From reading this title, many will already have preconceived notions of my intent. For instance, am I “pro-weed” or not. To set the record straight, I am not for the “war on drugs,” and I also believe that marijuana is far safer than many legal drugs.
Take alcohol for instance, the fourth-leading cause of preventable death (1). 5.9% of all global deaths in 2012 were attributed to alcohol (2). It is also a carcinogen and is attributed to 1/30 cancer deaths. A daily binge drinker increases his or her risk of esophageal cancer by around 50% (3).
So NO, I am not writing this article to warn people about the "terrible dangers" of marijuana because it is rather benign compared to alcohol and cigarettes, which are legal. However, I do wish to inform people that most things have side-effects. If a person tells you, "there is no danger in this," he or she is probably blinded by bias sources or emotional beliefs. This post is not about why marijuana should be legal or its potential health benefits (….which there clearly seem to be many). I will tell about one condition that is strongly linked with marijuana use although it is quite rare.
Cannabinoid Hyperemesis Syndrome:
It is a vomiting syndrome only discovered in the past 12 years and very similar in presentation to cyclic vomiting disorder (CVS). It is characterized by sudden nausea, abdominal pain, and extreme bouts of vomiting that is partially relieved by taking hot showers! WEIRD…. but it is certainly occurring. I have seen it a few times and will discuss that later.
Each “attack” lasts about 24-48 hours. The trigger is usually when a chronic marijuana user stops the drug. It is a “withdrawal from the substance" kind of effect.
Marijuana is a known anti-emetic (anti-vomiting agent). It is commonplace in many states now to medicate chemo-patients with cannabinoids because it truly helps people to stop vomiting. Unfortunately, we don’t understand why marijuana helps stop vomiting fully (partly because it is a Schedule 1 substance and very limited money is available to research it properly). Why it is a Schedule 1 drug while opiates and cocaine are lower?…haha that is a great question.
One Basic Theory:
One theory on why the excessive vomiting occurs is due to the fact that marijuana controls mechanisms in the body that prevent nausea. When one is deprived of this substance, there is a “rebound” increase in nausea. Many people suffering from this syndrome “self-medicate” by smoking more marijuana. When they can’t obtain or choose to stop, it is like a viscous cycle and the vomiting intensifies.
Research into this Syndrome:
Sun and Zimmerman, two pharmacists, did a major literature review on studies to get to the bottom of this issue! They also were striving to help make a viable way to treat and diagnose this condition. They found that this condition usually occurred in chronic users of marijuana for over a year duration (4). They also believe the most probable theory is that the CB1 receptor in the brainstem, a central control for nausea, is a main culprit (4).
In the 4th link provided they also map the symptom course of the syndrome; a prodrome stage lasting months or years where the marijuana user has nausea, fear of vomiting, and abdominal discomfort. The hyperemic stage encompasses the actual vomiting, which can be debilitating. It is during this second stage where a learned behavior to bathe or shower in hot water is recognized.
There is an interesting correlation seen with the CB1 receptor in the hypothalamus of the brain and the regulation of temperature (4). The relief of these symptoms occurs in HOT water. A very interesting/believable scientific suggestion of why HOT water relieves or reduces symptoms.
Lastly there is a recovery stage which generally occurs if the user remains off of cannabis for a period of time.
Complications of this Disorder:
Cyclic type vomiting can be debilitating. Vomiting is well known to remove acid from the body and can make a person's blood more basic. In simple terms, the body needs the pH level to be well regulated and any deviation from normal values can be dangerous. These individuals lose a lot of weight due to lack of appetite/fear of eating being a trigger, which can lead to extreme malnutrition. In addition, vomiting can lead to electrolyte and volume depletion, which can always be dangerous.
Treatment:
Firstly, if the individual has lost lots of fluid, IV hydration should be administered in the hospital for 24-48 hours. In the acuteness of the issue, lorazepam, a benzodiazepine, has been the most effective. Its analgesic/anti-emetic properties were shown to cease nausea and vomiting within 10 minutes (4).
Long term success is obviously from the cessation of cannabis.
A Patient Case:
I have seen cannabinoid hyperemesis syndrome multiple times; one interesting case to report about was during one my emergency medicine rotations last year. I was seeing a patient who was in his early 20s with cyclic vomiting. He was with his girlfriend who reported that he had been vomiting for over a day and would not stop. In fact, he had vomited so much that he had nothing left to bring up. He looked dehydrated, fearful... and just miserable.
When going though a detailed history, I remembered this condition in my differential. I asked, "do you smoke marijuana?" He said, “daily” but had not had any for the past few days….interesting. I then had to ask the bizarre questions…What makes it feel better?…I asked “do hot showers seem to make it better.” At that moment he looked at me like I was a mind reader. In surprise, he said it certainly did!!!
My diagnosis was basically clinched with this information. I told him that he likely was suffering form a vomiting disorder known to chronic marijuana use. I think he would have believed anything after I guessed hot showers made it better haha.
We gave him a benzodiazepine, and as the study suggested, within about 10-20 minutes he felt much better. His volume status was pretty good in a couple of hours, and we discharged him home.
Obviously, we educated him about the cessation of marijuana if he did not want these symptoms to return.
Discussion:
It is important to note that this is a rare condition. Many daily marijuana smokers will never face these symptoms. If one is a chronic user, one most likely will not get this, but one's risk is certainly increased. This is not to scare people away from what they choose to do, but it is meant to be informative. If these symptoms occur, one should strongly consider if he or she wants to face this for years. It is not as bad as getting cirrhosis of the liver or dying of cancer, but it is a debilitating condition.
Marijuana certainly has medical benefits and is a far safer drug than many legal ones, but that does not mean it is harmless. I have witnessed this condition and it makes people miserable! Hopefully in the future, we can learn more about this condition and how to treat it better. One thing is for sure—we need to be able to study marijuana effects more, but the federal government for whatever reason does not make it very easy!
Thank you for reading and feel free to follow me for more medical posts/music!
I am a medical student in my last two months of school
Sources:
1) http://emedicine.medscape.com/article/285913-overview#a1
2) http://emedicine.medscape.com/article/285913-overview
3) http://www.medscape.com/viewarticle/854786
4) http://europepmc.org/articles/PMC3847982
Pixabay Image Links (no sources were necessary)
1) https://pixabay.com/en/man-hippie-geek-glasses-bald-1531903/
2) https://pixabay.com/en/alcohol-hangover-event-death-drunk-428392/
3) https://pixabay.com/en/baking-cannabis-hemp-leaf-1293986/
4) https://pixabay.com/en/disgusting-man-sick-spew-vomit-1300592/
5) https://pixabay.com/en/thinking-brain-head-idea-2006869/
6) https://pixabay.com/en/capsule-drug-gelatine-medicine-158568/
7) https://pixabay.com/en/bend-bent-over-heaving-human-1296747/
8) https://pixabay.com/en/african-asian-black-brown-cartoon-2029984/
EDIT: Link 3 for sources is not working properly and brings up one of my image links. Just check out the corresponding source listed under sources