The Royal College of Pathologists have published guidelines on autopsy practice as a new set of standardised best practice scenarios. Scenario 1 (sudden death with likely cardiac pathology) was issued in 2005.1 The intention of the College Working Party on the Autopsy was that the scenarios would be periodically reviewed, updated and augmented.2 There is a need to place cannabis, nicotine, non-steroidal anti-inflammatory drugs (NSAIDs) and psychology in the proper context when reporting on cardiac deaths. The rationale follows.

In the list of drugs, both licit and illicit, which may cause sudden cardiac death is marijuana. The sentinel paper on cannabis as a trigger for sudden cardiac death is a case crossover study from Mittleman et al, which reported that the elevated risk of triggering myocardial infarction is limited to about the first 2 h after smoking cannabis.3 The RR of infarction was increased by 3.2 in the first hour if confounders were excluded. In the second hour, the RR was 1.7. The data …