Just hours before President Biden unveiled a major effort to reform federal marijuana laws on Thursday, the Centers for Disease Control and Prevention released a report highlighting some of the collateral damage from the harsh criminalization of the relatively safe drug.
The report documented mass poisoning by alternative marijuana products contaminated with rat poison. The event – which seriously sickened 52 people, killing four – is not the first or even the most important of these poisonings. In 2018, counterfeit products containing rat poison sickened nearly 200 people in a multi-state poisoning outbreak that also left four people dead.
In the most recent cluster, Florida health officials began noting cases in December of last year. And, based on the 2018 outbreak, they quickly linked illnesses to synthetic cannabinoids (aka spice, K2, synthetic marijuana, or fake weed).
Synthetic cannabinoid products are often sold in small foil packages containing some sort of shredded, dried plant material that has been sprayed with lab-made mind-altering chemicals intended to mimic the components of marijuana. They are also sometimes sold as liquids. The products are poorly regulated and may contain an ever-changing range of substances to circumvent ever-changing laws. Nevertheless, they are often falsely marketed as safe, natural and legal alternatives to marijuana, promising the same benefits as the real drug while being undetectable by drug tests.
Synthetic cannabinoids are questionable and can be risky, but products containing brodifacoum, a rat poison, are particularly dangerous. Brodifacoum is part of a class of rodenticides called “superwarfarins” and was once the active ingredient in “D-Con” rat bait. The toxic chemical is a long-acting vitamin K oxidoreductase antagonist, which blocks the activity of a specific enzyme. This results in an increase in an inactive form of vitamin K, which plays an essential role in blood clotting. Specifically, a blood protein directly involved in clotting, prothrombin, depends on vitamin K.
Ingestion of brodifacoum may prevent proper clotting, resulting in life-threatening bleeding. And it’s a long-acting drug, which means poisonings can take months to clear. Brodifacoum has a half-life of 16 to 36 days, and researchers have observed that it remains in the body for up to 270 days after acute exposure.
In the new Florida poisoning report, Tampa-area health officials noted that the most common symptoms of poisonings were abdominal pain, urinating blood and vomiting blood. And it was hard to deal with. “Many patients required high doses of oral vitamin K1 (i.e. 150 mg/day), which required taking 30 tablets of 5 mg per day during hospitalization and for 3 to 6 months after release,” the authors noted.
They were also expensive to process. Oral vitamin K1 treatments can cost $65,000 or more per month. And testing for brodifacoum poisoning costs upwards of $750. Florida officials noted that two-thirds of the patients were uninsured, and a private pharmaceutical company ended up donating enough vitamin K1 tablets to treat all 52 patients.
Officials aren’t sure why anyone would put brodifacoum in fake weed, but researchers have speculated that it may prolong or enhance the effects of synthetic cannabinoids. Brodifacoum has also been found contaminating marijuana and cocaine.
Poisonings are another reason drug policy reform advocates have called for the legalization and regulation of marijuana, which is already happening in some states. Currently, 37 states and the District of Columbia have laws permitting the medical use of marijuana, according to a report by the National Organization for Marijuana Law Reform. Nineteen states and District of Columbia laws allow some recreational use, and 27 have partially or fully decriminalized certain possession offenses.
On Thursday, President Biden made moves to reform federal laws by granting sweeping pardons for federal offenses of simple possession. He also called on federal authorities to review marijuana’s status as a “Schedule 1” drug, a designation used for the most dangerous drugs.
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