Marijuana Use May Cause Severe Cyclic Nausea, Vomiting

Marijuana use—both natural and synthetic—may cause cannabinoid hyperemesis (CH) a little-known but costly effect that researchers suggest is a serious burden to the health care system as it often leads to expensive diagnostic tests and ineffective treatments in an effort to find the cause of a patient’s symptoms and provide relief, according to two separate case reports unveiled today at the American College of Gastroenterology’s (ACG) 77th Annual Scientific meeting in Las Vegas. Cannabinoid hyperemesis is characterized by a history of chronic cannabis use followed by a cyclic pattern of nausea, vomiting and colicky abdominal pain. Interestingly, compulsive hot baths or showers temporarily relieve symptoms, another characteristic which aids clinicians in diagnosis.

“Most healthcare providers are unaware of the link between marijuana use and these episodes of cyclic nausea and vomiting so they are not asking about natural or synthetic cannabinoid use when a patient comes to the emergency room or their doctor’s office with these symptoms,” said co-investigator Ana Maria Crissien-Martinez, M.D. of Scripps Green Hospital and Clinic in San Diego. She said CH was first described in a 2004 case series of 9 patients in Australia and since then, 14 case reports and 4 case series have been published, including a prospective series of 98 patients published by Mayo Clinic in February 2012.

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“Patients who use cannabis whether natural or in synthetic form called ‘Spice’ also don’t realize their unexplained episodes of cyclic nausea and vomiting may be a result of this use, with some increasing their cannabis use because they may think it will help alleviate their symptoms—and it actually makes them worse,” said Dr. Crissien-Martinez . “The only resolution is cannabis cessation.”

Dr. Crissien-Martinez co-authored the case report, “Marijuana: Anti-Emetic or Pro-Emetic” which described a series of 9 patients with cannabinoid hyperemesis at Scripps Green Hospital with average age at diagnosis 30 years-old; 88 percent male; onset of cannabis use during teen years; 88 percent used cannabis daily; 56 percent compulsive bathing behavior; and 80 percent symptom resolution with cannabis cessation.

The other case report, “Spicing Up the Differential for Cyclic Vomiting: A Case of Synthetic- Cannabinoid Induced Hyperemesis Syndrome (CHS),” may be the first reported case of CH attributed to synthetic cannabinoid, according to Fong-Kuei Cheng, M.D. and his research team from Walter Reed Walter Reed National Military Medical Center/Uniformed Services University of the Health Sciences in Bethesda, MD.

“Legal synthetic cannabinoids became available in the United States by 2009 with widespread usage among military personnel due to its ability to elude standard drug testing. It is important to recognize that routine urine drug testing does not include JWH-018 and JWH 073, which are the primary components in synthetic cannabinoids,” said Dr. Cheng.

The case report described a 22-year active duty military male who was admitted with a 10-month history of progressive, intermittent abdominal pain, nausea and vomiting, with episodes occurring every two months and lasting up to a week. He underwent several diagnostic tests before a urine synthetic cannabinoid test confirmed the diagnosis of cannabinoid hyperemesis syndrome (CHS). Since discontinuing these drugs, the patient has remained symptom-free, according to the case report.

“This case illustrates that CHS should be in the differential diagnosis of unexplained, episodic abdominal pain with nausea and vomiting, particularly if relieved with compulsive hot showers. Recognition of this syndrome is important to prevent unnecessary testing and to reduce health care expenditures,” said Dr. Cheng. “We have also noted, particularly in the active duty population where drug testing for cannabis usage is done routinely, that there appears to be an increased usage instead of the synthetic cannabinoids, so we would advocate routine additional testing for them when the clinical suspicion is high.”

Patients frequently have multiple hospital, clinic and emergency room visits with extensive negative work-up to include imaging studies, endoscopies, and laboratory testing before they are finally diagnosed with cannabinoid hyperemesis, according to the researchers of both case reports.

“We estimate $10,000 to be the minimum cost of one admission—but on average our patients required admission to the hospital 2.8 times, a total of almost $30,000 for workup,” said Dr. Crissien-Martinez, who added that that cost does not include the added costs of primary care physician and/or gastroenterologist and emergency room visits, which averaged 2.5 and 6 times respectively.

Dr. Crissien-Martinez said that 80 percent of the Scripps Green patients who stopped cannabis experienced symptom resolution; however, only one of them remained abstinent and consequently symptom-free.

“As health care providers, we must be aware of the potential side effects of chronic cannabis use and understand that cannabinoid hyperemesis is diagnosed clinically to avoid expensive diagnostic and therapeutic modalities,” said Dr. Crissien-Martinez. “Instead the focus should be shifted towards counseling and resources allocated towards marijuana cessation.”

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21 thoughts on “Marijuana Use May Cause Severe Cyclic Nausea, Vomiting”

  1. Don’t worry!!! Soon it will happen to you. You all know the effects of weed. You all want to lead that reckless life. You should not have to smoke something to ease your mind. That is false feeling. It happen to my son. He is going through hell. BEWARE!!!!!


  3. Its understandable to be skeptical of this article. But i know it to have truth because i am suffering from this exact thing. Some people are very defensive to the information in this article because they feel it will hurt the cannabis movement. I am all for legalization however that doesn’t mean we ignore any faults cannabis has. I have had so much denial about my issues being from pot but i have factored out everything else and when i stop smoking for about a week i feel better. Although the first few days are hell because the only thing that stops the nausea at all is weed. I am 23 and have been consistently smoking it sense I was 16 and started experiencing problems about a year ago. I know this issue doesn’t happen to everyone so I figure there’s something different about how my body ( and some others) responds to cannabis over a long period of time. I have sensed stopped smoking even though i really don’t want to. However if anyone would like to challenge my view point id gladly listen. Maybe we will figure something out that will allow me to enjoy my pot again!

  4. Love weed but the are not lying about the effects of long term daily use.

  5. I’ve been smoking marijuana daily for 7 years, and for the past 4 years I’ve experienced intense nausea, uncontrollable vomiting, and ridiculous stomach pains. At first it would happen every two months, now it happens every month pretty much on the same date of every month. I’ve been to the ER countless times for relief and they tell me something different every time I’m discharged. I’ve heard everything from dehydration, ovarian cysts, gastritis, and more often than not they just say they don’t know whats wrong with me. I’m thankful that my mom came across this article. I always thought the weed would help my nausea, I mean I qualify for my medical marijuana card because of my severe nausea! I’m definitely going to cut out the weed for at least a few months to see if this is what my problem is.

  6. That’s funny… I smoke marijuana so I can have an appetite and keep down my food. I’m nauseous from chemo and this is the only thing that helps.

    To compare marijuana w/ Spice is ridiculous and this author has no idea of what the two are if he is considering the two the same.

    Sounds like REEFER MADNESS again!

  7. well over 2 or 3 years of inhaling i haven’t once been or even felt nauseous after marijuana. funny that alcohol makes everyone nauseous after a certain amount but that doesn’t get brought into question? equal rights for drugs (which includes alcohol). everyone should have the right to pick their own poison.

    • sorry you think this is propaganda and nonsense – my 60 year old brother lived a life of hell – with violent vomiting – and constant cycle of pot use – he died alone in a motel room for dehydration – – – because of this.

  8. What a load of bunk, it appears that labelling unspecific gastric issues “cannabinoid hyperemesis syndrome” is the fashion/convenience of the day. What a bunch of nincompoops!

  9. Can you post the statistics on doctor and ER visits caused by perscription drugs. How much does that cost. Any person who thinks we shoud make restrictions and laws for harm reduction lets make it happen. It should be easy to make the world and everythin in it illegal All of the whisky loving wife beaters should be treated like marijuana smokers. I hope you people never suffer what I have. I you do l want to be the one who kicks you when you are down .You deserve nothing less

  10. That sounds AWFUL we should make it illegal to keep people safe!

    Oh no that’s right, we’ve kept it illegal for more than 70 years and it DOESN’T stop people getting it and it DOESN’T keep people safe from it.

    All the prohibition does is arrest 800,000 people a year for possessing marijuana without preventing whatever harms that marijuana’s supposed to cause. This prohibition thing causes FAR more harm than good!!

    Paranoid old men keep marijuana illegal and make our children LESS safe!

  11. How is 25 people a representative sample for a study? You should be ashamed publishing this bunk science… and lumping organic marijuana into the same category with the synthetic marijuana (spice) created in a lab, that is actually nothing at all like organic marijuana. Get the real facts:

      • That’s what happens when you make something illegal – there’s no government oversight on its quality. The same thing happened during the alcohol prohibition when “wood alcohol” got sold as quality booze. We can blame the prohibitionists for this!

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