1. CANNABIS AND CANNABINOIDS: THE CONUNDRUM
A MEDICAL PERSPECTIVE 2018
Dr. Melissa Snider-Adler
Chief MRO, DriverCheck Inc.
Damage Prevention Symposium 2018

2. Prescription vs. Authorization Cannabis Impairment
AGENDA
What are cannabinoids
Prescription vs. Authorization
Cannabis Impairment
Damage Prevention Symposium 2018

3. WHAT IS CANNABIS Anything derived from cannabis plant
Over 100+ different cannabinoids
Delta-9-tetrahydrocannabinol = THC
Cannabidiol = CBD
Influences Endocannabinoid system
Appetite
Mood
Memory
Pain sensation
Damage Prevention Symposium 2018

4. 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
OFTEN PURCHASED FROM DISPENSARY OR ILLEGALLY ON LINE – no quality control
Damage Prevention Symposium 2018

5. TOOLS FOR PRACTICE – Alberta College of Family Physicians, November 2017
Compared to other medications, cannabinoids no better with more adverse events
No difference in Quality of Life
For most conditions (example anxiety), cannabinoid evidence is sparse (at best), low quality and non- convincing
Damage Prevention Symposium 2018

6. Damage Prevention Symposium 2018

7. Damage Prevention Symposium 2018

8. 2017 MARIJUANA STATS
39%
Driven under the influence of cannabis (within 2 hrs)
39%
Passenger with driver under influence of cannabis (within 2 hrs)
23%
Full time/Part-time workers use cannabis
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 who drove within one hour of THC use
5.6% for males
19.2% of males and 10.2% of females used THC in the last year
48% admitted to use more frequently than once a month
45.1% of the population who used marijuana in the past year had moderate or high risk TCH use. Meaning just under half of those who use marijuana would meet the criteria for substance use disorder
Roadside testing with oral fluid in BC (randomly done) = 5.5% tested positive for cannabis
Canadian Cannabis Survey – 2017
9215 respondents – telephone and then survey through mobile phones
Damage Prevention Symposium 2018

9. How does marijuana impair?
What do companies do with Cannabis authorized by a medical provider?
Is the employee safe?
How do you determine impairment while at work?
Do you need to accommodate?
Can you insist on no marijuana or other sedating medications?
Time distortion
Difficulty with divided attention
Cognitive impairments memory & learning
Euphoria and relaxation
Damage Prevention Symposium 2018

10. ACUTE Depends on the drug “high” “numb” Cognitive changes Attention
Reaction time
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11. RESIDUAL Hang-over Crash from cocaine/methamphetamine fatigue
Comprehension issues
Unclear mind
Attention
Reaction time
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12. WITHDRAWALS Most severe with opioids
Seen with cannabis, cocaine, methamphetamine
Cognitive changes
Attention
Reaction time
Concentration
Damage Prevention Symposium 2018

13. SAFETY SENSITIVE IMPACTS
Doubles car crash risk
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 risk of car crash
Second most commonly detected substance among drivers who die in traffic crashes in Canada
Euphoria
Relaxation
Driving UNDER the speed limit
Changes in perception
Time distortion
Attention span deficits
Difficulty with divided attention
Damage Prevention Symposium 2018

14. SUMMARY Medical evidence is still developing for use of cannabis
Many physicians who authorize cannabis do not consider workplace safety issues
Impairment is a real concern for those in safety sensitive positions
There are no tests of impairment, only of recent use and LIKELY impairment
Just because something is authorized or prescribed does not mean it is safe to use in the workplace
Damage Prevention Symposium 2018