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This randomized, double-blind, placebo-controlled, within-subjects trial examined the effects of smoked cannabis with varying \u03949-THC concentrations on simulated driving. Adults aged 19\u201345 who regularly used cannabis and held valid driver\u2019s licenses completed simulated driving tasks after smoking placebo, or cannabis containing low (6.25%\/47\u00a0mg \u03949-THC), medium (12.5%\/94\u00a0mg \u03949-THC), or high (22%\/165\u00a0mg \u03949-THC) \u03949-THC levels. The primary outcome was mean speed (km\/h); secondary measures included maximum speed, standard deviation of lateral position (SDLP), reaction time (RT), and subjective ratings of driving ability and intoxication. Mean speed did not differ across conditions. Maximum speed increased under medium (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006) and high (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02) potencies versus placebo. SDLP was higher across all \u03949-THC potencies (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), and RT was longer under medium and high potencies (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Both SDLP (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and RT (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.023) positively correlated with blood \u03949-THC concentrations. Participants reported poorer driving performance and reduced willingness to drive at higher potencies. Findings demonstrate potency-dependent impairments in simulated driving linked to \u03949-THC concentration, underscoring implications for road safety.\n                  <\/jats:p>\n                  <jats:p>\n                    Trial registration: clinicaltrials.gov, ID NCT03656029; First posted date: 04\/09\/2018; URL:\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03656029\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/study\/NCT03656029<\/jats:ext-link>\n                    .\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-43045-2","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T16:05:38Z","timestamp":1773158738000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Potency-related effects of smoked cannabis on simulated driving performance: a randomized, controlled crossover trial"],"prefix":"10.1038","volume":"16","author":[{"given":"Bruna","family":"Brands","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Zaweel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Di Ciano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Wickens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Matheson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Fares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer S. 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Dr. Le Foll has in-kind donations of placebo edibles from Indiva. Dr. Le Foll obtained industry funding from Canopy Growth Corporation (through research grants handled by the Centre for Addiction and Mental Health and the University of Toronto). He participated in a session of a National Advisory Board Meeting (Emerging Trends BUP-XR) for Indivior Canada and is part of Steering Board for a clinical trial for Indivior. Dr. LeFoll consulted with Shinogi, ThirdBridge, and Changemark. He is part of a scientific advisory board for NFL Biosciences. He received travel support to attend an event by Bioprojet and is supported by CAMH, Waypoint Centre for Mental Health Care, a clinician-scientist award from the Department of Family and Community Medicine of the University of Toronto and a Chair in Addiction Psychiatry from the Department of Psychiatry of University of Toronto. Dr. Christine Wickens serves on the Executive Committee of the International Council on Alcohol, Drugs and Traffic Safety (ICADTS) and on the Canadian Society of Forensic Science\u2019s Drugs and Driving Committee, which acts as an advisory body to the Department of Justice with respect to issues of drug impaired driving. In the past three years, she served on the Board of Directors of the Canadian Association of Road Safety Professionals (CARSP) and consulted for the AAA Foundation for Traffic Safety. She was awarded grant funding from Transport Canada, Ministry of Transportation Ontario, Canadian Institutes for Health Research, CAMH Foundation, and CAMH Remedial Measures Programs. She received travel reimbursement for academic presentations delivered to the Canadian Mental Health Association (CMHA) and the Canadian Council of Motor Transport Administrators (CCMTA). Professor Huestis is currently a consultant to many pharmaceutical and diagnostic companies, none of which had any role in this research and none of whom\u2019s products were used or mentioned in the manuscript. She also is an unpaid member of the scientific advisory board of the Smart Approaches to Marijuana organization. All other authors declare that they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"12961"}}