By: Maximilian Plenert

08. Mai 2014

On 25.2.2014 the article ‘Cannabis erstmals als Todesursache nachgewiesen’
(Cannabis proven for the 1st time to be cause of death) appeared in the
Rheinischen Post (major German regional daily newspaper). In it Dr Benno
Hartung, coroner and co-author of the underlying case-report which appeared in
the specialist journal ‘Forensic Science International’, is quoted with the
words, ”To the best of our knowledge these are the first cases of
cannabis-caused death worldwide which have been examined entirely in accordance
with state-of-the art scientific standards.’ He and his colleagues came to this
conclusion after they found THC in the blood of the corpses; all other causes
were in their opinion ruled out. The resonance of their report in the media was
formidable, it even gained international attention. On closer examination the
would-be proof evaporates and (such cases) are also not new.

The study can be scrutinised from various viewpoints. As well as criticism of
the analysis itself, the risk supposedly established should also be considered
in the entire debate (re legal cannabis).

1. Criticism of the Study itself

The examination by Hartung and colleagues displays many weaknesses. In
particular the procedural method, “We have excluded everything else, as a result
it must be cannabis,” is questionable. Furthermore one of the deceased suffered,
for example, from a hypertrophic cardiomyopathy. Sudden cases of death of people
younger than 35 commonly result from activity in sports, and an undiagnosed
hypertrophic cardiomyopathy. In an email we shall ask Mr Hartung to respond to
the points mentioned by ourselves and others.

Dr. med. Franjo Grotenhermen (International Association for Cannabinoid
Medicines): ”One mostly finds no cause of sudden cardiac death, and if one then
finds THC in those concerned, then it does indeed say nothing about the cause.”

In the weekly newspaper Die ZEIT Michael Tsokos, Director of Forensic Medicine
at the Berlin hospital Charité, Frank Mußhoff from Forensisch Toxikoloischen
Centrum (Forensic Toxicology Centre) Munich, and Prof. Rainer Thomasius,
Director of the Deutschen Zentrums für Suchtfragen des Kindes- und Jugendalters
(German centre for Addiction Research in Childhood and Adolescence) have already
expressed their opinions.

In reply to ZEIT’s question: “Do the detailed post-mortem findings actually
prove that both men died of hash?” Tsokos replied: “The individual findings do
not support that.” “From them it emerges that the 23-year-old deceased had a
serious cardiac pre-condition. If he had not by chance smoked cannabis the day
before his death, a connection (of cannabis) with his death could not have been
established (…) Cases in which the cause of death is unclear, occur regularly.
To assume cannabis is the cause is for me a Verlegenheitsdiagnose (a diagnosis
to prevent embarrassment / diagnosis ofconvenience).” Tsokos underlined: “This
is all about a coincidence not causality.”

Mußhoff is quoted with the following words: “Since nothing more turned up after
the analyses, Hartung and his team plumped for cannabis.” He referred to the
lowq THC and THCOOH values in the blood of the deceased. These contra-indicate
an ongoing state of intoxication.”

Prof. Rainer Thomasius – whom no-one could suspect of an affinity for cannabis,
he is comparable with Prof Neil McKeganey – commented: “People with heart
damage, dysfunctions of the lipid mechanism in blood, or vascular disease, have
an increased likelihood of a heart attack if they smoke cannabis (…) That is,
however, not a new perception (…).It concerns only a fraction of people and is
very seldom.”

The former Chairman of the Advisory Council on the Misuse of Drugs (ACMD) Prof.
David Nutt commented recently about a similar case of a “cannabis death” in
Great Britain.

2. “How dangerous is cannabis?” is not the crucial question

Dr. Raphael Gaßmann stated during the Bundestag Hearing concerning ‘Cannabis
Social Clubs’:
“From the point of view of the Deutschen Hauptstelle für Suchtfragen (German
Centre for Addiction Issues) the crucial question is not whether cannabis
consumption may make people dependent and whether it is damaging. The crucial
question is that of the prohibition of cannabis. Does the cannabis prohibition
have a positive impact? Does the ban result in fewer people taking it and that
those who do consume it take less as a result of the prohibition? That is the
crucial question, and not whether cannabis leads to dependency.”
In particular when the issue is a problem that occurs very rarely as in this
case, or also the risk of testicular cancer which has supposedly increased by
70% given that per year there are 7 cases of testicular cancer for every 100,000
men.

3. Cannabis may damage health

The use of cannabis in particular when it is smoked and with tobacco, may lead
to health problems. In particular the pregnant, people with schizophrenia or
heart problems should generally be cautious. Cannabis, especially when smoked
and with tobacco increases the heart rate, and that may be fatal in the worst
cases. When there are undiagnosed, pre-existing medical conditions, this is not
an avoidable risk.

Notwithstanding this risk is also present during other activities which may
induce tachycardia/palpitations e.g. sex, sport, sauna visits, arguments, visit
to Job Centres, bullying, dangerous situations in traffic, or perusing the
Rheinzeitung concerning the topic of cannabis deaths.

When one observes enough people over a sufficiently long period of time,
somebody will die e.g. one death during the Berlin Marathon is normal.

As a result the following statement by Hartung is meaningless: “The problem is
that we cannot estimate who will suffer from cardiac arrhythmia (irregular
heartbeat). We can nevertheless assume that theoretically it could affect every
cannabis user even when they have already smoked weed without developing symptoms.”

In Hartungs’s statements it is perceptible that he urgently wanted to find
something during his investigation, so as to counteract a supposed playing down
of (the dangers) of cannabis: “Until now it was often assumed that cannabis
could not cause damage.” He went on that cannabis is generally regarded as a
drug with “euphoric affects without adverse reactions.”
In his article he criticised, “”little public awareness of the potentially
hazardous cardiovascular effects associated with the consumption of cannabis” – in view of the relative risk, this would however be appropriate.

Dr Grotenhermen explains about the extent of the risk in comparison to other
substances, ,”If one could say about each medication after one has used it for
decades, ’we have now identified the first two cases of death,’ then actually
one would be completely enthusiastic,” the expert declares. “They will hardly
find that for any pharmaceuticals.”

4. Political impact

In political terms this study is grist to the mill of the “cannabis is
dangerous” faction. As with the “weed makes people stupid” study, only the first
headline will linger in their memory as it will with the general public, whereas
each critique however well founded will seldom be printed let alone taken notice
of. Therewith Hartung has contributed to muddying the waters of the debate –
possibly wilfully but certainly through negligence. Concerning Hartung’s
motivation we can only speculate.

Perhaps it was scientific curiosity plain and simple. But the scientists could
assume – on the basis too of their colleagues’ experiences when concerning
themselves with similar cases – how much media resonance their hypotheses would
bring about. As a result, the desire to make a big impact in the public mind,
might be possible motivation. The affect on political debate and their own
location is clear. In this context I would like to draw attention to the article
‘Von Hanf ist die Rede – Anmerkungen zum wissenschaftlichen und politischen
Diskussionsstand in Deutschland’ (Hemp is the Topic – Comments on the State of
the Scientific and Political Discourse in Germany)in which is delineated how
some researchers in the past raised their profile with large “Cannabis is
dangerous” studies, and with them appointed themselves Crown witnesses for
Prohibition.

To the dynamics of media in such media see: [So kommen Meldungen wie “Cannabis
macht dumm” zustande->http://www.alternative-drogenpolitik.de/2012/08/30/so-kommen-meldungen-wie-cannabis-macht-dumm-zustande/] (This is how reports come about like ‘Cannabis makes people
stupid’ ).

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