Restricted accessResearch articleFirst published online 2021-7
Assessment of cognitive and psychomotor impairment,subjective effects,and blood THC concentrations following acute administration of oral and vaporized cannabis
Cannabis legalization is expanding, but there are no established methods for detecting cannabis impairment.
Aim:
Characterize the acute impairing effects of oral and vaporized cannabis using various performance tests.
Methods:
Participants (N = 20, 10 men/10 women) who were infrequent cannabis users ingested cannabis brownies (0, 10, and 25 mg Δ-9-tetrahydrocannabinol, THC) and inhaled vaporized cannabis (0, 5, and 20 mg THC) in six double-blind outpatient sessions. Cognitive/psychomotor impairment was assessed with a battery of computerized tasks sensitive to cannabis effects, a novel test (the DRiving Under the Influence of Drugs, DRUID®), and field sobriety tests. Blood THC concentrations and subjective drug effects were evaluated.
Results:
Low oral/vaporized doses did not impair cognitive/psychomotor performance relative to placebo but produced positive subjective effects. High oral/vaporized doses impaired cognitive/psychomotor performance and increased positive and negative subjective effects. The DRUID® was the most sensitive test to cannabis impairment, as it detected significant differences between placebo and active doses within both routes of administration. Women displayed more impairment on the DRUID® than men at the high vaporized dose only. Field sobriety tests showed little sensitivity to cannabis-induced impairment. Blood THC concentrations were far lower after cannabis ingestion versus inhalation. After inhalation, blood THC concentrations typically returned to baseline well before pharmacodynamic effects subsided.
Conclusions:
Standard approaches for identifying impairment due to cannabis exposure (i.e. blood THC and field sobriety tests) have severe limitations. There is a need to identify novel biomarkers of cannabis exposure and/or behavioral tests like the DRUID® that can reliably and accurately detect cannabis impairment at the roadside and in the workplace.
AbramsDIVizosoHPShadeSB, et al. (2007) Vaporization as a smokeless cannabis delivery system: A pilot study. Clin Pharmacol Ther82: 572–578.
2.
ArkellTRLintzerisNKevinRC, et al. (2019) Cannabidiol (CBD) content in vaporized cannabis does not prevent tetrahydrocannabinol (THC)-induced impairment of driving and cognition. Psychopharmacology (Berl)236: 2713–2724. DOI: 10.1007/s00213-019-05246-8.
3.
BergCJStrattonESchauerGL, et al. (2015) Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: Marijuana, hookah, and electronic cigarettes win. Subst Use Misuse50: 79–89.
4.
BorodovskyJTCrosierBSLeeDC, et al. (2016) Smoking, vaping, eating: Is legalization impacting the way people use cannabis?Int J Drug Policy36: 141–147.
5.
BoskerWMKuypersKPTheunissenEL, et al. (2012) Medicinal Delta(9)-tetrahydrocannabinol (dronabinol) impairs on-the-road driving performance of occasional and heavy cannabis users but is not detected in Standard Field Sobriety Tests. Addiction107: 1837–1844.
6.
CarlinerHBrownQLSarvetAL, et al. (2017) Cannabis use, attitudes, and legal status in the U.S.: A review. Prev Med104: 13–23.
ConeEJHuestisMA (1993) Relating blood concentrations of tetrahydrocannabinol and metabolites to pharmacologic effects and time of marijuana usage. Ther Drug Monit15: 527–532.
9.
ConeEJJohnsonREPaulBD, et al. (1988) Marijuana-laced brownies: Behavioral effects, physiologic effects, and urinalysis in humans following ingestion. J Anal Toxicol12: 169–175.
10.
CooperZDHaneyM (2014) Investigation of sex-dependent effects of cannabis in daily cannabis smokers. Drug Alcohol Depend136: 85–91.
11.
CoulterCMillerECromptonK, et al. (2008) Tetrahydrocannabinol and two of its metabolites in whole blood using liquid chromatography-tandem mass spectrometry. J Anal Toxicol32: 653–658.
12.
CurranHVFreemanTPMokryszC, et al. (2016) Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci17: 293–306.
13.
DowneyLAHayleyACPorath-WallerAJ, et al. (2016) The Standardized Field Sobriety Tests (SFST) and measures of cognitive functioning. Accid Anal Prev86: 90–98.
14.
FinkDSStohlMSarvetAL, et al. (2020) Medical Marijuana laws and driving under the influence of marijuana and alcohol. Addiction115: 1944–1953. DOI: 10.1111/add.15031.
15.
GinsburgBC (2019) Strengths and limitations of two cannabis-impaired driving detection methods: A review of the literature. Am J Drug Alcohol Abuse45: 610–622.
16.
GoodmanSWadsworthELeos-ToroC, et al. (2020) Prevalence and forms of cannabis use in legal vs. illegal recreational cannabis markets. Int J Drug Policy76: 102658.
17.
GronwallDM (1977) Paced auditory serial-addition task: A measure of recovery from concussion. Percept Mot Skills44: 367–373.
18.
HartmanRLBrownTLMilavetzG, et al. (2015) Cannabis effects on driving lateral control with and without alcohol. Drug Alcohol Depend154: 25–37.
19.
HartmanRLBrownTLMilavetzG, et al. (2016) Cannabis effects on driving longitudinal control with and without alcohol. J Appl Toxicol36: 1418–1429.
20.
JaegerJ (2018) Digit symbol substitution test: The case for sensitivity over specificity in neuropsychological testing. J Clin Psychopharmacol38: 513–519.
21.
JongenSPerrierJVuurmanEF, et al. (2015) Sensitivity and validity of psychometric tests for assessing driving impairment: Effects of sleep deprivation. PLoS One10: e0117045.
22.
JongenSVuurmanERamaekersJ, et al. (2014) Alcohol calibration of tests measuring skills related to car driving. Psychopharmacology231: 2435–2447.
23.
JongenSVuurmanERamaekersJ, et al. (2016) The sensitivity of laboratory tests assessing driving related skills to dose-related impairment of alcohol: A literature review. Accid Anal Prev89: 31–48.
24.
KarolyHCMilburnMABrooks-RussellA, et al. (2020) Effects of high-potency cannabis on psychomotor performance in frequent cannabis users. Cannabis Cannabinoid Res. Epub ahead of print 10 September 2020. DOI: 10.1089/can.2020.0048.
25.
KingACByarsJA (2004) Alcohol-induced performance impairment in heavy episodic and light social drinkers. J Stud Alcohol65: 27–36.
26.
KleykampBAGriffithsRRMintzerMZ (2010) Dose effects of triazolam and alcohol on cognitive performance in healthy volunteers. Exp Clin Psychopharmacol18: 1–16.
27.
KnappAALeeDCBorodovskyJT, et al. (2018) Emerging trends in cannabis administration among adolescent cannabis users. J Adolesc Health64: 487–493. DOI: 10.1016/j.jadohealth.2018.07.012.
28.
KowalMAHazekampAColzatoLS, et al. (2015) Cannabis and creativity: Highly potent cannabis impairs divergent thinking in regular cannabis users. Psychopharmacology (Berl)232: 1123–1134.
29.
LaneTJHallW (2019) Traffic fatalities within US states that have legalized recreational cannabis sales and their neighbours. Addiction114: 847–856.
30.
McCrum-GardnerE (2008) Which is the correct statistical test to use?Brit J Oral Maxillofac Surg46: 38–41.
31.
McLeodDRGriffithsRRBigelowGE, et al. (1982) An automated version of the digit symbol substitution test (DSST). Behav Res Methods Instrum14: 463–466.
32.
MenetreyAAugsburgerMFavratB, et al. (2005) Assessment of driving capability through the use of clinical and psychomotor tests in relation to blood cannabinoids levels following oral administration of 20 mg dronabinol or of a cannabis decoction made with 20 or 60 mg Delta9-THC. J Anal Toxicol29: 327–338.
33.
MikulskayaEMartinFH (2018) Contrast sensitivity and motion discrimination in cannabis users. Psychopharmacology235: 2459–2469.
34.
MonfortSS (2018) Effect of Recreational Marijuana Sales on Police-Reported Crashes in Colorado, Oregon, and Washington. Arlington, VA: Insurance Institute for Highway Safety.
35.
National Academies of Sciences and Medicine (2017) The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: National Academies Press.
36.
NewmeyerMNSwortwoodMJAbulseoudOA, et al. (2017a) Subjective and physiological effects, and expired carbon monoxide concentrations in frequent and occasional cannabis smokers following smoked, vaporized, and oral cannabis administration. Drug Alcohol Depend175: 67–76.
37.
NewmeyerMNSwortwoodMJBarnesAJ, et al. (2016) Free and glucuronide whole blood cannabinoids’ pharmacokinetics after controlled smoked, vaporized, and oral cannabis administration in frequent and occasional cannabis users: Identification of recent cannabis intake. Clin Chem62: 1579–1592.
38.
NewmeyerMNSwortwoodMJTaylorME, et al. (2017b) Evaluation of divided attention psychophysical task performance and effects on pupil sizes following smoked, vaporized and oral cannabis administration. J Appl Toxicol37: 922–932.
39.
NiedbalaRSKardosKWFritchDF, et al. (2001) Detection of marijuana use by oral fluid and urine analysis following single-dose administration of smoked and oral marijuana. J Anal Toxicol25: 289–303.
40.
OdellMSFreiMYGerostamoulosD, et al. (2015) Residual cannabis levels in blood, urine and oral fluid following heavy cannabis use. Forensic Sci Int249: 173–180.
41.
PapafotiouKCarterJDStoughC (2005a) An evaluation of the sensitivity of the Standardised Field Sobriety Tests (SFSTs) to detect impairment due to marijuana intoxication. Psychopharmacology (Berl)180: 107–114.
42.
PapafotiouKCarterJDStoughC (2005b) The relationship between performance on the standardised field sobriety tests, driving performance and the level of Delta9-tetrahydrocannabinol (THC) in blood. Forensic Sci Int155: 172–178.
43.
PengYWDesapriyaEChanH, et al. (2020) Residual blood THC levels in frequent cannabis users after over four hours of abstinence: A systematic review. Drug Alcohol Depend216: 108177.
44.
RamaekersJGKauertGTheunissenEL, et al. (2009) Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. J Psychopharmacol23: 266–277.
45.
RamaekersJGRobbeHO’HanlonJ (2000) Marijuana, alcohol and actual driving performance. Hum Psychopharmacol15: 551–558.
46.
RichmanJEMayS (2019) An Investigation of the Druid® smart- phone/tablet app as a rapid screening assessment for cognitive and psychomotor impairment associated with alcohol intoxication. Vision Dev Rehab19: 31–42.
47.
SchlienzNJSpindleTRConeEJ, et al. (2020) Pharmacodynamic dose effects of oral cannabis ingestion in healthy adults who infrequently use cannabis. Drug Alcohol Depend211: 107969.
48.
SheldonMRFillyawMJThompsonWD (1996) The use and interpretation of the Friedman test in the analysis of ordinal-scale data in repeated measures designs. Physiother Res Int1: 221–228.
49.
ShollerDJStricklandJCSpindleTR, et al. (2020) Sex differences in the acute effects of oral and vaporized cannabis among healthy adults. Addict Biol. Epub ahead of print 29 September. DOI: 10.1111/adb.12968.
50.
SobellLCSobellMB (1992) Timeline follow-back: A technique for assessing self-reported alcohol consumption. In: AllenJPLittenRZ (eds) Measuring Alcohol Consumption: Psychosocial and Biochemical Methods. Totowa, NJ: Human Press, pp.41–72.
51.
SpindleTRBonn-MillerMOVandreyR (2019a) Changing landscape of cannabis: Novel products, formulations, and methods of administration. Curr Opin Psychol30: 98–102.
52.
SpindleTRConeEJSchlienzNJ, et al. (2018) Acute effects of smoked and vaporized cannabis in healthy adults who infrequently use cannabis: A crossover trial. JAMA Netw Open1: e184841.
53.
SpindleTRConeEJSchlienzNJ, et al. (2019b) Acute pharmacokinetic profile of smoked and vaporized cannabis in human blood and oral fluid. J Anal Toxicol43: 233–258. DOI: 10.1093/jat/bky104.
54.
SPSS (2005) Linear Mixed-effects Modeling in SPSS: An Introduction to the MIXED Procedure. Technical Report, pp.1–28.
55.
SteigerwaldSWongPOKhorasaniA, et al. (2018) The form and content of cannabis products in the United States. J Gen Intern Med33: 1426–1428. DOI: 10.1007/s11606-018-4480-0.
56.
StusterJ (2006) Validation of the standardized field sobriety test battery at 0.08% blood alcohol concentration. Human Factors48: 608–614.
57.
SwortwoodMJNewmeyerMNAnderssonM, et al. (2017) Cannabinoid disposition in oral fluid after controlled smoked, vaporized, and oral cannabis administration. Drug Test Anal9: 905–915.
58.
VandreyRHerrmannESMitchellJM, et al. (2017) Pharmacokinetic profile of oral cannabis in humans: Blood and oral fluid disposition and relation to pharmacodynamic outcomes. J Anal Toxicol41: 83–99.
59.
VolkowNDSwansonJMEvinsAE, et al. (2016) Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: A review. JAMA Psychiatry73: 292–297.
60.
WachtelSRElSohlyMARossSA, et al. (2002) Comparison of the subjective effects of Delta(9)-tetrahydrocannabinol and marijuana in humans. Psychopharmacology (Berl)161: 331–339.
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
