Pubdate: Mon, 19 Jun 2017
Source: Fresno Bee, The (CA)
Copyright: 2017 The Fresno Bee
Note: Does not publish letters from outside their circulation area.
Author: Molly Sullivan


Marijuana has long been lauded as a wonder drug for treating nausea
and vomiting. Now, health experts say your pot may be making you sick.

Emergency medicine physicians at UC Davis Medical Center said they've
seen young, often college-age patients come in once or twice a day
vomiting multiple times an hour and screaming uncontrollably.

"They keep moaning, shouting and yelling after they vomit. It's very
dramatic. It sounds like someone is dying," said Dr. John Richards, an
emergency medicine physician and professor at UC Davis.

Doctors have seen these symptoms in emergency rooms for years without
fully understanding what was happening, he said. Ultrasounds and CT
scans would be ordered, and opioids and anti-nausea medication
prescribed, but to no avail. It wasn't until a 2004 study, when
Australian doctors identified a connection between patients' marijuana
use and their recurring episodes of vomiting and abdominal pain that
the diagnosis was clinched.

Blazing up every day with potent strains of marijuana was eliciting
the symptoms, according to the study.

THC and other cannabinoid concentrations are also higher in medical
marijuana strains, which may be contributing to more cases of CHS.

"Imagine you have a beer every day and then one day I give you 100
proof alcohol and I say, 'Go at it,' " said Dr. Jeff Lapointa", a
toxicologist and emergency medicine physician in San Diego. "That's
similar to the effect potent marijuana strains have."

The condition is known as cannabinoid hyperemesis syndrome, or more
simply CHS, and doctors believe it's caused when cannabinoids in
marijuana -- a chemical that bonds to receptors in the central nervous
system -- bombard neurotransmitters, causing an imbalance in the
body's regulatory system.

Cannabinoids are naturally present within the body and they interact
with a complex system of endocannabinoid receptors. But when someone
inhales marijuana, they're getting a spike in cannabinoids, especially
THC, the cannabinoid responsible for highs. That inundates the body's
cannabinoid receptors, causing them to shrink back into cells. Other
neurotransmitter receptors kick into overdrive to compensate for the
overworked cannabinoid receptors.

The physical pain and psychological stress of repeated vomiting can
send people into emergency rooms writhing and screaming, said Dr.
Aimee Moulin, emergency medicine physician and associate professor at
UC Davis.

Not a single case has been reported after throwing back edible pot,
however. "Eating pot releases cannabinoids at a slower rate," Lapoint
said. "And most people don't eat multiple edibles in a space of a few
hours, while people often smoke marijuana at least a couple times a

CHS typically only affects a small number of chronic pot smokers, but
it's become the subject of more attention since pot is now the most
commonly used federally prohibited drug in the U.S., according to the
the U.S. Centers for Disease Control and Prevention.

Doctors noticed an uptick of CHS cases after the legalization of
medical marijuana, Moulin said.

And after the November election, recreational marijuana became legal
in eight states, including California. Richards said he anticipated
seeing more cases, which means it'll be important to know more about
the condition.

"It's good for physicians to know because when they treat people with
traditional methods and when they don't work, they think something is
really wrong," he said.

The key signs of CHS are regular pot use and compulsive bathing.
Scalding hot baths and showers have been shown to be an effective
treatment because the hot water redirects blood flow from an irritated
stomach to the skin, Richards said.

Lapoint recalled a 19-year-old woman who had been to the emergency
room two days in a row and had run through a number of tests without a
successful diagnosis.

"I heard her screaming down the hallway," he said. "She started
kicking and screaming on the bed. People with appendicitis or belly
pain don't do that. So I asked her about her marijuana use and she
said she had been smoking a high potency strain a couple times a day
for months. Then I asked her if hot showers helped and she said they
did. So that nailed the diagnosis."

Lapoint said he applied a capsaicin cream -- which contains the same
ingredients as chili peppers -- to her stomach since hot temperatures
relieve related stomach discomfort and stop the vomiting.

She was on her way home within 45 minutes, capsaicin cream in hand,
Lapoint said.

Only one long-term treatment, however, has the best chances of
success: putting aside the bong or blunt for good.

"It's counterintuitive because marijuana is something they use to
fight nausea, and now I have to tell them it's marijuana that's making
them sick," Lapoint said.

Since marijuana is ranked on par with cocaine and heroin by the Drug
Enforcement Administration, the long-term effects of marijuana have
not been studied in great length because the federal prohibition of
marijuana limits research, Moulin said.

"A lot of the research is federally funded, and the federal scheduling
of marijuana as not a medical substance really inhibits your ability
as a researcher to obtain funding and authorization to study
marijuana," she said. "It's an obstacle for studying the side effects
and efficacy of the different compounds of marijuana."

Richards and Moulin, along with two other doctors at UC Davis, have
found anti-anxiety and anti-psychotic medications are also effective
in treating CHS. That's in part because cannabinoids are stored in fat
cells. When under stress, the fat cells break down, releasing a blitz
of cannabinoids into the bloodstream.

Anti-anxiety medications help interrupt the release of more
cannabinoids into the blood, Richards said.

"It's super super complex," Lapoint said. "There's so many variables
to account for when trying to understand the body's endocannabinoid
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