Pubdate: Sat, 21 Oct 2017
Source: Daily Observer, The (Pembroke, CN ON)
Copyright: 2017 Pembroke Daily Observer
Author: Jessica Ross
Page: 5


As legalized pot looms, an ER physician argues we're unprepared for a
serious health syndrome

That was definitely vomit, I thought as I stepped in a slippery
substance and caught the rail of the stretcher to avoid sliding
underneath. That bilious smell does not come out of shoes.

After ordering an intravenous, a cocktail of anti-emetics - and a
change of footwear for myself - I run through a mental list. What
causes a 14-year-old patient to vomit like this? Appendicitis?
Meningitis? Overdose?

As an emergency room physician, it's always Big Bad Diagnoses that run
through my mind first.

When I return, I find my patient still slightly green, but no longer
vomiting. He has a mop of brown hair and looks much older than 14
years. I perch on the edge of his stretcher and check the name on his
chart: Nick.

"Hi, Nick," I start, "How are you feeling?"

As I gather my initial information, I learn Nick is a seemingly
healthy young man. No fever, diarrhea, or tropical vacations in his
recent past.

I run through my usual line of questioning as his mum hovers beside
him, holding his hand, before asking, "Would you mind heading to the
waiting room for a few minutes?"

When she leaves, the truth comes out. I learn that at 14 years old,
Nick drinks alcohol casually and from his own estimate, has been
smoking pot every day for the past two years.

Combined with that knowledge and a physical exam that reveals nothing
of note, I think I've cinched my diagnosis.

"Nick, I'm going to run a few tests to rule out anything worrisome,
but I'm fairly confident your vomiting is because of all the pot
you've been smoking."

Nick was suffering from cannabinoid hyperemesis syndrome (CHS),
abdominal pain, nausea and intractable vomiting due to chronic,
regular cannabis use.

Never heard of it? Neither had Nick's parents. Just a short time ago,
it wasn't on most doctors' radars either.

And this is a problem.

The legalization of recreational marijuana is upon us, and cannabis
use in youth already is rampant. Surveying Grade 7 to 12 students, one
in five had tried cannabis, and more than one in 10 had used it in the
past month, with an average initiation age of 15 years.

We already treat many of these patients for CHS. And, if we're
anything like the state of Colorado, we could see nearly a doubling of
cases, as they did following liberalization.

CHS poses serious health effects, such as dehydration. It also
contributes to missed school and work, and is costly to our already
faltering health-care system.

Patients often present multiple times to emergency departments,
undergo expensive and sometimes invasive tests, consultations and
treatments before they are appropriately diagnosed.

By increasing awareness among the public and the health-care
profession, patients can be treated promptly (with hot showers,
topical capsaicin cream and firm advice to quit), and the cost savings
could be significant.

Unfortunately, most youth think that using marijuana is generally
safe. Researchers speculate that's thanks in part to the media, which
lacks coverage about potential health effects.

In fact, most youth think there's no potential for severe harm from
marijuana use.

We need education for youth, parents, and health-care practitioners
and we need to share more stories like Nick's.

In the lead-up to the legalization of the possession and consumption
of recreational marijuana, scheduled for July 1 of next year, Health
Canada has prioritized educating youth about the health effects of

The Canadian Pediatric Society (CPS) and the Canadian Psychiatric
Association have come forward with position statements warning of the
harms of cannabis in youth. They outline risks such as impaired brain
development, increased prevalence of mental illness, and diminished
school performance and lifetime achievement.

However, there was no mention of CHS in either of these

It will be essential for those tasked with this massive undertaking to
figure out what to say by engaging stakeholders - including the
Canadian Association of Emergency Physicians - in order to shed some
light on CHS.

We need to find out how to say it, and who should say it so youth will
listen. And, this all needs to be done starting now; we are on a tight
time frame, after all.

July 1 is coming fast, and we aren't ready.
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MAP posted-by: Matt