The Weed-Induced Disease That Makes You Throw Up and Take Scalding Hot Showers
This post originally appeared in VICE UK
Weed isn’t for everyone. Mind you, for most, the worst that could happen after a couple of tokes is that you’ll feel mildly dizzy, throw up a bit on your shoes or potentially be exposed to a Ben Harper singalong.
However, for a very small number of regular users, there’s a much more unpleasant consequence to contend with.
Cannabinoid Hyperemesis Syndrome—or “CHS”—is a condition associated with chronic cannabis abuse. Its three primary symptoms are nausea, abdominal pains and cyclical vomiting, an ailment where you retch or throw up far more often than you should (around six to 12 times an hour). So not really the desired effects when you’ve just spent £10 ($15) on a gram of leaves.
The word “cannabinoid” might ring a bell; it’s started to crop up a little more since people realized that weed is good for more than enhancing video games and passing the time at school. But if it still means nothing to you, here’s a very brief explanation: Cannabinoids are a class of chemical compounds, some of which occur naturally in the human body, with the rest found in cannabis and other plants. They’re also responsible for all the miracle stories you’ll have heard about medicinal marijuana: It’s the cannabinoids that help to treat everything from glaucoma to epilepsy.
Unfortunately, cannabinoids don’t react so well to CHS sufferers. And because there’s little understanding of why this is, the condition is often misdiagnosed. According to the testimonies of patients I read online, this usually leads to numerous visits to the hospital, endless CT scans, and all other kinds of tests that, more often than not, paint a picture of a perfectly healthy person who just happens to throw up a lot.
Even more confusingly, cannabis is increasingly being prescribed—or recommended online, if you don’t live in a weed-friendly place—as an anti-nausea drug. So how a substance known for its antiemetic properties (stopping you from being sick, essentially) is encouraging exactly what it’s supposed to prevent is difficult to explain.
A man, who doesn’t have CHS, smoking a bong. Photo by the author
The earliest study into CHS was in 2004, when 19 Australians were identified as having both a cyclical vomiting illness and a fondness for smoking weed as often as they possibly could. Of that 19, only nine patients ended up participating in the study. In seven of these cases, “cessation of cannabis abuse led to cessation of the cyclical vomiting.” In other words, when they stopped getting high, they stopped throwing up all the time. Which seems like a pretty black-and-white solution to the problem.
Weirdly, though, there was one anomaly that couldn’t be explained: patients had developed a habit of taking scaldingly hot showers or baths, as these apparently helped to relieve their symptoms.
Roughly 30 studies were conducted between 2004 and 2012, with most focusing on singular subjects. Yet it’s still not clear what it is that actually causes CHS (whether a cannabinoid build-up is to blame, or if it has something to do with cannabinoid receptors in the brain) or why the condition has suddenly appeared now, despite the fact that—according to meticulously researched internet chatter—people also definitely smoked cannabis before the year 2004.
In 2012, Dr. Douglas A. Simonetto conducted the largest study into CHS to date, with 98 patients all meeting the relevant criteria. However, his research only reinforced the idea that CHS is a thing that exists. That, if you smoke too much weed, you might experience nausea and cyclical vomiting (84 also reported abdominal pain), and that if you stop, so too will the symptoms (in the vast majority of cases, at least). He also found that around half the participants mitigated their symptoms by bathing in incredibly hot water.
One of Dr. Larry Mellick’s videos of a CHS patient
While looking into CHS I found a YouTube account belonging to Dr. Larry Mellick, a professor of pediatrics at Georgia Regents University in the United States. For the past year he’s been documenting CHS patients, one of whom addresses this compulsive bathing habit in the video above.
“It’s not like I needed a shower—it’s something I just did without knowing I was doing it,” he tells the camera. His sister chips in, saying he would shower four or five times a day in “steaming hot water.” Water that she “couldn’t stand being in, it was so hot.” No explanation is given as to why she was trying to shower with her brother.
The bathing thing appears in almost every report I’ve read on CHS. In fact, in one case, a patient unknowingly scalded their skin in a bid to ease their symptoms.
It’s unclear why the hot showers help, but one certainty—and a positive one at that—is that they can aid medical staff in diagnosing the problem, as well as helping sufferers to understand that they have the condition. “Usually, when one mentions the hot showers bringing relief to their symptoms, it’s the first time the patient begins to accept that this might be their diagnosis,” Dr. Mellick told me.
Dr. Larry Mellick
I spoke to Ben, a student from Bristol, who claimed to have diagnosed himself with CHS. After two or three years of smoking “at least seven grams a week,” he started to experience the symptoms of CHS in February of last year, “waking up, feeling really sick, having a shower, retching and occasionally puking,” as well as suffering abdominal pain.
After a couple of misdiagnoses, Ben realized that he might have been suffering from CHS, so flushed his weed and—dramatically—smashed his bong to pieces. After a week of not smoking, his symptoms started to decrease—a marked improvement on his life before he gave up.
“I was bedridden. I had no energy and my stomach pain was getting worse,” he told me. “But I’m now able to move around the house and get on with my day-to-day life.”
Greg De Hoedt (bottom) at this year’s 4/20 smoke-out in Hyde Park. Photo by the author.
Of course, we’re still no closer to understanding why exactly CHS starts to affect a cannabis user; thanks to years of prohibition, little research has been carried out into the effects of cannabis on the human body’s endocannabinoid system. However, speaking to Greg De Hoedt—president of the UK Cannabis Social Clubs—I discussed the possibility that the emergence of the condition has something to do with the fact it’s become far easier—if not the norm—to get your hands on super strength skunk.
“Stronger cannabis is available and takes up most of the market,” said Greg. “But people don’t realize they can get milder strengths. Safer access [to cannabis, coupled] with strain advice is the best reduction for this kind of side effect.”
This may be the case for some, but so far the evidence suggests that the best way to cure CHS is to just cut out smoking weed altogether. Of course, that isn’t always going to be the easiest thing to convince a patient to do. “I always thought, Weed’s good; weed’s a medicine,” said Ben. “I thought it was probably helping me in the long run, but it wasn’t.”
Dr. Mellick said something to the same effect. “On occasion, there is a degree of denial, and one has to convince the patient that their presentation is textbook.”
Cannabis is becoming more widely accepted, and—in my book, at least—that’s not a bad thing at all. As long as you don’t end up wasting your life away on hash and Homes Under the Hammer, there’s no real reason not to get high every now and again if that’s something you like to do.
But, like any drug, cannabis becomes far less enjoyable once you start abusing it. Especially if you manage to wreak havoc with your body’s chemistry and find yourself vomiting every time you smoke a spliff.
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Cannabinoid Hyperemesis Syndrome is a real thing that can happen to you if you smoke too much pot.
News and Events
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.