Can cannabis kill? Characteristics of deaths following cannabis use in England (1998–2020)

Abstract

Background: Cannabis is the most widely used illegal drug but is rarely considered a causal factor in death. Aims: This study aimed to understand trends in deaths in England where cannabinoids were detected at post-mortem, and to evaluate the clinical utility of post-mortem cannabinoid concentrations in coronial investigations. Methods: Deaths with cannabinoid detections reported to the National Programme on Substance Abuse Deaths (NPSAD) were extracted and analysed. Results: From 1998 to 2011, on average 7% of all cases reported to NPSAD had a cannabinoid detected ( n = 110 deaths per year), rising to 18% in 2020 ( n = 350). Death following cannabis use alone was rare (4% of cases, n = 136/3455). Traumatic injury was the prevalent underlying cause in these cases (62%, n = 84/136), with cannabis toxicity cited in a single case. Polydrug use was evident in most cases (96%, n = 3319/3455), with acute drug toxicity the prevalent underlying cause (74%, n = 2458/3319). Cardiac complications were the most cited physiological underlying cause of death (4%, n = 144/3455). The median average Δ9-tetrahydrocannabinol post-mortem blood concentrations were several magnitudes lower than previously reported median blood concentrations in living users (cannabis alone: 4.3 µg/L; cannabis in combination with other drugs: 3.5 µg/L). Conclusions: Risk of death due to cannabis toxicity is negligible. However, cannabis can prove fatal in circumstances with risk of traumatic physical injury, or in individuals with cardiac pathophysiologies. These indirect harms need careful consideration and further study to better elucidate the role cannabis plays in drug-related mortality. Furthermore, the relevance of cannabinoid quantifications in determining cause of death in coronial investigations is limited.

Cannabis and Other Substance Misuse: Implications and Regulations

“…In addition, cannabis toxicity will be fatal if it occurs in individuals with a history of heart disease, as it can lead to heightened sympathetic activity, and reduced parasympathetic activity, resulting in tachycardia and an elevation in cardiac output even at low or moderate doses [ 33 ]. Therefore, it is necessary to consider the impact of addiction to cannabis consumption, which is fatal to causes death [ 34 ].…”

Towards a Cleaner Green: A Review of Microbial Testing of Medical Cannabis and Its Implications for Patient Health

“…The research on this topic is mixed, with some studies suggesting cannabis alone rarely directly causes death [38][39], while others indicate cannabis can be an indirect contributing factor in death due to traumatic injury or exacerbation of pre-existing cardiac conditions [40]- [43]. However, several case studies demonstrate that long term cannabis use or exposure to contaminated cannabis can lead to chronic fungal infections, which may become severe or even fatal if left untreated [44]- [46].…”

A qualitative content analysis of cannabis-related discussions on Reddit during the COVID-19 pandemic

“…Even though cannabis use on its own is not directly associated with death [ 36 ], its use is associated with adverse health effects such as increased risk of cardiovascular disease mortality, reduced cognitive function, and increased neuropsychiatric effects, especially among those who are underage [ 37 , 38 ]. Furthermore, cannabis may also interact with other medications.…”