O2170: Drivers of Children More Likely to Test Positive for Cannabinoids Following Recreational Legalization Measures

Background: Between 2010 and 2022, there were 20 states that passed laws legalizing the use of recreational cannabis. It was hypothesized that drivers of children involved in fatal car collisions would be more likely to test positive for cannabinoids following legalization measures.

Methods: The annual United States’ Department of Transportation’s Fatality Analysis Reporting System reports were compiled from 2010-2022. These datasets capture crash and passenger data for all motor vehicle collisions that result in at least one fatality in the US within 30 days of a collision. Drivers were included in the analysis if there was a child less than 14 years old in the car at the time of collision. Primary outcome was a positive screen for cannabinoids.

Results: There were 38,626 drivers of motor vehicles carrying children, who were involved in a fatal collision between 2010 and 2022, 11,679 (30.2%) of whom were screened for intoxicants and 1,855 (4.8%) tested positive for cannabinoids. Prior to legalization, the number of positive tests for cannabinoids among drivers who were screened were similar between states those states did and did not pass cannabis legislation. However, the number of positive screenings rose from 14.6% to 27.2% following cannabis legislation (p < 0.01, Figure 1). Multivariable logistic regression among those tested for cannabinoids and controlling for age of driver, sex, and race, demonstrated that following legalization drivers of children in states that passed recreational marijuana laws were more likely to test positive for cannabinoids compared to drivers of children in states without legalization (OR 1.56, 95% CI 1.15-2.11, p< 0.01). Additionally, in states that did pass recreational marijuana laws tested drivers with children in the car were more likely to test positive for cannabinoids following legalization than they were prior to legalization, even when controlling for driver age, sex, and race (OR 1.40, 95% CI 1.02-1.91).

Conclusion: These data demonstrate that following legalization of recreational marijuana in certain states, there was a significant increase in the number drivers of children who tested positive for cannabinoids. This suggests that legalization of cannabis is associated with lower threshold for users of cannabis to operate motor vehicles with children during the period in which they would screen positive for cannabinoids—a causal relationship between marijuana legalization or cannabis intoxication and whether this leads to increased child motor vehicle fatalities requires further investigation.