Death after consuming a marijuana edible

July 23, 2015, 6:08 pm

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Death Following Ingestion of an Edible Marijuana Product — Colorado, March 2014. MMWR 2015 July 24;64:771-772.

Full Text

This report describes the investigation by the Colorado Department of Public Health and Environment (CDPHE) into a well-publicized fatality that occurred shortly after recreational marijuana became available in that state.

In March 2014, a 19-year-old man ingested one piece of a marijuana cookie purchased by his 23-year-old friend. (Note: at that time as well as now, the legal age for using marijuana in Colorado was 21.) When he felt no effects after 30-60 minutes, he ingested the remainder of the cookie:

“During the next 2 hours, he reportedly exhibited erratic speech and hostile behaviors. Approximately 3.5 hours after initial ingestion, and 2.5 hours after consuming the remainder of the cookie, he jumped off a fourth floor balcony and died from trauma.”

The CDPHE investigation of this case provides some interesting details that hadn’t been reported previously in media coverage:

  • The deceased teenager had no previous history of drug or alcohol abuse, or mental illness.
  • The cookie content was listed on the label as “65 mg THC/6.5 servings.” The victim initially followed instructions and ate one-sixth of a cookie, but ingested the rest of the total 65 mg shortly thereafter.
  • The victim’s THC level at autopsy (central blood) was 7.2 ng/ml.

There are several things to note in this report. The THC level of 7.2 ng/ml at autopsy (performed 29 hours after death) was surprisingly low — the (rather arbitrary) legal limit for driving in Colorado is 5.0 ng/ml. Since THC undergoes post-mortem redistribution, the level at the time of death might have been even lower than the legal limit. This finding shows that blood THC levels are not good indicators of clinical effect. In addition, when ingested, THC undergoes the hepatic first-pass effect, producing the active metabolite 11-OH-THC, which may be more potent and longer-lasting than THC itself. Because of this — and because when marijuana is ingested it has a prolonged time to peak effect (1-2 hours) and longer duration than when smoked — the effects of marijuana edibles may be substantially different from those experienced after smoking or vaping.

I covered these issues in my Emergency Medicine News column “Four Things Maureen Dowd Should Have Known About Cannabis Before Going to Denver.” To read the column, click here.

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