Thursday, April 7, 2011

Marijuana, Vomiting, and Hot Baths


A case history of cannabinoid hyperemesis.

Cannabinoid hyperemesis, as it's known, is an extremely rare but terrifying disorder marked by severe episodic vomiting that can only be relieved by hot baths. (see earlier post). Sufferers are heavy, regular cannabis users, most of them. And hot baths? Where did THAT come from?

The syndrome was first brought to wider attention last year by the anonymous biomedical researcher who calls himself Drugmonkey, who documented cases of hyperemesis that had been reported in Australia and New Zealand, as well as Omaha and Boston in the U.S. "There were two striking similarities across all these cases," Drugmonkey reported. "The first is that patients had discovered on their own that taking a hot bath or shower alleviated their symptoms. So afflicted individuals were taking multiple hot showers or baths per day to obtain symptom relief. The second similarity is, as you will have guessed, they were all cannabis users."

The reports haven't stopped. This summer, an intriguing account appeared on the official blog of New York University's Division of General Internal Medicine, where med students offered a formal definition: "A clinical syndrome characterized by intractable vomiting and abdominal pain associated with the unusual learned behavior of compulsive hot water bathing, occurring in the setting of long-term heavy marijuana use."

Still skeptical? I received this heartfelt comment on my original post a few days ago:

Listen, doubters. My son has this. He has been cyclical vomiting and spending hours in boiling hot baths since last Autumn. It's getting worse and he has lost a hell of a lot of weight. He is 21 and an addicted, heavy cannabis user who started at 15. He has tried cutting down but every other joint of weed brings on the obsession. He refuses to co operate with medical staff who try to treat him.
He has been taken to numerous hospitals as an emergency for non-stop vomiting and begs medical staff to let him sit in a very hot bath. They try the best anti-vomiting drugs instead, to no effect, and then some let him go in a hot shower for an hour plus. He always ends up on a drip and as soon as he feels well enough, discharges himself, often the same day.

At the weekend he went to a sports event in the city with friends, realised on the way he was going to have an episode, so left friends and made his way into a hotel room and locked himself in. Police were called and got him out of a boiling hot bath against his will. Cue vomiting attack so bad police called an ambulance. Once again discharged himself from hospital, demanding drip be removed or he would do it himself. Has sat in bath at house he shares with girlfriend for at least 12 hours today, she tells me. She says water is so hot she has no idea how he bears it.

He says he has no pain in stomach, just a sensation that drives his head mad and he KNOWS it will not go, or the vomiting stop, until he gets in boiling hot bath and stays there. He has even done this while abroad on holiday and ended up on a drip before being flown home.

All of this is true. A mother.

I was intrigued, and discussed this briefly with the mother, who lives in the U.K. She added a number of details in an email exchange, and agreed to let me publish her comments:

“I am a mother in the UK whose son definitely has this, but is not officially diagnosed as he ‘escapes’ medical attention by discharging himself from various hospitals.

When it happens he is desperate to get in a hot bath. He lives with his girlfriend. I only realised what the hell was really going on when she insisted on telling me, and have since been regularly involved in the hospitals saga.

When I discovered the truth I put ‘cannabis’ ‘vomiting’ and ‘hot baths’ ‘showers’ in google and up came a perfect description of what my son does.

I am trying to get him to agree to go for counselling and psychiatric help as he has reached the stage where this obsessive vomiting and bathing is wrecking his life. But every time he gets a little better he believes he can ‘control it’ which is not the case at all.

Yes – we end up in the hospitals and the first young emergency doctor who has ever smoked a joint and/or thinks he knows everything, tells G “Oh no it can’t be that, cannabis stops vomiting, not starts it.” Of course, they have never heard of this condition and just think he is being irrational because of the constant need to vomit. They are sure it is food poisoning or some kind of spasm and take basic blood tests.

They find nothing, insist on giving him the best anti-sickness drugs usually for cancer patients and so on…, saying “this will definitely stop it” and still he vomits. He is not in pain, just rapidly dehydrating and panicking and complaining of a weird sensation in his stomach. He tells them “I know it’s in my head doing this” and desperately demands to get in a bath. Even when he has arrived at hospital because police found him in a boiling hot bath, this makes no sense to the medics who only give in when none of their drugs work. He then immediately stops vomiting but is petrified of getting out of the bath. Eventually, when he says it is under control, he agrees to get out, and is put on a drip. Approx an hour later, while the doctors are planning follow-up procedures like scans and more complex blood tests etc, he starts an argument with a nurse, insists the drip is removed and phones a friend to collect him, avoiding seeking a lift from me if he can. The over-pressed doctors here (the British system is like a cattle market) are left mystified and move onto the next emergency in their pile up of admissions. And so it goes on, and will do, until G accepts even the odd joint can set him off.”
----

Researchers speculate that it has something to do with CB-1 cannabinoid receptors in the intestinal nerve plexus--but nobody really knows for sure. Low doses of THC might be anti-emetic, whereas in certain people, the high concentrations produced by long-term use could have the opposite effect.

34 comments:

Peapod said...

Absolutely fascinating and one of thee areas where despite the anecdotal nature of these case reports, there is a ring of truth about this.

Anonymous said...

This is such a great resource that you are providing and you give it away for free. I enjoy seeing websites that understand the value of providing a prime resource for free. I truly loved reading your post. Thanks!

PandaBear said...

This is an amazing article. It explains a lot for me. I have been treated for h- pylori, gastritis, cyclic vomiting and abdominal migraines. This has been a reoccurring nightmare since I was 15 also. It's very strange to find a correlation between marijuana, hot showers/baths and "cyclic" vomiting. I always thought using herbs would help my vomiting syndrome, to find it doesn't help at all and us probably making my condition worse when it happens kind of scares me. I've smoked regularly since I was 15, with episodes only getting worse and lasting longer than the last. I would like to hear more information as or becomes available. I am completely appalled by these findings.

ct1320 said...

Omg. i always knew i vomited intensely wen i giv up weed.and i do like my baths/showers real hot. but now after reading this i dont feel abnormal. if i last symtoms out they usually disappear in 3/4 days but my life is on hold while this happens.yet ive been a heavy bong smoker for nearly 20yrs off n on.ud think i woulda learned by now....this is addiction.

Anonymous said...

My son suffers from this cannabinoid hyperemesis. At this moment he is here at my home on the couch suffering. I have been up with him for 3 days with the vomiting and hot baths. He says this time its over for good. This is our third bout. The first two time we went to ER, they put him on a drip to hydrate him, and gave him some pain medicine and nausea medicine. After a few hours he went home and recovered. This time we went to Urgent Care, put him on a drip, pain med, Benadryl, and Zofran. He felt better. That was yesterday, today we are right back with the nausea, but the Zofran limits the vomiting. I'm hoping tomorrow will be much better. He hasn't eaten for 3 days. He let me take a video of him at Urgent Care before treatment, and in the video he was heaving and begging himself with tears never to smoke again. My son has smoked for 14 years.

Dirk Hanson said...

Thank you so much for writing about your son's struggles with this. It helps people see that this thing is a concrete medical manifestation. Strange and rare, but bad business.

Dirk Hanson said...

Readers might be interested in updated coverage of cannabis hyperemesis at this science blog:

http://scientopia.org/blogs/drugmonkey/2012/04/28/cannabis-hyperemesis-a-brief-update/

the guy said...

I don't have vomiting problems but i am a heavy cannabis user who can't stop taking baths to save my life i have anxiety and alot of stress i dont know if that has anything to do with it but like every 30mins i seem to be running a hot bath it started about 4months ago its not a huge problem cause obviously i enjoy the baths i just wanna know why i have this weird urge all the sudden .?

the guy said...

I don't have vomiting problems but i am a heavy cannabis user who can't stop taking baths to save my life i have anxiety and alot of stress i dont know if that has anything to do with it but like every 30mins i seem to be running a hot bath it started about 4months ago its not a huge problem cause obviously i enjoy the baths i just wanna know why i have this weird urge all the sudden .?

HappyHarvester said...

Marijuana is a medicine. What these guys have is caused from spending too much time in your mothers basement. These guys should be ashamed of themselves for putting a bad name on marijuana. My guess is they are very weak human beings who can't handle leaving their mommy's houses. Either that or they lock themselves in the bathroom to do an actual hardcore drug(which can cause vomiting) while lying to their mothers and giving marijuana a bad name. Marijuana is a Medicide

Anonymous said...

Been smoking 2 years now, pretty much daily, never had a problem until 4 months ago when I fainted on the toilet. I ignored it and would faint again 2 months later but this time it would be really bad pains near the bellybutton and I'd vomit. Went to the ER they gave me fluid, felt better went home and was sick for an entire week (a week in which I wouldn't smoke at all), sick as in huge pains in the bellybutton area. Saw the Doc then a specialist who wanted me to get an endoscopy. As I was feeling better I decided not to get it. Made some pot brownies got really stoned but was ok, a week later I felt safe to smoke again (btw by smoke I mean vape, since I got a vape for Christmas vaped day 1 ok, vaped day 2 next morning I get sharp pains in the bellybutton area from a 6 inch subway sandwich and ended up passing out in class, woke up to the professor asking me if I was ok, then started to vomit, got up and went to the restroom and proceeded to vomit until that sandwich was gone. Well my family scheduled for the endoscopy, I've got it done. I've been abstaining from weed again and I can safely say that things seem to be returning to normal again. The results came in for the endoscopy and my stomach is just fine. All allergy tests came back negative. So now I'm going to have a colonoscopy to see if anything is wrong down there. Now my take is that its something else, but the relationship with the severity of the pains and the weed has me thinking the weed is aggravating whatever it is I have. I really want to continue to smoke/vape but until I find out what is wrong with me and get it fixed (if possible) I just can't .

A bit of some research and I found this. http://en.wikipedia.org/wiki/Cannabi...tinal_activity
Inhibition of gastrointestinal activity has been observed after administration of Δ9-THC, or of anandamide. This effect has been assumed to be CB1-mediated since the specific CB1 antagonist SR 141716A (Rimonabant) blocks the effect. Another report, however, suggests that inhibition of intestinal motility may also have a CB2-mediated component.[23]
So weed may be making my condition worse after all?

Also I figure the fainting maybe due to dehydration. I was drinking water when i was eating that subway sandwich and I was also running off of 5 hours of sleep. Still I've never fainted in my life until these past 4 months. BTW I thought maybe my weed has been tainted, but the second of the three fainting vomiting episodes I actually shared a blunt with me and my friends (one of which is the guy who provides me). None of my friends have had issues so I assume the weed isn't tainted and it must be my own body that has the issue with the weed.

So either A. I have something that the weed is making worse. B. It just the weed. C. The weed is tainted.

Man I've been such a good advocator of weed and now this shit happens to me. WTF.

Anonymous said...

Been smoking 2 years now, pretty much daily, never had a problem until 4 months ago when I fainted on the toilet. I ignored it and would faint again 2 months later but this time it would be really bad pains near the bellybutton and I'd vomit. Went to the ER they gave me fluid, felt better went home and was sick for an entire week (a week in which I wouldn't smoke at all), sick as in huge pains in the bellybutton area. Saw the Doc then a specialist who wanted me to get an endoscopy. As I was feeling better I decided not to get it. Made some pot brownies got really stoned but was ok, a week later I felt safe to smoke again (btw by smoke I mean vape, since I got a vape for Christmas vaped day 1 ok, vaped day 2 next morning I get sharp pains in the bellybutton area from a 6 inch subway sandwich and ended up passing out in class, woke up to the professor asking me if I was ok, then started to vomit, got up and went to the restroom and proceeded to vomit until that sandwich was gone. Well my family scheduled for the endoscopy, I've got it done. I've been abstaining from weed again and I can safely say that things seem to be returning to normal again. The results came in for the endoscopy and my stomach is just fine. All allergy tests came back negative. So now I'm going to have a colonoscopy to see if anything is wrong down there. Now my take is that its something else, but the relationship with the severity of the pains and the weed has me thinking the weed is aggravating whatever it is I have. I really want to continue to smoke/vape but until I find out what is wrong with me and get it fixed (if possible) I just can't .

A bit of some research and I found this. http://en.wikipedia.org/wiki/Cannabi...tinal_activity
Inhibition of gastrointestinal activity has been observed after administration of Δ9-THC, or of anandamide. This effect has been assumed to be CB1-mediated since the specific CB1 antagonist SR 141716A (Rimonabant) blocks the effect. Another report, however, suggests that inhibition of intestinal motility may also have a CB2-mediated component.[23]
So weed may be making my condition worse after all?

Also I figure the fainting maybe due to dehydration. I was drinking water when i was eating that subway sandwich and I was also running off of 5 hours of sleep. Still I've never fainted in my life until these past 4 months. BTW I thought maybe my weed has been tainted, but the second of the three fainting vomiting episodes I actually shared a blunt with me and my friends (one of which is the guy who provides me). None of my friends have had issues so I assume the weed isn't tainted and it must be my own body that has the issue with the weed.

So either A. I have something that the weed is making worse. B. It just the weed. C. The weed is tainted.

Man I've been such a good advocator of weed and now this shit happens to me. WTF.

Dirk Hanson said...

Have you tried out the hot baths?

Anonymous said...

Hot baths ARE not an indication of Cannabis Hyperemesis! I can shout it aswell incase you didnt hear it the first time!

People who keep repeating this are doing many CVS patients harm in ER's. You see many CVS patients who dont even use cannabis utilise hot baths. If the author can get that wrong it is clearly evident how much effort has gone into researching the illness.

If anyone is interested though please head on over to the CVSA Message Board....there is a LONG thread on the subject. I am still yet to find a convincing arguement. Also here is a statement made by a Cyclic Vomiting Specialist -

“Recently, there has been considerable controversy over the role of cannabis in these patients. While “cannabinoid hyperemesis syndrome” has been touted as a new diagnosis, there does not appear to be sufficient data to implicate marijuana as a “cause” of CVS. In a recent review of 31 published cases, the average duration of marijuana use preceding onset of vomiting was just over 10 years; the long delay in presentation of symptoms following chronic marijuana use argues against cannabis being a cause for the vomiting. Also, long-term follow-up is lacking in case series of patients with “cannabinoid hyperemesis.” The acute administration of marijuana has been shown in animal studies to stop vomiting and cannabinoid agents such as dronabinol and nabilone have been used to treat nausea and vomiting due to chemotherapy. The effects of chronic marijuana use are poorly understood and whether marijuana use unmasks CVS is unclear; further prospective studies are warranted to address this issue. We currently recommend abstinence of marijuana while treating patients with CVS as this is a risk factor for nonresponse to conventional medications.”

-------------------------------
I wont go on, I have replied in detail in the "update" linked. Thanks for reading!

Mayra said...

Anonymous, I believe it is the weed. I know you don't want to believe this. I enjoy marijuana myself, and would hate for it to make me sick, but unfortunately it does make you sick. Why dont you try not smoking for 6 months, and see that you will be symptom free. My girlfriend has it as well, and refuses to believe it's the weed. She has been in an out of the hospital for 4 months now. Constantly vomiting throughout the night, until she needs iv fluids at the hospital. At this point she has only "cut down" her smoking, and refuses to completely stop..

Awaiting our next hospital visit..

Anonymous said...

To all you deluded "fools" out there who believe smoking marijuana has NO long term health issues let me tell you....it does. My husband is a VERY long term smoker and has SEVERE Gastritis which is TRIGGERED by smoking and has depression/anxiety issues as well. For those of you who smoke on weekends you may never see any "side effects" but for long term smokers there are many issues. Oh, by the way, I have seen him have seizures and faint as well and have had him in hospital two times. Yes, this is ALL FROM POT SMOKING and NO, IT's NOT IN HIS HEAD. He's an addict....plain and simple. SO, keep lighting up and enjoy yourselves but remember there is a long term price you could be paying and for those of you who call me a wacko let me assure you I am NOT and have watched things get worse and worse through the years. I can only hope we can get him back to some sort of health. It amazes me that they call cigarettes bad when smoking pot is SO MUCH MORE WORSE but no one has done any "real studies" but I believe 15-20 years from now you will see a population of pot smokers with much worse health issues/cancers then cigarette smokers ever had. Think about your FUTURE.....you may need all those brain cells you are burning out. You can listen to me or not....it's your call.

Anonymous said...

Im just a little curious on how you came up with that. Me and my boyfriend have been living together for over a few years now and never had any problems untill now. So, i dont understand how living with your parents has anything to do with it.

Dirk Hanson said...

It doesn't. The two case reports I used came from mothers of people with cannabis hyperemesis, is all.

Anonymous said...

My point exactly u cant say that they are doing harder drugs ive been smoking cannabis since I was 15 I am now 21 female and each time I stopped smoking it I was vomiting for about a week and not beint able to eat or keep water down I had recently been in hospital and they put me on a drip and then gave me anti nausea medicine after taking 2 blood samples and 2 urine samples I was there for a good 8 hours and had just managed to sleep and they told me I can go they never told me if anything was wrong and im still unable to eat drink and sleep properly and im still not smoking and have never touched hard drugs in my life.

Joe Snuffy said...

My boy has been doing this exact repeat thing for almost 2 yrs now, when it kicks up he ultimately ends up in the hospital on iv's, Pain meds and anti Nausea to no avail only thing that helps is the hot showers "Which i did not know until yesterday" he has been "Possibly diagnosed" with everything from Chrones Disease to Pancreatitus.

Recently he moved closer to us indeed he is staying with us until he gets his new apt up here near us. Yesterday he started with an episode we had only heard of him Vomiting and ending up in the hospital for a day or so yesterday we got to witness it first hand. I was amazed that he would get into a shower so hot i couldn't touch it and would drain the 80 gallon water heater completely, he did this not once but 16 times in 24 hours. Claiming it was the only thing that made him feel better.which is weird to me because excessively hot showers tend to turn my stomach and my wife's cold showers are quite normal for people nauseous.

I was looking all kinds of things he had been past diagnosed with nothing fit then out of frustration i put in "Excessively Hot showers and Nausea" BINGO Forum after forum of stonies asking why it seems to help. then on to the Clinical studies. Yes my son is a Heavy smoker yes he has been doing it for a few years he fit perfectly. I'm a BIG fan of "Everything in Moderation" and i'm sorry 1.5 oz a week is not moderate usage. So I explained what i had found to him when this episode runs its course "He has stopped for now" we are going to work on cutting him way way back less then 1/4 of what he used to do. he has to he is 6'2" and now 135 lbs he is rapidly running out of options.

In further reading i have come to the conclusion that heavy use heads this way as a result of toxicity "A Build up from Chronic usage" i'm betting if he slows down and adds an internal cleanse once a month accompanied by stopping for a few days "Letting his body flush" this will not be such an issue "I HOPE" I know he is not going to give it up 100% so maybe making a recreational thing with some cleansing will help.

Is this "Cannabinoid Hyperemesis Syndrome" real i dunno i'm not a doctor but i sure do see what my Son is going through and i want to help him. I enjoy a few puffs with him on occasion, he enjoys puffing by himself life is about having fun but if something is harming you it must be scaled back into a safety zone. Being mostly into homeopathic prevention i will seek an alt route.

Good Luck all i will check back from time to time hopefully somebody finds an easy fix for this.

Dirk Hanson said...

Thanks for telling us your story. This is such a weird, awful disorder, thankfully rare, but no less troubling. I've been trying for years to make people understand that this syndrome is real.

jerelea said...

Happy harvester.....it depends if u have an addictive personality or if you are using weed as a coping mechanism...then Yes, it is very addictive. Both myself and my father have struggled our whole live to quite smoking weed in a way that is addictive. It is a medicine, that is true but used incorrectly it is a very dangerous drug in terms of mental stability and happiness. People get addicted to all kinds of medicine and I come from a small town in b.c where I know a lot of people struggling with their weed use. I have never used hard drugs myself. I am current on day one of no weed and am puking my guts out..cant even keep water down.

Anonymous said...

Hello, yes this piece of writing is truly fastidious and I have learned lot of things from it on the topic of blogging.
thanks.

Also visit my blog post :: youdomin

Anonymous said...

Little late but, I'm 16 female, live in Cali and Ive been smoking for 6 years heavily. Last march I woke up puking with nausea that wouldnt go away for anything, even breathing made it worse. I was taken to the hospital, they ran every test they could, scoped my stomach and found absolutly nothing wrong with me. I was hospitilized many times from march to june, they told me to quit smoking and I refused because it had been the only thing I thought to have been helping. Ive lost 40 pounds, can't make it to school or even out if the house because I'm constantly not feeling well. I have 2 days clean and I'm hoping this is going to put an end to all my pain/nausea/vomiting and that I can go back to a normal life. My advice to ANYONE dealing with odd symptoms and smokes is to quit! Its not worth the suffering and medical cost. This is a REAL thing and I just found out my best friend is dealing with the same thing and will not quit. Weed is a medicine but like all meds its not for everyone. Anything can cause harmful side effects because our bodies all react differently to different substances.

Anonymous said...

My son is 21, has been smoking dope for about 4 years. Last year he called us to take him from his college apartment to the ER because he could not get rid of nausea and stop throwing up. He was taking hot shower after hot shower, said it was the only thing that made him feel better. After a long ER visit with anti-nausea meds, IV fluids and various tests, they sedated him (he was writhing in misery). After sleeping a few hours, he felt better and was discharged. Over the last 18 months he has had about 15 episodes, with 5 more ER visits and two hospital admissions.

His weight has gone from about 200 lbs (he is 6'4"), down to 160. He refuses to believe that smoking dope can cause this (like Happy Harvester). His GI doctor suggested that he completely stop using dope. He refuses and has episodes every 6 weeks. Recently he has had episodes 2 weeks apart.

Because the case studies emphasize YEARS of cannabis use, he ignores the results.
We are not absolutely sure that the cause is dope, but until he stops using, no one will know. He cranks up the temperature on the water heater and takes a hot bath every half hour, saying it is the only thing that makes the nausea bearable. He has taken upwards of 50 baths in a three day attack (tough on the septic, the hw heater, and our towel supply, not to mention waking everyone up over and over at night.)

Because he cannot work for the duration of the attack (one to five days) he has lost several jobs and has dropped out of college.

This is an absolute nightmare.

Dirk Hanson said...

Thank you for relating this story, and thanks to everyone here who has done so. You're doing more good than you can imagine. People read these reports and identify for the first time the source of their cyclic vomiting. It's not exactly something they teach in Med School.

Anonymous said...

I have the "sickness" have been perscribed many stomach med have helped on and off but there is no "cure" like the "power" of the shower... my friends think im all sick and smoke just as much as me and have no sytoms like me they say its a mental sickness all in my head but its true. had dr. bring me news article of this before through one of my many admiteneces to hospital but it hits on and off sumtime I still smoke like champ but it hits rarely I find drinking heavily will start it more though

Anonymous said...

posted yesterday would love to know the medical reason why the shower cures me???? at my mothers doing luandry today ofcourse did my morning sickness deal with 2-3 hot and cold showers at home but over here just switched laundry felt sickness coming on took hot shower feel AMAZING again until I smoke more or what this needs to b figured out.... cause marijuana helps me with so many other things its crazy to think this is true

Dirk Hanson said...

That's part of the weirdness of this syndrome. Doctors aren't sure why the hot showers help, except to suggest that cannabis receptors are involved in thermoregulation in humans.

Titanick SOS said...

What happened to me is my stomach felt like it was burning on fire and I had to go lay down and then I knew I was going to puke probably. Then I did. I couldn't tell if I was hot or cold. I couldn't move my body because I was too heavy, even turning over to puke was almost too difficult. It just made my head spin and my stomach feel even worse. I was puking for over an hour! I am not a heavy cannabis user. It was my first hit all week but it was from a bong... by I took a normal sized hit the week before and I puked one time then drove him and slept it off but this time I couldn't even sober up enough to drive my car. I was in the bathroom crying and puking. I had nothing left in my stomach and then started puking water, then my lunch from earlier. I was feeling perfectly fine both of these times before smoking.

Anonymous said...

But you ARE abnormal. That's the whole point. Stop reaching for drugs for your mental and emotional well-being. Fix the PROBLEM.

Anonymous said...

Son and daughter have both had it. They have also both been deniers despite being otherwise bright individials. If u use ANY ingested substance for your mental/emotional well-being, then, to some degree, you are giving yourself to it. Do you think you are in control? You are not. You are taking a serious thing and making a game, a plaything out of it. If u could walk through London in the early 18th century, where every sixth or so house was a gin house, maybe u could start to get the picture of what man is easily reduced to... Why do people act like robots? THINK.

Tim Oakley said...

Unless you've walked a mile in someone's shoes. .

Anonymous said...

It's cuz you're high!!!! When I'm high I love baths it just feels so good

Related Posts Plugin for WordPress, Blogger...