Will Smoking Pot Make Me Vomit Forever?
Cyclic vomiting syndrome is on the rise among adults, and marijuana use may be partially to blame.
Updated at 4:40 p.m. ET
By all accounts, DARE—the acronym for Drug Abuse Resistance Education, an anti-drug education program founded in 1983 and, for a time, taught in up to 75 percent of American middle and high schools—doesn’t work: Students who’ve undergone the program are just as likely to use drugs as those who haven’t, and may be even more likely to drink or smoke cigarettes. That said: DARE definitely worked on me. As a high-school student the only thing I feared more than sex was drugs. Though I drank plenty in college, I refused to even be in the same room as marijuana (let alone everything else my classmates were doing). I held out until I was 24, and then I only smoked pot because a man hurt my feelings badly enough that I was willing to risk . death, or whatever else I thought was going to happen to me, in order not to feel them. But I was fine, like I have been fine every time I’ve smoked since, which hasn’t been that much, I swear. I stopped worrying, for the most part, until recently, when I first read about something called “cyclic vomiting syndrome,” and how smoking weed could cause it.
Cyclic vomiting syndrome is, I think, the best and worst clinical term for a condition that I’ve ever heard. Most clinical terms somewhat obscure the grossness of the thing described (think “incontinence” for diarrhea), but not cyclic vomiting syndrome (or CVS). It is pretty clear, pretty immediately, that what you are in for here is nonstop puking, in episodes lasting anywhere from a few hours to several days at a time. The exact cause is unknown, though there are a number of factors thought to contribute: emotional stress (particularly in children), hot weather, overeating, fatigue, migraines. A diagnosis of CVS is most common among young children, though the number of diagnoses among adults is increasing—and one of the reasons for that increase may be pot.
A study published in 2012 found that marijuana use may be as high as 40 to 50 percent among male CVS patients. (While studies show that the typical patient for CVS linked to marijuana use is a middle-aged white man, women and minorities are also susceptible.) Uncontrollable vomiting as a result of marijuana use is also sometimes referred to as “cannibinoid hyperemesis syndrome.” But some researchers say CHS should be considered a subset of CVS, and one literature review states that the “only reliable criterion” to distinguish the two is whether the symptoms completely stop after the person stops smoking. The two conditions are otherwise “clinically extremely similar, the researchers write.
So, because I fear throwing up about as much as I fear drugs, I decided to speak to a medical professional to find out how likely it is that the average casual pot smoker will develop CVS.
Robert Glatter, an emergency physician at Lenox Hill Hospital in New York, tells me he saw patients with CVS for years before the wider medical profession realized there may be a link between the syndrome and marijuana use. “I would see people in the emergency department with heavy and chronic [marijuana] use who would have these vomiting syndromes with abdominal pain, and we just didn’t know what it was,” he says. He describes CVS as an “underrecognized and underreported” phenomenon. Part of the reason it took so long to draw a link between marijuana use and CVS may be that marijuana is typically thought to reduce nausea. “If you look at the pharmacology of cannabinoids, there are multiple types of cannabinoids, and at low doses, the majority of these cannabinoids are antiemetic,” says Glatter. “But with higher and heavier usage what you develop is this paradoxical effect, this incidence of vomiting and nausea.”
The “higher and heavier usage” part of that statement is paramount. Most cannabis consumers who come to the hospital with CVS symptoms smoke heavily and daily—three to five times per day, at a median of 15 to 16 years, says Glatter. This is not to say that heavy, long-term use of marijuana will lead to CVS, only that it might, and physicians still aren’t sure what makes some people more predisposed than others.
“The exact cause is really unclear,” says Glatter. “Some research indicates that it may be related to a genetic polymorphism in what we call the cytochrome P450 enzyme system, which is how we metabolize marijuana.” But there’s probably more to it than that. For one thing, patients suffering from CVS often compulsively bathe during vomiting episodes, perhaps because taking a hot bath or shower can reduce nausea in the short term. Glatter says it may be the case that hot showers “ameliorate the disequilibrium, and re-adjust the set point of the thermoregulatory system in the hypothalamus.” Another theory, he says, is that “heat dilates blood vessels in the skin and muscle” which in turn diverts blood flow away from the circulation system that supplies the gut and intestines. “When there is less blood flow to the gut and intestines, symptoms of nausea and vomiting are reduced,” adds Glatter. But, he admits, there isn’t a lot of research on this yet, and there’s a lot about it physicians don’t understand.
I ask if Glatter thinks the lack of information may be owed in part to patients’ reluctance to disclose their drug use, particularly in states where marijuana has not been legalized. “The patients often don’t easily volunteer this history,” he agrees. “In states that have legalized, I think it’s easier to ascertain that history because they’re more willing to come forward.” But doctors are only recently beginning to ask CVS patients about their marijuana use, and even then, it’s usually considered as something of a last-resort contributing factor—the symptoms of CVS are serious enough that more dangerous diagnoses must first be eliminated, which can mean a lot of work for nurses and physicians. “We have to exclude everything else first,” says Glatter. “[It could be] endocrine, metabolic, something structural causing the vomiting, it could be a bowel obstruction or gallstones. To the patient who is newly presenting, you have to do the full workup. You don’t want to miss anything.”Cyclic vomiting syndrome is on the rise among adults, and marijuana use may be partially to blame.
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Do You Vomit When You Smoke Pot? Here’s Why.
If you experience nausea or vomiting after smoking marijuana, it may be cannabinoid hyperemesis syndrome. UW Health emergency medicine physician Marin Darsie, MD, explains.
What is cannabinoid hyperemesis syndrome (CHS)?
Cannabinoid hyperemesis syndrome (CHS) is a condition affecting regular marijuana users which involves recurrent episodes of nausea, vomiting, and crampy abdominal pain.
While the episodes generally last 24-48 hours, the symptoms tend to be very severe and lead to dehydration and even weight loss.
Patients with CHS often say the only thing that makes them feel better during these times are hot showers, but this is temporary. The episodes stop when patients stop using marijuana completely.
What are the symptoms of cannabinoid hyperemesis syndrome?
- Recurrent episodes of nausea, very frequent vomiting, and crampy abdominal pain which typically last 24-48 hours
- Patients frequently go to emergency departments very dehydrated and may have actually lost weigh
- Symptoms are temporarily improved by hot showers
- These episodes are typically separated by symptom-free periods lasting days, weeks, to months
How long does the vomiting from cannabinoid hyperemesis syndrome last?
Most episodes last 24-48 hours, but they recur by definition and the length of time between episodes of nausea, vomiting, and abdominal pain can range from days to months.
How do you treat cannabinoid hyperemesis syndrome?
The most effective long-term treatment is not using marijuana. During an episode of vomiting, the core treatments are IV fluids, intramuscular or intravenous haloperidol (Haldol), and capsaicin cream applied to the belly. It is counter-intuitive, but narcotic pain medications should be avoided as they can worsen the nausea and vomiting. Experts do not fully understand why these medications are effective, while other more traditionally accepted pain and anti-nausea meds are not effective.
How to get rid of or cure cannabinoid hyperemesis syndrome?
The only way to cure cannabinoid hyperemesis syndrome is to completely stop using marijuana. It can take several weeks of no use before the periods of vomiting stops, perhaps because some of the marijuana is stored in body fat.
I thought marijuana was a treatment for nausea, how can cannabinoid hyperemesis syndrome be caused by marijuana?
Research is ongoing regarding the exact cause of CHS, but it is likely due to the reactions of the more than 100 active compounds in marijuana. Some of these cannabinoids trigger receptors in the brain reducing nausea, whereas others trigger receptors within the stomach, gut and intestines which seem to promote vomiting. Furthermore, in animals, one THC metabolite (cannabidiol) has been shown to have an anti-nausea effect at low doses and at higher doses stimulates vomiting.
Experts believe that periods of vomiting are caused when there is a loss of balance between the anti-nausea and pro-vomiting properties of marijuana within the body. Because of confusion regarding this issue, many CHS sufferers actually increase their marijuana use thinking that it will reduce their nausea and vomiting, but it only makes the problem worse.
Will everyone who smokes marijuana develop cannabinoid hyperemesis syndrome?
No. Cannabinoid hyperemesis syndrome was first recognized in Australia in 2004, and initially it was thought to only rarely occur among people with several years of heavy marijuana use (up to 3-5 times daily). However, the number of cases of CHS seems to be increasing and more recent studies have found some cases of CHS have occurred in people who have been using marijuana heavily for less than a year and others who only use marijuana weekly. The authors of one recent study estimate that as many as 2.75 million Americans who use marijuana on a near daily basis suffer from CHS.
The rising numbers of CHS are not fully understood, but may be due to increasing awareness of the condition, increasing use with the legalization of marijuana, and/or the increasing potency of marijuana. In the early 1990s, marijuana had an average of 3.8 percent THC or tetrahydrocannibol. As of 2015 in Colorado where marijuana has been legalized, some strains containing nearly 30 percent THC are available in marijuana dispensaries, though the average THC content is 17.1 percent.
Experts still don’t know why CHS only affects some regular marijuana users and not others.
Is cannabinoid hyperemesis syndrome permanent?
Once a patient has developed cannabinoid hyperemesis syndrome, avoiding marijuana is the only known cure. Patients who have had CHS will almost always have symptoms if they start using marijuana again.
Can you die from cannabinoid hyperemesis syndrome?
In general, cannabinoid hyperemesis syndrome leads to dehydration and the other health consequences (e.g. acute kidney injury, electrolyte abnormalities) stem from the dehydration. While it is theoretically possible, a severe electrolyte abnormality could lead to a life-threatening abnormal heart rhythm, it would be very rare.
Are cyclic vomiting syndrome and cannabinoid hyperemesis syndrome the same thing?
There is definite overlap between cyclic vomiting syndrome and CHS. Cyclic vomiting syndrome can occur in patients who don’t use marijuana and there is no clear improvement when cyclic vomiting syndrome patients abstain from marijuana. Also, cyclic vomiting patients are more likely to have a personal or family history of migraines and have a reduction in their cyclic vomiting with use of preventative medications.
How difficult is it to quit using marijuana after heavy use?
Daily smokers of marijuana are more likely to exhibit withdrawal symptoms upon quitting than casual users.Dr. Marin Dorsie, UW Health emergency medicine specialist, explains cannabinoid hyperemesis syndrome. ]]>