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Research Pediatric Death Due to Myocarditis After Exposure to Cannabis

herbivore21

Well-Known Member
https://escholarship.org/uc/item/1n10w5pc

Abstract:

"Since marijuana legalization, pediatric exposures to cannabis have increased. To date, pediatric deaths from cannabis exposure have not been reported. The authors report an 11-month-old male who, following cannabis exposure, presented with central nervous system depression after seizure, and progressed to cardiac arrest and died. Myocarditis was diagnosed post-mortem and cannabis exposure was confirmed. Given the temporal relationship of these two rare occurrences – cannabis exposure and sudden death secondary to myocarditis in an 11-month-old – as well as histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death. In areas where marijuana is commercially available or decriminalized, the authors urge clinicians to preventively counsel parents and to include cannabis exposure in the differential diagnosis of patients presenting with myocarditis."


A news article relating to this study was posted on another message board recently. I thought it would be worth discussing this one here, however, with a focus on the original scientific research report.

Let's start with a few obvious questions some of you might have:

1. How much THC was found in the child's system?
The study reports 7.8nanograms per ml of blood. An average measure of the volume of blood in an adult (5000ml) would tell us that this equates to .039mg of Delta-9-THC. In an 11 month old child, we would expect drastically less blood volume - this study https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-6-3 suggests an approximate average volume of blood in a child weighing 20.5lb might be expected to be between 800-1200ml.

This would leave us with between .00625-.00936mg of delta-9-THC found in the child. This tells us two things, we're dealing with a very small amount of THC (much less than one could expect to absorb from a dab, for example), but we're also dealing with a very small child!

2. Is this study an isolated instance, or does it allow for generalization/extrapolation of findings to other cases?

This study is a case study. That means it is looking at a single, isolated incident involving the one child, who tragically died. This study does not provide evidence to support any causal link between cannabis use and myocarditis, rather, citing 3 sources which have implied or explicated such a link. These are citations 16-18 in the study. We'll consider that justification here:

16. Leontiadis E, Morshuis M, Arusoglu L, et al. Thoratec left ventricular assist device removal after toxic myocarditis.
Ann Thorac Surg.2008;86(6):1982-5.

17. Rodríguez-Castro CE, Alkhateeb H, Elfar A, et al. Recurrent myopericarditis as a complication of marijuana use.
Am J Case Rep. 2014;15:60-2.

18. Tournebize J, Gibaja V, Puskarczyk E, et al . Myocarditis associated with cannabis use in a 15-year-old boy: A rare case report. Int J Cardiol. 2016;203:243-4.


As many of you may immediately notice, the title of source (18) and the journal that source (17) were published in clearly indicate that these studies are also case reports. In fact, 18 is entitled 'A rare case report'. Obviously, these are not studies that deal with representative, large scale data that allows for extrapolation. Instead, these are isolated incidents with no demonstrated causal link between cannabis use and the myocarditis.

3. Is there any causal relationship between cannabis use and this death claimed or demonstrated by the authors?


In fact, source (16) is also a case study. None of these cases individually demonstrates a clear causal link between the cannabis use and myocarditis, each rely on a 'temporal relationship', in other words, co-occurence of cannabis use followed by myocarditis. As many of you will know, correlation does not necessarily equal causation. We need to demonstrate the causal relationship with experimental data before claiming a causal link. Even if all 3 of them did, and even if the evidence in the study that this thread considers was compelling in demonstrating that causality (it isn't!), these are three isolated incidents which do not provide sufficient evidence to suggest a causal link between cannabis use and myocarditis in the rest of a given population.

Actually, the authors imply this in their conclusion:

"we believe there exists a plausible relationship that justifies further research into cannabis-associated cardiotoxicity and related practice adjustments". In other words, Nappe and Hoyte believe that the isolated co-occurence that they observed in their unfortunate patient, as well as sources 16-18 above merit further study to investigate whether their is a causal link. These case reports may be used as a reasonable basis to justify further research, however, none of this research provides any reasonable basis to assert causality between cannabis use and myocarditis.

Now let's discuss the media coverage. The above is important to appreciate, because of the following headline:

Baby boy is first marijuana overdose death, doctors claim

http://www.nydailynews.com/news/nat...verdose-death-doctors-claim-article-1.3637939

Obviously, this headline already says more than the authors of the study were prepared to say! However, let's consider the following quote:

"Nappe and Hoyte wrote in their study that the first person to die from a marijuana overdose was an 11-month-old boy."

I quoted the above from the NY Daily article here to illustrate the sensationalized and unsubstantiated claims that we frequently find in media coverage of scientific research. The term 'overdose' actually does not appear at all in Nappe and Hoyte's report!

There was certainly no claim that there had been a cannabis 'overdose' in those particular terms, and Nappe and Hoyte's report actually stops short of claiming more than a correlation at this stage, instead suggesting the plausibility of a link, but that further investigation would need to be carried out to investigate whether a link exists. The title and main body of the original study clearly highlight a temporal, correlational link based on a very small number of isolated cases. This doesn't mean we should give tiny infants cannabis of course, but let's take this 'marijuana overdose' stuff with a pinch of salt. There's no demonstrable causal relationship to speak of yet and the body of literature used to suggest plausibility of a possible link to be investigated is not compelling by scientific standards for validity in generalization/extrapolation :peace:
 

OldOyler

Well-Known Member
Peace @herbivore21 !

From the CDC, some 5 year period death rates for perspective for everyone.

"Contact with powered lawnmower" — 951 deaths

"Fall involving ice-skates, skis, roller-skates or skateboards" — 1,139 deaths

"Constipation" — 2,167 deaths

"Contact with agricultural machinery" — 4,183 deaths

"Accidental suffocation and strangulation in bed" — 10,206 deaths

"Fall involving bed" — 10,386 deaths

"Fall from tree" — 1,413 deaths

Peace!

 

herbivore21

Well-Known Member
Peace @herbivore21 !

From the CDC, some 5 year period death rates for perspective for everyone.

"Contact with powered lawnmower" — 951 deaths

"Fall involving ice-skates, skis, roller-skates or skateboards" — 1,139 deaths

"Constipation" — 2,167 deaths

"Contact with agricultural machinery" — 4,183 deaths

"Accidental suffocation and strangulation in bed" — 10,206 deaths

"Fall involving bed" — 10,386 deaths

"Fall from tree" — 1,413 deaths

Peace!
Holy shit, people died from constipation!?

A lot of folks are blowing up and slinging all kinds of muck at the authors of the study cited in the OP here. Something that those people should note is that the authors do not suggest that cannabis is demonstrably and causally linked to myocarditis, and anybody reading the actual research will see that this is a very inconclusive case report about a very unfortunate loss of a child. The authors called for further research, which every researcher who ever published a study also has done since time immemorial!

The news articles talking about THC OVERDOSE and this kind of exaggerated nonsense are written by journalists, not researchers. They are the ones who IMO need to be held to a higher standard :twocents:
 

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