The legalization of recreational marijuana in two American states - Colorado and Washington - and medical marijuana in more than 20 others has raised concern that there will be more drivers stoned behind the wheel. What's not clear is whether that will translate into an increase in fatal crashes. Five things to know about marijuana and driving:
--- 1. WHAT WE KNOW
While marijuana users can perform simple tasks well while they are high, brain imaging has shown they have to use more of their brain to do so. Their reaction times are slower, peripheral vision is decreased and multitasking impeded. As a result, when sudden or surprising things occur to complicate those tasks - such as when a pedestrian steps in front of a car - they cannot respond as well. On the other hand, marijuana users tend to be aware they are impaired and try to compensate for it.
--- 2. WHAT WE DON'T KNOW
It's not clear how much marijuana use contributes to crash risk. Some studies have found that marijuana can double crash risk, but others have found virtually no increase.
--- 3. HOW HIGH IS TOO HIGH?
Traces of THC, the psychoactive ingredient in marijuana, can be detected in the blood of some habitual marijuana users days or weeks after they last used the drug, making it hard to use blood tests to discern a current level of impairment.
--- 4. REAL-WORLD EXPERIENCE
In 2013, the first full year after Washington state legalized pot, nearly 25 percent more drivers tested positive for marijuana than before legalization. But there has been no corresponding jump in accidents or arrests for intoxicated driving. A University of Colorado Medical School study found that the share of drivers involved in fatal motor vehicle crashes in Colorado who tested positive for marijuana more than doubled between 1994 and 2011. A National Safety Council study looked at the prevalence of drivers involved in fatal crashes who tested positive for marijuana in 12 states from 1992 to 2009, before and after implementing medical marijuana laws. Only three states showed an increase - California, Hawaii and Washington - and those appeared to be a one-time increase possibly associated with differences in testing.
--- 5. WHAT NEXT?
The National Highway Traffic Safety Administration is conducting research to get a better idea of how pot affects driving. NHTSA and Washington state officials have also teamed up to assess change in marijuana use by drivers before and after the state allowed retail sale of the drug, with results due next year.