SOURCES: Robert Glatter, M.D., emergency physician, Lenox Hill Hospital, New York City; Jessica Hancock-Allen, M.S.N., epidemic intelligence service officer, U.S. Centers for Disease Control and Prevention, Mitch Earleywine, Ph.D., chair, NORML, and professor, psychology, State University of New York at Albany; July 24, 2015, Morbidity and Mortality Weekly Report
THURSDAY, July 23, 2015 (HealthDay News) -- U.S. health officials on Thursday revisited the first reported marijuana-linked death in Colorado since voters there legalized recreational use of the drug in 2012.
A young man leapt to his death last year after consuming an entire pot-laced cookie, the new government report shows. The 19-year-old had no other drugs in his system at the time, health officials noted.
He first ate a single piece of the cookie, as instructed by a sales clerk, but then downed the rest within an hour because he didn't feel any immediate effects, according to the case study published in the July 24 issue of Morbidity and Mortality Weekly Report, a publication of the U.S. Centers for Disease Control and Prevention.
Two and a half hours later, the young man jumped off a fourth floor balcony after exhibiting erratic speech and hostile behavior, and died from his injuries.
An autopsy found that the young man had a blood level of 7.2 ng/mL of THC, the chemical in marijuana that produces intoxication. The legal limit for driving under the influence in Colorado is 5 ng/mL.
While the young man was definitely high, the THC in his system does not seem elevated enough to have caused a toxic reaction, said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.
"This is not a lethal amount he ingested," Glatter said. "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."
The young man had never used marijuana before, and had no history of alcohol abuse, illicit drug use or mental illness, according to the police report. The autopsy revealed no other drugs in his system.
Given his reaction, it's possible that the heavy dose of marijuana sparked a psychotic reaction due to a mental problem that had gone previously undiagnosed, Glatter said.
"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," he said, noting schizophrenia or psychosis as possibilities. "That's probably the issue here."
Case report author Jessica Hancock-Allen, an epidemic intelligence service officer with the CDC, agreed that the young man may have had mental issues. However, she would not rule out the chance that his reaction occurred solely due to the pot he consumed.
"Is it possible he had some other issues? Sure," she said. "It is possible he didn't have any issues and this would have been his first adverse psychological event? I think that's possible as well."
According to the police report, the young man broke a lamp and was roaming around the room in an agitated state, talking about feeling guilty regarding things that had occurred in his life, Hancock-Allen said.
"He was really speaking in a way that didn't make sense, very atypical kinds of behaviors and train of thought," she said.
This case highlights a regulatory issue over packaging and labeling of recreational pot products that's taking place in the four states where recreational use of marijuana is legal, Hancock-Allen said. Those states are Colorado, Washington, Oregon and Alaska. The District of Columbia has also made recreational use of marijuana legal.
Colorado, one of the first states to legalize the drug, has had numerous cases where people have accidentally over-consumed marijuana edibles, she said. Officials are investigating subsequent cases where such overconsumption may have contributed to death or injury.
The marijuana store where the cookie was purchased handed over all other cookies of the same brand to police for testing, the report says. The cookies all had THC levels within required limits.
Pot edibles take longer for the body to process, which leads to delayed but longer-lasting intoxication. A person unfamiliar with this may end up eating too much, since they don't immediately feel the effects, the case report noted.
"It's a significantly delayed effect," Hancock-Allen explained. "The average blood serum peak of THC is about two hours for eating, while it's 5 to 10 minutes for smoking. It's quite different from smoking."
About 45 percent of Colorado's marijuana sales involve edibles, including food, drink and pills, the report stated.
According to the police report, the sales clerk instructed the young man to divide each cookie into sixths and ingest one serving at a time, with each piece containing about 10 milligrams (mg) of THC. However, the report didn't indicate whether the clerk provided any instructions on how long to wait between servings.
In February 2015, Colorado instituted new packaging and labeling rules that require edible pot products either contain no more than 10 mg of THC, or be crafted in a way that clearly shows how to break the product into 10-mg servings.
Labels also must say that "intoxicating effects of this product may be delayed by two or more hours," Hancock-Allen added.
The pro-marijuana advocacy group NORML is in favor of such improvements in consumer packaging, said Mitch Earleywine, chair of NORML and a professor of psychology at the State University of New York at Albany.
"We have consistently supported clear labeling of edible products and remain eager to spread the word about their delayed onset and their potential for dramatic impact," Earleywine said. "Warning labels that emphasize these delayed, dramatic effects are becoming more common. We look forward to them becoming a standard for the market."
For more information on marijuana, visit the National Institutes of Health.