Aims: Cannabis is often considered a non-lethal drug with few cases of deaths attributed to cannabis in the scientific literature. This research aims to identify trends in drug-related deaths involving cannabis in England (1998-2020) as well as describe potential underlying causes and co-occurring drugs.
Methods: Deaths reported to the National Programme on Substance Abuse Deaths (NPSAD) where cannabis was detected at post-mortem that occurred between 1998-2020 were extracted for analysis.
Results: A total of 3,440 deaths with cannabis at post-mortem were reported to NPSAD. An average of 113 deaths were reported each year from 1998-2010. A subsequent sharp increase in reported deaths occurred (2011-2020, R2=0.91) with over 350 deaths projected in 2020. Deaths where cannabis was detected alone were rare (4%, n=136/3440), with the major underlying cause of death attributed to trauma (62%, n=84/136) as opposed to effects directly resulting from cannabis consumption (13%, n=17/136). Co-detection with other drugs occurred in the majority of cases (96%, n=3304/3440), with the underlying cause of death in these cases drug toxicity of the co-detected substances (76%, n=2519/3304). Drug toxicity which included implication of the detected cannabis in causing death accounted for only 7% of these cases (n=232/3304).
Conclusions: There has been a notable increase in deaths where cannabis was detected in England in the past 10 years. Although it is evident that cannabis alone has a limited toxicity profile, external harms that occur as a direct result of cannabis use that impact the safety of users and others need to be explored further.