{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T18:12:43Z","timestamp":1776190363807,"version":"3.50.1"},"reference-count":20,"publisher":"BMJ","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"crossref","award":["R49CE003090"],"award-info":[{"award-number":["R49CE003090"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["T32 DA007292"],"award-info":[{"award-number":["T32 DA007292"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In 2023, Maryland legalized recreational cannabis use; however, understanding of cannabis involvement in motor vehicle crashes (MVCs) remains limited. We examined toxicology findings, including routine cannabis testing, and crash circumstances among drivers fatally injured in MVCs in Maryland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated data from death investigation reports by the Maryland Office of the Chief Medical Examiner in Baltimore on drivers fatally injured in MVCs between October 2024 and March 2025. Routine comprehensive toxicology screening covered more than 100 substances, including alcohol and illicit drugs. Delta-9-tetrahydrocannabinol (THC), the active impairing ingredient in cannabis, was also detected using ELISA and confirmed by liquid chromatography tandem mass spectrometry. Any confirmed substances were considered positive. We defined a positive alcohol result as a blood alcohol concentration \u22650.08\u2009g\/100\u2009mL, based on the legal limit for driving in Maryland. We calculated frequencies of single-substance and multi-substance toxicology results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 90 fatally injured drivers. One-third (n=30) tested positive for alcohol, 30% (n=27) tested positive for THC and 40% (n=36) for other drugs, of which 18.9% were illicit drugs. 12 of the 30 alcohol-positive decedents (40%) were THC-positive. 15 decedents (16.7%) were positive for involved alcohol only, 22 (24.4%) were positive for other drugs only and 14 (15.6%) were positive for alcohol and\/or THC with other drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>One-third of fatally injured drivers in Maryland tested positive for THC, and nearly half of alcohol-involved cases also involved THC. Routine THC testing in crash death investigations is essential for characterising substance-related crashes and informing prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2025-045903","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T17:20:22Z","timestamp":1776187222000},"page":"ip-2025-045903","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Substance-related fatal motor vehicle crashes in Maryland: a preliminary toxicological analysis (2024\u20132025)"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1755-7035","authenticated-orcid":false,"suffix":"PhD, MPH","given":"Nae Y","family":"Won","sequence":"first","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MPH","given":"Stephanie","family":"Haddad","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5001-7810","authenticated-orcid":false,"suffix":"PhD, MPH","given":"Wendy","family":"Shields","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD","given":"Stephanie","family":"Dean","sequence":"additional","affiliation":[{"name":"Maryland Department of Health, Office of the Chief Medical Examiner, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"PhD","given":"Rebecca","family":"Phipps","sequence":"additional","affiliation":[{"name":"Maryland Department of Health, Office of the Chief Medical Examiner, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD","given":"Ling","family":"Li","sequence":"additional","affiliation":[{"name":"Maryland Department of Health, Office of the Chief Medical Examiner, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5083-8686","authenticated-orcid":false,"suffix":"PhD, MPH","given":"Renee M","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"2026041410201840000_ip-2025-045903v1.1","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.2105\/AJPH.2021.306466","article-title":"Trends in Cannabis Involvement and Risk of Alcohol Involvement in Motor Vehicle Crash Fatalities in the United States, 2000\u20122018","volume":"111","author":"Lira","year":"2021","journal-title":"Am J Public Health"},{"key":"2026041410201840000_ip-2025-045903v1.2","unstructured":"Thomas F , Darrah J , Graham L , et al . Drug Prevalence Among Seriously or Fatally Injured Road Users. National Highway Traffic Safety Administration 2022."},{"key":"2026041410201840000_ip-2025-045903v1.3","doi-asserted-by":"crossref","first-page":"106326","DOI":"10.1016\/j.aap.2021.106326","article-title":"Simulated driving performance among daily and occasional cannabis users","volume":"160","author":"Brooks-Russell","year":"2021","journal-title":"Accid Anal Prev"},{"key":"2026041410201840000_ip-2025-045903v1.4","unstructured":"National Center for Statistics and Analysis . State traffic data: 2023 data. National Highway Traffic Safety Administration; 2025."},{"key":"2026041410201840000_ip-2025-045903v1.5","unstructured":"Thomas FD , Darrah J , Graham L . Drug prevalence among seriously or fatally injured road users. National Highway Traffic Safety Administration 2022."},{"key":"2026041410201840000_ip-2025-045903v1.6","unstructured":"Office of the Chief Medical Examiner. Annual Report Office of the Chief Medical Examiner State of Maryland. Office of the Chief Medical Examiner State of Maryland, 2023."},{"key":"2026041410201840000_ip-2025-045903v1.7","unstructured":"The Maryland People\u2019s Law Library . Recreational cannabis use and possession in maryland. 2025. Available: https:\/\/www.peoples-law.org\/recreational-marijuana-cannabis-use-and-possession-maryland [Accessed 13 Jun 2025]."},{"key":"2026041410201840000_ip-2025-045903v1.8","doi-asserted-by":"crossref","first-page":"2582","DOI":"10.1093\/aje\/kwab184","article-title":"Estimating Cannabis Involvement in Fatal Crashes in Washington State Before and After the Legalization of Recreational Cannabis Consumption Using Multiple Imputation of Missing Values","volume":"190","author":"Tefft","year":"2021","journal-title":"Am J Epidemiol"},{"key":"2026041410201840000_ip-2025-045903v1.9","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1097\/TA.0000000000001983","article-title":"Motor vehicle crash fatalaties and undercompensated care associated with legalization of marijuana","volume":"85","author":"Steinemann","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2026041410201840000_ip-2025-045903v1.10","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.aap.2017.08.003","article-title":"Cannabis and crash responsibility while driving below the alcohol per se legal limit","volume":"108","author":"Romano","year":"2017","journal-title":"Accident Analysis & Prevention"},{"key":"2026041410201840000_ip-2025-045903v1.11","doi-asserted-by":"crossref","first-page":"106066","DOI":"10.1016\/j.aap.2021.106066","article-title":"Drug presence in driving deaths in Maryland: Comparing trends and prevalence in medical examiner and FARS data","volume":"154","author":"Ehsani","year":"2021","journal-title":"Accid Anal Prev"},{"key":"2026041410201840000_ip-2025-045903v1.12","unstructured":"Maryland Department of Transportation . Maryland impaired driving laws - pages. Maryland department of transportation. Available: https:\/\/mva.maryland.gov\/drivers\/Pages\/default.aspx [Accessed 16 Jan 2026]."},{"key":"2026041410201840000_ip-2025-045903v1.13","unstructured":"Maryland cannabis use biannual study: march 1, 2025. Maryland Cannabis Administration; 2025."},{"key":"2026041410201840000_ip-2025-045903v1.14","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.annepidem.2017.05.003","article-title":"Role of alcohol and marijuana use in the initiation of fatal two-vehicle crashes","volume":"27","author":"Li","year":"2017","journal-title":"Ann Epidemiol"},{"key":"2026041410201840000_ip-2025-045903v1.15","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.aap.2018.08.021","article-title":"Multiple imputation of missing marijuana data in the Fatality Analysis Reporting System using a Bayesian multilevel model","volume":"120","author":"Chen","year":"2018","journal-title":"Accident Analysis & Prevention"},{"key":"2026041410201840000_ip-2025-045903v1.16","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s10935-017-0478-3","article-title":"Marijuana and the Risk of Fatal Car Crashes: What Can We Learn from FARS and NRS Data?","volume":"38","author":"Romano","year":"2017","journal-title":"J Primary Prevent"},{"key":"2026041410201840000_ip-2025-045903v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2014.12.018"},{"key":"2026041410201840000_ip-2025-045903v1.18","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2022.964749","article-title":"The effects of oral and vaporized cannabis alone, and in combination with alcohol, on driving performance using the STISIM driving simulator: A two-part, double-blind, double-dummy, placebo-controlled, randomized crossover clinical laboratory protocol","volume":"13","author":"Zamarripa","year":"2022","journal-title":"Front Pharmacol"},{"key":"2026041410201840000_ip-2025-045903v1.19","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1093\/jat\/bkae052","article-title":"Difficulties associated with the interpretation of postmortem toxicology","volume":"48","author":"Stephenson","year":"2024","journal-title":"J Anal Toxicol"},{"key":"2026041410201840000_ip-2025-045903v1.20","doi-asserted-by":"crossref","first-page":"100303","DOI":"10.1016\/j.forc.2020.100303","article-title":"Cannabinoid distribution in postmortem samples","volume":"23","author":"Meneses","year":"2021","journal-title":"Forensic Chemistry"}],"container-title":["Injury Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ip-2025-045903","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T17:20:25Z","timestamp":1776187225000},"score":1,"resource":{"primary":{"URL":"https:\/\/injuryprevention.bmj.com\/lookup\/doi\/10.1136\/ip-2025-045903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":20,"alternative-id":["10.1136\/ip-2025-045903"],"URL":"https:\/\/doi.org\/10.1136\/ip-2025-045903","relation":{},"ISSN":["1353-8047","1475-5785"],"issn-type":[{"value":"1353-8047","type":"print"},{"value":"1475-5785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]}}}