Marijuana Decriminalization, Medical Marijuana Laws, and Fatal Traffic Crashes in US Cities, 2010-2017.

Objectives. To determine the impact of city-level cannabis decriminalization and medical marijuana laws (MMLs) on fatal traffic crashes in US cities.Methods. Using a census of fatal traffic crashes from the 2010 to 2017 Fatality Analysis Reporting System, we examined MMLs and cannabis decriminalization on fatal crashes by age and sex of driver. We used a Poisson difference-in-differences approach, exploiting temporal and geographic variation in marijuana decriminalization laws.Results. Cities experienced a 13% increase in fatal crashes involving 15- to 24-year-old male drivers following decriminalization (incidence rate ratio = 1.125; 95% confidence interval = 1.014, 1.249). This effect was immediate and strongest on weekend nights. We found no effect on female drivers or older males. Conversely, we found that MMLs were associated with fewer fatal crashes for both males and females, which was most pronounced in 15- to 24-year-old drivers.Conclusions. Unlike MMLs, which are associated with fewer fatal crashes, cities experienced a relative increase in fatal crashes involving young male drivers following marijuana decriminalization.Public Health Implications. MMLs stipulate consumption occurs at home, whereas decriminalization only lessens the penalty for marijuana possession. Therefore, travel incentives of such laws have heterogeneous effects on traffic safety.