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What are the odds of dying from drug intoxication among cannabis users who also used opioids, kratom, and alcohol?

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: Report our preliminary findings on the association of cannabis use with DI, leading to a fatality.

Methods: This retrospective study 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 opioids, alcohol, 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 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 safety implications, particularly among polysubstance users. More research is needed to elucidate the patterns of use among cannabis, opioids, and kratom users, including differences in product types for harm reduction.