NEWS: News.com.au - 23/03/09 'Cannabis users suffering new syndrome'

[hoptis]

Cannabis users 'suffering new syndrome'
By Danny Rose
AAP
March 23, 2009 05:47pm

THERE is mounting evidence to support the existence of a new syndrome afflicting heavy cannabis users, after the world's first cases were found in South Australia.

The condition "cannabinoid hyperemesis" was first identified in a group of about 20 heavy drug users in the Adelaide hills in 2004, and a new case has emerged this time in the US.

The syndrome is characterised by nausea, stomach pain and bouts of vomiting - ill effects which, oddly, sufferers say they get some relief from by taking a how shower or bath.


The new case, involving a 22-year-old man in Omaha, is published in the World Journal of Gastroenterology where doctors were also told to consider it when treating people with unexplained vomiting.

"Given the high prevalence of chronic cannabis abuse worldwide and the paucity of reports in the literature, clinicians need to be more attentive to the clinical features of this under-recognised condition," writes Dr Siva Sontineni, and colleagues, from the Creighton University Medical Centre.

In the US case, the sufferer had been smoking marijuana daily and in heavy doses for six years. This eventually led to bouts of vomiting lasting two to three hours daily, and this was worse after meals.

As with South Australian cases, the young man initially turned to "compulsive hot bathing behaviour" to relieve the symptoms but he was not cured until he gave up smoking cannabis altogether.

Adelaide-based drug expert and emergency ward doctor, Dr David Caldicott, said he had seen three cases of the illness and it was possibly also under-reported by sufferers.

"We're probably seeing the tip of the iceberg in the emergency departments, it's probably far more common but far milder (in the broader community)," he said.

Little was known about how cumulative cannabis use could lead to vomiting and, particularly, why sufferers would find some relief in hot bathing, Dr Caldicott also said.

"That's a distinct and unanimously recurrent feature of this condition, and we don't know why," he said.

"Grown men, screaming in pain, sweating profusely, vomiting every 30 seconds and demanding to be allowed to use the shower. It's a very dramatic presentation."

Dr Caldicott said the condition had been identified in a small number of cannabis users "but in the medical community it is now considered to be a real condition".

The National Cannabis Prevention and Information Centre, based at the University of NSW, is taking a more conservative approach.

Centre director Jan Copeland said more cases would need to emerge before it could be considered a new syndrome linked to chronic cannabis use.

"It is not unusual for there to be significant mental and physical health complications with this level of cannabis use," Professor Copeland said.

For more information on cannabis, the centre has a free national helpline 1800 304050.

News.com.au

 

[permastoned]

Forgive me but I'm blazed. Possible mech:

Serotonin is involved in hyperthermia right, we know this from E. Dopamine may also be involved. These neurotransmitters are also involved in the production of the sensation of nausea. Increased concentrations of dopamine and serotonin in the chemoreceptor trigger zone cause the sensation of nausea.

(http://en.wikipedia.org/wiki/Chemoreceptor_trigger_zone)

Now it may be possible that excessive CHRONIC cannabis use is causing an increase in the release of these NTs. This is especially so considering the mechanism of action of cannabinoids is to reduce the release of neruotransmitters throughout the brain (both excitatory and inhibitory).

Conventional neurotransmitters are released from a ‘presynaptic’ cell and activate appropriate receptors on a ‘postsynaptic’ cell, where presynaptic and postsynaptic designate the sending and receiving sides of a synapse, respectively. Endocannabinoids, on the other hand, are described as retrograde transmitters because they most commonly travel ‘backwards’ against the usual synaptic transmitter flow. They are in effect released from the postsynaptic cell and act on the presynaptic cell, where the target receptors are densely concentrated on axonal terminals in the zones from which conventional neurotransmitters are released. Activation of cannabinoid receptors temporarily reduces the amount of conventional neurotransmitter released. This endocannabinoid mediated system permits the postsynaptic cell to control its own incoming synaptic traffic. The ultimate effect on the endocannabinoid releasing cell depends on the nature of the conventional transmitter that is being controlled. For instance, when the release of the inhibitory transmitter, GABA, is reduced, the net effect is an increase in the excitability of the endocannabinoid-releasing cell. Conversely, when release of the excitatory neurotransmitter, glutamate, is reduced, the net effect is a decrease in the excitability of the endocannabinoid-releasing cell.

Over the longterm, this constant decrease of neurotransmitter release will naturally result in an upregulation of certain receptors including the dopamine and serotonin receptors. At the same time the cannabinoid receptors are downregulating due to excessive use. So what you get is the amount of receptors for serotonin and dopamine increasing and the number of receptors for cannabinoids decreasing. This means that eventually the cannabis is going to have a greatly reduced effect, meaning it will no longer causes a sufficient enough activation of cannabinoid receptors to suppress neurotransmitters release significantly, and because the receptors for these neurotransmitters have been greatly increased, it means that there will be a greatly increased serotonergic and dopaminergic action in the chemoreceptor trigger zone causing nausea.

Now, going back to serotonin causing hyperthermia, an increase in the level of serotonin in the brain causes hyperthermia. When the body temperature increases, e.g. someone gets in a bath, the body starts to get too hot for it to be at the optimal functioning temperature, and thus changes the 'set-point' in the hypothalamus of the brain. This causes the hypothalamus to decrease the levels of secretion of serotonin and dopamine, resulting in a decrease of body temperature, and also a decrease in the sensation of nausea as a side effect.

Yep, I know it's bullshit

 

[SupDUDES]

Blah blah blah. There's a new fucking word for everything nowadays.

 

[drplatypus]

Loads of interest in this at the moment from the media, but I would emphasize that the numbers involved are minutely small. I have literally seen thousands of patients who use THC and as I’ve said, only seen 3 that I think fall into this group. They have some things in common:
a) Chronic, very heavy consumption (very heavy to me is >20 cones/ day, but that may be conservative to some!);
b) Truly agonizing abdominal cramps- we’re talking sweats, renal colic, childbirth, sort of kill-me-now pain;
c) Intractable vomiting;
d) A clear association with relief from hot showers or baths.

This last feature makes it just odd, and I can’t explain it. My own instinct is that there is no undescribed toxic metabolite being broken down by the heat, but that instead it’s some sort of vascular result from the peripheral vasodilatation associated with the heat.
This isn’t a new phenomenon- it was first described in 2004, and as I have suggested, my gut instinct is that it’s real, but hens-teeth rare. We’d be keen to hear from anyone who’s ever suffered from it- P.M. me if you’d like to chat some more about it!

 

[Somewhat-damaged]

Wow, if heavy smoking is >20 cones a day i think some of my friends could break records without a doubt.

Would this happen the same to both bush and hydro smokers?

 

[drplatypus]

I’d be really surprised if it made an awful lot of difference- truth is, I just don’t know… I’m scouring the literature at the moment for any info, but can’t find a lot, which once again proves that this is really, REALLY rare. Things I’ve found so far-
a) I think there’s a case from 1996 from NSW which I think was mis-labelled ‘psychogenic vomiting’;
b) Very importantly for those rare folk who suffer it; IT IS NOT PERMANENT! Unfortunately, it does require abstinence to cure it, which in the heavy consumer is a whole different kettle of fish!
c) For the skeptics, I’ve now found between 20-30 cases worldwide, as case reports and small case series, which is still fabulously rare, but does suggest that it’s real. They’ve been published in journals like Gut and the Mayo Journal, where the peer-review is pretty stringent…

Would love to hear about anyone’s experience of this, particularly to see if it represents a sort of a spectrum thing, or whether it’s an all or nothing effect. How much cannabis is required? How long a duration of consumption before it kicks in? No idea! But maybe the Bluelight community has a better idea, and can help us out here… I’ll be long in my grave before I’ll personally see enough cases to make any sense of it… My tendency is to believe it’s more of an individual, all or nothing effect, but of course, there is no evidence to confirm or refute that…

 

[mindsurfer]

I think I've had this, although not as extreme as described. For several years I was a heavy cannabis user. Pretty much every day I would have a vomiting episode, usually in the morning (tho not always) before I'd eaten anything. It came and went like a thunderstorm - I'd vomit for a few minutes, sweating profusely, but after I'd feel fine, usually until the next day. I gave up cannabis for a few months, and the symptoms disappeared pretty much straight away.

Then I started smoking again, and the syndrome returned. Subsequently, I gave up cannabis completely ( a year or so ago) and I've never had an episode since.

For Dr Platypus' benefit, I was almost never vomiting food, it would usually just be water/slime, and the episode generally only lasted ten minutes or so. I have no doubt that it was linked to my cannabis use, and I've talked to another user that experienced the same thing.

I should probably note that I smoked cannabis off and on for nearly 30 years, and only experienced this in the last five years. Dr Platypus, if you want further details PM me.

 

[expothead]

Wow - never heard of this. Is it possible this condition is some form of 'psychosis' for want of a better word? Especially considering cannabis is such a good anti-emetic. Sounds like it would put a real dampener on the high.

 

[phase_dancer]

This effect is not all that surprising. My GERD and indigestion problems disappeared completely when I stopped smoking.

I can tell you that if cannabis is carefully dried to remove virtually all moisture without handling the buds (repeated applications with Silica Gel), most people will become nauseous from just the odour. An old guy I knew years ago used to store his pot like this and found it would last >5 years without significant degradation. He would re-hydrate it with port or some other liquor, but would never smoke it in the dried form as it made him nauseous.

 

[Montay]

Maybe they're just greening out?

 

[p3ace]

Maybe they're just greening out?

ahahahhah epic green outs. i can picture grown man high off there face screaming and spraying vomit all over hospital wards lol.

 

[drplatypus]

Very interesting, Mindsurfer- I’ll PM you as so as I get a chance!
Generally speaking we consider a psychosis as an entity of the mind, whereas this looks very like an organic or body issue…
And you’re absolutely right, Expothead- THC has excellent anti-emetic and pro-appetite generating properties, so much so that it is of tremendous interest to the medical community for therapeutic purposes… I think something might be ‘switched’ in the very rare people who suffer this.
What is this ‘greening out’ of which you speak, Montay? I’m afraid it’s not a term I’ve ever heard of…

 

[SupDUDES]

shut ya mouyth dr.platypus or ill wack you out./

 

[p i l l s]

Mindsurfer, i have a friends that does exactly that, his been smoking around 6 years now i think. He wakes up has a sip of his coffee and a ciga and he will throw up, not always, but it was pretty common. Sometimes as soon as he wakes up and starts coughing it would happen.
It was happening alot back in high school days, when we were smoking ourselves stupid.
Not sure how often it happens these days, but about 6 months ago it was a very regular thing for him. Id always stay at his house and in the morn he would go for his chuck.
He always said it was just watery slime and sumtimes a green colour.

 

[lil angel15]

drplatypus - 'Greening out' is simply having one too many cones and becoming physically ill as a result. It usually starts with the cold sweats and disorientation with the end result being the release of whatever is in your stomach. In most cases it continues for some hours until you start to sober up again.

One of the quickest ways to get there is having a smoke after drinking too much.

 

[Jakeperson]

drplatypus - 'Greening out' is simply having one too many cones and becoming physically ill as a result. It usually starts with the cold sweats and disorientation with the end result being the release of whatever is in your stomach. In most cases it continues for some hours until you start to sober up again.

One of the quickest ways to get there is having a smoke after drinking too much.

I would say I've learned this lesson many times but I obviously haven't learned it.
Well maybe I have now, it's been a while.
But I'm sure I will have to learn it again at some stage in my life.

 

[static_mind]

I spew from greening out. Iv was never a fan of grass. Id smoke some lay back, get all confused then spew. I was always the black sheep of my group of stoner friends. Theyd all sit around and smoke cone's and talk about storys about funny shit that happened in the past or talk about story's that didnt lead anywhere and everyone would nod and agree because they were all too stoned to understand anyway. Them storys often went for about 15min and no one but me would even notice (me being the exstacy user). Sorry off topic.

 

[mindsurfer]

Mindsurfer, i have a friends that does exactly that, his been smoking around 6 years now i think. He wakes up has a sip of his coffee and a ciga and he will throw up, not always, but it was pretty common. Sometimes as soon as he wakes up and starts coughing it would happen.
It was happening alot back in high school days, when we were smoking ourselves stupid.
Not sure how often it happens these days, but about 6 months ago it was a very regular thing for him. Id always stay at his house and in the morn he would go for his chuck.
He always said it was just watery slime and sumtimes a green colour.

Yes, that's very similar to (what was) my syndrome. It was almost always precipitated by coughing up a bit of phlegm. Always watery slime (never green that I can recall), pretty much every day - usually sometime in the morning, but sometimes in the afternoon.

 

[chugs]

I have a theory.

A common reaction to poisoning is cramping, diarrhoea, vomiting and sweating. A means of the body to expel the poison as quickly as possible. I remember when I overdosed on what was probably a poisonous mixture of home made crank (not of my making but it contained speed, crack, smack, cleaning fluid, whatever - tasted it all in my throat) that I spent 12 hours in deadly cramps, vomiting, profuse confusion, headache (cerebral haemorrhaging), diarrhoea.

Perhaps these chronic users have created a psychological relationship to cannabis and believe on a sub-consciousness level they are poisoning themselves. I say its a truism that there aren't many chronic cannabis users who believe their behaviour is healthy and acceptable. This perception may become so ingrained that it becomes self-fulfilling.

I too used to suffer dreadful cramps, vomiting, diarrhoea, sweating (though no profusely), as a chronic cannabis smoker. I found that this usually came on in the mornings (before i eaten) and that in those days psychologically I felt wasted, not necessarily from smoking (didn't really smoke in the morning). Just drained and wasted (I was suffering depression) before it came on. Dried mouth etc. Certainly if I had smoked dope these reactions would definitely be exacerbated, the heights of pain and discomfort would be far stronger.

I remember once I was dreadfully sunburnt, just covered head to toe, and I had one of those stupid lapses in reason and smoked a cone. The next 8 hours were horrendous. My entire body felt like i was being stabbed by thousands of tiny needles, especially after having a shower.

Not to say that being that sunburnt isn't uncomfortable and painful but my point is that in certain conditions cannabis can certainly heighten the pain.

The reason why I point to a psychological link to this syndrome is that i found two things stopped the symptoms. One when I stopped smoking cannabis, (though they continued on a sparodic level) and two when I finished high school (never had another after that fateful day).

Clearly there was a psychological relationship to my hatred of school (and the torture that such a place creates) and my use of cannabis.

Thus I believe there is a strong correlation to a belief of being poisoned the and environment factor, i.e. cannabis that result in the symptoms that closely match that of being poisoned....

My apologies, it is difficult to articulate all the aspects of this theory (since its just been produced on the spur of the moment.

 

[kingpin007]

I been smoking for like 15 years and never had any of the effects above ... Cannabis has been around for how long & only now theres this report and its from SA.

The world's first cases were found in South Australia<---being South Australia and the weed from Adelaide is top notch stuff and the chemicals used is more than likely be causing this.This is the worlds first case well that should tell you something ... its got to be something about the weed being grown or chemicals used thats having this effect for the people of South Australia ...

Maybe the people have been smoking the same source of weed for over very long periods and this is the problem due to the chemicals used to grow it.

If this starts to happen alot more then I think everyone should be looking at the growing methods used and what exact chemicals used..

it could be even pesticide residue left over if there was a insect infestation of plants.


But in this day and age with cotton wool babies and people getting more allergies to peanuts and so on well that might just be the problem and they cant smoke weed.