Watch Out, Here’s a Caveat about Medical Marijuana–Cannabinoid Hyperemesis Syndrome!

Caveat alert coming your way about medial marijuana, so some of you might want to close your eyes! I saw this article in Clinical Psychiatry News the other day about how medical marijuana is often used by people instead of their prescription medications for a variety of disorders including anxiety, insomnia, pain, and a variety of psychiatric disorders. More than 75% of respondents to an anonymous survey use pot for psychiatric disorders because it has fewer side effects and doesn’t make them feel like zombies [1]. The survey was reported at the American Psychiatric Association’s Institute on Psychiatric Services by Dr. Amanda Reiman, Ph.D., director of research and social services at the Berkeley (Calif.) Patients Group, a medical marijuana dispensary.

Most of the respondents were men, college-educated, employed, and middle-aged. The majority had health insurance but chose to obtain and use marijuana instead of prescription drugs even though their insurance would not pay for pot.

There’s a tendency to make medical marijuana sound like the perfect drug, but consulting psychiatrists have been hearing about another side of marijuana for years. It’s called Cannabinoid Hyperemesis Syndrome (CHS) and it makes people sicker than snot [2]. CHS is characterized by cyclic vomiting and compulsive bathing. I’ve seen patients made miserable by this poorly understood syndrome, which leads to intractable vomiting, dehydration resulting in hospitalization requiring intravenous rehydration, and I suppose really wrinkled skin from prolonged exposure to hot baths and showers.

The syndrome was first described in the medical literature in 2004 in 9 patients in Australia. More cases have been reported subsequently around the world. Chronic heavy users can develop CHS even after they’ve used marijuana without side effects (except for munchies and a tendency to say “Wow” a lot) for years. The only treatment for CHS is to quit smoking marijuana.

And the stuff is still illegal in most places. So I guess you could say that smoking marijuana could get you into hot water in more ways than one.

1. Otto, M. A. (2012). Medical Marijuana Often Used as a Prescription Drug Substitute. Clinical Psychiatry News, IMNG Medical Media. 40.
Major Finding: In an Anonymous survey, 66% of respondents said that they use marijuana as a prescription drug substitute.
Data Source: Survey of 350 medical marijuana clients at the Berkeley Patients Group, a medical marijuana dispensary in Berkeley, Calif.
Disclosures: Dr. Reiman said she has no financial conflicts.

2. Wallace, E. A., S. E. Andrews, et al. (2011). “Cannabinoid hyperemesis syndrome: literature review and proposed diagnosis and treatment algorithm.” Southern medical journal 104(9): 659-664.
Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic vomiting and compulsive bathing behaviors in chronic cannabis users. Patients are typically diagnosed with CHS only after multiple and extensive medical evaluations, consequently without a clear etiology of their symptoms or treatment plan leading to symptomatic improvement. Increased healthcare provider awareness of CHS as a cause of nausea, vomiting, and abdominal pain coupled with an attentiveness to focused history taking-especially noting symptomatic improvement with prolonged exposure to hot showers or baths-can lead to effective treatment through cannabis cessation. We propose a diagnosis and treatment algorithm for physicians to follow when evaluating patients presenting with nausea, vomiting, and abdominal pain who are suspected to suffer from CHS.

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Comments

  1. My son has had 3 separate long term episodes of this syndrome. There was no Dr. in the Dartmouth Hitchcock Medical Center that even knew of this syndrome. My son was seen by medical teams that could not figure out what was wrong with him. I was sitting in my son’s room while he was in DHMC; a team of Doctors were with him. I was doing a search of my son’s symptoms on the internet and came across this syndrome. I typed in severe vomiting and hot showers. I showed one of the Drs. what I had found on the internet. After some time they did diagnose him with this syndrome. I think all doctors should be aware of this. My son suffered severely for a month at a time with this. He almost died. He was in and out of the emergency room several times a week at 2 hospitals. Neither hospital had any knowledge of this syndrome. My son’s Dr. at DHMC has done a power point study since.

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    • Hello Lorry,

      Thank you for sharing this harrowing story about your son’s bout with this illness. I hope he’s recovered. It sounds like his doctor appreciated your proactive efforts on his behalf. I’ve no idea whether medical marijuana packages carry warning labels, but stories like yours make me believe they should.

      Best wishes,

      Jim Amos, MD

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  2. I have recently been diagnosed with C.H.S. and I am curious to learn all I can about the syndrome. I was a daily smoker for about a decade with countless E.R. visits,diagnosed with everything from Crohn’s to I.B.S. I have had two abdominal surgeries, even been to U.C.L.A. medical center to no relief. I was yet again in the hospital over Christmas 2011 and a young doctor brought this syndrome to my attention(thank god) I was very skeptical as any pot head would be,anyway did my research(the stuff I could find) and to my dismay the symptoms were identical to mine(I was convinced.) I quit smoking Jan. 17 and although I believe it is still in my system I have not had and symptoms return as of yet. Is there any book I could buy to inform me more on C.H.S.? If so please notify me at once and I would be grateful. Thank You.

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    • Hi Collin,

      Thank you for sharing your experience and I hope you continue to recover. I’m not aware of any book published so far about Cannabinoid Hyperemesis Syndrome (CHS). You and many others probably already know that just googling the term returns well over 12,000 hits while a quick PubMed search yields only about 20, mostly case reports. In my opinion, this wide disparity in the common knowledge base as compared to that of the scientific community indicates the lack of attention that medical researchers have given the subject. This may be changing and I’m hopeful that the future will hold clear, practical, and humane answers to the questions that sufferers have about this syndrome.

      Best wishes,

      Jim Amos, MD

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  3. Julie Schulman, MD says:

    I love making this diagnosis. Often the other physician hasn’t even asked about MJ use, so when I interview the patient, get the diagnosis, and tell the referring physician, I can practically see the internal gears whirring as they think, “Is she pulling my leg?” I suppose once the condition becomes common knowledge we won’t get to see it as much, but cyclical vomiting is well-known and we still see patients whose other docs have labelled them as “crazy.”

    I have to say, though, despite the reports about bathing, I haven’t had a lot of cases where the patients have confirmed this behavior.

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    • Hi Dr. Schulman,

      Your comments ring so true! I think you’re right, of course, about the novelty eventually wearing off. My internal medicine and OB colleagues are starting to get pretty savvy. I wonder if the inconsistencies in reports about bathing have anything to do with the number of bathrooms in households. If someone is yelling “C’mon outta there, other people have to use the john ya know!”, would that affect duration and frequency of bathing or showering? I’m only half-kidding.

      Many thanks!

      Jim Amos, MD

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