With COVID, we have never been more aware of critical shortages of masks, ventilators, hospital beds, etc., all leading to rationing. In this BLOG, Dr Frankel, examines how rationing in our medical care is a much bigger problem than just face masks.
“Major self-mutilation (amputation, castration, self-inflicted eye injuries) is frequently associated with psychiatric disorders and/or substance abuse. A 35-year-old man presented with behavioral disturbances of sudden onset after oral cannabis consumption and major self-mutilation (attempted amputation of the right arm, self-enucleation of both eyes and impalement) which resulted in death. During the enquiry, four fragments of a substance resembling cannabis resin were seized at the victim’s home. Autopsy confirmed that death was related to hemorrhage following the mutilations. Toxicological findings showed cannabinoids in femoral blood (tetrahydrocannabinol (THC) 13.5 ng/mL, 11-hydroxy-tetrahydrocannabinol (11-OH-THC) 4.1 ng/mL, 11-nor-9-carboxy-THC (THC-COOH) 14.7 ng/mL, cannabidiol (CBD) 1.3 ng/mL, cannabinol (CBN) 0.7 ng/mL). Cannabinoid concentrations in hair (1.5 cm brown hair strand/1 segment) were consistent with concentrations measured in chronic users (THC 137 pg/mg, 11-OH-THC 1 pg/mg, CBD 9 pg/mg, CBN 94 pg/mg). Analysis of the fragments seized confirmed that this was cannabis resin with high levels of THC (31-35%). We discuss the implications of oral consumption of cannabis with a very high THC content.
I posted this abstract last year, but took it down being concerned this was just too crazy to look at. I feel differently this year. Clearly this patient had very serious psychiatric issues. Most patients with serious psychiatric conditions use cannabis as an attempt to help their mood issues. These young adults or even teens, are in need of help and should receive it, If a young adult has serious psychiatric issues, but for the most part, cannabis is found to be helpful, they should be seen by a competent cannabis specialist and make every effort to get the patient to switch to dosed cannabis with CBD being a significant part of the therapy, but not necessarily without help from THC.
So, this was interesting, but the main point is that the blood levels they site are just NOT that of excessive THC use. The LEGAL LIMIT in states that use a plasma level to confirm intoxication is 5 ug/ml. This patient had 13, which is a bit more, but patients whether THC naive or long term users, will rarely have issues.
It is just as likely that this patient was feeling terrible, depressed and used cannabis to calm down. Clearly it did not work, but assuming this behavior was caused by cannabis is just not right.
One more article where cannabis is the real problem rather than the underlying disease.
IF this patient was schizophrenic, it is very common to use THC to try get their heads straight. By the time they reach 20 or 21 the schizophrenia clearly reveals itself. I have treated dozens of young adults with schizophrenia with CBD. We might be adding THCV in the future. I believe it is well worth trying as it has been shown in a German study on Schizophrenia where they compared anti-psycotics to CBD. They worked the same, but the CBD group had way less side effects.
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