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What was causing this intense stomach pain, Brittany wondered as she rode in an ambulance one late night in February.
Doctors at the hospital ran tests and ordered scans but could not name the source of her unrelenting nausea and vomiting. It was so bad she thought it might be a recurrence of her severe pancreatitis, the illness for which she once had been hospitalized and put on life support.
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While waiting for answers, she noticed an educational pamphlet on cannabinoid hyperemesis syndrome (CHS), a little-known illness characterized by an onset of intense vomiting. She wondered if her gastric distress might have been caused by the marijuana she regularly and legally smoked at her home in Toronto.
A doctor confirmed that Brittany’s years of cannabis use had manifested in CHS.
She felt upset, then bouts of anger. She felt isolated and like she had ruined her body.
“I basically spent that week laying in bed and just sipping slowly on water or sipping slowly on my Pedialyte, trying to get as much electrolytes and nutrition as I could,” recalled Brittany, 27, who today is sober. She asked to be identified only by her first name for fear of how future employers may view her history of marijuana use.
Doctors say CHS is rare, but its frequency may be growing. There’s no cure for this syndrome, with the only known, surefire treatment being abstinence from marijuana.
Though cannabis has become more culturally acceptable and more widely legal, both in the U.S. and abroad, its regular use is still a sensitive topic.
As the Biden administration considers reclassifying marijuana as a less dangerous drug, and Congressional Democrats work to end the federal government’s prohibition, some doctors are warning that while cannabis has legitimate uses, it can also be misused, with debilitating side effects.
Cannabinoid hyperemesis syndrome is an uncommon reaction to cannabis use. In addition to frequent and severe vomiting, patients may have difficulty eating and drinking, and only find (temporary) relief in hot showers and baths.
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Because research on CHS is so limited, and because state health departments don’t collect data on prevalence, it’s unknown how common it is, said Dr. Michael Camilleri, a gastroenterologist at the Mayo Clinic.
Also, it’s possible there are more cases than have been reported, since not everyone with the illness will seek medical help or tell their doctor they use cannabis, the Cleveland Clinic notes.
It’s not clear if some people are more prone to the syndrome than others. However, Camilleri said that men are more likely to develop it, as are people who have used marijuana frequently and for many years.
Though the condition remains unfamiliar to some medical professionals and the number of people diagnosed is relatively low, the prevalence of CHS cases observed in emergency departments doubled between 2017 and 2021 in North America, according to a paper authored by Camilleri and his colleagues in the journal Gastroenterology.
Anecdotally, the experts who spoke with the PBS NewsHour also say they have seen an increase.
When Dr. Deepa Camenga began her career about 20 years ago, she rarely if ever saw pediatric patients with CHS, she said. Today, hospitals in her area around New Haven, Connecticut, see pediatric CHS cases nearly every day, she added.
Camenga, associate director of pediatric programs at the Yale Program in Addiction Medicine at the Yale School of Medicine, partially attributes the rise to the increased accessibility of marijuana, largely by vaping.
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Decades ago, most people had less opportunity to consume cannabis in daily life. “No kid could use continuously throughout the day and also be doing anything else, because they would have been smoking a joint before,” she said.
Now, with the advent of discreet delivery devices, “you can be out, you can be in public, you can be in school, you can be at your job” and continually vape without much notice, Camenga said.
Other theories behind rising cases include the widespread legalization and cultural acceptance of cannabis, as well as the higher tetrahydrocannabinol (THC) content in modern marijuana, experts told the NewsHour.
Cannabis can both induce and subdue vomiting, a paradox doctors don’t fully understand, Camilleri said. Medical marijuana has long been prescribed for nausea and appetite loss for people with cancer and HIV/AIDS, and the Food and Drug Administration has approved drugs with synthetic THC for use by chemotherapy patients.
Experts also aren’t clear on what causes CHS, or why some people develop it while others don’t. Since it was first identified in 2004 in Australia, researchers have looked at the effects of cannabis on the vomiting centers of the brain.
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Patients are often diagnosed with the syndrome based on the way they treat their own symptoms. Typically, patients can only find relief from intense and persistent nausea by taking hot baths or showers.
“There is evidence that if you send a message to the brain that competes with the message that’s causing the nausea, vomiting, that you can suppress it,” Camilleri said. One possible explanation for this is called “gate control theory,” which postulates that to some extent, the brain can regulate how much pain it perceives.
Severe and uncontrollable vomiting increases the risk of dehydration and electrolyte imbalances, and in rare cases, patients can experience esophageal tears, Camenga said. Doctors often treat CHS patients who seek help at hospitals with fluids.
Typical antiemetics such as ondansetron, commonly known as Zofran, have often been found ineffective at suppressing nausea caused by CHS. There are some drugs that may help, such as amitriptyline, Camilleri said.
Ultimately, the only way to guarantee health is by totally abstaining, he added. If the patient quits cannabis consumption, vomiting due to CHS largely subsides. It’s possible that with lower amounts or lower frequency, patients might be able to use cannabis again, but the science is unclear.
Camilleri also said that cannabis use is positively correlated with anxiety and depression, and noted that doctors should treat the whole patient and not just the disorder.
“It may be that the cannabinoid is only sort of one aspect of the way the patient is hurting that needs to be addressed to really get them to heal,” he said.
Cannabis can be addictive, and people who stop using it can experience symptoms not unlike opioid or alcohol withdrawal, said Dr. Deepak Cyril D’Souza, director of the Yale Center for the Science of Cannabis and Cannabinoids.
Symptoms of withdrawal can include disrupted sleep, increased heart rate, sweating, irritability and mood swings, according to the Centers for Disease Control and Prevention.
Rates of cannabis use disorder have spiked in the past 40 to 50 years, D’Souza said, with some studies suggesting between 20 and 30 percent of marijuana users meeting the criteria for the disorder.
“We don’t have any treatment for cannabis use disorder. Neither the psychological treatments nor the pharmacological treatments seem to be that effective,” he said.
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He also warned that people with serious mental illnesses, such as schizophrenia, should be cautious about marijuana use, as studies show cannabis can exacerbate the effects of those illnesses.
But it’s also important to acknowledge the positive uses of marijuana, Camilleri said. He noted a 72-year-old patient who uses cannabis to help her sleep.
“It’s the best medication that helps her sleep for the last five years. So why would I stop that medication? She has no adverse effects, there’s no complications,” he said.
D’Souza also doesn’t consider marijuana to be inherently problematic. Instead, he’s concerned that marijuana production and sales will follow in the footsteps of the tobacco and alcohol industries, which have worked to sway public opinion and legislation in their favor.
“Is it an accident that the tobacco industry is entering the fray in the cannabis industry? No, they’ve invested billions of dollars in that,” D’Souza said. “The commercialization is what all of us should be concerned about.”
Brittany initially blamed herself for developing the syndrome. But she’s replaced her old habit with a new hobby; she’s read 60 books this year, she said, and she feels great.
Every once in a while she wishes she could indulge in a joint, but she knows there are healthier diversions.
“I always recommend to people: Stop completely. Don’t think continuing with small amounts is going to help you, because it’s not. You need to just stop.”
Left: People roll a blunt during the informal annual cannabis holiday celebrated on April 20, in Denver, Colorado, April 20, 2023. As marijuana becomes more culturally and legally acceptable, doctors warn that misuse can result in addiction, illness and withdrawal. File photo by Kevin Mohatt/Reuters
By Anthony Izaguirre, Associated Press
By Julie Carr Smyth, Associated Press, Samantha Hendrickson, Associated Press/Report For America
By Geir Moulson, Associated Press
By Jennifer Peltz, Associated Press
Hannah Grabenstein Hannah Grabenstein
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What is cannabinoid hyperemesis syndrome? Here’s what to know, and why experts say it’s on the rise – PBS NewsHour
