Several states either have or are moving toward legalizing recreational marijuana. This is partly because of a belief that it is benign.
However, there are risks. One is a condition called “Cannabinoid Hyperemesis Syndrome (CHS).” An excellent article on this topic was written by Maria Angulo, MD in the JAMA Patient Page on October 10, 2024. Most of the information in this blog is from her article.
CHS is a GI disorder due to “frequent and long-term use of cannabis (marijuana).” It has an abrupt onset “within 24 hours after last cannabis use” manifesting as “recurring episodes of nausea and severe vomiting” and “intense abdominal pain that lasts less than one week.”
These symptoms are not benign. Aside from significant pain and suffering, people can develop erosion of tooth enamel leading to loss of teeth, low levels of blood electrolytes that often requires visits to Emergency Departments, and sometimes hospitalizations.
Rarely, it may result in “cardiac rhythm abnormalities, kidney failure, seizures, and death.”
Some people get “temporary relief of symptoms when taking hot showers or baths, which may lead to compulsive bathing.”
Treatment can include IV fluids to treat dehydration from vomiting. Antiemetic medicines can be given to reduce nausea. “Topical capsaicin (0.1%) cream applied to the upper abdomen may reduce nausea.”
Some patients may benefit from “short-term use of antianxiety or antipsychosis drugs.” “Stopping cannabis use completely is the most effective long-term treatment but can result in withdrawal symptoms and high rates of relapse if stopped suddenly.”
“Long-term management may include counseling and a tricyclic antidepressant drug.”
Risk factors for developing CHS include regular use “daily, even multiple times per day for over one year, use starting before age 16, other substance use disorder, and/or smoking cigarettes.” Most cases have been in young men ages 16 to 34.
“The rise in CHS coincides with legalization of recreational cannabis and increase in delta-9-tetrahydrocannabinol (THC) concentration in cannabis products.”
According to Deepak Cyril D’Souza, MD from the Yale School of Medicine, “The marijuana and cannabis products that your grandparents may have used are very different from what’s out there today.”
In fact, the National Institute on Drug Abuse has noted that the potency of marijuana has increased from 4% in 1995 to 16% in 2022.
The bottom line is that THC is not as benign as is commonly believed.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
