States that have legalized marijuana in the United States have been experiencing a rise in unusual illnesses. Cannabis users have been showing up in the ER with severe intestinal-related issues.
Dr. Sam Wang, a toxicologist and pediatric emergency medicine specialist at Children's Hospital in Colorado, has been treating adolescents exhibiting this condition. He explains the most common complaints encountered:
"They are writhing, holding their stomach, complaining of horrible abdominal pain and nausea. They vomit and then continue to vomit whatever they have in their stomach, which can go on for hours."
"They often say they took a scalding hot shower before they came to the ER, but it didn't help. That's when we know we may have a case of cannabis hyperemesis syndrome, or CHS."
What Is Cannabis Hyperemesis Syndrome (CHS)?
This bizarre condition came to the fore of the medical scene in 2004. Some Australian researchers carried out a study after noticing a cyclical vomiting illness in South Australia. They explored the association between chronic cannabis abuse and the disease and wrote a pretty comprehensive piece about it.
In the study, these researchers wrote about 19 chronic marijuana users who had been experiencing repeated abdominal pain and vomiting. Over time, they kept up with 9 of them and discovered that on stopping cannabis use, the symptoms went away. When they resumed cannabis use, the symptoms returned.
They also noticed that 9 out of 10 of the original 19 displayed abnormal washing behavior whenever they experienced symptoms of the illness. These cannabis users reportedly used hot baths or showers to treat their symptoms.
Over time, hot baths became a go-to home remedy for the symptoms of CHS for the ever-increasing community of cannabis users.
"Patients often say, 'You know, it's always in the evening when I get this nausea, vomiting, so they tell me, 'I go take a hot shower, and it gets better, then it happens again the next night.' It's pretty universal for these patients to say they need a really, really hot shower or a really hot bath to improve their symptoms."
Why these patients choose to take hot showers remains unclear. One theory suggests that it could be that the hot showers foster some sort of distraction from the actual issue.
Weed contains tetrahydrocannabinol, also called THC. It is a psychoactive compound that has access to pain receptors in the human body. The theory proposes that the easing symptoms are probably because hot baths cause a sensation of extreme heat that sorts of inhibits the pain cycle.
Extracts from the marijuana plants such as THC have been used in making painkillers to relieve nausea and vomiting in cancer patients undergoing chemotherapy. Now, marijuana is also believed to relieve pain. So, how it causes pain in this new disorder is strange.
Although its effectiveness as a pain killer has not been conclusively confirmed, it is popularly known as a painkiller. If it is indeed a pain killer, why would it cause pain?
The ever-increasing potency of THC in marijuana products may be one cause. The increase in dosage levels could be another reason amongst many other likely possibilities.
"It's been well documented that the amount of THC that now comes in cannabis is increasing substantially. In the '90s, the average was like 4% or 5%. Now in Colorado, it's anywhere from 15% to 20%."
Do All Heavy Users Of Cannabis Experience CHS?
Not all heavy users experience this bizarre condition.
"It's not entirely clear who is predisposed to getting it. Is it a certain frequency or duration of use? Is it a specific potency? Or is it a specific type of product? We don't have that data."
How Much Is Known About CHS?
CHS is a "moving target." There is very little information about it, either how to prevent it or treat it. It does not have a medical diagnosis or insurance billing code.
Scientists have to compare medical records for reported cases of repeated vomiting with those of marijuana use in a particular area. This was what Wang and his colleagues did in Colorado when they noticed the increase in cases of this unusual illness.
In Colorado, medical marijuana has been legalized since 2009, but recreational marijuana was legalized in 2014. According to Wang's analysis, between 2013 and 2018, there were over 800,000 reported cases of vomiting in Colorado alone. This was 29% more than the cases recorded before the legalization of marijuana in the state.
People 25 years and younger made up over one-third of the vomiting cases. There were way higher reported cases of vomiting in countries that did not have prior marijuana dispensaries. This analysis was published in the JAMA Network Open.
How CHS Is Managed
"This is not a rare problem. When an adolescent comes in with cyclical abdominal pain and vomiting, my colleagues know to ask about cannabis use. It's pretty common practice to see this and diagnose and treat it."
To treat it, anti-nausea medications and IV fluids are administered. They help to rehydrate the patient after the long bouts of vomiting.
To rule out other likely causes, the patient has to undergo a barrage of tests, including CT scans, upper GI endoscopy, blood and urine tests, gastric emptying tests, amongst many others.
Wang also talked about situations that warranted carrying out the same tests repeatedly. "For some of our kids, this is their fifth ER visit in the past two months, with symptoms that they can't control," he says.
Can CHS Be Life-Threatening?
If patients take too long to go to the hospital, it can be life-threatening. Wang explains how:
"Regardless of whether it's cannabis hyperemesis syndrome or another virus that makes you vomit a lot if you let it go too long, you can have electrolyte disturbances, go into shock, and have organ failure. CHS is no different."
Should We Be Scared?
What does the future hold? One thing is almost inevitable. It doesn't spell anything good.
In 2020, a study about the prevalence of cannabis use significantly increasing in patients with cyclic vomiting syndrome stated that 1 in 5 people hospitalized for cyclical vomiting in the US had been concurrently using cannabis. Note that the study covered the periods between 2005 and 2014 when only medical marijuana was legal.
Now that recreational marijuana is legal, the numbers have most likely increased.
According to Pew Research Center, as of April 2021, 17 states and the District of Columbia have legalized recreational marijuana. Also, 36 states and several territories allow the medical use of marijuana.
A survey carried out by the research center showed that 60% of adults in the United States want marijuana to be legalized for both medical and recreational use. With results like this, other states may join in legalizing weed soon. Wang stated:
"In adolescents and young adults, that's where there is growing concern about habitual use and its effect on physical and mental health."
It will be great if the potential dangers cannabis use poses to younger adults are taken into consideration.