Medical cannabis and driving in Australia: Results from the cannabis as medicine survey 2022–2023 (CAMS-22)

• There were 2,609 respondents to the driving behaviour section of this latest iteration of the Cannabis as Medicine Survey. • More frequent medical cannabis use, being male, using illicit cannabis and smoking cannabis were all associated with increased odds of DUIC. • Among those who reported past-year DUIC, most thought they were unimpaired by their medical cannabis use. • Roadside drug testing is a robust deterrent against driving for many patients but also acts as a barrier to treatment access. As access to medical cannabis continues to expand, understanding how patients perceive and respond to driving-related risks is important for road safety. We conducted a cross-sectional online survey of Australians using cannabis for a medical condition between December 2022 and April 2023. In addition to collecting demographic and clinical information, we assessed self-reported driving under the influence of cannabis (DUIC, defined here as ‘driving while high’), driving-related behaviours, and beliefs about impairment. Binary logistic regression was used to identify predictors of past-year DUIC. Of the 2,609 respondents who had driven in the past 12 months, 73 % (N = 1905) were accessing prescribed medicinal cannabis and 28.3 % (N = 750) reported DUIC. Several factors were associated with significantly increased odds of DUIC, including more frequent medical cannabis use, being male, using illicit and smoked cannabis, and believing that cannabis does not impair driving. The most common reason for DUIC was respondents thinking they were unimpaired (N = 518, 69.1 %). While 69 % (N = 1,790) reported that roadside drug testing deterred them from driving after cannabis use, 51 % (N = 1,340) also indicated it influenced their treatment decisions. These findings reaffirm trends identified in earlier CAMS studies and align with international literature demonstrating that perceived risk and enforcement significantly influence DUIC behaviour. Efforts to reduce DUIC among medical cannabis users need to account for the nuances of therapeutic use, noting that high-visibility enforcement strategies like roadside drug testing can reduce risky behaviours but may also restrict treatment choices. Policymakers must strike a balance between road safety and equitable access to medical cannabis.