Canada's Big Day in "Progressive" Legislation

"I have been hearing more and more about it over the past few months. Physicians have been seeing more of it in emergency departments."
"They [Ontario doctors] are watching Wednesday [October 17, legalization date for recreational cannabis in Canada] approach and wondering what will happen."
"We want the government to spend more time researching, tracking and understanding usage patterns."
"Decriminalization is associated with healthier, safer communities. It brings it out of the shadows so it can be treated like any other substance. [The OMA uses a] harm reduction [view of the legalization of cannabis]."
"[The work of the Ontario Medical Association and physicians] is to educate the public so they make safe decisions]."
Dr. Nadia Alam, head, Ontario Medical Association

CHS sufferers feel compelled to take hot baths  Project CBD

"Fundamentally, the federal government needs to take responsibility for the consequences of this controversial legislation."
"To that end, it must provide adequate funding for robust monitoring of cannabis use among all segments of society, especially among youth and other populations at particular risk."
"[Any increase in cannabis use as a result of its legalization] should be viewed as a failure."
Canadian Medical Association Journal editorial

"While cannabis may be legal as of October 17, driving high is not."
"If you are charged with driving impaired by drugs, you face the same consequences as driving impaired by alcohol, which is a 90-day driver's licence suspension, a seven-day vehicle impoundment and criminal charges."
"If you plan on getting high and/or drunk, plan your ride home so we do not have to plan it for you."
Ottawa Police Service

 

Cannabinoid hyperemesis syndrome, which includes symptoms like vomiting and abdominal pain, can affect chronic users of marijuana. Source: Shutterstock.com

Just as physicians who are practising members of the Ontario Medical Association are becoming familiar with a newly-revealed syndrome resulting from excess and prolonged use of marijuana, they are also being informed of their professional duty to ensure that they do their utmost to inform the public of this new health menace relating to the new federal law legislating the de-criminalization of recreational marijuana, joining the years'-old freeing up of marijuana for medicinal purposes in a new atmosphere of freedom to indulge.

A notable new phenomenon of rising numbers of people appearing at hospital emergency departments in Ontario of recent months with a hitherto unseen condition related to heavy, chronic cannabis use has become a matter of some consternation in the medical community. And it is this syndrome which has compelled the Ontario Medical Association head, to alert both the professional community she serves and to put on notice the governments involved in this new public territory of normalizing cannabis use while setting up commonsense restrictions.

The syndrome is called Cannabinoid hyperemesis, identified by nausea of a severe nature and vomiting, alarming symptoms that obviously all is not well with a patient. First to be reported in 2004, according to the British Columbia Pharmacy Association, it is a frequent visitor to users who have accustomed themselves to one to five years of daily or even weekly use. Waves of severe vomiting ensues which hot showers appear to provide relief from.

It is this very visible and concerning syndrome, along with all manner of other potential imponderables that has the medical community in Canada concerned with the introduction of legal cannabis for recreational purposes. According to Dr. Alam, one of the more acute concerns is that improved access to marijuana will invariably increase its use, most particularly with young adults, and that THC -- the active chemical ingredient in cannabis responsible for achieving those highs -- is now present in higher concentrations than once was the case.

According to one study on the matter, the cannabis now being produced has been altered to contain about three times more THC than was present 40 years earlier. And since it is well known that young people up to age 25 are at risk when using cannabis while their brain function is not yet fully mature, still in its later development stages, the effect on that age group is particularly concerning. Add to that the awareness of doctors that a connection exists between marijuana use in youth and mental-health issues inclusive of psychosis, then add in impaired driving and there is a perfect storm warning.

Public health education logically requires that the government of Ontario track the impact trajectory of legalization in an effort to understand its import for the future. Aside from these concerns, Dr. Alam recognizes the advantage of positive outcomes through legalization; more public information and discussion relating to the use of cannabis. People would be more encouraged to speak to their doctors about usage, critical to ensuring that as much helpful information is relayed as possible.

Furthermore, as an anesthesiologist herself, Dr. Alam is aware of the importance of a patient conveying to doctors their regular cannabis use to ensure that during surgery proper dosages of anesthetic are applied, since patients who are users could have a higher tolerance for sedatives and the possibility they could launch into withdrawal while anesthetized during surgery would be in no one's best interests, to say the very least.

Cannabis is an antiemetic — but paradoxically, chronic use can cause intermittent debilitating vomiting known as cannabis (or cannabinoid) hyperemesis syndrome (CHS). Since the legalization of cannabis in several states in the U.S., hospital visits for persistent or cyclic vomiting have increased. With cannabis use in Canada increasing, pharmacists should be aware of CHS in order to help patients and other health-care professionals avoid delay in diagnosis and effective treatment.
Cannabinoid hyperemesis syndrome (CHS) is similar to cyclic vomiting syndrome. The association of CHS with chronic cannabis use was first reported in 2004, although the authors had noticed cases of hyperemesis with cannabis use for years. CHS typically occurs in younger patients who began using cannabis at an early age. It manifests after one to five years (though the range can be between four months to 27 years) of daily or at least weekly use. Between episodes, patients with CHS may be relatively symptom-free or experience morning nausea and occasional vomiting, anorexia and abdominal pain lasting for weeks to months. Then severe vomiting and retching begin suddenly.
Hot showers or baths provide temporary relief. A history of compulsive bathing or showering suggests the diagnosis of CHS. Vomiting may last hours to days (typically 48 hours) and then stops.
Complications include acute dehydration, renal failure, erosive esophagitis, weight loss, and scalding from hot showers. Patients may also experience social distress, impaired job performance and absenteeism. CHS may go undiagnosed for years, resulting in repeated hospital and physician visits, fruitless  investigations and ineffective treatment.