AMA: I was diagnosed with Cannabis Hyperemesis Syndrome four days ago.

Hello all. Long-time smoker, 35, male. Anything and everything but edibles. Mostly legit. Some D8 in a pinch but nowhere near the majority.

For the last four months, about once every two weeks, I’ll wake up, take a shower, walk into my living room, have a sip of water, and then run back into my bathroom, where I will vomit until the bile comes out and writhe on the floor, onto the bed, holding my stomach for 6-12 hours, screaming for God or Satan, whoever shows up first.

I’ve been in the hospital three times over the last month over it and only on the last visit was I asked if I used marijuana. There is nothing on any CT scan I’ve done, ultrasound, kidneys, liver, pancreas, appendix.

“Well I’ve never heard of this gobbledygook and I also have no idea how to search for stuff!”

Apparently, had you the genetic disposition, cannabinoids can bind to your stomach, and the sphincters to and from it, altering the timeframe it takes for your stomach to empty and the lagging or simply disabling entirely of the functions of the bottom of your esophagus until it’s over. You’ll be screaming in pain for around 8 hours. Buckle up.

Do I believe Cannabis is solely responsible?

The disease is rare and only shows up in people (usually men) who smoke daily for two or more years. I’ve been smoking daily for ten.

(Obligatory) Psyop?

If it were, I’d expect a little more than a matter-of-fact “quit and you’ll be ok”. Usually money or some type of group wants your attention from such things. I’m more leaning to this being a legitimate disease, and peers are kind-of agreeing on it. Multiple sources seem to be finding the same conclusions and I haven’t met a Doctor yet who hasn’t heard of it in some capacity.

I’m open to bribes, though.

I don’t blame cannabis. I smoked it. It didn’t jump in my mouth and light itself. I don’t blame anyone else. I am unlucky, genetically speaking. You may never get it. You may never have a single symptom, or you might. If weed works for you, fantastic. It worked for me for years, until it wanted to kill me one morning, such is the diceroll of living.

Edit: I’ll answer everyone after 4:30pm est. At work.

LanternEverywhere, (edited )

Cannabis can have very different effects on different people. For me when i smoke i get the normal euphoria, BUT the next day i get an equally DEPRESSED mood.

For a few years i was smoking regularly. I'd get high and feel fantastic, then the next day I'd be depressed, and the day after that I'd be extremely depressed, so I'd smoke again to get rid of my depression and feel great again! But then I'd be depressed the next day, and the cycle repeated over and over. Then i stopped smoking weed just to take a break, and within a couple of weeks i reached a relatively steady middle mood. I wouldn't get the euphoria from smoking, but the horrible depression went away too. It's been years since and it's still the same, if i smoke one day then I'll get euphoric, but the next day I'll be horribly depressed.

Most people don't seem to have this effect from weed, but I do. So it's very easy to believe that weed causes you to vomit, even though it doesn't do that to most people.

matty_ice,

ER nurse here. Yes, this is a real thing. Usually, the first symptom is a steadfast denial that cannabis is the cause, so props to you for acknowledging it is likely the cause of your pain nausea and emesis. It was tough to provide care for people twice a week who would refuse to believe cannabis was causing their symptoms. That said, it looks miserable so I was always bummed someone was going through it. It would often last longer than when they tried to quit too which feels a bit unfair and contributes to the denial. There is usually a distinct retching sound people make that would out them as CHS; it is not subtle. Two things that can help fairly reliably are 1) A hot shower and 2) capsaicin topical cream rubbed on the torso. Test the capsaicin cream on a small part of your forearm first to see if you are ok with it before you lather your chest. Something about that warming sensation made folks feel much better. YMMV. Best of luck to you and others that have CHS.

klemptor,

I wonder if a heating pad would work instead of capsaicin cream.

brotkel,
brotkel avatar

Anecdotally, yes, a heating pad helps, but not as much as a hot shower.

LSNLDN,

Can I ask do you think maybe retrospectively, were there any milder symptoms that you noticed in months or years leading up to the illness that could have been a sign that it was to come?

BlinkerFluid,

Stomach cramps here and there and a lot of what felt like acid reflux but without the actual acid.

The first doctor I saw went all in on the possibility of a stomach ulcer, after that I kinda let it go for a year or two, then the OP happened.

brotkel, (edited )
brotkel avatar

Just wanted to mention that my dad had this and it doesn’t get enough attention, imo. He was a daily smoker since his 20’s. It wasn’t until his early 60’s when it started affecting him, though. Due to unrelated medical issues, he started losing a lot of weight at that time and the cannabinoids that were stored in his fat cells started getting released into his bloodstream. Unfortunately, it took a year or more before his doctor happened to hear about this syndrome and put it together. During that time, he was pretty miserable and it really restricted him from going out. But taking a break of a few months and then limiting his usage afterwards was enough to make a full recovery.

When weed enthusiasts say that cannabis has no medical downsides, I think it hurts people who are negatively affected by real, debilitating medical issues like this. Especially when the treatment is so simple and doesn’t even have to involve fully quitting, it almost makes weed look worse by not acknowledging it’s existence.

LeonidasFett,

Glad your pa is ok. Yeah weed should not be underestimated. I smoked some very high THC weed which, coupled with a very unhealthy relationship with work, put me in the hospital after a 4 month long panic attack which was there 24/7. It took years for me to go back to my old self, I still have some aftershocks from whatever happened to my brain at that time. No doctor could tell me what was wrong other than that I had a very high white blood cell count. No other biomarkers were affected though, no infection, nothing. It was basically “just” 4 months of panic and around 5 years of moderate/low anxiety.

wolfshadowheart,
wolfshadowheart avatar

Interesting, this is the first I've heard of CHS possibly having a catalyst. Up to this point my experience with CHS has been through friends, one extremely heavy smoker a little younger than I, and one very light smoker only a generation older than myself. It's almost seen as an allergic reaction, however the release of excess THC stored in fat actually makes a lot of sense, much more than you suddenly being allergic to something you've been ingesting for decades.

Not that it's impossible or anything, this is how allergies occur all the time. It's just interesting to look at different avenues, there's still so little we know thanks to a lack of research. For what it's worth, a majority of reports of CHS come from daily extended smokers, so it doesn't seem like moderation or even light excess is something that commonly causes it. With what you mentioned about your father's case in mind, it seems to align with that idea as well. I mean, more people are smoking weed than ever but CHS hasn't exponentially grown in cases.

Hypothesis: CHS is rare because its condition is triggered by an overabundance of THC with how the bodies process and metabolize it. For your father, the young friend and older friend of mine, each of them had weight loss and metabolic problems that began around the same time they started having problems.

I'd be curious to see cases where short term smokers have symptoms of CHS and what potential afflictions surround them.

Of course it's important to mention, I'm no doctor or scientist, just a medically inclined stoner who has done a couple class studies in the field. My information is solely from public research, anecdotal sources, and assumptions based on my limited understanding.

ProcurementCat, (edited )

however the release of excess THC stored in fat actually makes a lot of sense

This also ties in perfectly with the anecdotal evidence shared in this post that extremely hot showers provide (immediate) help. Brown adipose tissue, or brown fat, is an extremely crucial part of maintaining body heat and regulating blood temperature - in fact, that’s its primary purpose.

my.clevelandclinic.org/health/…/24015-brown-fat#:…)%20and%20molecules%20of%20fat.

en.m.wikipedia.org/wiki/Brown_adipose_tissue

Together with the mentions of sudden weight loss, it really sounds like some change in the affected people’s bodies leads to a higher metabolic rate of fat burning, and when most of the white fat is reduced and the body turns to brown fat, stored THC enters the blood stream and ruins their day.

This would also explain why only people who have been smokey frequently for years develop this disease - it takes time and a lot of weed to get all this excess THC into the fat in the first place.

Edit: well well well, would you look at this paper from 2011: www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/

THC accumulates largely within body fat which serves as a long-term storage site for the drug [20,22]. This characteristic partially explains its prolonged elimination half-life. A large reservoir of stored THC in fat tissue may produce a “reintoxication effect” secondary to increased lipolysis during times of increased stress or food deprivation [23]. These characteristics of THC may have implications in Cannabinoid Hyperemesis Syndrome as these patients are chronic users of cannabis who likely have large lipid stores making them susceptible to increased cannabinoid levels in the plasma during times of stress.

dorkian_gray,

large lipid stores

So for chronically (lol) underweight people or people with little-to-no body fat, this is much less likely to be an issue?

brotkel,
brotkel avatar

Burning stuff stored in fat is one way to get toxic levels of stuff into your bloodstream, but I can’t imagine it’s the only way. It would just be hard to get sick off pot through normal use and not realize it.

I think you could get into a bad cycle with this if you didn’t have the information about what was causing it. Nausea makes you not want to eat, which makes your body burn fat. Not wanting to eat but knowing you have to might cause you to smoke more to treat the nausea. Nausea gets worse making it harder to eat, etc.

amio,

Exactly. Just because a ton outright propaganda was spread for decades, that doesn't mean every downside is "fake". Particularly now that some of the stigma is going away, making all this actually feasible to do research on.

surfrock66,
@surfrock66@lemmy.world avatar

My wife is an ER doctor in California, and with the advent of legality, they started seeing this more and more. It’s not a huge percent of consumers, it’s not an epidemic, it’s not something that means all people should stop consuming…but it’s super important to spread awareness. I feel like for years, the medical conversation meant people painted weed as this magic harmless cure-all, and that’s just not the case, and as use has gone up for a lot of adults, we’re seeing the edge cases. Since so many people use weed to treat nausea/appetite, this is particularly rife for denial, which just prolongs the suffering.

Maybe it’s just correlation and it’s something with specific strains, cannibinoids, ingestion methods, or farming procedures. The point is, it’s a real thing and now that we’re seeing a bigger sample size (especially a bigger sample size of people willing to admit usage to their doctors now that it’s legal) it’s certainly a thing. Now that there are less restrictions on research because of legality, I have a feeling root cause will be uncovered. I think in like 2017 I posted to /r/trees about it because my wife was seeing it, and I got down-vote nuked to oblivion because people were sure weed couldn’t cause this cyclic vomiting. It’s important to talk about this and understand that for some people, weed as consumed just isn’t an option…and that’s ok.

Seraph, (edited )
Seraph avatar

Are you concerned it's the Delta 8?

I don't know anything about it, but the FDA thinks it may be bad, though we need more research: https://www.fda.gov/consumers/consumer-updates/5-things-know-about-delta-8-tetrahydrocannabinol-delta-8-thc

Quote:
The FDA received 104 reports of adverse events in patients who consumed delta-8 THC products between December 1, 2020, and February 28, 2022. Of these 104 adverse event reports:

  • 77% involved adults, 8% involved pediatric patients less than 18 years of age, and 15% did not report age.
  • 55% required intervention (e.g., evaluation by emergency medical services) or hospital admission.
  • 66% described adverse events after ingestion of delta-8 THC-containing food products (e.g., brownies, gummies).
  • Adverse events included, but were not limited to: hallucinations, vomiting, tremor, anxiety, dizziness, confusion, and loss of consciousness.

National poison control centers received 2,362 exposure cases of delta-8 THC products between January 1, 2021 (i.e., date that delta-8 THC product code was added to database), and February 28, 2022. Of the 2,362 exposure cases:

  • 58% involved adults, 41% involved pediatric patients less than 18 years of age, and 1% did not report age.
  • 40% involved unintentional exposure to delta-8 THC and 82% of these unintentional exposures affected pediatric patients.
  • 70% required health care facility evaluation, of which 8% resulted in admission to a critical care unit; 45% of patients requiring health care facility evaluation were pediatric patients.
  • One pediatric case was coded with a medical outcome of death
EhList,

Hypermesis has been seen with good old regular cannabis

AttackBunny,

I’ve heard that taking an EXTREMELY hot shower helps with the “attack”. Did you find it helps at all?

Also, does cessation from weed stop the issue completely?

wolfshadowheart,
wolfshadowheart avatar

Abstaining does prevent CHS

AttackBunny,

Right, that’s why I asked if it stopped when op stopped weed.

BlinkerFluid,

If it comes back, I’m downing an 1/8th through my bong.

BlinkerFluid,

It does!.. until the shower ends or the water gets cold.

justastranger,

Doctors thought my sister was experiencing this the first several times she ended up in the hospital, turns out she actually has abdominal migraines. Though why it took so many visits to realize it persisted for days after cessation of use (from being in the hospital) is beyond my ability to understand.

AttackBunny,

It took me decades of trying to finally get a migraine with aura diagnosis (and they are very standard presentation). Also, women historically get FAR worse medical treatment, and are far more likely to be told it’s psychosomatic.

r1pp0ff,

I might have had similar symptoms, but it mainly came out of the back door, only sometimes vomiting. Did you ever have things in your stool that could look like tapeworm-ish? I’ve been through 3 rounds of treatment for tapeworms and nothing helped except when I stopped smoking, so I don’t know what is wrong with me anymore :(

agitatedpotato,

I’ve heard people are conducting studies to see if this is related to pestacides used in flower growing as some researchers felt the amount of uptick in cases of this disease wasn’t sufficient explained by the amount of rise in daily marijuana users.

gothicdecadence,

I believe it’s a combo of pesticides plus the extremely high THC that weed has now compared to the past few decades.

BlinkerFluid,

The medial science revolves around cannabinoids getting where cannabinoids shouldn’t be. What appears to be untested is if you can moderate and avoid CHS.

For instance, were I a monthly smoker… or became a monthly smoker.

Kiwi,

I have experienced much more mild CHS than what you’ve described. Mainly nausea and occasional vomiting spells, but usually just happens in the morning and I’m fine in the afternoon.

I’ve been self regulating for about 2 years by limiting my intake and switching strains often (and just avoiding certain ones). I did take a solid 6 months off after diagnosis and started introducing it back slowly.

I’ve found that I can still smoke daily, but not all day. I can smoke up to an ounce of a single strain before that specific strain starts to trigger symptoms and switching to a “different enough” strain will avoid further symptoms. Some strains just hit me wrong and will cause symptoms (ghost train haze) but others seem to be pretty safe and are a go to (member berry).

When symptoms come on quickly I just take a few days - a week off smoking and am usually good to start again with a different strain. I start to get heart burn / mild nausea in the morning and that’s when I know I need to change strains.

I haven’t tried the same strain from different dispensaries to see if there is a different factor like pesticides or nutrient solution that is actually the problem. I doubt the same strain from two dispensaries would be scientifically close enough to make it a worthwhile test. What confuses me is that while I am experiencing symptoms from a strain my body has turned on, I can fire up a bowl from a safe strain and it does a pretty good job of stopping the symptoms, which to me says either pot is a great anti nausea or that the level of THC in my system isn’t the issue but instead the level of a certain cannabinoid or terpene.

DharmaCurious,
@DharmaCurious@startrek.website avatar

That truly sucks. I’m sorry you’re going through that.

Just one thing real quick, though, just in case. My entire family has had similar issues, and for every one of us* it has been our gallbladder. Also for every one of us, they have refused to check our gallbladders. My mom was told ulcers, which she had none. Had to have emergency surgery when her gallbladder was on the verge of ruptured. My brother was told it was his drinking (±1 drink a week), quit drinking for two years with no improvement. When they finally removed his gallbladder it was so bad it literally fell apart inside him when they tried to remove it, and he was in the hospital for a week *I’m currently going through it, and they’re telling me it’s acid reflux.

The gallbladder is the medical bigfoot. Doctors refuse to believe it exists, I’m pretty sure.

BlinkerFluid,

Through the CT scans, I did have one doctor look at one stone that was high and ruled it out. One after told me “gallbladder looks good” so I shrugged it off. Sorry I didn’t mention it.

I am, however, going to a gastrointestinal specialist. They might find more than the ER did. Time will tell. I’m going full tilt on the issue, I’m not stopping at weed.

DharmaCurious,
@DharmaCurious@startrek.website avatar

That’s wild. Not doubting your diagnosis, just thought I’d mention because doctors treat the gallbladder like a cryptid. Lol.

I really hope you figure out a treatment plan that works, my friend. That sounds really awful.

ZephyrXero,

I had a sporadic stabbing pain in my lower right abdomen for over a year, and already had acid reflux issues. We did lots of different investigation paths and tests, till they finally figured out the muscles in my gallbladder were barely functional and had it removed.

Side effect, it slows your digestion and now my activation time for an edible can take up to 6 hours sometimes

DharmaCurious,
@DharmaCurious@startrek.website avatar

Holy crap. I don’t really use cannabis (not against it, majorly in favor of legalization, and occasion user. Just don’t particularly like being drunk or high personally anymore), so I’ve never really considered how gallbladder removal might impact edibles. That’s crazy.

OneCardboardBox,

My fiancé had prodromal (pre-vomiting) CHS from November to January. The symptoms appeared as gallbladder hyperactivity, but the doctors wouldn’t commit to saying it was a gallbladder problem. His big break came after spending 2 nights in a hospital and apparently recovering, then getting worse after he came home. We connected it to cannabis use after he came home, and quitting cold-turkey alleviated all symptoms basically overnight.

NPC,

Ugh, I’ve been having similar problems… Maybe I should visit my doctor as well. Though, for me it’s less bad and more often. I’ll be on almost constant abdominal pain and nausea and will vomit almost every day. I was thinking it was the alcohol I was consuming as well, eventhough it wasn’t that much, but quit that completely over 2 months ago and it didn’t get any better.

Radium,

I’ve had similar issues to what you’ve described and a long cessation (2+ weeks) from pot fixed my issues, though it slowly gets better and may take longer.

I still smoke daily and just have to be careful not to smoke too much or the wrong strain. I’ve found that smoking one strain for too long ( more than an ounce, but depends on the strain) can cause symptoms to come back. Some strains cause symptoms from the first smoke too.

I can avoid 95% of stomach issues by just paying attention to my usage. I can tell I’m starting to sour on a strain when I get slight nausea after smoking or experience light heartburn / nausea when drinking coffee.

When symptoms come back I take a few days off and get some new strains and start introducing when my stomach can handle a latte

FuntyMcCraiger,

You’ve been vomiting almost every day for at least two months and you haven’t visited the doctor yet?

Maybe you should, and possibly visit the dentist too. Stomach acid doesn’t play well with teeth.

loaf,
@loaf@sh.itjust.works avatar

Jesus, that sounds awful. I’m genuinely sorry you’re suffering. It sucks that something that can legitimately help someone (or at the very least, make them happy) is hurting you so much.

snail_hatan,

What was your daily use like (amount and approximate potency)?

Have you ceased use, if so how long ago, and how have your symptoms changed?

I wish you the best of luck, a close friends brother just went through the same and it sounds absolutely awful. I’ve heard hot baths help a ton!

BlinkerFluid,

Any chance of it happening again is unacceptable to me now that I have experienced it. I can’t let a personal vice tilt on a maybe, and while I kinda expected Delta 8 to be a target. Many classic flower users get it who never put a cart to their lips.

I will do anything to avoid ever feeling that sick again.

notfromhere,

You haven’t mentioned anything about how you smoke it. Could it be something in the specific papers or instruments of choice? Have you tried real vaporizers (not pens, but like a plastic bag that blows vapor into it), you said not edibles, so have you considered trying them? What about alcohol tinctures or smoking hash?

BlinkerFluid,

Easy. Usually I use a glass one-hitter and I kept whatever Delta 8 vape I could find on me when out in public. I had a bong I’d use on occasion but usually not that often. I do have a few dry herb vapes like my arizer air but it didn’t get much use really.

I’m not considering trying anything. Not smoking weed isn’t a problem… it’s just not preferred.

Had you thirty minutes with this shit, it would scare and traumatize the living hell out of you. It is not a good time. There’s sick and then there’s this. 8 hours, non-stop, pain. I have legitimate nightmares.

I personally believe the disease reacts to cannabinoids in your system. How they get there is irrelevant.

notfromhere,

Sorry you’re going through this. It sounds horrible.

agitatedpotato,

I had episodes of this so badly I had to go to the hospital because I couldn’t even drink water without throwing it back up and needed IV fluids. The stomach spasms are among if not the worst pains ive ever felt. It would take days for me to feel ready to eat actual meals again. Changed my whole diet, dropepd nicotine, caffeine, weed, everything. Picked weed back up after my stomach was clean for a bit and its been years since, no issue. Im hoping you can eventually smoke again, at least if you want to.

Transcendant,

I’ve heard a few people talking about delta-8. Personally I like my weed au naturelle. Was the D-8 you were vaping synthesised?

BlinkerFluid,

D8 so far as I know is all at least halfway synthetic.

As a realist, I look at chemicals like that on the basis that the chemical itself may be harmful, and not the fact that it’s synthetic.

I’ve never vomited my guts out over fake strawberry flavoring or vanillin even though this is anecdotal.

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