We all know that cannabis comes with many health benefits, but, with any substance, there’s the potential of “too much of a good thing.” Cannabis isn’t immune to this. While you can’t overdose – at least not in fatal terms – a rare cannabinoid toxicity exists in a small percentage of chronic smokers. As lax marijuana laws have paved the way for an increase in use, doctors are seeing more of this phenomenon: Cannabinoid Hyperemesis Syndrome is walking through emergency room doors. But is its incidence really increasing or are people merely recognizing it more?
What is Cannabinoid Hyperemesis Syndrome?
According to High Times, Cannabinoid Hyperemesis Syndrome is an illness characterized by cyclic episodes of vomiting. These episodes are usually debilitating, rending the infected all but glued to the toilet. Interestingly, people affected find that hot showers and baths relieve symptoms.
While this syndrome has the same symptoms as Cyclic Vomiting Syndrome, it’s not the same disease. However, Cannabinoid Hyperemesis Syndrome may be misdiagnosed as such. The main difference is the causative factors: Cyclic Vomiting Syndrome isn’t due to cannabis (its cause remains elusive).
Who Gets Cannabinoid Hyperemesis Syndrome?
Cannabinoid Hyperemesis Syndrome happens in people considered “heavy, long-time smokers.” Typically, this involves daily use (more than three times a day), for an extended period of time (years, in some cases).
Smoking for a large portion of your life doesn’t punch your ticket for this illness; it’s rare and the exception rather than the rule
It was first reported back in the olden days of 2004, but since then several more cases have been reported; in a 2010 study featured in the Canadian Journal of Gastroenterology, cases involving vomiting, dehydration, and kidney failure were noted.
A study conducted by the Mayo Clinic looked more closely at those affected. They found that patients were likely to be younger than 50, nearly everyone used cannabis more than once a week, and the majority used it for at least two years before symptoms appeared.
Why Cannabinoid Hyperemesis Syndrome Happens
Cannabis has long been hailed for its anti-nausea effects; it’s a mainstay in treatment of people undergoing chemotherapy. Thus, Cannabinoid Hyperemesis Syndrome is a bit ironic and the reasons it happens aren’t entirely clear. There are theories, though. One of these, per Forbes, is that the buildup of the psychoactive metabolites in THC mess up the regulation of the CB1 receptor in the brain. A small number of metabolites doesn’t do this; a large number does.
Another theory that’s been gaining ground is that the psychoactive metabolites of THC aren’t really the culprit; rather the concentration of THC is to blame.
Through research, it’s believed that THC is antiemetic in low doses, but it causes vomiting in higher doses
What’s further, extreme and elongated marijuana ingestion stimulates the CB1 receptor, which reduces the contraction of the muscles in the intestinal walls. This is why hot showers may relieve symptoms: CB1 sits near the hypothalamus, a small part of the brain that controls the body’s temperature (hot water may ease the stimulation of the hypothalamus caused by CB1’s malfunction). Others conclude that hot showers prove effective because they cause vasodilation and draw blood flow away from the digestive system.
An Increasing Incidence
The Internet is filled with reports of an increasing incidence of Cannabinoid Hyperemesis Syndrome, but whether or not this is a true increase remains to be seen. Some people want to blame it on marijuana’s legalization: we’ve made pot available, now suddenly everyone’s puking on everything. But, given that it often takes years for symptoms to appear (as mentioned above), it’d be strange for legalization to be that much of a factor; Colorado and Washington, the first states to legalize, did so four years ago (and it wasn’t until 2014 that pot shops actually opened).
The more logical explanation is that doctors are beginning to look for the syndrome rather than chalking it up to the stomach flu or other maladies. And people in legal states are much more likely to admit to marijuana use than they may have been in the decade before.
Treatment of Cannabinoid Hyperemesis Syndrome
Per the National Institutes on Health, Cannabinoid Hyperemesis Syndrome is a recurrent disorder and involves three phrases: pre-emetic, hyperemetic, and recovery phase. The initial phase is long lasting and not entirely interfering with a person’s life: early morning nausea, slight abdominal discomfort, and fear of vomiting presents. The hyperemetic phase involves persistent and intense nausea and vomiting (with some patients vomiting up to five times per hour). The recovery phase is exactly as it sounds: the patient returns to their regularly scheduled life.
The dangers of Cannabinoid Hyperemesis Syndrome mainly surround dehydration: minor dehydration causes headaches and muscle pain; major dehydration causes heart arrhythmias and kidney failure.
Treatment involves treating the dehydration and replacing lost fluid and electrolytes
As previously mentioned, hot showers help keep symptoms at bay, but this can be difficult for people who don’t have a great deal of free time to bathe. Ultimately, the best solution is to quit cannabis altogether. That is, in fact, considered by many to be the cure.
Yet, there have been reports of other forms of treatment in people unwilling to quit. A case study from the Medical University of South Carolina involved an eighteen-year-old patient with Cannabinoid Hyperemesis Syndrome who refused to stop marijuana ingestion but did agree to a clinical study involving haloperidol, an anti-psychotic often used to treat Tourette’s Syndrome. Her symptoms resolved after taking 5 milligrams a day. Upon quitting the haloperidol three weeks later, the symptoms did not return. However, she was lost to follow-up so whether not they ever came back is uncertain.