As more and more U.S. states expand marijuana legalization and weed use increases, doctors and lawyers are warning of a little-known condition that affects drug users.
Cannabinoid hyperemesis syndrome (CHS) causes severe abdominal pain, nausea and “cyclical vomiting” in regular marijuana users – and can lead to extreme dehydration and in rare cases death.
“It is very underdiagnosed,” said Dr. Joseph Habboushe, assistant professor of emergency medicine at Langone / Bellevue Medical Center at New York University, who co-authored a study on CHS in 2018. “Doctors don’t think about it. Patients appear in the emergency room an average of seven times before diagnosis and have it for many years before being diagnosed.”
“Many patients are also a bit rejected,” Habboushe continued. “These are people who have been using cannabis for many years and then develop these symptoms. As a result, they find it difficult to believe that these symptoms are actually due to the cannabis itself. “
This was the case with Brian Smith Jr., whose mother, Regina Denny, took him to an emergency room in Indianapolis in April 2018, when he was 17 years old, after telling her he had vomited for three days.
“We were on our way to the emergency room – I think I had to stop seven times on the way so that he could throw up,” said Denny.
At the hospital, doctors told her that his kidneys were failing. They asked Brian if he smoked marijuana and he said he did. Then a doctor asked an unusual question: Do hot showers and baths help? Brian said yes.
“You have CHS,” the doctor told him.
“Patients usually find that the symptoms go away when they take a hot shower,” Habboushe said. “You can spend four or five, six hours a day in the hot shower. So when you ask a patient, do you smoke marijuana? Yes I do. Do you shower hot, does it make it better? And when they do, their eyes will shine. You will say, “Hey Doc, you know what I have, you need to know what I have.”
It is unclear why hot showers temporarily relieve patients with CHS. Habboushe said that a specific receptor in the body’s endocannabinoid system – the TRPV1 receptor on the skin – is activated by hot showers and hot peppers.
“For some reason, turning on this receptor helps these patients feel better,” said Habboushe. “We are not sure why.”
Denny, however, doubted the CHS diagnosis. She had never heard of marijuana that caused nausea or vomiting and was only familiar with the various health benefits, including as a medicine to curb these symptoms. And Brian told her that he had smoked without nausea or stomach ache for years.
Still, Brian agreed to quit smoking for 45 days. He then started smoking again and had no CHS symptoms for six months. Then they came back.
Denny called Brian’s doctors after he had vomiting and dehydration again. She said he lost 40 pounds in a few months.
“He started grabbing his back,” said Denny, “and immediately I thought his kidneys. So I called 911. “
Brian stopped breathing. Denny performed CPR until the ambulance arrived, but the paramedics were unable to resuscitate him.
An autopsy later revealed the cause of death as “dehydration due to cannabinoid hyperemesis syndrome”.
Denny said she was relieved.
“I have an answer now,” she said.
According to Habboushe’s study, which was based on interviews with 2,127 adult emergency patients, about a third of those who smoked marijuana for at least 20 days a month said they had nausea and vomiting, which were specifically alleviated by hot showers.
If you apply this ratio to the 11 million Americans who use marijuana at least 20 days a month, approximately 2.75 million people may suffer from some form of CHS.
“I want to make it clear that a third of them don’t have this extreme version of CHS,” said Habboushe. “But a third can have some level of CHS.”
Some advocates of legalization have argued that CHS is rare and affects only “a small percentage of people”.
But Alice Moon, a publicist for the cannabis industry, experienced it firsthand.
Moon said she first noticed low-level symptoms in 2016. Two years later, she had her first big episode.
“I vomited every day for 14 days without a break,” Moon said. She has been diagnosed with CHS and no longer uses marijuana, although she encourages it in her work.
“I don’t want anyone to stop using cannabis,” she said. “I want them to be aware of the symptoms.”
The same applies to Denny, who wants marijuana to be legalized so that CHS can be examined without stigmatization.
“I hope we can get doctors to pay attention and do the trials,” she said. “This is how we can ensure that Brian is the last one to lose his life to CHS.”
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