- The frequent use of marijuana seems to cause a mysterious syndrome characterized by severe nausea and repeated vomiting.
- Little is known about this disease, known as cannabinoid hyperemesis syndrome, or CHS.
- Business Insider interviewed half a dozen patients who were diagnosed with a CHS, as well as emergency room doctors who treated him and scientists who studied him.
- Patients say that the disease has changed their lives. Experts worry that it is more common than we thought.
- Marijuana is gaining acceptance in the United States as more and more states legalize drugs. But we are just beginning to understand the diversity of benefits and risks associated with them.
- Visit BusinessInsider.com for more stories.
Alice Moon has already reviewed marijuana foods for a living. So, when a doctor told the 29-year-old Californian that she had to stop using cannabis because of a newly discovered syndrome, she threatened to transform her world.
Before giving up drugs, she wanted a last hurray. She would end up eating five years of weeds every day on a high note, she thought.
During a special dinner that night, Moon ate a five-course cannabis-based meal prepared by award-winning chef Holden Jagger. Between the dishes, Moon and the other guests were encouraged to choose an assortment of joints, hand-selected to complement the flavors of each dish.
Before the meal started, Moon joked with Jagger that it would be his last supper.
A few hours later, she was at home throwing up uncontrollably. She would spend the next few days at the hospital.
Moon had already been diagnosed with Cannabinoid Hyperemesis Syndrome, or CHS.
Very little is known about CHS, which was first identified in the early 2000s. Distinctive features of this condition include significant and consistent marijuana use, severe vomiting, and nausea, as well as high blood pressure. a tendency to use extremely hot baths or showers for relief.
Originally considered very rare, CHS is increasingly used in medical journals and emergency rooms around the world. There is no known cure. The only treatment that has been going on for a long time is to leave cannabis completely.
However, the disease can be avoided, which is why doctors and researchers say they want more people to know. Research suggests that more adults consume marijuana in recent years; It is still unclear whether this should be related to the increasing legalization of the factory by the states.
Cannabis is not a drug. It is a plant with hundreds of compounds. Each of them could have a unique effect on our health. But we are just beginning to understand what these effects are, because drugs have been largely illegal for decades, experts said.
The benefits of marijuana could include relief of symptoms related to serious health problems, ranging from pain and nausea to digestive problems and seizures. At the same time, its risks may include addiction, reduced cognitive performance, and CHS.
"We must recognize that the full range of potential adverse health consequences of cannabis use is not fully understood," wrote recently Dr. Nora Volkow, director of the National Institute for Disease Control and Prevention. Drug abuse in a major medical journal.
CHS could reach millions of Americans, but we do not know much
In interviews that Business Insider conducted with doctors, researchers, and more than half a dozen people with CHS symptoms, people painted a picture of a serious illness but still mysterious. Some researchers believe that this could affect millions of Americans. others hope that it is less common.
Since marijuana remains illegal at the federal level and the disease has only recently been identified, it is difficult to accurately determine the number of people with CHS.
The syndrome appears to affect people who use marijuana of all origins, ages, and sexes. Most say they have used cannabis several times a day for two years or even several decades. They describe a condition that appears suddenly and without warning, sometimes several hours after marijuana use.
For people who have been using marijuana for years, it's as if a switch was reversed. After the first event, whenever a person with SHC consumes cannabis, she may fall violently ill. Using pesticide-free marijuana, edible products, concentrates, products containing only CBD or spray pens does not change anything, they say.
In some cases, as in the case of other chronic diseases, CHS appears to cause relapses that are difficult to predict. Patients can sometimes spend weeks without symptoms and then suddenly experience particularly intense access.
Many sufferers end up in emergency rooms or emergency care centers, and some are admitted to the hospital. Complications can range from mild to severe and include problems such as infections, kidney failure and significant weight loss.
If left untreated, CHS can be deadly.
"People do not tell it to marijuana"
Initially, Moon was reluctant to believe that her illness was related to marijuana.
She had used the drug for half a decade without any symptoms. To make things more unsettling, she first turned to cannabis to relieve the occasional pain and nausea associated with problems such as menstrual cramps. Doctors say that Moon is not alone in his initial disbelief.
"People do not report it to marijuana because they've been smoking for decades" with no identifiable problems, said Dr. Joseph Habboushe, associate professor at Langone Health of New York University and senior author of A recently published study on the disease. year.
Moon has used various forms of marijuana every day for about three years (edible products, concentrated in vape pens and several flower-shaped strains). Then one day in 2016, several hours after smoking a part of a joint, she found herself upset by nausea.
After that, she would get sick every month or so. Thinking that alcohol might have something to do with her symptoms, she stopped. It did not help.
She tried to improve her diet. Nothing worked. Eventually, she found herself in an emergency care center, where doctors diagnosed her with stomach burns.
Moon's symptoms lasted more than a year. The only thing that helped me was spending hours in a very hot bath.
In 2018, things have taken a turn. She vomited every week. A specialist she saw at that time said that it could be acting CHS and told her that the cure was to stop using marijuana. She did not want to believe it, but she decided that she should try to stop smoking.
But before giving up, she went to a last event on cannabis. Moon described this as his last supper.
Moon spent the evening – and most of the next two weeks – in the bathroom. Every day her vomiting was so intense that she felt like she could barely breathe. One morning she was so weak that she fainted on her lawn. At that time, she was tired of it.
& # 39; I was in denial. I did not want to believe that it was true.
She left marijuana completely for three months and had no symptoms. Then she tried the CBD hoping she could enjoy it. One day, she took 200 milligrams of CBD in capsules. That night, she found herself in the emergency room.
After about a week in the emergency room, Moon developed three ulcers, a hernia and an infection. She lost 12 pounds of her already thin body, Christmas missed with her family and the New Year with her friends.
"I had the air of dying," she recalls.
In Colorado, where marijuana is legal, CHS has recently been identified as a major driver of cannabis-related emergency room visits.
For a study published last month, researchers looked at emergency visits between 2012 and 2016 and concluded that stomach problems such as nausea and vomiting were the main cause of displacement, ahead of time. reasons such as intoxication and paranoia. Among stomach problems, CHS was the most commonly reported problem.
"The CHS is certainly not very rare," said Business Insider's Dr. Andrew Monte, lead author of the study and associate professor of emergency medicine at UCHealth's hospital. the University of Colorado Colorado. "We see it absolutely every week in our emergency room."
For Moon, it took a CT scan, an MRI and an endoscopy to rule out any other problem before taking to heart the initial diagnosis of her doctor: she had CHS and had to stop using marijuana.
"I refused, I did not want to believe it was true," she said. "Cannabis is my world, it's all my life."
Hot showers provide temporary relief, but the only cure is to quit
Researchers began by describing the symptoms of CHS in the early 2000s, but it is only recently that physicians from different hospitals around the world have begun to define it as a single syndrome. At first, he was often associated with other digestive disorders sharing some of his features, such as cyclic vomiting.
Habboushe pointed out that the number of cases of cyclic vomiting that may be due to CHS is still unknown. Conversely, it is also possible that some cases of chronic haemorrhagic disease are quite different. To further complicate matters, some people initially turn to marijuana to help with their nausea and vomiting. (The THC-approved federal drug Marinol is prescribed to treat nausea and vomiting caused by cancer and AIDS treatments.)
One of the most distinctive features of CHS is the tendency of patients to use hot baths or showers to temporarily relieve symptoms. Other classic nausea remedies, such as antinausea medications, do not work.
Habboushe believes that heat helps because of the way CHS interferes with the body's natural temperature and pain control. For some reason, hot water tells the body that everything is fine and that the pain and nausea caused by CHS will go away for as long as the water stays hot.
"It's this need to be swaddled," Portland Business Insider Susie Frederick, a 30-year-old resident of Portland, told her, which she would have said would have a CHS there. ;last year. "This feeling of needing comfort everywhere."
Frederick asked Business Insider not to use his real name because she was working in the cannabis industry.
Frederick does not know if his symptoms are related to CHS or anything else, perhaps related to hormonal changes. She has a history of digestive problems, head injuries and gallbladder problems, which complicates matters.
Frederick stated that her vomiting and nausea tended to occur when she was in the menstrual cycle and when she was traveling or coping with increased stress. She had her first episode after receiving a small birth control implant in the upper arm, which releases the progestin hormone to prevent pregnancy.
"It's hard for me to say clearly that the CHS is what's really happening, it's a mockery of other things," said Frederick.
CHS-related nausea appears to be stronger and more intense than typical nausea related to things such as motion sickness or pregnancy, according to the patients.
Barry Howard, a 28-year-old chef in Birmingham, Alabama, said that what struck him most in his CHS was the feeling that he was in urgent need of getting rid of his body, for example a toxin. Business Insider does not use Howard's real name because he lives in a state where cannabis is illegal.
"It's not a normal feeling," Oh, I'm sick of stomach – you feel like your interior wants to come out – as if you were trying to get something out of it. " Howard told Business Insider.
Brian Smith died of dehydration after struggling for months with CHS
If someone with CHS continues to use marijuana, serious complications can occur. In one case, Brian Smith, age 17 and named in Indiana, died after more than six months battling CHS.
Regina Denney, Smith's mother, told Business Insider that the CHS diagnosis had been diagnosed for the first time in Smith in the spring of 2018, in an emergency room. On the way to the hospital, he had vomited so much that she had had to stop almost five times.
On an emergency basis, the doctors told Denney that his son was severely dehydrated and had warned him that his kidneys, the body's natural toxin filtering system, were about to stop. .
At first, Denney thought his symptoms were related to heartburn that had been diagnosed at the age of 10 and that they had been treating for years with drugs prescribed by a doctor, such as than Prilosec.
After administering water to Smith and passing a series of tests, they decided to keep him in the hospital all night.
While waiting for the results, a doctor asked Smith if he was smoking marijuana. When he said yes, the doctor said that she thought that he had CHS. The doctor said the CHS was caused by cannabis and told Smith that the treatment was stopped. She did not say that it could be deadly.
"We had never heard of marijuana as benefits"
Like other people diagnosed with CHS, Smith was somewhat dubious. He had been using marijuana for years without problems. Nevertheless, he agreed to stop until he saw a specialist.
"All we had heard about marijuana was the benefits," said Denney. "How does it help nausea, how does it help the appetite."
The specialist, a gastroenterologist, confirmed the emergency doctor's diagnosis a few days later and did not perform any other tests. He said Smith had CHS and had to stop using marijuana. Although Smith and her mother still doubted, she urged him to stop smoking.
The next two months were painful for Denney. Although her son stopped throwing up – at least as much as she could know – he continued to lose weight. He also complained sometimes of nausea. At first, she assumed that this was related to her stomach burns. But one day, when she noticed that her shoulder blades were slipping off the fine cotton of her t-shirt, she began to suspect that he was using cannabis again.
"He had skin and bones," said Denney.
Then one night, Denney got up in the middle of the evening to find her son sitting on the couch in the living room, belly to the head. He said that he was not feeling well. The next morning, he began to vomit violently. Between two races in the bathroom, where she was bending to hold a bucket under her son and rubbing her back, and the kitchen, where she was preparing her grandson's dinner, Denney called the doctor.
They sent her medicine to take to the pharmacy. But when Denney picked it up, it was the same anti-nausea drug that he had had in the emergency. After telling the doctor that the medications ordered were not working, they said they would order something else. In the meantime, she went home.
Suddenly, at home, Smith collapsed. He grabbed his back, near his loins, then his chest. He told his mother that he could not breathe. Denney immediately called 911.
By the time the paramedics arrived, Smith had stopped breathing. They tried CPR. Smith was pronounced dead half an hour later.
On her birthday, Denney received her son's coroner's report. When Smith died, he was severely dehydrated, according to the document. According to Business Insider, the cause of death in the report was "CHS dehydration".
Denney could not believe it.
"I said that marijuana could not have killed my son, it does not take people's lives," she said.
When Denney was cleaning her car a few days after Smith's death, she pulled her son's backpack out of the backseat. Inside, she found an unsealed baggy of edible products that looked like candy.
"I have to do something to educate people," said Denney. "I do not want anyone to go through there, no parent should lose a child, especially for something like this."
"People say I work for the federal government"
Some people with CHS are reluctant to talk about this disease, fearing to be seen as opposed to marijuana and efforts to legalize the plant. Moon and Howard reported that their friends, family members and others in their communities reacted significantly when they told them about CHS.
After Moon shared an article recently published by a person about his experience of the disease, his inbox was inundated with hate messages.
"People say I work for the federal government, people say I should leave the industry," she said.
Clinicians and researchers are investigating the possibility of treating dozens of diseases in marijuana compounds and there is already a cannabis-based drug to curb epileptic seizures.
But at the same time, as research on the potential benefits of cannabis continues, a disastrous trend toward marijuana, like everything else, has begun. In an effort to capitalize on the public's growing perception of cannabis as universally beneficial, hundreds of companies are taking care of everything from CBD lotions and beverages to cakes and sweets, many of which have not done so. the object of research.
People such as Moon, Frederick and Howard – people who turned to marijuana because they said it helped solve other health problems – seemed to be trapped. Frederick began using cannabis for sports injuries and said he also used it to help him make the transition between a high dose of antidepressants and anti-anxiety meds.
Howard first turned to marijuana because he thought his therapeutic qualities outweighed his risks.
Howard, who was seeking a college scholarship, had played football competitively in high school when he had developed a low back compression fracture. The injury left him with a lifetime pain. Wanting to avoid opioid analgesics because he feared becoming addicted, he turned to cannabis.
"If anything, I thought [marijuana] Helped what I was going through, "said Howard.
"It does not mean that marijuana is bad or good"
Monte and Habboushe pointed out that most CHS patients consume very high amounts of marijuana – far more than they would consider as a standard or "recreational" use. For them, this suggests that if CHS is severe, it can also be avoided with moderate cannabis use.
"Use in moderation is probably the best way to help people avoid this," said Monte. "People who consume 10 times a day are probably at high risk – even daily use is probably too much, unless you do it for medical purposes."
Despite fighting against CHS, Moon has not left the marijuana industry. It no longer reviews cannabis products, having abandoned all forms of drugs, including CBD. Today, she works for several marijuana companies and is responsible for public relations for a start-up specializing in cannabis, called Paragon.
"Cannabis fascinates me and I believe in its healing properties, but I also recognize that I may have drunk too much," she said.
Since the death of her son Brian, Regina Denney has created her own Facebook group in her memory. She hopes to educate the public about CHS.
"My goal is to get something positive out of grief," she said.