The latest CHS scare story broke just as Dr. Ethan Russo's Cannabinoid Hyperemesis Syndrome Survey and Genomic Investigation was being released.
The scare story takes place in Colorado, where some underaged users have reported extreme vomiting, what's called "scomiting" in the NBC News article — a combination of screaming and vomiting — after intake of cannabis. The article points to higher potency as the cause of an increase in cases at Parkview Medical Center in Pueblo between 2009-2017 from five to 120 during that eight-year period.
Russo's survey is another story. The noted cannabis researcher sought to have the first significant paper on cannabinoid hyperemesis syndrome, but was only able to study 29 patients and just 12 of them agreed to genomc testing due to resistance to partcipate by some in the "CHS community." It is still "the largest patient cohort of CHS examined to date," Russo writes, adding: "And first to note associated mutations in genes affecting neurotransmitters, the endocannabinoid system and the cytochrome P450 complex associated with cannabinoid metabolism."
Dr. Russo says CHS is a "manifestation of gene–environment interaction in a rare genetic disease unmasked by a toxic reaction to excessive THC exposure."
Gene mutations could be at the root of CHS, affecting a very small number of users. "CHS can contemporaneously be conceived of, not as a ‘functional’ GI disorder, but rather as a manifestation of gene–environment interaction in a rare genetic disease unmasked by a toxic reaction to excessive THC exposure."
According to Russo, gene mutation plus excessive use could result in a bout with CHS and send you to the hospital.
Russo also debunks the fallacy that exposure to chemical sprays can cause CHS: "Many CHS sufferers disbelieve THC overexposure as its etiology and the necessity of abstinence to achieve remission, prompting alternative hypotheses, such as pesticide contamination of cannabis. Organophosphate exposure symptoms or that for neem (Azadirachta indica), a botanical insecticide, are inconsistent with those of CHS."
Dr. Russo: "We Need to Really Tell the Truth
In an interview posted at Project CBD, Dr. Russo tells author Martin A. Lee about CHS:
"I've been a great proponent of therapeutic cannabis usage. However, we need to counter the mythology that cannabis has no side effects and really tell the truth. CHS happens to be one of the few serious side effects associated with excessive cannabis use. We have really not encountered this in therapeutic cannabis usage at low doses. It seems to only occur with high intake where tolerances develop over a long period."
He says between 350,000 and 2.5 million people have suffered form CHS.
Dr. Mary Clifton Critiques Ethan Russo's CHS Survey
Our resident medical cannabis expert Dr. Mary Clifton offers her take on the Russo CHS survey:
CHS is an uncommon condition leading to nausea that's relieved with cessation of cannabis use. Patients who suffer with CHS often report that taking hot showers relieves the symptoms, so much so that this behavior is considered almost diagnostic of the condition.
We still don't know what metabolite or interaction is causing the nausea in CHS, or how it's causing nausea. Nausea can be initiated in the brain, as is common with chemotherapies. In the case of antibiotic associated nausea, this is often due to a stimulation of motility in the GI tract. Some products can be directly irritating to the lining of the gut. In the case of alcohol and metronidazole co-administration, a disulfuram-like reaction occurs that can lead to severe nausea.
Dr. Clifton says, "Hybridization, farming methods, genetic modification and processing have drastically modified the cannabis plant."
Patients involved in this study used cannabis through multiple modes of administration, including flower, vapes and concentrates, and most study participants used more than one.
A surprisingly small number of CHS patients responded to the request for genomic study, likely due to the ongoing risks of admitting to cannabis use in many social settings and fear that the genetic testing may be misused. Also, 91.5% of participants admitted they were told at some point to stop cannabis usage for health reasons. Although over 200 patients were asked to participate, only 29 were finally evaluated.
RELATED: What Else You Need to Know About CHS
A group of mutations was consistently identified across the study population, and it appears to be affecting metabolism of some component of the cannabis products consumed by the study participants.
There is no evidence of what exactly is being metabolized differently, or what metabolite is causing the nausea, or by what mechanism. It may be any component of the plant or any additive that's used in the manufacturing and production.
Hybridization, farming methods, genetic modification and processing have drastically modified the cannabis plant and and may have risks in addition to benefits to the consumer.