use = likely impairment 2 ng/ml vs. 10 ng/ml URINE Unable to determine timeline THC Metabolite No indication of impairment Gold standard for riskbased programs (US DOT) BLOOD Cannot be used in workplace Short time frame More complicated for THC (given in and out of fat cells) DUI based on blood levels
HOW TO PASS A URINE DRUG TEST
substance use disorder
PICTURE SOMEONE WITH ADDICTION
Underlying issues of self-medication Physical and emotional pain Depression Anxiety Trauma Neglect Affect intolerance
Summary 1. Impairment from THC is a real concern for those in safety sensitive positions 2. Many physicians who authorize cannabis do not consider workplace safety issues 3. Just because something is authorized or prescribed does not mean it is safe to use in the workplace 4. There are no tests of impairment, only of recent use and LIKELY impairment 5. Substance use disorder is common medical disability
Questions