When marijuana makes you sick
Most people in the general public have never heard the term cannabis hyperemesis, but Emergency Room doctors are well-acquainted with it. The term literally means severe vomiting caused by marijuana use.
“People don’t often make the connection, but people are really miserable when it happens,” said Cape Cod Hospital Emergency Medicine Physician Kristen Liska, MD. “They have severe abdominal pain in their upper abdomen and they vomit profusely and can’t stop.”
The reason this happens in some people has to do with the body’s receptors for THC, the psychoactive component of marijuana, she explained. There are THC receptors in your brain, which is what causes the high feeling and activates anti-nausea centers. It’s the reason some people who are undergoing chemotherapy use marijuana. For most people, marijuana actually helps with nausea, she said. However, there are also THC receptors in your brain that, in some people, can have the opposite effect on the gastrointestinal system.
When the receptors backfire, a small number of people have cyclical vomiting that is only relieved by taking a hot shower. Unfortunately, as soon as they leave the shower, the vomiting comes right back.
Most people who suffer from cannabis hyperemesis are regular users of marijuana products by either smoking it or eating edibles. It can come on suddenly, even if the person has used marijuana for years with no problem. It also can last for months after a person has stopped using marijuana because the THC stays in a person’s system for that long.
“It you’re a regular user, it builds up in your system,” Dr. Liska said. “That’s why you can detect it in things like hair. It can take a few months to really get it all out of your system to get those receptors back to normal. So, some people can still experience cyclical vomiting and abdominal pain months after stopping, unfortunately. But it will eventually stop if they stop using.”
Home and Hospital Remedies
In addition to showering, home remedies include putting a heating pad on your stomach or rubbing capsaicin cream to mimic the warm sensation of a shower. Dr. Liska also recommends trying small sips of water or Gatorade.
“But if you get to the point where you can’t keep anything down, you’re going to get dehydrated, and that’s when you should definitely come into the ER,” she said.
Treatment in the ER consists of intravenous fluids, anti-nausea medications and pain medications, because the condition is very painful. The dangers of vomiting that violently include inflammation of the lining of the stomach that can cause bleeding and small tears on the surface of the esophagus. Rarely, a condition called Boerhaave’s syndrome occurs, which is a tear fully through the esophagus. If that happens, surgery is necessary.
Once a patient is fully hydrated and stops vomiting, Dr. Liska advises them to stick to a bland diet at first, starting with clear fluids, like broth. After the clear broth, they should follow the BRAT diet of bananas, rice, applesauce and toast until they feel better. They should also take an antacid because severe vomiting causes the stomach to become very acidic. Spicy foods, fried foods and dairy should be avoided because they are irritating or hard to digest.
Even though cannabis hyperemesis only affects a small portion of the population, it is common enough that ER doctors ask all patients who come in with vomiting about their marijuana use as part of their medical history. It is more prevalent in teenagers and young adults, Dr. Liska said, but legalization doesn’t seem to have increased the number of cases that she’s observed.
It is a diagnosis that a lot of people don’t want to accept, especially if they enjoy marijuana. Dr. Liska said some people come back to the ER over and over again because they don’t take it seriously and therefore don’t stop using marijuana.
“A lot of people don’t want to believe it because it’s an enjoyable thing that they do,” she said. “It’s unfortunately bad luck if you’re that person who it happens to and your friends are all fine.”
She also assures patients that this isn’t a shameful thing.
“Marijuana products are legal and very accessible and people use them,” she said. “It’s not like this is an embarrassing thing if this happens to you. We are not judging you at all.”
