Often when we think about teens smoking weed, we think of scenes like That Seventies Show, with kids enjoying the giddy side effects and having fun. There is another side to marijuana use though, and it isn’t often talked about in the media. Cannabinoid Hyperemesis Syndrome (CHS) is a condition that is brought on by using high potency THC over a long period of time. The syndrome causes severe nausea and vomiting, and often occurs within 1-5 years of chronic use.
The medical community is slow to acknowledge how rapidly this condition is becoming more and more common. Look on-line and you’ll find established medical centers using words like “rare” and “only after long periods of daily use.” However, what is happening in my practice is I am seeing prodromal phase of this condition with an increasing frequency.
People who suffer from this condition experience three phases of the illness: the Prodromal phase, the Hyperemetic phase, and the Recovery phase. The Prodromal phase is the stage in which symptoms of abdominal pain and nausea are uncomfortable and occur mostly in the morning. Ironically, those suffering in the early phase of the illness often use marijuana to try to curb the nausea, as it is known to abate nausea in many people who are suffering from ill effects of other conditions. Unfortunately, this use establishes a pattern of worsening symptoms. In the Hyperemetic phase, the abdominal pain and nausea become productive and manifest in repeated bouts of intense cyclical vomiting. During this time, the desire to eat and drink diminishes, causing weight loss and dehydration. Taking hot showers and baths help alleviate the symptoms temporarily, but if marijuana use continues, symptoms continue to worsen. The Recovery Phase occurs when marijuana use has stopped and is out of the system. It is then possible for the person to eat and drink normally. It may feel like normal life has finally resumed, this can last for many months, unless the person uses marijuana, at which point the symptoms can re-emerge and set the cycle into effect all over again.
But Cannabis is Used to Reduce Nausea, So What Gives?
It does seem like a strange reality that the very substance often used for alleviating nausea can cause this type of illness for some chronic pot users. Apparently, the difference lies in the area of the body being stimulated by marijuana use. People who get relief from nausea through marijuana use experience this relief due to the impact of the substance on the areas of the brain that effect nausea. For CHS sufferers, they are experiencing the impact of marijuana use on their digestive tract. Early on in marijuana use, brain receptors are more sensitive to THCs effects; high levels of THC marijuana usage decreases the brain’s sensitivity to the THC effects, and this can result in greater sensitivity to the digestive effects of the substance (nausea and vomiting). And todays marijuana industry is selling legally and illegally THC strengths upwards of 50% - 90% THC.
Parents of teens who use marijuana frequently may notice digestive issues emerging in their kids. Having an awareness of CHS and the stages of the illness can help parents and kids monitor these symptoms and determine if the digestive upset is being caused by marijuana use or some other cause.
Helping Your Teen Become CHS Aware
Teens are skeptical of parental input regarding marijuana use, particularly if they already know that their parents are not in agreement with their usage. Information about CHS can be shared with teens as a possible medical issue brought about by marijuana use. Informing them of symptoms to look out for (abdominal pain, nausea, vomiting) and offering to arrange a medical consult may empower them to look into the condition on their own or start to observe any trends related to their usage patterns. Initially, teens who are struggling with some of the symptoms may resist the idea that it could be CHS, since the only way to reverse the symptoms is to cease all use of marijuana. As with many other areas of parenting a teen, engaging in a power struggle about it is futile. Sharing information and expressing your care and concern may show your teen that, while you love them and want them to be healthy, you also understand that they need to come to terms with the possibility that their physical health is being impacted by marijuana use, and how disappointing that must feel for them. It can be challenging to strike a balance between trying to help them “fix” the problem and encouraging them to take a look at the facts and determine it for themselves; especially since we know that their prefrontal cortex is still developing process and they actually DO need our help to make decisions and think critically! Showing teens that their thoughts and opinions are important and encouraging them to consider their digestive symptoms and whether they could be related to marijuana use is a non-confrontational way to have the conversation and encourage self-reflection.
Your Medical Professional Can Help
Many teens may under report their THC use to their doctor, and with child consent laws being what they are in many states (as low as 14) you as their parent may be in the dark about the level of information your child is providing their doctors. That said, as a proactive parent, it is worth sharing your concerns to your child’s doctor about the possibility of CHS, particularly as it is still not a commonly known condition, particularly in the prodromal phase. Don’t be afraid to bring this up to the care team. Often having a doctor support the possible diagnosis and share details with your teen directly can be impactful.
Lastly, the only definitive test for CHS is to stop smoking weed altogether. While on the one hand you might think, “great! Easy fix! My kid will get better immediately, “ the truths is these higher concentrations of THC are incredibly addictive, and take more than willpower to overcome. This is why so many of my clients end up needing residential care to help them to stop. Once they begin to see and feel healthy again, they have taken the most important first step to stem a very serious medical condition, not to mention the positive impact on drug-free brain development. It is a rough road, but there is hope and help.
Can marijuana use cause something as extreme as psychosis? That is a frightening thing to consider, especially given the proliferation of weed use in our youth. The answer is a complicated one to assess. It is tricky due to the many factors that can potentially be at play. Although the research on this topic is growing, it's still somewhat limited. Nonetheless, I believe it's vital for us to look at the information we have, as the impact, particularly on adolescents and young adults can be serious.
So, what are the potential factors related to the connection between psychosis and the use of marijuana? Let's take a brief look.
What Factors Come Into Play?
Cannabis remains the most commonly used drug worldwide. Vaporizer pens, designer cannabis strains, edibles, and butane hash oil or “dabs” offer access to higher-than-ever-before concentrations of THC. With this increase in popularity, availability, and potency, many are looking closely at the connection between cannabis use and psychosis. Also known as cannabis-induced psychosis (CIP), this state of psychosis can occur due to many different causes.
Talley Webb, MA, CRMC