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A recent CBS article irresponsibly reported an increase in the controversial cannabis hyperemesis syndrome (CHS) in legal-use states. The report lacks scientific proof and, according to experts, the symptoms are so rare – it could simply be an allergy to certain terpenes, or an issue with unregulated flower.

“This drives me nuts,” began Martha Montemayor, Clinical Nurse Consultant and Director of Cannabis Clinicians Colorado.

“Yes, cannabis hyperemesis is a real thing,” she continued, “but it’s very, very rare, and does NOT mean every time you vomit in your life, it’s all because you took a puff off a joint in high school.”

She said it’s like saying the gas station egg salad sandwich you ate in 2004 is still making you sick, twelve years later.

“We have patients being refused treatment for actual flu vomiting in Denver emergency rooms because they said ‘yes’ when asked if they use cannabis.”

The controversy

Mark Malone, Executive Director of the Cannabis Business Alliance, agrees with the medical professional. He even goes a step further, suggesting that the link between CHS symptoms and cannabis use is far-reaching and unsupported.

He called it an ‘alleged disease’ because real numbers are not presented, and the fact that the study relies on information that patients “were more likely to endorse marijuana use” proves nothing.

The facts

This is a recent phenomenon affecting very few people around the world.

Since the term was coined in 2004, medical reports diagnose patients with habitual marijuana use, presenting the following symptoms:

  • cyclic vomiting
  • abdominal pain
  • compulsive showering
  • improvement of symptoms with cessation of cannabis

The 2009 study cited in the CBS article is titled Cyclic Vomiting Presentations Following Marijuana Liberalization in ColoradoThe report reveals, in the end, there is no definitive link:

“Patients presenting with cyclic vomiting after marijuana liberalization were more likely to have marijuana use documented in the ED record, although it is unclear whether this effect was secondary to increased use, more accurate self-reporting, or both.”

While a few studies have generated interest in this topic, there have been no epidemiologic studies associating marijuana use with CHS.

According to the same study, “this deficit is likely multifactorial due to the lack of formal diagnostic criteria for CHS, the relatively low prevalence of this syndrome, and the social stigma regarding marijuana use that discourages self-reporting.”

Malone is one of the many cannabis experts who remain skeptical about CHS. He said the report is unfounded and not well-researched.

His opinions represent a camp of professionals who were NOT represented in either the CBS article, or the versions Huffington PostDaily Mail, and Mary Jane’s Medicinals published on their sites.

“The industry in Colorado has not heard of this issue until this news story,” added Malone.

A third study from 2012 used a relatively small sample of 98 patients, only ten of which followed up with the researchers. In total, seven of the ten patients in the study stopped using cannabis. Six of the seven patients went into remission after stopping cannabis.

In the 2009 report, the researchers admit their interest in the subject was sparked by the few reports which suggested a ‘novel syndrome’ of cyclic vomiting associated with repeated marijuana use.

The report goes as far as to note, “despite a high rate of marijuana use in our community, the absolute prevalence of cyclic vomiting remained low, underscoring that CHS is a relatively uncommon condition.”

Other possibilities

In her medical opinion, Montemayor said cannabis hyperemesis is a real – but rare – phenomenon that appears to be strain specific.

Of the 20,000 patients she’s helped join the Colorado registry since 2010, there’s only been one reported case. She said another clinic owner, with three times more patients than hers, also has had one patient who experienced it.

In both of those cases, switching strains solved the problem.

  • In both cases, the cannabis used raised questions
  • It wasn’t tested for molds, pesticides, or any other contaminants
  • It also had not been tested for terpenes

Think of terpenes as the building blocks of essential oils, Montemayor explained. They are the little short chain isoprenes that give plants their fragrance.

So, cannabis that smells like pine trees contains some of the same terpenes found in actual pine needles. Which means if you are allergic to pine trees, you may want to avoid using cannabis that smells like pine – it’s the pinene terpene that could be causing negative symptoms.

For Montemayor, it’s clearly stemming from molds and contaminants – not the THC.

Bottom line, said Montemayor, USE TESTED MEDICINES.

Regulated for safety

Remember, the story features an Indiana man, and Indiana doesn’t have legal cannabis. CBS never addressed the lack of quality control for what he was illegally obtaining in their report.

Malone wants to remind consumers that the cannabis industry stands behinds its products – products that are more regulated than any other food or drug in the country.

Sensationalized clickbait

The article has made its rounds, being picked up by dozens of news outlets. Besides the one-sided storytelling, CBS also threw in a pinch of classic anti-pot propaganda with a quote that feeds into the ‘stoner’ stereotype.

“Now all kinds of ambition has come back,” the patient told CBS. “I desire so much more in life and, at 37 years old, it’s a little late to do it, but better now than never.”

His level of laziness has no relevance, it’s not clinical, and not a symptom of CHS.

Readers respond

Over 500 comments flooded that article. Most readers are outraged over the lack of due diligence for the report.

  • “Doctors are known to be little more than dealers for big pharma. This was a shoddy, half-assed attempt to drag reefer madness out of the closet.”
  • “Too much competition, Big Pharma?? So you gotta go LOW???!!!”
  • “Sorry…May be an allergy in a very small number of people or something added to weed. I know too many lifelong users with no adverse physical effects. This is pure Big Pharma and the coming Jeff Sessions war on weed. Pure Propaganda.”
  • “The only thing i can find on this is that even though it is Organic, farmers can use Neem Oil, which is a product called Azamax, and they can spray this on for mites… Funny thing is, Neem Oil poisoning and Azamax can have the exact symptoms these people are talking about, and this product has become more prevalent in the last 10 years, this is around the time this disease has been popping up…”

Mary Pat Hoffman is gearing up to open a Maryland medical marijuana dispensary. A pharmacist by trade, she knows how drugs interact.

From her research on CHS, it happens in chronic users. Since the endocannabinoid system is involved in homeostasis, “it seems to be an issue with receptor regulation and the body just gets out of whack.”

“I think it has been misportrayed by the media and sensationalized a bit,” Hoffman added. “Imagine the articles we could write on side effects and ER visits from prescription drugs.”

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