Drug Recognition Expert (DRE) examination characteristics of cannabis impairment.
The Drug Evaluation and Classification Program (DECP) is commonly utilized in driving under the influence (DUI) cases to help determine category(ies) of impairing drug(s) present in drivers. Cannabis, one of the categories, is associated with approximately doubled crash risk. Our objective was to determine the most reliable DECP metrics for identifying cannabis-driving impairment. We evaluated 302 toxicologically-confirmed (blood Δ(9)-tetrahydrocannabinol THC ≥1μgL) cannabis-only DECP cases, wherein examiners successfully identified cannabis, compared to normative data (302 non-impaired individuals). Physiological measures, pupil sizelight reaction, and performance on psychophysical tests (one leg stand OLS, walk and turn WAT, finger to nose FTN, Modified Romberg Balance MRB) were included. Cases significantly differed from controls (p<0.05) in pulse (increased), systolic blood pressure (elevated), and pupil size (dilated). Blood collection time after arrest significantly decreased THC concentrations no significant differences were detected between cases with blood THC <5μgL versus ≥5μgL. The FTN best predicted cannabis impairment (sensitivity, specificity, positivenegative predictive value, and efficiency ≥87.1%) utilizing ≥3 misses as the deciding criterion MRB eyelid tremors produced ≥86.1% for all diagnostic characteristics. Other strong indicators included OLS sway, ≥2 WAT clues, and pupil rebound dilation. Requiring ≥24 of ≥3 FTN misses, MRB eyelid tremors, ≥2 OLS clues, andor ≥2 WAT clues produced the best results (all characteristics ≥96.7%). Blood specimens should be collected as early as possible. The frequently-debated 5μgL blood THC per se cutoff showed limited relevance. Combined observations on psychophysical and eye exams produced the best cannabis-impairment indicators.