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What Is Cannabis Hyperemesis Syndrome?

 

We hate to be the bearer of bad news, but unfortunately there is a sickness that is seemingly a result of smoking marijuana. Though cannabis has been proven to help treat medical conditions, in some cases it just may be the cause of feeling ill. Cannabis hyperemesis syndrome (CHS) is described as repeated and extreme vomiting that results from long-term, excessive cannabis use. Some readers may be thinking ‘this can’t be true. I’ve been smoking for years and it’s never happened to me,’ like us. However although it is considered rare, the condition has become more prevalent as more states legalize medical marijuana.

Herbalists, like us, do not want to believe that cannabis could actually be making us sick. Especially when there are patients who use cannabis to treat conditions like nausea. Research is limited at this time, so it is still unknown why the disorder occurs in some heavy marijuana users and not others, which method of consuming cannabis CHS is associated with, or the risk factors that come with the disorder. A study was done in Australia back in 2004, in which cannabis use was a noted similarity among patients experiencing cyclical vomiting symptoms. A few studies thereafter led to the conclusion that CHS could have likely been misdiagnosed as cyclical vomiting syndrome (CVS).

Most cases of CHS are “young adults with a long history of cannabis use,” according to the 2011 Temple study. “In nearly all cases there is a delay of several years in the onset of symptoms preceded by chronic marijuana abuse. Daily marijuana use is characteristic and often reported as exceeding three to five times per day,” the study stated. It is speculated that overuse of THC can potentially make a person’s cannabinoid receptors act paradoxically.

CHS symptoms, though similar to those of CVS, include severe abdominal pain, nausea, excessive vomiting, profuse sweating, dehydration and more. There are three phases of CHS that herbalists should be aware of and recognize because canna-doctors are familiar, but only a handful of physicians are educated about CHS.

How could cannabis help nausea and also cause it? In the brain, marijuana helps prevent nausea and vomiting by activating specific parts of the central nervous system however, activating CB1 receptors with THC can cause gastrointestinal issues such as altered intestinal motility, reduction in gastric motility, delays in gastric emptying, lower esophageal sphincter relaxation, inhibition of gastric acid secretion, and visceral pain. With repeated use of marijuana, certain receptors in the brain may stop responding to the drug, allowing the stomach to violently respond.

PHASE 1: PRODROMAL PHASE

During this phase, herbalists may feel nauseous and/or develop a fear of vomiting. Although your appetite may be affected, you may also experience abdominal pain and discomfort and even symptoms similar to morning sickness during pregnancy. The prodromal phase can last for several years and usually occurs before the excessive vomiting.

PHASE 2: HYPERMETIC PHASE

This is the worst of the three phases due to the intense, overwhelming vomiting. Aside from hurling your brains out, you may feel mild abdominal pain, dehydration and experience weight loss as well. It has been known for vomiting to occur unexpectedly, up to 5 times per hour and can last up to 48 hours. A common remedy for this phase of CHS is a hot shower, which has been said to ease the nausea because of how the hot temperature affects a part of the brain called the hypothalamus, which effects both temperature regulation and vomiting. As per a 2014 study, “The brain may react to changes in core body temperature due to the dose-dependent hypothermic effects of [THC]. Alternatively, the bathing behaviour may be a result of direct CB1 receptor activation in the hypothalamus by [THC] or another active compound and may not necessarily be a response to changes in core body temperature.” Treatment during this phase can include:

  • IV (intravenous) fluid replacement for dehydration

  • Anti-emetic medicine

  • Pain medicine

  • Proton-pump inhibitors, to treat stomach inflammation

PHASE 3: RECOVERY

Recovery isn’t said to begin until the herbalist completely stops using cannabis because it has been said that using cannabis, either during CHS or after, could cause the symptoms to return. However, it has also been said that after experiencing CHS, herbalists who consumed lower doses of cannabis have been able to smoke again. To stop using marijuana is the only “treatment” for CHS to this day. After quitting, patients usually begin to feel better after a few days, sometimes weeks or months. The recovery phase can last for a few days, weeks or a few months.

Are you worried you may have cannabis hyperemesis syndrome? Being that CHS has only recently been discovered, many physicians are either uneducated, unaware or have the tendency to confuse CHS with CVS. If you smoke five or more times per day and are experiencing belly pain, nausea and/or vomiting, relief when taking hot showers, you may want to consider adjusting your smoking habit or consider visiting a doctor. A doctor more qualified to diagnose CHS would be one trained in diseases of the digestive tract (gastroenterologist). Some ways of ruling out CHS would be to take tests such as:

  • Blood tests for anemia and infection

  • Tests for electrolytes

  • Tests for pancreas and liver enzymes, to check these organs

  • Pregnancy test

  • Urine analysis, to test for infection or other urinary causes

  • Drug screen, to test for drug-related causes of vomiting

  • X-rays of the belly, to check for things such as a blockage

  • Upper endoscopy, to view the stomach and esophagus for possible causes of vomiting

  • Head CT scan, if a nervous system cause of vomiting seems likely

  • Abdominal CT scan, to check for health problems that might need surgery

A doctor might also recommend you stay in the hospital for a while so that your vomiting and recovery can be monitored. Severe, prolonged vomiting can cause muscle spasms or weakness, seizures, kidney failure, heart rhythm abnormalities, shock and in some cases brain swelling.

The best, most highly (pun intended) recommended way to prevent cannabis hyperemesis syndrome is to be mindful of your doses of THC. “In my experience,” Dr. Bonni Goldstein, a Los Angeles-based physician says, “medical cannabis patients that are thoughtful in their use of THC-rich medicine are at very low risk for developing CHS… CHS is quite easy to avoid if you are thoughtful about your use of THC and make sure to not over do it.”

 
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