1. Driving While High: Facts and Public Attitudes
New England Cannabis Convention
Boston, Massachusetts March 24, 2018
James Lynch, FCAS MAAA, Chief Actuary
Insurance Information Institute  110 William Street  New York, NY Tel:  

2. What is the Insurance Information Institute?
Improving public understanding of insurance...
…what it does and how it works 2

3. Who We Are and What We Do
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We Are…
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The go-to source for credible and unbiased insurance information for the media, the industry and consumers.
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4. Insurance Industry Snapshot: By the Numbers
2.5 million
People in the U.S. employed, in a wide variety of careers, from human resource administrators to public relations managers to financial analysts
$5.8 trillion
Assets under management at year-end 2016, including $1.5 trillion for the property/ casualty sector and $3.7 trillion for the life sector
$508 billion
Contributed to the U.S. gross domestic product in 2016, roughly 2.7% of the whole
$40.0 billion
Federal and foreign income taxes paid in 2016, plus U.S. premium taxes paid
Source: A Firm Foundation, Insurance Information Institute.

5. Today’s Talk Public attitudes toward legalization
Research about cannabis use and driving
Public attitudes toward cannabis use and driving

6. Public Attitudes Toward Legalization

7. “Do You Think the Use of Marijuana Should Be Made Legal, Or Not?”
12/01/09 - 9pm
Support for Legalization Grows
% Saying Yes
“Do You Think the Use of Marijuana Should Be Made Legal, Or Not?”
No survey in years where no data appears.
SOURCES: Gallup Poll Social Series,

8. “Do You Think the Use of Marijuana Should Be Made Legal, Or Not?”
12/01/09 - 9pm
Support for Legalization Grows
% Saying Yes
“Do You Think the Use of Marijuana Should Be Made Legal, Or Not?”
SOURCES: Gallup Poll Social Series,

9. Congressional Cannabis Caucus
Cannabis in the USA
Legalization is Accelerating
Congressional Cannabis Caucus
Rohrbacher (CA)
Bluemenauer (OR)
Young (AK)
Polis (CO)
There were 9 referenda on marijuana legalization. Only one failed – recreational use in Arizona.
Six states require use of medical marijuana in WC claims – CT, ME, MA, MN, NJ, NM
Six states forbid use of medical marijuana in WC claims – AZ, CO, MI, MT, OR, VT
It is illegal to use the banking system to purchase marijuana. So an insurer can’t write a check against to pay for the drug. They use cash.
Trump OK with med mare. Sessions, not so much. We wind up with one more conflict, Trump vs. his Cabinet.
SOURCE: National Journal.

10. Driving While High – the Legal Framework
Illegal Everywhere, but What Makes You High?
● Under the Influence ● Per Se ● Incapacitated
Increasing use of DREs (Drug Recognition Experts) – something like in US (certified by International Association of Chiefs of Police)
Per se DUID makes it an offense for a driver to have marijuana in their body while operating a motor vehicle.
Under the influence DUID standard requires the driver to be under the influence of or affected by marijuana.
Incapacity DUID standard requires the marijuana in a driver's system make the driver incapable of driving safely. The prosecutor must show a connection between drug ingestion and the incapacity of the driver.
RI: ‘Zero Tolerance (Medical Exception).’ Rest of NE: ‘Incapable of Driving Safely.’
SOURCE: National Conference of State Legislators, National Organization for Reform of Marijuana Laws (NORML),

11. Blood Levels vs. Intoxication
BAC and ‘feeling drunk’ rise and fall in lockstep
THC levels in blood and ‘feeling high’ rise and fall at different rates
18 mg is one joint
It Is Difficult to Use Blood Test to Measure Whether Someone is High.
SOURCE: Sewell, Poling, Sofuoglu, “The Effect of Cannabis Compared with Alcohol on Driving,” American Journal on Addictions, 2009.

12. Cannabis and Drivers

13. Legalization Put More Drivers With THC in Their System on the Road.
12/01/09 - 9pm
THC on the Road
% THC-Positive Drivers (WA)
Legalization Put More Drivers With THC in Their System on the Road.
SOURCE: National Highway Traffic Safety Administration.

14. Driving While High Conclusive evidence Substantial evidence
The Science
Review of Literature
Conclusive evidence
Improves the lot of adults in chronic pain.
Substantial evidence
Increases the risk of motor vehicle crashes.
There is conclusive evidence or substantial evidence that marijuana:
Improves the lot of adults in chronic pain.
Increases the risk of motor vehicle crashes.
Increases the risk of developing schizophrenia and other psychoses.
There is moderate support suggesting that marijuana:
Improves short-term sleep outcomes for people with fibromyalgia or chronic pain.
Increases impairment of learning, memory and attention span.
Increases dependence on alcohol, tobacco and illicit drugs.
It is not possible to determine whether marijuana use is statistically correlated with occupational injuries.
47,000 drug deaths in USA in 2015
SOURCE: National Academy of Sciences, health-effects-of-cannabis-and-cannabinoids-the-current-state

15. Marijuana and Driving Skills
What the Studies Say
Cognitive Studies
Culpability Studies
‘Impairment in every performance area that can reasonably be connected with safe driving’
Suffer from
Sampling delay
Reliance on carboxy-THC
Experimental Research
Case Control Studies
‘Marijuana users tend to overestimate their impairment, and consequently employ compensatory strategies.’
Hard to create a good control group (accidents that didn’t happen)
Cognitive: how marijuana affects driving skills. Marijuana use impairs: tracking, motor coordination, visual functions, and particularly complex tasks that require divided attention
Experimental: how drivers perform when under observation. Cannabis users perceive their driving under the influence as impaired and more cautious. Given a dose of 7 mg THC (about a third of a joint), drivers rated themselves as impaired even though their driving performance was not; drivers were just the opposite – their performance was impaired even though drivers rated themselves as unimpaired.
cannabis use may impair some driving skills (automatic functions such as tracking) at smoked doses as low as 6.25 mg (a third of a joint), but different skills (complex functions that require conscious control) are not impaired until higher doses, and cannabis users tend to compensate effectively
culpability studies, classify drivers who have crashed according to their degree of responsibility for the crash, then compare drug use in each category. If there is greater use of the drug in those culpable for crashes, then the drug is judged to be responsible for a greater crash risk.
Measure if being high makes you more likely to crash. 100 accidents involving high drivers – if 75 of the high drivers were at fault, implies driving while high increases crash risk
Case control studies – look at an at-risk population that differs only by one thing (users and non-users). If one group suffers more than the other, the ‘one thing’ is the difference-maker.
65K health care members – male cannabis users were more likely to suffer from injuries in motor vehicle accidents than male non-cannabis users
SOURCE: Sewell, Poling, Sofuoglu, “The Effect of Cannabis Compared with Alcohol on Driving,” American Journal on Addictions, 2009.

16. Chance of Accident Rises Sharply As Consumption Rises.
Accident Probability
WA ‘per se’ limit
Chance of Accident Rises Sharply As Consumption Rises.
SOURCE: Sewell, Poling, Sofuoglu, “The Effect of Cannabis Compared with Alcohol on Driving,” American Journal on Addictions, 2009.

17. But Blood Tests Aren’t Perfect
Blood Test vs. Drug Recognition Experts (DREs)
THC Concentration (ng/mL)
Sensitivity (“Catches the Bad Guys”)
Specificity
(“Frees the Good Guys”)
Overall Accuracy (“Gets It Right”) 1
80.4%
70.2%
77.0% 2
72.3
75.2
73.3 3
60.1
78.0
66.1 5
39.7
84.2
54.8 7
29.7
89.9
50.0 10
14.1
95.0
41.5
SOURCE: AAA Foundation, An Evaluation of Data from Drivers Arrested for Driving Under the Influence in Relation to Per se Limits for Cannabis, March 2016.

18. Cannabis Doesn’t Supplant Drinking
Marijuana + Alcohol
A Killer Combination
Studies Agree
Cannabis Doesn’t Supplant Drinking
Cannabis Hurts Automatic Functions (Lane Usage) More Than Complex Tasks
Alcohol Does the Opposite
Cannabis Users Become Less Daring
Alcohol Users Become More Daring
Liquor Tax Collection, % Change from Year Earlier
SOURCES: Colorado Department of Revenue. (Data for first 10 months of year to allow like-to-like comparisons.

19. Legal Sales Lead to More Accidents
Look at ‘Real World’ Crashes
All Measures Statistically Significant
‘Overall’ Measure a Good Proxy for What Will Happen in Any State
SOURCE: Highway Loss Data Institute.

20. Pedestrian Deaths and Cannabis
Walking While High?
From Date of Legalization
From Date of Legal Sale
Pedestrian Deaths (2012 = 100)
Pedestrian Deaths (2014 = 100)
First six months of year.
SOURCE: Governors State Highway Association

21. Public Opinion On Driving While High

22. III Survey
Agree or Disagree: Driving After Smoking or Consuming Marijuana Results in More Vehicle Crashes.
Source: Insurance Information Institute Annual Pulse survey, November 2017.

23. I.I.I. Survey: Cannabis vs. Alcohol
Would You Ride With a Driver Who Drank Too Much?
Would You Ride With a Driver Who Was High?
Respondents Seem Much More Tolerant of High Driver, Even Though They Understand the Risk.
SOURCE: Insurance Information Institute Pulse survey, November 2017.

24. Summary Key Takeaways Conclusions Customers
Driving While High Is Dangerous
Better Roadside Testing Needed
Don’t Drive While High
Smokers wait at least 4-6 hours
Edibles: wait at least 6-8 hours
Don’t Mix Booze and Weed
Don’t Get in a Car With a Driver Who Is High

25. Thank You!