Be Advised :  Rough Road Ahead

"It will be essential for those tasked with [educating youth about Cannabinoid Hyperemesis Syndrome -- CHS] this massive undertaking to figure out what to say by engaging stakeholders, including the Canadian Association of Emergency Physicians, in order to shed some light on CHS."
"We need to find out how to say it and who should say it so youth will listen."
"And, this all needs to be done starting now; we are on a tight time frame, after all. July 1 [2018, when Marijuana possession becomes lawful in Canada] is coming up fast, and we aren't ready."
Dr. Jessica Ross, emergency physician, Ontario

In this Feb. 17, 2016 photo, plants grow at the home of Jeremy Nickle, in his backyard in Honolulu, Hawaii. (AP / Marina Riker)

Abdominal pain, nausea and intractable vomiting resulting from chronic, regular cannabis use is a condition with a name: Cannabinoid Hypermesis Syndrome. Some doctors are familiar with the symptoms to enable them to make an accurate diagnosis and proceed with appropriate treatment, which of necessity includes persuading teens that it is not in their best interests to smoke pot. And some physicians have never heard of CHS, much less are knowledgeable about its symptoms; ergo, no diagnosis will be made in identifying an ill teen accompanied by a worried parent.

Dr. Ross, on the other hand -- in her capacity as an emergency physician, once she had ascertained that the very sick young man who had been admitted to her hospital in the company of his frantic mother had no fever, no diarrhea, and hadn't recently been on a trip to the tropics -- was able to identify the symptoms and link it to the cause. Her questioning of the 14-year-old boy and his mother elicited few clues, but the light slowly began to dawn when Dr. Ross suggested that the boy's mother briefly withdraw. And then it was that the boy admitted that he is a casual imbiber of alcohol and a daily pot smoker.

At the ripe old age of 14, the tow-haired boy said he was actually a veteran pot user, had been smoking it daily for a full two years. Making Dr. Ross quite confident in diagnosing his symptoms. She ran a few tests and then informed her patient and his mother that his vomiting was a result "of all the pot you've been smoking". Dr. Ross is becoming fairly confident and comfortable about such diagnoses, even while she is fairly perturbed and definitely uncomfortable that the syndrome is on the increase.

That being so, she is more than slightly concerned at the impending legalization of recreational marijuana. All the more so that cannabis use in the youth of Canada is taken as a casual reality, with more young people using the drug than most parents are prepared to credit. Young people feel relaxed about their cannabis use -- after all, 'everybody does it' and whatever is popular is a must for youth who are otherwise engaged in proving how 'different' they are from everyone else.

Young people in grades 7 through to 12 in responding to surveys affirm that one in five have tried cannabis, with over one in ten using it in the past month, while the average age of initiation into the ritual use of pot appears to be 15 years of age. In the United States, Colorado legalized marijuana use and if a dependable example is sought, they can qualify as a model for avoidance given they experienced close to a doubling of CHS cases following liberalization.

Hazards such as dangerous dehydration can result from CHS, which also contributes to absenteeism from school and from the workplace, even if setting aside the effect it has on an already overburdened health care system with emergency departments seeing the same sufferer on multiple occasions. And diagnosis is often elusive, leading to needless and expensive tests and prescribed treatments after consultation, which bypass correct diagnosis until an accurate diagnosis finally occurs.

Despite which the belief persists among young people that marijuana use is pretty safe. Education for parents, their children and health-care practitioners must be dependably in place to inform all parties. Health Canada has made it a priority to educate about the health effects of  cannabis, particularly among the young, while the Canadian Pediatric Society and the Canadian Psychiatric Association have produced positions statements giving warning of  cannabis harms to youth.

Risks such as impaired brain development, increased prevalence of mental illness and diminished school performance as well as lifetime under-achievement are real potentials and people need to understand this to be fact, not fiction, as they would prefer to believe. All to the good; Dr. Ross applauds their efforts, yet on the other hand, wonders why mention of CHS in these documents is completely absent.

Cannabis use has become one of the most commonly abused drugs in the world. It is estimated that each year 2.6 million individuals in the USA become new users and most are younger than 19 years of age. Reports describe marijuana use as high as 40–50% in male Cyclic Vomiting Syndrome patients. It is this interest in cannabis in the World, coupled with recognition of a cyclic vomiting illness associated with its chronic use that beckons a review of the most current articles, as well as a contribution from our own experiences in this area. The similarities we have demonstrated for both cannibinoid hyperemesis syndrome and cyclic vomiting make the case that cannibinoid hyperemesis syndrome is a subset of patients who have the diagnoses of cyclic vomiting syndrome and the role of marijuana should always be considered in the diagnosis of CVS, particularly in males.

Mithun B. Pattathan, Reza A. Hejazi, and Richard W. McCallum  U.S.National Library of Medicine: National Institutes of Health: Published online 2012 Jun 29.