Green Labs: A New Kind of Gateway

Impaired driving is impaired driving regardless of the reason – whether due to alcohol, prescription drugs, non-prescription drugs, lack of sleep, or distractions. Paramount to public safety is the establishment and enforcement of impaired driving laws, particularly as the adult use cannabis markets emerge. As new laws are passed, it is imperative that safety is part of the conversation. Adult use was legalized in my home state of Maryland this past November and state legislators are now having that exact conversation while the new industry’s rules and regulations are being established. How do we ensure safety for something that has been touted for decades as a “dangerous drug” and a gateway to negative consequences? Education.

Chesapeake Region Safety Council (CRSC) is a private, non-profit, non-governmental public service organization established in 1923 to provide safety training and education to reduce disabling injuries and save lives. A chapter of the National Safety Council, which was founded in 1913 and chartered by the US Congress in 1953, CRSC started hosting “green labs,” in 2019. These experiences involve safety professionals, law enforcement officers, and willing participants who are medical cannabis patients in Maryland. The officers are training with drug recognition experts (DREs), to experience, assess, and practice their interactions with impaired individuals and to know what to look for when performing traffic stops on suspected impaired drivers.

The process aims to understand the differences in impairment when comparing cannabis to other substances. For example, horizontal gaze nystagmus (HGN) is the involuntary jerking of one’s eyes due to alcohol consumption. This does not happen with cannabis use. However, with more and more people consuming cannabis, law enforcement must understand the difference between use and impairment. The presence of a substance does not automatically equal impairment, particularly in the case of Δ9-tetrahydrocannabinol (THC), which is the compound in cannabis that causes euphoria and can often lead to impairment. The current technology can establish the presence of THC, however because of the way THC is stored in our bodies, a positive result is not an accurate determination of impairment.

SAFETY ASSESSMENT IN REAL-TIME

I recently had the opportunity to participate in a green lab where I was joined by five other people, four males and one female. We were brought into a room and given a baseline assessment by a paramedic who checked vital signs, and then a baseline sobriety assessment by a law enforcement officer. This included a standard sobriety field test, assessing balance, coordination, and eye movement. Additionally, we completed a baseline assessment using the Druid app from Impairment Science, Inc., which uses a series of cognitive and motor function tests to measure impairment using one’s personal smartphone. This includes tasks like tracing a moving dot on the screen with your finger and holding the phone in one hand while balancing on the opposite foot for thirty seconds. Following the baseline tests, we were told to start medicating with cannabis. For test purposes, one other patient and I were “polysubstance users” meaning we were drinking alcohol and smoking cannabis concurrently. We were in a large room with open windows and the law enforcement officers were there as well. We consumed for approximately one hour and observers were then brought into the room to talk with us.’

I spoke with several people and answered the many questions they had about my personal cannabis consumption practices. I showed them the packaging my cannabis medicine comes in and how I read the labels to determine if the product has what I am looking for (this is why manufacturing practices and marketing labels need to be regulated, too.) Next, we were taken to separate rooms, and each patient was paired with a law enforcement officer to perform the sobriety field test while observers watched.

After we performed the tests at least twice for different groups, we completed the Druid test again, and then we discussed the results as a group. Results were generally consistent in that at the time of the initial sobriety tests (i.e., peak impairment), none of us would have driven. There was one patient who stated they would have driven throughout the entire experiment. By the time we were reviewing the results, four of the six of us said they could drive, as it was now two-three hours past the time of consumption. The two of us who had also been drinking stated we were still too impaired to drive. We were also asked if we could work under such conditions of impairment. This received mixed results. Two of us (myself included) stated we would not be able to work; we are both healthcare professionals. Four people – all of whom work in dispensaries – stated they would be able to work.

EDUCATION MITIGATES RISK

The CRSC presented these findings to the House Cannabis Referendum and Legalization work group, a bipartisan gathering of Maryland state legislators. The nuances of cannabis legalization involve a myriad of perspectives and competing priorities from patients and consumers, employers and employees, small business owners, safety professionals, law enforcement, and more. At the center of these different priorities is safety, whether it is while operating on the job or on the road. As an Emergency Department nurse, I often educated patients about not taking certain medications before driving or operating heavy machinery and cannabis is no different. With a better understanding of how and why cannabis is used as medicine and how it affects people, we can develop fair and equitable treatment and laws that ensure safety without limiting access. The technology will take time to develop, but current cannabis education – not the misleading and outdated D.A.R.E. program – can be implemented now. It’s not only the legal system and law enforcement who need this education, but also new young drivers.

For many of these entities, legalizing cannabis means increased risk, particularly for inexperienced drivers who may have misconceptions about whether cannabis is impairing or not. The Massachusetts Registry of Motor Vehicles (RMV) is leading the way in educating new drivers about cannabis impairment by partnering with the Massachusetts Cannabis Control Commission and AAA to offer the educational program, “Shifting Gears: the Blunt Truth about Marijuana and Driving.” The curriculum is taught through a 25-minute educational video and builds on the previous module that only referenced alcohol and drugs in general. There will now be a special section on cannabis-impaired driving featuring research-based information that explains how THC can affect cognition, reaction time, coordination, and vision. This will be the first group of new student drivers to receive this education since cannabis became legal for adult use in Massachusetts in December 2016. This curriculum will be taught to approximately 50,000 drivers per year in over 460 locations across the state.

Massachusetts is to be applauded for this proactive stance, and more states should be adopting a curriculum specific to cannabis. As states establish adult-use markets, legislators should be giving thought to who is educating their constituents. For example, CannabizMD is a woman-owned and led company founded in Maryland whose mission is to help fill the void of quality medical cannabis science and policy education. Collaborations between traffic safety professionals and cannabinoid experts will ensure accurate education and opportunities to engage with groups that might otherwise seem at odds.

There is plenty more to be done to ensure safety on the roads and in the workplace, but it starts with education. CRSC plans to continue hosting green labs in different areas across Maryland, with the next lab slated for late February 2023.

Emily Jacobs, BSN, RN will receive a Master of Science in Medical Cannabis and Therapeutics in May 2023 from the University of Maryland Baltimore School of Pharmacy. A former Emergency Department nurse of 12 years, she is currently serving as the CannabizMD intern and serves on the board of its ESG , nonprofit Tea Pad.  

References:

Massachusetts Adding Cannabis Education to Driving School Curriculum. Press Release. Massachusetts Department of Transportation. December 16, 2022. Accessed January 4, 2023. https://www.mass.gov/news/massachusetts-adding-cannabis-education-to-driving-school-curriculum

The opinions expressed in this post are the author’s own and are independent of the views of CannabizMD.