On December 15, 2019, the American Journal of Case Reports ran an article with a contentious headline, “Neonate Death Due to Marijuana Toxicity to the Liver and Adrenals,” by Connie Bao and Shiping Bao at the Champaign County Coroner’s office in Urbana, Illinois. A twenty-year-old mother had found her 11-day old baby unresponsive at home. By the time she reached the hospital, the child had already died. The coroners attributed this tragic event to cannabis, whose metabolites had been found in in the baby’s umbilical cord.
Given that cannabis use have never been shown to cause a lethal overdose, as Bao and Bao recognize in their report, the bar should be quite high for claiming that “the cause of death was… due to maternal use of marijuana.” But details in this case are sparse, wrapped into a single paragraph that ends with an ominous caveat: some information is “confidential at this time due to legal circumstances.”
This final sentence suggests that the mother may be prosecuted for the death of her child. (Project CBD was unable to confirm this; the author did not reply to a request for comment.) Illinois, where this event occurred, considers maternal drug use a form of child neglect, which can be prosecuted, possibly as manslaughter or homicide.
Backed into a corner
Women are increasingly backed into a corner. Alongside diminishing access to abortion in the United States, there are a slew of anti-abortion laws that heighten a mother’s legal culpability for harms befalling a fetus. Coupled with the longstanding cultural view that motherhood is a woman’s highest aim, women are less able to avoid a pregnancy, while its potential consequences magnify.
Why was the death blamed on cannabis? The case is described as follows:
“A complete autopsy and full investigation were conducted. Positive macroscopic findings included extensive hemorrhage of both adrenals (Figure 1), petechial hemorrhage of the entire liver (Figure 2), and focal hemorrhage of the thymus (Figure 3). X-ray revealed no fractures of any bones, and there was no evidence of trauma. Newborn screening of inborn errors of metabolism, and post-mortem neonate blood toxicology test, were both negative. The newborn drug screen of umbilical cord homogenate was conducted at the United States Drug Testing Laboratories (Des Plaines, IL, USA) and it revealed 528 pg/g carboxy-THC (screen cutoff at 50 pg/g). Microscopic examination of the liver (Figure 4) and adrenals (Figure 5) showed extensive necrosis and hemorrhage. There was focal hemorrhage of the thymus (Figure 6). Microscopic examination of the other major organs were non-contributory, and there was no congenital disease or infection. The cause of death was extensive necrosis and hemorrhage of the liver and adrenals due to maternal use of marijuana. The maternal blood marijuana concentration, and pattern of marijuana use prior to and during pregnancy, are confidential at this time due to legal circumstances.”
Reading this brief report, one may wonder how the authors concluded the death was attributable to marijuana. It was a “diagnosis of exclusion,” they explain.
Although the child was born pre-term, there were no congenital problems; autopsy didn’t find an infection or trauma which could have resulted in the child’s death. Based on this evidence (or lack of evidence), the mother’s cannabis use was deemed responsible for the child’s death. Essentially, the coroners viewed cannabis as the most likely cause – in spite of their own preclinical evidence – so they published a report stating definitively that it is the cause.
What research do the authors present to back up the presumed toxicity of THC? They cite six references (12-17) published between 1969 and 1987, describing pregnant animals exposed to THC or cannabis. They admit, however, that “[t]here has been no experimental data that show in utero fetal deaths resulting from maternal marijuana injection in large animals.” Extremely high doses of THC (e.g. 200-500 mg/kg, injected into the mother) appear to cause reabsorbtion of the fetus into the uterus in rabbits, mice, and other small animals. Much of the research they cite uses sample sizes that are too small to reliably detect an effect from cannabis.
One could argue that cannabis should have been excluded as a culprit based on the fact that it has not been implicated liver hemorrhage or fetal death in humans or other large animals, meaning there is no precedent for the allegation. “This case is unique in that other possible causes of death can be eliminated,” such as other drugs, according to Bao and Bao, although they do not disclose the list of other drugs that were assessed. (Hemorrhage is a common complication of synthetic cannabinoid exposure, for example, which is rarely detected in routine drug screens.)
This is the first case claiming cannabis causes liver and kidney hemorrhage. The paucity of evidence implicating cannabis, along with the complete lack of historical precedent, is problematic, especially when considering the possible legal culpability of the mother. It is bad enough that professionals stretch and contort evidence to fear-monger about cannabis. If this poorly substantiated argument is used in the prosecution of the mother, it would be catastrophic.
Coda: A curious flipflop
It turns out that Shiping Bao, the second author of this report, performed the autopsy of Trayvon Martin, a black teen who was followed and shot to death by George Zimmerman in a high-profile court case that laid bare (once again) systematic racism within the US legal system.
Bao found THC in Martin’s body, but initially stated that it would not have impacted Martin. Bao changed his testimony part-way through the case, taking the position that Trayvon Martin might have been intoxicated at the time he was attacked. This gave additional justification to Zimmerman, who was ultimately acquitted.
Two months after the ruling, Bao was fired. He threatened to sue his ex-employer and the State of Florida for wrongful termination, claiming that the prosecution had hoped to lose the case and set him up to fail (such that he would be scapegoated for Zimmerman’s eventual acquittal). The lawsuit – for $100 million in damages to Bao’s reputation and well-being – appears not to have been filed.
Adrian Devitt-Lee, Project CBD’s chief science writer, is pursuing a PhD in math at the University College of London.
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