Marijuana and death. A thread👇🏻
As a forensic pathologist it is my job to certify death in cases of drug intoxication. I can’t think of a single case in my 20 year career where THC (the active ingredient in weed) was ever the cause of death on its own. /1
THC may be present in combination with other drugs such as synthetic cannabinoids, alcohol, or methamphetamine in mixed drug intoxication deaths. In those cases we may list THC on the death certificate (DC) with the other drugs. This is to acknowledge its presence /2
NOT to imply that it would have killed the decedent on its own. In illegal drug markets it’s may not be unusual for THC to be tainted with “spice” “K2” (synthetic drugs) or fentanyl derivatives to increase the “high.” These additives are more likely to kill the user. /3
THC may also be found in cases of deaths from blunt trauma, such as motor vehicle fatalities. Compared to alcohol, which has a specific legal limit, THC levels are hard to interpret in the post-mortem state and especially at low levels may just be an indicator of chronic use. /4
There have been case reports of acute cardiac arrhythmias precipitated by acute cannabis intoxication. See: ncbi.nlm.nih.gov/pmc/articles/P… /5
This might be a potential mechanism of sudden cardiac death in a subset of users (who may have underlying heart disease at autopsy). See: ncbi.nlm.nih.gov/pmc/articles/P…
The other thing to consider in deciding on whether to legalize cannabis is its effects on DUI & the likelihood that it’s legalization and accessibility will increase use in younger people. iii.org/sites/default/… /6
Legalization raises a lot of complex issues: medical, legal, sociological. They are not easily tackled in tweet form, nor are they well addressed by studying individual states’ experiences since each one did it differently. I’d like to see Feds & @CDCgov lead on this.

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More from @drjudymelinek

30 Jan
In response to @nytdavidbrooks
A thread. 👇🏻
You can’t argue studies & reports with fear. Minority communities have been disproportionately affected by their families dying. The unions are representing the teachers who are also POC, at risk & don’t want to die.
I see both sides of this issue and it’s only a problem because of a lack of a Federal response and Federal leadership. If the US had a functional @CDC last year and had set out guidelines for school reopening we wouldn’t be here.
I quit my job because the protocols I wrote weren’t being followed so I don’t blame unions one bit for advocating for the health & safety of their workers.
Read 10 tweets
7 Jul 20
So we just landed in New Zealand. Temperature checks and symptoms screening on landing. Now taken on a bus to a quarantine hotel for two weeks in Auckland. This is how you properly manage a border in the age of #COVID19 Image
We are staying at the Sudima hotel. This was breakfast the first day. Little adorable meat pies and porridge. The meat pies were good. I chomped one before thinking to take the photo. Image
This is the booklet we got when we checked in. Published by the New Zealand Government @ChiefSciAdvisor It’s 20 pages long. It covers all the questions you might have about quarantine including what might happen if you test #Covid19 positive. Image
Read 25 tweets
30 May 20
So what does "no physical findings that support a diagnosis of traumatic asphyxia or strangulation" mean? google.com/amp/s/amp.www.… #GeorgeFloyd - a thread /1
Without seeing the actual autopsy report or autopsy photos it’s hard to tell based on that phrase alone. Generally it means that there’s no trauma to the front strap muscles of the neck, hyoid bone, thyroid or laryngeal fractures. /2
But a broad, even force on the side of the neck wouldn’t necessarily leave much of a mark on the strap muscles of the front of the neck the way a hand would in manual strangulation. /3
Read 10 tweets
6 Jan 20
Thread. Jeffrey Epstein photos are out and here’s my take: cbsnews.com/news/jeffrey-e… 1
Disclaimer: I wasn’t consulted by the press & don’t have access to all the photos, just the ones in the news reports. The quality is not as good as if I had originals digital files. 2
That said, in the photos shown the ligature furrow appears horizontal and does not appear to elevate behind the ears. There is also injury to the right back base of the neck. This is concerning for a strangulation rather than a hanging. 3
Read 9 tweets
4 Aug 19
@neiltyson 1. The medical errors number is wrong. It’s based on grossly extrapolated data with no autopsy confirmation and assumes that if someone died after surgery it was due to the surgery and not to the underlying disease the surgery was for. 2. Mass shootings are homicides.
@neiltyson 3. @neiltyson do you really want to use comparative data to effectively minimize the human reaction to the horror of a mass fatality incident? All of these deaths are preventable and we should be working on all of them. #NotOneMore
@neiltyson 4. We have public health measures & evidence based legislation in place to address flu deaths, medical errors, MVAs, even suicide. Why don’t we have it in place to address gun violence? @ResearchAffirm #ThisIsOurLane
Read 4 tweets
11 Nov 18
These are the guidelines @NRA was complaining about: Reducing Firearm-Related Injuries and Deaths in the United States: Executive Summary of a Policy Position Paper From the American College of Physicians annals.org/aim/fullarticl… @ACPinternists
1. The American College of Physicians recommends a public health approach to firearms-related violence and the prevention of firearm injuries and deaths.
a. The College supports the development of coalitions that bring different perspectives together on the issues of firearm injury and death.
Read 51 tweets

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