Talk:Cannabis (drug)/Archive 13

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RFC: Cannabis overdose

The following WP:MEDRS sourced claim about cannabis overdose (reverted by User:Alexbrn) should:

• A: Be included in the Cannabis_(drug) article
• B: Remain out of the article

"There is no evidence of death from cannabis overdose". (See this *Diff* for full references). Finney1234 (talk) 17:23, 7 January 2022 (UTC)

A drug overdose fatality is a short-term response to ingestion of a large quantity of a drug. It is common with opiates, and also can occur with alcohol, amphetamine, cocaine, and other drugs. It is separate from the effects of long-term use of a drug, as well as from a fatality resulting from a preexisting health issue. A short discussion occurs in the immediately preceding Talk page section. Finney1234 (talk) 17:27, 7 January 2022 (UTC)

Finney1234, I find your wording a bit confusing. I suspect you mean this:

"A drug overdose fatality is a fatal response to short-term ingestion of a large quantity of a drug."

Valjean (talk) 21:32, 10 January 2022 (UTC)

Thanks, User:Valjean, that's a better definition.Finney1234 (talk) 00:01, 11 January 2022 (UTC)

I made a reference to the preceding talk page section, but the information there is important enough that I should have copied it to this RFC. I hope that adding this as an additional lead paragraph(s) is appropriate; please let me know if it's not.

Drummer et al (2019) is the single (WP:MEDRS) study cited in the "Fatalities" section; it was claimed to supersede the 2010 overdose claim. However:

1. Drummer does not mention the word "overdose" at all.

2. Multiple deaths (5-10) have been reported due to cannabinoid hyperemesis syndrome(CHS). But acquiring a potentially fatal (and rare) disease due to long term heavy use of cannabis is not the same thing as an "overdose" (just like liver disease due to long-term alcohol use is not an "overdose").

3. Drummer reports that multiple cardiovascular deaths have occurred in cannabis users. However, the article explicitly states that "the evidence for a link between cannabis use and increased risk of cardiovascular disorder is not clear" (the association appears to be solely correlation, not causation). In addition, the Drummer article states that "most of the cases and series reporting a possible link between cannabis use and a cardiovascular event have not had a blood measurement positive for THC", that is, there is little evidence for immediately preceding cannabis use (required for an "overdose" fatality).

As such, the weak Drummer citation does not address "cannabis overdose" AT ALL. The reversion of the overdose claim appears to have no basis. Finney1234 (talk) 14:59, 8 January 2022 (UTC)

• No. the source is not WP:MEDRS as it's out of date in being superseded by more recent science on this topic, which we cite. Alexbrn (talk) 18:30, 7 January 2022 (UTC)
• I'm not super familiar with MEDRS standards, but here is a peer-reviewed study from 2020 [1] that states No scientific evidence was found for Cannabis overdose in the literature nor in our experience in the Forensic Medicine department of Tunis. _signed, Rosguill ^talk 19:30, 7 January 2022 (UTC)
  • It's a case report, so especially unreliable per WP:MEDRS. Alexbrn (talk) 19:31, 7 January 2022 (UTC)
• No, per arguments given by Alexbrn. Pyrite Pro (talk) 19:40, 7 January 2022 (UTC)
• B For starters, poorly worded RfC. But second, science can learn new things. The source claiming no deaths is from 2010. The source claiming a small number is from 2019. In those nine years, cannabis use and study have skyrocketed, so I would treat the newer source as more reliable. CaptainEek ^{Edits Ho Cap'n!}⚓ 19:43, 7 January 2022 (UTC)

• Commment WP:MEDDATE which is the section of MEDRS that Alexbrn has used to justify removing this states In many topics, a review that was conducted more than five or so years ago will have been superseded by more up-to-date ones, and editors should try to find those newer sources, to determine whether the expert opinion has changed since the older sources were written. To me, this does not mean that old sources are not permitted, but rather that we should use them with care, ensuring that they have not been superseded by more recent sources. That said, Calabria only has this to say about overdose: Because cannabis use is not reported to cause fatal overdoses and "not reported" is subtly different to "no evidence". Looking at the literature, I found a review in Neuropsychopharmacology from 2018: [2] which states There are no known cases of fatal overdose from cannabis use in the epidemiologic literature. This does certainly support including something along these lines in the article. SmartSE (talk) 20:09, 7 January 2022 (UTC)

• @Smartse: good find. I've added that source - let's see what people think. Alexbrn (talk) 17:38, 8 January 2022 (UTC)

• That's correct. 2018 and 2020 (below) are as fresh as they could be. AXONOV (talk) ⚑ 22:40, 8 January 2022 (UTC)

• No (B) The source admits more study is necessary and the later studies indicate a possible low incidence of death. Tom94022 (talk) 21:31, 7 January 2022 (UTC)
• Comment: The current wording pf the section seems to overstate the risk of death as described in the visible portion of the reference. "At least 13 deaths" even if under-reported seems like a very low risk given it is "a drug with widespread usage among the community ... ." I suggest someone with more expertise and accesss revise the section on Fatality to better reflect the current science. Tom94022 (talk) 21:51, 7 January 2022 (UTC)
• A, Yes, include "There is no evidence of death from cannabis overdose", unless Wikipedia or the foundation are sponsoring a 2022 remake of Reefer Madness. Isn't "overdose" defined as an amount used at one time (note that cannabis is not mentioned on the 'Drug overdose' page)? If so, the statement is correct and should be included for accuracy. Randy Kryn (talk) 22:00, 7 January 2022 (UTC)
• B, Definitively No as stated. There is enough evidence that it is controversial that it should not be stated in Wikipedia's voice. Also, there is no need to have only a single opinion included on this question. WP:proportion should be used. Dominic Mayers (talk) 23:35, 7 January 2022 (UTC)
• A, yes relative to overdosing. US DEA claims that as of 2020 there were no reports on Marijuana overdose deaths: [3]; so I think it's safe to mention this fact at least for now. AXONOV (talk) ⚑ 22:37, 8 January 2022 (UTC)
• B because even if it were true, it is apparently out of date. See this source (a 2021 review article in a good journal[4] published by Springer):
  • Takakuwa, Kevin M.; Schears, Raquel M. (2021-02-10). "The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review". International Journal of Emergency Medicine. 14: 10. doi:10.1186/s12245-021-00330-3. ISSN 1865-1372. PMC 7874647. PMID 33568074.{{cite journal}}: CS1 maint: unflagged free DOI (link)
• which says, in a section labeled "Acute intoxication/overdose", describing people with "acute exposures to cannabis (without co-ingestants)" (that means the problem is due to the amount of cannabis, and you can't blame it on other things, like the beer they didn't drink or the opiates they didn't take), "There was one reported adult requiring intubation and one death."
  So there we have it: a current, MEDRS-ideal source saying that at least one human has actually died specifically and directly from acute intoxication/overdose, in a way that cannot be blamed on anything except excessive cannabis consumption.
  Also, as a second point: The correct and accurate way to describe this is not "no deaths from overdose, so no worries, dude" or "only one reported death from overdose", but to say that some people die as a result of using cannabis, and that the mechanism usually involves cannabis causing a heart attack rather than what's technically considered "an overdose", using the narrowest possible definition of that term. Also, it would be good to place those risks in context with similar subjects (probably opiates, cigarettes, and alcohol). This "only overdoses really count" framing strikes me as being just as inappropriate and manipulative as the US tobacco industry claiming that tobacco's safe, because smokers almost never "technically" overdose. They just get lung cancer or die of heart attacks. We could make the same argument about opiates: opiates don't kill you pharmacologically; they just make you not care whether you breathe. It's not breathing that kills you; ergo, no overdose deaths, right? People dying matters, even if they're dying because cannabis smoke triggered a fatal asthma attack, or because endocannabinoids caused a myocardial infarction, or because the person had a psychotic break and did something dangerous because of the paranoia or panic. Wikipedia is NOTCENSORED, and that means not acting like the only thing that matters is whether any users died through a single, narrowly defined mechanism. You wouldn't accept that for any other potentially dangerous product, and you shouldn't accept it here. WhatamIdoing (talk) 23:14, 8 January 2022 (UTC)

  In case anyone wants to wikilawyer over the source, please note that the lead author chairs the research committee of the Society of Cannabis Clinicians and owns part of a legal cannabis business. This is not a 'reefer madness' source. Bona fide professionals in the cannabis industry are saying that someone died from acute cannabis overdose. WhatamIdoing (talk) 23:27, 8 January 2022 (UTC)

  The source doesn't say whether the death was due to overdose or not.There is no citation next to a statement you quoted (i.e. one reported … intubation and one death) either.--AXONOV (talk) ⚑ 08:21, 9 January 2022 (UTC)

  You are correct Alexander, the source says the death followed overdose (and so was not necessarily caused by it). So that's what Wikipedia can say too. I do however agree with WAID that there is a subtle POV in insisted on focussing on overdose specifically as a (non-) cause of fatality — the fact that we're only finding dribs and drabs on this consideration in the (extensive) literature should be a warning flag. Alexbrn (talk) 08:38, 9 January 2022 (UTC)

  Lack of coverage is open for interpretation. The edit you made recently^{[08:28, January 9, 2022]} is rather spurious. Acute toxicity is not the same as overdose. Stop pushing this nonsense. AXONOV (talk) ⚑ 15:50, 9 January 2022 (UTC)

  That death was originally reported in PMID 30676820, which is titled "Acute Cannabis Toxicity". The original research was summarized in a review article in a title labeled "Acute intoxication/overdose". This is not spurious. It might be a desperate attempt at hair-splitting as part of an effort to whitewash the subject, though. People actually do die from using this stuff. Don't scaremonger about it (more people die each year from just walking down the street, which is overall a health-promoting activity), but don't try to censor that, either. WhatamIdoing (talk) 16:14, 10 January 2022 (UTC)

  … a desperate attempt… as part of an effort to whitewash the subject… I doubt that. Nobody is trying to pretend that canabis is completely safe. The proposal isn't about that. The #Fatality subsection already addresses this concern. AXONOV (talk) ⚑ 08:29, 11 January 2022 (UTC)

  Here's another source:

  "The likelihood of accidental overdosage is much higher when 'skunk' cannabis is involved.  There are a number of reports of sudden unexpected death is young people associated with cannabis use alone.  Concentrated products such as resins and liquid concentrates, for example butane hash oil (BHO, also known as butane honey oil), made by extracting cannabis plant material with liquid butane), were associated with greater toxicity than other cannabis products.  BHO and similar products typically contain 80% w/w THC.  Distilled concentrates have been reported up to 99.6% w/w THC.  Liquid cannabis preparations have been known to be injected, sometimes with fatal consequences."

  This is from ISBN 978-1119122340, page 550.

  BTW, the preceding paragraph in this book says that CBD tends to reduce the acute toxicity of THC, but doi:10.1016/S2215-0366(20)30074-2 says that's not been proven. (It's still possible and plausible, but there's not been enough research to prove it.) StatPearls recommends, if chest pain is present, to "assess myocardial ischemia or infarction. There is thought to be an elevated risk up to 4.8 times for MI within 1 hour of marijuana use." It also mentions "intensive care admissions due to central nervous system depression".

  Here's another source, this time a primary source:

  "we describe a death following acute myocardial infarction with ventricular tachycardia shortly after inhaling vaporized cannabis in the form of a concentrate. There may be an increased risk of myocardial ischemia while smoking cannabis [6] due to both the induction of tachycardia with supply-demand imbalance as well as the inhalation of particulate matter"

  This is from doi:10.1080/24734306.2020.1852821, which is focused on older people. However, the fatal mechanism described appears to be the same as the one described in doi:10.1146/annurev-devpsych-040320-084904 as "More recently [=since 2009], there have been reports that require further investigation of cardiovascular deaths in healthy young men after smoking large amounts of cannabis".

  Taking a broader view than the narrowest definition of "overdose" that we can find, we can go back to doi:10.1186/s12245-021-00330-3, which also says: "cannabinoids and analogs associated with 0.51% of single substance fatal exposures, 1.4% of total substances reported in fatal exposures and as the 22nd of 25 top fatality substance categories". Being in the top-25 for fatal pharmacological exposures is not an indication of safety. It's great that it's barely in the top 25 for fatalities, but it's not good that it's in the top 25 at all, if you want to keep telling a story about cannabis being a basically non-fatal product that is the only exception to the rule that The dose makes the poison in the history of the universe. We need to tell a neutral story about cannabis, and that includes noting that a small number of people have died from it. WhatamIdoing (talk) 17:18, 10 January 2022 (UTC)

Other than the confirmed deaths from cannabinoid hyperemesis syndrome (which have occurred in a small number of heavy, long-term cannabis consumers) , *none* of the sources cited here provide solid evidence that cannabis has caused a death. Drummer et al (2019) is discussed in the opening paragraphs of this RFC, where he admits there is no evidence connecting cannabis use with cardiovascular death, and no evidence that cannabis use had occurred preceding the cardiovascular deaths. Takakawa and Schears (2021) "narratively" (no critical evaluation) cite Noble et al. (2018), which documents that there *is* a single confirmed death from an ER patient who had been using cannabis. However, there is *no* data for causation (and I believe neither Takakawa nor Noble cites anything about the patient's previous cardiovascular history). In my personal opinion, this is just a continuation of a common approach to cite speculative WP:MEDRS sources as "facts" in cannabis-related articles, in order to promote a negative (not neutral and scientifically valid) perspective (that is, WP:NPOV is interpreted as "Negative Point of View"). Nothing yet has overridden the well-established and factual "no evidence for cannabis overdose fatality" claim (in particular, the Drummer source which was originally cited by User:Alexbrn in the removal of the claim, and which was the motivation for this RFC). This strikes me as exceedingly inappropriate for what is supposed to be a fact-based encyclopedia. Finney1234 (talk) 18:04, 10 January 2022 (UTC)

Wikipedia relays knowledge, which is subtly different from "facts". What we have now is decent. I think the point is that choosing a weird set of super-strict criteria adrift of what the literature is focusing on (i.e. what an "overdose" is proved to cause or not cause), risks being undue/POV. Trying to use an outdated source is a symptom of that. Invoking "previous cardiovascular history" is a lot like what we hear from the died-with-covid-not-OF-covid folk. i.e. denial. Alexbrn (talk) 18:29, 10 January 2022 (UTC)

User:Alexbrn Can you provide one or two Wikipedia official guidelines backing up the claim that "knowledge" (which, based on the current Cannabis_(drug)#Fatality section, seems to mean speculation) is the basis of Wikipedia rather than facts, and how it specifically differentiates the two? (In a WP:MEDRS required portion of an article!!). Please provide both a WikiLink to the guideline, and a specific pointer to the sentence backing up the claim. E.g, WP:MEDRS does refer to "reflect(ing) current knowledge", but it doesn't distinguish "knowledge" from "facts". A single review article is not "scientific consensus"; it is the author's personal interpretation of existing sources. Thanks. (Note: this discussion partly duplicates a discussion below; it probably ought to be addressed in one location rather than two). Finney1234 (talk) 21:05, 10 January 2022 (UTC)

• THC lethal dose that can be linked to overdose deaths is impossible to estimate.^{No known lethal dose} There is little research in humans on that. There are, however, tonnes of reports, both old and new noting that that in animals ratio of LD / Least Psychologically Active Dose is very huge. It's in line with the fact that deaths of overdose alone are extremely rare and the fact that some heart problems in humans may arise at relatively low doses. Nobody is trying to downplay some adverse effects. The number of WP:TERTIARY sources with evidence that there were basically zero cases of overdose deaths is overwhelming. AXONOV (talk) ⚑ 10:19, 11 January 2022 (UTC)

  Nobody is trying to downplay some adverse effects ← in fact, the OP of this RfC has argued that this article should not have an "Adverse effects" section at all, and has attempted to edit it away. As for your ludicrous sources, stuff from 50 years ago and Google search results are not what we're looking for here. We should find the WP:BESTSOURCES are summarize them. And, we're getting there. Maybe try to help with that? Alexbrn (talk) 10:39, 11 January 2022 (UTC)

  …stuff from 50 years ago… Outrageous nitpicking. Stop this gameplaying.
  …summarize them… Couple of tertiary sources arelady did this for you. See above. AXONOV (talk) ⚑ 10:49, 11 January 2022 (UTC)

  «A lethal dose of THC in humans is unknown.…» If the LD is unknown, no way to know whether a person died from overdose or not. That's simple. AXONOV (talk) ⚑ 11:02, 11 January 2022 (UTC)*

Actually, User:Alexbrn, my replacement of the "Adverse Effects" section by an "Effects of Cannabis" section was an attempt to go for actual "Neutrality" (WP:NPOV) rather than having a negatively oriented section that allowed no space for non-negative effects. As you can see by the article history, and the Talk page, I did not remove *any* of the actual statements in the "Adverse Effects" section: I believe in facts and science. Note also that "Adverse Effects" is a suggested section title for medical articles (which Cannabis_(drug) does not strictly belong to, IMO, although it has some WP:MEDRS sections), it is not required (see WP:MEDMOS). Since you reverted my "Effects of Cannabis" title change (contrary to the non-objection consensus which had been reached, see this), a "Non-Adverse Effects" section will need to be added, which will be sort of bizarre...but it's the only current option.Finney1234 (talk) 00:52, 13 January 2022 (UTC)

Added sentence

The following sentence should not have been added in the article given that it is controversial in view of the current RfC.

As of 2018 there were no reported cased of cannabis overdose being a cause of death.

In particular, if you read the reference, you notice that it itself refers to the 2010 study and to the 2016 book The health and social effects of nonmedical cannabis use from the World Health Organization, which also refers to the 2010 study. So, essentially the primary source is the 2010 study and the other sources confirms the credibility of that source and its notability, but it still remains a 2010 study, not a 2018 study.

References

Dominic Mayers (talk) 18:18, 8 January 2022 (UTC)

The source's sources are earlier, but the review is 2018 (or 2017). It says "There are no known cases of fatal overdose from cannabis use in the epidemiologic literature". We can't second guess the source. Alexbrn (talk) 18:25, 8 January 2022 (UTC)

We need to understand the source and the source's sources are important to have the correct understanding. The role of Wikipedia's editors is not to blindly repeat what a source says. Verifiability is not a syntactical criterion. We must consider the meaning, not just repeat the words. When the interpretation is controversial, we must help us with other sources. Besides, the source did not say "As of 2018". So, only on that basis, the sentence was incorrect. Dominic Mayers (talk) 18:39, 8 January 2022 (UTC)

I think the assumption is that a review will have performed an up-to-date review, but this could be solved put putting "A review of 2018 said ... " yes? Alexbrn (talk) 18:44, 8 January 2022 (UTC)

I agree with Alex and don't understand Dominic's reasoning. The fact that Alex objected to the previous source, but agrees that this one is suitable, means that it should not be a controversial addition. Just in case, more is needed, that review also cites this 2016/2017 review which says cannabis is not known to cause fatal overdoses. Citing the two of them provides pretty rock-solid justification for including the statement. SmartSE (talk) 19:04, 8 January 2022 (UTC)

You can not just write "A review said..." and conclude that it is necessarily fine, because it's verifiable and attributed. You need to make sure that the content that you include takes into account all relevant information from the source. Would it make a difference for the readers if they knew that the source was referring to the 2010 study? (By the way, the other sources also referred to the 2010 study.) If the answer is yes, then you know that you must take it into account in some meaningful way, because you want the readers to have the best information possible available in the source. Verifiability is not just a game in which if you can show that the source said so, then it's fine. Dominic Mayers (talk) 19:17, 8 January 2022 (UTC)

Sounds like you disagree with the review, and think the authors should have said something different. Sorry, but we don't do that. Alexbrn (talk) 19:20, 8 January 2022 (UTC)

I am hurt by your assumption that I am pushing my opinion. I came here because I was randomly summoned by a bot. I have no opinion about cannabis, it's influence on death, etc. I am only here to help, certainly not to push an opinion against the sources. On the contrary, if you read me carefully, I am saying that we must report the sources in the best way possible and consider all relevant information. So, I do the opposite of what you suggest that I do. If I was as rude as you have been, I would say that, on the contrary, it's you that seems to use the sources in a suboptimal way that allows you to push your personal opinion. Let's not attack each other in this kind of manner. Dominic Mayers (talk) 19:36, 8 January 2022 (UTC)

I assumed no such thing, merely putting that you disagree with what the authors wrote and apparently think they should have written something different (not sure what). The authors are reviewing the subject area, and give the state of knowledge in their view. This is the kind of knowledge Wikipedia is bound to reflect. All I want to do is reflect the sources. Alexbrn (talk) 19:42, 8 January 2022 (UTC)

Well, you seem to truly believe that my arguments were pushing a personal view that is opposed to the source's view. This is called POV pushing. Perhaps you were simply honest about what you feel or believe, but it's still rude. I am not going to argue further, but it's easy to make the mistake that an isolated sentence taken from a review is what the review wanted to convey. You accuse me of wanting to say something different than what is in the source, but it's only that, as an author, if I say something with some reference, I usually wish to be interpreted in view of the reference that I have provided. It's part of what I wrote. I consider that doing otherwise, would be misrepresenting what I wrote. I assume it's the same for the authors of the review. Dominic Mayers (talk) 20:16, 8 January 2022 (UTC)

Consider the following fictive experiment, which could actually be done, but I don't suggest it. Let's write to the authors and ask them on which basis they suggest that as of 2018, there is no evidence of death by overdose of cannabis. I would not be surprise that they would respond that we should look at the references that they provided to understand more precisely what they were referring to. Dominic Mayers (talk) 21:05, 8 January 2022 (UTC)

Their meaning is plain, sorry. Alexbrn (talk) 21:45, 8 January 2022 (UTC)

My understanding is that you so much blinded by your interpretation, which you say is plain, that if neglecting information supports it, then we must do that, because otherwise it's disagreeing with the source. It's weird. In contrast, I am only saying that it's better to take into account more information and I avoid claiming that anything is plain or obvious. Dominic Mayers (talk) 22:11, 8 January 2022 (UTC)

The issue could be that you focuses on what you think they intended to say. You feel perhaps that they based their point on a 2010 reference (and a book, which they must have known, also refer to the 2010 reference), but nevertheless they meant that it is still now the case. I tend to believe that this might actually be the case. So, I know how you can feel, but what I believe and feel or what you believe and feel is irrelevant. What is actually conveyed in the source is more important for accuracy. The authors actually referred (directly or indirectly) to the 2010 study and we know that as a fact. I really suggest that for maximum accuracy and to allow the readers to have the best information, we should not ignore that. Dominic Mayers (talk) 22:47, 8 January 2022 (UTC)

Better than a guidelines, there is hard policy. See Wikipedia:What Wikipedia is not#Encyclopedic content. This is fundamental. Knowledge is a layer of interpretation, analysis and synthesis (among other things) at a higher level than "facts". Alexbrn (talk) 21:31, 10 January 2022 (UTC)

Cool, a specific policy! Specifically, in Wikipedia:What Wikipedia is not#Encyclopedic content, "A Wikipedia article should ..(be).. a summary of accepted knowledge regarding its subject". What defines accepted knowledge? Some review articles are close to consensus; other are speculative opinions of the authors. As WP:MEDRS makes clear, it's necessary to evaluate the quality of a given source. Finney1234 (talk) 23:55, 10 January 2022 (UTC)

Shrug - you asked ... Accepted knowledge does not have to be "consensus", that is a special case requiring the high bar of WP:RS/AC. A truly "speculative opinion", not based on underlying literature, is not secondary. If you want to know what policy says, read policy. For what we base articles on, I suggest WP:PSTS and WP:SECONDARY as WP:PAGs of interest. Maybe see some featured medical articles to get a feel for what good encyclopedic medical writing is. But this is getting off topic for this Talk page. Alexbrn (talk) 05:56, 11 January 2022 (UTC)

Stuff from the last century? Let's stick to WP:MEDRS to ensure we have good content. Alexbrn (talk) 12:25, 11 January 2022 (UTC)

See WP:STONEWALLING. AXONOV (talk) ⚑ 14:02, 11 January 2022 (UTC)

a little more objectivity would be nice

“cannabis is a drug and bad >:(“ is the entire vibe of this article. For people interested in a medical sense it’d be nice to include positive research applications of cannabis (PTSD, chronic pain, autism, panic attacks etc) instead of just negative stuff. That’d be like talking about amphetamines without mentioning that they do actually still provide benefit to people with ADHD or narcolepsy. 75.134.225.137 (talk) 18:36, 27 January 2022 (UTC)

Thing is, reliable sources are needed. Alexbrn (talk) 21:09, 27 January 2022 (UTC)

For example, this source Juan.h.gonzalez.1 (talk) 19:42, 6 July 2022 (UTC)

The fatality section is poor

"Cannabis is suspected of being a potential, and under-reported, contributory factor or direct cause in cases of sudden death, due to the strain it can place on the cardiovascular system." - No adequate reference or explanation of what that "strain on the cv system" is or how it could be the direct cause of death - No discussion of the LD50 or overdose potential of cannabis relative to other drugs - No contextualisation of the rarity of death by cannabis 2400:2650:8DC0:1800:6C83:9F84:B505:6F08 (talk) 17:29, 9 July 2022 (UTC)

Outdated info

On the page under “legal status” it says “Medical marijuana was legalized in Mexico in mid-2017; legislators plan to legalize its recreational use by late 2019.” It’s just that this is outdated and someone should get on it. Thank you Austinball (talk) 06:35, 1 August 2022 (UTC)

Semi-protected edit request on 12 September 2022

In the “methods of consumption” section, there should be an additional indentation for “Concentrates/ dabs” with a brief description of Hydrocarbon Solvent cannabis extracts (bho/pho) and solventless cannabis extracts (rosin).

These are common in the cannabis community, and in the dispensary i work in are more popular than two other listed methods of consumptions (cannabis tea and cannabis oil/ tincture) 107.141.98.99 (talk) 22:17, 12 September 2022 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. You'll need to provide the prose, or at the very least some reliable sources to work from. ScottishFinnishRadish (talk) 22:23, 12 September 2022 (UTC)

Wiki Education assignment: Seminar in Academic Inquiry and Writing

This article was the subject of a Wiki Education Foundation-supported course assignment, between 30 August 2022 and 20 December 2022. Further details are available on the course page. Student editor(s): Agentmcmuffin001 (article contribs).

— Assignment last updated by Agentmcmuffin001 (talk) 17:07, 1 December 2022 (UTC)

Cannabis

Cannabis Is A Botanical Herb. VerifyTruth927 (talk) 03:43, 26 January 2023 (UTC)

Fatality: relevance of Fatality, second paragraph

I updated the information in the 2nd paragraph under "Fatality" (diff) as it was incomplete and, to me, suggested acute cannabis toxicity as the sole cause for this man's death.

This additional info makes me doubt the relevance of the second section as a whole. It's a case report, and the sources (such as abstract 88 at the Congress) don't establish causality: "a fatal MI that was temporally associated with and putatively precipitated by inhalational cannabis use." (or even correlation, for that matter).

The case report could maybe function as part of a section explaining that cannabis use has been implicated in some deaths, but as a standalone section, I don't see why it should be in the article.

This is related to the RFC: Cannabis overdose talk, but not specifically about overdose, and, at the bottom of that talk page under "The fatality section is poor":

"Cannabis is suspected of being a potential, and under-reported, contributory factor or direct cause in cases of sudden death, due to the strain it can place on the cardiovascular system." - No adequate reference or explanation of what that "strain on the cv system" is or how it could be the direct cause of death - No discussion of the LD50 or overdose potential of cannabis relative to other drugs - No contextualisation of the rarity of death by cannabis
— 2400:2650:8DC0:1800:6C83:9F84:B505:6F08 17:29, 9 July 2022 (UTC)

Douweziel (talk) 18:58, 18 April 2023 (UTC)

This is using weak sources to 'undercut' WP:MEDRS ones, which is bad. Bon courage (talk) 19:11, 18 April 2023 (UTC)

I'm not sure what you're saying. The original source states: "There was one reported adult requiring intubation and one death."

They mention nothing else about this death, but they do give a source for this statement. It's the first source I cited and it provides additional information:

"One 70-year-old man died shortly after presentation to the ED after intentional inhalational exposure to vaporized liquid concentrate product, with documented wide-complex tachydysrhythmia and ST-segment elevation on electrocardiogram. Autopsy revealed acute myocardial infarction of the anterior left ventricular wall, acute thrombosis of the left anterior descending artery, and atherosclerotic disease of multiple coronary arteries."

They also give a source for this statement. The passage is unclear about the role of cannabis usage in this death, so I also looked up that source.

88. Fatal myocardial infarction after inhalational cannabis use.

Background: (...) We report a case of fatal MI following vaping of concentrated cannabis product.

Case report: A 70-year-old male with no known chronic medical conditions and remote marijuana use (pipe smoking of loose leaf plant material several decades previously) presented to the Emergency Department (ED) in cardiac arrest. The patient had been admitted to the hospital 1 week prior to his arrest with chest pain and exertional dyspnea, and was found to have anemia due to a bleeding duodenal ulcer attributed to non-steroidal anti-inflammatory drug (NSAID) use for headaches. (...) Following discussion with the patient’s family, the decision was made to terminate the resuscitation. Autopsy revealed acute myocardial infarction of the anterior left ventricular wall, acute thrombosis of the left anterior descending artery, near complete occlusion of the right coronary artery, and atherosclerotic disease of multiple coronary arteries.

Discussion: Acute cardiovascular and cerebrovascular events following inhalational cannabis use have been reported but remain rare. This patient, with previously unrecognized critical atherosclerotic coronary artery lesions, suffered a fatal MI that was temporally associated with and putatively precipitated by inhalational cannabis use. With the increased number of US states in which medical and recreational cannabis use is allowed, an increased prevalence of such use may be expected. As such, providers should be aware of the cardiovascular risks of inhalational cannabis use and the implications for users who may otherwise be at risk of coronary artery disease.
— Matt Noble and Shana Kusin, Oregon Health & Science University, Oregon Poison Center. In: Clinical Toxicology (2017), 55(7)

I'm not sure what I'm undercutting here. Feels like the statement on the Wiki as it was (and now, again, is) undercuts the facts of this death and its alleged link to cannabis - or at the very least leaves it up to interpretation. Douweziel (talk) 20:10, 18 April 2023 (UTC)

Right, you're re-running the secondary source with what you think they should have said based on what they cite. That's called WP:OR and is forbidden by policy. Bon courage (talk) 20:14, 18 April 2023 (UTC)

I'm not quite sure what you're saying - are you saying the reported death is about a different person, so WP:SYNTH?

Or do you mean the subsequent 2 sources from Clinical Toxicology are indeed about this same person, but are unreliable? Douweziel (talk) 20:26, 18 April 2023 (UTC)

You say the reliable source we cite "mentions nothing else about this death". So why should Wikipedia? Bon courage (talk) 20:39, 18 April 2023 (UTC)

I was under the impression that including relevant information from reliable sources, such as the age and pre-existing medical condition of the person who died, is not considered original research as long as it is presented in a neutral and verifiable manner. It provides important context and nuance to the statement. So unless you think the given sources are unreliable/unverifiable, or that it was presented in a non-neutral manner, I'm not quite sure what the problem is. Douweziel (talk) 20:46, 18 April 2023 (UTC)

The primary source are not MEDRS, no. Using them to present knowledge in a different way to the reliable source is POV, yes. Additionally, you seem to have misrepresented the primary source by inventing a "pre-exisiting" qualification for the cardiovascular problems. Bon courage (talk) 21:17, 18 April 2023 (UTC)

So if I understand this correctly, the material from the Clin Tox report "Acute cannabis toxicity" that the Int J Emerg Med. cites (which is that an adult died who had been admitted for acute cannabis exposure) is reliable, but material from that same Clin Tox report detailing this death and the material that it references from a different article in Clin Tox aren't? As in, the validity of any single statement in a primary source hinges entirely on the statement being reproduced in a secondary source?

Sources being primary is not invalidating in itself. The sources are used to describe a specific case and not to make broad generalizations about cannabis toxicity (so, low weight), and are only used to describe conclusions made by those sources. As such, I don't see how using them is inappropriate in the context of the article.

Also, they/I don't present knowledge in a different way from the original source. The original source only states: "There was one death" (in the context of the Clin Tox report of exposure to cannabis without co-ingestants). Detailing this death does not change that statement.

Just to be sure any link to MI is not a problem, I'll provided a reliable source as per the effects of cannabinoids on MI. From this review: "cardiovascular effects from cannabis use can precipitate to a MI much more acutely." Similar statements are also made by the original Int J Emerg Med. review. Douweziel (talk) 23:39, 18 April 2023 (UTC)

The advice is "cite reviews, don't write reviews". Especially if that pushes sources beyond the meaning they can bear. The gap between the source's "a fatal MI that was temporally associated with and putatively precipitated by inhalational cannabis use" to having Wikipedia announce "The case report did not establish a causal link between his cannabis usage and his death" raises at least one eyebrow. I shall not respond further unless new reliable sources are produced. If you have further questions I suggest asking at WT:MED. Bon courage (talk) 05:00, 19 April 2023 (UTC)

Ah, I only now see your addition of 'misrepresented the primary source by inventing a "pre-exisiting" qualification for the cardiovascular problems.'

I agree, and I apologize. The only pre-existing condition was artherosclerotic disease of multiple coronary arteries. It appears my brain made a conjecture; I know that acute AMI without any predisposing factors or lifestyle risk factors is extremely rare—same for the thrombosis and occlusion—and that atherosclerotic disease of multiple coronary arteries is a significant risk factor for all three of those.

I did not make this distinction clear at all, and would require sources to do so. Thank you for pointing it out.

I also mostly agree about the "lack of causation" — the sources do not explicitly mention this, making it a deduction on my part (though, because of "associated" and "putative", not an entirely unreasonable one).

However, I have to admit I was (and still am) confused by the primary-source-problem, because WP:MEDRS's explanation mostly pertains to "exploratory and often not reliable", and the autopsy statements strike me as neither. Was the actual problem that I used them wrongly? Or are the autopsy statements, in fact, unreliable? Douweziel (talk) 23:27, 19 April 2023 (UTC)

Famous People

There should be a list of famous people from the past or present who like(d) Cannabis (Wikipedia would keep this list voluntary). King Solomon might be one of them. — Preceding unsigned comment added by EKantarovich (talk • contribs) 13:26, 22 April 2023 (UTC)

@EKantarovich Please go to WP:RA. Aaron Liu (talk) 01:02, 28 April 2023 (UTC)

Weed

Despite using the term (whether legalization would increase weed use by children), there is no mention of the term anywhere else. Is there a reason for this? Aaron Liu (talk) 01:02, 28 April 2023 (UTC)

 Done Good catch, I went ahead and updated this. Esb5415 (talk) 20:07, 1 May 2023 (UTC)

Is there any reason there should be no mention of “weed” in the article? Aaron Liu (talk) 17:19, 2 May 2023 (UTC)

There are some old discussions about this in the archives. See [5]. I personally feel that the link to other names in the lead is enough, especially since the article already uses two names (cannabis and marijuana), but you can always be bold if you have something you think would make the article better. Esb5415 (talk) 17:47, 2 May 2023 (UTC)

Poor Methodology in citied studies relating to pregnancy.

So, first, the citing #122 "American College of Obstetricians Gynecologists Committee on Obstetric Practice (July 2015). "Committee Opinion No. 637: Marijuana Use During Pregnancy and Lactation". Obstetrics and Gynecology." has been withdrawn and is no longer available, so is not a valid source. Next is a meta-data analasys from 2014 that includes studies the article directly references as no long held as valid (the one with tobacco use not separated from cannabis use at least, and probably the one that didn't differentiate any drugs that this article used to cite.) After that is a website that no longer exists that was pure propaganda and not scientific "Drugabuse.gov" And finally, another non-study biased source is cited for behavioural problems. I would like to once again direct the people with the power to edit this article to review https://pubmed.ncbi.nlm.nih.gov/1957518/ "Five-year follow-up of rural Jamaican children whose mothers used marijuana during pregnancy". This is the only study in relation to cannabis use that actually holds up to a serious review of the research methodology, and most "analasys" articles just aggregate the same studies with poor methodology and further bury the one that was actually done correctly. 198.91.167.173 (talk) 18:19, 19 July 2023 (UTC)

A primary source in a backwater journal from the last century? Bon courage (talk) 06:00, 21 July 2023 (UTC)

Methodology is better than ANYTHING that's ever been posted here.

Stop being elitist. 198.91.167.173 (talk) 09:39, 21 July 2023 (UTC)

See WP:MEDRS and WP:BESTSOURCES. Bon courage (talk) 11:11, 21 July 2023 (UTC)

• First, ...173, please don't accuse other editors of bias. Second, Bon courage isn't being elitist when pointing out that the proposed source is old, obscure and non-secondary; they're being accurate. The study dates from a time when in-depth, scientific investigation of the effects of cannabis were virtually impossible in most developed countries. It's a primary source that, afaik, hasn't been cited in any major review of the data in over three decades and thus is of limited value.

As for the meat in your argument, I don't find it. Your claim about 122 being 'withdrawn' is facially untrue since I just read it and there is nothing I saw that suggested withdrawal. Trying to disparage a source as a 'meta-analysis' doesn't work. What we want are secondary, integrative analyses of underlying sources, and attacking a few of their inputs is ineffective. Call 124 propaganda is (imho) completely fair, but 'unscientific' is certainly not and it's definitely still out there. I'm not defending the conclusions of any source, just objecting to your criticism of them.

Most importantly, though, you haven't actually said what you want changed in the article, only kvetched about the methodology of the sources that support the current wording. From what I can see of your source, it would do little more than weaken the sentence supported by source 121 (a sentence that I personally feel is scaremongering anyway and would love to see moderated or removed). Give us proposed wording, please, that is at least as widely sourced as the current content. Cheers, Last1in (talk) 11:34, 21 July 2023 (UTC)

l-Theanine Prevents Long-Term Affective and Cognitive Side Effects of Adolescent Δ-9-Tetrahydrocannabinol Exposure

https://www.jneurosci.org/content/41/4/739

This amino acid is found in green tea and was historically drank in Japan.

Is this article going to talk about safe uses of the drug or not? — Preceding unsigned comment added by 67.80.64.41 (talk • contribs) 10:39, 11 September 2021 (UTC)

Proposed article removal/merging with Cannabis (plant genus)

There are several problems with the classification of Cannabis as a "drug" separately from as a plant.

On wikipedia, plants with psychoactive properties are not usually referrred to as drugs themselves (I am trying to find even one example where a plant itself is referred to as a drug, if you can find one, I would be very interested). The drug is the active chemical.

Here are some examples:

1. Opium is not listed as a drug, but as "a dried latex" (but the drugs contained within opium are e.g., codein, morphine). 2. Coffee and tea are not listed as drug, but as "beverages". Its active components are (the same goes for tea). 3. Psilocybin mushrooms are not listed as a drug, but psilocin and psilocybin are. Pilocybin mushrooms are listed as an "informal group of funghi". 4. Tobacco is not listed a drug, but as a plant, while its active components are.

I am therefore proposing that the contents of this article be split between the articles for cannabis (plant genus), "cannabis smoking", other related articles, and a new article: "drugs contained in Cannabis".

It is misleading to refer to cannabis itself as a drug.

Does anyone have any thoughts on my proposed changes or any alternative solutions? Kieranvolbrecht (talk) 06:29, 18 August 2023 (UTC)

Fine as is; it's to disambiguate from Cannabis (plant), which already exists. Bon courage (talk) 06:38, 18 August 2023 (UTC)

Why are we disambiguating cannabis (drug) from cannabis (plant)?

We haven't disambiguated "psilocybin mushrooms (drug)" from "magic mushrooms (polyphyletic group of funghi).

Cannabis is not a single drug, it is a plant that contains many drugs. Kieranvolbrecht (talk) 07:53, 18 August 2023 (UTC)

It's as it is because of the idiom used in sources. See the archives for extensive prior discussions about naming. Bon courage (talk) 09:26, 18 August 2023 (UTC)

Heart effects and death

I just heard and saw at "the late show with Seth Meyers" that cannabis causes heart attacks.

The only time i have read such a stupidity was here. Based on absolutely nothing.

Nice work. All of you should just quit and shut it down. Seriously. 2A02:8070:6188:76A0:5112:CBE4:3815:6640 (talk) 03:27, 8 November 2023 (UTC)

PMID:30925348 is cited, which is quality science. Bon courage (talk) 03:35, 8 November 2023 (UTC)

It is my belief that a more effective approach to this would be to re-examine the majority of the "Adverse Effects" section of this page from a more view that takes the drawbacks into prospective with the manner in which other influential substances (an key example would be the page relating to alcohol) are cautioned against. as well as modernizing the data related to cannabis and it negative effects. this page and other like it, that relate specifically to substances that have the propensity to be abused, are vastly essential and should be modified and approached with caution and respect. it is also imperative in my eyes to make the information contained especially in the Adverse Effects page palatable, and free from anything that could be viewed as 'Doublespeak' such as not to inhibit informational conveyance. BialysAreJustBagels (talk) 03:59, 23 November 2023 (UTC)

So for heart effects and death PMID:30925348 is a high-quality source. Are there high-quality sources we are missing? Bon courage (talk) 04:17, 23 November 2023 (UTC)

It feels inappropriate to cite a government source for a topic so riddled with historic goverment misinformation https://americanarchive.org/primary_source_sets/war-on-drugs BialysAreJustBagels (talk) 15:11, 23 November 2023 (UTC)

"Government source" ? Bon courage (talk) 15:26, 23 November 2023 (UTC)

Yes that's nonsense, the authors are Australian academics. That said, I have rewritten the text as it did not to a good job of summarising the article. They explicitly state that there is no clear evidence for a link with deaths from cardiovascular disease: However, as seen in the larger scale retrospective studies and the systematic reviews the evidence for a link between cannabis use and increased risk of cardiovascular death is not clear. SmartSE (talk) 15:42, 23 November 2023 (UTC)

my mistake, I am now unable to locate the source I was referencing so I should assume I was incorrect in this. The updated section seems more reflective of reality. BialysAreJustBagels (talk) 18:08, 23 November 2023 (UTC)

It seems I had several tabs open, and I mistakenly switched to source (51) instead of the one I was reviewing. BialysAreJustBagels (talk) 18:11, 23 November 2023 (UTC)

Infobox / US legal

Currently reads: |legal_US = Schedule I.

This seems inappropriate. I'm thinking something including a link to Legality_of_cannabis by_U.S._jurisdiction is appropriate. Why? 9 of the 10 largest states have legalized medical and recreational marijuana, and the 10th (TX) has substantially legalized medical marijuana. In most states, medical marijuana is legal. In 24, recreational marijuana is legal too. On federal property (a small fraction of the US) Schedule I still applies to >0.3% non-synthetic Δ9-THC, but per https://www.federalregister.gov/documents/2017/03/23/2017-05809/schedules-of-controlled-substances-placement-of-fda-approved-products-of-oral-solutions-containing, "Syndros, a drug product consisting of dronabinol [(-)-delta-9-trans-tetrahydrocannabinol (delta-9-THC) oral solution" is "in schedule II of the CSA" effective March 23, 2017, and per https://web.archive.org/web/20221104154012/https://www.deadiversion.usdoj.gov/fed_regs/rules/1999/fr0702.htm, Marinol is Schedule III <sic> (None of which is reflected at Synthetic cannabinoids! )

I'm swapping in: Legality varies from Schedule I to legal for medicinal and recreational use.

-- RudolfoMD (talk) 03:19, 18 December 2023 (UTC)

I think for clarity the wording should be "Federal: Schedule I; varies state-by-state for medicinal and recreational use" or some variation. That is, I think it should be made clear that it is federally illegal; I think this is important to point out because federal law under CSA overrides state laws and at any point federal law can be enforced even where recreational use is legal. The way it currently sits (after your edit) obscures the fact that by federal law (which supersedes local laws) it is still illegal (Schedule I). Kimen8 (talk) 14:51, 18 December 2023 (UTC)

"Legality varies from Schedule I to legal for medicinal and recreational use." already indicates that it is federally illegal. Severe undue weight is placed on the largely unenforceable and unenforced federal law by your proposed wording. Given that the vast majority of US law enforcement treats at least medical use as legal, if anything, the current wording (my own) emphasizes federal law too much and "Legal for medicinal and/or recreational use in most of the US, per state laws but still Schedule I under federal law." or "Legality varies from most medicinal and recreational use is legal to a Schedule I ban." would be more balanced. But if you want to push "Varies state-by-state for medicinal and recreational use; Federal: Schedule I" I won't fight over it. RudolfoMD (talk) 22:09, 18 December 2023 (UTC)

I agree that the former wording was WP:UNDUE, but the new wording seems to lean too far the other way. Perhaps something like, 'Legal for medical and/or recreational use in most states; Schedule I at the federal level' might be better. It doesn't emphasise it, but it does warn people that, in places where federal law prevails (like points of entry and all TSA locations), even minor possession can get you in serious legal trouble. Cheers, Last1in (talk) 22:31, 18 December 2023 (UTC)

Acceptable compromise. RudolfoMD (talk) 23:03, 18 December 2023 (UTC)

Done. We can continue to adjust the wording based on additional feedback. Cheers, Last1in (talk) 23:34, 18 December 2023 (UTC)

"Legality varies from Schedule I to legal for medicinal and recreational use." already indicates that it is federally illegal., except that it doesn't. States can designate things Schedule I at the state level, which is not connected to their federal scheduling. To simply say it varies from Schedule I to recreational (especially if you mention on a state-by-state basis), it is not clear whether it is Schedule I (at the state level) or Schedule I (at the federal level) that you are referring to. The version below by Last1in seems like a good balance. Kimen8 (talk) 23:42, 18 December 2023 (UTC)