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A Perplexing Marijuana Side Effect Relieved by Hot Showers

By the time Thomas Hodorowski made the connection between his marijuana habit and the bouts of pain and vomiting that left him incapacitated every few weeks, he had been to the emergency room dozens of times, tried anti-nausea drugs, anti-anxiety medications and antidepressants, endured an upper endoscopy procedure and two colonoscopies, seen a psychiatrist and had his appendix and gallbladder removed.

The only way to get relief for the nausea and pain was to take a hot shower.

He often stayed in the shower for hours at a time and could be in and out of the shower for days.

When the hot water ran out, “the pain was unbearable, like somebody was wringing my stomach out like a washcloth,” said the 28-year-old, who works as a production and shipping assistant and lives outside Chicago.

It was nearly 10 years until a doctor finally convinced him the diagnosis was cannabinoid hyperemesis syndrome, a condition that causes cyclic vomiting in heavy marijuana users and can be cured by quitting marijuana.

Until recently the syndrome was thought to be uncommon or even rare. But as marijuana use has increased, emergency room physicians say they have been seeing a steady flow of patients with the telltale symptoms, especially in states where marijuana has been decriminalized and patients are more likely to divulge their drug use to physicians.

“After marijuana was legalized in Colorado, we had a doubling in the number of cases of cyclic vomiting syndrome we saw,” many of which were probably related to marijuana use, said Dr. Cecilia J. Sorensen, an emergency room doctor at University of Colorado Hospital at the Anschutz medical campus in Aurora who has studied the syndrome.

“C.H.S. went from being something we didn’t know about and never talked about to a very common problem over the last five years,” said Dr. Eric Lavonas, director of emergency medicine at Denver Health and a spokesman for the American College of Emergency Physicians.

Now a new study, based on interviews with 2,127 adult emergency room patients under 50 at Bellevue, a large public hospital in New York City, found that of the 155 patients who said they smoked marijuana at least 20 days a month, 51 heavy users said they had during the past six months experienced nausea and vomiting that were specifically relieved by hot showers.

Extrapolating from those findings, the authors estimated that up to 2.7 million of the 8.3 million Americans known to smoke marijuana on a daily or near-daily basis may suffer from at least occasional bouts of C.H.S.

“The big news is that it’s not a couple of thousand people who are affected — it’s a couple million people,” said Dr. Joseph Habboushe, an assistant professor of emergency medicine at N.Y.U. Langone/Bellevue Medical Center and lead author of the new paper, published in Basic & Clinical Pharmacology & Toxicology.

Others questioned the one-in-three figure, however. Paul Armentano, the deputy director for the National Organization for the Reform of Marijuana Laws (NORML), said that even with more widespread use of marijuana, “this phenomenon is comparatively rare and seldom is reported” and strikes only “a small percentage of people.”

And several physicians who routinely prescribe medicinal marijuana for conditions ranging from chronic pain to epilepsy said they have not seen the cyclic vomiting syndrome in their patients, but noted that they typically prescribe compounds that are not designed to produce a high and contain very low amounts of the psychoactive ingredient THC.

Dr. Habboushe said doctors in other parts of the country may be unfamiliar with C.H.S. or mistake it for a psychiatric or anxiety related syndrome. And even if they are aware of it, many regard it as a “rare, kind of funny disease,” replete with anecdotes of patients who spend hours in the shower.

But the condition can be quite serious. One 33-year-old military veteran who asked not to be identified by name described bouts lasting up to 12 hours in which he felt “like a puffer fish with sharp spikes was inflating and driving spikes into my spine from both sides. I’ve broken bones, and this blew it out of the water.”

“I know patients who have lost their jobs, gone bankrupt from repeatedly seeking medical care, and have been misdiagnosed for years,” Dr. Habboushe said.

“Marijuana is probably safer than a lot of other things out there, but the discussion about it has been so politicized and the focus has been on the potential benefits, without looking rigorously at what the potential downside might be,” he said. “No medication is free from side effects.”

Patients often arrive at the hospital severely dehydrated from the combination of hot showers and the inability to keep food or liquids down, and that can lead to acute kidney injury, said Dr. Habboushe.

But since many patients develop the syndrome only after many years of smoking pot, they don’t make the connection with their pot habit and have a hard time accepting the diagnosis.

The confusion is understandable, Dr. Sorensen said. “Marijuana is viewed as medicinal, and it’s given to people with cancer and AIDS. People know it’s used to help with nausea and stimulate the appetite, so it’s difficult to get patients to accept that it may be causing their nausea and vomiting.”

It’s unclear why marijuana can produce such discordant effects in some users. But Dr. Sorensen often tells patients that it’s similar to developing an allergy to a favorite food.

Getting the right diagnosis often takes a long time. The average patient makes seven trips to the emergency room, sees five doctors and is hospitalized four times before a definitive diagnosis is made, running up approximately $100,000 in medical bills, Dr. Sorensen’s study found.

“They get really expensive workups, lots of CT scans and sometimes exploratory surgery” to rule out dangerous conditions like appendicitis or a bowel obstruction, Dr. Sorensen said. “At the end of the day they’re told, ‘You’re smoking too much pot.’”

The symptoms of C.H.S. often do not respond to drug treatment, though some physicians have had success with the antipsychotic haloperidol (sold under the brand name Haldol) and with capsaicin cream.

The good news is that C.H.S. has a pretty simple cure: abstinence. Patients stop having pain and vomiting episodes when they quit smoking, experts say. And if they start smoking again, they are likely to have a recurrence.

Mr. Hodorowski said he quit smoking once he accepted that marijuana was the cause of his problems, but acknowledges he was in denial for a long time. Now, he says, he’s telling his story so other people can learn from his experience.

“I hope they’ll be honest with themselves so they don’t have to go through what I’ve been through,” he said. “I’m very lucky to have survived this.”

Emergency room doctors are seeing a growing caseload of nausea and vomiting in marijuana users whose only relief is a long, hot shower.

Chill or Anxious AF? How Weed Affects Anxiety

There are plenty of people out there who claim cannabis is the key to quieting anxiety and achieving a state of blissed-out relaxation. Yeah, you know who you are.

But there’s probably just as many people who claim that weed sends them spiraling into panic, paranoia, and anxious thoughts — making their anxiety about a million times worse.

Personally, I’ve experienced both. Sometimes, a few hits are all it takes for my mind to stop racing, for my shoulders to relax, and for me to (finally!) chill the eff out.

Other times, those same few hits can send me into a full-blown panic, hyperventilating on the floor of the bathroom, convinced I’m going to be high and trapped in the hot, anxious mess that is my brain from now until eternity.

So, what’s the deal? Why is weed a virtual miracle cure for some people’s anxiety and completely anxiety-inducing for others?

And, more importantly, how can you make sure your experience with cannabis has you feeling less anxious and totally relaxed — instead of on the verge of panic?

The first thing to understand about cannabis and anxiety is that not all weed is created equal.

There’s hundreds of compounds (known as cannabinoids) produced by the cannabis plant, but when it comes to anxiety, there’s two you need to know about: tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC is what most people think of when they think of cannabis. It’s the compound responsible for getting you “high.”

CBD, on the other hand, is non-psychotropic — meaning it’s not going to produce the same “oh man, I’m so stoned” feeling you get from THC.

There’s no one-size-fits-all approach to cannabis — it’s not like CBD is better than THC or vice versa.

But understanding the differences between the two — and how it relates to your particular brand of anxiety — can help make your experience with cannabis more anxiety-relieving and less anxiety-inducing.

“There are a lot of different types of anxiety which will definitely influence how people respond to different forms of treatment or therapeutic intervention with something like cannabis.

“Anxiety can be anticipatory or it could be generalized or it can be connected to depression or it could be more of a panic disorder,” says Emma Chasen, cannabis educator and founder of Eminent Consulting Firm. “And so all of those different types will respond differently to cannabis.”

If your anxiety goes hand in hand with an overall “blah” feeling, THC can be just what you need to lift your spirits. “For people who have anxiety connected to depression [or] general dysphoria, THC can actually be really helpful because it is euphoric,” says Chasen.

But THC — especially in high doses — can cause a cascade of side effects, like elevated heart rate or racing thoughts. This can actually exacerbate certain kinds of anxiety. And that’s where CBD comes in.

“CBD is non-psychotropic, so it’s not going to give you any of those negative side effects,” says Chasen.

“It may help to alleviate some more anticipatory anxiety, some more generalized social anxiety and may even help with panic disorders because it does influence and interact with your serotonin system.”

So, in a nutshell, too much THC can definitely create a more anxiety-inducing smoke sesh, while CBD can help you chill out, but won’t get you stoned.

Luckily, you can have your cake and eat it too — according to Chasen, a mix of THC and CBD may be the best approach to using cannabis to feel less anxious and more relaxed (and get a nice buzz in the process).

“I would definitely look for something with a mixed ratio of cannabinoids,” says Chasen. “A 1:1 or a 2:1 ratio of THC to CBD will typically be very helpful at stimulating euphoria and decreasing anxiety — especially if you take it very slow and low [with your] dosage.”

Finding the right balance of CBD and THC is key to keeping your anxiety in check when using cannabis. But if you want to take weed’s anxiety-fighting benefits to the next level, there’s something else you want to be mindful of — and that’s terpenes.

Terpenes are the fragrant oils that give each cannabis plant its distinct aroma. And just like cannabinoids, different terpenes produce different effects — including effects that can lower anxiety.

Chasen says there are terpenes that have “documented anti-anxiety properties.”

According to Chasen, there are three terpenes you should be on the lookout for if you want to use cannabis to treat your anxiety — limonene, linalool, and beta-caryophyllene.

If your anxiety has you feeling down or depressed, look for limonene, which can create euphoria and put a little anxiety-busting pep in your step.

“Limonene [is] the terpene found in the rind of citrus fruit [and] it does interact with your serotonin and dopamine receptors and helps to stimulate euphoria, so that is a great one to help reduce anxiety,” says Chasen.

If you’re more in the market for a major de-stressor that will help you chill out and log a solid night of shut-eye, try linalool, a compound of lavender that has a more sedative, relaxing effect.

“We know that lavender is a good de-stressor, and linalool is a compound of lavender — so it does the same type of thing in cannabis,” says Chasen.

And if you’re looking for something in between the euphoria of limonene and the chill sleepiness of linalool, try beta-caryophyllene.

“Beta-caryophyllene, which is found in black pepper and cinnamon, also has some really wonderful anti-anxiety properties,” says Chasen.

“If limonene is the more uplifting one and linalool is the more sedating one, then beta-caryophyllene is kind of right in the middle. It’s more analogous to like a glass of red wine at the end of a long day [to help you unwind.]”

Getting the right blend of THC, CBD, and anxiety-busting terpenes is key to having a positive experience with cannabis. But there’s a few other things you’ll want to keep in mind to make sure your next foray into the world of weed is chill, relaxed, and anxiety-free:

  • Control your consumption. There’s lots of different ways to consume cannabis (tinctures and gummies and flower, oh my!). But if you want to have the most control of your experience, try edibles. “With edibles, you can really take a very precise dose,” says Chasen. “With smoking, it’s a lot harder to measure your dose.”
  • Take it low and slow. If you’re using THC, the best way to keep anxiety at bay is to start with a low dose and then slowly add more THC until you find the dose that gives you the high you’re looking for — without the side dish of anxiety. If you’re using edibles, Chasen recommends starting with 2.5 milligrams. “Monitor how it makes you feel and don’t consume any more for that entire [episode],” says Chasen. If you feel like you need more, increase your dosage by 1 milligram per consumption period until you find your sweet spot.
  • Counteract THC-induced anxiety with CBD. If you find yourself feeling overly anxious from THC, you can counteract those anxious feelings with a healthy dose of CBD. “Smoking or vaping CBD can provide immediate relief from THC-induced anxiety,” Chasen explains. Depending on your dose of THC, you may need to consume a decent amount of CBD to get rid of the anxiety — but it will definitely help you feel better (and fast).

Why is cannabis a miracle cure for some people’s anxiety — and totally anxiety-inducing for others? A cannabis educator shares everything you need to know, plus tips for how to make sure your next experience with weed leaves you chill to the max and not on the verge of panic.