More cannabis hyperemesis Cases

Oct 28 2013 Published by under Cannabis, Drug Abuse Science

There was a twitt from Dirk Hansen today

which pointed to Chen and McCarron in Current Psychiatry. This paper seems to be a set of diagnostic and therapy recommendations and contains an example Case Report.

This triggered a bunch of the usual incredulity, in this case from @drogoteca.

those two are but the tip of this person's denialist iceberg on cannabis hyperemesis. He or she is quite convinced that this cannot be a real outcome of chronic pot smoking.

It can and is.

For background, I've discussed the evidence for a cyclical vomiting syndrome associated with cannabis use here, here and here. Also see Dirk's post.

For grins I thought I'd see if there were any new Case reports and found several I had not seen before.

Hickey and colleagues (2013) report a Case of Cannabis Hyperemesis Syndrome that was treated with haloperidol:

A 34-year-old man well known to our ED arrived with epigastric pain, nausea, and vomiting for 4 days. He had been unable to tolerate anything orally but reported temporary relief only with long hot showers. He came to the ED that night to be admitted because he knew his symptoms would not improve, and he was always admitted in the past when his symptoms were so severe. He denied fevers, chills, diarrhea, hematemesis, melena, or hematochezia.

The patient's history was significant for similar symptoms every 2 to 3 months for approximately 10 years. He reported daily cannabis use since 1992, with only short intervals of abstinence resulting in complete resolution of his vomiting. He has been admitted to our hospital from the ED 7 times and had multiple unremarkable diagnostic tests including 3 computed tomographic scans, an esophagogastroduodenoscopy, and several specialty consults. He has also been admitted to several other local hospitals for cyclical vomiting. Other than substance abuse, he has no known psychiatric history. A diagnosis of CHS was finally made in 2012, a few months before this ED arrival.

Mohammed and colleagues (2013) reported a Case (which they are at pains to point out is from the Caribbean) that resolved with abstinence.

A 26-year-old Caucasian male presented to our center with a
1-week history of severe colicky epigastric pain heralded by significant nausea for 3 weeks. He had approximately 20 episodes of bilious vomiting daily with numerous bouts of retching. He admitted to smoking 4 “joints” or marijuana cigars every day for the last 2 years, and denied alcohol and tobacco use. He had 4 similar episodes over the last 6 months. During
these admissions, he was rehydrated and abdominal imaging revealed no abnormalities. His ongoing nausea was relieved
by taking hot showers, of which he took up to 15 times per day, sometimes for more than an hour.

...

The diagnosis of CHS was made and he was counseled on abstinence from marijuana. Though he refused to enter a substance
abuse program, he remained cannabis-free and on follow-up at 1, 3 and 6 months revealed no recurrence in symptomatology.


Enuh and colleagues (2013)
report a case from the US.

A 47-year-old African American male with a history of epilepsy and drug addiction presented to the hospital with a seizure complicated by nausea, vomiting, and severe abdominal pain. He was known to be diabetic, hypertensive, and addicted to marijuana for 30 years. He smoked two to three “blunts” (cigar hollowed out and filled with marijuana) most days and occasionally up to eight blunts daily. The drug was last taken on the day of his admission.

He immediately went to the bathroom and remained under a hot shower with the exception of two 15-minute breaks for the rest of the day. He believed that a warm shower could relieve his nausea and vomiting. He stated that it made him feel better than medication. Intravenous ondansetron was of limited benefit. It was difficult to persuade him to exit the shower for the rounds and physical examination. Receiving medication and eating were problems because of this compulsive showering. The same event of entrenching himself in the shower had happened 2 months prior to his hospitalization for a grand mal seizure. Abstinence from marijuana during the hospital stay made the patient’s nausea, vomiting, and obsessive warm showering resolve after 3 days.

Not as satisfying as it could be with respect to the workup and the post-hospitalization followup, of course. But interesting.

Sofka and Lerfald (2013) report a series of four Cases. All had histories of chronic cannabis use, all used hot showers to alleviate symptoms and all had negative GI scans and other clinical workups. One individual was reported to have ceased cannabis use and had remained symptom free. The other three were reported as continuing their cannabis use and continuing to have symptoms. Frustratingly, the authors do not specify the followup duration for any of the cases.

Gessford and colleagues (2012) report a Case that is significant for the comment on the efforts to find a cause prior to the identification of CHS:

A 42-year-old Caucasian female, who has routinely been seen at our institution for nausea, vomiting and abdominal pain since 2003, presented with the complaint of nausea, vomiting and abdominal pain. She stated that the symptoms occurred this time after eating four bites of ice cream. ...

Her physical exam was normal except for some mild epigastric tenderness which she attributed to her excessive vomiting. Laboratory studies including a comprehensive metabolic panel, amylase, lipase, and complete blood count were normal except for anemia, which had improved since her last admission. Urine studies, including urinalysis, were normal with a urine drug screen positive for delta-9-tetrohydrocannabinol (THC), benzodiazepines and opiates. Abdominal and chest x-rays were normal.

During the course of her admission, further investigation into her history revealed chronic marijuana use. She reported that long hot showers provided the only relief for her pain and nausea. She claimed that she took so many showers that her bathroom was growing excessive amounts of mold and mildew. Research into her medical records revealed an even more disturbing fact: excessive radiation exposure and medical cost. In total, she has had in excess of 97 abdominal x-rays, eight abdominal CT scans, two abdominal MRIs, an abdominal MRA, small bowel follow-through, three gastric emptying studies, four esophagogastroduodenoscopies (EGD), and three colonoscopies. Since 2003 these tests produced two abnormal findings: (1) the two most recent gastric emptying studies at 224 and 180 minutes (gastroparesis) and (2) gastritis/duodenitis on EGD. Throughout her complete sevenyear work-up, celiac sprue, peptic ulcer disease, Barrett's esophagus, porphyrias, ischemic bowel disease, appendicitis, ulcerative colitis, Crohn's disease and H. pylori infection have been excluded. The patient's medical record indicated that since 2005 she has had 97 emergency room visits. Additionally, since 2007 she has had 42 admissions.

Emphasis added. This is a feature of many of the clinical Case Reports that cannot be ignored. The lack of awareness of cannabis as the causal agent is costly. In terms of the dollar costs of diagnosis and care and in terms of the drugs and invasive diagnostic procedures administered to the patient.

I don't have access to Morris and Fisher (2013) which the Abstract states reports a single Case.

In trolling around on Google I ran across this comment in a pot user forum:

As far as symptoms are concerned, they began about 3 years ago when I would wake up feeling nauseated. Shortly after the nausea started, I'd vomit once and (after smoking) I would feel better. This continued off and on without me giving it much thought until February of this year, when I was floored by intractable vomiting for about 48 hours. I couldn't keep anything down (not even water), and the only time I felt like I didn't want to die was when I was in a hot shower. When the vomiting and nausea finally relented after that first episode, I chalked the experience up to acute gastroenteritis. However, about three days later, I woke up feeling nauseated. I went to work as usual, but by noon I was throwing up unstoppably again and had to go home. By the time evening came around, I could eat light food like white rice and slept. But as soon as I awoke the next morning, I had the same stomach pains and nausea. Again I went to work and again the unstoppable vomiting kicked in right around midday. The only thing that brought relief was a hot shower or bath. So long as I was under hot water, I felt alright.

This person details a history of medical workups and a bit of the recur/remit presentation before ending up with his conclusion:

At this point, I have been completely abstinent from ze herb for 5 days and I have already noticed improvement. Although I, too, was skeptical about CHS at first, I just do not know what else could be causing the problem. Although I absolutely love to get high, at my current weight/height (I am 6'1" and 129lbs now) I am quickly running out of options. If I can't find a solution to this problem soon, it will literally kill me. And I'll be damned if I gonna become the first known death directly related to marijuana consumption.

Naturally, the other forum users express the usual incredulity we see from the leegalizeetmon crowd. It's worth a read.

I also ran across this blog post from a person claiming to be an ER doc:

Since I have become aware of this association between marijuana use and CVS type presentations it has been my “good fortune” to care for nearly a dozen patients in the emergency department who self-reported diagnosis of CVS. Curiously, of these patients about 10 admitted active marijuana use, and the 2 who denied it had positive urine screenings for marijuana. This does not exactly make a case series, but is certainly another interesting observation. Of course, since the prevalence of marijuana use in our Emergency Department seems to approach 100% sometimes, this also may not be a statistically significant association!

I conclude with points I made in prior posts. At the moment, this syndrome is clearly quite rare considering estimates for chronic cannabis users worldwide. Some of this is due to lack of diagnosis..the Case Reports make very clear that an extended history of diagnostic investigation of more usual gastric disorders is typical prior to the identification of cannabis as the causal agent. But even so, very likely this is a rare reaction. Given that, it is not impossible that there is some as-yet-undetermined source of the chronic vomiting that is merely correlated with cannabis use. [In the event your imagination fails you, people tend to suggest moldy weed, herbicide/pesticide and/or contamination from smoking devices as causes.] Nevertheless, it appears to me to be likely that as we accumulate more and more Cases separated by time and place, which involve individual users with a variety of phenotypes and environmental circumstances, which present similar clinical pictures and which seem to have chronic cannabis smoking (not synthetic marijuana products, for example) as the only commonality.... well it becomes very difficult to sustain any alternative hypothesis.

__
Hickey JL, Witsil JC, Mycyk MB.Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6. doi: 10.1016/j.ajem.2013.02.021. Epub 2013 Apr 10. [link]

Mohammed F, Panchoo K, Bartholemew M, Maharaj D.Compulsive showering and marijuana use - the cannabis hyperemisis syndrome.Am J Case Rep. 2013 Aug 23;14:326-8. doi: 10.12659/AJCR.884001. [PMC link]

Enuh HA, Chin J, Nfonoyim J. Cannabinoid hyperemesis syndrome with extreme hydrophilia. Int J Gen Med. 2013 Aug 19;6:685-7. doi: 10.2147/IJGM.S49701. [OpenAccess link]

Sofka S, Lerfald N. Cannabinoid hyperemesis syndrome: A case series. W V Med J. 2013 May-Jun;109(3):20-3.
[link]

Gessford AK, John M, Nicholson B, Trout R. Marijuana induced hyperemesis: a case report. W V Med J. 2012 Nov-Dec;108(6):20-2. [link]

85 responses so far

  • Could this "paradoxical" effect be due to downregulation of some CB receptors as a consequence of long-term high-dose exposure to agonists/partial-agonists in weed smoke?

  • drugmonkey says:

    That is certainly my first suspicion. CB1 in area postrema and pals in the dorsal vagal complex?

    But then why so uncommon....? Some rarity in the endocannabinoid system perhaps? It's really all quite fascinating.

  • And why the compulsion to take hot showers/baths? There are temperature sensing pathways into the brain stem, right?

  • anonymous postdoc says:

    I suffer from migraines which recur with regrettable frequency. For me, long, hot showers are a reliable (partial) refuge from the nausea and pain. That said, I do eventually get out of them. Perhaps there are unknown roles for cannabinoids in temperature regulation, but these people tend to report showering because of nausea, not coldness, no?

    On a different tack, the existence of this effect in some people does not constitute an argument that this is a generally unsafe drug. Indeed, legalization will probably increase the understanding of this and other negative effects of marijuana, which people are currently motivated to deny using because of its legal implications.

  • Isabel says:

    This post reeks of desperation, DM.

    Meanwhile just saw this more interesting article:

    http://www.salon.com/2013/10/26/science_for_stoners_what_is_marijuana_abuse/

  • dr24hours says:

    Considering how many substances have multiple effects, some of which only manifest in a small percentage of users (i.e., medical side effects), why is it in any way surprising that cannabis could affect a small percentage of users this way?

    What "reeks of desperation" is the need for stoners to insist that marijuana has absolutely no negative effects for anyone at all.

  • Dr. Noncoding Arenay says:

    "What "reeks of desperation" is the need for stoners to insist that marijuana has absolutely no negative effects for anyone at all."

    I am sure that "stoners" accept that *some* people will suffer negative consequences, just like from any other external substance that the body is exposed to (drugs, food ingredients, alcohol, etc). In fact, what doesn't have negative effects? Heck, even excessive water consumption has negative effects. That said I'm not on either side when it comes to marijuana use because I have not seen conclusive results supporting either argument. I just find the back and forth amusing because neither side is going to convince the other.

  • That said I'm not on either side when it comes to marijuana use because I have not seen conclusive results supporting either argument.

    I don't know what "sides" you are referring to, but it is absolutely conclusively established that whatever personal and societal harms are attributable to marijuana, they pale in comparison to various other psychoactive substances whose possession is 100% legal.

  • drugmonkey says:

    I have not seen conclusive results supporting either argument

    which "arguments" do you mean?

  • drugmonkey says:

    Meanwhile just saw this more interesting article:

    It is indeed *very* interesting. Somehow I suspect the reason I find it interesting (incoherent babbling dressed up in HumanitiesSpeak) is not the reason you find it so fascinating?

    One way to consider the question is through the lens of structural dynamics. Structural dynamics is a framework taught by many business consultants and life coaches. Robert Fritz is perhaps the reigning guru of this kind of thinking. A fundamental of structural dynamics is that there is inherent tension in wanting anything because the condition of not having it is incongruent with the desired outcome of having it. The brain, no fan of incongruence, will work to resolve the tension.

    The brain may work to resolve the tension in favor of the individual’s objectives, thereby bringing what is desired into conformity with what is. Or, the brain may seek to resolve the tension by deeming the objective impossible, or denying the desire. In the first instance, one resolves the inherent tension by moving toward the desired outcome. In the second, one resolves the inherent tension by trying to change the desire.

  • dr24hours says:

    @ Dr. Noncoding Arenay,

    Yes, I should have qualified "some" stoners.

  • Isabel says:

    "What "reeks of desperation" is the need for stoners to insist that marijuana has absolutely no negative effects for anyone at all."

    Claimed by no one, ever, except in imaginary quotes by desperate prohibitionists 🙂

    "Yes, I should have qualified "some" stoners."

    Name one. Someone we will all recognize (a frequent poster, famous person, official activist, etc and please provide a link). Or put that canard to rest already. Put up or shut up.

    DM<
    I thought the article was interesting simply because it brings up some issues that are not widely discussed. no one is saying it isn't a typical salon article. And the part you quoted does make some sense when in context. Do you have better suggestions?

    From the article:

    Refraining from pot was good. Using it was bad. Then, as medical marijuana gained recognition, users of marijuana ended up split into medical and recreational users, the worthy and the wayward, the legal and the criminal.

    Even with medical use laws, many people believed that “green cards” — medical marijuana permits — were often being issued to fakers, people using medical-use laws as a cover for their recreational interest in marijuana. In many cases, the critics were right, but that doesn’t undermine the reality of marijuana’s medical applications. So, even when following the letter of the law, users are still split into the good and bad, the deserving and those taking advantage of the new medical-use laws. Not only were bad people abusing the “drug,” they were abusing the law.

    But, as marijuana’s legal status changes, should the framework for what constitutes “abuse” change, too? Is a recreational user of marijuana like the social drinker, using not abusing, indulging a vice but not committing a crime? Advocates of marijuana legalization often, on one hand, point out that the negative social impacts of alcohol are far worse than those of marijuana, which are barely detectable outside of use by minors.

    [....]

    Consider, too, the marijuana use of a person with a mindless job (not operating heavy equipment or working with dangerous materials) who finds that marijuana use makes her more pleasant, more patient and less irritable. Her employer doesn’t know she uses marijuana and is satisfied with her job performance. Does the fact of her being “high” at work automatically categorize her “use” as “abuse”? Does being altered necessarily mean being impaired?

    Or, what about the artist who uses marijuana to gain an alternative perspective on his or her work? Is this “recreational” use? Or should the artist be able to write off his stash as a business expense?

    Are the above examples like, or unlike, drinking alcohol in the same circumstances? What differentiates “use” from “abuse”?

  • Isabel says:

    Immediately following the paragraphs you quoted:

    "Any addiction can serve as a model of this. One wants a different kind of life but then responds to inner or outer stress by returning to the addiction for relief. This prevents the person’s ability to change their life. It only allows for the relieving of stress that is the consequence of not changing.

    Utilizing the structural dynamics framework, consumption of marijuana might be characterized as “use” if it facilitates one’s progress toward a desired outcome. Conversely, consumption of marijuana might be characterized as “abuse” if it is serving to relieve the tension but is not leading toward a desired outcome. In health-related circumstances determined chronic or terminal, there is no desired outcome beyond symptom relief. However, if one’s assessment of a situation as unchangeable is incorrect (“this boring job is my only option”), the relief gained by using marijuana might, in fact, allow an undesirable situation to be more easily endured, and thus enabled to persist. Perhaps this is “abuse.”

    Marijuana can be used as an escape (from pain), a temporary crutch or a bridge. Good/bad. Safe/scary. Like booze. Like pharmaceuticals. The many, often contradictory, purposes of marijuana use won’t be resolved by reducing marijuana to fit current cultural classifications. It will be resolved as research and our own minds allow for a larger, possibly more complex and more accurate idea of its role. The need to define a thing by comparing it to something else is natural. But when it comes to marijuana, the reductionist impulse obscures reality. And failing to deal with reality might not to lead to the best possible policy."

    I think this is at least more complex than the NIDA assertion (as stated by Nora V.) that all use, even the very first time, is "abuse".

  • Grumble says:

    "I don't know what "sides" you are referring to"

    Seems pretty clear to me. DM referred to "the leegalizeetmon crowd". Isabel referred to Nora's contention that even the first use is abuse (presumably referring to cannabis - reference, Isabel?).

    (Anyone want some popcorn?)

  • Isabel says:

    Ha ha hold the popcorn, I am not going down that road again. I am just surprised to see DM is still floundering away. But for the record Nora said this, yes in reference to cannabis, in one of her "letters from the Director", maybe her first one. I've quoted it here before. Any evidence she (or any NIDA representative) has ever viewed any use as not abuse, Grumble? 🙂

  • Dr. Noncoding Arenay says:

    @CPP and DM - what Grumble said.

    Studies on "chronic, heavy use" (read abuse) of anything are useful for purely academic purposes. Abuse is abuse. Irrespective of what you are consuming you will most likely see negative consequences. Then why the hoopla around this particular syndrome? I don't understand why marijuana users would get incredulous over such studies or why anti-marijuana folks would feel that it strengthens their stand, unless neither party understands the meaning of "abuse".

  • drugmonkey says:

    or why anti-marijuana folks would feel that it strengthens their stand

    Who do you imagine this to be?

  • anonymous says:

    Just an aside, I see an interesting correlation between the timeline for the description of CHS (the bulk of the papers and abstracts start to appear ~2009) and the timeline for the development of more potent cannabis extracts (e.g., bubble hash and especially hash oil, which has also become increasingly prevalent only in recent years). Hash oil, or dabs, require the user (abuser?) to essentially free-base the drug off a torch-heated piece of metal or glass. I've heard more than one dabber say they vomitted after a morning dab because of the increased heat and irritation from the new smoking method (though the hot shower thing is news to me). I'd be willing to bet that this new-fangled, hotter smoke is the prime culprit for CHS. Early reports of CHS may have involved similar hotter methods of cannabis smoking using earlier methods of THC concentration (after all they do have a lot of hippies in Nimbin, AUS -- http://en.wikipedia.org/wiki/Nimbin,_New_South_Wales -- though I don't know how often those folks make it to Adelaide where the original case report originates). In any case, it's probably going to be a while before physicians are hip enough to make the connection and ask the right questions during a clinical examination....

  • dr24hours says:

    Isabel: see Andrew Sullivan and his slavering acolytes. And take a look in the mirror, apparently.

  • not spartacus says:

    This is so disturbing, I think I'm going to hyperemesis all over the floor.

  • Isabel says:

    "Isabel: see Andrew Sullivan and his slavering acolytes."

    Never heard of the guy. Who is he? Link? Where he says it is "never harmful to anyone ever". i.e. no goal post changing 🙂

    "And take a look in the mirror, apparently."

    Nope. never said it, not once. Good luck finding that quote (you won't). I certainly don't agree with that statement.

    And "apparently"? What the heck does that mean? You just epitomized the DM attitude. People who want to end the stupid prohibition think pot is magical blah blah.

  • Isabel says:

    "unless neither party understands the meaning of "abuse"."

    Well, I am a proud "legaleeze folk" and I believe we need to get a better understanding of it, but that abuse definitely exists. DM always posts these weird rare cases and in all those cases (the addiction papers also) there is a small N (or these single case studies) based on people smoking huge, atypical amounts. (see DM archives for endless discussions about this)

    I totally agree that all these cases are the result of heavy abuse and harmful addictive behaviors that have little bearing on the prohibition issue because they aren't relevant to most users.

    Do you think all use is abuse? DM and the NIDA and Dr24hrs all agree that that is the case.

  • Isabel says:

    "I totally agree that all these cases are the result of heavy abuse and harmful addictive behaviors that have little bearing on the prohibition issue because they aren't relevant to most users."

    Or to society I should add.

    And bringing up the health costs of bizarre over-treatment of these very rare cases as a societal issue related to general use is absurd. hence my claim that he is desperately floundering.

    Even heavy users do little damage to anyone.

  • DrugMonkey says:

    When did I say "all use is abuse", Isabel?

  • Isabel says:

    At this point you need to say it, DM. I am not beating around the bush like you are, I admit possible harm and abuse, and I am stilled misquoted!

    SAY IT if you think that "use" that is not "abuse" is possible and common. What is the dividing line, or lines? It's your freaking field, yet you keep your opinions guarded and hide behind these weird stories. Seriously, what do you expect people to think you believe?

    So you have a fascination with weird disease. hey, I have weird fascinations, too. But none of it has nothing to do with prohibition. Can you admit that? No.

    I said both exist. Use. Abuse. Now it's your turn. SAY IT.

    Afraid to stand to your boss? I always tell my bosses I'm a user at the earliest opportunity. Especially if they want to drug test me. Nobody cares. Only you and Trotsky's uptight granddaughter. Is she still palling around with Joe Kennedy's drug-addict grandson?

  • Isabel says:

    'anything to do with prohibition' not "nothing' lol, and 'stand up' to your boss, sorry. Too tired to write. Just admit I am right already and save us all from this grief and exhaustion. You will feel like a great weight has lifted, I promise.

  • Isabel says:

    Grumble: I just remembered to add that the Director's letter from Nora I referred to earlier was on the NIDA website. No time to track it down myself at the moment, plus that bogus propaganda-filled site makes me see red and I am trying to stay calm this evening.

  • Comradde PhysioProffe says:

    DoucheMonkey is just all agitated because the government ditchweed he gets just gives him a headache. Try some decent shittio Holmes!

  • Grumble says:

    "I have weird fascinations, too. But none of it has nothing to do with prohibition. Can you admit that? No."

    So [chomp, chomp - this popcorn is delish!] correct me if I'm wrong, but DM's post was all about throwing up after you smoke a lot of pot. A weird fascination indeed. But [head scratching] he didn't say anything about prohibition. So what exactly is there to admit?

    [chomp, chomp]

  • bsci says:

    @Isabel, I just scanned a good portion of the marijuana page at NIDA and don't see any such statement.
    Here are the two prominent letters from the director:
    http://www.drugabuse.gov/about-nida/directors-page/messages-director/2013/02/challenging-marijuana-myths
    http://www.drugabuse.gov/about-nida/directors-page/messages-director/2012/09/marijuanas-lasting-effects-brain

    Both seem very careful to talk about "use" rather than "abuse." There are statements that an early age of initial use is a risk factor for abuse.

    In the long fact sheet on marijuana abuse, I found one non-ideal use of the word "abuse"
    http://www.drugabuse.gov/publications/marijuana-abuse/how-does-marijuana-use-affect-your-brain-body Has a box titled "Consequences of abuse" that includes both the risks of short and long term usage. This is non-ideal, but actually stands out in how the rest of the document doesn't use the word "abuse"

  • DrugMonkey says:

    Isabel- I spend a lot of pixels on this blog pointing out that dependence is a minority outcome for most who try a given recreational drug. I also fail to substitute the word abuse when I mean use, your apparent issue of the day. So again, whither comes your accusation that I deploy "abuse" in rightful place of "use"? Or is this just your conspiracy paranoia talking again?

  • DrugMonkey says:

    Seriously, what do you expect people to think you believe?

    I expect people to believe that I blog about drug-related science issues that interest me. And that I would prefer discussions based on available evidence rather than endless accusations about my "beliefs" as if that is the strongest refutation of science you appear not to like.

  • Isabel says:

    "months for approximately 10 years. He reported daily cannabis use since 1992, with only short intervals of abstinence resulting in complete resolution of his vomiting. He has been admitted to our "

    complete resolution but he goes back to smoking & puking non-stop. And we are supposed to care about this person? I am more concerned about this fact, that he keeps doing something that makes him puke. Not normal.

    "vomiting daily with numerous bouts of retching. He admitted to smoking 4 “joints” or marijuana cigars every day for the last 2 years, "

    cigars now? Four spliffs for one person? One or two small buds is all the high that anyone needs a day. The rest is wasted-they are not getting any higher. Not with pot. And that's a hell of a lot of unfiltered smoke.

    "diabetic, hypertensive, and addicted to marijuana for 30 years. He smoked two to three “blunts” (cigar hollowed out and filled with marijuana) most days and occasionally up to eight blunts daily. "

    What the hell is wrong with these people? After a few hits they are not getting any higher. Hollowing out cigars? This consumption is way over the top, and completely ineffective. Not to mention it is making them throw up all day (remember how miserable you felt last time you were sick and vomiting?) and they keep doing it! 4-8 "cigars" day!

    These cases need a mental health profile, stat. Maybe the key to the illness is here. Could some parasite be controlling their behavior? Can't addicts usual be controlled by these very mechanisms? eg some pill that causes them to feel sick when they use their poison?

    From DM, casting aspersions as usual (for Grumble, also see comments):
    "Naturally, the other forum users express the usual incredulity we see from the leegalizeetmon crowd. It's worth a read."
    Also Grumble, you think DM, who studies addiction and is funded by the NIDA, just happens to be fascinated with some puking disease for no other reason? His main goal seems to want to blame cannabis and build his case against legalization, as usual.

  • Isabel says:

    "Isabel- I spend a lot of pixels on this blog pointing out that dependence is a minority outcome for most who try a given recreational drug."

    Okay, so you do not agree with Nora. You admit that most cannabis users are not "abusing" the drug. Thanks for clearing that up.

  • DrugMonkey says:

    I don't find the term "abuse" to be that useful, as it happens. Use and dependence are much better defined.

  • DrugMonkey says:

    My case against legalization, Isabel? Those voices in your head must really be fascinating.

  • DrugMonkey says:

    It is hilarious that you try to no-true-Scotsman the cannabis addict, Isabel. Just throw your fellow travelers under the bus when they become inconvenient to your cause, eh?

  • Grumble says:

    "From DM, casting aspersions as usual (for Grumble, also see comments):
    "Naturally, the other forum users express the usual incredulity we see from the leegalizeetmon crowd. It's worth a read." "

    Casting aspersions, or making an observation?

    "Also Grumble, you think DM, who studies addiction and is funded by the NIDA, just happens to be fascinated with some puking disease for no other reason? His main goal seems to want to blame cannabis and build his case against legalization, as usual."

    But he didn't mention anything at all about how hyperemesis could or should play into the debate about legalization. All he did was make the comment that certain defenders of legalization dismiss the hyperemesis data. That's. It. You simply cannot get from there to any conclusion about what his "main goal" is.

    And for the record, I think your intimation that anyone who "studies addiction and is funded by NIDA" must be against legalization (especially if he brings up oddities like hyperemesis) is just complete bullshit. For one thing, I study addiction and am supported by NIDA, and I fully endorse cannabis legalization. There are plenty of other NIDA-funded scientists who agree with this point of view. One public and vocal example is Carl Hart.

    Your vilification of NIDA and the scientists it supports is, frankly, as stupid as the Tea Party's vilification of guv'mint in general. Grow the fuck up.

  • Jonathan says:

    Would love to see some genomic follow up to this to see if there's a particular (rare?) CB receptor polymorphism responsible.

    The reaction from some smokers flat-out denying this is possible is sad, but to be expected. Still, in the grand scheme of things the incidence of CHS seems exceedingly small and should perhaps be viewed in the context of deleterious effects of chronic EtOH use, which is anything but.

  • Isabel says:

    It was revealed by the fact that you can only attribute incredulity over these puking stories to the "legaleeze it crowd" as if everyone else would easily accept them. Clearly that is not the case. And you haven't answered to the bizarre overconsumption. Yet you make mocking comments inferring mental illness to me. Seriously, in order to smoke eight "cigars" you would have to smoke 1/2 cigar full of of per waking hour. In other words ALL these people do is smoke pot. And yet you blame their massive health care costs on people like me, trying to end the harmful prohibition that is tearing our society apart?

  • Isabel says:

    "All he did was make the comment that certain defenders of legalization dismiss the hyperemesis data."

    All he said was it was a *smokers forum*.

  • DrugMonkey says:

    Aha, Grumble, *obviously* you are also part of the vast right wing conspiracy and it doesn't matter what you claim your beliefs to be....you work for them !!!11!!

  • DrugMonkey says:

    Wait...Isabel Are you pointing to tobacco co-use? Proposing an actual hypothesis? Progress!

  • Isabel says:

    No, Flounder, I hypothesized severe mental illness. Anyone else think 1/2 cigar full of pot per hour is almost beyond comprehension? For 16 straight hours, then starting over the following day, every day, year after year? I mean it would literally take an hour to smoke that much, maybe with an occasional eating or vomiting break.

    And you didn't answer my Q addiction experts. Isn't causing nausea a trick to put people off substances? Talk about ignoring the elephant in the room. That's whats weird about these stories.

    As they say on the internet, I call bullshit 🙂

    Maybe a little paranoia IS called for here. Hmm, could The Grandkids be cooking up some fake stories? They could be planting them on blogs, and populating smokers forums and posing as "legaleezeitfolks".

    "Aha, Grumble, *obviously* you are also part of the vast right wing conspiracy and it doesn't matter what you claim your beliefs to be....you work for them !!!11!!"

    If Grumble is keeping his beliefs to himself, not acting on them and not speaking out against that lying website, all so he can collect a paycheck from the organization that is largely responsible for the prohibition (after all policy needs scientific backing) then he's just a plain old loser.

    Like you he is part of the problem. Apathy and greed explain it pretty well I think, no conspiracy theories need be invoked 🙁

  • Isabel says:

    "It is hilarious that you try to no-true-Scotsman the cannabis addict, Isabel. Just throw your fellow travelers under the bus when they become inconvenient to your cause, eh?"

    I just noticed this comment. I don't get it. What does any of this weird rare disease hype have to do with me or my "cause"? Who am I throwing under the bus? I am trying to get your attention so you can get them the mental health care that they need. This is beyond addiction, it is a bizarre compulsion.

  • DrugMonkey says:

    One unpleasant withdrawal and people drop heroin right? One nic fit and soyannara ciggies, yes? One ride on the porcelain bus and no more mangotinis, eh?

    WHY WOULD ANYONE DO THAT??? It's just so mysterious...it must be all lies.

  • DrugMonkey says:

    "Beyond addiction"?

    No. It IS addiction.

  • Isabel says:

    " All he did was make the comment that certain defenders of legalization dismiss the hyperemesis data. "

    Grumble, he did not identify those "defenders" or even offer any evidence that they were defenders. He was on some smokers forum. Do you not understand that you can find somebody who claims anything you want if you look hard enough on the internet? Do you think representatives of NORMAL or the MPP would claim that cannabis is harmless, or that all claims of harm are bullshit? Of course not. You need to educate yourself about real activists (not random stoners on forums) and their beliefs.

    "And for the record, I think your intimation that anyone who "studies addiction and is funded by NIDA" must be against legalization (especially if he brings up oddities like hyperemesis) is just complete bullshit. "

    I said nothing of the kind, you are mixing up several statements of mine. This is just non-sensical.

  • Isabel says:

    ""Beyond addiction"?

    No. It IS addiction."

    It is addiction if it is causing an effect. But this is a compulsion to smoke, and to self harm directly (inhale smoke/throw up, repeat. all the while not getting any reward). And sure I threw up from a particular drink (white russian) and couldn't stand the smell for the rest of my life. I ate several pints of raspberries as a kid, unnoticed, the first time I went raspberry picking, and then later that same day ate a raspberry desert that my aunt made and ended up sick. It put me off anything even slightly raspberry flavored until adulthood. Even a lolipop.

    You never heard of this? Now imagine every time you eat something you get sick. But you keep on doing it. For researchers to ignore this loss of ordinary reaction is strange. Something is wrong with the basic brain wiring of these people. Don't you think it's worth considering? Do you at least agree that they are not getting any more high? So why do it? Why punish themselves? There is no reward, so why do it?

  • Isabel says:

    Hmm, thinking about it, it could be an addiction, and there could be a reward. But the addiction is to something we have not identified yet, and the reward is something besides getting higher (not possible). Or even high at all as the effect diminishes, rather than increase with overuse (any user knows this - less is definitely more with cannabis). Clearly they are unable to cut down. What is the reward from self-cutting? Could it be a related syndrome?

    I just remembered about the showers. That takes up a lot of time also, leaving even less time to consume all that cannabis. So these people obviously don't work, since they spend all their walking hours smoking, eating, puking, and showering, yet they can afford a $300. ounce of pot every few days?!

  • Beaker says:

    Grumble and DM, give up. You can never defeat the Isabel reality deflection mind trick. In her alternate universe, reason and data are powerless. And how much popcorn can a person eat before hyperemesis ensues?

  • Isabel says:

    " You can never defeat Isabel"

    True 🙂

    "reason and data are powerless"

    The only offerings so far here have been:

    1. isolated cases of bizarre diseases suffered by people with apparent mental disorders. These are being used to make disparaging comments about cannabis anti-prohibition activists based on:

    2. random comments made by anonymous users on internet forums.

    Is that your idea of "reason and data" ? Or else, what are you talking about?

    This is what happens when total nerds try to act like experts in a field they have no life experience of.

    If you used the stuff, or knew people who did, you would know that "less is more" with cannabis and that this behavior is extremely compulsive rather than assuming it is a simple addiction case.

    How can medical people overlook the fact that these patients are compulsive doing something that is making them vomit? And NOT getting them high?

    Maybe the cannabis is triggering this physical reaction but they are addicted to the vomiting cycle, and constant medical attention, if anything.

  • Isabel says:

    "But then why so uncommon....? "

    Maybe because the vast majority of even hard core users don't smoke anywhere near eight hollowed-out-cigar-fulls of pot per day?

    And now I notice that some of these people stay in the shower all day practically! Okay how do they smoke a half ounce of weed per day if they are spending most of that day in the shower?

  • Isabel says:

    @bsci, from your first link:
    "We know from abundant research that marijuana use during adolescence has the potential to set young people up for a cascade of life-altering events, impeding their success and hindering them from fulfilling their potential"

    Really? Well I guess it has the "potential". On the other hand how many super intelligent and creative kids managed to make it through the stupid, crushingly boring and petty high school years thanks to weed:) I know I did.

    "Young people’s growing skepticism about marijuana’s dangers is reflected in the questions I and other NIDA scientists receive from high school students...Many of these students challenged our claims about the dangers of this drug, expressing their belief that it is safer than other drugs, that it is not actually addictive, or that it is even beneficial. Some teens are no doubt hearing and being influenced by marijuana’s many outspoken advocates, who claim that the drug does not deserve continued Schedule I status and that decades of prevention messaging have overstated its dangers. The ongoing public conversation over medical marijuana may contribute to the impression that, since some people use marijuana therapeutically, it couldn’t be that harmful."

    The students are correct. And really? It does deserve schedule I? ?

    She should be telling them that they are correct, and curious and thoughtful individuals, but that they have developing brains and should minimize exposure to all drugs and unhealthy foods and behaviors (like playing contact sports) until they are older. She should emphasize that activists are talking about adults.

    "Rather, marijuana use, particularly when initiated at a young age, sets the user on a downward life trajectory, one that is driven by a "

    Nope, no exaggeration here, Nora!

    "The key may be to do a better job of educating America’s youth about the value of their brains, and how utterly important it is not to engage in behaviors that could permanently compromise that organ during a very vulnerable period in its development."

    Avoiding contact sports would be a more relevant topic if that's your main concern. And permanently jeopardize?

    I can't find the letter either, but my tolerance for that awful site is low. She opened it by saying something like kids think pot is not harmful if they only experiment, but they can be harmed the first time they abuse the drug. And no those links are not reassuring and they really put DMs comments in perspective. Talk about drinking the kool aid. There are many reasons adolescents should be encouraged to avoid drugs and unhealthy foods and behaviors. No one is arguing with that.

    This interview with a Harvard professor just showed up on Fb today and is an excellent example of what I was saying about the disconnect between swallowing all the hype and having actual life experience:

    http://motherboard.vice.com/blog/psychiatrist-lester-grinspoon-smoked-weed-with-carl-sagana-lot

    "My wife Betsy and I went to a party with Carl not long after we met, and it quickly became clear that marijuana was a regular feature of social life within his little circle in Cambridge.

    As a physician, I saw all that smoking going on, and I was really concerned about it. I suffered from a kind of arrogance that sometimes afflicts physicians. Doctors are supposed to automatically be experts on drugs, and so I found myself spieling off the stuff that the government was saying, telling this wonderful group of people that I was concerned about marijuana's detrimental effect on their health. Because I truly believed pot was a very harmful drug."

  • Grumble says:

    You need to educate yourself about real activists (not random stoners on forums) and their beliefs.

    Why? DM made an off-hand comment about what he read on a board full of some random stoners. The comment is exactly what it is: off-hand and throw-away. It amazes me that anyone could make such an enormous salad out of such a tiny leaf.

    "And for the record, I think your intimation that anyone who "studies addiction and is funded by NIDA" must be against legalization (especially if he brings up oddities like hyperemesis) is just complete bullshit. "

    I said nothing of the kind, you are mixing up several statements of mine. This is just non-sensical.

    What you said was this: "Also Grumble, you think DM, who studies addiction and is funded by the NIDA, just happens to be fascinated with some puking disease for no other reason? His main goal seems to want to blame cannabis and build his case against legalization, as usual."

    You used DM's funding source and topic of research as evidence that his main goal is anti-legalization. In other words, what you said was precisely an intimation that anyone who studies addiction and is funded by NIDA must be against legalization.

    If Grumble is keeping his beliefs to himself, not acting on them and not speaking out against that lying website, all so he can collect a paycheck from the organization that is largely responsible for the prohibition (after all policy needs scientific backing) then he's just a plain old loser.

    Like you he is part of the problem. Apathy and greed explain it pretty well I think, no conspiracy theories need be invoked

    1. Policy doesn't need scientific backing. Just look at all the textbooks teaching evolution popping up all over Texas. NIDA's role in addiction policy is far less important than the role of the DEA, the prison guards, and conservative assholes in general. In fact, if the views espoused by most NIDA-funded scientists held sway, there would be FAR more treatment for addiction and much less incarceration.

    2. Izzy, I love the way you reliably attack even people who largely agree with you, at least about legalization. I find your accusation that I keep my views private so I don't jeopardize my NIDA funding quite hilarious, as you have no idea who I am and what I say publicly.

    I have to say, it's fun baiting someone as predictable, self-defeating and annoying as Isabel. The fun factor does, however, diminish as the waste of time becomes more obvious.

  • drugmonkey says:

    I do try to space out my posts on cannabis, Grumble. For the obvious reasons.

  • drugmonkey says:

    But the addiction is to something we have not identified yet

    Actually we have. It is to the marijuana. And most likely to the delta9-THC.

    , and the reward is something besides getting higher (not possible).

    ahhhh. enlightenment dawns....

    Or even high at all as the effect diminishes, rather than increase with overuse (any user knows this - less is definitely more with cannabis).

    Indeed. One of the major theoretical poles of addiction science, which is increasingly holding sway, is that the feel-good of acute intoxication is not the story of addiction. The story of addiction is the negative affective state that is produced in the wake of ongoing, chronic exposure to pleasurable or rewarding drugs. The negative, below-normal state that is felt when unintoxicated is what is driving the behavior. The relief from that negative state is what is called negative reinforcement of the behavior. [Ob Behaviorism101: The negative refers to the removal of the stimulus, here the negative affect. The reinforcement refers to increasing the probability or strength of the response, i.e., pot smoking. ]

    George Koob, a major proponent of this idea, writes a metric shit ton of reviews that are reasonably accessible to the less-informed reader. I suggest you read some.

    The casual lay audience will recognize this from the popular notion of the heroin addict who injects "just to get straight". Also from the fact that your morning coffee restores you to the normal cognitive and arousal state of nondrinkers, instead of making you super-office-worker.

  • Isabel says:

    "You used DM's funding source and topic of research as evidence that his main goal is anti-legalization."

    Again, no. My conclusion is/was based on the sum total of his posts. As far as his innocent remark, no. You quoted ME about the "random stoners". He implied that this was a typical view of anti-prohibitionists.

    "Policy doesn't need scientific backing."

    Seriously, now you are going to drag in Texas?? And you say you aren't desperate....of course in this case science needs to appear to be behind policy, and it is the work of NIDA/NIH that is used, I have linked to proof of this several times.

    "y most NIDA-funded scientists held sway, there would be FAR more treatment for addiction and much less incarceration."

    Ah yes the 3rd way - as I have proved, equally oppressive. You need to just back off a bit. Anybody favor that approach?

    "I find your accusation that I keep my views private so I don't "

    I said "if" you keep your views private...

    You aren't enjoying your popcorn anymore? Maybe if you weren't such an asshole from the beginning, treating it as a joke you would get more out of the conversation? I have brought up many points that you have not addressed because you can't, so you act bored and say I am predictable.

  • Isabel says:

    "The relief from that negative state is what is called negative reinforcement of the behavior."

    Where is the relief coming from? The puking it seems.

    No, coffee is not comparable, or cigarettes even though I agree they are not getting you high like they are originally. This could explain some smoking, but it does not explain the great quantities. It's like the equivalent of 48 cups of coffee per day. If someone was drinking that much and retching non-stop would you blame the resulting physical problems on the addictive qualities of caffeine?

    So they need it to feel normal, a couple of hits regularly throughout the day is still not going to add up to 4-8 blunts, nowhere close.

    btw I learned yesterday that, according to Nora, when people make these "blunts", they only partially hollow out the cigars. (gross!) So there IS tobacco involved, most likely. Again, where is the discussion of this, which as everyone (except addiction scientists) knows, is a much stronger addiction? What about the co-use of the two drugs are there any synergistic effects?

    I maintain there is a mental illness aspect besides the addiction. The stories are strange from Day 1. One guy tells how woke up, felt nauseous, smoked and vomited on a regular basis for 3 years and apparently didn't think much of it or mention it to his doctor until things got worse etc etc. Too weird. And you haven't explained the financial aspect. I am kidding of course about the stories being planted, but come on, you have to admit there is something wrong with people who will not stop a behavior that makes them retch non-stop day after day.

    If they are throwing up this much they are probably suffering malnutrition, which should be central to any discussion of their health being discussed. What these people are eating isn't discussed either it's all expensive diagnostic tests and dehydration. So if all that the medical people are doing is 97 stomach x-rays for 97 visits (!), maybe the problem isn't that the ER doctors are not aware of the pot connection, as you also suggested.

  • Grumble says:

    There is no point in continuing with you, Izz; I've had my fun getting exactly what I wanted - your undies all tied up in knots about the usual things.

    "The negative, below-normal state that is felt when unintoxicated is what is driving the behavior."

    The Koobian point of view probably has merit in many cases, especially in addicts who are overcoming withdrawal. But I don't see how it explains relapse after many months or even years of abstinence. For that, other theories seem better, such as those suggesting that addiction is a deeply learned behavior that can be activated by conditioned stimuli even in the absence of a "negative affective state". If you believe that, then there's no reason why the same learnin' can't also activate behavior in addicts going through withdrawal, and in the period after too.

  • Isabel says:

    Even if they hollow the cigars out completely, there is still substantial tobacco involved:

    "Officially, a cigar is defined as a tobacco product that is wrapped in a leaf tobacco or other product containing tobacco...While the wrapping may not make a great difference in the amount of tobacco in a cigar, most do have a substantial amount of tobacco...Many cigars have as much tobacco, or nearly as much, as an entire pack of cigarettes. Thus, the addictive properties and negative health effects are amplified with cigars in most cases.

    ...

    Also, most cigars do not have filters, another difference between a cigar and a cigarette. This makes cigars especially dangerous, simply because there are fewer safeguards filtering some of the harmful chemicals from entering the body. While filters by no means make smoking safe, they do help somewhat."

    http://www.wisegeek.com/what-is-the-difference-between-a-cigar-and-a-cigarette.htm

  • Isabel says:

    "There is no point in continuing with you, Izz; I've had my fun getting exactly what I wanted - your undies all tied up in knots about the usual things."

    See ya, loser. Sounds like you are the one who is all tied up in knots. 🙂

  • drugmonkey says:

    But I don't see how it explains relapse after many months or even years of abstinence.

    It's a decent point but....why not? This presumes that the baseline level of "happiness" has been restored after abstinence. Or the baseline level of resilience to challenge has been restored. It is not obvious that this is the case.

    those suggesting that addiction is a deeply learned behavior that can be activated by conditioned stimuli even in the absence of a "negative affective state".

    likely important but this smacks of black-box behavioralism to me. a different level of description for what may be the same phenomenon. take depression. one might view this as a disorder in which too many stimuli become triggers of the negative state. So you could likewise blame the associative processes instead of a primary reward deficit.

  • drugmonkey says:

    as far as I am aware, Isabel, cigarette or cigar smoking has not been associated with a chronic hyperemesis similar to the described syndrome. Do you know of any such thing? or are you just throwing up "what-if" irrelevant chaff to distract?

  • Isabel says:

    Okay so you are ignoring the tobacco use in the anecdotal examples you've offered because it hasn't been previously associated with this extremely rare phenomenon. Makes perfect sense.

    I think this may be a psychological disorder. It has very strong elements- the oral fixation of the extreme overuse, then the purging and cleansing. The repetitive aspect is also almost ritualistic. We need more information about their nutritional deficiencies and a full psychological work up of each patient.

    You didn't answer my question - if someone was drinking 24-48 cups of coffee per day and puking their guts out, would your attention be focused on their addiction to caffeine? Even if it was spiked with, say alcohol in many cases?

  • Grumble says:

    "This presumes that the baseline level of "happiness" has been restored after abstinence. Or the baseline level of resilience to challenge has been restored. It is not obvious that this is the case. "

    Fair enough. But see below...

    "likely important but this smacks of black-box behavioralism to me. a different level of description for what may be the same phenomenon."

    Actually, it's not so much "black box behaviorism" as a rejection of explanations that are purely psychological. I just don't buy that "negative affect" necessarily has to be causal to behavior. There's a reasonable school of thought that says that most (if not all) emotions are simply epiphenomena of the neural processes that generate cognition and behavior. If that's the case, the psychological explanation isn't just a "different level" of explanation from the neural explanation: the psychological explanation is wrong.

    "take depression. one might view this as a disorder in which too many stimuli become triggers of the negative state. So you could likewise blame the associative processes instead of a primary reward deficit."

    I'm not sure you can tease "primary reward deficit" (whatever that is) apart from associative processes. To do so you'd first have to supply a definition of "reward" that everyone can agree on. Good luck with that. However, if you'd like to talk about reinforcement and the neural processes whereby associations are made and then motivate behavior, you can point to a lot of real and valid research that suggests how these processes work. I'm much more comfortable thinking about depression (or any psychiatric disorder) in these terms than in terms of any psychological framework -- even though there is regrettably little data yet that links most psychiatric disorders to real brain processes.

  • karl says:

    wondering if a little bit of cannabis could be of any use in attenuating a just initiating bad flu with sore throat.

  • shandi says:

    Its taken me nine years but I now know that this is what is wrong with me.

  • karl says:

    taking in crap, month after month and year after year, damages the brain without possibility of repair, no matter how much therapy one gets. one only has one brain which is essential to life and her enjoyment. so, stop taking crap in.

  • karl says:

    and btw, taking crap in damages not only the brain but also the second brain.

  • Rob says:

    I am a huge supporter of pot.

    But

    I have this problem, I don't call it a disease because all you have to do is stop

    But

    This is very real and very scary if you have been through it.

    Dear Isabel, I think we agree on a lot but this is very painful and very real

  • Dave says:

    People think the hot baths are helpful but thats what is causing it. It only temporarily relieves the symptoms of nausea. When the symptoms come back they are stronger than ever.

    Its like scratching a mosquito bite. You want to do it.... but ur not helping yourself.

    Tell the people who have this disorder to stop taking hot baths/showers and I garuntee they will stop vomiting.

    People who are smoking all the time anyways don't have very high self control. Thats why they won't stop taking baths or smoking weed.

  • guess says:

    No experience with it

  • Anonymous says:

    I am coming to realize that I am sufferer of Cannabis Hyperemesis and am more pissed than relieved to know what is going on, despite all the pain and pointless emergency room visits. Marijuana is a good friend that I clearly need to say goodbye to. And all this after it has virtually been legalized where I live, including growing at home which I invested in. Shit.

    Anyways. Here are my variations on this: I don't really need to vomit, but I do so to relieve the pain after drinking cold fluids.. also to relieve the pain. For me it is primarily horrendous abdominal pain, sweating and hyperventilation (deep breathing is much more painful than short, shallow breathing which leads to other muscle cramping). It is so bad that I cannot really move about without great effort. Whether or not I can get up to use a computer, for example, is questionable. I mostly move in and out of the bathtub. A shower does nothing for me at all. I need to submerge my stomach in hot water. This can completely take away the pain for up to an hour. I am honestly afraid that I will fall asleep in the bathtub and drown. The pain is so excruciating that when it lets up in the bath I often almost pass out and awake hearing my hands splash into the water.

    I've been denying that cannibus hyperemis was really my diagnosis for a few months now, I guess, but it has sent me to the ER countless times with what I have come to think of as a horrendously painful but not life threatening illness. I always suspected it was some sort of drug use, but only now have I been free from other drugs besides marijuana for a very long time eliminating the other chemicals as possible factors.

    Well, I just harvested two strains of really goddam beautiful marijuana flowers and I am not sure what in the hell I should really do with them.. .not to mention the absurd lights needed to make these flowers.

  • At least one case in Spain

    Vómitos cíclicos secundarios al consumo de cannabis | Gastroenterología y Hepatología - http://zl.elsevier.es/es/revista/gastroenterologia-hepatologia-14/vomitos-ciclicos-secundarios-al-consumo-cannabis-13139490-observaciones-clinicas-2009

  • DrugMonkey says:

    Thanks for the link. Interestingly there is some Twitt who keeps asserting cannabis hyperemesis is never seen in Spain. Perhaps this will be convincing!

  • Isabel says:

    Anonymous from Jan. 6:

    "I am coming to realize that I am sufferer of Cannabis Hyperemesis....I've been denying that cannibus hyperemis was really my diagnosis for a few months now, I guess, but it has sent me to the ER countless times with what I have come to think of as a horrendously painful but not life threatening illness."

    So were you actually diagnosed by a medical professional?

    Were you referred to nutritional and psychological counseling?

    Lastly did you mix tobacco in or smoke blunts?

    Thanks, and good luck.

    it is interesting that the Indian Hemp Commission, when looking at hundreds of millions of users (via their doctors) uncovered no evidence of this affliction.

  • DrugMonkey says:

    When was that conducted again? What were the methods? How quantitative are the "millions of users" numbers? Just give the audience a feel for what you are referring to, there, would ya?

  • Maureen says:

    Right now my 23 year old son is in the hospital. 6 days with intractable vomiting. This is his diagnosis. He started smoking 5 years ago. A few months ago he began throwing up most mornings, this would last for 1/2 hour and then progressed. Thinking pot should help nausea he increased his drug us and said he began to think it would be worse without it.He admits that for the past month he has thrown up every morning and for hours , he feels full after just a few bites of food.He woke up last week and just could not stop, I took him to ER . They put him on Zofran and then Phenergan and then Reglan nothing helped, he vomited every few minutes for 24 hours. CT scan negative, ultrasound negative.By the next evening he had eaten jello so they sent him home, next morning once again vomiting. Now 5 days later it has lessened and reoccurs in the morning lasting for a few hours.He is still in the hospital on IV fluids Now he is also on Amytriptoline, which is helping some. Still cannot hold down even ice chips.I have researched this and everything I have read leaves me with a question mark on the dx because He has no abdominal pain at all and didn't do the shower thing until today when the dr. told him he should take a hot shower. He did and stopped vomiting.Can someone have this problem without abdominal pain?Oh he has also had a Gastric emptying scan in nuclear medicine ( negative) and an MRI ( negative) The dr.s just insist he has this. I hope he does because just stopping the pot is the cure. If it really isn't this we still have a problem.

  • DrugMonkey says:

    Good luck with it. Do recognize that "just stopping pot" may not be completely simple though.

  • […] is often associated with chronic cannabis smoking. I've written about it a few more times (here, here, here) and you can check out additional posts at Addiction Inbox (here, here). I urge you to read […]

  • Noone says:

    I sincerely wish there was more information on this topic. I believe this is hereditary. However the information is all on CRONIC users. I only tried it once and was doubled over in pain for 24 hours after one hit. It is now even if I smell it my stomach churns. I found out years later after trying it for my first and only time that my father has the same response to it as I do. It was enough that he never tried it again as well.

  • Julie Gonzalez says:

    I was diagnosed w/ CHS. I was a heavy pot smoker since age 16. At 25, I developed severe stomach pain with vomiting and nausea. My attacks gradually increased in frequency and severity, until it became a daily occurrence. The only thing that helped was taking hot showers/hot baths, up to 15-20 times a day; besides being hospitalized for pain control. In 2011, a doctor at Cedars-Sinai told me he learned of a condition called Cannabis Hyperemesis Syndrome (CHS). He told me all CHS sufferers had this commonality of taking a lot of taking hot showers/baths to help alleviate their symptoms; it affects 1% of heavy pot-users, but believed there were more undiagnosed cases as most doctors were unaware of this condition. Since I stopped smoking weed, I’ve now been painfree for 4 years. I hope by sharing my story, it will at least help one person and will help spread the word to inform people about CHS.

  • drugmonkey says:

    I don't think we have enough epidemiology to estimate the percentage of cases amongst any definition of "users" at this point. It has quite obviously been slow for medical care providers to start thinking of this as a possible cause and to investigate pot use. The case reports and some user comments on the web (such as this thread) point to case histories in which the medical providers were clearly perplexed.

    Cannabis Hyperemesis does appear to be relatively rare, however, even among people who smoke pot daily for years. If it were more common, I suspect we'd have known more about this for quite some time.

  • Pierre says:

    I was first diagnosed with Canabinoid Hyperemesis a few years ago and let me tell you, it is no laughing matter. I first spent almost a week in the hospital running a myriad of tests with no conclusive results. I took a break from pot for a year and saw no symptoms come back at all. I slowly started to smoke again, small amounts, leading to a more regular daily use. After about a year of steady daily smoking, the symptoms started to reappear. Within a week of the first signs of the sickness coming up again, I was back in the hourly vomiting only slowed by hot showers.
    I'm now facing a return to sobriety and that fact is hitting me like a truck. Pot is such a staple of my life, my friends, my entire social life revolves around it, it's how I regulate my depression and anxiety without having to result to chemical meds, and now that part of my life is about to be gone.
    Not sure why I felt like posting this here, but the skeptics here are shockingly ignorant.

Leave a Reply