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The rare syndrome that makes stoners puke uncontrollably

Doctors describe Cannabinoid Hyperemesis Syndrome (CHS) as “paradoxical” because it causes some chronic weed smokers to vomit uncontrollably, and yet a proven effect of THC – a component of cannabis – is nausea relief.

CHS has been in the news recently with emergency room doctors in Colorado reporting a rise in people presenting with this rare condition.

Marijuana was legalised in the state five years ago. Since then, more than US$6 billion worth has been sold in the jurisdiction.

Other states have also followed suit and legalised the drug.

For these reasons, reports from Colorado of a “dramatic increase” in stoners presenting to hospital with CHS have been read with interest.

Physicians say the uncontrollable cyclical bouts of vomiting can last for days and then stop, only to restart about a month later.

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Associate Professor of emergency medicine and toxicology at UCHealth University of Colorado hospital, Dr Andrew Monte, has researched the medical consequences of weed legalisation and how it’s changing who turns up to emergency rooms in the state.

Dr Monte told Hack CHS occurs in people who’ve been smoking heavily for years and can’t be treated with traditional anti-nausea medication.

“Typically this results in patients ending up with unremitting vomiting happening in cyclic time periods,” he said.

Our typical patient uses [cannabis] approximately ten times per day and ultimately ends up having these cyclic vomiting episodes.

ABC News: Niall Lenihan

Dr Andrew Monte has been researching the health impact of legal marijuana on the state of Colorado.

ABC News: Niall Lenihan

And there’s only one way to stop these patients from having continued vomiting episodes: “The only known proven treatment is to stop smoking cannabis,” Dr Monte said.

CHS first researched in Australia

CHS was first described in medical literature in 2004 by a GP in the Adelaide Hills, Dr James Hugh Allen.

“The first patient I saw with it was a 20-year-old man,” Dr Allen told Hack.

“He’d present every couple of months, absolutely vomiting, and the odd behavioural thing is he’d sit in hot showers.

“He’d sometimes even burn himself heating himself up.”

After nine months of recurrent vomiting episodes, the patients confided in Dr Allen he thought it could be caused by his heavy weed use.

“He was actually smoking quite industrial quantities,” Dr Allen said.

Dr Allen went on to observe 19 patients with chronic cannabis use and this vomiting illness and wrote a paper on it.

They were smoking up to 30 or 40 cones a day for some of them.

One of the weirdest observations was that people would compulsively shower because the heat would help with the sickness.

“As soon as they got out of the hot shower they’d start with nausea and vomiting again, they’d wrap themselves in electric blankets, they’d burn themselves with hot water bottles,” Dr Allen said.

Now, a recommended treatment for CHS is cream laced with capsaicin – the hot stuff in chillies. The cream tricks your body into thinking it’s hotter than it is.

More research needed

It’s still unclear why some heavy cannabis users get CHS, but others don’t. Having seen a mother and daughter with the same syndrome, Dr Allen suspects genetics may play a part.

Dr Andrew Monte from Colorado isn’t surprised CHS is only now being studied, as people’s attitudes towards marijuana have changed and people are more comfortable talking about their use.

“This is a relatively new condition and only now it’s becoming more common and in numbers where we can study it in a population,” Dr Monte said.

ER doctors are seeing it more in places with legal weed.