Case of the Month: Cannabinoid Hyperemesis Syndrome (CHS)

Vomiting and nausea as an overdose symptom from ingesting marijuana is on the uptick in our society. It has not been a syndrome much studied or even considered as marijuana is not legal in most states at this time and is also classified by the Drug Enforcement Administration as a Schedule I drug (drugs which have a high potential for abuse and no medical application or proven therapeutic value). Most American believe this to be untrue from what I hear and read.

Since people are still not that open to admitting they use marijuana, there is a feeling that this syndrome could theoretically affect upwards to two million people in the United States—a little known syndrome affecting a bunch of people with people not seeking medical attention for the symptoms which is why I am discussing this syndrome. As usual, when you use forms of any kind of medicine, if a little of it is good and works, a lot is not necessarily better. They say marijuana is not addictive, but I recently had a younger client discuss with me her habit of smoking up to 30 bowls per day with these same symptoms and her doctors were not able to determine the cause of her illness. Talk about a whopping case of reefer madness!

The Cannabinoid Hyperemesis Syndrome (CHS) was first named through a published article in a journal titled Gut by the British Society of Gastroenterology in 2004. As the story goes, a woman ended up in the emergency room because she had been feeling extremely nauseous. She had discovered on her own that a good hot bath would take away the symptoms but that when the water in the bathtub cooled down the symptoms came back. So she started using water that was successively hotter and hotter until one day she ended up with burns on her body.

The doctors determined that the woman was a frequent and heavy marijuana user. In the past people have used marijuana to treat nausea (especially in cancer cases), stimulate appetite and lately it has been discovered that some varieties of marijuana can be used to treat seizures in children. So the doctors felt this was a rare case. But is it?

A new study done by clinicians at New York University may negate that idea. When they surveyed thousands of patients with the nausea/vomiting symptoms, they were able find frequent marijuana users from the pool. Frequent use was defined as using marijuana at least 20 days each month. They ended up with 155 people who met the protocol. These 155 people smoked nearly every day or several times a day and had been using for about five years or more. From this population, roughly one third of them had symptoms that qualified them as a CHS case. These cases do not respond to anti-nausea medications and there is no known treatment for this disease. It does reside when the person stops using marijuana, but would a person smoking several times per day want to give up their habit? Most people I’ve worked with will give up something that causes pain and irritating symptoms but when the pain or symptoms are resolved, I see them often going back to the same harmful habits.

Some other negative effects of the use of cannabis include:

• Anxiety in social situations
• Chronic bronchitis (goes away when use is discontinued)
• Decreased reaction time
• Depression (interferes with serotonin receptors in the brain)
• Disturbs sleep cycles in the later stages of REM sleep
• Fetal Birthweights lower/Increased need for neonatal intensive care when exposed by mother’s use of marijuana
• Impaired academic achievement (Chronic use)
• Incoordination
• Overeating
• Paranoia
• Poor posture (postures associated with the cerebellum and basal ganglia)
• Red eyes (Cannabis acts as a vasodilator)
• Schizophrenia (of particular concern for people at risk for schizophrenia)
• Short term memory issues (worse with infrequent or inexperienced users)
• Time loss (Altered blood flow to the cerebellum)

From what I’ve read, the cannabis we once had in the 70s is not the same cannabis that is available on the market nowadays. The older varieties used to be much higher in CBD (Cannabidiol) than the THC component of the plant. If it is not grown or processed correctly, marijuana can harbor Aspergillus mold which can be harmful to fungus/mold sensitive people and to those with suppressed immune systems. And if you don’t know the source is organic, it can be sprayed with all kinds of chemicals (probably like tobacco). I have consulted with a few people over the decades who have been exposed to irritating chemicals or mites from the plant/growing operations. Those are long-term, itchy cases that are difficult to help.

Historical uses of Cannabis include:

• Alcohol consumption-safer than drinking, it can help people cut back on alcohol consumption
• Alzheimer’s slows progression of and calms behavioral disturbances of dementia patients
• Anti-inflammatory
• Cancer cells stop spreading (in vitro study only so far)
• Chronic pain
• Creativity increases with mild use
• Crohn’s
• Decreased appetite
• Epilepsy (especially Dravet syndrome- a rare form of childhood-onset epilepsy associated with multiple types of seizures)
• Glaucoma (Marinol is the FDA approved drug) studies show that higher doses are needed
• Hepatitis C-decreases side-effects from treatment for
• Improves appetite in cancer and in AIDS patients
• Inflammatory bowel disease
• Insomnia
• Anti-nausea drug used for cancer treatments
• Lennox-Gastaut Syndrome (Seizures in kids aged 2-6 with brain disorders, brain trauma or mental development issues)
• Multiple Sclerosis
• Muscle spasms
• Neuropathic pain
• Nightmares—helps alleviate by disturbing sleep cycles for late stage REM sleep (also a negative effect)
• Overactive Bladder
• Pain reducer so ingesting cannabis may reduce opioid consumption reducing opioid deaths
• Pain in movement
• Parkinson’s Disease-may help with shaking and pain associated with the disease
• PTSD is the number one reason for people receiving a medical marijuana license
• Rheumatoid arthritis
• Spasticity
• Strokes-may protect the brain after having a stroke (vasodilator activity?)
• Ulcerative colitis

The older varieties contained about 4% THC (Tetrahydrocannabinol–the stuff that causes euphoria). In the last 20-some years the THC has increased to a whopping 12% as the CBD levels have diminished so say in the 70s that the THC to CBD ratio went from 14 to 1 to about 80 to 1 within 24 years.

If the public is so interested in not getting high and using CBD for its therapeutic affects then are there varieties out there that could be grown for its medicinal and not euphoric effects? It seems like it would be safer to have patients ingest these varieties as the whole herb than it would be to try to elucidate the individual components from the plant (probably with some very toxic chemicals) to than make standardized versions of this synthetic component to instill into products or capsules used to treat people. Currently, Sativex, Marinol and Epidiolex are three drugs containing cannabis components. Will there be future labeling issues? Will the product legally have to be labeled as synthetic or natural? Now we’re getting into regulations again.

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