Around 2 weeks ago, I discovered a service which Google provides called Alerts. Basically, when the search engine indexes anything pertaining to a given keyword into its database, Google emails you an alert to let you know. Or if the topic was fairly large, you will get a list of new results daily.
I decided to start following the keywords “Marijuana Research” because it’s one of my areas of research of late. And since anything of any pertinence to the topic isn’t going to be showing up for years (at minimum), this seemed a good way to keep in the loop.
Along with the useful stuff, you get other materials as well. Most of which tend to either be positive leaning opinion pieces or negative leaning news reports, most originating from local TV newsrooms around the US. Not surprising, given the bias which is often at play within these newscasts.
2 words . . . Sinclair Media.
Either way, marijuana hit pieces are just par for the course, at this point. However, this one is a whole new ball game altogether.
A coroner who said a woman died from a THC overdose, considered the first in the country, stands by his report. THC, or tetrahydrocannabinol, is the active ingredient in marijuana.
An unnamed 39-year-old woman died in February from a THC overdose, St. John the Baptist Coroner Dr. Christy Montegut said in his report released late last month, The Advocate reported.
This is (or as it stands, would be) a first. However, one of the things that jumped out at me about this was right in the headline. Coroner.
Though they share the same job as a medical examiner, the skill set is not always . . . required. Thanks to many factors, one of them including serious budget cuts in many areas of the US. An issue brought to my attention recently by John Oliver.
Before I go any further ahead, we have to go back a bit. Time for a history lesson.
How Qualified Is Your Coroner?
Introduced to the colonies by early settlers, the role of coroner dates back to English common law. King Richard I developed the system in the 12th century, partly to fund the expensive Crusades. “Crowners” as they were then known, conducted inquests on the king’s behalf to identify the deceased and investigate how they died, but more importantly, to collect death taxes on their estates.
The more than 2,000 coroner offices across the United States are vestiges of this royal system. Individual state statutes dictate whether death investigations — which include examining the scene, reviewing medical records, performing autopsies and determining the manner and cause of death — are conducted by a coroner or a medical examiner. As opposed to coroners, most medical examiner systems operate under the direction of a licensed physician, who is almost always trained in pathology and forensic science.
The Variations From State to State
More than 1,500 counties operate under a coroner system, where qualifications and expectations vary, according to the National Association of Medical Examiners.
- Kansas, Ohio, and Louisiana require coroners to be certified forensic pathologists.
- In Nebraska coroners are often also the county attorney.
- Indiana and Wyoming require completion of a basic coroner-training course and some additional annual training. An 18-year-old made headlines when she was elected deputy coroner in Jay County, Ind. while still in high school.
- Colorado state law encourages its coroners to have training in forensic death investigation methods, but it’s not required.
- North Dakota requires that coroners be licensed physicians, but only in counties of more than 8,000 people.
- Georgia requires that you be at least 25 years old, have no felony convictions, have a high-school education and complete a week’s training course in death investigation before you take the job.
- In Wisconsin and West Virginia, non-physicians can serve as medical examiners.
In reality, the coroner system (as noted) is an entire topic in itself. As it stands, however, not the topic at hand.
This source has served to relax some of my reservations, however. As noted above, Coroners in Louisiana have to be certified forensic pathologists, a title achieved through many studies. Though such a title doesn’t necessarily eliminate all human bias factors (as I learned here), at least we seem to be dealing with someone with the right qualifications to be making such a claim.
“I’m thinking this lady must have vaped this THC oil and got a high level in her system and (it) made her stop breathing, like a respiratory failure,” Montegut, who has served as coroner since 1988, told The Advocate.
However, experts are doubtful. There are no reports of teens or adults dying solely from marijuana, according to the National Institute on Drug Abuse.
“We know from really good survey data that Americans use cannabis products billions of times a year, collectively. Not millions of times, but billions of times a year,” Keith Humphreys, a former senior policy adviser at the White House Office of National Drug Control Policy, told The Advocate. “So, that means that if the risk of death was one in a million, we would have a couple thousand cannabis overdose deaths a year. Let’s assume (that the woman died from THC) is a fact. What do you conclude from that? It doesn’t justify really anything from a policy viewpoint. It’s just so incredibly unlikely.”
Montegut stands by his report.
“I’m 100 percent sure of the readings we’ve found,” he told WWLT. “I definitely did some research before I came to the conclusion that this was the cause of death.”
Not included in the short republished version (quoted previously) of an article originating in The New Orleans Advocate is this:
Montegut said the THC in her system likely came through a vaping device with highly concentrated THC oil. A toxicology report said she had 8.4 nanograms per milliliter of blood.
Impaired driving can occur with as little as 2 nanograms of THC per milliliter, according to at least one study. But even more than four times that level shouldn’t have been nearly enough to be fatal, according to Bernard Le Foll, a professor and scientist at the University of Toronto who studies addiction.
“That number is not very high,” Le Foll said.
While there’s not a specific threshold considered by experts to be a lethal dose, based on his research, Le Foll estimated that any threshold would likely fall between 100 and 1,000 times higher than the THC level found in the LaPlace woman’s blood.
Past estimates have suggested that a person would need to smoke more than 20,000 joints to reach a potentially lethal THC toxicity.
Still, there’s no way to be sure how much THC was in the woman’s system when she died, Le Foll said, because by the time an autopsy was done, the THC concentration, which falls quickly, had certainly gone down.
The last sentence is rather amusing. I’m pretty sure that is someone had somewhere in the area of 20,000 joints worth of THC in their system, tests would find more than hardly a trace of that number in their system.
Also within the New Orleans Advocate article (and not the subsequent reprint) is this:
St. John the Baptist Parish Coroner Christy Montegut said last week that toxicology results for a 39-year-old LaPlace woman who died in February showed that she was killed by an excess amount of THC, the main active ingredient in marijuana.
“It looked like it was all THC because her autopsy showed no physical disease or afflictions that were the cause of death. There was nothing else identified in the toxicology — no other drugs, no alcohol,” Montegut said. “There was nothing else.”
The woman’s name was not released.
Montegut, who has served as the St. John coroner since 1988, believes this could be an index case in medicine, perhaps the first death on record solely as a result of THC exposure.
And there it is, folks. The human factor.
Imagine all the doors that would open if you are the first forensic pathologist with a proven case of death by THC on their resume. You end up with both reason to find your way to this end result, AND reason not to want to admit any possibility of error.
Some drug researchers and experts are skeptical.
Rightly so. This is more transparent than a broken window.
Later in the same article, you have this quote from Keith Humphreys, former senior policy adviser at the White House Office of National Drug Control Policy:
“We know from really good survey data that Americans use cannabis products billions of times a year, collectively. Not millions of times, but billions of times a year,” said Humphreys. “So, that means that if the risk of death was one in a million, we would have a couple thousand cannabis overdose deaths a year.”
Humphreys also said it’s not uncommon for coroners to see a drug in the system, with no other sign for what might have caused an event leading to death, and so conclude that the drug was the cause.
“There’s always some imperfection in these kinds of assessments,” he said.
At this point, I am comfortable with accepting the seemingly overwhelming evidence that this more than likely was not a death associated with THC. A potential lead to follow lies in the delivery method (is there something off with the vaping fluid?), but again, that is conjecture. Considering that this looks to be a one-off. And with many people vaping, you would think this would have shown up again.
Either way, I doubt that Dr. Cristy Montegut is willingly going to go back and recheck her work for validity (as though that would be credible anyway). It would be great for this to move on and for a 2ed (hopefully unbiased) physicians opinion to be heard on the matter. But that is unlikely, and arguably disrespecting the deceased.
Though not nearly as disrespectful as bringing this into the national (well, international) spotlight to begin with.
Either way, the damage is already done. The one track minded have potentially gained a source to cite for the 1st ever death related to THC. And no matter how thoroughly this may be debunked in the future, many will only see the preliminary diagnosis.
She probably didn’t die from THC poisoning. We may never know what she died from. Such is how the world works. We don’t always know the answer. We may never know the answer.