Can I Get Cannabinoid Hyperemesis Syndrome From Smoking Too Much Pot?


“If you smoke too much pot, you’re going to puke your guts out!”

As marijuana legalization continues to take root in America, the prohibitionists are desperate to frighten the populace back into fearing the devil’s lettuce. The latest is a scare that marijuana’s going to make you engage in a Technicolor yawn, laugh at your shoes, pray to the porcelain goddess, or sell a Buick to Ralph and Earl.

The last scare: Smoking pot makes you permanently stupid!

“The children! They’re going to lose 8 points of IQ!” they bellowed in 2012. A long-term study in New Zealand had found that teens who had smoked pot heavily went on to have lower IQ scores in middle age, even if they stopped smoking pot.

That fueled a “Pot Kills IQ” scare that has been regurgitated by every prohibitionist talking head and press mouthpiece ever since. Never mind that the conclusion was based on just 50 teenagers. Never mind that the same study found that the kids who smoked pot moderately had elevated IQ. Never mind that the same data was reanalyzed by another researcher who found socio-economic factors better predicted the IQ drop, and never mind that his analysis was published by the same journal. Never mind that a subsequent study examined identical twins, one who smoked and one who didn’t, and found no cognitive differences between the twins.

Once a prohibitionist lie gains traction, it can take a long time to fade away. Younger pot smokers no longer hear the scare that boys who smoke pot will grow boobs and girls who smoke pot will become permanently infertile, but tokers in my generation grew up with those frights presented to us as fact.

The new scare: Smoking pot will make you vomit!

So let’s nip this latest prohibitionist scare in the bud – the idea that marijuana legalization is leading to an epidemic of cannabinoid hyperemesis (extreme vomiting) syndrome (CHS).

Dr. Kennon Heard, an emergency room physician at the University of Colorado Hospital in Aurora, Colorado… co-authored a study showing that since 2009, when medical marijuana became widely available, emergency room visits diagnoses for CHS in two Colorado hospitals nearly doubled. In 2012, the state legalized recreational marijuana.

First, let me assure you that there is such a thing as cannabinoid hyperemesis syndrome.

It was a summer night in Los Angeles when I was first introduced to the syndrome. I was riding around with my friend Cheryl Shuman on our way to visit a well-known Denver concentrate maker who was staying in a downtown hotel. We went up to his room and he offered me a dab.

A true friend will still support you even after you’ve blown chunks all over the inside of her Prius.

“How big do you want it?” he asked me.

“Heh, you know me, man,” I boasted, “I’m a professional!”

The concentrate guru handed me a tool loaded with a double-dab* and I did my macho best to inhale the whole damn thing. The world wobbled a bit as I exhaled with a ferocious bout of hacking, but I took the whole thing.

We left the hotel and got back into the Prius to make our way to our next destination. As I sat in the passenger seat, I felt that warm, clammy wave through my body and that salty, oversalivating feeling in my mouth that precedes a stomach reboot.

Before we could get off the freeway, I was ferociously vomiting into a plastic shopping bag Cheryl had in the car. It wouldn’t stop. I was on my fourth serious convulsion when Cheryl pulled into a parking lot near a 7-Eleven to try and buy me some relief.

Unfortunately, that parking lot also abutted an open-air patio of a Chinese restaurant. The smell threatened to force another gastronomic ejection. Not wanting to ruin a bunch of diners’ evening, I left the Prius and stumbled around the corner. That’s where Cheryl found me, curled up in the fetal position on the sidewalk, violently dry-heaving, punctuated with my own laughter from disbelief that I was still puking.

Since that event, I have had one other instance of hyperemesis, this time from overeating some cannabis edibles. So I do not write this piece to convince you there’s no such thing as CHS. There is, and it’s awful.

But there is no epidemic.

Buying two lottery tickets doubles your jackpot chances, right?

After so many years of reading media coverage of scientific studies then discussing them with NORML’s Dr. Mitch Earleywine on my show every Monday, I’ve come to recognize many of the rhetorical tricks used to frighten us about these studies.

“Emergency room visits diagnoses for CHS in two Colorado hospitals nearly doubled,” states the press. Always be suspicious when someone tells you the percentage change in something without telling you the absolute values. Often, the percentage is far more frightening than the values – as in this CHS study:

The prevalence of cyclic vomiting visits increased from 41 per 113,262 ED visits to 87 per 125,095 ED visits after marijuana liberalization…

Oh! My! God! Over the course of a year (mid 2010-mid 2011), 87 pot smokers in Colorado puked their guts out in a hospital! Let’s see now, the rate of annual pot smoking for ages 12+ in Colorado in 2010-2011 was almost 17 percent. There were 4.3 million people in Colorado, with about 82 percent of them aged 12 and older, or about 3.5 million. Seventeen percent of that works out to 600 thousand annual pot smokers.

In other words, about a little over 1.5-one-hundredths of one percent (0.015%) of Colorado’s pot smokers that year suffered CHS.

Maybe that’s not fair, as it is only the heavy marijuana users that are going to get CHS. I can’t get daily use figures drilled down to just Colorado, and it’s hard to find a daily use figure for the general population. But Monitoring the Future recently cited the national daily use rate among college students (age 19-28) at a 35-year-high of 5.1 percent.

Even if we pretend that every CHS case was aged 18 and older and pretend that the daily pot smoking rate among everyone 18 and older is 5.1 percent, we’d still only be looking at 87 CHS cases among 163 thousand daily tokers, a rate of just five-one-hundredths of one percent (0.0533%).

“It is certainly something that, before legalization, we almost never saw,” Heard said. “Now we are seeing it quite frequently.”

Before legalization, the study says there were 41 of 113,262 emergency room visits – that’s a rate of 1 CHS case for every 2,762 patients. After legalization, the 87 of 125,095 visits works out to 1 per 1,437 visits. This was in two Colorado hospitals, so to look at it another way – before legalization, a doctor in one of those hospitals would see a CHS case every eighteen days (“almost never”) on average; after, they’d see one every eight days (“quite frequently”).

There’s also a serious confounding issue with any study that compares the differences pre- and post-marijuana legalization: fear of prosecution. Whether it is your kid or dog getting into the marijuana edibles or you puking your guts out from a double-dab, prior to marijuana legalization, you have a strong incentive to lie to emergency room doctors about what caused the emergency. There may not be so much of a rise in those statistics as there is an increasing likelihood people will honestly report their marijuana use.

Weed Making You Puke? Go Hit the Showers!

Still, when it happens to you, it doesn’t matter if it is a one-in-a-thousand situation. It really sucks and you want it to stop. Fortunately, this doesn’t require expensive medicine, intrusive surgeries, or difficult lifestyle changes.

If you want to relieve your cannabinoid hyperemesis syndrome, take a hot shower and lay off the pot for a while.

Doctors still don’t understand why a hot bath or shower helps, but they hypothesize it may have to do with the endocannabinoid system and its role in regulating bodily homeostasis.

While previous research has suggested that the anti-nausea effect of cannabis is achieved by its principal psychoactive ingredient, delta-9-THC, research has yet to undercover the rationale of how this compound can then paradoxically lead to its exact opposite effect—intense vomiting. One theory proposes that a buildup of cannabis’ toxic metabolites in the brain leads to downregulation of the CB1 receptor, which then results in paradoxical enhancement of the compound’s intended effect.

A newer and more popular theory is that it’s the concentration of cannabidiol in marijuana—as opposed to the psychoactive component delta-9-THC—that explains the proemetic effect in CHS. Animal models have demonstrated that cannbidiol is antiemetic in low doses but leads to vomiting at higher doses.

Researchers believe that because CB1 is situated closer to the so-called thermoregulatory center in the hypothalamus, the continuous hypothalamic stimulation of CB1 might be relieved by showering with hot water. Another theory involves the concept known as “cutaneous steal syndrome” in which hot showers help ease symptoms by drawing blood flow away from the gut, since chronic cannabinoid use results in CB1-induced vasodilation.

Whatever is causing it and however it is relieved may be in doubt, but one thing is crystal clear: CHS is the latest paper tiger used to scare naive voters into continuing the ticketing and arrest of cannabis consumers.

* The “Radical” Russ Universal Extract Measuring System – It’s Dib/Dab/Glob/Slab:

  • dib is the smallest unit of extract you can get on the tool;
  • dab is three dibs;
  • glob is three dabs;
  • slab is three globs.

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