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A mysterious syndrome in which marijuana users get violently ill is worrying researchers

Cannabinoid hyperemesis syndrome characterised by nausea and vomiting after smoking cannabis and was thought to be incredibly rare – until now

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Mrs. X knew something was wrong when she burned herself in the bath for the third time.

The Australian woman – whose experience was documented anonymously in a published case study – had experienced sudden and severe episodes of illness for nine years. She’d get nauseous and a feel like the room was spinning, which was followed by violent vomiting and severe stomach pains. As it turned out, she had a mysterious syndrome that doctors are only now beginning to recognise.

Cannabinoid hyperemesis syndrome, or CHS, appears to occur in people who use marijuana frequently for years. Aside from quitting marijuana, there are no known treatments.

Mrs. X told her doctors that soothing herself with a warm bath was like magic – her symptoms seemed to melt away into the warm tub. But as soon as the water began to cool, her symptoms creeped back. It felt like she couldn’t get the water hot enough. She learned to progressively heat the water, preferring to stay in the bath as long as she could.

But one day, the water got too hot and she emerged with red skin and a bad burn. The third time it happened, she ended up in the hospital.

Mrs. X was eventually diagnosed with CHS. Patients who get it usually experience a very upset stomach in connection to frequent, heavy marijuana use. Mrs. X’s case report, along with those of nine other people with similar symptoms, was published in 2004 in the medical journal Gut, an official journal of the British Society of Gastroenterology. It was the first time the set of symptoms was given a name.

Until now, cases of CHS were presumed to be incredibly rare. But some recent evidence indicates cases could be on the rise, and a new study from emergency clinicians at New York University Langone suggests the syndrome may affect far more people than initially thought. The worst part may be that patients have no idea that cannabis may be causing their symptoms, since paradoxically, weed is sometimes used to treat nausea.

“This is something that’s poorly understood that doctors don’t know about,” Joseph Habboushe, an assistant professor at NYU Langone and the lead author on the paper, told Business Insider. “It could affect millions.”

The first study to give a sense of how many people this may affect

The stories of Mrs. X and the others in the 2004 study didn’t cause widespread concern among medical professionals. Marijuana was still largely illegal at the time, for one thing. And the symptoms appeared to disappear for good as soon as the patients stopped using the drug.

Plus, Mrs. X’s story was part of a series of case reports, a type of paper that doesn’t involve rigorous research parameters; it merely describes the symptoms of one or several people.

The scientists behind the latest study, published in the journal Basic and Clinical Pharmacology and Toxicology, looked into CHS by examining a large sample of adults admitted to an emergency room in New York City. The researchers surveyed thousands of patients in an attempt to find only those who used marijuana frequently – at least 20 days per month – and ended up with 155 people who met their criteria. All of those individuals smoked nearly every day or multiple times a day, often for five years or more.

Among those patients, roughly a third had symptoms that qualified them for a diagnosis with CHS.

That’s a big number, Habboushe said – far bigger than he anticipated.

“Some of my colleagues and I had some idea that this might be more common than initial studies suggested, but we were still pretty surprised,” he said.

Given that figure, Habboushe and his colleagues estimated that as many as 2 million US adults could be affected by the syndrome. Still, given the small sample size, it may be too early to say how many people could really develop CHS.

More studies could help identify potential treatments

The only thing that appears to stop the symptoms of CHS is permanently avoiding marijuana. Hot baths and showers offer only a temporary fix.

“As far as we know there are no good treatments for this. Most anti-nausea medications don’t work,” Habboushe said. “The only thing that helps is stopping. And many patients will stop for a few days, and it goes away, but then they start smoking again and it comes back.”

Habboushe is currently working on another study that aims to identify some of these potential treatments.

But as is the case with any study, the latest paper has some limitations. Chief among them is the fact that people are still hesitant to be open and honest about marijuana use, so the figures could be off. Another important factor to consider is that we have no data on the strength, strain, or potency of the marijuana being used. Habboushe said he believes that stronger cannabis may be contributing to the rise in cases of the syndrome, but without data or concrete regulations around THC content, it’s impossible to know for sure.

The study also did not exclude people who took other drugs, meaning that other drugs could be playing a role as well. Lastly, there’s no way to know whether a specific compound in cannabis – such as THC or CBD, the two most well-known compounds – plays more of a role here than others.

These caveats mean more research is needed. But in the meantime, Habboushe is concerned.

“We are going to see more of this disease,” he said. “This doesn’t mean marijuana is bad or good it just means it has side effects — side effects that we need to understand and learn how to avoid and treat.”

Read the original article on Business Insider UK. © 2018. Follow Business Insider UK on Twitter.

1 /1 The syndrome that causes marijuana users to get violently ill & vomit

The syndrome that causes marijuana users to get violently ill & vomit

Cannabinoid hyperemesis syndrome characterised by nausea and vomiting after smoking cannabis and was thought to be incredibly rare – until now

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Cannabinoid hyperemesis syndrome characterised by nausea and vomiting after smoking cannabis and was thought to be incredibly rare – until now

If Weed Makes You Extremely Nauseated, You’re Not Alone

In the fall of 2016, I became an egg donor. Following my hormonal treatments and egg retrieval, I began to experience unusual bouts of nausea. I didn’t think much of it at first, assuming it was an interim experience attributed to the hormonal changes my body was undergoing. I also found that cannabis, which I’d typically used to treat insomnia, provided temporary relief from the sick feeling in my stomach.

But as time went on, the rounds of nausea became prolonged and more severe. The smell and sight of food repelled me. I couldn’t bring myself to eat, sometimes for days on end, and I started to lose a lot of weight. I scheduled an appointment with a gastroenterologist to see if we could figure out what was going on.

I had noticed that the more I used cannabis to treat my nausea, the more sick I felt during the hours I wasn’t smoking. It seemed counterintuitive that cannabis might be playing a role in my sickness since it’s often recommended to alleviate nausea, but I felt compelled to tell the doctor I’d been smoking on a regular basis.

To my surprise, he told me that U.S. states that had legalized the medical or recreational use of cannabis, leading to an increase in cannabis usage, had also seen a significant rise in a condition known as cannabinoid hyperemesis syndrome (CHS). I was consistently experiencing prolonged nausea throughout the day—a common symptom of CHS. Because I smoked cannabis on a regular basis, the doctor believed my condition was, in fact, linked to cannabis use. My various test results came back normal, indicating he was likely right.

CHS is a puzzling condition occurring in long-term cannabis users. Common symptoms include extreme nausea, intractable vomiting, and abdominal pain. Many patients report finding relief by taking hot showers. It’s an unusual illness given that medical cannabis is often used to treat the nausea of cancer patients, for example. But it turns out that while cannabis is frequently effective against nausea and vomiting, it can also trigger it.

The symptoms of CHS sometimes take years to surface. The first course of action for cannabis users suffering from severe nausea and/or uncontrollable vomiting should be to cease cannabis use and see if symptoms subside within 2-3 days. I was advised to do this, and within two days, I was completely back to normal.

The cause of CHS is unknown. Because cannabis has complex chemical properties, it makes it difficult to pinpoint what leads to this seemingly paradoxical syndrome. Some research is focused on the body’s receptors which are affected by cannabis use. Heavy, frequent use is thought to deregulate receptors, causing the symptoms of CHS. Cannabis use, however, has been common for centuries in countries like India, and symptoms of CHS have only begun to be reported in the last couple of decades. In addition, there are no reports of CHS by chronic users in some regions, such as South Asia, at least not to the extent we see in the United States. This has led some doctors to be skeptical of the idea that cannabis itself is the problem, theorizing that additives may be the issue instead. In the case of Asia, however, lack of reports may also be due to the fact that weed remains strictly illegal in many of its largest countries, even as it gains acceptance in the West.

In my case, my fertility specialist believed CHS was directly linked to changes in my receptors caused by the hormones I was taking. I was scheduled to undergo a second round of egg donation, and he thought it was possible my receptors would revert back to normal afterward. Sure enough, following the second procedure, I no longer experienced the symptoms of CHS when using cannabis.

Cannabis use is increasing across the country as states not only legalize its recreational use, but also as it becomes increasingly seen as an effective alternative treatment to many commonly used pharmaceuticals, including opioids. Regardless of its cause, doctors expect to see a rise in cases of CHS coinciding with its increased use. Hospitals across the country have already seen more and more cases of CHS in states where weed has been legalized.

Cannabis was illegal in my state, so I was hesitant to tell the doctor I’d been using it. And, because of my unique situation, it would have been easy to blame my symptoms on recent hormone treatments, especially since cannabis provided temporary relief. But if I hadn’t been transparent, I would have continued to be sick. Be honest with your doctor if you use cannabis regularly and begin to exhibit these symptoms. Also be aware that many doctors may not yet be aware of CHS, and you may need to be the one to bring this possibility to their attention. It likely won’t remain under the radar for long, however. As cannabis continues to become more acceptable and accessible across the United States, we’ll need to work toward developing a better understanding of what causes CHS and how to prevent it.

Doctors are seeing an increasing number of cases of cannabinoid hyperemesis syndrome, which has symptoms cannabis is, ironically, often prescribed to treat.