Cannabis can cause serious health effects that Canadians may not be aware of, such as non-stop vomiting and heart problems

Non-medical cannabis has been legal in Canada since 2018.

Although a primary motivation for legalization was to increase public awareness of the health risks associated with cannabis use, the Canadian government’s online resources on the harms of cannabis may not paint the full picture.

Known health effects of cannabis use include breathing problems, decreased cognitive ability, psychosis, and the risk of future substance use.

It has recently been established that cannabis addiction poses a risk for users of all ages.

About one in ten adults and one in six teenagers who experiment with cannabis becomes addicted. For daily users, the risk increases to one in two.

Chronic use is defined as weekly or more frequent use of cannabis over a period of months or years.

Chronic cannabis users are at risk of more serious and less discussed health consequences. Examples include Cannabinoid Hyperemesis Syndrome (CHS) and Takotsubo Cardiomyopathy (TTC).

These conditions are rarely mentioned in the media. They are also absent from Canada’s online consumer cannabis resources, although they can be potentially debilitating and even fatal in some cases.

Further research is needed to estimate the incidence rates of these diseases.

Cannabinoid Hyperemesis Syndrome

First defined in 2004, cannabinoid hyperemesis syndrome refers to cyclical vomiting in chronic cannabis users (“emesis” means vomiting).

People with CHS can have recurrent episodes of nausea, vomiting, abdominal pain, and dehydration, sometimes requiring hospitalization.

CHS is typically divided into three phases. In the first, prodromal phase, a person begins to react negatively to cannabis, but vomiting has not yet started.

Symptoms include nausea, abdominal pain, severe indigestion and loss of appetite. This initial phase can last months to years, with most sufferers maintaining their normal eating habits.

Next comes the hyperemetic phase, characterized by cyclical vomiting or “hyperemetic episodes.”

Patients report severe and overwhelming vomiting during this phase. Some find that hot showers or baths temporarily relieve their nausea.

The hyperemetic phase lasts until the person stops using cannabis. Once cannabis use has stopped, the recovery phase begins.

Currently, the most informative online resources about CHS are hosted on Reddit in threads like r/CHSinfo.

Although CHS cases are not well documented, evidence suggests that the commercialization of the cannabis market has led to an increase in CHS-related emergency room visits.

Greater public awareness of CHS could help reverse these trends.

Takotsubo cardiomyopathy

Takotsubo cardiomyopathy, also known as “broken heart syndrome,” is acute reversible heart failure characterized by a weakening of the left ventricle of the heart, often caused by severe emotional or physical stress.

“Takotsubo” refers to the apical balloon shape in TTC, which resembles Japanese squid traps.

Although initially thought to be a harmless condition, TTC carries a significant risk of death.

TTC is most common in postmenopausal women, but studies suggest a link between chronic cannabis use and TTC in younger individuals.

Incidents of TTC in cannabis users are associated with serious illnesses such as stroke and cardiac arrest, although these patients typically have a more favorable cardiac risk factor profile compared to elderly patients who do not use cannabis.

While the link between chronic cannabis use and TTC remains unclear, researchers have hypothesized that cannabis use and stress have similar hyperactivation effects on the amygdala, a structure in the brain’s temporal lobe.

Excessive activation of the amygdala and sympathetic nervous system is believed to be a major cause of TTC.

The cost of chronic cannabis use

Although I research cannabis, I wasn’t aware of TTC and CHS until I heard Liv Wilder’s story on episode 135 of the This Is Indeed Happening podcast.

I reached out to Wilder, who lives in the United States, and asked him about his experiences with cannabis and these conditions, which he also talks about on Instagram.

When Wilder was exposed to cannabis at the age of 20, he found a new sense of peace after struggling with fear and alienation since childhood. He started using cannabis on a daily basis.

After a few months, he experienced severe nausea and vomiting that lasted for hours. Some episodes required visits to the emergency room, where he received anti-nausea medication intravenously, but received no definite diagnosis.

When Wilder switched from dried flower to concentrates colloquially known as “dabs,” the higher dose of cannabinoids increased the frequency of his nausea and vomiting.

Over the next two years of cannabis use, his nausea and vomiting got progressively worse.

After a minor, unrelated surgical procedure performed under general anesthesia, Wilder breathed vomit into his lungs during recovery, turned blue, and was admitted to the emergency room.

The top of his heart had ballooned from the stress of anesthesia, years of chronic cannabis use, and constant vomiting.

He was on dialysis and life support, which resulted in his right femoral artery becoming blocked, causing his foot to die. His leg was amputated while he was in a coma.

He woke up as a transfemoral amputee some time after his surgery. Three years of chronic cannabis use had cost him his right leg.

Wilder was diagnosed with TTC, CHS, acute kidney injury, and left foot neuropathy.

After his amputation, he struggled with cannabis and alcohol abuse for 18 months, but has refrained from both since July 2019.

He is now very active in the gym and loves rock climbing and camping.

Improving Cannabis Education

At this time, the occurrence rates of CHS and TTC in Canada remain unclear. According to the 2022 Canadian Cannabis Survey, one in five Canadian cannabis users reported daily use in the past year.

It is estimated that one in every 200 daily cannabis users is affected by CHS. Associations between TTC and chronic cannabis use are not well understood.

There is a need to provide consumers with a regulated source of cannabis that is not synthetic, contaminated with pesticides, or laced with other drugs.

As a scientist studying cannabis emissions, I am an enthusiastic supporter of legalization. However, commercializing the market without adequate education about cannabis goes against the goal of the Cannabis Act: protecting the public health and safety of Canadians.

Now that the federal review of the impact of legalization in Canada is underway, it is important to highlight chronic cannabis use and the health risks associated with it.

The government has a duty to ensure that information about the health risks of cannabis use is available to the public in the same way that cannabis products are.

Written by Kristen Yeh. The conversation.

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