Accuracy and Perceptions in Detecting Cannabis Intoxication: A Video-Based Study Among Alcohol and Other Drug Healthcare Staff

Introduction: Accurate detection of intoxication is critical in alcohol and other drug (AOD) healthcare settings, yet clinicians often rely on subjective assessments, particularly for substances such as cannabis where real-time testing is limited. This study examined AOD staff’s ability to accurately detect cannabis intoxication using standardised video stimuli, alongside their confidence in and perceived barriers to managing intoxicated patients.Methods: Seventy staff members from five public AOD services in New South Wales (NSW), Australia, participated in an online survey. Participants viewed two short videos of individuals under blinded cannabis or placebo conditions and judged intoxication status. Participants then responded to questions on self-reported confidence in recognising, discussing, and managing intoxication, along with perceived barriers. Group differences were analysed by professional role, years of experience working in NSW Health, and frequency of AOD patient interaction.Results: Participants correctly identified the intoxicated subject in only 50% of cases (M=1.1 out of 2, SD=0.71), with no significant differences by role, experience, or confidence. Confidence in managing intoxication was higher among medical and nursing staff and those with more frequent patient contact compared to those in non–patient-facing roles. However, confidence and accuracy to detect intoxication were not correlated. Common barriers included fear of patient aggression (77%), upsetting patients (69%), and misjudging intoxication (66%).Discussion and Conclusions: Despite moderate confidence, AOD staff demonstrated limited accuracy in detecting cannabis intoxication. Frequent exposure and professional role influenced confidence but not detection accuracy, suggesting that intoxication detection, particularly for cannabis, may not be a presumed skill. These findings highlight the need for targeted education, training and validated tools to support clinical decision-making and safe care delivery.