Cannabinoid Hyperemesis Syndrome: Yes, Teens, Smoking Marijuana Too Much CAN Hurt You

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by Elena Vidrascu, MSc

Welcome to Preventing America’s Next Drug Epidemic: A Multidisciplinary Approach, a series designed to introduce the many facets of substance misuse and how integrating the work of multiple partners may be the best approach towards prevention and treatment.

Teens Smoking MarijuanaThe other day I got a text from a friend asking if I was familiar with cannabinoid hyperemesis syndrome. Her friend’s brother had just been hospitalized for throwing up every day for a month.

The marijuana enjoyed by millions of Americans today is very different from that from the 1960s. Today you can easily find marijuana plants and edible products containing 15% THC, the chemical responsible for the psychoactive effects: the “high.” Back in 1995, the THC concentration was on average 4%, and even less in preceding years. In well-developed markets like those in Colorado and California, it’s not difficult to find products with over 25% THC.

The government crackdown of marijuana growers in the 1980s drove the boom of the indoor growing industry, allowing evasion from the police and the art of refining plant growth under artificial conditions, cultivating desired concentrations of chemicals of interest. Marijuana consists of over 100 chemical compounds called cannabinoids, with two of them being THC and CBD. THC gives you the “couch high,” if coming from an indica strain of the plant, primarily helping with pain management and sleep, or the energetic focus that can make you actually enjoy cleaning your room for two hours, if coming from a sativa strain. With CBD you don’t feel that head high; rather, it helps ease symptoms of anxiety, depression, pain, and epilepsy, and can even aid in the recovery from substance use disorder; however, there is insufficient research done with humans.

In 2004, the medical literature first reported cannabinoid hyperemesis syndrome (CHS), and emergency departments are increasingly reporting its occurrence, with common symptoms including nausea, vomiting, and extreme abdominal pain. There are a couple prevailing theories for why this syndrome might occur, but in general it results from chronic (>2 years) and heavy marijuana use. The receptors to which cannabinoids bind and exert their effect are not only found in the brain but also throughout the body. Excessive and chronic activation of these receptors can prevent the stomach from emptying properly, therefore causing regurgitation after having food sit there for too long.

Drug tests can detect THC for quite some time after consumption, partly because THC enters our fat cells and is stored there. People who use marijuana regularly will already have high THC concentrations in their blood, and when the body breaks down fat cells to use energy, more THC is released into the blood stream, increasing the likelihood of toxicity. And actually, it’s not just THC but also its active metabolite, 11-OH-THC, that is responsible for the drug’s effects. After entering the body, THC is transported to the liver to be broken down by certain enzymes. With edibles (eg, brownies), the digestion process can produce almost 3 times as much 11-OH-THC than with smoking, which doesn’t leave much THC in the bloodstream. It’s doubtful that many people, let alone teens, know this, and edibles are extremely popular. To no surprise, recovering from CHS consists of stopping marijuana use, which may require many to enter treatment programs due to psychological dependence on the drug. With increasing trends of cultural normalization and legalization, educating youth on marijuana use is of critical importance.  

Chronic marijuana consumption can have additional negative effects, such as raising resting heart rate and making the heart pump harder, which poses problems for those who might have underlying heart disease. In moderation, marijuana use may have some positive benefits, but high concentrations of THC have been shown to elicit anxiety in users and further exacerbate it in those who already have preexisting anxiety disorders. There is also an increased risk of psychosis, which can potentially trigger onset of bipolar disorder and schizophrenia for those who are at increased risk.

Just to be clear: I’m not claiming that marijuana use causes schizophrenia; rather, in those who might have a predisposition to developing the disorder, marijuana use can be that key difference between those who present with symptoms and those who don’t. Onset of schizophrenia appears in the early 20s, so teens should be especially cautious of their marijuana consumption.

Advocating for the legalization of marijuana doesn’t have to be contingent on the conviction that people should indulge in it. Legalization can allow for less stringent regulations on conducting research on marijuana. Drugs placed in the schedule 1 category, which include marijuana, heroin, and LSD, are considered those that serve no medical value and pose high risk for abuse, and therefore they’re considered the most dangerous (cocaine is a schedule 2 drug, mind you). In compliance with the Controlled Substance Act of 1970, researchers wishing to study schedule 1 drugs must register with the DEA, which can be a taxing process. Many of the medications prescribed today are derived from natural compounds extracted from plants, like those to treat Alzheimer’s, pain, and chronic obstructive pulmonary disease. There have already been great discoveries and advancements from studying marijuana and the individual cannabinoids making up the plant. Epidiolex is a formulation of CBD that was approved by the FDA in 2018 for those with rare forms of epilepsy.

By implementing public health approaches to educating the public on possible hazards of marijuana use, we can prevent risks associated with chronic, heavy marijuana consumption. Online responsible marijuana vendor (RMV) training has been implemented in recreational stores in Colorado, Oregon, and Washington state, and survey responses demonstrated the satisfaction of employees with the program and their confidence in identifying intoxicated customers and authentic IDs.  Whether this will reduce distribution to minors, reduce use, or prevent onset of use remains elusive and warrants further research, but combined with educational materials targeting at-risk populations, this is an approach in the right direction to protect our youth.  

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Elena Vidrascu, MSc

Elena Vidrascu, MSc, recently graduated from Wake Forest University with her MSc in Physiology and Pharmacology. Her primary field of interest is substance abuse, with goals to disseminate information to the public, including addicts and those in recovery, and to influence policy change to push for more integrative approaches towards prevention and treatment. In her spare time, she enjoys playing tennis, hiking, doing puzzles, and cuddling with her kitten Maple.

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