Can cannabis kill? Characteristics of deaths following cannabis use in England (1998–2020)
Open accessAbstract
Background: Cannabis is the most widely used illegal drug but is rarely considered a causal factor in death. Aims: This study aimed to understand trends in deaths in England where cannabinoids were detected at post-mortem, and to evaluate the clinical utility of post-mortem cannabinoid concentrations in coronial investigations. Methods: Deaths with cannabinoid detections reported to the National Programme on Substance Abuse Deaths (NPSAD) were extracted and analysed. Results: From 1998 to 2011, on average 7% of all cases reported to NPSAD had a cannabinoid detected ( n = 110 deaths per year), rising to 18% in 2020 ( n = 350). Death following cannabis use alone was rare (4% of cases, n = 136/3455). Traumatic injury was the prevalent underlying cause in these cases (62%, n = 84/136), with cannabis toxicity cited in a single case. Polydrug use was evident in most cases (96%, n = 3319/3455), with acute drug toxicity the prevalent underlying cause (74%, n = 2458/3319). Cardiac complications were the most cited physiological underlying cause of death (4%, n = 144/3455). The median average Δ9-tetrahydrocannabinol post-mortem blood concentrations were several magnitudes lower than previously reported median blood concentrations in living users (cannabis alone: 4.3 µg/L; cannabis in combination with other drugs: 3.5 µg/L). Conclusions: Risk of death due to cannabis toxicity is negligible. However, cannabis can prove fatal in circumstances with risk of traumatic physical injury, or in individuals with cardiac pathophysiologies. These indirect harms need careful consideration and further study to better elucidate the role cannabis plays in drug-related mortality. Furthermore, the relevance of cannabinoid quantifications in determining cause of death in coronial investigations is limited.
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There is a link between cannabis use at high doses and lethal motor vehicle collisions.
“Risk of death due to cannabis toxicity is very low, but there is a link between cannabis use at high doses and lethal motor vehicle collisions, cardiac pathophysiology and possibly suicide [17, 77, 78].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [77]
The Discussion section, “Risk of traumatic injury outweighs that of toxicity” (page unavailable), reports fatal road-traffic collisions following cannabis use and says the median THC blood level in those fatalities indicated probable cognitive impairment. It does not establish that the cannabis was used at high doses; it notes impairment can occur at low THC blood levels. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThere is a possible link between cannabis use at high doses and suicide.
“Risk of death due to cannabis toxicity is very low, but there is a link between cannabis use at high doses and lethal motor vehicle collisions, cardiac pathophysiology and possibly suicide [17, 77, 78].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [77]
The Discussion ('Risk of traumatic injury outweighs that of toxicity'; page unavailable) reports that self-inflicted injuries were the largest category of trauma-related deaths and discusses possible pathways linking cannabis use to suicide-related risk. It does not link suicide specifically to high-dose cannabis use. The Results ('Levels of cannabinoids'; page unavailable) say median cannabinoid concentrations were comparable across manners of death, so the high-dose qualifier is unsupported. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere is a link between cannabis use at high doses and cardiac pathophysiology.
“Risk of death due to cannabis toxicity is very low, but there is a link between cannabis use at high doses and lethal motor vehicle collisions, cardiac pathophysiology and possibly suicide [17, 77, 78].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [77]
Risk of death due to cannabis toxicity is very low.
“Risk of death due to cannabis toxicity is very low, but there is a link between cannabis use at high doses and lethal motor vehicle collisions, cardiac pathophysiology and possibly suicide [17, 77, 78].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [77]
It is unclear whether mortality is related to cannabis use, predisposing factors or combinations thereof.
“It is unclear whether mortality is related to cannabis use, predisposing factors or combinations thereof.”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [77]
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Cites
Time for united action on depression: a Lancet–World Psychiatric Association Commission
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BackgroundExploring the association between cannabis use and depression.
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Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits
Hoch, E., Volkow, N. D., Friemel, C. M., Lorenzetti, V., Freeman, T. P., & Hall, W. (2025) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01880-2 · Cited by 139 · see citing works
“Risk of death due to cannabis toxicity is very low, but there is a link between cannabis use at high doses and lethal motor vehicle collisions, cardiac pathophysiology and possibly suicide [17, 77, 78].”
- Authors
- Rock, K. L., Englund, A., Morley, S., Rice, K., & Copeland, C. S.
- Affiliations
- King's College London (GB)
- Leicester Royal Infirmary (GB)
- Corresponding author
- Copeland, Caroline S
- Venue
- Journal of Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2022-08-10
- Volume
- 36
- Issue
- 12
- Pages
- 1362-1370
- ISSN
- 0269-8811 (ISSN-L)
- 1461-7285
- PMC
- PMC9716494
- OpenAlex
- W4297830666
- Cited by
- 32
- References
- 3
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 6 · 2023: 3 · 2022: 2
- FWCI
- 4.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Psychopharmacology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Keywords
- cannabis, drug-related deaths, tetrahydrocannabinol, polydrug use, traumatic injury, cardiac complications, acute drug toxicity, coronial investigation, causes of death, England
- MeSH terms
- Analgesics, Cannabinoids, Cannabis, Hallucinogens, Humans, Psychotropic Drugs, Dronabinol, Cannabinoid Receptor Agonists
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