Armiel Suriaga
Florida Atlantic University
Co-Authors: Oliver Grundmann2, Lenny Chiang-Hanisko1, Raquel Panos1, Sebastian Kuzak1
1Florida Atlantic University, 2University of Florida
Background: Drug-related overdose or intoxication is a serious public health issue that has claimed the lives of more than one million people since 1999. The National Institute on Drug Abuse (2023) reported a steady increase in drug-involved overdose death rates from opioids, stimulants, benzodiazepines, and antidepressants. Opioids contributed to nearly 70% (70,601 out of 106,000 deaths) of these deaths in the United States in 2021 alone. However, the association of cannabis use with drug-related intoxication (DI) is seldom reported.
Objective: Our study aimed to report our preliminary findings on the association of cannabis use with DI, leading to a fatality.
Methods: We used de-identified data from the Florida Department of Law Enforcement from 2020 to 2021. Analyses included descriptive statistics and regression modeling with Stata 17. We restricted our analysis to the association of cannabis use with DI among those who also used alcohol, opioids, and kratom. The presence of mitragynine in biological fluids commonly identifies kratom use. We dichotomized DI (yes/no) as the cause of death as determined by the medical examiners through autopsy and toxicology results.
Results: Our results indicated that 2,888 out of 7,287 decedents with cannabis use died from DI. Among decedents with cannabis use, the mean age was 38.34 (SD= 14.8) and ranged from 0-94 years. Males are more affected (n=5,830 or 80.01%), white (n=4,973 or 68.3%), and those in the 25-34 age group (n=2,037 or 28%), followed by the 35-44 age group (n=1,596 or 22%). Among cannabis users, 5,304 (72.8%) used two or more substances; 87 used kratom, 3,113 used opioids, and 2140 used alcohol. In the intercept model, the odds of dying from DI increased by .63 times compared to the odds of dying among non-cannabis users. After controlling for confounders (age, gender, ethnicity, opioid, alcohol, and kratom), the odds of dying from DI among those who used cannabis was .60 (OR=.60, [95% CI .59, .68]), p=<0.001. Among those who also used opioids, the odds of dying from DI increased (OR=15.92, [95% CI 14.97, 16.93]), p=<0.001; mitragynine, (OR=5.06, [95% CI, 3.77, 6.80]), p=<0.001. No significant result with alcohol (OR=.95, [95% CI .89, 1.01]), p=0.103. Limitations of the study included no data on cannabis doses and frequencies, cannabis source, and indications of use.
Conclusion: This result has clinical implications among those who co-use cannabis with opioids and kratom, which necessitates innovative harm reduction strategies and education dissemination for public safety, particularly young adult users.