A new report from the Centers for Disease Control and Prevention uses a death in Colorado that was tied to a marijuana cookie as an example of why there should be stricter pot-edibles regulations and better messaging about their consumption not just here but in many places across the country.
Along the way, the article — "Notes from the Field, Death Following Ingestion of a Marijuana Edible Product," included in the latest edition of the CDC publication Morbidity and Mortality Weekly Report (MMWR) — provides more details about the tragic case, which we covered in this space last year.
The name of the person who died isn't mentioned in the piece, but the specifics of the description make it clear the victim was Levy Thamba, a Wyoming college student who fell to his death from a hotel balcony in March 2014.
As noted by the Powell Tribune, a newspaper in Powell, Wyoming, Thamba, nineteen, was from the Republic of Congo. He began attending Powell-based Northwest College in January 2014 after submitting an essay to an international scholarship program. His academic focus was engineering and advanced mathematics.
The Tribune article notes that he quickly made friends at Northwest, and a couple of months later, he joined some of them on a spring-break trip to Denver.
Then, on March 11, tragedy struck. At the time, Thamba was at the Holiday Inn Denver East, at 3333 Quebec Street, a Stapleton area location captured in the following interactive graphic. If you have problems seeing the image, click "View on Google Maps."
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Thamba was on an upper floor and fell to his death from a balcony.
Last year, then-Denver Office of the Medical Examiner spokeswoman Michelle Weiss-Samaras told us that Thamba and at least one additional person consumed a marijuana cookie. Shortly thereafter, she says, "another kid got sick and [Thamba] had this happen."
After Thamba's death, toxicology revealed what a coroner's office release describes as "post-mortem chest cavity blood results (basic, synthetic cannabinoids and bath salts panels)." They showed a Delta-9 THC reading of 7.2 ng/mL and a Delta-9 Carboxy THC of 49 ng/mL.
In the end, the cause of death for Thamba (referred to in documents by his full name, Levi Thamba Pongi) was found to have been by "multiple injuries due to fall from height."
However, the determination adds that the fall took place after the consumption of a marijuana cookie and listed "marijuana intoxication" as a "significant condition."
This conclusion made sense in Weiss-Samaras's view because "that's all we had. He was fine, he was normal, he was an easy-going kid, and then he ate this cookie and went over the balcony. And this was not a kid who was suicidal."
Weiss-Samaras acknowledged that the determination of marijuana's role in Thamba's death was "a little unique." But she believed getting the information out was important, particularly for parents. "We don't know how this will affect you," she allowed. "We all react differently."
This same point is made in the CDC item, included in the complete MMWR issue, on view below.
Authors Jessica B. Hencock, Lisa Barker, Michael Van Dyke and Dawn B. Holmes write that they "reviewed autopsy and police reports to assess factors associated with [Thamba's] death and to guide prevention efforts."
They learned that thirty-to-sixty minutes after consuming a single piece of the THC-infused cookie, the student "consumed the remainder of the cookie" — a much higher dose than recommended, especially for someone like Thamba, who is described as "marijuana-naive, with no known history of alcohol abuse, illicit drug use or mental illness."
"During the next two hours," the authors continue, Thamba "reportedly exhibited erratic speech and hostile behaviors. Approximately 3.5 hours after initial ingestion, and 2.5 hours after consuming the remainder of the cookie, he jumped off a fourth floor balcony and died from trauma."
The cookie in question doesn't appear to have been any more potent than advertised. "The marijuana store where the implicated cookies had been purchased voluntarily gave all 67 remaining cookies of the same brand to the Denver Police Department," the authors state. "Testing confirmed that the THC levels in the items were within required limits.
"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 report goes on. "Consuming a large dose of THC can result in a higher THC concentration, greater intoxication, and an increased risk for adverse psychological effects."
Moreover, "systemic THC levels and psychoactive effects after ingestion are highly variable because of differences in bioavailability, rate of gastrointestinal absorption, and metabolic first-pass effect whereby an orally administered drug is partially metabolized (principally in the liver) before reaching systemic distribution. Because absorption is slower, the onset of effects is delayed (with mean peak plasma concentration at 1–2 hours after ingestion, in contrast with 5–10 minutes to peak plasma concentrations if smoked), and duration of intoxication is longer when THC is ingested compared with when it is smoked. Whereas a single-serving recreational edible marijuana dose in Colorado was set at 10 mg of THC, multiple-dose recreational edible products, often containing 100 mg of THC, were available during March 2014."
In the view of the authors, Thamba's death "illustrates a potential danger associated with recreational edible marijuana use." They point out that "some studies have suggested an association between cannabis and psychological disturbances" and "marijuana-attributed morbidity and mortality surveillance can help guide efforts to prevent overconsumption" in jurisdictions where they are sold legally, including Colorado, Washington, Oregon, Alaska and the District of Columbia.
This past February, the article stresses, "Colorado instituted new packaging and labeling rules, requiring that recreational edible marijuana products contain no more than 10 mg of THC, or have clear demarcation of each 10-mg serving. In addition, before distribution, cannabinoid potency testing is now performed on batches of recreational edible marijuana products by state-certified laboratories."
The authors believe that "other states permitting recreational marijuana use could potentially reduce adverse health effects by considering similar THC limits in marijuana edible products, and by enforcing clear labeling standards that require information on multidose products.
"Although the decedent in this case was advised against eating multiple servings at one time," they go on, "he reportedly consumed all five of the remaining servings of the THC-infused cookie within thirty–sixtyminutes after the first serving, suggesting a need for improved public health messaging to reduce the risk for overconsumption of THC.
Here's the MMWR edition in question. "Notes from the Field" can be found on page nineteen.
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