Cannabis hyperemesis: A brief update

April 28, 2012

Dirk Hanson‘s post on cannabis hyperemesis garnered another pertinent user comment:

Anonymous said…

My son suffers from this cannabinoid hyperemesis. At this moment he is here at my home on the couch suffering. I have been up with him for 3 days with the vomiting and hot baths. He says this time its over for good. This is our third bout. The first two time we went to ER, they put him on a drip to hydrate him, and gave him some pain medicine and nausea medicine. After a few hours he went home and recovered. This time we went to Urgent Care, put him on a drip, pain med, Benadryl, and Zofran. He felt better. That was yesterday, today we are right back with the nausea, but the Zofran limits the vomiting. I’m hoping tomorrow will be much better. He hasn’t eaten for 3 days. He let me take a video of him at Urgent Care before treatment, and in the video he was heaving and begging himself with tears never to smoke again. My son has smoked for 14 years.

I reviewed several case reports back in 2010. The comment thread was robust (this was originally posted at the Sb version of the blog) and there was considerable skepticism that the case report data was convincing. So I thought I’d do a PubMed search for cannabis hyperemesis and see if any additional case reports have been published. There seem to be at least 17 new items in Pubmed since the Soriano-Co et al 2010 that I referenced in the update.

One in particular struck my eye. Simonetto and colleagues (2012) performed a records review at the Mayo Clinic. They found 98 cases of unexplained, cyclic vomiting which appeared to match the cannabis hyperemesis profile out of 1571 patients with unexplained vomiting and at least some record of prior cannabis use. The profile/diagnosis was created from the prior Case Report literature that I reviewed but unfortunately I can’t get access to this paper to tell you more.

The other thing to think about is the relative increase in case reports in the past year or two. As I think I commented at the time, this is typical of relatively rare and inexplicable health phenomena. The Case Reports originally trickle out…this makes the medical establishment more aware and so they may reconsider their prior stance vis a vis so-called “psychogenic” causes. A few more doctors may obtain a much better cannabis use history then they otherwise would have done. More cases turn up. More Case Reports are published. etc. It’s a recursive process.

I think we’re seeing this at work.

And as more cases emerge, separated in time and space, the denialist position of blaming a contaminated cannabis product (or bad bongs) gets harder and harder to sustain.

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107 Responses to “Cannabis hyperemesis: A brief update”


  1. Interesting stuff, I’d never heard of cannabis -induced vomiting before. Could it be that it’s some sort of an inverted U-shape, where small doses of cannabis prevent nausea (for example in people receiving chemotherapy), but larger chronic exposure causes vomiting (and different people have a different dose-response curve)?

    Like

  2. HCA Says:

    The hot baths and showers are what catches my attention, especially the independent convergence of so many patients on them and the apparent relief they offer.

    Maybe it’s all in their heads, a side-effect of whatever underlying biochemical problem leads to all this. But since I’ve never worked with an endothermic species, the effects of temperature are always in the back of my mind. Maybe there actually is some physiological reason why it works, which could help unravel the underlying pathophysiology? Perhaps something like two different, competing pathways with different thermal sensitivities (Q10) and/or thermal optima, such that only above some critcal temperature does one reaction start outcompeting the other? Maybe some key protein denatures above a critical temperature?

    It’d be interesting to measure the body temperature of a sufferer as they warm up in a bath, and see if there’s some consistency in how hot they have to get for relief (+2 deg core temp, +10 deg skin temp, etc.) Do regional applications of heat work, or does it have to be whole body?

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  3. Beaker Says:

    Perhaps that hot shower water on the back of the neck affects signaling in the area postrema (the vomit center). There are CB1 receptors there.

    The case reports indicate that whatever causes this syndrome, it is seen mainly in chronic smokers who use de chronic in high doses (i.e. bong Olympians). It takes weeks to go away after cessation, so a metabolite could be the culprit, or receptor desensitization.

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  4. physioprof Says:

    Sounds horrible. My bet is on receptor desensitization. The one time I felt like I ODed on weed–I ate too many brownies made with wheelchair pot–I didn’t feel any nausea, just like I was gonna pass out if I didn’t sit down.

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  5. drugmonkey Says:

    Thanks to everyone who sent me the article!

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  6. Kaviani Says:

    I will venture that “herbal incense” is highly probable here. Most herbal incense users will not admit to authorities what they really did ingest; “just pot” is the common answer.

    I know plenty of people who have smoked since the 70s and enjoy hot baths who have never had this issue. If it’s not a synthetic product inducing such a reaction (and believe me when I say they most certainly CAN), it’s bound to be drug interaction…possibly with another newfangled jolly like kratom, kava, woodrose, etc.

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  7. DrugMonkey Says:

    “herbal incense” is *highly* improbable for the first few case reports to emerge (discussed in the prior post). 2004, 2005ish. Simonetto et al searched records from 2005-2010 but unfortunately do not present their findings by year.

    also, if you look at comments on dirk’s post, the self-confessions and the friend/relative comments all say “pot”. no reason for them not to mention synthetics, especially if you review the comments to my posts, Abel Pharmboy’s posts and many other online discussions of synthetics…. nobody but nobody seems shy about accusing K2/Spice type products of all kinds of bad effects, especially for the users who defend (as always) their blessed marijuana. I see no basis whatsoever for your claim that people will deny using the synthetics where there is at least a chance of claiming they are legal products.

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  8. Beaker Says:

    CB1 blockers can induce vomiting. Those affected by cannabis hyperemesis report that smoking more dope in the morning relives the nausea. So, what we have here is some sort of down-regulation of signals downstream of CB1, which is reversed by heat or new agonist.

    Like

  9. Drugmonkey Says:

    Possible indication for FAAH / MAGL inhibitors????

    Like

  10. Beaker Says:

    Possible indication for FAAH / MAGL inhibitors????

    The cure for cannabis hyperemesis is to simply stop smoking dope. Perhaps those inhibitors would make the withdrawal period less unpleasant, or they could prolong it.

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  11. Sounds from the above like the cure is wake-and-bake.

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  12. Beaker Says:

    wake-and-bake

    One of the Comradde’s famous recipes: wake, bake and grate!

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  13. Seanzy Says:

    I am 17 years old and I have been smoking cannabis 6-10 times a day, every single day, without miss. I recently br0ke up with my girlfriend of two and a half years, just to realize 3 days later that it was the weed influencing my thoughts. I got back together with her and promised to stop. I am on my second day of complete sobriety and I have been throwing up non-stop. Yesterday, I threw up at school 3 times in less than an hour and 5 times after school, 3 of which were at a Starbucks bathroom with less than 5 minute intervals in between, the other 2 episodes occurred at my house with about an hour in between them. I have realized that exercise, for me, actually makes it worse. I cannot stop thinking about how much better I could sleep and live my daily life if I were to just smoke once. I need help. This article has definitely help me understand what’s going on with me right now.

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  14. I need help.

    I am not a physician, but you should go to a physician right away. They can prescribe you anti-emetics that will keep you from hurling constantly while you detox.

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  15. Drugmonkey Says:

    Also seanzy, sounds like you have discontinuation emesis whereas the subject of this post is a syndrome that appears to accompany smoking-as-usual. Point being that if you are going through acute withdrawal effects there is a good chance things will peak then start to remit over days. A week to ten days perhaps? But I’ll agree with PP that you should find medical assistance. If nothing else your county health dept probably has a hotline that can point you somewhere. You took the most important step, no shame in getting help to make it all the way.

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  16. Isabel Says:

    “sounds like you have discontinuation emesis ”

    Or something unrelated? I have never heard of “discontinuation emesis” when ceasing use of cannabis.

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  17. drugmonkey Says:

    google it isabel

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  18. Dude, Loonabel never heard of it. Don’t you know that means it doesn’t exist?

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  19. Isabel Says:

    “This article has definitely help me understand what’s going on with me right now.”

    How did it even relate to his case? It’s a classic case of MISunderstanding spread through the internet. DM it’s not a common symptom anyway. Nausea maybe, but not extreme vomiting. I’ve seen lists of withdrawal symptoms many times; I don’t feel like downloading crazy articles about rare cases right now. I don’t know what you are trying to accomplish with these posts about rare cases.

    They get picked up by others. Just now googling I came across another blogger discussing your posts about cannabis hyperemesis and all these commenters saying “my boyfriend has this!” and “this article is true people, I have this exactly and I never knew what it was!” Soon DM the number of reported cases is going to skyrocket I think.

    And anyone suffering from constant vomiting should seek medical attention immediately.

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  20. Beaker Says:

    DM, I don’t think the case reports indicate a clear demarcation between emesis during “smoking-as-usual” and that triggered by withdrawal. It sounds more like different degrees of withdrawal. Some of the reports indicate that daily heavy smokers experience the worst emesis just after they wake, and to relive it they bake and/or take a hot shower. Hair of the dog and all that. The most severe cases–those which lead to an emergency room visit or a few days in the hospital–are also very likely to be in withdrawal because they are unlikely to be hitting the bong while in hospital. Those hospital cases are also the most likely ones to appear as published case reports.

    I didn’t see a single case report where the patient said something like, “I took a couple of big hits and then began feeling nauseous…”

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  21. drugmonkey Says:

    DM, I don’t think the case reports indicate a clear demarcation between emesis during “smoking-as-usual” and that triggered by withdrawal. It sounds more like different degrees of withdrawal.

    you could be right.

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  22. Isabel Says:

    Meanwhile:

    http://www.guardian.co.uk/world/2012/may/14/mexico-drug-cartel-massacres-analysis?newsfeed=true

    This weekend’s discovery in Mexico of 49 headless, handless and footless bodies dumped alongside a road just outside the northern industrial hub of Monterrey was the worst event of its kind, but it was far from the only one.

    Last Wednesday, 18 mutilated bodies were found in abandoned vehicles near the country’s second largest city, Guadalajara. The week before that, nine bodies were hung from a bridge, and in another case 14 severed heads were left in ice boxes outside the local government office in the north-east border city of Nuevo Laredo.

    The federal government issued a statement following the latest incident in this spate of mass murders, blaming the cartels for “unleashing inhuman and inadmissible episodes of irrational violence in their criminal dispute”.

    Most independent observers, however, question the portrayal of the horror as mindless. They tend to put the massacres firmly within the dynamic of the inter-cartel rivalries that form a core part of the violence that has killed more than 50,000 people since President Felipe Calderón launched an offensive against the cartels in December 2006.

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  23. drugmonkey Says:

    That is horrendous Isabel. You’d think pot smokers would be so horrified at what they cause to happen that they’d all just stop buying pot. I wonder why they won’t?

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  24. Isabel Says:

    “That is horrendous Isabel.”

    It is fucking unbelievable isn’t it? Actual 21st century North American news stories that include sentences like “14 severed heads were left in ice boxes outside the local government office…”

    But the rest of your comment is asinine. It couldn’t be organized from the ground up anyway one user at a time- ion the other hand you are in a position to try to spearhead such a campaign but I don’t see you lifting a finger.

    I wonder how historians will look back on the anti-racists, leftists of all stripes, faux-hipster bloggers and diversity promoters who completely turned their backs on this decades-long human and civil rights travesty. Who treated it as fodder for FWDAOTI and little else. Oh, and yeah, a nice paycheck from the government.

    Keep spreading your scare stories, Drugmonkey. The actual sufferers of cyclic vomiting syndrome are not exactly thanking you though.

    http://cvsa.websitetoolbox.com/post/Cannabis-5614043?trail=30

    Finally, here’s a rant for you. It perfectly captures my feelings about people who think Obama’s references to his drug use are unimportant or even endearing, and who make cheech and chong style jokes whenever the subject of cannabis comes up.

    http://blog.nj.com/njv_paul_mulshine/2012/05/penn_jillette_skewers_obama_on.html

    Like

  25. Isabel Says:

    Moderation????????????

    And I was JUST about to compliment you for not moderating me and others. I’m disappointed. Please don’t destroy my faith in your tolerance of opposing views.

    As you can see from my last comment, I was not (or at least not intending to be) off topic, either. Hopefully my comment in moderation will make those connections to the OP and recent comments clear.

    According to the blogger I mentioned above (it was addiction box blog, or some such name) you, Drugmonkey, are credited for spreading the word on this supposed new syndrome. And googling the news stories over the years, most wait to put the part about rarity, or possibly non-existence, in the second or third paragraph.

    I also see that these reports, along with the feverish comment threads, have been published on-line and discussed in blogs since 2004. Yet we still don’t have large numbers of actual confirmed cases, nor do we have any idea what is going on in the body to cause these symptoms. And now I find out on my own that other cvs sufferers do the bathing thing – this strange learned behavior is not even special to the few cannabis user cases.

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  26. Isabel Says:

    Maybe it is the links? I hope so, DM. But I thought it was 3 links or more cut-off? Now even two links? Or the totality of links in recent posts? Well, I’ll try no more than one link at a time in the future.

    Like


  27. Hey Dirk to me Cannabis is pretty safe but I have personally seen a guy hit a really dirty bong and then pass out and fall down. He was smoking low quality hash with tobacco so that could be a factor too.

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  28. Isabel Says:

    I wondered who Dirk was, then scrolled up to the OP, and further realized I had already stumbled across his blog.

    “They get picked up by others. Just now googling I came across another blogger discussing your posts about cannabis hyperemesis ”

    I also see he has already linked back to this blog post. Scratching each others’ backs I guess. Keep up the hype!

    His blog is filled with these kinds of bogus-sounding anonymous anecdotes. More like a alternative therapy blog than a science blog.

    Like

  29. Kay Says:

    The past year I started smoking a lot more than ever before.
    I’m 21, and every single morning I wake up with the worst upset stomach. It gets all the way to the point where I’m running to the bathroom to throw up and nothing ever comes out. The doctors think its in my head. Awesome. When this first began happening I would just make myself throw up but once I began it wouldn’t stop for hours and I had to be taken to the emergency room. I feel like I’m dying!! But of course I feel completely better when I go smoke. It’s insane!

    Like

  30. drugmonkey Says:

    It isn’t “insane”, it’s pharmacology. So far the case reports show that the best chance of stopping the vomiting is by stopping the cannabis use. It seems likely that smoking to relieve the nausea has the potential for a vicious cycle. Note, this assumes what you are experiencing is indeed cannabis hyperemesis…not sure how much your doc has already excluded.

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  31. Jonathan Says:

    Is this the same effect you can induce by smoking cannabis after drinking alcohol? When I was young that was a reliable way to spend all night heaving bile into the toilet, reproducibly. Oddly, reversing the combination (cannabis first, then EtOH) never caused it.

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  32. drugmonkey Says:

    This is not an acute syndrome. Check the links in this post, scan a Case Report or two.

    This is clearly an outcome of long term consumption. There is a hint, as with this posting from a sufferer, that on a daily basis the symptoms come on with length of abstinence and can be alleviated with further cannabis use.

    It sounds very much like classic pharmacological tolerance or downregulation in response to chronic exogenous drug exposure. As we say, further laboratory investigation is needed!

    Like

  33. drugmonkey Says:

    Another set of four Cases

    http://www.ncbi.nlm.nih.gov/pubmed/22480624

    Like

  34. treasurecrow Says:

    No matter what your views or politics are on pot, or whether or not you believe that Cannabinoid emesis syndrome is real or not ,,,,it is very important that we pay attention to this issue . Two reasons. One- cannabis may be a trigger for cyclic vomiting syndrome, just like red wine is a trigger to migraine sufferers. Two-( this is where the politics and true travisty occurs) The Healthcare system treats a cyclic vomiting syndrome episode differently, without regard for the torture a sufferer is in once a blood test reveals cannabis in the system.

    It took two years, many tests, and eight cyclic vomiting episodes before my 21 year old son was diagnosed with cyclic vomiting syndrome. Please, don’t confuse nausea in the a.m. or a loss of appetite with this illness. An episode of C.V.S. is a dehibilitating illness that renders the sufferer unable to eat or drink, sleep or get any comfort. The nausea is relentless and the vomiting continues for days and the sight of blood is a sign of secondary damage to the esophegus. Left untreated, a sufferer is in agony and risks severe dehydration and potassium deficentcy. Thats what happenes when the human body does not eat or drink for more than four days.

    Each episode my son would lose over 35 pounds. By the seventh episode, the e.r. had learned of the protocal for treating C.V.S. and were able to help my son abort the episode before the blood and damage and he came out of it fast. On his ninth episode in two years,,,they sent him home,,, after hydrating him through I.V. with a little copy of a study on Cannabinoid Emesis sydrome. We had to fight to get the propper treatment just because THC showed up in his system. This is not fair to sufferers and puts any research done on this terrible illness back. oh it is easier to blame the victim.

    Pay close attention to where this goes,,, if not for the real C.V.S. sufferers, for another excuse to blame an insignificant weed for the worlds problems. That said,,, we hope beyond hope that it is that simple,,, that all he has to do is stop smoking,,, that will be easy, but how horrifying, if beacuse of this connection people are not treated and further research is not done, and a system says see,,, it’s all your fault.

    Like

  35. Bgall Says:

    I found out about CHS this past Monday, during one of my vomitting / nausea episodes. I’m a regular at the ER, and the case studies presented often match my symptoms to a tee.

    At 4am on Wednesday morning when my symptoms began flaring up, I rushed to the ER for relief. They are all well aware for my medical history, but couldn’t believe I had CHS because they never heard of it.

    Amidst my pain, I pulled up every scholarly article I could find to draw similarities between my symptoms and the case studies. My doctors still didnt believe in CHS and continued to give me non effective medicine and unnecessary tests. (I’ve had 2 ct scans at this hospital this year, and an endoscopy in July).

    3 miserable days later, I’m still in the hospital. They still dont have a diagnosis, and the head attendant admitted my theory (CHS) looked the most plausible.

    Daily / chronic smokers – we have to slow down and educate each other! CHS is pure torture!

    Doctors / nurses / Emergency caregivers – please read the literature currently available on CHS and write more articles detailing your own experience!

    Like

  36. Danielle Says:

    Im 17, with CH. Cannabis hyperemesis IS pure torture. Last month, around the 11th I woke up puking along with diarrhea. No abdominal pains until later. I thought it was from anxiety about going to a festival. I’ve been smoking every day for 6 months or more until this happened. I would get hot then cold constantly, getting nauseous around 4 in the morning (it’s 4:40am right now, I puked at 4 and have been awake since) also around 2/3pm and sometimes before bed. I vomit bile, and when I feel nauseous like this I lose my appetite completely.

    I was hospitalized about two weeks ago due to me not being able to drink enough fluids and eat enough. They put fluids into me and prescribed me zofran which doesn’t work much. After I got out of the hospital I was feeling much better and there was a time I didn’t smoke for 5 days. I started smoking again, and my symptoms came up again yesterday morning.

    I am highly considering quitting smoking just due to how shitty this is making me feel. It’s torture.

    Like

  37. drugmonkey Says:

    “considering”? Why would you *not* stop?

    Like

  38. Rizzle Says:

    I def have this. 28 yrs old, been smoking everyday for the past six years with maybe a few days of time off of smoking . Made a trip to hawaii to get sober. I have been in pure hell for six days, went into the er on the 4th w severe dehydration. Double dose of zofran? Ha. Puked thru it. Jello makes me puke, anything really. The only thing that helps are hot baths, i even sleep in the tub sometimes. Either sweating my balls off or really cold. Honestly i went thru zanex wdrawl which is worse than heroin wdrawl and this CES takes the cake as far as misery goes. Its like starving to death while being dehydrated, anyone who says it isnt real is a complete fool. I refuse to ever smoke again if i can only get through this. Up all the time. I sleep maybe 2 hrs a night , usually waking up about 5 times. I WILL make it through this, and post again letting everyone know when i am again able to eat / drink fairly normally. God have mercy on n e one else going thru this hell that is CES

    Like

  39. Spiny Norman Says:

    “You’d think pot smokers would be so horrified at what they cause to happen that they’d all just stop buying pot. I wonder why they won’t?”

    Look up Shell Oil and Nigeria (to take just one of scores of examples). You’d think people who drive cars would be so horrified at what they cause to happen that they’d all just stop buying gas. I wonder why they won’t?

    Or look up “blood diamonds,” and if you’re engaged or married, consider the possibility that you bought one, and the consequences that ensued.

    Like

  40. Spiny Norman Says:

    …and then there’s the tobacco industry. One person killed for every $10,000 in profit.

    Like

  41. DrugMonkey Says:

    It’s the great woman diamond extortion scheme to blame, not me man. I’m a victim of the system!

    Like

  42. Spiny Norman Says:

    You’re claiming that you’re deprived because she’s depraved?

    Like

  43. DrugMonkey Says:

    I just ain’t had a normal home

    Like


  44. Made a trip to hawaii to get sober.

    You made a trip to motherfucken Hawaii to get off weede?????

    Like

  45. CVS Sufferer Says:

    Evening all,

    I wont go on and on because if you are really interested in this syndrome you will follow Drug Monkey to the CVSA Message board. There is a LONG thread on this “theorised illness” and I encourage anyone who is interested in CHS or has the same symptoms to go there aswell. You will learn alot more than on here, that is for sure!

    @ Drug Monkey –

    As posted above in the comments sections “According to the blogger I mentioned above (it was addiction box blog, or some such name) you, Drugmonkey, are credited for spreading the word on this supposed new syndrome” Please, can I ask you head on over to the CVSA Message Board as above and take a read of what I have found. I have spent more hours than I dare to admit in researching this “theorised” illness cannabis hyperemesis. You see, that is all the journals are which you keep pasting. I am surprised you dont already know that though. It has been explained to me that the journals are merely published by a doctor who are “theorising” a new illnesses. In most of the “studies” the doctors have never even met the patients, this is especially apparent in the most often quoted 98 case study by the Mayo Clinic. Like I said, I have reviewed this study and others in alot of detail and they unfortunately confirm nothing.

    Yes I say unfortunately, I certainly wish the cure was so simple as quit something!! Alot of CVS sufferers are being treated terribly in ER’s due to the cannabis hyperemesis rumour, as one of the posted comments proves. Alot of people wrongfully quote Cyclical Vomiting and a possible cause being cannabis. Well it isnt……whether it unmasks the illness they do not know but it certainly isnt a cause! Here is a statement made by our own CVSA doctor due to the poor publicity being posted –

    “Recently, there has been considerable controversy over the role of cannabis in these patients. While “cannabinoid hyperemesis syndrome” has been touted as a new diagnosis, there does not appear to be sufficient data to implicate marijuana as a “cause” of CVS. In a recent review of 31 published cases, the average duration of marijuana use preceding onset of vomiting was just over 10 years; the long delay in presentation of symptoms following chronic marijuana use argues against cannabis being a cause for the vomiting. Also, long-term follow-up is lacking in case series of patients with “cannabinoid hyperemesis.” The acute administration of marijuana has been shown in animal studies to stop vomiting and cannabinoid agents such as dronabinol and nabilone have been used to treat nausea and vomiting due to chemotherapy. The effects of chronic marijuana use are poorly understood and whether marijuana use unmasks CVS is unclear; further prospective studies are warranted to address this issue. We currently recommend abstinence of marijuana while treating patients with CVS as this is a risk factor for nonresponse to conventional medications.”

    I am not posting this to argue with you drug monkey, for from it, I truly believe you think you are doing the correct thing but at the same time I dont think you realise the potential harm you are doing to CVS as an illness. Maybe there is such an illness called Cannabis Hyperemesis but it isnt Cyclic Vomiting like a few people state.

    That being said, like I say, I am investigating it from all angles. I post on all of these threads, blogs, to try and speak to these people who are suffering and learn more and maybe even help them. The symptoms they post are very similar to what I go through with CVS, although mine is most certainly not caused by cannabis…….also the hot baths, again please, this is another common misconception. Many CVS patients utilise hot baths with their illness and making this statement only causes even more problems for patients.

    I will end my long post ( I didnt intend it to be so long but while I was here lol) in saying if anyone is suffering from CHS please come for a chat on the CVSA Message board. We are friendly and will talk in detail with you about what you suffered from and how you are better from abstaining. I check a few different threads regularly so I am sure you have seen me if your looking. I have been able to check daily of late because after 10+ years of suffering with this awful illness, I have responded extremely well to the emperic treatment guidelines of CVS. If my doctor happened to come across this thread for example, he may have come to his own conclusion and I could still be going through hell proving it wasnt cannabis causing!

    Peace and good health to everyone!

    Like

  46. CVS Sufferer Says:

    It would appear I went on and on lol Sorry!

    I just hope you see I am not arguing but putting another side of the story across. I hope my post isnt deleted 🙂

    Like

  47. alex Says:

    I´ve been a smoker/grower for over 15 years. Started suffering from morning sickness a couple of years ago. I´ve also had a few episodes of incontrolled vomiting that took me several times to ER. I´ve been checked for everything. Colon, stomach, intestines, hormones, sugar in blood…. Everything seems to be fine with me. I read a few days ago about CHS and could not believe it.
    I´ve been a weed defender all my life. I love smoking weed, its part of my life damn it!

    I´ve cut down from 15-20 joints a day (mixed with tabacco) to 5.

    First morning after cut down has been today. Feel just as sick as any other day. Usually I smoke first thing after waking up. Today I haven´t and I feel a bit worse than usuall. Stomach cramping really bad right now.

    Ill try to keep a 5 joint diet for a week to see if things get better. If they don´t Ill go cold turkey for another week and see if theres any changes.

    I LOVE CANNABIS. But i hate feeling sick. I might have to quit. DAMN!

    Like

  48. alex Says:

    I would also like to say that HOT showers help a lot. Also Im very reliefed after burping many times.
    The sickness usually wakes me up in the morning.

    Like

  49. Beaker Says:

    I don’t understand the distinction between cannabis hyperemesis and chronic vomiting syndrome. Do people who don’t smoke dope get CVS? What is the evidence that they are different syndromes?

    CVS sufferer: I doubt that cutting back to 5 joints/day is gonna solve your problem. Try a week of cold turkey.

    Like

  50. alex Says:

    From what I´ve read cannabis triggers some type of CVS after years of heavy use. Really hope not .
    I´m at the second day of 5 joints/day (three so far) and the only difference is that I´ve gotten a lot shit done that i had to do. LOL.
    Stomach feels the like shit in the morning, fine the rest of day like always. Last episode of CVS has been over two months ago. I think I´ve had like 8 episodes in the last 2 years.
    Hope this info is helpfull to someone.

    Like

  51. alex Says:

    One other thing my longest CVS episdoe was like 10 hours but they usually only last 3 or 4. I get in the bath drop two dogmatil (SULPIRIDE) 100mg
    http://en.wikipedia.org/wiki/Sulpiride
    And feel like I´m in heaven in about an hour.
    The first two hours Im sitting in the toilet sweating, cold, puking and shitting.

    Like

  52. Drugmonkey Says:

    Was Sulpiride prescribed for that purpose or did you work it out for yourself?

    http://www.ncbi.nlm.nih.gov/pubmed/10405234

    Like

  53. Beaker Says:

    CVS is a general syndrome, which can be triggered by migraines, foods, or hormone fluctuations. It is most commonly seen in children, but adults can get it too. Good discussion here. The EM docs in the comments say that the anti-emetic droperidol is effective for stopping the acute symptoms.

    Adult CVS has multiple triggers in different people. Cannabis hyperemesis symptoms overlap with CVS, but it is not clear if they are separate entities or whether chronic use of large amounts of cannabis should be considered as just another “trigger” for CVS in susceptible people.

    I find it surprising that those who suffer from cannabis hyperemesis are struggling to decide between chronic vomiting and giving up pot. “Wake and bake” seems to be a common behavior among hyperemesis sufferers. Have any users tried postponing the first bake until, say, after lunch and a coffee?

    Like

  54. Drugmonkey Says:

    Coffee is not counter-indicated for CVS, Beaker?

    Like

  55. kat vessels Says:

    People suffering from nausea associated (or not) with weed. Thc causes gastric emptying. Eat first. I had cvs. Was prescribed marinol. Lmao.

    Like

  56. kat vessels Says:

    Btw. Didnt smoke but couldn’t afford marinol. Funny isn’t it, tbhat they can prescribed that but lock u up for the other. After two feeding tubes, puff puff pass plz

    Like

  57. alex Says:

    The Sulpiride was given to me during one of my episodes by the doctor.
    Its great stuff. Don´t know much about side effects. I´ve only taken it a few times. It does make you feel a bit horny, kind of strange. 100mg is the best dosage for a CVS episode in my case less wont do.
    I´ve heard people that take it for massive hang overs.

    I´m not that concerned with CVS as much as I am with the morning sickness. CVS has only poped out a few times and usually after very heavy dinners. Now I only have light dinners, I seem to sleep better and haven´t had an episode since.

    Can´t take Sulpiride every morning

    Like

  58. alex Says:

    Been awake for two hours. I feel great. Like if i could go run or play soccer or do anything. No sickness at all. Just came back from the bathroom. Hadn´t felt like this in the morning in a long time.
    Don´t know if its from cutting back on smoking but im going to keep the 5 joints a day diet as long as I feel this good.
    This will be the third day.

    Like

  59. physioprof Says:

    5 joints a day

    Pinners or fatties?

    Like

  60. drugmonkey Says:

    I love it when PP tries to act cool….

    Like

  61. alex Says:

    About 2-3 grams a day. I only plant hazes and sativas. Sometimes some kush or afghan but not usually.
    I was smoking 5-10 grams so its been a real cutback.
    Funny when u grow ur own weed tobacco is the most expensive stuff on the spliff than the paper and finally the weed.

    Like

  62. Lisa Says:

    My husband has been suffering from Cannabanoid Hypermesis Syndrome for 9 years and we only found out a year and a half ago what it was!! for all of you who think its a joke and its not the weed let me set the record straight IT MOST CERTAINLY IS!!!!!!!
    Our lives have been a living hell he started smoking weed at 14 he is now 32 and this started when he was 23..He has LITERALLY had a MILLION DOLLAR work up between three hospitals including MASS GENERAL nothing can be found wrong with him.Endoscopies, stomach emptying tests,cat scans, mri’s, blood tests, exploratory surgery, multiple hospital stays, HUNDREDS of ER visits, so much more, i have lost track …..He too can spend 12 hours a day in the shower!!!!!!!!! My anxiety is through the roof watching this, shower , throw up , shower , throw up er, hospital , er , hospital ………OMGGGGG I cant take much more. Thanks to one smart ER DR who had heard of the showering thing and happened to ask that question on one of our frequent visits and connected all the dots about this STOMACH Disease no one could figure out !! He quit smoking for three months and poof 10 years of BULL and pain and unknowing GONE he started back up again and here we are ,,,,,,he is a chronic smoker anywhere from 5-9 blunts and or joints a day !! NO KIDDING! every day , all day ……..its shutting his guts down…….I dare any of you non believers to live one day in my life and I can GUAREENTEE you , you will be re-evaluating your precious weed !!!

    Like

  63. alex Says:

    Lisa tell him to quit. Weed is great when it makes you feel good, but something that makes u sick doesn´t make sense. I feel great since I´ve cut back to 2 grams a day. I weight the bud in the morning put it in a baggy and when I ran out I don´t smoke any more till next day.
    I haven´t had an episode since, and the mornings are wonderfull totally nausea free.

    If I had known this years ago….. I´ve had a few episodes myself. Its interesting how we all end up in the shower or the bath.

    Also light dinners have been a big help for me.

    He should try to cut back.

    Like

  64. Qwerty McJones Says:

    Thanks for the comment, Lisa. I have been going through this once in a while since I started smoking a couple years ago. I’m am everyday smoker (nowhere near what you all smoke, I’m a lightweight I guess) and have been amazingly sick for the last handful of days. This is unbearable and in the last couple hours have come to the conclusion tha weed is most likely causing this. I am up at 2 in the morning (now 4:30) and I can’t go to work on days like this. I smoked twice since 2 because of the discomfort and nausea but the smoking seems to have made my symptoms worse in the last couple hours.

    I’m putting it down as soon as I get back to normal health and hopefully can find an alternative to make me feel better in the meantime. Pepto Bismol and other things don’t help whatsoever.

    If it is indeed weed, I’m done with it forever. Plain and simple. Thanks again for the comment, you may have spared me future years of pain and suffering.

    Like

  65. Qwerty McJones Says:

    Btw, I’m having pretty much all of the symptoms described above by other people.

    Constipatn, nausea, one day of vomiting, hot flashes, volative body temperature, hot showers are one of the only things that helps, etc.

    I WILL UPDATE AS THINGS PROGRESS OVER THE NEXT FEW DAYS.

    Like

  66. Qwerty McJones Says:

    Constipation*

    Like

  67. Joan Says:

    How do you make someone believe this ! My son refuses to . Same story as all others.

    Like

  68. Joan Says:

    This all started back in late 07 it was about the time all the medical stores opened .my son get pain and then vomits and showers. we have done over 10 CT scan upper lower scopes x rays chrones testing , all blood work done. he was be in the hospital for over night stays 5 times and over 30 visits to the er. Hospitals bills in the 10 thousands he even had a person have to stay in him room do to them thinking he was going to kill him self because the pain was so bad. the refused to treat him with any pain meds because they couldnt find anything wrong with him.

    he gets very upset because no one will help him ? they cant help him if they dont know whats wrong with him…..this has been so hard for me and the rest of our family. he refuses to belive that this could be cannabis causing all this. The hospital sent us to a rehab because they said he was there only to get pain killers and has a problem, i went to the place they sent us and they were no help at all they never even herd of CHS and could only treat him for opits , which the hospital was giving him to treat his pain.
    i do understand the opits asbeing a problem but nothing stops the pain. Im lost with what to do. I fell so helpless i dont understan why he doesnt get it ……………..he cant even live a normal life and do to this our family cant . I have printed all theses story to share with him , im hoping it will make him understand that yes he does have CHS

    Like

  69. drugmonkey Says:

    Joan- I’m not a clinician or therapist so I can’t really be specific. In more general terms, well, sounds like he’s addicted. And addicts throw up a lot of cognitive defenses to avoid considering it might be their favored substance doing them the harm.

    At the very least you should now have some references to studies which you can mention to any doctors that treat your son in the future. They are not all aware of such things the instant they are published after all. Always useful to do some advocating if you think the medical staff have not considered this possibility.

    Like

  70. Lisa Says:

    JOAN: My heart is breaking for you!! You are living my life !! A life of uncertainly and at times PURE HELL!……The only way your son is going to believe this is CHS is if he quits for ONE MONTH …….PLEASE PLEASE PLEASE tell him to quit for one month to “prove everyone wrong ” that its not the weed and when he NO LONGER has the attacks and his life is NORMAL again , MAYBE that will do the trick …., maybe not…My husband almost DIED twice 3 and a half weeks ago , it was one of the worst attacks ever, lasted two weeks of ER, shower , vomiting anxiety, heart stopping, Blood pressure dropping to 60 its been a nightmare to say the very least ……..He quit that day 3 and half weeks ago and for the last week , after two weeks or so for his stomach to heal , he has woken up every day PAIN FREE , ANXIETY FREE, SHOWER FREE and HAPPY!!!!!!! Please feel free to contact em for support or questions or just to vent , ILL PRAY for you and your family becuase the family suffers just as much !! if not MORE!!

    Like

  71. alex Says:

    Its been over a month with 1-2 grams a day and no attacks. feeling great!

    Like

  72. Lisa Says:

    I wondered how Joan’s son is doing ?? Joan?? Alex are you still standing strong? Attack free??

    Like

  73. sam Says:

    I have been a pot smoker for 6 years and today i woke up with all the symtoms and had to be taken to the ER. The doctor informed me about CHS and im convinced i have it. I smoke about 1 to 3 grams a day. this is the second time i had to be taken to the ER in 5 months both times for the same reasons. The first time i went in they had no clue and a bunch of tests were done but nothing helpful came of it. I hope it is not weed but im almost 100 percent sure that it is. It sucks and it is hard to quit something you enjoy and makes life easier but unfortunatly i think it must be done 😦 im 20 and live in canada

    Like

  74. Ariel Says:

    My roommate suffers from CHS, it has been a long process of getting her to accept that smoking is the cause of all her problems, but after suffering from severe CHS for over 5 years she is finally beginning to actively take steps towards stopping smoking. I know to most pot smokers this seems ridiculous and untrue, but I am a HUGE pot smoker myself and also had to come to the realization that if my roommate didn’t stop she would die from this. It took a lot of time but I basically read every case study out there to her on CHS and she is finally believing that it is the cause of all her pain and vomiting. We have gone to the hospital numerous times throughout the years, and racked up huge medical bills and have gotten no results. After stopping smoking, everything has gotten better, she is healthy and happy and has never been better

    Like

  75. Cvser29 Says:

    I have had cvs all my life, and was formally diagnosed 8 years ago (after years of testing, and many many doctors who gave up on me). I was always against drugs, but after going through every single medication recommended for CVS, and no results, I decided to ask my doctor for marinol (synthetic THC), and guess what? It is the most effective antiemetic I have ever taken. The problem is that it takes about 2 hours to kick in. Imitrex nasal spray seems to help too, but only for a few minutes. I take them together and I am able to abort most episodes. There is a history of heart disease in my family and I have high blood pressure, so the assumption is that MM would be a much better replacement, if only it were legal in my state. Please do not be judgemental of people who are seriously sick.

    Like

  76. Cvser29 Says:

    Ps. Marinol does not cause HBP, I was referring to Imitrex, which helps me until marinol starts working. CHS certainly needs to be ruled out when diagnosing CVS, but the two should not be confused. If MM helps some people with CVS it should be considered.

    Like

  77. Ariel Says:

    My roommate has been misdiagnosed as having CVS for the past 5 years, smoking only makes her worse, for those of you who don’t believe in this, just google it and read every case study out there on it like I did, it is a legitimate diagnosable syndrome that gets misdiagnosed as CVS all the time because most people don’t tell their doctor that they smoke weed all day every day. Your CB1 receptors in your brain and peripheral nervous system are triggered by THC, which in turn inhibits the peristaltic motions (wave like motions) that move food through your stomach and gastrointestinal tract. This causes delayed gastric emptying, so your body responds by having to get it out somehow- vomitting, and crampy colicky stomach pains. It is yet to be determined why hot baths/showers ease the nausea and pain, but its seems to be the case with every CHS patient. The weed we smoke nowadays is 30-50 times stronger than what it used to be so it is not unrealistic that our bodies would start developing adverse affects from it. Every time my roommate gets sick she cant keep anything down, not even water for at least a week, she gets so dehydrated and her organs get so depleted that they will eventually stop working. She becomes so potassium deficient that her heart slows down which is very scary. So this is not a laughable matter and it is a REAL thing. She has been in denial about it for a very long time, which Im sure most people would be, but the fact of the matter is that if she doesnt stop smoking she will never get better and this will limit her life forever, she cant go anywhere, especially if there isnt a hot bath somewhere near for her to run to. Just do some research if you dont believe me, its not that hard, the scientific facts are there and really cant be disputed. If anyone suffering from this wants to get better, the reality of the situation is that you just have to stop smoking, it sucks, it really does, smoking weed is awesome, but if it will eventually kill you then i think its worth stopping

    Like

  78. Ariel Says:

    And for those of you who don’t believe, read the studies about people who have suffered from this for years and then finally decide to quit smoking and then never have a problem again, i dont think that is just a coincidence, it is because smoking weed was the root of the problem. To CVS sufferer, if you dont smoke weed you probably do have CVS, but for those of you who are too ignorant to believe in CHS I feel sorry for you, because your suffering will continue and your medical bills will keep growing as they keep testing you and doing things for you that truly will not help because the only answer is to stop smoking. This is a NEW syndrome, yes there is not a lot of research on it yet, but there is research on it! Think, there was a time when there wasnt research on things like CVS and even cancer! So to discredit this as something stupid and theorized is just ignorant on your behalf, if you can’t give up a drug for your health then that is your own problem, but ive lived with my roommate and taken car of her through her episodes for 5 years now, and let me tell you, when she gets sick, it affects a lot more people than just herself, and it is very hard on everyone. So do the people in your life a favor and just give it a try, stop smoking for a little bit, if the doctors in the hospitals havent found a cure for you yet, dont you think you should be willing to try anything at this point? Just quit for a while, just give it a try, and if it doesnt work for you then CHS is not what you have, but there are a lot of people suffering from it and there will be more and more research on it as time goes by.

    Like

  79. DethWench Says:

    I’m an epidemiologist with CVS. I have no NIH funding right now, but hey, who knows what tomorrow will bring?

    It is very easy to determine if cannabis helps or hurts you if you have a vomiting problem. You do a case-crossover study on yourself. That’s where, when you get diagnosed, you ask yourself, “What have I been doing for the last year? Smoking pot, or not smoking pot?” If you have been smoking pot, quit for a year. If you haven’t been, start for a year.

    Why a year? Well, in order for me to see if these vitamins I’m taking now actually work, I’m going to have to compare my number of ER visits in the year before I started the vitamins (n=3) to the next year. What if n=3 next year? or 2? or 1? Well, the rate is so low, it is hard to tell. I’d say if it was =3, I’d stop because they are expensive.

    My point is that even an epidemiologist experimenting on herself has work to do on this one. The study designs on both CVS and CHS that introduce interventions (like quitting pot) suffer from 1) recall bias and 2) too short of a follow-up (not to mention a ton of other problems, but these are the most obvious). Notice that in the Simonetto study, “Follow-up was available in only 10 patients (10%). Of those 10, 7 (70%) stopped using cannabis and 6 of these 7 (86%) noted complete resolution of their symptoms.” This is 10 out of 98. No offense, but that is not a very good study. Worse, in the abstract, they point out the rates of abdominal pain and showering, implying those are factors that distinguish CHS from CVS – they are not. CVS people (pot-smokers or not) have abdominal pain and shower, too. The Mayo Clinic has a pretty building in Rochester that I love to visit when I’m back home, but that doesn’t inoculate it from lousy study design.

    I’ve noticed there are mostly case studies on CHS and a few case series on CVS. Without doing proper longitudinal studies observational (cohort) studies on these individuals, or even some case-control studies, scientists jump to interventional designs such as making people quit pot or take amitriptyline. That can only confuse the issue if we have not really worked out the natural history of CVS or CHS, which you can’t do without long-term follow-up.

    Everyone is arguing here, and we all sound like misguided scientists. We all probably have the same thing, it just has a different natural history in us. Since hormones change over time and cannabis has a hormonal influence, sometimes it helps, and sometimes it hurts. When it helps, do it, when it hurts stop. Just do your own case-crossover study on yourself. Why? Well, just read this blog! NIH isn’t going to fund it.

    We don’t know if these people who quit cannabis due to CHS in their 20s get CVS later in their 40s and have to take it up again. We don’t know if people who get CVS in their 40s who aren’t pot-smokers can benefit from pot. Realize all the comments here are either 1) I stopped smoking pot and my CVS was fixed (or I wish a loved one would do this so his/her CVS was fixed), or 2) I had CVS and started smoking pot/taking Marinol, and then it got fixed. Doesn’t that imply something of the same mechanism?

    Do you think NIH will actually fund a study so we are followed longitudinally and they actually figure this out? I’m not holding my breath! No one cares about us. A nurse laughed at me in the ER when I asked for morphine. Patient advocacy did rush in to prevent the malpractice suit I’m sure they were imagining when they saw my MPH from the U of MN.

    If this bothers any of you, e-mail me – my webside is http://www.dethwench.com. PCORI is offering beaucoup bucks for studying Patient-centered Outcomes Research – read their definition of it if you wonder what this is: http://www.pcori.org/research-we-support/pcor/. If you agree to be surveyed and studied, I can put in a grant and do it, because I am a patient myself and am sick of going to the ER. I’d like to figure out what to do about it. We might as well work out this CHS vs. CVS thing along the way.

    Like

  80. DrugMonkey Says:

    The Simonetto paper was a records review, not a prospective study. So you should extend a little consideration for that.

    Like

  81. DethWench Says:

    Good point, but I respectfully disagree. They were clinicians treating patients. Lack of clinical follow-up records on so many patients means they said the patient should stop smoking pot, the patient did for some weeks, then their clinicians did not make a point to follow them to make sure it stayed okay – especially through a few menstrual cycles for women. I just think they should have made a point to follow them if they told them to stop smoking, at least for months if not a year. Their follow-up rate would then not have been nearly so small (even 40-50% would be reasonable).

    Like

  82. drugmonkey Says:

    Ok, but that’s an objection to the clinical practice and care. You made it about study design

    No offense, but that is not a very good study.

    which is what I was addressing.

    Like

  83. Alex Says:

    Worst attack ever!!! Started with light food poisoning
    And ended loosing 8 kilos. I’m in the hospital with
    Chs. Had to explain it to the docs. Going back to the shower.
    Catch u all later. Damn I’m sick. Been in hospital 3 days what can I do????

    Like

  84. Dan - Colorado Says:

    First of all I want to say to all of you non-believers out there that CHS is a very REAL disease! I have lived in Denver for the last 5 years and my symptoms started showing about a year after I got here. I have been using cannabis since I was 16 and never had any issues until about a year after I moved to Colorado. It started maybe twice a year the first two years then the bouts would be more severe and last longer. Since January 2013 I have had symptoms lasting anywhere from 4 to 12 days four times! I am just ending the current bout which has lasted 5 days.

    I found out about CHS when I told a co-worker(I work in the medical cannabis industry) about the hot showers being the only thing that cured my nausea and she then told me about one of her friends being a doctor and having experience with CHS. I talked with her friend on the phone and told her my symptoms and she told me that is was for sure CHS. I also was seeing a MD at the time and he put me through a battery of tests and told me that there was nothing physically wrong with me. He thought it was stress or a gluten intolerance, but then when I took him the information about CHS he scratched his head and said ‘You dont say”.

    I have never been so sick in my life the past few days – I mean during the height of the bout I am welcoming death and crying, balled up in the fetal position on the floor telling myself I would never smoke again. The only relief I would get is in the shower for about an hour at a time – then I would wait until the water heated up again and then hop back in. I just got back from the urgent care center where I begged them to give me IV fluids. The Dr. also prescribed Zofran to help with the vomiting.

    I quit using cannabis for about a month but then could not fall asleep at night so I would take a few hits and then that lead to me smoking again. I don’t know why I can’t quit – It’s like asking a Budweiser Rep to NOT drink a beer.

    This frequent vomiting cannot be good for my internal organs, esophagus and body in general. I think that a lot more people suffer from this disease than we think – just in a more mild form. Especially when we live in a state that has legalized marijuana and it is being engineered to be stronger in THC content. I have seen the good that this plant can do over and over again, but also I have seen the devastation that it can cause. I also wonder why none of my friends have experienced this dreadful sickness and I have – I have really cut down on cannabis use a great deal. I guess I will have to be done for good.

    Like

  85. Beaker Says:

    Dan, would you care to elaborate on how fast the CHS returns once you begin smoking again? You said you started up again with a few puffs before bed. Did the symptoms come back at that dosage? Or did the CHS only return once you returned to heavy use? If the latter, what constituted heavy use in your case?

    If the Zofran isn’t working for y0u, you might ask your doc to prescribe droperidol instead. If the anecdotal case reports are to be believed, antiemetics that target the dopamine system may work better for CHS than ones that target the serotonin system.

    Like

  86. Beaker Says:

    Another case report has appeared. The patient had been in and out of the emergency room 7 times, and none of the treatments they tried blocked his cannabis hyperemesis syndrome (CHS). Then they tried haloperidol, and the symptoms were alleviated. This result supports the previous anecdotal evidence that DA receptors are involved in CHS. Haloperidol acts acts as an inverse agonist at DA receptors in the chemoreceptor trigger zone.

    Like

  87. "Legalize it" type Says:

    What’s with the hysteria? A few cases a year of hyperememsis and the conversation turns to how ‘devastating’ this drug is, the echo chamber bias is deafening here.

    Like

  88. Beaker Says:

    None of my comments have been hysterical. CHS is fascinating from the standpoint of neuropharmacology–a frequent topic on this blog. And if a heavy chronic user comes into the ER puking up bile, it’s good to know that a shot of halperidol might shut off the hurling. The only person in this thread who has called it “devastating” is a CHS sufferer. If that’s not you, then party on dude.

    What’s hysterical on this thread are the deniers, those who say that CHS isn’t real–as if the fact that they don’t experience it proves it doesn’t exist.

    Like

  89. imDONE4sure (jayy) Says:

    Thank you for this article… I am 17 and been smoking chronic since I was 14 or 13 everyday up to maybe 15, 20 times a day. Joints, blunts, pipes, bongs, bubblers .. everything… last 2 years iv had slow down episodes like I would stop for a little mostly because school started up and every morning I would throw up bile.. i went to the doctor they did tests but couldn’t figure out what was wrong. i went back to smoking chronically and i just regulated the symptoms never felt 100 percent. just recently I am attempting to quit smoking all the way its been 3 days complete sober and I have diahrea, no sleep, alot of sweating, and only couple bites a day never a full meal.. also I been throwing up a lot, like right now I am starving but my stomach is this close to making me throw up in the next 30 mins. I will throw up to feel a little better than wait an hour than eat a couple bites of something. And it will most likely reoccur later.. the stomach pains are the worst.. also recently I noticed my hands tremble.. and I think its because of the amt. Of thc I was inhaling and am not getting now.. I wish everyone the best of luck I love marijuana but I hate the downsides.. so now I will quit forever! These withdrawals are very real.. I would not wish them upon anyone… also I used to be a LEGALIZE IT type a guy but now I’m not so sure.. 🙂 :/ happy quiting everyone…

    Like

  90. misswakenbake Says:

    Another CHS sufferer here from Australia.

    Most cases I have read online are from long term users, however I have only been smoking for 3-4 months tops (around 2 grams a day).

    It started off as only morning sickness, which a nice wake n bake seemed to alleviate all nausea and I was great and functional for the whole day.

    2 Weeks ago, no amount of bongs/pipes could ease the nausea and I ended up vomiting with excruciating nausea lasting all day and night. After 3 days and I was still vomiting, unable to eat, sleep or even tolerate water, my fiance decided we had to go to the ER since I was very frail and weak.

    The first ER in Werribee I went to was very bad. I was in excruciating pain from constant nausea and vomiting, was so very dehydrated from not being able to eat, drink or sleep for 3 days straight, and could barely walk from being so weak. After waiting 5 hours in the ER was about to give up but I collapsed trying to leave, I was given maxolon tablets(anti-emetic), panadol and neurofen and was told I was young and I could tough it out…. I could still hold nothing down. They finally gave me an IV fluid, a prescription for Zofran and more maxolon through IV. My fiance was researching CHS the entire time I was there and tried to discuss the condition with doctors and nurses.. however they refused to hear us out and treated us like trash bag drug abusers and wanted me discharged immediately. 1 nurse who was taking out my IV catheter had the nerve to straight out tell me she had no empathy for marijuana users.

    After being discharged with Zofran, which was ineffective, my fiance took me to a different ER because I was still in the same condition, if not worse than before. I was given IV fluids with potassium, more maxolon and zofran (they really are ignorant and do not listen when we tell them that anti-emetics are ineffective for this condition) and ended up staying the night since nothing they tried were effective. My fiance really had to fight the nurses and doctors, who still were very ignorant on the subject and their only solution was to pump me with more anti-emetics.

    My fiance still continued to research the condition and learned that hot water baths have helped other sufferers alleviate their symptoms. We also found some patients found benzodiazepines were effective at sedating patients so that they could sleep.

    Doctors refused to give me any benzos, but it wasn’t until 1 fantastic ER nurse who had a son who was a smoker, was able to show compassion and discuss with us the condition. She convinced the doctor that it was ok to give me 1 diazepam to sedate me, and I was able to sleep for the first time in 5 days. But it would only last for a couple of hours when I was waken with nausea again. They discharged me next day with a px for 4 diazepam tablets only (they are very strict in giving those in australia it seems?)

    For a week straight after being discharged I spent 16 hours a day in a bath of hot water. It was my only relief, and I would take the diazepam to knock me out so I could sleep for a couple of hours at night before waking and rushing to the bath tub again. Rinse and repeat. I was able to tolerate tiny amounts of powerade and food ONLY whilst being in the bath.

    A week after all of this I was starting to feel better, eating little bit more everyday. We thought we would be in the clear and it would be ok for me to be around passive smoke since it has been a couple of days since my last episode, and I was way across the other side of the room so it was very indirect passive smoke.
    Next day, full blown symptoms again so I went to my GP still throwing up, and begged for more benzos for sleep relief. They gave me a shot of maxolon (sigh) but was also given 10 tablets of diazepam this time.

    I was able to recover faster this time, 3 days of being in the bath tub and using 2 diazepam tablets to completely knock me out so I could sleep a full 8 hours before rushing to the bath.

    Yesterday I tried going to the gym, to regain some strength since I had unhealthily lost 10kgs very fast. I felt nauseated and vomited, but it has settled.

    I am still having trouble eating, it seems to bring on the nausea still, and I am still nauseated slightly in the mornings. I am glad that this site and others exist otherwise we would not have ever known about it since doctors are very clueless on the subject and I would probably have died from the ineffectiveness of ANY anti-emetic or pain medication if not from severe dehydration.

    My question is, how long from the time of abstinence can THC stay in my system for? Why does food and exercise still trigger nausea and how long until I will feel back to normal? Is there any other remedies that can help while I am starting to recover?

    If it helps I am a 23 year old female, I weigh 67kgs now and have been smoking 2grams consistently for 3 months up until 2 weeks ago.

    Thank you all so much.

    Like

  91. Sligo Says:

    My sister has been to hospital several times with CHS, usually given a drip and sent home when she was able. It was only last year after 3 visits to hospital in as many months that a nurse (in another town) heard that sis was compulsively bathing and told us what it was.

    She has been back to hospital twice since then. The last time was two months ago when she was admitted as a mental health patient with burns on her back as a result of vomiting in a boiling hot shower for 3 days running. She was kept in there for 3 weeks and diagnosed with depression. The nurses at the hospital researched CHS when I told them about and believed it to be the issue, particularly as she kept up the bathing behaviour while in there, but the psychiatrists dismissed the idea (because the condition doesn’t exist?).

    After her release less than a month ago she has returned to pot smoking and had a bout of CHS two days ago – she was discovered smoking pot and shaking while lying down in the shower of a hotel. She recovered after only 8 hours this time and promised never to do it again.

    She has been smoking pot this morning.

    Like

  92. Tim in Virginia Says:

    I’m 55, male, have smoked pot since I was about 14, and have been having occasional episodes of “intractable vomiting” (as the docs call it) for many years. I love pot, believe there are plenty of good medical uses, but realize that too much of a good thing may become a bad thing.

    My wife first read about cannabis hyperemesis syndrome three or four years ago. It’s obvious from the posts I’ve read that many people do not believe it is real. My gastro doc had never heard of CHS a few years ago, now he says it is a recognized syndrome.

    I can’t count the number of times I’ve been to the ER for dehydration after a day or more of puking. The docs re-hydrate me with two bags or fluids, give me IV Phenergen and IV pain killer to ease the stomach distress, and send me home once things settle down.

    Before I knew the appropriate protocol, I had upper GI, lower GI, CT scans of my belly, I even had my gall bladder removed in 2001 on an ER visit. I’ve had endoscopies, colonoscopies, flex-sigmoidoscopies, pretty much every test you can imagine. All the tests came back normal except a stomach emptying test, which I had while an episode was just beginning. It showed very delayed emptying.

    Right now I am about 30 days without pot. I’m past the cravings and have had no stomach problems. My earlier symptoms during a bad episode match pretty much everything described here and in the medical journals, including the compulsive bathing for symptom relief.

    I am a former newspaper editor and photojournalist, and I’m looking for real-life examples of people who have dealt with this, to eventually put together an article, not for a medical journal, just a layman’s view of this whole thing.

    I’d like to gather descriptions from other people who suffer from this. I will use only first name (fake is fine), city or state, gender, and age.

    I’d also like to hear from researchers and/or doctors.

    I’ll watch here for replies, or if you’d like to email me about this, I created an email for this purpose, it is TimInVirginia (at) aol (dot) com.

    If anyone has stories about cannabis hyperemesis syndrome I’d appreciate hearing them.

    Many thanks and thanks for reading. Be well.

    Tim in Virginia

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  93. misstheweed Says:

    really miss it but the stomach pain was just too much. i have celiac disease as well and smoked many years. i stated at 16 and quit at 35. then imstated again in my late 40s. 50 plus now and i just cant do it anymore. agree with the hot bath and shower. will miss it and maybe smoke again someday but for now justmhappy to be pain free!

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  94. Nick Says:

    I have been smoking marijuana for about four years now. I’m a 21 year old male standing at 5ft7. 32 days ago I weighed 128 pounds. Today I’m sitting at 95 pounds. I smoke at LEAST a gram a day, and usually dab a bit. I started noticing symptoms of IBS our crohns/celiacs. I wake up nauseous and constantly bloated with severe lower abdominal pain. I’m constantly burping and could throw up what feels like pure stomach acid if I wanted. I was allergy tested, cut dairy, soy and gluten from my diet, and checked into the hospital. This is by far the lowest point in my life. I’m 95 pounds, pale, dehydrated and hooked to an IV. I just had a cat scan, endoscopy, colonoscopy, ekg, gastric emptying test, x ray, ultrasound and an MRI. All came back perfect. It’s so frustrating trying to explain to everyone that I have physical pain. It’s not like I would purposely stop eating for no reason. ANY food/drinks cause the burps/lower abdominal pain (even IVed salene).

    It wasn’t until the doctor brought up pot use, which I was honest about. I told her.I smoke quite a bit, and dab daily. Like many smokers, I didn’t believe it. I’ve always been pro weed and assumed it would help if anything. After it was brought up, I went to the internet. Tons of stories just like mine popped up mentioning chs. The only pain cure I have is hot baths or showers. Once I leave the hospital tomorrow, I’ll be 3 days clean. I don’t want to quit, but I refuse to be a 21 year old stick. I just want a normal life, and this is the next step. I will report back in a month with my progress. I can’t lay in my apartment bathroom pulling on my hair in pain with diarrhea anymore. It’s literally the worst pain I’ve ever endured and I’ll do anything to feel better. Good luck to everyone with this horrible, scary issue. I feel your pain. And if you can toke with no issues, keep on keepin on. I’ll always respect my fellow stoners, and hope I get the same in return.

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  95. Tim in Virginia Says:

    Hey Nick –

    I bet you have found the cause. Cannabis hyperemesis is very rare, but it is real. Read my post above and you will see I’ve had all the tests you have had, all normal except the gastric emptying (which I had while an episode was just beginning).

    Cannabis hyperemesis syndrome was only first described in the medical journals in 2004, so it is very new relatively speaking.

    Lots of people (at least on this site) will tell you that it’s not real, and I wish them well and hope they never have to endure hours and days of puking and gut pain. But they are wrong; it’s real.

    I am a former journalist (still do some freelance) and I am collecting stories for an eventual article on the subject. If you feel like sharing your story or just need to correspond with someone who has been through it, feel free to email me at TimInVirginia(at)aol(dot)com.

    PS I am about 45 days without weed and have had no stomach problems. It takes about 30 days for pot to get completely out of your system, so hang in there. I honestly hope I can smoke again, but only if I can find a level that doesn’t make me sick.

    Frankly, it sucks to not be able to get high!

    Tim in Virginia

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  96. Barny Says:

    I am currently suffering from this Cannabis hyperemesis syndrome ( not 100 percent sure but pretty certain It may be) I’ve been smoking copious amounts of marijuana for the past 5 years of my life. About two weeks ago I got a free 1g sample of synthetic “pot” I had done it earlier in the year with no noticeable ill effects. But this time after about 2-3 cones and about two hours after smoking I started to feel a little light head & had minor stomach pains anyway I didn’t worry to much about it. (All up I smoked half a gram of synthetics in this day and decided to discard the rest because I know it can lead to organ failure.) the next day I continued to carry on with my regular drug habbit, 2-3Grams of pot per day I started to feel quite ill on this day. No vomiting at that point though just nausea and abdominal pain. The next day is when it got bad everyday after this I woke up feeling like I had been on a 5 day bender my stomach felt bloated I could barely even stomach water. And I would vomit at least once every morning, my mouth was dry and could not hydrate no matter how much water I tried to consume or wash my mouth with. I continued to smoke pot for another week after this thinking it may help the nausea after a week I started researching all effects of synthectic marijuana on the stomach anyway I read about this Cannabis hyperemesis syndrome and it described completely how I felt right down to the relief from hot showers I decided to try to stop smoking . This is my 5th day without and my first day without vomiting. (I was close but I kept it down thank god considering I’ve dropped nearly 5 kilos in 2 weeks because of CHS effecting my ability to eat and keep food down. Anyway I’m on medocation for nausea and it sort of helps in the afternoon, but in the morning the nausea is so strong the medication has no effect whatsoever. My mind is set on quitting and that is the only cure for CHS. But are the any meds I can take in the morning for the next week or so while I recover that will actually help?? Please, I’m really scared for my weight and I still can barely eat at the moment, only way I can eat early in the day is fruit smoothies and protein powder & at night I can down a bit of solid food but nowhere near as much as my body requires. Thanks in advance. & smoke responsibly. Sorry if i don’t make much sense.My email is barny.lives.here@gmail.com please email if you have any helpful info or have any questions.

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  97. Breathe Says:

    I’m 15, almost 16. I’ve currently been having stomach pains for the past year. During my last birthday is the day I was introduced to weed. As of last month I bought 21 grams, smoked it in very quickly, then bought an ounce, and smoke it all on 10/2/13. I usually smoke about 3-4 bowls everytime I feel like smoking, and usually 12-16 bowls a day. I have recently been experiencing severe stomach pains also my stomach feels so bad that I believe I’m almost going to puke, but nothing comes up. I also currently have extreme body temperature changes,; I will wake up early in the morning in a pool full of sweat, then all of a sudden I’m freezing cold. My parents tell me there’s nothing wrong with me, but it’s extremely hard to believe that I’m just making this all up in my head. I don’t want to go to a Doctor just so they can tell me there’s nothing wrong with me because I’m not the richest person you’ll see. I’ve been reading up on CHS as one of my friends recommended that it is a most probable cause for my pains, as my pains usually lift for a short while after I take a steaming hot shower.

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  98. Daniale Says:

    I was suffering from cannabis hypermesis for 4 years, however I did not no that was what I was suffering from. It started with severe nausia and when it started I could not stop which would lasT for days or weeks, which meant no eating or drinking but only to help me vommit easier with out the burning pain in my stomach, I pretty much lived In the bath tub or with a heating pad, the heating pad was like my life line, I could not go anywhere without it, I had several vists to the emergency department and had every test under the sun, I had lost half my weight, I would get a few good days a month and be sick again, and by sick I mean it brought me to my knees with bath, always screaming and moaning, trying to fix my diet thinking it was this and that but nothing helped the burning, ten mins in the tub of hot water would ease my pain for about ten mins then I would be right back in or laying on my heating pad. In the ER they would give me pain meds and send me home that only worked till they wore off. Sometimes not at all. The doctors didn’t have a clue and kept telling me to change my life style and I didn’t no what more I could change I stopped drinking, ate goodness when I could and smoked alot of weed, which I thought that helped with the abdominal pain, I always told the doctors I. Smoked it, then two years later a nurse had printed a paper off the net about cannabis hypermesis and I thought they were crazy cos I smoked it for years and really thought it was helping, sometimes I would feel a relief after smoking it. Every day I woke up over the last two years I was in so much pain I would drown myself with valume, somehow that helped and it put me to sleep so I didn’t have to deal with it, after 3 years of pain everyday and not being able to get up unless I was running for the tub I got all test done again thinking they missed something and everything was negative, the only time of year I felt good was may and June, when it was hot out, so I thought I needed sun all the time, then after the 3 years with it, I never felt good not even in the summer, I lost my job my house, I could no longer take care of myself and moved in with my mom, laid with my heating pad and smoked more weed cos that’s all I could do, thought well if I can’t go anywhere at least I’ll do something I enjoy and smoked more and more then in September it was 4 years now that I was sick. October 2nd this year 2013 my friend sent me a text all about cannabis hypermesis, this time I red up on it and it described me to a T, I was so I’ll that night I went to the ER and told them I had cannabis hypermesis, they admitted me for 9 days and that was the first dryout I had in 8 yrs, I needed it, I was in pain the first 6 days or so and they gave me meds intervenis and now I feel great, I got released on the 11th of this month, and I quite weed i feel great, I find myself still in the tub sometimes after a bowel movement but its cos hypermesis attacks your digestive system and mine went on for years before I realized what I had, so its a habbit not so much pain, I’ve not vomitted once in 3 weeks and no more rolling around in the tub or with my heating pad, I believe that if a joint came my way now I could have a few puffs and it won’t hurt me, just saying that for those who hate the fact they have to give it up, I have had a few puffs after a 2 week dry out, not good but was something I enjoyed, my body needed that dry out to get better, I will not be a chronic smoker ever again, health is more important and hypermesis was the worst pain I’ve ever went through, as long as your not a chronic smoker and have a good dry out, it will not come back, well at least it has not for me but its only been 3 weeks, I feel like a normal person again, for me its like a second chance at life, at one point I thought I would never be able to take care of myself, I’m 32 and am thankful to live life not in pain. Good luck to the ones suffering from hypermesis, its worth quitting weed no matter how much you love it, after awile the odd puff won’t hurt just need to go weeks or days at a time without it, something I never did.

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  99. AlaskanEskimo Says:

    I smoked marijuana for 6 years straight from July 2007 to July 2013, every day, without a day break, 6-10 joints a day. One night, I woke up at 4 A.M. with bad abdominal pain 10/10 pain, severe nausea 10/10, and I started vomiting non-stop, I vomited bad green bile every 5 to 10 minutes and the nausea/abdominal pain never even stopped, not even for a minute. I went to get checked at 8 A.M., and the health aides (village doctors) said I had the ‘flu’, so they sent me home. I knew it wasn’t a flu, because I kept vomiting non-stop with severe nausea/abdominal pain, even though the health aides (village doctors) gave me nausea medication. I went back to the clinic about 1 P.M., very pale, weak, dehydrated, sweating, retching, and just in bad pain. They then put me in I.V., gave me more medication, and shots, and nothing stopped my severe nausea, vomiting, and abdominal pain. I went through 8 I.V.s, and those never helped. They pee tested me, and they found out I smoked marijuana and started asking me questions, how often I smoke, how much I smoke, etc. Around 10 P.M., the health aides decided to try something different, put a tube through my nose to my stomach, and drain out all the bad green bile that was non-stop building. Draining out that bad green bile cut down my non-stop vomiting a lot, also all the I.V.’s, medication, and shots finally started helping after the drainage. Little after 11 P.M., I finally stopped vomiting, after 19 straight hours of non-stop nausea, non-stop vomiting, and non-stop abdominal pain, and finally got sent home.
    That 19 hours of non-stop vomiting, non-stop nausea, and non-stop abdominal pain made me learn a big lesson in my life, to stop smoking marijuana for good. Few days later after my sickness, I obviously was going through marijuana withdrawals, but that was nothing compared to my Cannabis Hyperemesis Syndrome. My marijuana withdrawals lasted about 3 weeks with slight 2/10 nausea but no vomiting, lack of sleep (about 3-4 hours of sleep a day), slight 2/10 stomach ache, acid refluxes, anxiety, stress, jittery, head aches about 1/10, loss of appetite, and the worst of all was coughing and spitting out the nasty tasting black tar from the lungs (resin tar from years of smoking). After 3 weeks, all my symptoms went away, except the resin tar from the lungs. The resin tar lasted 1 month and 3 weeks of coughing and spitting out black resin tar every day. Once in a great while, I will still spit out very little tar, but not bad as the first month and 3 weeks. To this day, my lungs feel very clear, I sleep easy, my appetite is back, I have a lot more money than I did when I used to smoke, I don’t get uptight about finding ways to get money now, the acid refluxes are gone, the anxiety is gone, the stress is gone, no more nausea or stomach aches, and the best feeling of all is that I don’t have the urge to smoke any more.

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  100. mile cyrus Says:

    AlaskanEskimo,

    You are very brave. I wish I could say the same thing about smoking cigarettes. I keep trying and trying and even after months, six months, the urge to smoke never goes away. Smoking cigarettes is a desire fixed in my brain. I wish I could tell your same story very soon. Good luck with your determination and perseverance.

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  101. mile cyrus Says:

    Even after months, 6 months, of being totally smoke free, the urge doesn’t go away. The urge makes me return to the cigarette.

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  102. C Doyle Says:

    I want to say that I have smoked chronically since 1981, by that I mean daily consumption for thirty three years. Eighteen years ago I had my first episode which lasted for three days! The next bout was in 2006, and then in 2008 both lasting about 36 hours and the last was yesterday and has resolved already. In all cases hot baths relieved the symptoms for very short periods after having them. On one occasion I was not able to go to the hospital until twenty four hours after onset and I spent the night in the bath tub and was able to sleep while the water remained from hot to just a little hotter than lukewarm however, it did result in a Nasty case of “swimmers ear”. In my case it took morphine or OxyContin to subdue the vomiting. Now one thing chronic use has not led to in my case and that is loss of motivation. I have always been and remain a highly motivated individual and have only taken off time from work due to the use of the substance Alcohol. I have never been a chronic user of alcohol and in fact I consume about one bottle in total in a year but I had a few encounters with hangovers. ! Having children does that for some of us. I just figured that it isn’t their fault you feel like crap and they don’t deserve an out of commission parent that is sick mostly because they stupidly over consumed.

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  103. Michelle Says:

    My daughter has been suffering with this off and on for over 4 years. I know there are people that have been smoking for years (a former one myself) and never had this issue. My daughter has had every test known to man and even had her gall bladder removed unnecessarily due to this condition. She has been told numerous times from an internist and a gastro doc that this is her problem, and she will quit for months at a time, then gradually start smoking a little bit here and there until she starts getting sick again. She is as I write this on her way to the ER once again. Even as she suffers, her boyfriend has her convinced that is is a bunch of “bull” and not why she is puking. No coincidence that a few weeks after she started smoking again, she’s sick…….DUH!
    If there is anyone else suffering with this or if you know of anyone since it is very rare, please encourage them to please stop smoking. Maybe one day my daughter will realize what she is doing to herself and her 2 year old daughter. 😦

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  104. John Says:

    Here’s my CHS story:

    I am 27yrs old, and have been smoking marijuana for about 2 years now. I have always been a thin guy, at 5’10” and 135lbs, but I have always been healthy. Never had any surgery or medical complications or conditions. No diseases, I avoid taking any kind of medicine including OTC stuff like Advil, unless I absolutely have to. I’ve been to the hospital maybe 3 times in my adult life. I have also never had a problem digesting anything, iron stomach, no food allergies.

    I started smoking occasionally in the beginning, and after about a year, began smoking daily. For the past 6 months I’ve basically been high from the moment I woke up to the moment I went to sleep. For the last two years my marijuana use has consisted of both tree and BHO concentrates. For the last year it has been 99% concentrates. No sketchy shit, I am particular about the oil I smoke. I started noticing a little nausea on some days, no biggie, take a hit and it disappears. The pattern became cyclical. More nausea, more marijuana to counteract it. Never in my wildest imagination did I have even the slightest inclination that the marijuana could be responsible. Eventually the nausea evolved into vomiting, not every meal, typically in 2 week cycles. At first, because I have a relatively high fat diet, I assumed my gallbladder was acting up. I didn’t have health insurance at the time so I didn’t see a gastroenterologist. After a few weeks of that, it got worse and I began vomiting a few days a week. Diarrhea was a daily occurrence and bowel movements were sporadic and typically an emergency. I was previously a very regular person. I noticed rapid weight loss. As I write this I weigh 110 lbs. Over the course of a month I ended up in the emergency room 3 times because of relentless and painful vomiting. I would vomit for hours, the last time for nearly 16 hours.

    By this point I was fed up with the uncertainty that any meal could result in painful vomiting and a costly hospital trip. I got health insurance and went to visit my gastro. After describing the symptoms (did not offer that I smoked marijuana) he asked if I smoked and I admitted to it. He suggested that it might be the problem and I was devastated. I love marijuana, I love being high, I love doing things high, I just flat out love weed. I even stopped drinking (heavy drinker previously) because I prefer it over alcohol. I don’t do any other drugs, and do not have a history of drug use. I have never been interested in anything beyond marijuana.

    My doctor scheduled me for an endoscopy and a sigmoidoscopy on the week after my doctor visit and I continued to smoke. I had an episode the day of the examination and ended up in the hospital again. The last hospital visit was by far the worst. The next day I had my procedure done and they found nothing wrong with me, aside from signs of gastritis on my stomach walls. I stopped smoking that day, and a few days later I started feeling better. It’s now been two weeks since I’ve smoked and I’ve been able to hold down food. I’m not writing this because I have anything against weed, I still love weed. It honestly sucks that I can’t join my friends for sessions, or just be high. I’m hoping a solution can be found so I can continue to smoke, but I’m pretty sure that it’s not exactly a high priority medical research topic. I had another episode after my procedures and tried the shower remedy and it did provide temporary relieve (wish I would have known that before I spent 15 thousand dollars at the hospital). I just wanted to share my story because it is a first-hand experience devoid of speculation. I’m not a junkie that is having complications because of other drugs. I’m not a previously sick person. I’m not some kids parent who wants him to stop smoking. I’m just a regular guy who loves weed; who now has to stop smoking because of CHS.

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  105. judy Says:

    MY 38 yo son has been suffering from this agony for 15 yrs. He has 4-5 episodes per year requiring hospitalization and many more which he aborts with hot baths. IT IS REALLY TORTURE FOR THE SUFFERER AND HIS FAMILY. NO ONE CAN EVER CONVINCE ME IT IS NOT CAUSED BY WEED.
    I am a gi nurse and we are seeing more and more cases. THE ER DOCTOR TOLD ME WHEN MY SON WAS THERE IN JANUARY. HE IS SEEING TWO CASES A DAY.This is really bad

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  106. Nathan Says:

    Im a 20 year old guy who started smoking about 2 years ago. For the past year I have been consistently smoking every day I can and just recently have experienced symptoms related to chs. It started with nausea and vomiting but the most obvious thing is the abdominal pain that nags on. Ive been sick for about a month now including visits to the ER with not a single positive test. I haven’t smoked in two days and will continue to abstain until hopefully my symptoms disappear. My question today is will I ever be able to smoke again? I do not drink or smoke cigarettes but weed is a joy in my life. Please let me know if anyone who’s gone through this has been able to smoke again, even in small amounts.

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