Pubdate: Sat, 21 Oct 2017
Source: Vancouver Sun (CN BC)
Copyright: 2017 Postmedia Network Inc.
Author: Jessica Ross
Page: 12


Action needed as legalization looms, Dr. Jessica Ross says.

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 doesn't 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 that Nick is a seemingly
very healthy young man. No fever, diarrhea or tropical vacations in
his recent past. I run through my usual line of questioning as his mom
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, 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 pot is upon us, and cannabis use in
youth is already 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
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 on our
already-faltering health-care system. Patients often show up multiple
times to ERs, undergo expensive and sometimes invasive tests,
consultations and treatments before they are appropriately diagnosed.
By increasing awareness among both 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 pot, scheduled for July 1 of next year, Health Canada
has prioritized educating youth about the health effects of cannabis.
The Canadian Paediatric 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 documents.

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 up fast, and we
aren't ready.
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MAP posted-by: Matt