The curious case of cannabinoid hyperemesis syndrome

October 19, 2016 2:20 PM

After years of heavy use, some chronic pot smokers begin to vomit repeatedly and feel nausea and abdominal cramps, and the only source of relief is "stifling hot water... the hottest water I could get. My body was beet blood red afterwards." First described medically in Australia in 2004, the biological mechanism is not known, though the hypothalamus is a prime suspect and compulsive bathing in hot water is a typical symptom. High Times says that the syndrome is very rare, though one Canadian emergency room physician says he personally sees about one case a week.

The typical pot user reporting these symptoms used Cannabis daily, for, on average, 9.8 years before symptom onset. The amount of Cannabis used, although generally high, is difficult to quantify, and has been described as heavy and hourly in units of blunts, cones, joints, bongs, etc.

posted by clawsoon (40 comments total)

my brother is an Emergency Medicine doc is colorado and he sees this frequently. he says that whenever he tells the person they need to take a break, they don't believe him, since their suffering from this stomach vomit thing, they assume that more thc will soothe it.

no doubt it's due to the crazy high levels you can achieve with edibles??
posted by danjo at 2:24 PM on October 19, 2016

oh yeah, they usually come to the er when they run out of hot water...
posted by danjo at 2:24 PM on October 19, 2016 [6 favorites]

CHS is a very rare syndrome and is easily cured by stopping the consumption of cannabis. This should not, by any means, hurt marijuana’s reputation for being the safest recreational drug around, but people need to be aware of the syndrome’s existence. If you know anyone with these symptoms tell him or her go to a doctor and stop smoking.

pretty solid advice from High Times
posted by thelonius at 2:28 PM on October 19, 2016 [6 favorites]

If you tell people "There's no such thing as overdosing on pot" they will do their level best to prove you wrong.
posted by Mr.Encyclopedia at 2:33 PM on October 19, 2016 [21 favorites]

I see this in Washington state about 2-3 times a year. It's tough because it's a diagnosis of exclusion (i.e. there's no "test" for it and you have to rule out lots of other stuff) and it can take a couple weeks of abstinence to see it resolve. On top of that, because MJ is an antiemetic at the same time, vomiting can get worse before it gets better. So there's a fair amount of "I've been smoking pot for years, doc, I know that's not the problem." But standard nausea drugs don't work well, and these people can suck up a lot of resources seeking care. I've admitted someone to the hospital for dehydration from this. Hopefully with increased legalization (which I fully support), we'll see increased awareness. Overall, it does seem to be relatively rare.
posted by Slarty Bartfast at 2:33 PM on October 19, 2016 [6 favorites]

Wow, that is chronic.

Reminds me of:

Danny: The joint I am about to roll requires a craftsman and can utilize up to twelve spliffs. It is called a Camberwell carrot.

Marwood: It's impossible to use 12 papers on one joint.

Danny: It is impossible to roll a camberwell carrot with anything less.

Withnail: Who says it's a Camberwell carrot.

Danny: I do. I invented it in Camberwell and it's shaped like a carrot.
posted by My Dad at 2:34 PM on October 19, 2016 [13 favorites]

I just learned about this while accompanying a friend to the ER during a weeklong bout of intense nausea and non-stop vomiting. Two ER docs who saw my friend were all like, "yup, see it all the time." I was blown away.

Cannabis is the safest known recreational drug. It is fun and can have many life enhancing properties. It should be legal and easily accessible for home use. It should be much more widely tested for medical use, and easily accessed for nausea, anorexia, and pain.

Having said all that, it's clearly not without potential problems, both physical and psychological. But in the anecdotal experience of other mental and physical health practitioners I've talked to about this, and in my own anecdotal experience, pot fans are extremely reticent to drastically reduce or stop smoking weed - no matter what problems it may be contributing too. Seems to me there are ways that pot is actually harder to reduce or stop than many highly addictive drugs, possibly because the negative effects are few?

I'm curious to hear more stories of people with this hyperemesis syndrome - really wondering if people are cutting down or stopping when this happens.
posted by latkes at 2:36 PM on October 19, 2016 [5 favorites]

DOCTOR IT HURTS WHEN I DO THIS

maybe stop doing it?

FUK U UR NOT MY MOM
posted by Sebmojo at 2:42 PM on October 19, 2016 [62 favorites]

Weirdly enough this is also a symptom of chronic Totino's pizza roll abuse.
posted by theodolite at 2:43 PM on October 19, 2016 [20 favorites]

My husband has this problem! Lifelong smoker, initially to self-medicate due to stomach problems, and then somewhere along the way the pot was the cause of the stomach problems. The initial diagnosis came from a doctor in CA who had read about it. He quit, but started up again later, and eventually got sick again. This time he went to a doctor in OR, where they refused to believe that this condition was a real thing and decided he was just withdrawing/seeking opiates.. so they refused to treat his pain (due to vomiting uncontrollably for 12+ hours) at all.

Let me tell you, nothing dries up your hope in the medical system like watching your spouse writhe in pain for hours while nurses go in and out the room and refuse to help.
posted by hopeless romantique at 2:45 PM on October 19, 2016 [22 favorites]

My daughter has had Cyclic Vomiting Syndrome (a similar form of hyperemesis) since she was small, and weirdly her only form of relief is also continual baths in scalding hot water just like the first link describes. While medical marijuana isn't legal in our state one of her physicians mentioned to us that when he practiced in California pot was used to *treat* patients like her.

It's fascinating to me that the same substance can both treat and trigger these symptoms, and that the boiling hot baths are a common compulsion.

Bodies are so weird.
posted by Mamapotomus at 2:47 PM on October 19, 2016 [16 favorites]

I'm curious to hear more stories of people with this hyperemesis syndrome - really wondering if people are cutting down or stopping when this happens.

It took a few go-arounds of hospital visits, but my husband has finally realized that smoking with any regularity will flip on the addiction switches in his brain and eventually lead to a bad situation.
posted by hopeless romantique at 2:49 PM on October 19, 2016 [1 favorite]

Heavy and hourly. Hourly? Christ, I'm a died in the wool old man pothead, and hourly just amazes me.
posted by Abehammerb Lincoln at 2:55 PM on October 19, 2016 [4 favorites]

A friend of mine is an ER doctor in Vancouver, WA. He says he sees this quite often, always in chronic users, though not necessarily heavy users. He's not sure why it doesn't get more press as most folks (myself included) think of pot as a totally innocuous drug. That quote at the end of the one case a week article -- “There’s this belief that (marijuana) is totally safe, a miracle drug, Not true,” he says. -- echoes his sentiments exactly.
posted by funkiwan at 2:56 PM on October 19, 2016

Cannabis is the most commonly abused drug in the United States.

Certainly alcohol?
posted by Abehammerb Lincoln at 2:56 PM on October 19, 2016 [50 favorites]

If you tell people "There's no such thing as overdosing on pot" they will do their level best to prove you wrong.

OK, but "heavy usage for over a decade" is sort of the Austin Powers Steamroller Stop Scene of overdoses.
posted by Celsius1414 at 3:13 PM on October 19, 2016 [17 favorites]

Nobody said it would be easy.
posted by Mr.Encyclopedia at 3:21 PM on October 19, 2016 [3 favorites]

Well, there goes the legalization vote.
posted by Thorzdad at 3:46 PM on October 19, 2016

Too much of a good thing is too much of a good thing. QED.
posted by grumpybear69 at 3:51 PM on October 19, 2016 [2 favorites]

"Units of Blunts. "

So over ten years at 2 to 3 blunts a day that should be about 9 KiloBlunts.
posted by srboisvert at 3:56 PM on October 19, 2016 [6 favorites]

I mean, water is pretty safe as well but I'm not going to drink 15 litres of it in one sitting.
posted by turbid dahlia at 3:59 PM on October 19, 2016 [11 favorites]

Still safer than booze.
posted by Beholder at 4:00 PM on October 19, 2016 [8 favorites]

Even after reading through this thread, I keep seeing the title as "The curious case of cannibal hyperemesis syndrome," and thinking "how common can that be?" To be fair, I imagine it's pretty hard to get the confirmed long-term cannibal to stop using as well, no matter what the health risks....
posted by GenjiandProust at 4:10 PM on October 19, 2016 [7 favorites]

I'm certainly familiar with nausea as a symptom of short-term overdose - that and postural hypotension. Connected with long term use though I've only read about.
posted by atoxyl at 4:16 PM on October 19, 2016

It's fascinating to me that the same substance can both treat and trigger these symptoms

Reminds me of all those antidepressants with side effects of 'suicidal ideation'.
posted by FatherDagon at 4:42 PM on October 19, 2016 [12 favorites]

Wow, I had a boyfriend who went through this many times, never had a diagnosis, used to lie moaning in the shower.
posted by mareli at 5:39 PM on October 19, 2016 [1 favorite]

I have had cyclic vomiting syndrome since I was a young child. (One of my earliest school memories is vomiting during the Pledge of Allegiance and the teacher making me stand in my vomit until the Pledge was finished). It is distressing and difficult and in my personal experience it is most often linked to stress and my menstrual cycle. I also smoke cannabis. Now when I see a doctor who doesn't know me they conclude that any vomiting episodes I have had were/are cannabis induced. I quite smoking for one year but that didn't stop the cyclic vomiting, if it had I would have been happy to stop using cannabis. After one year on a ketogenic diet I have had far fewer episodes.
posted by ginky at 6:21 PM on October 19, 2016 [7 favorites]

As an at least somewhat frequent sufferer of both nausea and abdominal cramps who loves super hot water for bathing and showers I cannot imagine combining the two. Is this something I'd need to not have an overactive vasovagal response to understand? Because I'm pretty sure if I tried to bathe in hot water while nauseous I'd pass out in the first 2 minutes.

I mean, it sounds terrible, and I have great sympathy, and also if I developed this problem I would die of drowning before ever making it to the emergency room.
posted by deludingmyself at 8:38 PM on October 19, 2016

Bloody hell. Never happened to me. God knows I tried. Not allowed it any more - other reasons, mainly to do with unexpectedly falling over. Miss it. Still. Fuck.
posted by motty at 9:20 PM on October 19, 2016 [1 favorite]

used Cannabis daily, for, on average, 9.8 years before symptom onset. The amount of Cannabis used, although generally high, is difficult to quantify, and has been described as heavy and hourly in units of blunts, cones, joints, bongs, etc.

Weirdly enough this is also a symptom of chronic Totino's pizza roll abuse.

"I'm allergic to sushi. Every time I eat more than 80 sushis, I barf."

Bodies are certainly weird, though.
posted by tobascodagama at 10:00 PM on October 19, 2016

one time I took a huge hit off my friend's bong and then coughed so much I threw up

weed is treacherous, man
posted by ryanrs at 3:36 AM on October 20, 2016 [4 favorites]

weed is treacherous, man

weed will fuck you up
posted by Sebmojo at 3:56 AM on October 20, 2016 [3 favorites]

I wonder if this was a cause for Cobain's stomach problems. I know he was a cannibas user, but I don't know if there was ever an official Dx for his stomach pain?
posted by wires at 5:25 AM on October 20, 2016 [1 favorite]

pretty solid advice from High Times

Perhaps doctors should keep a copy of the High Times article on hand so that they can present the condition (and the cure) from a trusted source.
posted by clawsoon at 7:09 AM on October 20, 2016 [5 favorites]

But in the anecdotal experience of other mental and physical health practitioners I've talked to about this, and in my own anecdotal experience, pot fans are extremely reticent to drastically reduce or stop smoking weed - no matter what problems it may be contributing too.

Is anyone surprised when the push to accept weed for medical uses comes largely from the weed-using constituency? I'm all for medical marijuana, but it's quite interesting to see how the norml path to regulatory approval has been overwhelmed by public pressure and the lure of Very Large Profits.
posted by sneebler at 7:55 AM on October 20, 2016

"hourly in units of blunts, cones, joints, bongs, etc." for 9.8 years??? Is this really what the study says?

Holy crap, I've known some people over the years that I thought were really heavy smokers- but hourly blunts, every day, for a decade?! Hard for me to imagine anyone is capable of that. I would bet a lot than anyone smoking this ferociously for this long is not just smoking some weed. They probably have all sorts of other vices too on top of who knows what kind of issues that would make them have that much of a drive to get high.
posted by Patapsco Mike at 8:39 AM on October 20, 2016

latkes: "But in the anecdotal experience of other mental and physical health practitioners I've talked to about this, and in my own anecdotal experience, pot fans are extremely reticent to drastically reduce or stop smoking weed - no matter what problems it may be contributing too. "

Certainly the fan boys (and it is almost always men IME) revolve their life around their next hit, planning their next hit, talking about their last hit, etc. Kumar from Harold and Kumar at first glance looks like a parody but I've know a few guys who could have plugged right into the part.
posted by Mitheral at 10:33 AM on October 20, 2016 [2 favorites]

For all those talking about whether it's pot intrinsically that's bad or whether it's just too much, just remember the words of Philippus Aureolus Theophrastus Bombastus von Hohenheim Paracelsus; "'Alle Ding sind Gift und nichts ohn' Gift; allein die Dosis macht, das ein Ding kein Gift ist." Or the more colloquial form:

"The dose makes the poison."
posted by Metro Gnome at 6:22 PM on October 20, 2016

Did anyone in this thread say pot is intrinsically bad?
posted by latkes at 9:01 PM on October 20, 2016

i did but i was jokin'
posted by Sebmojo at 1:11 AM on October 21, 2016