Can you OD on marijuana?

This is a question that was asked on the Illinois Poison Center Facebook page a couple of weeks ago.  Up until a year or two ago, I would have said no.  Now I am not so sure.

Marijuana has changed a lot in the decades since President Obama intercepted and sucked down half a joint at high school parties in Hawaii.  The quality of weed (as measured by THC content) grown in the 1970’s and 80’s does not compare to what is available today.  According to the University of Mississippi Marijuana Potency Monitoring program, the percent of THC in marijuana seized by federal agents increased from 1.37 to 8.49 percent in the 30 year period 1978 to 2008.  For medical marijuana, extracts like BHO and edibles, the THC content can be even higher.

So what does the availability of great weed have to do with poisoning?

The mantra of poisoning is that it is the dose that determines a compound’s toxicity.  A little bit of aspirin is good, a lot of aspirin is deadly.  Water is healthy for you, but too much water is deadly.  There is nothing on this earth that is not without poison, it is only a matter of dose.

In the past 8 months, there have been an increasing number of articles on a potential link between marijuana and cardiac effects, especially in young people without other risk factors.

• July, 2014 (hot off the presses) the Journal of Emergency Medicine presented a case of a 21 year old male with clean coronaries who suffered a heart attack after acutely smoking marijuana
• April, 2014 in Acta Cardologica, a case series of three individuals who developed heart attacks after smoking marijuana was published
• April 2014, in the Journal of the American Heart Association published a study from France that collated 35 cases of cardiovascular effects after smoking marijuana.  These cases had a 25% mortality rate.
• December, 2013 in Forensic Science International is a case report of a 21 year old gentleman who was undergoing continuous heart monitoring and it was noted that his heart would stop beating for up to 5 seconds when smoking weed.  On repeat heart monitoring after he ceased all marijuana smoking, his heart monitor exams returned to normal.  It is proposed that prolonged periods of a non-beating heart can lead to sudden death.

Besides an increase in the reports of cardiac effects attributed to marijuana, there is also a rise in the number of cases of “Cannabinoid Hyperemesis Syndrome” (CHS).  In these cases, people who smoke A LOT of marijuana end up in a cycle of prolonged continuous vomiting.  A common trait of the syndrome is that the only relief that affected individuals get is from taking hot showers or hot baths.  However, as painful as vomiting for hours on end sounds, the adverse effects of CHS to other organs can be much worse:

• Patients with Cannabinoid Hyperemesis Syndrome are at risk for acute kidney failure
• Takotsubo Cardiomyopathy (literal translation is “broken heart)  in conjunction with CHS was reported in April, 2014 in the Hawaii Journal of Medicine and Public Health.

With the changes in laws and increasing availability around the country, more people are smoking marijuana.  With potent clones being chosen for cultivated marijuana, the quality of weed available has never been higher.  It is not a stretch to say that more people, smoking more potent marijuana in large amounts, will lead to an increasing number of adverse effects being reported.

So is weed bad?  As medical marijuana gains acceptance and there are more controlled trials, my impression is that in controlled, regulated amounts, benefit may be shown for many diseases.  In unregulated or ‘overdose’ amounts, there is a chance that weed will be bad for you.  Kind of like drinking beer, there is a line between moderation and excess.

For the past several years, I had a standard line in a canned illicit drug lecture that “no one ever died acutely from smoking weed.”   Half the audience would high five each other.  Sadly, with the influx of new reports of adverse cardiovascular effects, I won’t be able to use that line any more.

Til next Tuesday,

Mike

Related posts:

1. Highlights of the New Illinois Medical Marijuana Act
2. Medical Marijuana in Illinois Part 2—Child Safety Concerns
3. The Breakdown on K2
4. The Case of the Tube Switcheroo
5. Native to Illinois, Jimson Weed is highly toxic and in season