Pubdate: Tue, 28 Nov 2017
Source: Fresno Bee, The (CA)
Copyright: 2017 The Fresno Bee
Author: Pauline Bartolone


For 17 years, Chalfonte LeNee Queen suffered periodic episodes of
violent retching and abdominal pain that would knock her off her feet
for days, sometimes leaving her writhing on the floor in pain.

"I've screamed out for death," said Queen, 48, who lives in San Diego.
"I've cried out for my mom who's been dead for 20 years, mentally not
realizing she can't come to me."

Queen lost a modeling job after being mistaken for an alcoholic. She
racked up tens of thousands of dollars in medical bills, and her
nausea interrupted her sex life. Towards the end of her illness,
Queen, who stands 5-foot-9, weighed in at a frail 109 pounds.

Throughout the nearly two decades of pain, vomiting and mental fog,
she visited the hospital about three times a year, but doctors never
got to the bottom of what was ailing her. By 2016, she thought she was
dying, that she "must have some sort of cancer or something they can't
detect," Queen said.

But she didn't have cancer. She had an obscure syndrome called
cannabinoid hyperemesis syndrome, a condition only recently
acknowledged by the medical community. It affects a small population
- -- namely, a subset of marijuana users who smoke multiple times a day
for months, years or even decades.

There are no hard data on the prevalence of the illness. But in
California and Colorado, which have loosened marijuana laws in recent
years, emergency physicians say they're seeing it more often. One
study in Colorado suggests there may be a link.

Dr. Aimee Moulin, an emergency room physician at UC Davis Medical
Center in Sacramento, said she has seen a rise in the number of cases
since California voters legalized recreational marijuana last
November, and she expects to see another increase after commercial
sales are permitted starting in January.

Doctors say it's difficult to treat the condition. There is no cure
other than to quit using marijuana, and many patients are skeptical
that cannabis is making them sick, so they keep using it and their
vomiting episodes continue.

Doctors can do little to relieve the symptoms, since traditional
anti-nausea medications often don't work and there are no pills to
prevent the onset of an episode. Patients may need intravenous
hydration and hospital stays until the symptoms subside.

"That's really frustrating as an emergency physician," said Moulin. "I
really like to make people feel better."

Diagnosing the syndrome can also be frustrating -- and expensive.
There is no blood test to link the stomach ailment with marijuana use,
so physicians often order pricey CT scans and lab tests to rule out
other medical problems.

Cannabinoid hyperemesis syndrome was first documented in Australia in
2004. Physicians have historically misdiagnosed it as the more generic
cyclic vomiting syndrome, which has no identifiable cause or, as in
Queen's case, acute intermittent porphyria (AIP).

"Five years ago, this wasn't something that [doctors] had on their
radar," said Dr. Kennon Heard, an emergency physician at the
University of Colorado in Aurora, who co-authored the Colorado study
showing a possible tie between the liberalization of marijuana and a
surge of the vomiting illness. "We're at least making the diagnosis
more now."

One surefire sign of the illness is when patients find relief in hot
showers and baths. Queen said she would vomit repeatedly unless she
was in a hot shower -- so she'd stay in there for hours. Toxicologists
say the heat may distract the brain from pain receptors in the abdomen
but, like the syndrome itself, that phenomenon is not well understood.

The exact cause of the condition is still a mystery. Toxicologists say
the chemical compounds in marijuana may throw off the normal function
of the body's cannabinoid receptors, which help regulate the nervous

Some people may be genetically predisposed to the syndrome, or
marijuana's potency or chemical makeup may have changed over time,
said Dr. Craig Smollin, medical director of the San Francisco division
of the California Poison Control System, who also works as an
emergency physician at Zuckerberg San Francisco General Hospital.

The vomiting link to cannabis is counterintuitive to many, because of
its widely known reputation as an anti-nausea remedy for cancer patients.

Dr. John Coburn, an emergency physician at Kaiser Permanente in south
Sacramento, says his department sees the cannabis-related vomiting
illness every day.

"A lot of times, people just don't believe you," said Coburn. Even
after being told that quitting may help, some patients will visit the
hospital multiple times before they stop smoking marijuana, Coburn
said. "I can't really tell you why. I mean, why do people ride
motorcycles without helmets on?"

Cameron Nicole Beard, 19, of East Moline, Ill., said she struggled to
believe her doctors about the link between pot and severe vomiting.

"Who wants to be told you can't smoke marijuana, when you think
marijuana can help?" said Beard, while recovering from a
marijuana-related vomiting episode at a University of Iowa hospital in
Iowa City, Iowa last month. She said she had lost 20 pounds in 10 days.

Although there's still no magic cure for a patient's marijuana-related
hyperemesis, Moulin and other doctors say they're getting better at
treating the symptoms, using old anti-psychotic medications and cream
for muscle aches.

Dr. Heard said the cases in Colorado seem to have leveled off. But
without hard data, and because the overall numbers are small, it's
hard to say for sure. Heard said he doesn't believe cases of the pot
syndrome increased after recreational use was legalized in 2012,
because chronic users probably already had medical marijuana cards.

Queen is still struggling to completely quit marijuana, but her
symptoms are down to a dull stomachache. She now smokes a couple of
times a day, compared to her constant use in the past. She says it's
the only thing that works for her depression and anxiety.

Queen is back to a healthy weight and hasn't been to the hospital in a
year. She said she wouldn't want to discourage anybody from smoking
weed; she just wants people to know heavy use can bring them some
serious misery.

"Now, if I get sick, as sad as I'll be and as upset and disappointed
with myself as I would be, at least it's a freaking choice," she said.

This story was produced by Kaiser Health News, which publishes
California Healthline, an editorially independent service of the
California Health Care Foundation.
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MAP posted-by: Matt