What Would Jeff Spicoli Do?

If chronic pot smokers present to your office with recurrent episodes of tummy trouble, consider a diagnosis of cannabinoid hyperemesis syndrome.

Image courtesy Flickr user Torben Bjorn Hansen via Creative Commons License.

First reported in Australia in 2004, cannabinoid hyperemesis syndrome (CHS) is marked by “horrible abdominal pain, but mostly nausea, and vomiting” in chronic pot smokers, Dr. Walter J. Coyle said at a conference on primary care medicine sponsored by the Scripps Clinic.

Symptom relief comes only after patients take a hot bath or shower. Patients who experience CHS tend to be males who have been smoking “at least two bongs a day for a long time—months and months,” said Dr. Coyle, who, with Dr. Emily Singh, published the first clinical report of the syndrome in the United States. “The treatment is to quit the weed.”

 Sometimes patients take baths or showers with water so hot that it causes scald marks on the skin, Dr. Coyle said. Others refuse to curb their pot smoking. In fact, one patient told him “thanks for telling me [about CHS]. I’m not gonna stop.”

According to a 2009 article from the American Journal of Gastroenterology, the suggested pathogenesis of CHS includes “toxicity due to marijuana’s long half-life, lipophilicity, delayed gastric motility, and dysfunction of thermoregulatory and autonomic effects on the limbic system and hypothalamus secondary to the effect its active ingredient, Tetrahydrocannabinol, on the endogenous Cannabinoid receptors CB1 and CB2.”

If the fictional character Jeff Spicoli from the 1982 film “Fast Times at Ridgemont High” were to visit his physician with telltale signs of CHS, one wonders how that dialogue might go.

 SPICOLI: Gnarly stomach trouble, Doc. Really cramping my style. Can’t surf. Can’t impress the ladies.

SPICOLI’S DOCTOR: The only way you’ll get better is if you quit smoking pot. Is that something you’ll consider?

SPICOLI: Um, dude. I don’t think so.

SPICOLI’S DOCTOR: But if you quit you’d be able to master the ocean waves and you’d have good breath for the ladies.

SPICOLI: I didn’t think of that. You’re smart, Bud. Let’s party!

— Doug Brunk (on Twitter@dougbrunk)

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Filed under Drug And Device Safety, Family Medicine, Gastroenterology, IMNG

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