In a dramatic piece of investigative research, The New York Times has published a lengthy piece exposing the dangers of excessive cannabis use. In particular, the article focuses on a condition known as cannabinoid hyperemesis syndrome, or CHS, which is estimated to impact millions of Americans.

A systematic review of the scientific literature in 2017 tried to get a handle on the characteristics of CHS and this is what they came up with:

• 100% of the patients used cannabis regularly
• 97% used cannabis at least weekly
• 73% self-identified as male
• 100% experienced “cyclic nausea and vomiting”
• 92% self-treated with hot baths or showers

It should be noted that 2017 was prior to many states legalizing THC products. The Times estimates that 18 million Americans ages 18 and up have reported symptoms of cannabis use disorder. The Times estimates that six million adult Americans suffer from CHS. The research  was quite thorough, as summarized here:

The Times examined medical records and public health and insurance data; reviewed scientific research; and interviewed more than 200 health officials, doctors, regulators and consumers. Reporters also surveyed more than 200 physicians in about a half-dozen specialties and almost 600 people who suffer from cannabinoid hyperemesis syndrome.

As near as we can tell from The New York Times article, here’s what’s going on. Long-term THC use, whether smoked, inhaled through vaping, or ingested as gummies or in foods, builds up until it causes gastrointestinal distress. The distress comes in the form of vomiting, or the urge to vomit, particularly in the early morning hours, when the stomach is typically empty. 

Cannabinoid hyperemesis syndrome can lead to “extreme dehydration, seizures, kidney failure and cardiac arrest,” according to the trio of investigative reporters for The Times. The journalists say CHS has led to death on at least eight documented occasions. It is not something to be ignored and it will not go away without treatment.

The preferred treatment is abstinence. The 2017 systematic study found that 94% of patients recovered completely within six months of stopping THC use. More recent studies have recommended amitriptyline, a tricyclic antidepressant used to treat nerve pain, until the patient has been off THC for six to 12 months. Patients typically self-medicate with hot baths or hot showers, which provide temporary relief from abdominal pain. People with severe symptoms frequently go to emergency care for treatment. 

A major problem in the diagnosis and treatment of CHS is that so little research has been done on the effects of smoking marijuana, vaping or ingesting THC. Because marijuana is still illegal under U.S. law and treated as a controlled substance, quality studies are difficult to find. It is recommended that persons who feel they might suffer from CHS inform their medical providers about their THC use, and seek help in reducing or eliminating the use of THC products.

Written by Steve O’Keefe. First published October 9, 2024.

Sources:

“As America’s Marijuana Use Grows, So Do the Harms,” The New York Times, October 4, 2024.

“Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment — a Systematic Review,” Journal of Medical Toxicology, December 2016.

“Cannabinoid Hyperemesis Syndrome: Definition, Pathophysiology, Clinical Spectrum, Insights into Acute and Long-Term Management,” Journal of Investigative Medicine, December 1, 2020.

Image Copyright: Kevin Galens, used under Creative Commons license.