October 19, 2021
With many states legalizing marijuana for recreational and medicinal use, it has become rampant among people. Its consumption is on the rise—raising the question, how much marijuana is too much? In April 2021, Marijuana got legalized in 16 states and the District of Columbia for medicinal and recreational purposes, leading to a spike in substance abuse disorder and other health complications.
According to a study, published in the JAMA Network Open, and authored by Dr. Sam Wang, a professor of pediatrics at Children’s Hospital Colorado, the health facilities in Colorado have seen a rapid surge in vomiting-related illnesses from 2013 to 2018, shortly after the United States legalized recreational marijuana.
There was approximately 29 percent increase in vomiting-related emergency department visits in Colorado between Jan. 1, 2013 to Dec. 31, 2018. Around 820,778 people were treated for symptoms of vomiting and nausea in the emergency departments. The reports showed nearly 30 percent of those patients were below 25 years of age. Even the counties with no prior marijuana use history witnessed a significant rise in vomiting-related emergency department visits.
Dr. Sam Wang said his patients suffered from unbearable abdominal pain, nausea and continuous vomiting until they had everything out of their stomach. This acute intestinal distress is known as cannabis hyperemesis syndrome, or CHS.
Cannabis hyperemesis syndrome first came to light in 2004, when a group of Australian researchers investigated 19 chronic marijuana users who had repeated episodes of vomiting, retching and abdominal pain. The researchers followed nine patients for years and found that the symptoms of intestinal distress went away once the cannabis consumption stopped, while it returned back when cannabis consumption started once again.
The patients of CHS used to self-medicate their symptoms by taking extreme hot baths. With a significant rise in CHS symptoms, taking hot water bath became concrete as a home treatment for CHS.
Dr. Wang said his patients used to complain of nausea and vomiting every evening, while taking hot water bath used to alleviate the symptoms. However, they used to get the same symptoms the very next day. How hot water played a key role in stopping vomiting is still not clear.
Some researchers have attributed this mechanism to Tetrahydrocannabinol or THC (the primary psychoactive compound in marijuana). THC is interlinked to body’s pain receptors, and taking hot water bath interrupts the pain cycle, which, in turn, alleviates the symptoms.
Paradoxically, THC and other cannabinoids in the marijuana plant have been used for relieving nausea and vomiting in cancer patients undergoing chemotherapy. Marijuana has been previously used as a painkiller, but studies show mixed results of its effectiveness. It is still unclear why the same compound relieves pain and also causes pain.
Dr. Wang also mentioned not all heavy users of marijuana are affected by CHS. It’s not entirely clear who is predisposed to get CHS. “Is it a specific potency? Is it a certain frequency or duration of use? Or is it a specific type of product?” There is no sufficient data to support it.
To fully understand the condition, the new cases of CHS must be documented and symptoms must be compared, Dr. Wang added.
So far, the immediate treatment for CHS includes IV fluids to combat dehydration from vomiting and anti nausea medication. But the patients have to take multiple tests such as gastric emptying tests, unpleasant upper GI endoscopy, blood and urine tests and expensive CT scans to rule out other possibilities. Adolescent children seem to show extreme symptoms of CHS and they have to visit emergency department frequently.
Dr. Wang also said, “Whether these vomiting symptoms is due to cannabis use or due to any virus it’s still not clear but such symptoms if left untreated for prolonged period of time can lead to electrolyte disturbances and trigger organ failure”.
Cannabis hyperemesis syndrome is a concern
CHS is now considered as a nation problem. According to a 2020 study, approximately one in five people hospitalized for continuous vomiting in the United States reported concurrent cannabis use. Surveys reveal that with legalization of marijuana, its abuse has gone up to a significant level. About 60% adults in the United States support the usage of marijuana for medicinal and recreational purposes. Many people consider marijuana to be safe and ignore its potential health risks. There is a noticeable rise in marijuana abuse among young adults and adolescents affecting their mental and physical health.
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