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 In a new case report, doctors describe the heart attack of a man who
ate a lollipop laced with high levels of TCH, marijuana's
psychoactive ingredient. This patient's story may serve as a warning
that cannabis isn't as benign as some would like to think, doctors
write in the Canadian Journal of Cardiology.
The 70-year-old Canadian man, who had preexisting heart disease,
suffered a heart attack half an hour after consuming most of a
lollipop that contained 90 mg of TCH. The man had hoped it would
help with arthritis pain and sleep. The dose in the lollipop was far
greater than what people typically inhale with a single marijuana
joint (7 mg), the researchers note.
"With access to marijuana legal now in Canada, it's going to be
accessible to a larger proportion of the population and it's more
likely that some of them will have heart disease," said study
coauthor Dr. Rob Stevenson, a cardiologist at the New Brunswick
Heart Center in St. John, New Brunswick. "This could be the canary
in the coal mine."
The man already had been diagnosed with atherosclerosis and had
bypass surgery, but he was taking medications to treat the
condition, and his disease was "stable" at the time he consumed the
edible cannabis, said lead study author Dr. Alex Saunders, chief
resident of the internal medicine program at the St. John's site for
Dalhousie University. "After his bypass surgery he had no repeats of
chest pain other than this one," Saunders said.
The man had smoked marijuana in his youth and had fond memories of
it, Saunders said. But once the effects of the high-dose THC in the
lollipop started to hit, the man's blood pressure and heart rate
quickly shot up. "He described fearful hallucinations," Saunders
said "He was very afraid he was going to die."
By the time family members got to him, "he was not only having
hallucinations, but also intense chest pain," Saunders said, adding
that the terror the man experienced may have been too much for his
heart.
Once at the hospital, doctors confirmed that he'd had a heart
attack. The man survived his heart attack, but tires more quickly
than before with exercise.
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Saunders worries that with marijuana now legal in Canada, increasing
numbers of people with heart disease will be using it and some of
them will be at risk for heart attacks. "When I was in my
rheumatology rotation, over half of my patients were asking if
marijuana would help with the aches and pains that don't get better
with traditional medicine," she said.
And while many would have avoided cannabis before, "now that it's
legal they don't feel as bad," Saunders said.
"One of the most reliable acute effects of the THC in cannabis is
that it increases heart rate," said Ryan Vandrey, who wasn't
involved in the case report. "And it's dose dependent. Even at
modest doses you can get increases in heart rate of 20 to 30 beats
per minutes. And it can go higher. If someone with cardiovascular
risk factors experiences a short-term bump in heart rate, that would
be a concern."
Vandrey, a psychiatry researcher at Johns Hopkins Medicine in
Baltimore, Maryland, was especially disturbed by the high dose of
THC in the lollipop. "Part of my frustration with products like this
is that nobody is going to take just a couple of licks and then put
it away," he said. "There should be no circumstance where you get a
product and you're not supposed to consume the whole thing and it's
not clear when you're supposed to stop."
In an editorial accompanying the case report, Dr. Neal Benowitz of
the University of California, San Francisco, outlines the different
mechanisms by which THC can affect the heart and cautions doctors to
keep these in mind when deciding whether and how to use cannabis to
treat patients with heart disease.
(This story corrects transposed letters in paragraph 3)
SOURCE: https://bit.ly/2X2G8zc and https://bit.ly/2MXEpGL Canadian
Journal of Cardiology, online February 11, 2019.
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