Can too much weed kill you?

 

The idea for this post came from a Facebook friend who indicated they were concerned about the US’s recent push to legalize marijuana, particularly in light of the chances of death from an overdose. Myself and another ED colleague had never heard of a death resulting from THC. So off to research I went.

Scouring the search engines I could find no credible evidence to say overdosing on marijuana has, in fact, been attributed to a death. Having too much marijuana can cause a number of unwanted conditions within the body which can make you VERY uncomfortable:

  • Temporary feelings of paranoia, fear and anxiety
  • Shortness of breath
  • Pupil dilation
  • Vomiting and/or nausea
  • Fast heart rate
  • Shaking that is hard to control, feeling cold
  • Disorientation or hallucinations
  • Hangover

But these symptoms are also common with other illicit and legal drugs, such as alcohol. Studies have shown that a person would have to receive a massive amount of THC, the active high-producing ingredient in marijuana, to die from it- this would equate to pounds being used at a time. Very unlikely.

So marijuana is harmless?

Not so fast! The question is whether you can die from a single overdose of marijuana. But just like other chemicals that humans used for pleasure marijuana can have serious effects which could indirectly lead to death. It is these items I think many are talking about when they discuss the dangers of marijuana consumption.

A report from Colorado USA where marijuana is legal has found that traffic fatalities with drivers showing marijuana in their system at the time of the accident rose by 154%! Hospital presentations were also mentioned as increasing due to marijuana consumption, however the evidence was not clear that marijuana definitely had an impact. School suspensions from marijuana use were also mentioned.

Marijuana also has shown long-term health affects in terms of memory and brain function. There can also be secondary effects from smoking the drug and there are associated birth defects when women who are pregnant use marijuana.

The bottom line…

The actual THC in marijuana can kill you if consumed in large enough quantities. However, obtaining and using those quantities will either land you in jail for a very long time or be practically impossible. There are no known attributed cases to anyone dying from consumption of marijuana.

However, there are dangers in misuse of marijuana. As with all other chemicals consumed by individuals to obtain a euphoric state marijuana can alter a person’s functioning and cause health concerns. Therefore, any use of this or any other substance must be done so with full knowledge of the effects. And there it goes without saying a careful review of current laws on consumption in your area.

Should it be legal?

The eternal debate in modern society. Like other legal substances marijuana has very negative side-effects both short and long term, however that has not stopped tobacco and alcohol from remaining legal. Some would argue that it is a ‘gateway’ drug and could lead to greater abuse. However we do not know the numbers of individuals who use marijuana and never progress to harder drugs, so how can we really know? Like alcohol marijuana can impair a person’s driving and other complex and fine motor skills. So policies and laws would need to be put in place outlining legal limits on consumption and operation.

There is growing credible evidence that marijuana is beneficial to relieving pain and other neurological symptoms. Therefore, I think it’s use as a medical alternative to stronger and harsher medications is welcomed. Especially if those with severe and chronic pain can be helped. These individuals are often struggling, and if allowing this avenue can bring relief then I am all for it.

As for the rest of us, I still don’t know. I will state for the record I have never used marijuana. I can see both sides of the debate, and I guess as I have gotten older my views have become more complex. While once very much against the idea now I am leaning toward society’s choice. There are some distinct advantages to legalizing marijuana.

  • Once legal safe limits on consumption can be placed.
  • Regulations on growing, processing, and distribution can be instated and ensure a safe product.
  • There will be a decreased demand from law enforcement agents in going after marijuana users and dealers.
  • Marijuana use can be taxed leading to revenue.
  • Legalization may also spark increased interest in investigating other medicinal properties.

So I guess I am on the legalizing side of the debate. I also can see the arguments with those who wish to uphold the laws against marijuana use. However, I do feel that they will be fighting a loosing battle in years to come.

References

Herb.com: Marijuana Deaths: How Many Are There?

Huff post: Here’s How Many People Fatally Overdosed On Marijuana Last Year

New Health Guide: Can You Overdose On Marijuana?

Family Council: Number of Deaths Caused by Marijuana Much More than 0

National Institute on Drug Abuse: What is marijuana?

 

 

 

Advertisements

Should Australia adopt a national Dementia plan?

 

Anyone who works in healthcare, particularly those in aged care, can attest to the fact that dementia is one of the largest problems facing our aged population. Here are a few Australian facts courtesy of Alzheimer’s Australia:

  • There are more than 413,106 individuals in Australia living with dementia
  • Currently 244 new individuals will be considered has having dementia every day
  • Dementia is the second leading cause of death of Australians
  • In 2017 the cost of caring for those with dementia in Australia is estimated to be 14.67billion
  • Dementia is the single biggest factor leading to disability of adults over the age of 65
  • Dementia accounts for 52% of those residing in aged care facilities (RACF)

It is a huge problem! In an article on the 2nd of June in Australian Ageing Agenda Maree McCabe of Alzheimer’s Australia has strongly encouraged Australia to join the international community in developing and funding a national Australian dementia policy. In the article it states that the World Health Organization (WHO) has adopted a Global Plan of Action on Dementia, and that Australia should join other countries in adopting it.

What is Australia doing about it?

The government’s response has not been favorable to Alzheimer’s Australia’s (AA) request. Dr Margot McCarthy told a Senate estimates committee that, although she was aware of AA’s request there was no national strategy but a series of increased funding for research and new dementia-specific programs. Dr. McCarthy also in her statement referred to the National Framework on Action on Dementia, but said the government had to decide on how to follow-through with the framework.

The National Framework on Action for Dementia 2015-2019 was developed by the  Australian Health Ministers Advisory Council (AHMAC) through a consultative process and merely serves to

The purpose of the Framework is to guide the development and implementation of actions, plans and policies to reduce the risk of dementia and improve outcomes for people with dementia and their carers. It does this by drawing on current evidence to promote dementia friendly societies and delivery of consumer-focused care.

The keywords here is ‘guide’ and ‘development and implementation’. This is NOT a national framework, but merely a fact-finding paper with the results of interviews and consultations on the problem. While the national framework policy does not give any direct action to the problems of dementia, there have been some attempts by the government to tackle dementia issues.

In June of 2016 the government began a commitment to tackle the issue of dementia in the community by the initiation of the Severe Behviour Response Teams (SBRT), a partnership between the government and Hammond Care. The SBRT is meant to be an assessment and management team designed to visit the individual and work to identify and create strategies to handle adults who suffer from dementia-related behaviours. The government also acknowledged at the time that specific dementia facilities for those with behaviours would be needed. Dr. Judd, then chief executive of Hammond Care, indicated that accreditation standards for aged care facilities had led to those facilities increasing in size and therefore “as nursing homes get bigger and bigger, it becomes harder not to have institutional buildings which are less homelike and more regimented… Today, the public areas of some aged care ‘facilities’ look more like airport lounges than lounge rooms” (quote by Dr. Judd taken from this article).

A year later and the Ageing Australian Agenda article confirmed that the special dementia units promised in 2016 were largely not developed. Therefore, the bulk of dementia-specific management of older adults rests squarely on the shoulders of current residential aged care staff and caregivers when dementia-sufferers are at home. But what about the WHO’s Global Action on Dementia? Wouldn’t that give some indication on where Australia should go?

The World Health Organization and Dementia

I have looked through the WHO’s website and cannot see any agreed final document on the global action on dementia. According to the WHO dementia has been labeled as a public health priority in 2012 and a Ministerial Conference on Global Action on Dementia did occur in 2015, resulting in a draft document of the same name. In the push for WHO development of information a site entitled The Global Dementia Observatory was meant to be a sharing house for information relating to statistics on global dementia and development of strategies to treat and handle those with dementia. However, in my research neither has the Global Action on Dementia been finalized nor has the Global Dementia Observatory been created and implemented despite statements made by Alzheimer’s Australia.

So from my perspective after looking at all of the information the WHO is no further in looking for a unified dementia strategy than Australia is. We continue to develop reactionary stop-gap measures to modify behaviours and reduce pressure on caregivers. But that does not help identify and treat the root cause. Non-government organizations like Alzheimer’s Australia and Hammond Care are doing great things to try and help this looming national (and international) epidemic.

We in healthcare are at the front-line of this issue. Of the patients I see a vast majority are over the age of 65, as they take up more acute healthcare beds. And while I do not have specifics of those with dementia I can say with my experience that many who enter our beds do. Dementia causes quite a few issues that can lead to life-shortening situations.

My thoughts

Those who follow this blog know that I have talked twice about the concept of ‘premature deaths’ a topic surrounding why individuals in aged care facilities are dying from un-natural causes. Falls was listed as the greatest cause of these premature deaths. I wonder if Mr. Ibrahim’s proposed study would look to identify of those falls how many patients have a diagnosis of dementia? Being reasonable and looking at common sense, if I do not have dementia and have all of my faculties would I not use the vast range of mobility aids and ask for help to prevent falling when I look to walk or even stand? Those with dementia do not have the for-sight to realize that they are no longer able to mobilize without help, and therefore are at higher-risk of falling.

Interestingly Dr. Judd in his address in 2016 also talked of aged care facilities becoming larger. This is another troubling point. Larger facilities mean more residents for staff to monitor in a larger space. Another interesting study could look at the amount of time each staff is given per resident. I think it would find that staff have difficulty in adequately supervising residents, particularly those with dementia who are prone to stand and walk- and therefore fall.

Unifying Australia’s stance on dementia and the associated research and programs would give clarity and focus within all aspects of the aged care community. Let’s face it, the aged care population is faced to grow over the next few years. And with it those with dementia is also most likely going to grow. It is a debilitating condition that we need to know more about to effectively care for and treat. I agree with Mrs. McCabe, Mr. Judd and the WHO that we need to put more focus on a unified and strategic plan to deal with this growing epidemic.

References

Australian Ageing Agenda: Australia behind as global dementia plan endorsed

Alzheimer’s Australia: KEY FACTS AND STATISTICS FOR MEDIA – NSW

Australian National Framework for Action on Dementia 2015-2019

Australian Ageing Agenda: Coalition to fund special dementia care units for severe behaviours

Dementia Behaviour Advisory Service

Hammond Care: Severe Behavoiour Response Team

World Health Organization: Dementia

 

Premature deaths in aged care facilities, what is really the root cause?

 

A recent article in The Conversation by Joseph Ibrahim discussed recent findings that a large number of residents in residential aged care facilities (most commonly known as nursing homes) died as a result of ‘unnatural causes’. The three most prolific causes identified by a recent report from the coroner’s court was falls (81.5%), choking (4.4%) and suicide (1.9%). The study also stated that while in over 90% of the cases the cause of death was initiated in the nursing home over 67% of the actual deaths occurred in an acute facility, such as a hospital. This is reflected in the patients I see in my emergency department. The report goes on to say that these incidents result in a ‘premature’ death and are in many ways ‘preventable’. I would like to bring up some important factors which may confound such a simple statement.

While I do agree that there are most likely things that can be done within Residential Aged Care Facilities (RACFs) to minimize deaths related to the above items, I do think some moderation of the situation is in order. With the ageing-in-place legislation and current climate allowing elderly people to remain in their own homes longer RACFs are seeing residents coming to them older, and more importantly, more unwell with their disease process advanced. While not an excuse I wonder how much longer RACF residents would be able to functionally thrive in their own home rather than in a facility? From my experience of working in RACFs I can say that most likely a resident is placed in a facility due to either an acute turn in their condition (i.e. fracture or some major medical setback) or commonly due to a decline in mobility and functionality due to dementia which would preclude them from staying at home. Along with the decline in mobility and functionality is an increasing possibility for falls.

A second issue is exactly what is the role of a RACF in the health care continuum? According to the MyAgedCare website in a RACF ” Staff at aged care homes can help you with day-to-day tasks (such as cleaning, cooking, laundry); personal care (such as dressing, grooming, going to the toilet); or 24-hour nursing care (such as wound care, catheter care).” Additionally, the Aged Care Quality Agency standards for RACF homes is very general with standard 2.4 simply stating ” Care recipients receive appropriate clinical care” and standard 2.14 on mobility stating ” Optimum levels of mobility and dexterity are achieved for all care recipients.” These are very broad clinical statements with no specific measurable outcomes. They are also included with other standards such as 4.8 which state ” Hospitality services are provided in a way that enhances care recipients’ quality of life and the staff’s working environment” and 3.7 ” Care recipients are encouraged and supported to participate in a wide range of interests and activities of interest to them.” Therefore, my question again is where does the RACF fit clinically within the healthcare continuum? Is it meant to be a sub-acute residential centre with clinical nursing care as a role on-par with items such as hospitality services and leisure activities?

This case can further be made if Mr. Ibrahim speaks to RACF clinical staff. In most RACF homes the registered nurse is the clinical decision maker for initial diagnosis and guides treatment of patients. However, they have limited assessment and diagnostic tools at their disposal. They have no access to blood tests, CT scanners or even x-rays within a reasonable time frame nor I have found a RACF with a 12 lead ECG machine which is seen as a critical piece of equipment in any hospital emergency department. Additionally, medical services are exclusively provided by general practitioners who can give limited medical support within their clinic hours and an after-hours GP service which does not know the patients and can only provide cursory and event-specific advice. This leaves the registered nurse having to care for a much larger number of patients than any hospital-based nurse would dream of doing with much less equipment and no medical support on-hand.

My worry is with Mr. Ibrahim’s study, as with many previous examinations of care given in RACF homes, will place the burden of responsibility for ‘premature deaths’ at the feet of the registered nurse. I think this is largely unfounded as the RACF system is flawed and needs a truly complete analysis and re-think moving forward. If the RACF is to prevent these events from happening then let us give the registered nurses on the floor appropriate staffing numbers, the right tools and education in assessment using them along with adequate medical support no matter the time of day or night and I think you will see the number of premature deaths decrease rapidly.

References

MyAgedCare: Aged care homes (nursing homes)

The Conversation: Many older people in care die prematurely, and not from natural causes

Aged Care Quality Agency: Accreditation Standards