Looking into Cannabis Hyperemesis Syndrome

The belief that marijuana is an addictive substance has been a point of social and medical debate for over a century. While occasional users may overlook the addictive potential of this drug, medical cannabis, for some, marijuana use can become a regular and compulsory part of their day. But marijuana isn’t just to help relax at the end of a long day, or to start the party. Many use it for bona fide medical conditions.

Many students have anxiety, ADHD, poor sleep, or even arthritis and other medical conditions that cannabis might help. Before using cannabis for a symptom or condition, it is best to seek medical advice. When taking a new medication, including medical cannabis, it is important to remember that everybody is different. The “medicine” can interact with people in diverse ways. Patient weight, sex, and fat content; drug dose and ingestion in relation to food, and even hydration and other medications can all affect a drug. For some people, a small amount of THC may have little effect, although for others who are more sensitive, a small amount can lead to negative side effects like paranoia, headaches, and a racing heart, even precipitating a full-blown panic attack.

Dr. Brun Del Rey is a family doctor working with Bodystream Medical who regularly prescribes medical cannabis (MC) to patients. He warns of the potential side effects of using more THC than a person can tolerate, “When anybody tries any new medicine, they don’t know if they may be sensitive or not. In general, you start low and go slow. You raise the dose amount so that you have a chance to see if there’s any issues that develop.”

If one begins to experience unpleasant side effects like dry mouth or anxiety, it may be best to dial back the dose. If you aren’t sensitive, you may choose to increase the dose slowly to find your comfort level. He explains, “So you gradually step up and you want all the good effects and none of the side effects, so you find that sweet spot. You might even push the limits and see where you start [experiencing] unpleasantness.”

Bruce McKay, a faculty member at Laurier in the Department of Psychology, understands the potential risk of addiction to marijuana, having studied it for years. “If someone regularly uses cannabis and they stop using cannabis, they will have withdrawal symptoms,” he stated. “I would say in the last few years, more students understand that cannabis is an addictive drug. I remember teaching about this eight or ten years ago, and there was kind of a widespread disbelief that people could become addicted to cannabis; that was for other drugs. But the reality is, it’s actually quite addictive, as is any rewarding thing that people do.”

Studies show addiction can occur in adults 18-24 years old at about 6% and up to 10% in teenagers. So, what are the potential consequences of cannabis addiction? One thing to consider is that young adults do not have a fully formed frontal brain (higher decision making, organization, and judgment) until about age 24-25 years. Research shows that chronic cannabis use, especially from an early age, can lead to cognitive dysfunction in memory, learning, and attention.

It’s important to remember that the negative effects of cannabis are exacerbated by regular use of high levels of THC. Regular use of high-THC is associated with cognitive dysfunction, although low levels of THC use may have positive benefits like improved concentration and reduced anxiety.

Both CBD, which is not psychoactive, and THC, which is, have a bipolar tendency. In low doses, CBD and THC have one effect, and in high doses, they often have an opposing effect. Dr. Brun Del Rey said, “[A] classic example with THC … at a low dose you’ll find that it stimulates the appetite. The munchies is a classic side effect, whereas at a higher dose, it’s the opposite. You’re actually vomiting or having diarrhea, so that your whole digestive system is rejecting it.”

One consequence of overuse of cannabis is a condition called Cannabis Hyperemesis Syndrome (CHS). Although rare, a small number of people, with long-term use of high-dose THC (weekly for two years) develop dramatic and intense cyclical episodes of nausea, vomiting, and abdominal pain. It can cause concern and lead to an ER visit with bloodwork and x-rays. This condition is believed to be caused by an excessive stimulation of the cannabinoid receptors (those binding to THC) in the gastrointestinal tract. Interestingly, sufferers find that multiple hot showers each day can temporarily relieve the symptoms.

“The cause is … regular use of cannabis from a fairly early teenage years,” McKay said. “It tends to be really high concentration cannabis use as well. So higher THC concentrations and typically lower CBD concentrations.”

This condition can lead to negative health effects including esophageal tearing from excessive vomiting, persistent nausea, dehydration, weight loss, and electrolyte imbalances. “The only solution is to stop using cannabis,” McKay said. Some patients [with severe abdominal pain] might end up having “exploratory surgery” to look for a cause and end up with an appendectomy. Following the cessation of cannabis use, symptoms resolve within a few days to weeks, and in unfortunate cases, it may take several months.

The prevalence of CHS is not well known, with some studies citing 1 in 200 frequent cannabis users will develop CHS, to other studies indicating only 0.3% of the population is suffering from this condition. While overall CHS is quite rare, it is important to consider this potential outcome, as well as other potential side effects of heavy or regular cannabis use. To remain on the cautious side, consider limiting use, using lower doses of THC, and remember to “start low, go slow.” If you have a medical condition, talk to a doctor knowledgeable on cannabis as well.

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