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This page is excerpted and quoted from the National Academies of Science, Engineering, and Medicine. A Committee of over 40 experts, researchers, and reviewers in The Health and Medicine Division published a 486 page report in 2017 entitled “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.”
If you would like to access the entire report you may do so by clicking this link.
Medical Marijuana and Overdose Injuries and Death
“According to the American Association of Poison Control Centers (AAPCC), 2,047 calls to position control centers in the United States made in 2014 were in response to single-substance exposures to cannabis, up from 1,548 such exposures in 2013 (Mowry et al., 2014, 2015). Of these exposures, 37 were classified as having major effects, and death was the outcome in 1 (Mowry et al., 2015).7 However, these data do not account for overdose injuries or deaths that did not prompt calls to poison control centers. Data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) database of the Centers for Disease Control and Prevention indicate that in 2014 there were 16,822 deaths in the United States due to accidental poisoning by and exposure to narcotics and psychodysleptics—a broad category that includes cannabis as well as cocaine, heroin, codeine, morphine, and several other narcotics (CDC, 2016b; WHO, 2016). Due, in part, to the limitations of current surveillance tools and medical record coding systems, there is a limited amount of more comprehensive and precise data on the association between cannabis use and overdose injury or death.
Meanwhile, the increasing availability, diversity, and potency of cannabis products create the potential for an increased risk of adverse health effects related to cannabis use, including overdose injury and death. Accidental ingestion of cannabis by young children can result in respiratory failure and coma, as noted by several case reports (Amirav et al., 2011; Appelboam and Oades, 2006; Carstairs et al., 2011), and the consumption of cannabis edibles has been identified as a contributing factor in the accidental death of at least one adolescent (Hancock-Allen et al., 2015).
Thus, the emerging cannabis products market creates the potential for an increased risk of cannabis-related overdose injury or death, while limitations in the current clinical and public health surveillance system hinder efforts to detect, characterize, and respond to this population health issue. This section reviews the available evidence on the association between cannabis use and overdose injury and death and discusses possible actions to improve the state of research on this health endpoint.
The committee identified few studies that report on the association between cannabis use and overdose death. Cannabis was not identified as a main cause in the intoxication deaths of drug addicts in five Nordic countries or a top cause of U.S. deaths related to pharmaceutical products. However, studies on the risks to Nordic populations posed by cannabis products available in those countries may not reflect the risks to U.S. populations posed by domestically available cannabis products, and cannabis might still be associated with overdose deaths without also being a top cause among pharmaceutical-related exposure deaths. Data from the National Poison Data System indicate that death was the outcome in a small number of single-substance exposures to cannabis; however, lacking further information, it is not possible to determine whether and to what extent cannabis contributed to these deaths. Case reports implicate acute cannabis intoxication in one accidental death and suggest that cannabis use may pose a risk for sudden cardiac death. However, these individual case reports cannot be used to infer a general association between cannabis use and overdose deaths. Overall, the committee identified no study in which cannabis was determined to be the direct cause of overdose death.
Several studies report that unintentional pediatric cannabis exposure is associated with potentially serious symptoms, including respiratory depression or failure, tachycardia and other cardiovascular symptoms, and temporary coma. Similar symptoms were not reported in adults exposed to cannabis. Most study limitations were related to the origin, quality, and completeness of data. For example, Wang et al. (2013) noted that findings based on data from a single children’s hospital or regional poison centers may not be generalizable to other health care facilities or poison centers, especially those in areas where laws regarding cannabis use are different than in Colorado. Search strategies employed in retrospective reviews of records from hospitals and poison centers may fail to capture all pertinent records, and some records may be incomplete (Wang et al., 2016). Data from poison centers will capture only the subset of cannabis-related overdose injuries or deaths that resulted in a call to a poison center and may overrepresent serious cases or cases from states where cannabis is legal (Wang et al., 2014). Moreover, Onders et al. (2016) observed that cannabis exposures are not identical to poisonings and overdoses; consequently, data on trends in cannabis exposures do not necessarily allow for an estimation of trends in cannabis overdose or poisoning.
9-4(a) There is insufficient evidence to support or refute a statistical association between cannabis use and death due to cannabis overdose.
9-4(b) There is moderate evidence of a statistical association between cannabis use and increased risk of overdose injuries, including respiratory distress, among pediatric populations in U.S. states where cannabis is legal. ”
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