Driving under the influence of cannabis, alcohol, and illicit drugs among adults in the United States from 2016 to 2020

Motor vehicle crashes (MVC) are a leading cause of death and injury in the United States (US) and are especially prominent in early adulthood when substance use is most prevalent (Merikangas and McClair, 2012, Xu, 2019). Driving under the influence of cannabis, alcohol, and/or other drugs impairs driving abilities and increases MVC risk (Asbridge et al., 2012, Elvik, 2013, National Center for Statistics and Analysis., 2014). Substance use is a common contributing factor in fatal MVCs; national data indicate that alcohol, cannabis, and opioids were present in 36%, 38%, and 16% of fatally-injured drivers drug tested in 2016, respectively (Association, 2018). Moreover, the prevalence of MVC deaths involving cannabis tripled from 1999 to 2010 (Brady & Li, 2014). National roadside surveys measuring alcohol and other drug use from 2007 to 2013 found a 33.1% decrease in the prevalence of alcohol-impaired drivers (12.4–8.3%) and a 48.0% increase in the prevalence of cannabis-positive drivers (8.6–12.6%). In these data, the prevalence of illegal drug-positive (including cannabis) drivers increased by 21.8% (12.4–15.1%) and medication-positive (i.e., prescription, over-the-counter) drivers increased by 25.6% (3.9–4.9%) (Berning, Compton, & Wochinger, 2015). National surveys from 1991 to 2013 and 2002 to 2014 (Azofeifa et al., 2015, Fink et al., 2020) show declining trends in self-reported driving under the influence of alcohol (DUIA). However, National Survey on Drug Use and Health (NSDUH) data from 2002 to 2014 showed a non-significant change in the prevalence of driving under the influence of cannabis (DUIC) (Azofeifa et al., 2015). Nationally representative data regarding trends in driving under the influence of drugs other than cannabis (DUID) is lacking.

Changes in the sociopolitical environment surrounding substance use, particularly policies increasing cannabis access, have implications for impaired driving. For example, states with legal medical cannabis have shown greater increases in self-reported DUIC and MVC compared to states without such laws (Berning et al., 2015, Farmer et al., 2022). As of September 2022, medical and recreational cannabis is permitted in 38 and 22 states and territories, respectively, (Conference, 2022). In recent years, risk perceptions related to consuming cannabis, cocaine, and alcohol among US citizens declined (Center for Behavioral Health Statistics and Quality, 2021). Lower perceived risk of substance use is associated with greater use and may influence consequent driving under the influence (DUI) behaviors, further emphasizing the need to monitor this behavior (Han, Funk-White, Ko, Al-Rousan, & Palamar, 2021). As social and policy climates surrounding substance use continue changing, informed policies promoting safe driving rely on accurate and current data. Thus, the purpose of the current study is to use nationally representative data to estimate and describe trends of recent DUIA, DUIC, DUID, and any DUI among adults in the US.

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