Title: Cannabis recent use in sudden unexpected deaths

Abstract

Objective The objective was to review all sudden unexpected death received in our laboratory for the four years period (2018 – 2021) after a recent cannabis use. Parameters evaluated were age,antecedents, sex, cause of death and toxicological results Scope: To elucidate whether cannabis use increase the risk to suffered from sudden death Methods The study was carried out by searching the LIMS database of the Department of Seville from INT-CF from 2018 until 2021, for all cases of sudden unexpected deaths related to cannabis use. We selected those in which cannabis use was recent due to the presence of THC in blood postmortem. Blood samples were screened for cannabis by CEDIA and Δ9-tetrahydrocannabinol (THC), 11-hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) and 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) were confirmed and quantified using solid-phase extraction (SPE) followed by gas chromatography tandem mass spectrometry (GC-MS/MS). The cut-offs applied were 1 ng/mL for THC and 11-OH-THC and 5 ng/mL for THC-COOH. Results 48 sudden unexpected deaths following recent cannabis use were recorded. In 87.5% of cases were male, the age rangeof 16 to 74- years-old, being the median 50-years-old and the mode 47-years-old. In 77% of cases the cause of death was cardiogenic, 6.2% subarachnoid hemorrhage and the rest other causes. Most decedent had pathological antecedents like arterial hypertension, obesity,epilepsy. THC concentrations detected inblood postmortem have been increasing for the period studied (Figure 1). The number of deaths increased from 7 in 2018 until 21 in 2021. Conclusion In people with certain pathologies and/or alcohol and tobacco use habits, cannabis use is a risk factor that could contribute to sudden unexpected death.