Marijuana Causes Cyclic Vomiting

8 Feb 2013

With the recent legalization of recreational marijuana in the state of Washington more and more people will be consuming larger quantities of pot. With this increased use comes the potential for toxicity from marijuana. In the past decade a new phenomenon has been described that is now exploding with cases being seen in emergency rooms all across America. The new diagnosis has been coined “cannabinoid hyperemesis (CH)”.

Initial descriptions were infrequent but as greater numbers of cases began to be recognized it became clear that CH is not rare. Now, a large series of 98 patients has been published by the Mayo Clinic in Rochester, MN. These individuals were all under the age of 50; most smoked pot more than once per week; the duration of smoking ranged from less than one year to greater than eleven years; most had some form of gastrointestinal complaint ranging from pain, nausea, vomiting and diarrhea; and resolution of symptoms occurred following abstinence from cannabis.

One of the more interesting features of CH is that nearly all patients get temporary relief from symptoms while taking a hot shower or bath. Not recognized even by the individuals suffering from CH, most patients suffer an average of 7 or more attacks per year. Patients become profoundly dehydrated from vomiting and require hospitalization.

At a time when America is liberalizing recreational pot use while looking to find ways to cut the cost of healthcare, many of these patients end up with very expensive medical bills. Repeated emergency room evaluations and hospitalizations lasting an average of 3-4 days for nausea and pain control that can reach over $100,000 per patient per year.

Cannabinoid hyperemesis has now been described in two children in the pediatric literature. As more pot is being consumed in the home, more children will have access to their parents’ pot. I remember trying to smoke one of my dad’s cigars when I was a youth. It made me deathly ill and the event broke my curiosity very quickly.

What will be the next chapter concerning CH? Habits die hard. The pot habit can lead to very expensive medical bills, possibly affect our children and perhaps even lead to irreversible damage (see marijuana and the brain article) to our children’s brains.

I have now seen four patients with CH since I became aware of this diagnosis. How many thousands of emergency room visits and hospitalizations could be prevented by not smoking marijuana? The cost could easily be in the billions of dollars per year, let alone the price of permanent brain damage to our children. As I learn more I will keep you posted.

References:
Mayo Clinic Proceedings 2012; 87:114-119.
Journal of Emergency Medicine 2011; 40:e63-66.
Pediatric Emergency Care 2010; 26:919-20.
Psychosomatics 2012; 53:212-19.