Skip to main content

Advertisement

Log in

Cannabis, possible cardiac deaths and the coroner in Ireland

  • Original Article
  • Published:
Irish Journal of Medical Science Aims and scope Submit manuscript

Abstract

Background

The elevated risk of triggering a myocardial infarction by smoking cannabis is limited to the first 2 h after smoking.

Aim

To examine the possible role of cannabis in cardiac deaths.

Cases and results

From 3,193 coroners’ cases over 2 years, there were 13 cases where the clinical information was compatible with a primary cardiac cause of death. An inquest was held in three cases. Myocardial infarction was the primary cause of death in 54%. Other causes were sudden adult death syndrome, sudden death in epilepsy, and poisoning by alcohol and diazepam. Cannabis was mentioned once only on a death certificate, but not as a cause of death. Blood delta9-tetrahydrocannabinol-carboxylic acid was recorded in one case and in no case was plasma tetrahydrocannabinol (THC) measured.

Conclusions

To attribute sudden cardiac death to cannabis, plasma THC should be measured in the toxicology screen in coroners’ cases where urine cannabinoids are positive. A positive urine cannabinoids immunoassay alone is insufficient evidence in the linkage of acute cardiac death and cannabis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE (2001) Triggering myocardial infarction by marijuana. Circulation 103:2805–2809

    Article  PubMed  CAS  Google Scholar 

  2. Huestis MA, Barnes A, Smith ML (2005) Estimating the time of last cannabis use from plasma Δ9-tetrahydrocannabinol and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol concentrations. Clin Chem 51:2289–2295

    Article  PubMed  CAS  Google Scholar 

  3. Guidelines on autopsy practice. Scenario 1: sudden death with likely cardiac pathology. Royal College of Pathologists. January 2005

  4. Cahill E, Byrne M (2010) Alcohol and drug use in students attending a student health centre. Ir Med J 103:230–233

    PubMed  CAS  Google Scholar 

  5. O’Cathail SM, O’Connell OJ, Long N et al (2011) Association of cigarette smoking with drug use and risk taking behaviour in Irish teenagers. Addict Behav 36:547–550

    Article  PubMed  Google Scholar 

  6. Lyons S, Lynn E, Walsh S, Sutton M, Long J (2011) HRB Trends Series 10., Alcohol-related deaths and deaths among people who were alcohol dependent in Ireland, 2004–2008. National Drug-Related Deaths IndexHealth Research Board, Dublin, pp 9–10

    Google Scholar 

  7. Lynn E, Lyons S, Walsh S, Long J (2009) HRB Trends Series 8., Trends in death among drug users in Ireland from traumatic and medical causes, 1998 to 2005. National Drug-Related Deaths IndexHealth Research Board, Dublin

    Google Scholar 

  8. Tormey W (2011) Cannabis misinterpretation and misadventure in a coroner’s court. Med Sci Law. doi:10.1258/msl.2011.011087

  9. Huestis MA, Mitchell JM, Cone EJ (1996) Detection times of marijuana metabolites in urine by immunoassay and GC–MS. J Anal Toxicol 19:443–449

    Google Scholar 

  10. Huestis MA (2007) Human cannabinoid pharmacokinetics. Chem Biodivers 4:1770–1804

    Article  PubMed  CAS  Google Scholar 

  11. Verstraete AG (2004) Detection times of drugs of abuse in blood, urine, and oral fluid. Ther Drug Monit 26:200–205

    Article  PubMed  CAS  Google Scholar 

  12. Reiter A, Hake J, Meissner C, Rohwer J, Friedrich HJ, Oehmichen M (2001) Time of drug elimination in chronic drug abusers. Case study of 52 patients in a “low-step” detoxification ward. Forensic Sci Int 119:248–253

    Article  PubMed  CAS  Google Scholar 

  13. Manno JE, Manno BR, Kemp PM et al (2001) Temporal indication of marijuana use can be estimated from plasma and urine concentrations of delta9-tetrahydrocannabinol, 11-hydroxy-delta-9-tetrahydrocannabinol, and 11-nor-delta9-tetrahydrocannabinol-9-carboxylioc acid. J Anal Toxicol 25:538–549

    PubMed  CAS  Google Scholar 

  14. Gunnell D, Hawton K, Kapur N (2011) Coroners’ verdicts and suicide statistics in England and Wales. Br Med J 343:d6030

    Article  Google Scholar 

  15. The High Court Judicial review. Fiona Byrne v Dr Kieran Geraghty. 2007/134JR

  16. Sorensen LK (2011) Determination of cathinones and related ephedrines in forensic whole-blood samples by liquid-chromatography–electrospray tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 879:727–736

    Article  PubMed  CAS  Google Scholar 

  17. Office for National Statistics. Deaths related to drug poisoning in England and Wales, 2009

  18. Health Research Board. Drug-related deaths and deaths among drug users in Ireland: 2008 figures from the National Drug Related Deaths Index, January 2011

  19. Nawrot TS, Perez L, Kunzli N, Munters E, Nemery B (2011) Public health importance of triggers of myocardial infarction: a comparative risk assessment. Lancer 377:732–740

    Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to W. P. Tormey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tormey, W.P. Cannabis, possible cardiac deaths and the coroner in Ireland. Ir J Med Sci 181, 479–482 (2012). https://doi.org/10.1007/s11845-011-0802-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-011-0802-5

Keywords

Navigation