{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T03:25:49Z","timestamp":1782444349035,"version":"3.54.5"},"reference-count":41,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T00:00:00Z","timestamp":1636502400000},"content-version":"unspecified","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2021,10,26]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Eleven states have instituted laws allowing recreational cannabis use leading to growing public health concerns surrounding the effects of cannabis intoxication on driving safety. We hypothesized that after the 2016 legalization of cannabis in California, the use among vehicular injury patients would increase and be associated with increased injury severity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>San Diego County\u2019s five adult trauma center registries in were queried from January 2010 to June 2018 for motor vehicle or motorcycle crash patients with completed toxicology screens. Patients were stratified as toxicology negative (TOX\u2212), positive for only THC (THC+), only blood alcohol &gt;0.08% (ETOH+), THC+ETOH, or THC+ with\u2009any combination with methamphetamine or cocaine (M\/C). County medical examiner data were reviewed to characterize THC use in those with deaths at the scene of injury.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 11,491 patients identified, there were 61.6% TOX\u2212, 11.7% THC+, 13.7% ETOH+, 5.0% THC+ETOH, and 7.9%\u2009M\/C. THC+ increased from 7.3% to 14.8% over the study period and peaked at 14.9% post-legalization in 2017. Compared with TOX\u2212 patients, THC+ patients were more likely to be male and younger. THC+ patients were also less likely to wear seatbelts (8.5% vs 14.3%, p&lt;0.001) and had increased mean Injury Severity Score (8.4\u00b19.4 vs 9.0\u00b19.9, p&lt;0.001) when compared with TOX\u2212 patients. There was no difference in in-hospital mortality between groups. From the medical examiner data of the 777 deaths on scene, 27% were THC+.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>THC+ toxicology screens in vehicular injury patients peaked after the 2016 legalization of cannabis. Public education on the risks of driving under the influence of cannabis should be a component of injury prevention initiatives.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>III, Prognostic<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2021-000736","type":"journal-article","created":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T12:41:55Z","timestamp":1636634515000},"page":"e000736","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Driving under the influence: a multi-center evaluation of vehicular crashes in the era of cannabis legalization"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1838-0852","authenticated-orcid":false,"given":"Johanna Marie","family":"Borst","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd W","family":"Costantini","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Reilly","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan M","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Stabley","sequence":"additional","affiliation":[{"name":"Examiner's Office, San Diego County Medical Examiner\u2019s Office, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Steele","sequence":"additional","affiliation":[{"name":"Trauma, Palomar Medical Center, Escondido, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Wintz","sequence":"additional","affiliation":[{"name":"Trauma, Sharp Memorial Medical Center, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Bansal","sequence":"additional","affiliation":[{"name":"Trauma, Scripps Mercy Hospital, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter L","family":"Biffl","sequence":"additional","affiliation":[{"name":"Trauma, Scripps Memorial Hospital, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura N","family":"Godat","sequence":"additional","affiliation":[{"name":"Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego School of Medicine, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,11,11]]},"reference":[{"key":"2025082410423840000_6.1.e000736.1","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1001\/jamapsychiatry.2017.0724","article-title":"US adult illicit cannabis use, cannabis use disorder, and medical marijuana laws: 1991\u20131992 to 2012\u20132013","volume":"74","author":"Hasin","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"2025082410423840000_6.1.e000736.2","doi-asserted-by":"crossref","unstructured":"In Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda Board on Population Health and Public Health Practice Health and Medicine Division National Academies of Sciences, Engineering, and Medicine . 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