As more and more U.S. states expand marijuana legalization, and with weed usage on the rise, doctors and advocates are warning about a little-known condition affecting heavy users of the drug.
Cannabinoid hyperemesis syndrome, or CHS, causes severe abdominal pain, nausea and “cyclic vomiting” among regular marijuana users — and can lead to extreme dehydration and, in rare cases, death.
“It’s very underdiagnosed,” said Dr. Joseph Habboushe, an assistant professor of emergency medicine at New York University Langone/Bellevue Medical Center, who co-authored a 2018 study on CHS. “Doctors aren’t thinking about it. Patients show up to the ER at an average of seven times before they’re diagnosed and have it for many years before it’s diagnosed.”
“Also a lot of patients are in a bit of denial,” Habboushe continued. “These are folks who have been consuming cannabis for many years, and then they develop these symptoms. So it’s hard for them to believe that these symptoms are actually due to the cannabis itself.”
That was the case for Brian Smith Jr., whose mother, Regina Denney, rushed him to an emergency room in Indianapolis in April 2018, when he was 17, after he told her he had been vomiting for three days.
“We were on our way to the ER — I think I had to stop seven times on the way so that he could vomit,” Denney said.
At the hospital, doctors told her that his kidneys were failing. They asked Brian if he smoked marijuana, and he said that he did. Then a doctor asked an unusual question: Do hot showers and baths help? Brian said yes.
“You have CHS,” the doctor told him.
“Patients typically discover that when they take a hot shower, the symptoms go away,” Habboushe explained. “They can spend four or five, six hours a day in the hot shower. So if you ask a patient, do you smoke marijuana? Yes, I do. Do you take hot showers, does that make it better? And if they have this, their eyes will light up. They’ll go, ‘Hey, doc, you know what I have, you must know what I have.’”
It’s unclear exactly why hot showers offer temporary relief for patients with CHS. Habboushe said that a specific receptor in the body’s endocannabinoid system — the TRPV1 receptor, found on the skin — is activated by hot showers and hot peppers.
“For some reason, turning on that receptor helps these patients feel better,” Habboushe said. “We’re not sure why.”
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