Too Much Marijuana Can Make You Unpleasantly, Dangerously Sick

Feb. 11, 2022 — At the middle of the rising science on the unintended penalties of each day long-term use of marijuana lies a paradox.

For years, medical marijuana has been used to ease nausea from most cancers chemotherapy and GI situations. Now, with larger legalization comes rising consciousness that continual use of marijuana — often known as hashish — can set off a situation the place, mockingly, an individual has hard-to-control vomiting and nausea.

Some folks with the dysfunction, often known as “cannabinoid hyperemesis syndrome,” additionally report crippling stomach ache.

Linda can relate. The 33-year-old Oregon resident, who requested to stay nameless to guard her privateness, refers to a medieval spiky steel ball on a sequence when describing the ache.

“Picture a mace inside your abdomen, pushing up inside your chest and, on the identical time, exploding out,” she says.

To search aid, she will get down on her knees, adopts a baby’s yoga pose, and runs sizzling water within the toilet for hours on finish, a trick many with the dysfunction says has offered aid. She additionally sometimes goes exterior and tries strolling it off.

“I might simply wander round my neighborhood, lots of instances at like 4 or 5 within the morning,” she says.

“The recent air helps a little bit bit. I simply maintain strolling down the road, take about 10 steps, cease, vomit — stroll a little bit bit extra, cease, vomit.”

Her first expertise with the dysfunction started in the midst of one evening in 2017 whereas she was at a convention in Las Vegas.

“We went out to eat the evening earlier than, and I awakened about 4 within the morning with simply essentially the most intense ache I’ve ever had,” she says.

“I discovered myself in a very sizzling bathe in between throwing up every little thing and making an attempt to say get some water down,” she says. “I used to be sharing an Airbnb with my colleagues, so it was lower than preferrred.”

Many folks with cannabinoid hyperemesis syndrome discover aid from sizzling baths or showers. Researchers consider that sizzling water helps as a result of temperature sensors within the pores and skin ship indicators to the mind that may assist ease the signs, no less than for some time.

The downside is that folks with this syndrome “cannot dwell within the water,” says emergency physician and medical hashish skilled Leigh Vinocur, MD.

Fast-forward 6 months to a different occasion in Boulder, CO. Again, Linda awakened and couldn’t cease vomiting.

“I used to be not feeling any higher. Showering wasn’t serving to. I ended up within the hospital,” she says.

She acquired opioids for her ache. But neither she nor the emergency room workers had been fairly certain what was taking place. Her discharge paperwork learn “cannabis allergy.”

Cannabinoid hyperemesis syndrome “shatters that picture of hashish solely being a superb factor. It’s a daring assertion, however, you understand, when you begin to consider it, it is like a little bit an excessive amount of of something is not good,” Linda says.

Experts recommend larger consciousness is required to determine this syndrome earlier, by each cannabinoid customers and medical doctors. The bouts of vomiting, specifically, can get so extreme that folks can find yourself hospitalized with dehydration, electrolyte problems, and weight reduction.

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

“By the time they arrive into emergency care, they’re in unhealthy form,” Vinocur agrees. “Many attempt to ignore it, however they proceed to vomit.”

Genetic Risk Factors?

One thriller is why some common marijuana customers get this syndrome whereas others don’t.

“I can say that not everyone will get this, thank goodness,” says Ethan Russo, MD. “But there must be a purpose that sure individuals are inclined and others are usually not.”

Interestingly, a brand new examine from Russo and colleagues means that genes play a job. They recognized 5 genetic adjustments that might make a continual marijuana consumer extra more likely to have cannabinoid hyperemesis syndrome in a examine revealed July 2021 within the journal Cannabis and Cannabinoid Research.

They in contrast 28 folks with the dysfunction to 12 different high-frequency marijuana customers with out these signs.

The outcomes are usually not ultimate however might assist information future analysis, Russo says.

“What we have found — and it was excess of we anticipated — is that there is much more to this than a hypersensitivity to hashish,” says Russo, a neurologist and founder/CEO of CReDO Science, a agency that promotes hashish analysis and develops business merchandise.

Also, he says, these affected by cannabinoid hyperemesis syndrome might be at increased danger for different situations, comparable to dependancy to alcohol or different substances, dementia, diabetes, and coronary heart illness.

“Most folks with CHS are going to be youthful,” he says. “What we’ve demonstrated is there is a risk for more serious problems for decades to come. So someone who has these symptoms really deserves a look at this genetic screening.”

Battling Disbelief

Getting back to the paradox, many users don’t believe marijuana can trigger serious vomiting and nausea because of its reputation for doing the opposite.

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

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

Most kinds of marijuana act in this way — doing opposite things at different doses. Once a certain threshold is passed, people with cannabinoid hyperemesis syndrome are “just uniquely susceptible and really can’t tolerate any significant amount of THC,” Russo says, referring to tetrahydrocannabinol, the substance that gets marijuana users high.

Once diagnosed, quitting is the most effective strategy. But it can be tough to persuade someone to stop using marijuana.

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

People should “realize the root cause of this is its cannabinoid ingestion, and the treatment is really best directed at absolute avoidance,” Johnson says.

Unfortunately, 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 that quit for a month, a year, 2 years and upon resumption, almost invariably, they’re back into bouts of the hyperemesis along with all the other [symptoms],” Russo says.

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

What Recent Research Reveals

Cannabinoid hyperemesis syndrome is a relatively young disorder — first described in 2004 — and early reports and case studies are giving way now to studies looking into potential 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 trigger the temperature-sensitive skin sensors to lessen the symptoms, Johnson says.

An October 2021 study in Spain looked at 54 emergency department visits among 29 people with cannabinoid hyperemesis syndrome. For 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 disorder.

“This should be of concern given the increase in cannabis use due to its legalization and permissiveness,” says Burillo-Putze, an emergency doctor at Hospital Universitario de Canarias in Spain.

Cannabinoid hyperemesis syndrome appears not to discriminate across racial and ethic groups. Although most studies to date include white participants, a July 2021 study of 29 people, 90% of whom were Black, found repeat visits to the emergency room were common.

The study found that 16 people returned 42 times to the emergency room and accounted for 10 hospital admissions, for example.

Cannabis Conspiracy Theories

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

Some “myth busting” is so as, he says.

For instance, cannabinoid hyperemesis syndrome doesn’t occur due to publicity to merchandise from a tree referred to as neem or from pesticides utilized to marijuana crops throughout cultivation, Russo says. It may also happen with high-dose artificial cannabinoids, he says.

The State of Recreational and Medical Marijuana

Recreational marijuana is authorized in 18 states, Washington, DC, and Guam as of January 2022, in keeping with a report in US News. More states allow medical marijuana use — 37 in whole, plus Washington, DC, in keeping with Britannica ProCon.

One of the states the place solely medicinal use is authorized is Maryland, which is the place Vinocur practices.

“We are seeing rising numbers of instances” of cannabinoid hyperemesis syndrome, she says.

In addition to continual use or increased doses, it is seemingly that the upper efficiency ranges of THC within the authorized marijuana trade set off the syndrome in some folks as properly.

Linda estimates she ended up in emergency rooms no less than a half-dozen instances within the final 5 years. In April 2021, she had a “fairly severe occasion.” She blames it on touring loads for work, not consuming proper, and never getting sufficient sleep. She broke her 2-year abstinence with alcohol.

“I principally did not hearken to my physique and paid a reasonably vital worth for it,” she says.

Linda didn’t cease altogether however says she “drastically modified the categories and type of the hashish I used to be utilizing.”

“I can inform you on the report that I might be 100% useless with out this plant,” she says.

“The prospect of dwelling with out it was extra detrimental to me than all of these issues I simply described to you, as a result of dependancy runs in my household and I had opiate issues myself that I overcame with hashish.”