November 20, 2017

Was this the first marijuana overdose death? Not so fast, doctors warn.

Daily Briefing

    Amid headlines about the "first marijuana overdose," doctors who authored a case report on the first death "associated with" cannabis are urging the public not to jump to the conclusion that marijuana killed the affected child.

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    In the case report, published in Clinical Practice and Cases in Emergency Medicine, Thomas Nappe, director of medical toxicology at St. Luke's University Health Network in Pennsylvania, and Christopher Hoyte, a Colorado physician, described the prognosis and death of an 11-month-old male who had been admitted to an ED after having a seizure. The authors were part of the child's care team.

    According to the report, the child's guardian said the child had been "irritable" over several days before ED admittance and was retching and lethargic. Doctors examined him and his history and found he was otherwise healthy.

    However, the boy was unresponsive in the hospital, and his condition worsened. Doctors intubated him when his nervous system started shutting down. The boy's heart stopped, and after medical interventions to save him failed, he died about an hour later, according to the report.

    The doctors investigated the boy's condition further and determined that myocarditis—inflammation of the heart muscle—was the cause of death. After ruling out "almost every other cause" of myocarditis, Hoyte said the doctors found evidence of THC, which is the main psychoactive ingredient in cannabis, in the boy's blood. "The only thing that we found was marijuana. High concentrations of marijuana in his blood. And that's the only thing we found," Hoyte said.

    The researchers hypothesized the child had consumed a large quantity of cannabis at once According to the researchers, researchers have documented several instances of people smoking marijuana and subsequently experiencing myocarditis—although the individuals in those cases recovered, and they also had consumed other drugs.

    The report concluded, "As of this writing, this is the first reported pediatric death associated with cannabis exposure."

    The authors recommended that "in states where cannabis is legalized, it is important that physicians not only counsel parents on preventing exposure to cannabis, but to also consider cannabis toxicity in unexplained pediatric myocarditis and cardiac deaths as a basis for urine drug screening in this setting."

    Experts: Don't jump to conclusions

    According to "To Your Health," the report gained media attention last week, generating headlines about "the first marijuana overdose death"—but Hoyte and Nappe are urging people not to jump to conclusions.

    Nappe stressed that the word "associated" should not be taken to mean cannabis killed the boy.  He added, "We are absolutely not saying that marijuana killed that child." And as Hoyte pointed out, the child's myocarditis could have had a cause the doctors were not able to test for.

    Rather, the authors said they aimed to share an unusual set of events to alert the medical community that further research could be warranted into the potential relationship between cannabis and myocarditis. According to the Washington Post's "To Your Health," a case report is distinct from a research review or scientific study, which may be used to assess or establish causal relationships.

    Other drug policy and health experts have cautioned the public not to misinterpret the report, "To Your Health" reports. For instance, Noah Kaufman, a Northern Colorado emergency physician, said, "I think it's a pretty big leap to say that it is" a clear case of a cannabis overdose death.

    Separately, Keith Humphreys, a Stanford University psychiatry professor who served as a senior policy adviser at the White House Office of National Drug Control Policy during the Obama administration, said that if further research finds the boy's death was caused by marijuana overdose, it would be "a very unusual event." He continued, "It would not be correct to go from this to a generalized panic about the lethality of cannabis."  

    Caution with marijuana around children

    At the same time, experts are urging people to be cautious and attentive when storing marijuana within proximity of children.

    Kaufman said, "Even if I'm not convinced that it could kill your kid, you need to be really careful because it could make [him or her] really sick. It needs to be locked up away in a medicine chest because it can cause seizures. It can cause real big problems in kids that can lead to other problems."

    According to Children's Hospital Colorado, the warning signs of marijuana ingestion include balance issues, sudden or unusual sleepiness, and difficult breathing (Silverman, "To Your Health," Washington Post, 11/17; Berson, AP/Sacramento Bee, 11/17; Rittiman, KUSA/USAToday, 11/16). 

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