Dirty Dozen #5: Marijuana Can Make You Vomit—To Death

By Laura Stack

Marijuana users say it helps with nausea. Ironically, though, science shows long-term marijuana use may cause some of the nausea they’re experiencing—and if so, treating it with pot just makes them sicker. It’s a vicious cycle.

It sounds almost like a South Park joke—marijuana use can make some people vomit until they die. It’s a medical term called Cannabinoid Hyperemesis Syndrome (CHS). Some doctors call it “scromiting,” because victims are screaming and vomiting at the same time. It’s also called “greening out” by the stoner crowd. Death by CHS is rare, but it does happen, because we all have CB2 receptors throughout out bodies where THC binds, including in our digestive tracts.

In one notable 2018 paper, researchers recorded at least two deaths caused by CHS, and a third CHS contributed to. In another case, a bereaved mother has written a heart-rending account of her son’s undignified death due to CHS. In all these cases, marijuana and CHS provided the mechanisms of death; the direct cause was acute hyponatremia (very low levels of sodium) caused by dehydration. In fact, there are 12,500 members in a private “Cannabinoid Hyperemesis Syndrome Recovery” group on Facebook on how to stop using marijuana, so they can stop throwing up.

The only cure for CHS is to stop using marijuana, cold turkey. Forever. If you start using again, the illness will return. For years, many people in the pro-weed community have doubted that CHS even exists, since it sounds like a propaganda scare tactic. Worse, scientists first identified it only in 2004. As people in the marijuana community have pointed out, some of them have used pot for decades, and the medical community never noticed CHS before. Furthermore, some cultures have been used cannabis for centuries. So how could a new disease just appear out of nowhere? Mostly because of the increase in extreme potency of today’s marijuana.

Actually, it’s entirely possible that people have suffered from and died of CHS for all that time, but the syndrome wasn’t yet recognized. Medicine is a dynamic and evolving science, constantly refining and splitting out diseases, syndromes, and the like from the catch-all categories into which they’ve been lumped. For example, before 1976, no one had ever heard of Legionnaires Disease. Now American doctors diagnose about 13,000 cases a year. No one had heard of COVID-19 in 2018, but since late 2019 it’s killed over 4.2 million people worldwide, including more than 628,000 in the United States alone. It’s easily confused with the flu, and only distinguished through testing.

Similarly, researchers now understand that physicians often mistake CHS for Cyclical Vomiting Syndrome, a similar, enigmatic disorder. CVS usually occurs children aged 3-7, but according to the Mayo Clinic, “the number of cases diagnosed in adults is increasing.” I have to wonder how many cases of adult CVS are really cases of CHS, where the physician either isn’t aware of CHS, or doesn’t know his or her patient uses marijuana, including teens.

Causes and Symptoms

We don’t know the specific cause of CHS yet. Researchers believe it could be triggered by THC binding to specific molecules in the digestive system. Although marijuana does seems to ease nausea that starts in the brain, especially for chemotherapy patients, it can have the opposite effect in the gut. CHS usually starts only after a minimum of several years of marijuana use, especially among those who smoke multiple times per day, though weekly use may also result in CHS. There’s an alternate theory in the pro-pot community that suggests that the cause is actually pesticide poisoning caused by organic neem oil, though not all observers in the community agree, as neem oil poisoning has different symptoms.

Whatever the case, CHS may cause up to 6% of emergency room visits for patients with recurrent vomiting. Symptoms include:

• Ongoing nausea
• Repeated vomiting, often intense
• Stomach pain
• Decreased food intake
• Weight loss
• Dehydration
• Repeated hot showers or baths daily

Why the last symptom? Apparently because the brain’s hypothalamus regulates both vomiting and body temperature. Hot showers are a key indicator to doctors and can convince sufferers themselves to seek treatment.

Doctors diagnose CHS using blood, urine, drug, and electrolyte tests, also testing to screen out anemia, infections, and in women, pregnancy. Expensive workups with X-rays, CT scans of the head and abdomen, and endoscopy of the esophagus and stomach may follow to eliminate other causes of vomiting, only to be diagnosed with vomiting from weed.

If not treated, CHS can cause muscle spasms, weakness, kidney failure, heart problems, shock, brain swelling, and death.

Treatment

Though CHS is relatively new syndrome, the treatment protocol is well-established. Physicians typically prescribe IV fluids to fight dehydration; pain meds; mild tranquilizers; antihistamines; lots of hot showers; and sometimes capsaicin cream rubbed on the belly. As long as the patient stops using marijuana, the CHS symptoms usually go away within 10 days. Normally, they disappear after just one or two days.

The only cure for CHS is not using marijuana at all, in any form. Even after months of cannabis abstinence, CHS can return with a vengeance if the patient resumes usage. As long as users avoid weed, they can stave off CHS indefinitely. British physicians have recorded one case of a young man who presented with CHS and renal failure, and he admitted to smoking marijuana 4-6 times a day for 15 years and took 10-15 hot showers a day. After treatment, followed by psychiatric support, he remained free of CHS symptoms after three cannabis-free years (as of July 2019).

CHS is real, and it can be fixed—with sobriety and treatment for addiction. The problem is recognizing it, accepting it, and getting sufferers the help that they need. Don’t think it can’t happen to kids just because it takes years to manifest. The young man mentioned earlier whose mother wrote so eloquently wrote about his death was 17.

Keep a close eye on your adolescents for these signs, especially if you suspect or know they’re using marijuana. Although Cannabinoid Hyperemesis Syndrome is rare, it can strike any regular user, at any age.