By Min Zan
“The illness led to a new word - ‘scromiting’ - to describe simultaneous screaming and vomiting.”
Doctors are reporting a rise in people coming into emergency rooms with stomach pain and unrelenting vomiting. They compulsively take hot showers. Anti-nausea medication offers little relief. The unexpected culprit is Cannabis - overconsumption can lead to what is known as cannabinoid hyperemesis syndrome (CHS).
“Many patients with CHS have violent hurling when they arrive at the emergency department,” says SamTorbati at Cedars-Sinai Medical Center in Los Angeles.
They often show up weak and dehydrated and sometimes lose consciousness, he says.
Cannabis is commonly associated with relieving nausea - so much so that chemotherapy patients are often prescribed medications containing THC (Tetrahydrocannabinol that is found in Cannabis), the psychoactive compound in the plant. But in humans and some other mammals, high doses of THC can have the opposite effect.
CHS is a relatively newly defined condition, first described in a handful of cases in Australia in the early 2000s. There is no blood test or scan to determine whether someone has the condition, so doctors instead look for a combination of symptoms, including unrelenting nausea, bouts of vomiting, and stomach pain. The intensity of this illness has led to the informal advent of a new word - “scromiting” - describing episodes where people are simultaneously vomiting and screaming in pain. “The cause of this syndrome is unknown,” says Linda Parker at the University of Guelph in Canada, but it seems to be limited to long-term and high-dose users - so people won’t come down with this condition after a single toke. CHS has a series of escalating phases, which can last days to years. A loss of appetite builds to the “hyperemetic phase”, which includes persistent, painful vomiting. This is usually when people begin compulsively bathing in hot water, which may offer temporary relief by diverting blood flow from the abdomen to the skin or possibly by activating a part of the brain called the hypothalamus, which is involved in both temperature regulation and appetite, among other things.
A growing problem
Though still rare, the prevalence of CHS has soared in the past decade. For example, one study found that the rate of emergency room admissions in Ontario, Canada, increased 13-fold from January 2014 to June 2021.
CHS shows up unpredictably, which makes it even trickier to spot. Decades-long marijuana users can develop CHS late in life, while some young people are coming down with the condition after a few years of heavy smoking.
Mounting research suggests one reason for the increase in cases may be greater access to marijuana, from vapes to edibles.
In Colorado, there was a 29 per cent increase in vomiting-related emergency room visits in the five years following the legalization of the drug for recreational use.
A similar pattern has played out in Alberta, Canada. After marijuana was legalized in the province in 2018, the rate of CHS-related emergency room visits went from 15 per 100,000 people to 21 per 100,000. In 2020, it jumped to 32 visits per 100,000 people across all age groups. For those aged 16 to 24, the rate climbed to 600 per 100,000 individuals.
One reason that CHS is more common among young adults may be because they consume the most marijuana. Another factor may be potency. Cannabis available today contains more than ten times as much THC, on average, as it did in the 1970s. Doctors can manage some symptoms with medication and intravenous fluids, but the only “cure” is cutting out Cannabis and waiting for symptoms to subside, which may take months.
Rewiring the brain
Some find temporary relief from creams containing capsaicin, the active ingredient in chilli peppers, applied to the arms and belly.
Experts think this warming sensation, similar to the effect of taking a hot shower, activates a receptor in the stomach that can calm nausea and vomiting.
Experts don’t know the exact mechanisms behind why Cannabis can trigger this illness, but they agree that THC is to blame. The compound binds to receptors in the endocannabinoid system, which regulates sleep, appetite, mood, and more. “We currently believe that CHS may result from chronic overstimulation of endocannabinoid receptors in the body, leading to derangements in the body’s intrinsic control of nausea and vomiting,” says Torbati.
Long-term, heavy cannabis use “can change how our brains regulate nausea and vomiting”, says Marieka DeVuono at Western University in Canada. “While much more research is needed to understand the link, it seems likely that endocannabinoid system impairment is underlying CHS.”
Marijuana users can lower their chance of developing CHS by taking the drug less often and reaching for less-potent products. There is some evidence that using products with cannabidiol (CBD)- the non-intoxicating part of the plant - could help prevent THC-induced nausea. What is more, I would like to share some knowledge about Cannabis and marijuana in order to understand more for my esteemed readers.
Key takeaways:
Cannabis and marijuana are both terms used to refer to the Cannabis sativa plant.
Cannabis is the scientific term for a large family of plants. Only some of these plants produce the mind-altering compound tetrahydrocannabinol (THC).
Marijuana is generally used to refer to products or types of Cannabis that make you feel high. But this term has also been used as a tool for racial discrimination.
You may think the words Cannabis and marijuana mean the same thing. However, they have significant cultural, legal, and scientific differences. Marijuana has a complicated history, so many people now prefer Cannabis.
Here’s a bit of background and reasons to choose these words carefully.
What’s the difference between Cannabis and marijuana?
In Botany (the science of plants), the term Cannabis is used to refer to a family of plants called Cannabis sativa. These plants produce unique chemicals known as cannabinoids.
Some types of cannabis plants mainly produce cannabidiol (CBD). CBD is the active ingredient in Epidiolex, an FDA-approved epilepsy medication. These plants are often referred to as hemp. People tend to use CBD products for things like anxiety, stress relief, or nerve pain.
Other types of cannabis plants produce more of the mind-altering chemical tetrahydrocannabinol (THC). THC is well-known for its ability to make people feel “high.” But it’s also responsible for some of cannabis’ potential medical benefits, like pain relief.
In popular culture, the word marijuana generally refers to types of Cannabis that contain THC. Most people in the US understand this term to mean a plant that gets you high. Most laws, state regulations, and history books use the word marijuana when referring to high-THC Cannabis. To find out why, we need to take a step back in time.
What’s the history of the term marijuana?
By the 1850s, Cannabis was a very popular medicine in the US. You could find it over the counter in drugstores across the country. The word Cannabis even appeared in the US Pharmacopeia, a trusted reference book for pharmacists.
In the early 1900s, the Mexican-Spanish word “marihuana” first appeared in American English. Because of Henry Anslinger (the first director of the Federal Bureau of Narcotics), the use of this word spread throughout the 1930s. Anslinger, who remained in office for 30 years, was powerful and outspoken against Cannabis — which he chose to call marijuana. He used propaganda films and movie theatres (a brand-new technology at the time) to spread disinformation about Cannabis.
In 1937, the word marihuana (or marijuana) became legally fixed with the passage of the Marihuana Tax Act. This federal law defined the plant using the term marijuana and made it essentially illegal in all 50 states. The American Medical Association opposed the Tax Act. They stated that the bill was an “obvious” effort to re-brand Cannabis and stop people from using it.
Today, the word marijuana still appears in most laws and rules about Cannabis due to the legal precedent set by the Tax Act.
Why is the term marijuana problematic or controversial?
Henry Anslinger was well-known for his racist beliefs and remarks. They were documented in many of his public speeches.
Anslinger and other cannabis opponents chose the word marijuana (rather than Cannabis) on purpose. They wanted to make the familiar medicinal plant sound like a foreign threat. They also racialized the plant by changing its name — they gave it a new identity by associating it with immigrants and people of colour.
Anslinger was successful in his mission to portray cannabis use as disgraceful and shameful. This shameful legacy, known as stigma, still persists today.
Marijuana and the war on drugs
Anslinger was also the first person to use the term “war on drugs.” This was a controversial movement that President Richard Nixon later supported. Nixon and his administration used harsh drug laws to target people of colour as well as those who disagreed with the Vietnam War.
By the 1990s, studies showed that the war on drugs was mainly a war on Cannabis. From 1990 to 2002, 82 per cent of drug-related arrests were for Cannabis offences. And the vast majority (88%) were for cannabis possession.
The war on drugs has had devastating effects, mostly for people of colour. Black and Latino people are arrested far more often for cannabis possession despite the fact that rates of cannabis use are similar across all races. As a result, the US has more people in prison for drugs than any other country, many because of marijuana.
Why is Cannabis the preferred term to use?
The word-cannabis is the proper scientific term for the plant. It also doesn’t have historical baggage associated with racism and the war on drugs. Because of this, experts are advocating that states should replace the word marijuana in their laws and regulations with the word cannabis.
However, some Latino communities are reclaiming the word marijuana. That’s because it’s only associated with racism and other negative things in the US — not in Mexico or other Latin American countries. Some Cannabis activists also suggest that we shouldn’t completely erase the use of the term marijuana. They believe that doing so could erase the important history behind it and allow people to ignore or forget how it’s been used to target certain racial and ethnic groups.
What about other slang terms for Cannabis?
People often feel a need to be careful when talking about Cannabis because it’s illegal. This is part of the reason cannabis has so many nicknames. In North America, some of the slang terms for Cannabis include:
Weed
Pot
Grass
Herb
Mary Jane
Ganja
Trees
Broccoli
Other slang terms may not be good to use because they have complicated histories or negative meanings:
Dope (also used as a slang term for more dangerous drugs)
Reefer (used in 1930s propaganda)
Like all slang, the word marijuana may also discount people’s meaningful and complex experiences with the plant. Some consider it to be a sacred medicine or spiritual tool that should be spoken of with respect.
In conclusion, the rise in cases of cannabinoid hyperemesis syndrome (CHS) serves as a stark reminder of the complex relationship between Cannabis overconsumption and unexpected health consequences. The emergence of the term “scromiting” highlights the severity of the condition, characterized by simultaneous screaming and vomiting. CHS, though relatively rare, has seen a significant increase in prevalence over the past decade, potentially linked to greater marijuana accessibility and higher THC potency. The syndrome’s unpredictable onset, ranging from long-term users to relatively new consumers, poses challenges in diagnosis. As research delves into the underlying mechanisms, the only known “cure” remains the cessation of Cannabis use. This intriguing connection between Cannabis and CHS underscores the need for careful consideration of marijuana use, taking into account not only its potential benefits but also the evolving understanding of associated health risks. Furthermore, a deeper appreciation of the historical and cultural context surrounding the terms “Cannabis” and “marijuana” encourages a nuanced discourse that acknowledges the complexities of this widely used plant.
Reference: New Scientist
11 Nov 2023
