The findings point to a need for education on the risks of "simultaneous use" of alcohol and marijuana, researchers said.
The study of US high school seniors found that teens who had used both drugs in the past year had higher rates of traffic tickets/warnings and car accidents.
At particular risk were kids who used alcohol and marijuana at the same time: They were about 50 to 90 per cent more likely to admit to unsafe driving than their peers who did not drink or smoke pot.
"But this suggests that it's not only the frequency of substance use that's important. The patterns of drug use are also related to the risk of unsafe driving," Terry-McElrath said.
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The findings come from surveys of more than 72,000 US high school seniors, conducted yearly from 1976 to 2011.
Both drinking and marijuana use declined over time. In 2011, one third of high school seniors said they hadn't used either drug in the past year-versus only 12 percent in 1979.
Those kids were at heightened risk for reporting unsafe driving - even compared with their peers who only drank, and those who used alcohol and marijuana but not at the same time.
Roughly 40 per cent of teens who used both drugs together had received a traffic ticket or warning in the past year. And about 30 per cent had been in an accident.
It's not clear why those teenagers were at increased risk, according to Terry-McElrath.
The study was published in the Journal of Studies on Alcohol and Drugs.