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ERs see uptick in severe vomiting from too much marijuana

Heavy smoking, edibles send some to hospital with cannabinoid hyperemesis syndrome
Attendees smoke marijuana during the 2014 marijuana festival, in Denver’s downtown Civic Center Park. Emergency rooms are reporting an uptick in the number of patients experiencing uncontrollable vomiting, apparently a result of consuming too much pot.

DENVER – As more states legalize medical and recreational marijuana, emergency room physicians in Colorado warn their colleagues around the country to be on the lookout for an illness that strikes heavy users of marijuana. It’s called cannabinoid hyperemesis syndrome – a nasty affliction whose central symptom is uncontrollable retching and vomiting.

There are a lot of unanswered questions about it because cannabis research has been thwarted for so long. But Dr. Kennon Heard, a toxicologist at the University of Colorado School of Medicine, says it’s a real problem that goes beyond pot tourists overindulging.

He noted that the number of patients doesn’t come close to the numbers of those seeking treatment for alcohol or drug overdoses.

Mercy Regional Medical Center also confirmed it is a condition its emergency room deals with on a somewhat regular basis.

“It’s typically the result of people consuming edibles versus smoking,” said David Bruzzese, spokesman for the hospital. “The cycle that occurs is people consume edibles, don’t immediately feel the effects, think they’re not working and consume more ... and then all of a sudden they’re ill.”

People suffering from the condition experience uncontrolled vomiting, he said.

Here are some highlights from the Colorado Public Radio interview with Dr. Kennon Heard:

What it feels like

So, how do you know you might be suffering from cannabinoid hyperemesis?

“It will cause a lot of abdominal pain nausea, vomiting. Patients are really, really uncomfortable. It’s a sort of uncontrollable dry retching and abdominal pain, and they feel terrible. ... It can last for several days. It’s a recurrent disease so patients can get it, get a little better for a few days, then it can come back, and they can even have multiple episodes of this over the course of several months.”

Frequency of reports

Heard sees it regularly in the emergency room: “Really, a daily to weekly basis. And talking to my colleagues around the state, you know pretty much everyone is seeing it to some extent.”

Patient profile

What kind of person is most likely to get it:

“We don’t have a really good characterization of this yet. There hasn’t been a lot of systematic evaluation. I can tell you in our emergency department the majority of people that we see are really consistent with the people who are most commonly using marijuana. So: younger, a little bit higher proportion of males, people who are using or report heavy use – usually daily at least.”

Does this happen through smoking and use of edibles?

“The vast majority the patients that we’re seeing in our emergency departments are smoking. I don’t think we have really good information about how often it occurs with each type of exposure, but my impression is that it’s more common with smoking than with edibles.”

The cause

Why does this illness strike?

“Based on the fact that it’s usually seen in people who are frequent heavy users, what we see with other drugs is frequently the nervous system changes in response to that constant stimulation from the active chemicals in the drug, something like you’d see from someone who becomes dependent on opioids or alcohol for example, and as you are exposed to the drug or heavy amounts of the drug for a long period of time, your body makes adaptations to that. And then those adaptations can likely cause the effects we are seeing. Now we don’t have any real good science to explain what exactly those adaptations are; that’s very much a 30,000 foot view and we’d like to get some more information because it will help us understand the cause of this disease and potentially even some other therapeutic ways that cannabinoids could be used.”

This content is shared with our readers under a content-sharing agreement between the The Durango Herald and Colorado Public Radio. To read the full story and listen to the interview with Dr. Kennon Heard, go to cpr.org. Herald Staff Writer Shane Benjamin contributed to this report.

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