Some people who smoke marijuana on a daily basis are at risk of developing Cannabinoid Hyperemesis Syndrome (CHS), a disorder that causes sudden repeated attacks of severe nausea, vomiting and abdominal pain that can last for several hours and is temporarily relieved by taking a hot shower or bath.
CHS is thought to be caused by stimulation of the cannabinoid receptors in other parts of the body and various physiological processes such as changing the appetite and possibly slowing down smooth muscle contractions in the gut, leading to changes in digestion.
Until recently, CHS was considered uncommon or even rare. But as marijuana use has increased, especially in states where marijuana has been legalized or permitted for medical use, emergency-room physicians and primary-care physicians are reporting a steady flow of patients who are experiencing the symptoms.
In Colorado, practitioners reported a doubling in the number of cases of cyclic vomiting syndrome since legalization went into effect in 2014.
In a 2018 study at Bellevue, a large public hospital in New York City, 2,127 adult emergency-room patients under 50 were studied. Of 155 patients who said they had smoked marijuana at least 20 days a month, about one-third experienced uncontrolled nausea and vomiting symptoms that were specifically relieved by a long, hot shower.
"Since medical marijuana is viewed as medicinal, and frequently given to people with cancer, nausea and HIV, it seems paradoxical and illogical for the same drug that helps nausea and stimulates the appetite to cause nausea and vomiting. It's not clear why these paradoxical effects can occur in different patients."
If this information is extrapolated across the country, it's likely that 2.7 million of the 8.3 Americans known to smoke marijuana on a daily or near daily basis may suffer from at least intermittent bouts of cyclic CHS.
While the number of people affected by CHS is unclear, it's almost certainly higher than what was previously thought. It appears that many people are affected, rather than only a small percentage of regular marijuana users.
Several physicians also report not seeing a considerable amount of CHS when prescribing medical marijuana for conditions ranging from chronic pain to epilepsy to HIV/AIDS or cancer, saying that the cyclic vomiting syndrome appears to be associated with the psychoactive cannabinoid THC rather than the compound typically found in higher doses in medicinal products, the cannabinoid CBD. Alternately, doctors may be unfamiliar with this diagnosis, mistaking it for other diagnoses that lead to excessive nausea and vomiting, or even misdiagnosing as a psychiatric or anxiety-related disorder. Some doctors may dismiss the diagnosis as a rare or kind of funny disease where people spend hours in the shower.
However, people suffer tremendously with CHS, with some people arriving at the hospital severely dehydrated from the combination of hot showers and persistent nausea. Some patients have experienced acute kidney injury related to dehydration. Because the syndrome often occurs only after many years of marijuana use, physicians often don't make the connections, and patients have a hard time accepting the diagnosis.
Since medical marijuana is viewed as medicinal, and frequently given to people with cancer, nausea and HIV, it seems paradoxical and illogical for the same drug that helps nausea and stimulates the appetite to cause nausea and vomiting. It's not clear why these paradoxical effects can occur in different patients, but some doctors liken it to patients who have trouble with allergies to a favorite food. Oftentimes, repeated multiple exposures can promote an allergy that otherwise may have not been noticeable.
The diagnosis of CHS is often made after considerable time duration and expensive workups, including CT scans and exploratory surgery. Patients do not respond to drug treatment, even though some physicians have reported success with antipsychotic medications such as haloperidol and also with topical capsaicin cream.
The good news is CHS is easily cured by stopping marijuana use. If pain and vomiting end when they quit smoking, they can attempt to restart smoking. Patients are likely to have a recurrence, in which case, the diagnosis is almost certainly CHS.
Excerpted from The Grass Is Greener by Mary Clifton MD and Dr. Tom O'Bryan.
A Perplexing Marijuana Side Effect - New York Times
A Mysterious Syndrome - Business Insider
A Brief Examination - The Fresh Toast
Weed Makes Me Throw Up - Forbes
Is Neem Oil Causing CHS? - Leafly
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