Report from Colorado doctors finds possibility of first death attributed to marijuana

Doctors call for more research after findings

DENVER – An 11-month-old child who died after being exposed to marijuana is believed to be the first person whose death has been attributed to marijuana exposure, according to two Colorado doctors who published a report on the death in August.

The report by Thomas M. Nappe, DO, who works at the Rocky Mountain Poison and Drug Center in Denver, and Christopher O. Hoyte, MD, with the Department of Emergency Medicine at the CU Anschutz Medical Center, was published in the August edition of the journal “Clinical Practice and Cases in Emergency Medicine.”

According to the report, the infant had “no known past medical history,” yet was admitted to the emergency room unresponsive with a depressed nervous system, then went into cardiac arrest and later died. The report notes that the infant was “irritable with decreased activity” in the day or two beforehand, but “was noted to be healthy” beforehand.

A subsequent medical examination on the child was performed, which found THC enzymes in his blood, though the report notes that “route and timing of exposure to cannabis were unknown.”

However, the report noted: “Additional history disclosed an unstable motel-living situation and parental admission of drug possession, including cannabis.”

It also said it was “highly unlikely” the THC entered the boy through “passive exposure,” which could mean second-hand smoking or breastfeeding, among other things.

The autopsy of the boy found he was suffering from myocarditis, an inflammation of the heart that, according to the Myocarditis Foundation, “usually attacks otherwise healthy people” and “is believed” to cause between 5 and 20 percent of sudden death in young adults. But the autopsy didn’t find signs of bacterial or viral infections, which often can contribute to myocarditis, according to the foundation.

Nappe and Hoyte in their report say that they “propose a relationship between cannabis exposure in this patient and myocarditis, leading to cardiac arrest and ultimately death.”

That conclusion, they say, should lead fellow medical professionals to consider urine screenings for THC in child patients who show signs of myocarditis and live in areas where marijuana is widely-used, like Colorado. They also recommend that parents be counseled on how to prevent such exposures, writing that children are at an increased risk of exposure through edible marijuana.

Their report says they believe given the timing of THC’s metabolism in the human body that the boy ingested “a single, acute high-potency” dose between 2 and 6 days before his death.

While no death has been directly linked to a marijuana overdose, the authors also note other instances in which young adults were diagnosed with myocarditis after ingesting marijuana, though all recovered.

The authors’ conclusion says:

Of all the previously reported cases of cannabis- induced myocarditis, patients were previously healthy and no evidence was found for other etiologies. All of the prior reported cases were associated with full recovery. In this reported case, however, the patient died after myocarditis associated cardiac arrest. Given two rare occurrences with a clear temporal relationship – the recent exposure to cannabis and the myocarditis-associated cardiac arrest – we believe there exists a plausible relationship that justifies further research into cannabis-associated cardiotoxicity and related practice adjustments. 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.

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