Last month, both the cannabis and medical industries experienced a significant first: a coroner in Louisiana officially reported the cause of death of a 39-year-old woman as an overdose of Delta-9-tetrahydrocannabinol, or THC, the main psychotropic chemical in cannabis and the cannabinoid responsible for the plant’s psychoactive effects.
If true, this would be the first recorded case of a person overdosing on THC in the world. This finding has, of course, raised a lot of questions, not the least of which include: a) whether it is even possible to overdose on THC (something believed to be impossible to date as there has never been a report of such on record); and b) what it means to be an expert on cannabis/marijuana and whether those experts truly do exist. Let’s discuss.
The Situation: The First THC Overdose on Record?
Throughout the ongoing debate over federal and state-level cannabis legalization for medical and recreational use, advocates on both sides of the issue have been extremely vocal about the benefits and potential dangers of cannabis use. Understandably, the findings of Louisiana coroner Dr. Christy Montegut that pointed to a THC overdose made national news as cannabis naysayers and advocates alike weighed in on the issue.
So how did we end up here?
When a 39-year-old woman was found dead in her Louisiana apartment in February, Dr. Montegut was called upon in her capacity as coroner for the local parish to investigate the cause of death, as none was immediately apparent. According to local news sources, the woman’s boyfriend told responding police officers that his girlfriend had used a marijuana vaping pen. Additionally, he revealed that the deceased had visited the hospital three weeks prior for a chest infection and was prescribed the over-the-counter drugs Mucinez and Robitussin D.
The woman’s autopsy, however, showed that both her lungs and her other organs were “totally healthy” and showed no signs of illness. Montegut’s next assumption was alcohol poisoning, however the only elevated substance to appear on the woman’s toxicology report was THC. “For marijuana to show up positive on our toxicology test, the level has to be greater than 0.5,” Montegut said. The woman’s actual THC level was 8.4 nanograms per milliliter of blood. “At high levels, marijuana can cause respiratory depression, which means a decrease in breathing,” Montegut explained. “If it's a high enough level it can make you stop breathing.” This statement alone effectively summarizes Montegut’s ruling regarding the woman’s death.
Many other physicians are calling Montegut’s findings into question, however. Colorado doctor Noah Kaufman, for example, suspects that other factors may have come into play with regard to this particular case. He points out that THC shouldn't affect breathing because of how the substance enters the body, and that it is possible other drugs were not detected in the toxicology test.
"THC is becoming so powerful these days that we are kind of playing with fire a little bit, and there may be more and more and more people that start to have some kind of an adverse reaction," Kaufman said. "Everything looked above the board, and the only thing they found was the THC in the blood and so they made an association."
Unfortunately, when even medical professionals are unable to agree on whether cannabis can be fatal, it becomes extremely difficult for the average person to discern overall safety. As such, a need arises for reliable sources who are deeply aware of cannabis’ intricacies and are capable of communicating those details at large.
What Does it Mean to Be a Cannabis Expert?
As a licensed physician and in the context of this discussion, I consider medical training of some kind to be a prerequisite to being an “expert” on cannabis. That said, I want to make it painfully clear that a medical or nursing license alone does NOT automatically qualify a person as an expert on this topic.
In fact, as Mike Adams points out in his Forbes article on the subject, the majority of physicians are woefully undereducated or misinformed when it comes to the topic of cannabis. A recent study published in the Journal of American Medical Association (JAMA) found that most doctors do not know anything about cannabis, including the applications and possible effects of the CBD products now available over the counter in retail stores like Urban Outfitters, Bed Bath and Beyond, and Ulta.
The Stanford University School of Medicine researchers that conducted the study found that 85% of medical professionals have “absolutely no education or training when it comes to cannabis,” and that close to 80% of physicians don’t even realize that marijuana is a Schedule I substance (read more on the scheduling status of cannabis here). Even more frightening: about 40% of medical professionals think that “weed” is a drug that has already received FDA approval.
Lead researcher and resident physician at Stanford Nathaniel P. Morris, MD commented on the study findings:
“I had always heard it was difficult, if not impossible, to die from marijuana use. We hardly learned about marijuana during medical school, and I don’t remember many questions about marijuana on our licensing examinations that went beyond redness of the eyes. Why focus on marijuana when physicians must worry about medical emergencies such as cardiac arrest, sepsis, pulmonary embolisms, opioid overdoses, and alcohol withdrawal?
“Just a few years later, marijuana seems ubiquitous. [...] In California, where medical and recreational marijuana use is legal under state law, I drive to work past billboards advertising home delivery services for marijuana. Within blocks of my apartment, 3 dispensaries offer marijuana buds, vape pens, oils, cookies, brownies, and gummies with varying degrees of tetrahydrocannabinol (THC) and cannabidiol. Marijuana has become an inescapable part of my medical training, and most of my learning has come from patients.”
Interestingly, a retired assistant administrator for operations from the US Drug Enforcement Administration (DEA), John Coleman, MS, MA, PhD added his thoughts on the study findings via a comment on Dr. Morris’ article:
“Dr. Morris gives a fair but disturbing account of the knowledge base among the medical profession as to the harms of marijuana. That more than a third of a site survey of resident physicians believed marijuana is FDA-approved (and, presumably, OK to prescribe for medical use) is very troubling for a public that depends on the knowledge and skill of their physicians for good health. [...]
“With the burgeoning of the commercial marijuana industry in the US, and the emergence of large capitalized sources, we may begin to see a rapid increase in the needed research that Dr. Morris suggests is essential. It is unacceptable in this day and age that physicians be expected to acquire their knowledge of this drug on the unverified appraisals of its users. Those appraisals more often than not will reflect the intoxicating or psychic effects of the drug rather than its therapeutic benefits, if any.”
As basic cannabis training is largely unreliable and unavailable to most US medical professionals, expertise in the subject relies on dedicated self-training and independent research. Patients and consumers are, as always, encouraged to exercise caution when exploring medical cannabis options as qualification is not always apparent. Ask questions, test knowledge, and make educated decisions about whether your health is the first priority for the practice you choose to engage.
So, DO Cannabis Experts Exist? And If So, Who Are They?
Despite what we just discussed above, I hold that cannabis experts do in fact exist--they’re just much fewer and farther between than popular belief currently holds.
How do I know, you may ask? The simple, straightforward answer is that I am one. Unlike many of the cannabis physicians or other “experts” you see promoting their knowledge and “treating” patients in various parts of the country, I spent time training in neurological surgery, conducting and presenting basic (lab-based) scientific research on the applications of cannabinoids during various neurological insults, presenting research at academic meetings, and developing a robust clinical practice dedicated to the safe and efficacious application of cannabinoid therapies.
Additionally, I have spent countless hours studying and consulting with legislators and legal scholars in order to fully understand the intricacies of our local, state, and federal cannabis and hemp laws. It is simply not enough to have a robust medical and pharmacological knowledge base when it comes to the medical cannabis systems in this country--a physician must also become an expert in the legal environment in which he or she practices.
In summary, medical, pharmacological, and legal training and experience is critical when seeing a medical provider as a “cannabis expert”. We do exist, and it is important that those rare few of us with the proper training and knowledge be given the regional and national platform to spread our wealth of information and dispel untruth where we find it.
Luis Enrique R. Liogier-Weyback, MD is the founder of Doctor Jane, Florida’s most discreet, professional and convenient concierge medical cannabis practice. Doctor Jane provides South Florida patients and their caregivers with a safe space where they can exercise their right to access medical cannabis therapy in an environment of their choosing, free from stigma and complications. To learn more about Doctor Jane, visit www.DoctorJane.net.
About Doctor Jane
Doctor Jane is South Florida’s most discreet, professional, and convenient concierge medical cannabis practice. Dr. Luis Enrique R. Liogier-Weyback and his wife, Katie Liogier-Weyback, B.S., R.N., founded Doctor Jane on the core tenets of bringing personal, convenient, professional and discreet patient care to the medical cannabis treatment process. Doctor Jane provides South Florida patients and their caregivers with a safe space where they can exercise their right to access medical cannabis therapy in an environment of their choosing, free from stigma and complications.
Visit our website to find out more or to schedule your own medical cannabis consultation. www.DoctorJane.net.