This Report is Based on “By Guess” and “By Gosh”, NOT Evidence
Recently, a great deal of ink and internet memory was used to claim that cannabis caused the death of a child from cardiomyopathy. The article discussed a possible relationship, but the headlines have really jumped to a conclusion with few facts. I am here to bring some facts to this fiction.
To date, there has never been a death from cannabis overdose. The vast majority of overdose deaths are caused by depressed respiration and this does not happen with cannabinoids because there are few or no CB1 receptors in the brain stem. Just because Donald Trump has popularized the term “fake news” doesn't mean this is another one of his exaggerations. A better term is not doing your research and sensationalizing the news.
This looks like a case where the physicians were trying to explain a diagnostic conundrum. We know little or nothing about cannabis here. The only thing we know about cannabis in this case is that the child was exposed to cannabis at some time in the weeks prior to his demise. This was likely more than three or four days prior to the blood draw. This is based on the absence of THC and 11-hydroxy-THC, which can be found in the urine several days after last exposure. The 9-carboxy-THC at 7.6 ug/ml is very low for having recently consumed cannabis.
So, as far as we know, cannabis does not cause myocardititis. Myocarditis is an inflammation of the myocardium and cannabis contains numerous anti-inflammatory molecules including THC, CBD, plus many of the over 200 terpenes are anti-inflammatory.
The report does not indicate actual consumption, only exposure, whatever that means. In their introduction, the authors are parsing their words. They call this "a potential link between cannabis exposure and myocarditis." Given the lab findings and case report that is unsubstantiated idle speculation. Clearly this is not a proven cause of death due to cannabis. It is death due to myocarditis.
While this case report does not meet any standard for evidence based medicine, keeping cannabis out of reach of a child is just one more item to place at the bottom of a long list of responsibilities in raising a healthy child: This is not a clarion call to parents that cannabis will kill your child. It is a reminder that we need to make sure medicine - aspirin, iron tablets, alcohol, cleaning material - are kept out of the reach of a child. Being a parent is the hardest job you'll ever have. It requires time, care and diligence.
The references cited have been cherry-picked and are inconsistent with 60 years of modern research:
Let's take a look at what the research really shows regarding the cardiovascular effects of cannabis. A 2002 article in the Journal of Clinical Pharmacology by R.T. Jones entitled "Cardiovascular System Effects of Marijuana" is a good place to start:
Tolerance to Cardiac Effects is Rapid: Jones states, "Tolerance to most of the initial cardiovascular effects appears rapidly. With repeated exposure, supine blood pressure decreases slightly, orthostatic hypotension disappears, blood volume increases, heart rate slows, and circulatory responses to exercise and Valsalva maneuver are diminished."
Positive Cardiovascular Effects: There are positive cardiovascular effects of cannabis. It helps minimize cell death in an ischemic event. Inflammation has been found to play a central role in vascular occlusions from atrioventricular septal defects (AVSD). Cannabis is anti-inflammatory. Animal research has shown cannabinoids can decrease cardiac damage caused by transient decreases blood flow (e.g., cardiac ischemia).
The beneficial cardiac potential for CBD was highlighted in a 2013 review article in the Journal of Pharmacology. The review explains that in rodent models, cannabis reduced vascular tension, a condition that causes additional strain on the heart. Cannabis has also been shown to protect the arteries from damage from glucose. The same article wrote that cannabis reduces the general inflammation in blood vessels.
The active compounds in cannabis engage with the cardiac system to produce protective effects . A rodent study published in the International Journal of Cardiology found deficiencies in the endocannabinoid system possibly contributing to chronic arteriosclerotic heart disease (ASHD). Mice that had lower levels of cannabinoid 1 receptors (CB1) suffered more heart abnormalities than mice with healthy CBl expression.
"In this study we found that CBl deficiency contributed to the extensive chronic cardiac remodeling ... revealing a new role of CBl in [chronic heart failure]."
CB2 receptor activation is anti-atherogenic. Steffens et al. showed a decrease in progression of atherosclerotic lesions in murine models after oral administration of low dose THC. THC also down regulates Thl immune response cells, which are the major cells in atherosclerotic lesions . A synthetic CB2 receptor agonist was shown to decrease the size of plaque and macrophage content in atherosclerotic lesions. The CB2 receptor agonist also reduced oxidized-LDL-mediated NF-kb activation and pro-inflammatory cytokine expression.
In a 15-year longitudinal follow-up of 2,617 adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, there was no association between marijuana and cardiovascular risk after adjusting for confounding factors.
At this point it might be worth doing a few well designed animal studies. We can do that right after we check the relationship of vaccines to autism. Until we have real evidence and not speculation based on one case and no information as to time, date and dose of exposure, and if cannabis was even consumed, there are an enormous number of public health issues to address such as the impact of climate change.
The evidence to the contrary about cannabis's effect on the heart is substantial. It protects heart tissue. As an anti-inflammatory it is protection against MRI. Medicinal cannabis should be treated as one would any other medicine. We still see overdose deaths from aspirin and iron tablets, so the advice to keep medicine out of the reach of children is well taken.
We need to take aggressive action against airborne irritants and toxins in the water and genetically engineered food that we eat and drink which may affect our health.
The conclusion is muddy. It is an exercise to make a connection that does not exist. We know the child had myocarditis. We do not know what caused it. There is only speculation at this point. This may be worth doing some research on— although the research on cannabis's effect on the cardiovascular system is extensive. Only after this unusual case is more fully investigated and further epidemiological studies and more basic science work is done can we definitively find that there is some nexus between the cardiomyopathy and the ingestion of cannabis.
This case does suggest that cannabis should be rescheduled to schedule II so it is easier to do tissue cultures, animal and human studies on cannabis as requested by the American Medical Association House of Delegates in 2009.
"You just can't make those statements because then what happens is lay people say, 'Oh my God, did you hear a kid died from marijuana poisoning?' and it can be sensationalized ," Noah Kaufman, a Northern Colorado emergency room physician, told The Washington Post. "It's not based on reality. It's based on somebody kind of jumping the gun and making a conclusion, and scientifically you can't do that."
The most likely cause of cardiomyopathy here is the sequelae of a viral infection: cardiomyopathy secondary to a viral infection is so common that it was a plot line in a November 2017 episode of Major Crimes. The media needs to be on the alert for fake news. Kudos to The Washington Post for not being taken in by an operator of Judge Moore who was trying to plant fake news.