Our study provided insight into the perceptions of youth and young adults about the impact of cannabis consumption on road safety. The facilitated discussions uncovered the perception that DUIC had become a normalized and socially acceptable practice with the potential for further perpetuation in the face of peer pressure. Regardless of age, there appeared to be a lack of knowledge around cannabis and driving risk, with some misconceptions regarding perception of risk. It was commonly shared that cannabis was less dangerous than alcohol and there was a gap in education on the impact of cannabis impairment on driving ability. A number of prominent individual and contextual factors emerged for increased youth in DUIC related behaviours, including a) self-identification as a boy or man, b) the operation of off-road vehicles, c) living in rural areas, and d) limitations with detection of cannabis impairment.

Youth and young adults believed that there is an array of factors that comes into play when emerging adolescents decide to drive when impaired by cannabis. As Juarez et al. (2006) [32] have modelled (see Fig. 1 of Juarez et al., 2006 [32]), the factors can come into play at different periods such as ‘antecedents’ that occur before the engaging in impaired driving, choices that present during operation of a motorized vehicle while under the influence of cannabis, and consequences signified by the magnitude of the potential harms posed to oneself or others that can be influenced by the road conditions (e.g., poor visibility or road conditions) or lack of implementation of safeguards (e.g., frequency of law enforcement in urban versus rural areas). Interventions are important at all levels to prevent or reduce the commonality of DUIC as exemplified by our findings (see Table 2) by tailoring awareness campaigns to the antecedents, equipping youth with knowledge to inform decision making when reaching various ‘choice points’, and minimizing the size of the consequences (i.e., injury or fatalities).

Extending upon this notion, another concerning finding from our study was that DUIC or passenger consumption had become a normative practice in society. Recent data from the National Cannabis Survey (NCS) noted 30% of youth (15 to 24) reported DUIC compared to only 16% of adults over 25 [33]. Moreover, past findings from an international survey of youth between the age of 16 to 19 revealed DUIC occurred more frequently among adolescents in Canada than those residing in England [28]. In our study, there was the perception that young males engage in DUIC more than females, which aligns with the NCS with males reporting DUIC twice as often than females [33, 34]. The NCS [33] also identified a small gender difference in risk perception with females found to be more likely to associate DUIC within an hour of consumption to be of graver danger than males perceiving no potential for increased harm [35]. Males were also more likely to vape or consume edibles when driving under the influence of cannabis, leading to later impulsive or erratic driving behaviour on the road or increased risk of accidents [36]. Recent findings by Earle et al. (2019) [37] found that young males tend to report the perspective that DUIC will lead to minimal harm, low levels of impairment, and are more accepting of DUIC than young females. As a result, the lack of perceived harm, consequence, or change to driving ability contributes to the prevalence of youths’ engagement in DUIC. In contrast to past studies, Carpino et al. (2020) [38] did not report any differences in perceptions between genders or whether youth resided in urban versus rural locations.

As a result, it is important that public health campaigns and youth education take into account the gender composition of their target audiences to improve the applicability of the content created for youth. Numerous studies have demonstrated that lower perception of risk is a predictor for DUIC behaviours [24, 29, 39, 40]. Our findings highlight the need for a greater emphasis on educating youth about the dangers posed to themselves and society when choosing to DUIC or ride with a cannabis-impaired driver. Perceptions, especially among youth, are malleable with the potential for efficacious and empirically informed education to promote behaviour change [41]. Furthermore, the development of accessible literature tailored to geographic regions, age groups, and genders brings forth potential to reduce the risk for fatalities or life-changing harm to those at most significant risk, when made applicable or relatable to their everyday lives.

Our study also revealed common misconceptions around perceived risk of the impact of cannabis on driving ability, with many youths and young adults unaware of the impact that cannabis has on one’s driving ability. In some instances, there was the perception that cannabis can enhance driving performance or that experienced consumers had built up a tolerance which mitigated their impairment. Past research has revealed that nearly 75% of Canadians believe cannabis has the potential to harm driving ability [42], however, it has also been noted that cannabis impairment was often perceived as not requiring compensatory behaviour [24]. The Canadian Cannabis Survey (CCS) [10] also found complementary results, with 28% of Canadian consumers reporting the effect of cannabis on driving ability was either context-dependent or completely non-existent. Scott et al. (2021) [22, 23] provided further support identifying that beyond context, one of the strongest factors predicting the likelihood to engage in DUIC was the intent to DUIC over the receptibility to drive cannabis-impaired (i.e., planning to DUIC versus being open to the possibility of DUIC).

In our study, DUIC was commonly perceived as less dangerous than alcohol, but recognized that alcohol-impaired driving was never acceptable. These perceptions aligned with Ontario youth, who also reported that DUIC was most likely to occur when cannabis was perceived as low risk, and legalization was supported by society and by younger males [43]. Wickens et al. (2019) [24] also explored perceptions from youth about DUIC and found that denial of risk of harm was common among new drivers, general acceptance among peers, and bias that they were immune to the potential dangers. This is particularly concerning in light of recent findings of a randomized control trial testing youths’ driving performance following consumption of cannabis [44]. They discovered that 100 mg of cannabis consumption by youth did not impact simple driving tasks but led to marked impairment on complex response tasks lasting up to 5 hours. Authors also found that perceived driving ability and safety among youth was significantly lower after cannabis use compared to non-use. This further illustrates the importance of increasing awareness of the impact of cannabis on driving ability, as self-perceived impairment may not be detectable for minor driving performance tasks but can substantially impact response to major operational tasks.

A novel finding from our study was around the reported increased DUIC among drivers of off-road vehicles. The nationwide Health Behaviour in School-Aged Children survey conducted pre-legalization (2009-2010) found self-report of DUIC or other substances as the operator or passenger of an on or off-road vehicle to be greatest among youth from rural communities [45]. Although past findings have utilized inclusive definitions of transportation, our study brings forth new support for DUIC as more common with operation of off-road vehicles and the importance of sharing knowledge that can be applied practically by youth to their lived experience (e.g., addressing the perception that driving off-road is a safe alternative to on-road driving). Similar to Pickett et al. (2012) [46], youth in our FGs discussed how off-road vehicles can be driven before they are of legal driving age, while young adults expressed that the off-road vehicle and often the destination are for recreational purposes, tying in the importance of considering intent to DUIC. Hammond and colleagues (2021) [47] also observed similar patterns post-legalization among residents of the Northern territories with significantly higher rates of DUIC than all other provinces in Canada, noting the contribution of the absence of alternative transportation. Youth in our study also spoke to the notion that DUIC was further elevated when residing in rural areas, therefore, extending the impact of rural living on DUIC beyond the Canadian territories.

Youth and young adults in our study also expressed that it was harder to detect cannabis impairment among peers, which could pose safety risk among those who were passengers in vehicles. Many youths felt confident in detecting alcohol but advised that cannabis was easily concealable and regular consumers often did not exhibit signs of impairment. This was also noted in other studies insofar as the absence of efficacious roadside detection methods for cannabis impairment due to the poor reliability of field sobriety [48] and THC blood tests [49, 50]. Instead, Spindle and colleagues (2021) [50] advocated for the employment of a mobile application of executive functioning tasks with field tests for psychomotor and cognitive capability, however, the need for the development of a sensitive cannabis impairment detection method remains ongoing. Improved access to and awareness of cannabis-impairment methods is also important for the protection of public health. As youth and young adults shared in our FGs, they often unknowingly face potential harm when they are unaware of signs of impairment or unable to detect impairment of their designated drivers or others on the road unless it has been explicitly disclosed or prior consumption has been witnessed.