Too Much Marijuana Can Make You Uncomfortably And Dangerously Sick

February 11, 2022 — At the heart of emerging science about the unintended consequences of daily long-term marijuana use lies a paradox.

For years, medicinal marijuana has been used to relieve nausea from cancer chemotherapy and gastrointestinal ailments. Now, with more legalization, there is growing awareness that chronic use of marijuana – also known as cannabis – can cause a condition where, ironically, a person has difficult-to-control vomiting and nausea.

Some people with the condition, known as “cannabinoid hyperemesis syndrome,” also report crippling abdominal pain.

Linda can understand. The 33-year-old Oregon resident, who wished to remain anonymous to protect her privacy, refers to a medieval spiky metal ball on a chain when describing the pain.

“Imagine a club in your stomach, pushing up into your chest and exploding out at the same time,” she says.

To seek relief, she gets on her knees, assumes a children’s yoga pose, and runs hot water in the bathroom for hours, a trick that many with the condition believe has brought relief. She also occasionally goes outside and tries to run it away.

“I would just wander around my neighborhood, often at 4 or 5 a.m.,” she says.

“The fresh air helps a little. I just keep walking down the street, take about 10 steps, stop, vomit – walk a little more, stop, vomit.”

Her first experience with the condition began one night in 2017 while she was at a conference in Las Vegas.

“We went out to dinner the night before, and I woke up around 4 a.m. with just the most intense pain I’ve ever had,” she says.

“I found myself in a really hot shower between throwing up everything and trying to say to get some water down,” she says. “I was sharing an Airbnb with my colleagues, so it wasn’t ideal.”

Many people with cannabinoid hyperemesis syndrome find relief from hot baths or showers. Researchers believe warm water helps because temperature sensors in the skin send signals to the brain that can relieve symptoms, at least for a while.

The problem is, people with this syndrome “can’t live in water,” says emergency physician and medical cannabis expert Leigh Vinocur, MD.

Fast-forward 6 months to another event in Boulder, CO. Again, Linda woke up and couldn’t stop vomiting.

“I didn’t feel better. Showering didn’t help. I ended up in the hospital,” she says.

She was given opioids for her pain. But neither she nor the emergency room staff were quite sure what was going on. Her discharge papers said “cannabis allergy.”

Cannabinoid hyperemesis syndrome “shatters that image that cannabis is only a good thing. It’s a bold statement, but you know, once you start thinking about it, it’s like a little too much of something isn’t good,” says Linda.

Experts suggest that more awareness is needed to identify this syndrome earlier, both by cannabinoid users and physicians. The bouts of vomiting, in particular, can become so severe that people end up in the hospital with dehydration, electrolyte disturbances and weight loss.

The severe electrolyte imbalances “can be truly life-threatening,” says David Johnson, MD, a professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk.

“By the time they get to the emergency room, they’re in bad shape,” Vinocur agrees. “Many try to ignore it, but they keep throwing up.”

Genetic risk factors?

A mystery is why some regular marijuana users get this syndrome and others don’t.

“I can say that not everyone gets this, thank goodness,” says Ethan Russo, MD. “But there has to be a reason that certain people are susceptible and others are not.”

Interestingly, a new study from Russo and colleagues suggests that genes play a role. They identified five genetic changes that would make a chronic marijuana user more likely to develop cannabinoid hyperemesis syndrome in a study published in July 2021 in the journal Cannabis and Cannabinoid Research.

They compared 28 people with the condition to 12 other high-frequency marijuana users without these symptoms.

The results aren’t definitive, but could help future research, Russo says.

“What we’ve discovered — and it was much more than we expected — is that there’s a lot more going on than just a cannabis hypersensitivity,” said Russo, a neurologist and founder/CEO of CReDO Science, an advocacy company. for cannabis research and develops commercial products.

Also, he says, those who suffer from cannabinoid hyperemesis syndrome may be at higher risk for other conditions, such as addiction to alcohol or other substances, dementia, diabetes and heart disease.

“Most people with CHS will be younger,” he says. “What we’ve shown is that there’s a risk of more serious problems in the coming decades. So someone with these symptoms really deserves a closer look at this genetic screening.”

Fighting disbelief

Getting back to the paradox, many users don’t believe that marijuana can cause severe vomiting and nausea due to its reputation for doing the opposite.

“People who have this are just uniquely resistant to the concept that cannabis is actually the problem and not the solution,” says Russo.

“It’s kind of counterintuitive because people think, ‘Oh, cannabis helps with nausea,’ so they use more of it,” said Vinocur, who is also a spokesperson for the American College of Emergency Physicians and has a medical cannabis practice.

Most strains of marijuana work this way – they do opposite things at different doses. Once a certain threshold is crossed, people with cannabinoid hyperemesis syndrome are “just uniquely susceptible and really can’t tolerate a significant amount of THC,” says Russo, referring to tetrahydrocannabinol, the compound that makes marijuana users high.

Once diagnosed, stopping is the most effective strategy. But it can be difficult to convince someone to stop using marijuana.

“You have to try and convince them… to try abstinence and watch and see what happens,” says Vinocur.

People need to “realize that the cause of this is cannabinoid intake, and treatment is really best aimed at absolute avoidance,” Johnson says.

Unfortunately, the evidence also shows that once a person stops using marijuana and gets relief, going back to marijuana or other forms of cannabinoids can cause the syndrome to start all over again.

“We’ve had people who stop for a month, a year, 2 years and when they resume, almost always, they’re back in bouts of hyperemesis along with all the others. [symptoms]’ says Russo.

Marijuana and cannabinoids can cause digestive problems, Johnson says, which can cause more problems.

What Recent Research Reveals

Cannabinoid hyperemesis syndrome is a relatively young condition – first described in 2004 – and early reports and case studies are now giving way to investigations into possible treatments.

So far, the strongest evidence suggests a role for an over-the-counter cream called capsaicin to help manage symptoms, but more studies are needed.

Similar to hot showers, this ingredient from chili peppers can warm the skin and activate the temperature-sensitive skin sensors to reduce symptoms, Johnson says.

An October 2021 study in Spain looked at 54 emergency room visits among 29 people with cannabinoid hyperemesis syndrome. In the 75% treated with capsaicin, vomiting stopped after an average of 18 minutes.

Lead author Guillermo Burillo-Putze, MD, PhD, says he is most surprised by the growing number of new cases of the condition.

“This should be concerning given the increase in cannabis use due to legalization and permissiveness,” said Burillo-Putze, an emergency physician at Hospital Universitario de Canarias in Spain.

The cannabinoid hyperemesis syndrome does not seem to distinguish between racial and ethical groups. While most studies to date have included white participants, a July 2021 study of 29 people, 90% of whom were black, found that repeat emergency room visits were common.

The study found that 16 people returned to the emergency room 42 times and accounted for, say, 10 hospitalizations.

Cannabis Conspiracy Theories

“Unfortunately, this condition has become the subject of great speculation about conspiracy theories as its true cause,” Russo noted in a September 2021 letter to the editor in TheAmerican Journal of Emergency Medicine.

A little “mythebusting” is in order, he says.

For example, cannabinoid hyperemesis syndrome doesn’t occur because of exposure to products from a tree called neem or from pesticides applied to marijuana plants during cultivation, Russo says. It can also occur with high-dose synthetic cannabinoids, he says.

The State of Recreational and Medical Marijuana

Recreational marijuana will be legal in 18 states, Washington, DC and Guam as of January 2022, according to a report in US News. More states allow medical marijuana use — 37 in all, plus Washington, DC, according to Britannica ProCon.

One of the states where only medicinal use is legal is Maryland, where Vinocur practices.

“We’re seeing more and more cases” of cannabinoid hyperemesis syndrome, she says.

In addition to chronic use or higher doses, the higher potency levels of THC in the legal marijuana industry are also likely to cause the syndrome in some people.

Linda estimates that she has ended up in the emergency room at least half a dozen times in the past 5 years. In April 2021, she had a “pretty serious event”. She blames it on traveling a lot for work, not eating right and not getting enough sleep. She broke her 2-year abstinence with alcohol.

“I actually didn’t listen to my body and paid a pretty high price for it,” she says.

Linda didn’t stop completely, but says she “drasically changed the strain and shape of the cannabis I used”.

“I can officially tell you that I would be 100 percent dead without this plant,” she says.

“The prospect of living without it was more detrimental to me than all the things I just described to you, because addiction runs in my family and I myself had opiate problems that I overcame with cannabis.”

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