Cannabinoid Hyperemesis Syndrome: Marijuana Overuse in Teens

Lately, I'm seeing a lot of teens, some kids as young as 12, who are using marijuana on a daily basis. According to the Centers for Disease Control and Prevention, in 2019, 37% of United States high school students reported using marijuana, and 22% said they had used it in the past 30 days. This is often as vaping. Eight percent of 8th graders, 19% of 10th graders, and 22% of 12th graders reported vaping marijuana. My kids can validate those numbers. They often have reported going to the bathroom at their schools and finding other students vaping.

How Marijuana Affects the Developing Teen Brain

In addition to the known negative side effects on the brains of teens smoking pot, such as problem-solving issues, hard time staying focused, and problems with school attendance and performance, we are also finding that teens who are using marijuana are having temporary psychosis symptoms. There is also an association between marijuana and schizophrenia, in that the earlier and more frequently a kid uses marijuana, the more likely they are to develop schizophrenia as a young adult. Also, about 3 in 10 people develop something called a marijuana use disorder. It's basically an addiction to marijuana.

What is Cannabinoid Hyperemesis Syndrome?

Another side effect that's negative, that was more often seen in adults, but I am now starting to see in kids is called cannabinoid hyperemesis syndrome. Basically, it's when people who smoke marijuana have frequent severe nausea and vomiting. The risk increases for those who smoke marijuana at least once a week or if they start smoking at a young age. It can start in teens, though, after as little as three months of regular marijuana use. There is no cure, and we've seen that teens who stop smoking marijuana, can continue to have this for a long time even after they stop. It's worse if they were smoking a lot of marijuana a week for more than a year.

It doesn't happen very often, but it completely disrupts the lives of those who have it. Persistent vomiting can even lead to tooth decay because of stomach acids hitting the teeth and something called Mallory-Weiss syndrome, which is when a person's esophagus tears from repeated muscle spasms and acid exposure.

I've seen teens that vomit every day. I've seen teens who are hospitalized for dehydration, malnutrition, and severe weight loss because they are physically unable to keep food or even water down, even after they're given anti-nausea medications.

Diagnosing and Treating Cannabinoid Hyperemesis Syndrome in Teens

So how does this happen? Well, cannabinoids are the active ingredient in marijuana. They bind to receptors in the brain, gastrointestinal tract, and immune cells. While studies are still being done to determine exactly what the body is doing, the thought is that long-term use of cannabinoids eventually has the opposite effect. Initially, it acts to help with nausea and vomiting. But then it starts triggering nausea and vomiting. Some researchers think there is a genetic component to who is most at risk for this paradoxical event.

Some people are lucky and only have symptoms for about 10 days, kind of like a withdrawal period. For some people, this can last months. According to a study that came out by researchers at Johns Hopkins Children's Hospital, cannabis hyperemesis syndrome can be confused with cyclic vomiting syndrome. So it's important that doctors ask kids who repeatedly vomit about any drug use. This study found that the average age of teens who present with cannabis hyperemesis syndrome was 17, and it was mostly seen in teens who used marijuana an average of 21 times per week.

Again, the most difficult part of this is treatment. It is all supportive care. Some reports say that hot showers seem to help. Some kids need to be admitted to the hospital, and even then they may still have symptoms. The only thing that completely eventually will stop symptoms is not using cannabis of any kind at all ever.

So if your child has repeated nausea and vomiting and it seems like something else is going on, be sure to take them in to see their doctor, and don't be surprised if your doctor does ask about drug use. Marijuana is not as harmless as a lot of people think.