Elsevier

Drug and Alcohol Dependence

Volume 72, Issue 2, 24 November 2003, Pages 99-115
Drug and Alcohol Dependence

Review
Injury risk associated with cannabis and cocaine use

https://doi.org/10.1016/S0376-8716(03)00202-3Get rights and content

Abstract

The purpose of this paper is to review the results and limitations of studies of injury risks associated with cannabis and cocaine use. Three types of fatal and non-fatal injuries are considered: injuries due to collisions, intentional injuries and injuries in general. Four types of studies were reviewed: (I) laboratory studies, (II) descriptive and analytic epidemiological studies on the prevalence of cannabis or cocaine use through drug testing of those injured, (III) studies of non-clinical samples, and (IV) studies of clinical samples of drug users. The research that utilized drug tests showed similar proportions testing positive for cannabis in fatal and non-fatal injury groups, and for collisions, violence and injuries in general. By contrast, large differences in the average proportions testing positive for cocaine were found among these same injury groups. For example, 28.7% of people with intentional injuries (primarily homicides) tested positive for cocaine, while 4.5% of injured drivers tested positive. Studies of non-clinical samples have shown that both cannabis and cocaine use are related to intentional injuries and injuries in general. Results indicate higher risk for all types of injuries among cannabis and cocaine clients in treatment. Strengths and limitations of the different types of studies are discussed. More rigorous studies are needed which should focus on ruling out alternative explanations for relationships between drug use and injuries.

Introduction

Cannabis and cocaine are two of the most commonly used illicit drugs (e.g. Adlaf et al., 1994) and the hazards posed by these drugs to users have been the subject of considerable debate over the years (e.g. Alexander, 1990, Commission of Inquiry into the Non-Medical Use of Drugs, 1973, Erickson, 1980). A major concern about the use of any psychoactive drug is its possible influence on risk of injury from various causes, including motor vehicle collisions and violence.

The purpose of this paper is to review the available empirical research in order to assess the risks that cannabis and cocaine may pose for traffic collisions, intentional injuries and injuries in general. The review also aims to determine whether risks of cannabis or cocaine use are the same across these injury groups and between fatal and non-fatal injuries within each injury group. The review also permits an analysis of the relative dangers of each drug. The strengths and limitations of these studies and priorities for future research are identified.

For this review, computerized literature searches were conducted using keywords such as cannabis, cocaine, violence and injuries, with search programs (e.g. PubMed and PsychoINFO) to identify published articles. In addition, manual searches of selected journals were conducted where articles on this topic are likely to be published. Bibliographic references of recent relevant papers were also reviewed to ensure that the widest range of suitable studies was included. Inclusion criteria were studies that specifically addressed the relationship between cannabis or cocaine use/abuse and injury risk. Studies that investigated the risks associated with cannabis and cocaine use/abuse and driver-related traffic injuries, intentional injuries and injuries in general were included in this review. These studies are further sub-divided into fatal and non-fatal injuries. Studies of other types of specific injuries, such as those occurring in the workplace, are excluded. The literature on domestic violence, child abuse, physical threats and fights not involving injuries requiring hospitalization is not addressed in this review. Some traffic and intentional injuries were included under injuries in general if these groups were not analyzed separately.

In order to obtain an adequate understanding of the influence of cannabis and cocaine on injury and collision risk, laboratory studies, epidemiological studies and survey studies are necessary. In the past two decades, numerous epidemiological studies have been published on the involvement of these drugs in injuries and collisions. In this review, conclusions will be based on four types of studies: (I) Laboratory studies on the direct effects of cannabis or cocaine on psychomotor performance; (II) descriptive and analytic epidemiological studies on the prevalence of cannabis or cocaine use through drug testing in injuries; (III) studies of self-reported drug use and injuries in non-clinical samples; and (IV) studies of clinical samples of drug users. The findings of these studies, and their strengths and limitations will be addressed.

Section snippets

The psychomotor effects of cannabis and cocaine

In order to better understand how cannabis and cocaine use might be related to injuries, it is useful to study the direct effects of these drugs on psychomotor performance. Numerous laboratory studies and reviews of these studies have been conducted. Conclusions from these reviews are described briefly.

Laboratory research indicates that cannabis impairs various behavioral and cognitive skills, including those related to safe driving. In a landmark review of cannabis studies, Moskowitz (1985)

Studies using drug tests of injured subjects to detect cocaine or cannabis metabolites

Studies that obtained drug tests of urine or blood from those injured at the time of their injury are included in this section. This section is divided into three parts, epidemiological studies of those injured in car collisions, intentionally and due to all causes. These studies were further subdivided into fatal injuries and non-fatal injuries. The research methodologies and results of these studies are described in Table 1. Studies on driver injuries (i.e. fatal and non-fatal driver

Survey studies of non-clinical samples

Surveys that have investigated the relationship between self-reported drug use and injuries of individuals with no clinical diagnosis of drug abuse are reported in Table 2.

Injured drivers

One study found that clinical substance abuse populations are likely to drive after using cannabis. For example, in a study of cannabis users in treatment, 62% reported driving at least once after using the drug (Albery et al., 1999). A similar study was not found for driving after using cocaine.

Few studies exist that examine collision risks experienced by clinical samples of individuals receiving treatment for cannabis or cocaine abuse (see Part A of Table 3). In the first of these studies,

Discussion

This paper is an important extension of previous reviews for several major reasons. First, the number of studies included in this review makes it the most comprehensive review to date. Second, while previous reviews have tended to focus on collisions, we have also considered violent injuries and injuries in general. Third, it is the first review published where the average percent testing positive has been calculated in all studies combined. Comparison across groups permits an examination of

Acknowledgements

This paper received partial financial support from the Canadian Institute of Health Research.

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    The views expressed in this paper are those of the authors and do not necessarily reflect the views of the Center for Addiction and Mental Health.

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