On October 4, the NY Times published an article entitled, "As America’s Marijuana Use Grows, So Do the Harms."It recounted the growing number of dangers of cannabis use, especially as more and more states legalize its use, and the cannabis being dispensed grows more and more potent:
From Washington State to West Virginia, psychiatrists treat rising numbers of people whose use of the drug has brought on delusions, paranoia and other symptoms of psychosis.
And in the emergency departments of small community hospitals and large academic medical centers alike, physicians encounter patients with severe vomiting induced by the drug — a potentially devastating condition that once was rare but now, they say, is common. “Those patients look so sick,” said a doctor in Ohio, who described them “writhing around in pain.”
The syndrome is called "cannabinoid hyperemesis syndrome," and it is becoming increasingly prevalent across the country. I had never seen a case, but I think it is prudent to be aware of this condition. The syndrome is characterized by cyclical vomiting in people who use cannabis near daily at high doses. It is not entirely known why this occurs, and it is more common in male older adolescents and adults.
Patients also have abdominal pain, and for some reason, hot water baths and showers relieve the symptoms. According to the NY Times article,
"Hundreds of people recounted to The Times, in interviews and survey responses, that they had spent hour after hour in hot baths and showers. Some were burned by scalding water. One teenager was injured when, in desperation, he pressed his body against a hot car."
These episodes of intense nausea and vomiting can obviously cause dehydration, kidney failure, and electrolyte abnormalities leading to seizures and even death. The Times article said, "it has caused deaths — at least eight in the United States."
Thus, whenever we see a patient in the Emergency Department, Hospital Medical Floor, or even ICU with severe hyperemesis, we should be screening for cannabis use. We also should ask whether hot baths/showers relieve the symptoms.
The NY Times article also recounted stories of patients who have had paranoia, psychosis, and hallucinations as a result of cannabis use:
Many physicians said that they have seen growing numbers of patients with cannabis-induced temporary psychosis — lasting hours, days or even months. While it is more common among younger consumers, it can afflict people of all ages, whether heavy or first-time users, and with or without a family history or other risk factors for psychosis.
So, if we see patients with acute psychotic episodes, we should also be screening for cannabis use.
Now, I have to say this: I was never a believer that cannabis - with all its potential benefits notwithstanding - was completely benign. I always suspected that, as time passed, the harms of cannabis will become more evident. It seems this is starting to bear out.
Indeed, the NY Times article quoted Dr. Scott Hadland, associate professor at Harvard Medical School, as saying:
“Cannabis should not have a free pass as something that is safe because it’s legal — or safe because it’s natural — because actually it clearly causes harm in a number of my patients."
Dr. Hadland oversees adolescent medicine at Mass General for Children. I agree completely.
I fear that adverse effects of cannabis, such as cannabinoid hyperemesis syndrome, will continue to increase in prevalence, causing suffering to a lot of people. We clinicians need to be aware of conditions such as these so we can learn to treat them effectively.
References:
NY Times article: https://www.nytimes.com/2024/10/04/us/cannabis-marijuana-risks-addiction.html?smid=nytcore-ios-share&referringSource=articleShare
UpToDate Article: Cannabinoid hyperemesis syndrome
