Comments

1
Stoned drivers do not swerve all over the road and recklessly accelerate and rage against other cars the way drunk drivers do. I'm not convinced it's a comparable degree of impairment.
2
Dom, you aren't telling your readers that the proposed DUI statutes were defeated last year in Colorado, because the science wasn't there to support it. Senator Steve King (R) Colorado, the one proposing the DUIC, is an ALEC member - I have yet to find a connection between per se DUI on cannabis, and the American Legislative Exchange Council (ALEC), but I'm looking for it (any help in this matter is appreciated).

Read Paul Armentano's piece You Are Going Directly To Jail: What It ….

The difference between including DUI provisions in an initiative vs. the legislature are; we cannot change the language for two years from an initiative to the legislature; and we can fight against the legislative process to prevent such a law from being enacted, which is what happened last year in Colorado, and will have to happen again.

The goal here is to defeat unfair DUI statutes, until such time that science actually supports such legislation. Why surrender another freedom to give law enforcement another law with which they can target and profile suspect cannabis users?

Dom, you do everyone a great disservice when you twist the study results to meet your needs to defend I-502. We need legitimate, science based discussion here, not pandering to opinions or fear.
3
The same studies quoted by 502 supporters also say that some people perform better on some areas of dving skills. These studies also say that THERE IS NO CORRELATION between blood levels and impairment. Like all statistics, you may choose the one you prefer.

Dom, you are very misleading in your rhetoric. I still have my challenge open for a debate on the merits of 502. Cannabis Defense Coalition venue. Choose your seconds if you are not afraid of a public duel...
4
Uhhhh, google the words "cannabis improves driving".... the top entries are as follows.....
PDF]
Cannabis, Cannabinoids and Driving
davidbearmanmd.com/docs/Cann&Driving.pdf
File Format: PDF/Adobe Acrobat - Quick View
safely. According to research by British scientists, a moderate amount of cannabis may actually improve driving performance. A group of 20 drivers aged 21-40 ...
You visited this page on 2/23/12.
Driving and Marijuana
www.iowatelecom.net/~sharkhaus/driving.h…
In fact, marijuana use may slightly improve driving performance, according to science. Two studies (one indexed below) have shown a negative correlation ...
You visited this page on 2/23/12.
Cannabis 'improves' driving, some users say | Stuff.co.nz
www.stuff.co.nz/national/.../Cannabis-im…...
Sep 22, 2009 – Two thirds of cannabis users say the drug does not affect their driving ability, while 16 percent say it improves it, according to a new survey.
[PDF]
Cannabis improves symptoms of ADHD
www.cannabis-med.org/english/journal/en_…
File Format: PDF/Adobe Acrobat - Quick View
by P Strohbeck-Kuehner - Cited by 2 - Related articles
Mar 2, 2008 – Keywords: ADHD, cannabis, performance, driving. This article can be ... were much improved under cannabis and that dronabi- nol (THC) had ...
5
" According to research by British scientists, a moderate amount of cannabis may actually improve driving performance. A group of 20 drivers aged 21-40 "

Tell us, OH wise one... Do some of us get the good driving pass which REQUIRES us to have the cannabis in order to drive better. Just sayin', Dominic Holden, science is real, Your opinions are NOT.....
6
I'm pretty sure the amount of stoned drivers on the road for the past 40 years not generating a considerable amount of statistics against them could be... wait... a statistic?
7
You can argue the fine points of how to devise an accurate and fair test. But Dom's point is essentially valid. The public will not accept pot legalization without some sort of DUI component. You would have a very difficult time trying to convince the general public that someone who is high as a kite can safely operate a vehicle and shouldn't be subject to any sort of DUI limitations. If that is your base argument, no matter how scientifically sound you think it is, you have lost already.
8
Dom, you are obviously motivated by your personal connections to the people driving this initiative. Furthermore, you'd support any legislation that punished people who drive cars. Go on, admit it, it might even make you more credible.

I would love to see an objective review of the relevant research from a qualified scientist, preferably one who doesn't have an agenda one way or the other.
9
@ 8) Of course you know this, but I have personal connections to the people opposing the initiative, too, so your criticism doesn't really have any bearing. Also, you wrote that I would "support any legislation that punished people who drive cars."

I think hyperbole and ad hominem just had a lovechild on your keyboard.
10
Innocent pot patients shouldn't drive. There's plenty of medication under which you shouldn't drive. I'd never take the wheel while on muscle relaxants.
11
@7 - No - this is a matter of messaging, and educating the public instead of pandering to their fears. They need to be educated on two primary facts:

1.) We already have a law that makes it illegal to drive stoned: RCW 46.61.502.
2.) Cannabis impairment is not relative to alcohol impairment, it cannot be defined by the same standards and levels as alcohol.

New Approach Washington decided to kowtow to public fear and polling, instead of educating voters, to ease their concerns on this matter. The fact that this has become such a heavily weighted discussion, only serves to propagate fears that were previously held in minority opinion. If stoned driving was considered to be such a huge public safety issue, it would have been addressed when voters approved medical cannabis in 1998. Instead, we are only just now talking about it, after the introduction of I-502 (then they have the audacity to accuse people like me of "fear mongering").
12
@badstone #1 - their mode of causing more crashes is unimportant - motivated by rage or apathy or obliviousness. per Dominic, 5 milligrams is show "by science" to be associated with more accidents.

Personally, I'd rather have the limit be so low that if you are at all "high", your choice is simple: don't drive. for every inconsiderate drunk, there's another DUI charge for an otherwise responsible person driving just on the edge of the limit because they wagered they were legal and "felt okay" to drive. A lower (or zero) limit would eliminate the "accidental DUIs", but that boat has sailed. let's not screw it up with marijuana the same way.
13
Aside from the fact that many (most?) people drive better when high than when sober, there's the inconvenient detail that you can test positive for pot literally weeks after you were last high. If you want to ban impairment, you need a way to test for impairment, not the remaining chemical traces of a drug you're no longer being affected by.

And a piece of anec-data, FWIW: I get road rage a lot. It makes me do stupid things with my car. I never get road rage when I drive while high.
14
@9: Yes, it's obviously an exaggeration to say you'd support any legislation that punishes driving, but your antipathy for cars is abundantly documented here on SLOG. I'm pointing out your stated opinions, and I'm suggesting that they have influenced your position on this issue. That's not a personal attack, nor is it hyperbole.

Backing up a bit, your entire career at The Stranger shows you to be a devout practitioner of "advocacy journalism". You pick a side, and argue only on behalf of that side, no matter what, just like Fox News.

That's great for issues like gay marriage, where one side is right and the other wrong. For more complicated issues, such as transportation projects or an initiative that asks pot smokers to trade in one set of civil liberties for another, your black and white approach is every bit as dishonest and unhelpful as when Fox News does it.

It also makes your writing pretty fucking useless to those of us anyone wishing to make an informed and analytic decision. If the science suggests (as I think it does) that unimpaired drivers could be arrested with the 5ng limit, could I trust you to report that? I don't think I could. I think your mind has been made up, and I don't think you are open to influence from contrary facts.

This isn't based on any personal grudge I have against you. I've never met you, and if I did, I'm sure we'd get along swimmingly. This is based on the record of journalism you've left here on SLOG. It's your record. Own it.
15
Unlike with alcohol, there is no blood test known to mankind that can accurately measure impairment of cannabis of moderate or heavy users. NAW's own propaganda states this when NAW says "5 ng/ml is accurate for light users"

So.... let's make a law to lock people up, ruin the job's, families, and reputations all on an scientifically invalid blood test.

Make believe science - real life consequences. NO THANK YOU!

16
@14) Sometimes I pick a side, sometimes I'm neutral; sometimes my take is black and white, and sometimes it's very nuanced. If you choose to ignore hundreds of posts to make your point, go for it. But that doesn't make you right--it means you're calling the kettle black.
17
There are lots of things Dom conveniently didn't mention here. But anyone who expects "journalism" out of these guys is even more deluded than they are. That is all.
18
In order to understand impairment from thc, one must first understand about two very important words: tolerance and titration. Let's start with tolerance. In the medical field, we look at two main things:

"tolerance /tol·er·ance/ (tol´er-ans)
1. diminution of response to a stimulus after prolonged exposure.
2. the ability to endure unusually large doses of a poison or toxin."
http://medical-dictionary.thefreediction…)
What this means is that after being exposed to a medication over the course of time, you don't have effects as strong as when you first began to take said medication. It also means that over time one is able to take larger and larger doses, due to the decrease in effects.

Now we look at titration.
"titration (tītrā´shn),
n incremental increase in drug dosage to a level that provides the optimal therapeutic effect." (Taken from the same site as tolerance definition) What this means is that a patient is started on a small dose of medication and that dose is increased, either in amount or frequency or both, over time, so that the patient "tolerates" the dose without having a lot of problems with side effects.

Cannabis is one of those meds which can be titrated and to which tolerances can develop. What is important to understand about all of this is that you cannot measure impairment (which is a side effect of many medications) by taking blood from a patient who has developed a tolerance to these higher medication dosages. It just does not work using the science we know today. Different patients on different doses will have different tolerance and impairment levels, and a fair and logical standard cannot be set using a standard blood level. There is far too much variation in the levels of titrated patients who show a tolerance to cannabis and absolutely no impairment.

And that is what it says in every study NAW cites. And as a professional in the medical field, I am appalled that the science of cannabis would be completely ignored and Reefer Madness continues to rear it's ugly head. Perpetuating these fallacies when the science is quite clear is irresponsible at best. Using it to make criminals out of the innocent is disgusting. Using it to exchange one bad law for another is political diversion tactics, something most of us are really sick and tired of seeing.

I will not stop telling the truth until 502 is defeated!
19
Stoned drivers may drive slower, and not swerve but they still are a risk. They could lose focus, be too slow (unsafe), not pay attention to lights or signals, etc, etc...
I think stoned driver are safer than drunk drivers.. but they are still a risk. And not everyone is a competent stoned driver. We need traffic rules that cover the safety for EVERYONE.
To try and deny that just to justify your own pot smoking is fucking stupid.
I smoke pot and yes sometimes I drive while stoned too.
20
@14) I'd add that in my last post on I-502, despite your claims, I acknowledged the civil-liberty problems with per se cutoffs and then examined the best science I could find (also apparently the best science that the No on I-502 campaign can find). I also specifically asked for scientific data that proves the other side. That is, my most recent reporting on this subject contradicts your claims. But if you don't like it, don't read my blog posts.
21
Well, now I know that pot advocacy apparently impairs one's ability to argue on the internet.
22
Friends don't let friends drive stoned.

But posting on the Net? Sure!
23
My wish to see pot legalized as soon as possible is based entirely on my desire for potheads to shut the fuck up about pot already.
24
@16: On this issue, you are obviously in advocacy mode. Can you at least admit to that?

I'm not a kettle here. For the record, I don't yet know how I'm going to vote on this issue. If it appears that I'm taking sides, it's simply in reaction to your lopsided reporting.

And again, I think we'd all benefit from having a qualified scientist summarize the research on this subject. I read through New Approach Washington's summary of the research a few months ago (which I can no longer find on their web site), and left with the distinct impression that 5ng was arbitrarily chosen and very likely too low.

But if the science so clearly favors this initiative, you have only to gain by shining a light on it, right?
25
Dom, you fail as a journalist, (for obvious reasons)...
26
@18 This is also true for alcohol (tolerance and titration), and yet we have a legal limit for DUI for alcohol.

Fighting the DUI limitation on the pot initiative is just silly. It's common sense to put a limitation on there. Granted, the science isn't convincing to me either way, but legalize it, and I'm sure there will be plenty more studies to find out what a reasonable legal limit is. I'm thinking 5ng/mL sounds like a reasonable first stab based on the studies available.

I also love how people say they drive better stoned. Dummies. I don't care how you perceive your driving ability while stoned. You also think your conversation is scintillating, and let me tell you, it is not.
27
And the discussion goes on,The point this guy doesn't but should make is that,In order to pass,any legalization measure will have to appeal to a large segment of voters who don't/have never/will never smoke pot .they know nothing about Pot,and are not interested in learning.The DUI blood limit does that.When combined with the rules for probable cause it becomes(in my mind)a necessary evil.One that wont be used that often.
28
truly spoken by someone who does not smoke weed
29
PDF]
Cannabis, Cannabinoids and Driving
davidbearmanmd.com/docs/Cann&Driving.pdf
File Format: PDF/Adobe Acrobat - Quick View
safely. According to research by British scientists, a moderate amount of cannabis may actually improve driving performance. A group of 20 drivers aged 21-40 ...
You visited this page on 2/23/12.
Driving and Marijuana
www.iowatelecom.net/~sharkhaus/driving.h…
In fact, marijuana use may slightly improve driving performance, according to science. Two studies (one indexed below) have shown a negative correlation ...
You visited this page on 2/23/12.
Cannabis 'improves' driving, some users say | Stuff.co.nz
www.stuff.co.nz/national/.../Cannabis-im…...
Sep 22, 2009 – Two thirds of cannabis users say the drug does not affect their driving ability, while 16 percent say it improves it, according to a new survey.
[PDF]
Cannabis improves symptoms of ADHD
www.cannabis-med.org/english/journal/en_…
File Format: PDF/Adobe Acrobat - Quick View
by P Strohbeck-Kuehner - Cited by 2 - Related articles
Mar 2, 2008 – Keywords: ADHD, cannabis, performance, driving. This article can be ... were much improved under cannabis and that dronabi- nol (THC
30
......"marijuana use may slightly improve driving performance, according to science. Two studies (one indexed below) have shown a negative correlation"...
.
31
@29 Maybe we should REQUIRE people to smoke pot before they drive then! BRILLIANT!
32
@11 - "Instead, we are only just now talking about it, after the introduction of I-502"?

That's simply not true.

A per se DUI threshold for THC was introduced in the Washington State Legislature in January 2011 as HB 1648 -- five months before I-502 was filed. Colorado's first per se THC DUI bill was introduced in February 2011.

Fourteen other states have marijuana per se DUI statutes, the earliest of which was passed in 1983, the most recent of which was passed in 2007. Eleven of those statutes are zero tolerance, and half of those include inactive metabolites in addition to the active THC to which I-502 is limited.

The National Drug Control Strategy released in July 2011 by the Office of National Drug Control Policy identifies "encouraging states to adopt per se drug impairment laws" one of its top policy priorities.

This issue was not raised by I-502, and it is not going away for the foreseeable future.

@15, @18, @24 -- the science is in the "DUI Factsheet" that continues to be available here: http://www.newapproachwa.org/content/faq. If you examine the graph on Page 2, you'll see that the available science indicates that risk of accident does, in fact, go down in correspondence to active THC levels between 0 and 5 ng/mL in whole blood (this is the initial dip in the line). However, at 5 ng/mL, the risk surpasses that of sober drivers.

New Approach Washington wants to end marijuana prohibition. We want Washington voters to take a decisive step in that direction in 2012. To accomplish that goal, we know we must deal with the political landscape as it exists now. The 5 ng/mL active THC DUI threshold in I-502 is reasonable and supported by the available science. Moreover, I-502 dedicates funding for additional research on this issue.

Alison Holcomb
Campaign Director
New Approach Washington
33
Look up Rick Steves in Portugal talking about how 502 is just like their system. When they show them in the store looking at it, it's all open containers and loose. They got their fingers all over it and shit LOL They just sell it the same way you might by any type of herb. I502 is nothing like the model of Portugal.
34
@16 paraphrased: Sometimes I'm honest in the information I present; sometimes I don't disclose inconvenient facts that would tear giant holes in the side I'm supporting. You just have to guess which is which, and trust me.

Yeah, right.
35
If you purposefully drive while stoned, you are a selfish fuck and I have no sympathy for you for whatever happens to you when you get caught.

If you think you drive better when stoned, you are also a self-deluded selfish fuck.

Grow up. The adults are trying to make the world a better place by ending one of the most pointless and destructive policies of the last century. A DUI provision is politically unavoidable. It's the price of admission. And it really isn't that high, all things considered.

36
prescription opiates are legal, and we don't have a fluid based dui test for them.
37
Blah blah blah, I'm still going to vote no on your piece-of-shit "legalization" scheme.
38
@4: If you're looking for scientific support, use http://scholar.google.com rather than http://www.google.com
@21: Ba-ZING!

Seriously, this thread is dildos.
39
Please consider the following which was my speech in Olympia to educate to Senate judiciary committee in Olympia about 6 weeks ago. In a subsequent post I will address more specifically the scientific studies that Mr. Holden is misrepresenting.

Here's the testimony:

January 18, 2012
Dear Distinguished Ladies and Gentlemen,
I am a board certified, residency trained emergency trauma physician with three decades of experience in acute care and I am also a patient advocate for medical cannabis patients. I am a certified medical review officer (MRO) and substance abuse testing in the workplace is a large portion of my current occupational medicine practice. My company sets up work place drug testing policies for private companies in efforts to address impairment on the job and manages those programs.
A couple of months ago I was on a panel with other professionals discussing legislative and legal issues that impact medical cannabis patients. The issue of the per se DUI provision came up and I explained to the medical cannabis patients present that it is my fear that if they medicate with cannabis at least twice daily that they would probably be unable to drive legally in Washington state because their active THC level would likely never fall below 5 ng/ml.
I went on to explain that it behooves patients to know if, indeed, their level of active THC exceeds this 5 ng/ml level throughout the day at their usual usage. It was my suggestion that if they really wanted to get a clue as to where their levels were through the day that they actually get tested early in the morning before medicating and then follow the active THC level with serial blood draws throughout the day. I also suggested that because impairment was the issue behind this 5 ng cutoff that they undergo concurrent sobriety testing with each blood level taken.
It wasn't long before doctor-approved medical cannabis patients were calling my office in Federal Way and asking to have their active THC levels tested. Over the past 8 weeks we have done over $5000 on in testing at a NIDA certified lab in St. Paul, MN. In addition to just drawing the patients' active THC levels I included in each patient's evaluation not only the standardized Washington State DUI Arrest Report Sobriety Tests but also a full battery of neuro-cognitive medical tests including reflex and reaction time testing.

When the lab results came back we were all astonished. Our worst fears were confirmed.
We found many regular users of medical cannabis never have levels that fall below 10 or 20 ng/ml even after a night's abstinence. Levels after medicating were generally around 40 to 70 ng and one patient topped out at 147 ng! I’ve made a graph of her levels; it’s the first in your packet. Despite her active THC level being nearly 30 times the 5 ng cut-off, she was perfectly fine to drive. BUT Unfortunately, she’d be breaking the law 24/7 if per se legislation remains unchecked and she’d be accused of a crime she did not do.
If you flip over to the second chart you’ll see a patient that abstained from cannabis for 48 hours still had levels just under 5 ng/ml. No impairment was present the whole time. The implications here for a zero tolerance policy are clear. IT’S WRONG. All the medical cannabis patients tested easily passed the standardized Washington DUI Sobriety Tests with flying colors regardless their active THC levels. They also did fine on the other tests including reaction time; a summary of those tests is on the next page.
My patients and I were profoundly shocked at the implications of these tests and that's when I turned to the medical literature to find out if other researchers had similar finding in regular users of cannabis.

Indeed, the recent literature mirrors our finding and the next slides are summaries of those recent, science based legitimate studies.

The first study is outlined is from the Forensic Institute of Toxicology in 2008, (S.W.Tonnes). I’ve provided the abstract and the summary is on the following page. The take home message is that regular users of cannabis have levels exceeding 5 ng/ml for days after their ceasing its use. In their official abstract the authors conclude,
"FROM THE RESULTS, IT MUST BE CAUTIONED THAT WHOLE BLOOD CANNABINOID CONCENTRATIONS FROM HEAVY USERS....MAY BE DIFFICULT TO DISTINGUISH FROM CONNCENTRATIONS MEASURED AFTER ACUTE CANNABIS USE."

The second study, abstract is seen below, not only confirms the first but even cautions us all right now, cautions this very committee, they are almost calling you out by name ladies and gentlemen, to consider these scientific findings when dealing with per se limits.
This is the Karschner study of 2008 and because it's most often misquoted, I'll let the authors again speak for themselves, as seen in their official abstract:
Purpose: to qualify delta-9 THC in regular cannabis users greater than 7 days of continuous monitored abstinence.
Of 25 participants, 9 had no active THC at day 7. HOWEVER, ON DAY 7, SIX DAYS AFTER ENTERING THE UNIT, SIX PARTICIPANTS STILL DISPLAYED DETECTABLE THC CONCENTRATIONS.
CONCLUSION:" SUBSTANTIAL WHOLE BLOOD CONCENTRATIONS PERSISTS MULTIBLE DAYS AFTER DISCONTINUATION IN REGULAR CANNABIS USERS."
Karschner conlcudes his abstract wtih this warning,"These findings may impact the implication of per se testing in driving under the influence of drug legislation."

The third study published in 2010 in the peer reviewed journal Psychopharmacology confirms and explains how regular users of cannabis accommodate and acclimate to the side effects and have no impairment. The last study is from the American Academy of Addiction Psychiatry. It explains how this accommodation even leads to safer driving.

In summary I strongly believe that impairment testing for active THC needs to be correlated with road-side sobriety tests and not based solely on a number with absolutely no scientific basis.

The people of Washington demand science based laws and I trust you will carefully consider the current science that indicates that per se testing for impairment from active THC will wrongly convict innocent citizens of a crime that they did not do.

But there's a bigger issue at stake that reaches far away from Olympia. It's my hopes that this committee sends a resounding message all the way to the White House in Washington DC and other states considering per se legislation that their lead on this issue of per se DUI testing for drugs is scientifically, morally and ethically as wrong as it can possibly be. Washington State set this nation on the right track by taking on alcohol prohibition nearly a century ago. You, ladies and gentlemen, can do the same thing today with cannabis prohibition by critically examining these flawed per se DUI laws.

Respectfully,
Gil Mobley, MD
Fellow, American College of Emergency Physicians
Diplomate, American Board of Emergency Medicine
Certified, Medical Review Officer
40
7 has it exactly right. I hope we can all agree that there is a level at which it is unsafe to drive stoned. Hell, there's a level at which I can barely walk straight, much less drive. So, at this point it should simply be a matter of identifying what the correct limit is.

Correct me if I'm wrong here but it sounds like the folks against this law are saying there should be no limit and I guarantee you that a law that legalizes pot without any DUI provision will never pass, or at best it will pass followed by the legislature passing a DUI provision themselves. Now you may be right that 5ng is too low but a workable counter-argument is to suggest a different limit (10ng? 15ng?) not to suggest there should be no limit. That will get you nowhere.

@11, I don't see anywhere in that law what the limit for driving under the influence of drugs is. Is it 0ng? 1ng? 2ng? Seems open to interpretation by the prosecutor.

@13, this law does distinguish between active THC and inactive. If you'd been reading SLOG recently you would have seen that the primary study being cited showed the extremely heavy users studied showed virtually no active THC in their blood the day after the study began.

To everyone who says they drive better when stoned, and this is coming from someone who drives stoned often enough to know, you may drive more carefully while stoned and you may have less road rage (really dude, get that shit under control in general) but your reaction time to emergencies is absolutely reduced. You may be fine stoned 99% of the time but that 1% of the time when someone comes out of your blind spot suddenly and you don't react quickly enough someone's going to get hurt.
41
Mr. Holden you say you're following the science.

Then if you are completely serious about this, please respond to this research. It clearly shows how innocent people could be affected by the initiative. Thank you very much for your time:

Emphasized:

"Finally, serum THC concentrations as high as 7 ng/mL
can result from passive exposure to cannabis smoke or from consumption by regular cannabis users
as much as 24–48 hours prior to a test."

Full paragraph:

Serum THC concentrations as high as 12–13 ng/mL
can be produced by the lowest effective THC dose of 2 mg and by higher doses even 2–3 hours after
smoking, i.e., when impairment has subsided. Finally, serum THC concentrations as high as 7 ng/mL
can result from passive exposure to cannabis smoke or from consumption by regular cannabis users
as much as 24–48 hours prior to a test. Figure 8 confirms the notion that a THC concentration in
serum below 7–10 ng/mL (about 3.5–5 ng/mL whole blood) is too low to indicate an elevated
accident risk. THC concentrations as high as 7 ng/mL are found in persons who smoked more than
3–4 hours ago and are not associated with impairment of driving-related skills. Such concentrations
are also found in persons who were exposed to second hand cannabis smoke.

Source:

Developing Science-Based Per Se Limits
for Driving under the Influence of Cannabis (DUIC)
Findings and Recommendations by an Expert Panel

http://www.canorml.org/healthfacts/DUICr…
42
@39 Dr Gill, thank you for the information but you still have to accept that there is a point at which someone is too high to drive. I'm sure that just like alcohol that level is different from person to person but we have to set some limit just as we have with alcohol. As a Dr who has clearly studied this can you suggest a limit that would be appropriate?
43
Dr. Mobley--

Thank you for the information.

Regarding your study: I hope you write this up and submit it for publication. It is a potentially important contribution to this discussion. I do agree that a more robust data set correlating blood THC levels to testable impairment is needed.

Regarding the Tonnes study you cite--is this published somewhere? I cannot seem to find it on Pubmed. I can't find the "Forensic Institute of Toxicology" either. What/where is this institute?

Regarding the Karschner study, the abstract of which you quote: if you look at the actual data (i.e., numbers, in Table 2) in the paper, the "substantial" THC levels referred to are, with exactly one exception (a single subject on day 1), below 5.0 ng/ml.

I also think you are being a bit disingenuous in your characterization of the last sentence of the abstract as a "warning". The last paragraph of the paper in full reads:

"In summary, we found highly variable, but often substantial whole blood THC concentrations in chronic cannabis users for many days after last drug exposure. These findings may be relevant for legislation employing THC concentrations to define intoxication and accident culpability. The findings also raise the intriguing possibility that cannabis-associated cognitive and motor impairment, demonstrated in some individuals for many days after last cannabis exposure [16, 17, 42–44], may be related to the persistence of THC in the blood and by implication, in the brain [45]. [emphasis added] If so, our findings suggest that residual neurocognitive impairment after days of abstinence might be quite variable among individuals, depending on the persistence and magnitude of THC in an individual’s brain. These data suggest a potential mechanism for cognitive impairment after chronic cannabis use and provide data for evidence-based policy decisions on DUID. In subsequent studies, it will be invaluable to assess the association between neuropsychological performance and simultaneous blood THC concentrations. If neurocognitive impairment is documented after at least seven days of abstinence, the implementation of per se impairment limits may be valid." [emphasis added]

44
@ 41) Blood plasma levels of THC are roughly twice as high as whole blood levels. In other words, 7 ng/mL of plasma equals 3.5 ng/mL in whole blood.

That's below the 5ng/mL cutoff described in I-502.
45
This is @ 41

Mr. Holden I have a few more things to point out based around the science that has been performed.

First of all, please provide us with the science behind this concept of whole blood being twice as high as serum and where I-502 clearly differentiates between the two.

Now let's just assume for this discussion that your above claim is correct (still would prefer to see the proof).

Then if so, are you absolutely confident that even with what would be a whole blood reading of 3.5 ng/ml amount 24 - 48 hours after second hand exposure, that it would be impossible for a cannabis consumer sober enough to drive to have a whole blood reading above 5 ng/ml from exposure within the previous twelve hours?

Also did you read the rest of the report? There were many other troubling indicators based upon this notion of a 5 ng/ml amount being the reason for an automatic DUI. Oral consumption as opposed to smoking (which is much better for health) further complicates the issue as ng / ml amounts can still be significant 24 hours after consumption.

Will average people be expected to purchase expensive personal testing equipment to not have to worry about potential DUI's? Or plan out cannabis consumption versus driving schedules days prior to planned events just to be completely safe? An automatic DUI is a very serious charge and can have life long ramifications.

Just would like voters to be informed as much as possible before voting on this issue.

Thanks again for your time responding to these matters.
46
@43 I love you.
47
If listening to the concerns of the voters while acknowledging that the science out there is immature at best is "pandering," then I'm proud to pander. However, I honestly believe commonsense is a better word for it.
48

@45: You said "please provide us with the science behind this concept of whole blood being twice as high as serum and where I-502 clearly differentiates between the two." Sure thing. Grotenhermen, et al, which is a study cited by Patients Against I-502, explains that blood concentrations are half the serum concentrations:

Blood serum is the clear liquid that separates out when blood is allowed to clot completely. Serum is blood plasma after removal of fibrinogen by clotting. THC concentrations measured in serum and plasma of a given sample are virtually identical and are typically 1.6-2.2 times higher than those measured in whole blood (Giroud et al. 2001). For example, 5 ng/mL of THC in whole blood corresponds to 8-11 ng/mL in serum or plasma. For simplicity, this report will use a factor of 2 to convert whole blood THC concentrations into serum concentrations... To obtain THC concentrations in serum, multiply by 2.


The text of I-502 is clear that the measure concerns whole blood, not serum:

"THC concentration" means nanograms of delta-9 tetrahydrocannabinol per milliliter of a person's whole blood.

49
@43 Bleedingheartlibertarian

Thanks for the reply. Great points.

We are submitting my study for publishing and that takes a year at least. Thanks for your encouraging words!

Karschner's concluding point about impairment may lasting more than 7 days along with residual THC levels is solely a hint for further investigation. He is actually implying that without impairment documented at 7 days out per se testing is invalid.

And that's what this patient population in Seattle set out to do when they requested my help.

Again, my recent studies on patient approved medical cannabis patients showed that they had normal sobriety tests (The WA State Patrol Roadside DUI Sobriety Tests) and normal if not at times FASTER reflex testing after "medicating" let alone hours and days following.

In all my experience, I've not seen even one patient or regular, experienced cannabis user ever fail the standard sobriety tests or reflex reaction time testing despite how high their post-medicating blood levels are.

Regarding your request for additional info in the scientific literature:

There are fees to download these articles, I believe, as I had to get them from my medical staff library at the hospital where I'm on staff. I could share my own personal copies but want to drop them off for Mr. Holden to review first.

Comparison of Cannabinoid Pharmacokinetic Properties of Occasional and Heavy Users of Smoking a Marijuana and Placebo Joint. Institute of Forensic Toxicology.
Stefan W. Toennes
Journal of Analytical Toxicology, Vol 32 September 2008

Please contact me at drgilmobley@gmail.com if you have difficulties getting this article. I can arrange getting you a copy if I have our hospital med-staff library pay the additional costs.

I hope that helps!

Respectfully,

Gil Mobley, MD
50
Really, Dom? So now you are smarter than the doctors doing the research?

44 is not even an argument, it's grasping at straws that aren't even there.
51
@50) Hi, Mimi. You're right: It's not an argument. It's a statement of fact that blood plasma levels of THC are roughly twice as high as whole blood levels.

If you believe that fact is false (even though I've cited a scientific study in my comment @48 as the source), I'd be happy to hear your argument.
52
@39 Root

"Can I suggest a level in which it is too high to drive?"

Well, no. Please recall that impairment is a physical finding, not a number.
And the government knows this and has carefully crafted their drug screening policies over the years in full recognition of this principle.

Let me give an example:

As a Medical Review Officer I interpret thousands of drug screens a year for over-the-road (OTR) drivers for such companies as UPS, FedEx and Walmart. There are certain prohibited drugs that drivers can't have in their system and if they show up in the urine then they've got some explanation to do.

But if, in that explanation, they offer a valid script for morphine, amphetamine (from ADHD or diet medications) or even THC (form Marinol), then it really does not matter what their blood level is because of the physiolocial tolerance that all medicines produce. Anyone crafting drug testing policy knows that there is no scientific way to correlate impairment with a single number no matter what the drug is.

In other words, if on a random DOT drug test, the driver has an extraordinary high THC, meth or morphine level in his urine, it's not at all an issue if they have a valid script for Marinol, ADHD or diet meds or various pain meds, respectively. The Feds (The Federal Motor Carriier'Highway Safety Administration) tell me to allow those drivers to climb right back up in the cab and drive. Their emphasis instead, is on indentifying clinical impairment with findings that would then set reasonable suspicion testing. Then, if they have the physical findings of impairment along with the elevated levels, they are nailed and removed from the road until undergoing rehab.

I hope that helps. (I sure wish those crafting I-502 understood these scientific principles that, once we've educated the public, will ultimately doom the initiative.)

Respectfully,

Gil Mobley, MD

53
@49--Thanks! I actually have access to that journal (I'm a pharmacologist.) I think I couldn't find it on Pubmed because I was searching for "Tonnes" instead of "Toennes".

Looking at their data set... again, their cohort of heavy users do have residual THC concentrations that are higher than those of occasional users, and certainly measurable. However, the mean *serum* (not whole blood) concentration of this group hits 5 ng/ml (meaning 2-3 ng/ml whole blood) around 3 hours after smoking (Figure 1). This certainly leaves open the possibility that there are some individuals over the legal limit at that time point...individual serum concentrations of THC at 8 hours after smoking are tabulated, and the highest one in the group is 10.7 ng/ml in serum...in other words, right at the proposed legal limit. The rest are lower. So, I remain unconvinced that the published literature really give us much cause for worry that many people will test over the proposed legal limit, except shortly after smoking (or otherwise imbibing.)

That said, both of these studies deal exclusively with the PK data, and not with impairment. And it sounds like the PK data you're describing indicates that your patients have much higher and more persistent THC levels than the cohorts in those studies (more potent medical grade cannabis, perhaps?) So, I'll look forward to reading your paper. Best of luck with it!

54
"is my fear that if they medicate with cannabis at least twice daily that they would probably be unable to drive legally in Washington state because their active THC level would likely never fall below 5 ng/ml."

Please explain how this is a problem. If they are constantly medicating they should either not be on the road.
55
I'm with @54. The anti-502 crowd can dig up all of the data that supports driving while baked, and explain how awesome you drive after 3 bong hits, uh-huh, but modern society just won't allow you to drive stoned -- medical allowances for the intoxicant or not. This is how it is, people. It is incredible that marijuana activists are actually trying to lower the bar for stoned driving below that which is set for cough syrup, but hey - knock yourselves out. You guys are a fringe group anyways, and cooler heads will prevail in November. Legalize it!
56
@52, Dr Gill,
"Well, no. Please recall that impairment is a physical finding, not a number.
And the government knows this and has carefully crafted their drug screening policies over the years in full recognition of this principle."

Again, thank you for your response and the additional info. I agree that impairment is a physical finding and not a number but let's take alcohol for an example. I understand it's different since alcohol isn't typically a drug prescribed by a Dr but it's the only example I'm aware of that we test for roadside for DUI.

Long term alcoholics can pass the roadside DUI tests (walk a straight line, touch your nose, etc) yet be well beyond the legal limit for driving and be too impaired to safely drive. Pot users can also perform simple tasks while still being unable to do complex ones requiring quick reflexes like driving. Determining a DUI conviction solely based on the dance routine the cops put you through on the side of the road is an unreliable way of determining a conviction as the cop may be biased or simply bad at his job. That's why we have breathalyzers. Personally I think the levels we've determined for DUI are unnecessarily low but we clearly have to have some objective roadside test to determine whether someone's too intoxicated to drive. Some people may be able to drive safely above that limit while some would be too drunk well below it but there has to be some objective test with a real legal limit.

Same goes for pot, and again I say this as someone who enjoys pot and drives after smoking sometimes, that we need some objective limit so we're not leaving DUI conviction solely based on a cops roadside opinion. Now 5ng may be far too low but without some objective measure we're left in a situation where you might be in court defending your DUI charges based on the cop saying "he stumbled on the walk a straight line test" when you're totally sober but just a little clumsy.

In the end, there is no way pot will be legalized without some objective test with legally set limits for DUI so we can either work to find a level that's realistic or we can kiss our dream of ending prohibition goodbye.
57
"In other words, if on a random DOT drug test, the driver has an extraordinary high THC, meth or morphine level in his urine, it's not at all an issue if they have a valid script for Marinol, ADHD or diet meds or various pain meds, respectively."

You're saying that there's never any DWI cases for people with medical scripts?

If someone is pulled over for impairment and nobody is injured, even if the person is visibly swerving on the road or driving in an erratic manner (let's say slowly, on the shoulder), what happens?
58
@55: Right. If they give a damn about changing opinions, they had better offer a functional alternative for the system in place. Without that, their sincerity-level and my concern for their opinion drops. "It's too hard/impossible" is a good way to get everyone to consider you unconcerned and irresponsible.
59
@57. If he is saying that, then he is wrong according to WA state.

"Driving under the influence (DUI) refers to operating a motor vehicle while affected by alcohol, drugs, or both. This applies to both legal and illegal drugs, including prescription medication and over-the-counter drugs. ... How is DUI determined? A driver may be charged with DUI if: ... He or she is found to be driving a vehicle under the influence or affected by alcohol, any drug, or a combination of alcohol and drugs, regardless of the concentration of alcohol in their breath or blood."

http://www.dol.wa.gov/driverslicense/dui…

So I can't really take Dr. Mobley seriously. If his patients are pulled over now, they can get charged with DUI if there is sufficient reason to believe they are impaired-- whether they have a script or not. He's not protecting anyone by railing against the 5ng/ml proposed limit.

60
@59: Oh, I know this is likely the case. But, I want to hear a direct response to the question.

Because it seems like the shills and other people who work in this industry are outright lying about the policies currently in place.
61
Folks,
I am quoting Feredal Law, as mentioned above. CFR part 40 to be specific.
The Feds with their years of financing attorneys to look at drug testing issues
understand impairment is a physical finding and not a number.
Good points though.
Thanks.
62
@32, but per se impairment standards for alcohol are becoming increasingly ineffective as a prosecutorial tool. The .08 "limit" is one factor in the legal determination of impaired driving; however, because the breath test is often ruled inadmissible -- due largely to our brilliant legislature's inability to write good law when there is any kind of science involved -- deputy prosecutors in KC usually assume that they will have to make their case based on other evidence (i.e., FSTs, observed driving behavior, statements of the defendent, etc.). And juries often do convict even without a specific blood-alcohol number.

No, we already have a perfectly adequate statute that covers not only alcohol, but also marijuana, prescription drugs, and even over-the-counter cold medicine.

Oh yeah, and driving while baked is pretty stupid.
63
@61: "I am quoting Feredal Law, as mentioned above. CFR part 40 to be specific. The Feds with their years of financing attorneys to look at drug testing issues understand impairment is a physical finding and not a number."

Right, but this is not going to affect Federal law.

How is this currently put into place on a STATE level?

"No, we already have a perfectly adequate statute that covers not only alcohol, but also marijuana, prescription drugs, and even over-the-counter cold medicine."

It is not "perfectly adequate", nor will it be once marijuana becomes available for sale to the masses.

If we need better science, we need better science. Your inertia in claiming that there IS no problem is not fixing the "problems".
64
Her point that "This issue was not raised by I-502, and it is not going away for the foreseeable future." is absolutely true.

I definitely concede that this is an imperfect solution, as is the BAC level, but hand-wringing and claiming some sort of impossibility (rather than attempting to get as close to accuracy as possible) is an absolute enemy of legalization.
65
@62 uar:

It is not "perfectly adequate", nor will it be once marijuana becomes available for sale to the masses.


How is it not adequate? Are there no convictions for DUI involving marijuana right now?

In fact, drivers are regularly stopped, cited and convicted for operating a motor vehicle while under the influence of pot and all sorts of other legal and illegal intoxicants besides alcohol. There has been no credible evidence put forward by the backers of a per se THC limit that it will aid in reducing the number of pot-addled drivers or improving the safety of our roads.

I definitely concede that this is an imperfect solution, as is the BAC level, but hand-wringing and claiming some sort of impossibility (rather than attempting to get as close to accuracy as possible) is an absolute enemy of legalization.


Again, the legislature and the state crime lab have shown themselves to be incapable of writing a statute and supporting regs to have a testing regime that works. From a purely functional standpoint, BAC tests are very nearly worthless in DUI prosecution in most of this state. Because there is little current scientific consensus about the benchmarks and testing procedures for THC levels, I can guarantee that the only constituency who will really benefit from I-502 will be the DUI defense bar.

So let's, at minimum, be intellectual honest here. I-502 is a politically-motivated knee-jerk reaction that is aimed at consolidating votes in the legislature and making the public feel good. It is not about solving an actual criminal justice issue in a rational way.
66
@65: "Again, the legislature and the state crime lab have shown themselves to be incapable of writing a statute and supporting regs to have a testing regime that works. "

My point is that saying "this is not a good regime" is not a substitute for a working regime, and being evasive about that is no substitute for good science. I'm sympathetic to claims that this is inaccurate. I want better options.
67
uar@66: It's a regime that a broad swath of stakeholders think is broken: the legislature, law-enforcement, prosecutors, MADD. Yet it's been in place since 1985. Even the debate over replacing the DataMaster has been going on for 15 years.

So fine, if the science can demonstrate that there is a level of THC that constitutes impairment beyond a reasonable doubt, and the legislature can manage to write a law that is better than RCW 46.61.506, then by all means have a THC limit. But putting something into law now is extremely premature. I have no problem making stupid and dangerous the enemy of the good.

BTW, my interests in this don't lie in the dueling pro- or anti-I-502 factions, or with the anti-legalization groups. For a variety of good public policy reasons, I believe marijuana should be legal. I also don't believe that anyone should drive while intoxicated on anything, be it weed, booze or Robitussin.

My interests are that: 1) the WA state legislature stops passing bad law based on narrow political interests, stupidity and fear, and 2) the criminal justice system is given the tools to maintain public safety without undue infringement of individual rights.

And FWIW, I'm married to a criminal prosecutor.
68
In comment number 32, Alison Holcomb suggests that per se DUI for THC is reasonable because legislation has been introduced in the past.

What she FAILS to mention (or purposely omits) is that HB 1648, introduced by Rep. Roger Goodman, was also WITHDRAWN from consideration by the prime sponsor himself. Why is that? It turns out that after several YEARS of discussing the issue, a workgroup could not go forward with a recommendation for a per se DUI level for THC. Why? Because science DOES NOT SUPPORT setting such a level.

The EXACT same thing happened in Colorado in February of last year. A workgroup REJECTED the idea completely after learning that blood levels of THC cannot be consistently correlated to impairment. The findings of the workgroup are public information and can be found here: http://norml.org/pdf_files/MMIG_Workgrou…

Unfortunately, the efforts in Colorado were immediately renewed upon learning about the "legalization activists" in Washington who mistakenly support what NORML calls an "arbitrary, unnecessary and unscientific" proposal.

As for the fourteen other states that have marijuana per se DUI statutes, let's talk about how many of those states permit any legal use of marijuana. The answer: TWO. Two out of the fourteen states that permit these "arbitrary, unnecessary and unscientific" limits permit cannabis use for medicinal purposes. What do these states offer to keep these two different laws from competing with each other? An EXEMPTION for those who are legally permitted to use cannabis. It only took ONE SENTENCE to protect this vulnerable population. ONE SENTENCE that requires "actual proof of impairment" for legal cannabis users. Was it really that difficult for New Approach Washington to include this ONE SENTENCE in its 66 pages of legislation, in order to protect unimpaired drivers? Apparently so. As a result, the cannabis community has been deeply divided and NAW has only furthered this division by pitting recreational users against patients.

All of the factsheets in the world do not change the simple concept which NORML has laid out so clearly. I-502's DUIC provision is "arbitrary, unnecessary and unscientific." If the 5 ng/mL active THC DUI threshold in I-502 is "reasonable and supported by the available science," why has NORML continually called this law unscientific, arbitrary and unnecessary, even going so far as to say, "there's a new front in the war on drugs and its name is DUID." Please read NORML's objective review of the data here:
http://norml.org/library/item/you-are-go…
and here: http://norml.org/library/item/cannabis-a…

We do, however, appreciate NAW having the guts to admit that they are working alongside the Office of National Drug Control Policy, by putting a per se drug impairment law into place on their behalf.
69
@68: "A committee couldn't decide what limit to set" ≠ "science is against setting a limit"
You keep banging on about NORML calling the limit mean things, but you're not really laying out much of an argument against it. And NORML is not objective about cannabis. They have a cannabis-related agenda; they inherently have some amount of bias. Try quoting someone other than them, you twit.
Man, you couldn't pour water out of a boot with instructions on the heel.
70
How does Colorado deal with drivers drowsy on antihistamines? Drivers shouting on the phone to their exes? Drivers with three kids screaming in the back?

I've ridden with all of those, and I prefer riding with a stoned driver.

Silvio Levy
71
And you keep bringing up NORML without mentioning that our board unanimously endorsed I-502.

The reason? We're able to see the big picture.

Per se DUID? Bad.

Prohibition? Abomination.
72
Exchanging one freedom by destroying the rights of another is also very wrong. To do that to a population that can do little to defend itself is morally corrupt. To intentionally incriminate the sick, disabled and dying so others can have a good time legally is the most heinous of crimes itself. To ask the disabled to give up a privilege that provides them with just a fraction of the freedoms of the healthy, so that healthy people can enjoy even more freedoms–what kind of demented hypocrisy is that?
73
@72: "To do that to a population that can do little to defend itself is morally corrupt. "

Driving and self-medicating is a privilege, not a right. I care more about the innocent non-medical tokers than I do the unlimited ability to smoke up and get behind the wheel.

If you think you're getting anywhere by calling us "morally corrupt", you're going to get steamrollered over and over again.
74
Sobriety tests. If you can say your ABC's backwards, touch your nose and hop on one foot in a counterclockwise circle around the officer while you're stoned, who cares how much THC is in your blood? I have been smoking every day for a few years now. When I first started smoking, you couldn't have given me a million bucks to get behind the wheel stoned. As I became more accustomed to the effects of marijuana, the physical reaction does not negatively effect my driving skills. It relaxes me, suppresses any road rage I may feel, and helps me keep my speed down (I'm normally a bit of a leadfoot when I'm not stoned).

I believe traffic accidents would be greatly reduced if marijuana was legalized based on the sheer number of law abiding citizens who would gladly trade their beer for a joint if it didn't mean risking a trip to jail.

Marijuana is more widely accepted by American citizens. Alcohol consumption goes down. Alcohol related accidents go down.
75
Sobriety tests. If you can say your ABC's backwards, touch your nose and hop on one foot in a counterclockwise circle around the officer while you're stoned, who cares how much THC is in your blood? I have been smoking every day for a few years now. When I first started smoking, you couldn't have given me a million bucks to get behind the wheel stoned. As I became more accustomed to the effects of marijuana, the physical reaction does not negatively effect my driving skills. It relaxes me, suppresses any road rage I may feel, and helps me keep my speed down (I'm normally a bit of a leadfoot when I'm not stoned).

I believe traffic accidents would be greatly reduced if marijuana was legalized based on the sheer number of law abiding citizens who would gladly trade their beer for a joint if it didn't mean risking a trip to jail.

Marijuana is more widely accepted by American citizens. Alcohol consumption goes down. Alcohol related accidents go down.
76
I am currently prescribed Methadone for pain. In order to get my medication, I had to sign a "pain agreement" in which I agreed to not take any drugs that were not prescribed, or have any drugs prescribed by anyone other than my Primary Care Provider. I was tested through a urinalysis after not smoking any pot for 26 days. My reading was "positive ( >=50 NG/ML)". If I'm OVER 50 NG/ML after 26 days, how am I supposed to get below 5NG/ML without at least 45 days of non-use? I'm with Dr. Gil on this one........ NO on I-502!!!
77
I believe that hypocritical stoners like Roger Goodman should not drive their kids around while high. Is there a law we can pass that will target this behavior?
http://www.kirklandreporter.com/news/194…
http://www.wsrp.org/media/icymi/icymi-go…

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