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As the legalization of marijuana has spurred drug use across the country, doctors are seeing an increase in cases of cannabis, or cannabinoid, hyperemesis gravidarum (CHS), experts said. MedPage today.

Earlier this month, New York Times reported on CHS as well as other damages from marijuana that doctors are encountering more and more.

Tucker Woods, DO, chairman of emergency medicine at Lenox Health Greenwich Village in New York, said MedPage today that he rarely saw CHS two decades ago. Now, he sees her “almost daily in our emergency department.”

Although cannabis is commonly used as an antiemetic, it can sometimes have the opposite effect, resulting in repeated bouts of nausea, vomiting and abdominal pain after use.

Woods said people who develop CHS tend to have an initial phase of nausea, followed by a second phase of cyclical vomiting that can last 48 hours, then begin to recover in the third phase.

It can also cause severe pain, he said, noting that some patients experience what Woods calls “regurgitation,” in which a patient screams and vomits at the same time.

CHS usually occurs in people who have been using it for at least 6 months, but it can also affect people who have been using it for much longer — even more than a decade, Helen Senderovich, MD, of the University of Toronto, a SAPS MedPage today in an email. It is known to occur in older people and people with multiple comorbidities, she said.

Woods points to the increased use and potency of cannabis as likely culprits for the rise in CHS cases. An estimate showed cannabis potency, defined by the average concentration of delta-9-THC, increased from 9.75% in 2009 to 13.88% in 2019.

“This is no longer your grandparents’ marijuana, and there is a decrease in the perception of harm,” Woods said. “As it becomes legal, people see it as legal as safe.”

Stopping the use of marijuana or cannabinoids “is the first line of treatment” for CHS, Senderovich said. One systematic reviewshe and her colleagues found that several other treatments improve CHS symptoms, including haloperidol, droperidol, benzodiazepines, propranolol, and aprepitant. Hot showers and topical capsaicin cream rubbed on the abdomen can also be effective, she said.

Woods said it can be especially difficult to diagnose CHS because a lot of conditions cause nausea and vomiting. Still, he encouraged clinicians to keep the diagnosis in the back of their minds because there have been “horror stories” of CHS patients getting it by mistake. had their gall bladder removed.

Woods added that some CHS patients can be identified using a urine drug screen, but cautioned that some synthetic cannabis products do not show up in these screens.

“I think the most important (thing) is just community awareness, because a lot of people really believe that marijuana is non-addictive and that it’s safe,” he said, “but for some users those assumptions are dangerously wrong. “