The Improbable Truth of Sudden Death with Marijuana

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iStock image

A study by German researchers, “Sudden Unexpected Death Under Acute Influence of Cannabis,” has stirred up a firestorm of controversy as a result of their conclusion that two unexplained deaths were the result of marijuana use. High Times ridiculed the study as another round of “Pot Kills” propaganda. They claimed that news sources like Mail Online were “bastardizing” the story and spreading a certain level of fear. High Times and other news sources then quoted the head of the German Association for Drugs and Addiction (FDR) as saying that cannabis does not paralyze the breathing of the heart. “Deaths due to cannabis use are usually accidents that are not caused by the substance, but to the circumstances of the use.” But let’s take a look at what the study and the researchers actually said.

The case report (here and here) described two young, healthy men who died unexpectedly under the acute influence of cannabinoids (THC). “To our knowledge, these are the first cases of suspected fatal cannabis intoxication where full postmortem investigations, including autopsy, toxicological, histological, immunohistochemical, and genetical examinations, were carried out.” After excluding other possible causes of death, they assumed the men died from “arrhythmias evoked by smoking cannabis.” HOWEVER, “this assumption does not rule out the presence of predisposing cardiovascular factors.”

They noted the absolute risk of cannabis-related cardiovascular effects was low and that the cannabis-induced changes were transient. Yet they cited two studies indicating that the risk of myocardial infarction was elevated almost 5 times in the first hour after smoking marijuana; then it declined rapidly afterwards. “Consequently, the relative risk of cardiovascular effects is most probably increased within this period.”

The Mail Online article cited the research claims of the German study, namely that cannabis can kill, but also stated that: “it remains unclear how it can trigger heart problems.”  They pointed to more significant risks associated with marijuana use and quoted David Raynes of the UK National Drug Prevention Alliance as saying about the study’s findings: “These deaths are rare and will remain rare. The real risks are from long-term effects on the young brain.”

There was another alleged case of unexplained death from THC, a young woman named Gemma Moss. A Colorado doctor who works with medical marijuana patients in that state said: “There’s no history of any reports of a death from cannabis ever.” He admitted that it could cause an increased heart rate, so there was a potential problem with someone with a pre-existing heart disease. “But there’s no known dose of cannabis that could kill a human.”

Well, there does seem to be a known dose of THC that would kill a human. The above noted report cited a 2009 study in American Scientist on the toxicity of recreational drugs suggested that using more than 1,000 times the effective dose of THC in marijuana would have to occur for possible fatalities. This fact—that typical doses of THC are well below the supposed lethal dose—was also noted by the German researchers. But they suggested further study of the potential issue and cautioned against individuals who are at high risk of cardiovascular disease to avoid the use of cannabis.

It is impossible to predict how certain individuals respond to cannabis smoke, as underlying illnesses and complicating factors may be unknown. The presented case highlights the potentially hazardous cardiovascular effects of cannabis in putative healthy young persons.

The researchers had an approach that Sherlock Holmes would have been proud of. They said: “After exclusion of other causes of death we assume that the young men died from cardiovascular complications evoked by smoking cannabis.” Holmes famously said: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” It seems to me that pro-marijuana individuals and organizations are dismissing the results of the study out-of-hand for their own propaganda purposes.




Pandora’s Box is Now Open

image credit: iStock

image credit: iStock

A drinkable form of marijuana called Legal is now available at eight of Washington State’s recreational marijuana stores. The drink comes in five different flavors and is infused with 22 milligrams of THC: “enough to know you’re high, but not so much as to overwhelm.” Each flavor is supposed to give you a slightly different high. The Company’s founder, Adam Stites said that “drinakables” don’t carry as much of a taboo as other forms of marijuana, “It’s more approachable” to ask your parents if they want a Legal instead of a joint. Stites sees “green” beverages as an amazing, untapped new market:

It’s an opportunity to make an amazing, unique, unusual, and delicious product while also making history. . . . I think my grand-kids will be amazed to know that people used to go to jail for having a plant.

At the same time that Denver and Seattle city officials are denying that legal marijuana is bringing in pot tourists (here and here), travel websites have reported an increase in searches for both destinations. Taylor Cole, who handles public relations for Hotels.com said: “We’ve seen that searches for both destinations have spiked dramatically.”

Year-after-year, there has been a 73 percent increase in traffic at Hotels.com for Denver rooms during its 4/20 festivities. And there was a 68 percent increase among travelers looking for Seattle rooms during July, the first month of legal marijuana sales in that state.

My 420 Tours of Denver Colorado offers a variety of pot-based tour packages. You can take a cannabis cooking class; a Dispensary & Grow Tour, a Sampler Vacation package. You can book a 420 friendly luxury hotel room in the heart of downtown Denver. “Enjoy vaping in your room or smoking freely on 420 smoking deck overlooking downtown Denver.”

You can take a six-hour ride on the My 420 Tours Cannabus, stopping at some of Denver’s top retail marijuana stores. A tour of a professional grow facility, a cannabis friendly lunch, and a 4:20 pm smoke out are all included. There is also free sampling of cannabis edibles on the bus throughout the tour.  In a 2½ hour cooking class you will learn “how to make and use various cannabis oils and a variety of organic cannabis-infused treats.” Oh, and you get free samples during class and to take home.

Along with the new edible products and tourism destinations, marijuana legalization is having some potentially harmful and far-reaching consequences. On March 10th, a college student from Wyoming bought four marijuana cookies for herself and her three friends and returned to their Denver hotel. A few hours later, her 19-year old friend leapt over the fourth-floor railing into the lobby.

The woman who bought the cookies said she believed it was the first time her friend had ingested marijuana. They began eating their cookies around midnight. Levy Thamba said he wasn’t feeling anything, so he ate the rest of his cookie. Later that night Levy was “screaming, speaking in French, apologizing for criminal behavior that he had not committed, smashing fixtures and finally jumping off the balcony.” They had been advised to split the cookie into six pieces and eat one piece at a time.

In May of 2014, the governor of Colorado signed legislation to tighten controls on edible and concentrated forms of marijuana. The first law created a task force to devise packaging for cannabis-infused edibles to make those products readily distinguishable from regular foods. Why? Because Colorado Children’s Hospital reported they had treated 13 children, six who became critically ill from edible marijuana.

The hospital’s medical director of the emergency room reported that a number of children had been admitted for “for sedation or agitation and one child suffered breathing problems that required a respirator.” A Colorado study reported in JAMA Pediatrics found there has been an increase of unintentional ingestion of marijuana by children since the modification of drug enforcement laws for marijuana possession in 2009. State Senator Mike Johnston said: “By improving labeling and giving kids a way to tell the difference between a snack and a harmful substance, we can keep kids … out of the emergency room.”

The second law regulates the amount of concentrated marijuana that can be sold to an individual. Marijuana edible companies were encouraged to make products containing no more than 10 mg of THC. If they do, these products will be tested less often for potency than other edibles.

Another incident of suspected marijuana intoxication involved a Denver man shooting his wife to death as she was on the phone with an emergency dispatcher. She told the dispatcher her husband had use pot and was hallucinating and frightening her and their three children.

Under emergency rules that were adopted on August 1, if a marijuana edible is more than 10 mg and up to 100 mg, “you have to score it or demark it in such a way that it is intuitively obvious to the consumer how to break off a serving size of that edible.”

Like opening Pandora’s box, the increased availability of marijuana as a medicinal and recreational drug is having some unanticipated detrimental consequences. Children are being poisoned and people are dying after unintentional ingestions and overdoses of THC. And we are only at the beginning of the medicalization and legalization movement. Where will we be in five or ten years from now? Hopefully the corrections mentioned here will minimize what we’ve seen so far. But like Pandora, I’m afraid that it is already too late to close the container. The genie is already out of the bottle.