Thread by @drjudymelinek

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

https://twitter.com/ryanmarino/status/1358084701559390210

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.