I thank Dr Ocana for his insightful article, “Cannabis use by adolescents: Practical implications for clinicians” [BCMJ 2018;61:14-19]. I would, however, question his conclusion that “there are more accidental overdoses and deaths. . .” attributed to the legalization of cannabis. His reference for this statement mentions a single death due to myocarditis in an 11-month-old who tested positive for THC. In a Washington Post article about that case, the child was said to be in an “unstable motel-living situation” with parents who admitted to multiple drug possessions, including marijuana. No causal relationship was suggested in the case report described in that article, and the death was attributed to myocarditis, not marijuana exposure. In fact, authors of the case report noted, “As of this writing, this is the first reported pediatric death associated with cannabis exposure.” Also in the article, “Nappe emphasized that the word ‘associated’ should not be interpreted as indicating a cause and effect.” I would also question the conclusion that cannabis legalization has led to more overdoses. Certainly legalization has been associated with more reported overdoses, but this could reflect willingness of parents to report accidental exposure because of decriminalization.
—Mike Figurski, MD, CA-CPHIMS
This letter was submitted in response to “Cannabis use by adolescents: Practical implications for clinicians.”
2. Silverman E. Washington Post. The truth behind the ‘first marijuana overdose death’ headlines. Accessed 2 April 2019. www.washingtonpost.com/news/to-your-health/wp/2017/11/17/the-truth-behind-the-first-marijuana-overdose-death.
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