Recreational marijuana is currently permitted in state law in Alaska, Colorado, Oregon, Washington and the District of Columbia.
Marijuana intoxication was reported as a chief contributing factor to the death of the student who jumped from a fourth-floor balcony at a hotel in Colorado after eating a whole cookie - equivalent to six and a half servings.
The police report for the incident states that, initially, the deceased ate one single piece of the cookie, as advised by the sales clerk who had sold the product. After not feeling any effects, however, approximately 30-60 minutes after eating, the deceased consumed the rest of the cookie.
Over the next 2 hours, the police report describes the deceased's behavior as becoming hostile and his speech becoming erratic. Approximately 2.5 hours after eating the entire cookie, the man jumped from the balcony to his death.
The autopsy found 7.2 nanograms of tetrahydrocannabinol (THC) - the high-inducing compound in marijuana - per milliliter of blood of the deceased's body. As a point of comparison, the legal THC limit for driving in Colorado is 5.0 ng/mL.
It can be difficult to see the psychoactive effects of marijuana on an individual that has consumed an edible marijuana product at first because of how slowly the drug is absorbed compared with smoking. Peak THC concentrations within the body are not reached until 1-2 hours after ingestion, whereas with smoking they are reached within 5-10 minutes.
Additionally, the length of time for which an individual is intoxicated is much longer with edible marijuana than it is when the drug is smoked. For these reasons, it is very important that people taking recreational marijuana take care to get their dose levels correct.
"Because of the delayed effects of THC-infused edibles, multiple servings might be consumed in close succession before experiencing the 'high' from the initial serving, as reportedly occurred in this case," the Centers for Disease Control and Prevention (CDC) state. "Consuming a large dose of THC can result in a higher THC concentration, greater intoxication, and an increased risk for adverse psychological effects."
Accidental overconsumption reports spur packaging changes
The police report indicates that the deceased had been informed by the sales clerk to divide the marijuana cookie into sixths - each sixth containing around one 10 mg serving of THC - and that the cookie should only be ingested one serving at a time. However, the report does not mention whether the sales clerk advised how long the deceased should wait between servings.
Colorado is one of four states and the District of Columbia in which recreational marijuana is permitted for adults older than 21. Its first state-licensed recreational marijuana stores opened in January 2014, 2 months before the death of the student. Around 45% of the state's marijuana sales involve edible forms of the drug.
Dr. Robert Glatter, an emergency physician, told HealthDay that the amount of the drug ingested by the deceased was not a lethal amount:
"You could eat several of these cookies and be put into a euphoric state, and possibly have anxiety, but that, in and of itself, would not be lethal. He likely may have had a predisposition or some underlying mental illness we didn't know about, that became unmasked when he ate the cookie. That's probably the issue here."
According to the police report, the deceased had no known history of mental illness, nor had he any known history of alcohol abuse or illicit drug use.
In February this year, Colorado revised their packaging and labeling rules for recreational marijuana after analyzing surveillance data and reports of accidental overconsumption. Recreational edible marijuana products must now contain no more than 10 mg of THC or have each 10 mg serving clearly marked.
The CDC state that this case suggests there is a need for improved public health messaging to reduce the risk for overconsumption of THC. They also recommend that other states could potentially reduce adverse health effects with similar policies to the ones brought in this year by Colorado.
Earlier this month, Medical News Today reported on a study that found THC is triggered by a pathway that is separate from its other effects.