6 Conditions That Marijuana Can Mimic
Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Marijuana is touted as the safest of all recreational drugs. There is considerable debate about that, but the good news is that deaths from marijuana only are rarely reported. Marijuana used in conjunction with other drugs, however, is a much bigger problem. Even alcohol potentiates the effects of weed significantly. After hearing how mellow marijuana is supposed to be, many folks who try it for the first time are surprised by their reactions.
As drugs go, especially naturally occurring drugs, marijuana is one of the most complicated. Made from the cannabis plant, it contains more than 113 active ingredients, called cannabinoids. These cannabinoids all affect the body in some way, and not always in the same way. Those who are well versed in the different choices have the ability to choose the sort of high they want.
Those who are new to the scene, however, can be surprised by the reaction they feel. There are plenty of stories of folks trying weed for the first time—or more precisely, the first time since college—and discovering that the high isn’t exactly what they expected. A quick internet search will find a bevy of 911 calls from people who didn’t quite enjoy the high they were feeling.
More Harsh Than Mellow
Some people go to the hospital thinking they’ve had a medical emergency.
The various psychoactive substances in marijuana are likely to create all sorts of different reactions to its consumption and even the way the drug is consumed makes a difference.
Eating a marijuana brownie metabolizes the weed differently than smoking a joint, which means the same bud could have different effects when eaten than it does when smoked. It also takes longer to feel the effects after ingesting the drug than it does after smoking it, which often leads newcomers to eat too much, thinking they aren’t getting anywhere. When the weed starts kicking in, it comes on all at once.
The two most well-known cannabinoids in pot are tetrahydrocannibinol (THC) and cannabidiol (CBD). Medical authorities aren’t entirely sure how each works exactly, but it’s generally believed that the paranoia and anxiety produced by THC are partly offset by the anti-anxiety properties of CBD. Some people are using CBD extract medicinally for things like seizure control and anxiety reduction with some success. Other folks go for the most extreme concentrations of THC they can find, which leads to a high that looks more like that of a stimulant than the sedative most people expect marijuana to be.
To meet the demand, modern marijuana farmers are very good at improving their yields. The same advances in agriculture that have increased food production per acre—and even per plant—around the world have also increased the concentration of THC in weed. THC in confiscated cannabis samples increased from 3.4% in 1993 to 8.8% in 2008. On top of that, there are other forms of marijuana besides the usual bud. Hash oil, sometimes called butane honey oil or BHO, is known for being extremely potent, up to 80% THC. The more THC in the product, the more anxiety, and stimulant-like reaction can be expected.
Not only is there great agricultural advances pushing the limits of farming efficiency, but there are also synthetic copies of marijuana. K2 or Spice are examples of synthetic cannabinoid compounds that mimic the effects of natural weed and act on the same cannabinoid receptors in the body. It sounds great to say we can make weed instead of growing it, but the reality is that you really don’t know what you’re getting. Beyond the fact that weed can mimic certain medical conditions, synthetic cannabinoids might have other drugs either as part of their chemical make-up or can be laced with other drugs to enhance their effects.
Can Weed Feel Like a Heart Attack?
With well over a hundred more cannabinoids in the marijuana compound besides THC and CBD, there’s a whole lot we don’t know about how weed affects the body. Because of the fact that it gets you high, scientists have focused on the effects of marijuana on the brain and central nervous system. But, evidence shows that weed also affects the heart.
There are several documented cases of marijuana causing heart rhythm disturbances and even one death through a fatal arrhythmia. It’s very possible these people could have had pre-existing cardiac conditions, even if they didn’t know it, but the weed certainly affected the way their hearts were functioning while they were high. In at least one case of atrial fibrillation, the effect persisted after the high wore off.
With the cardiac effects of marijuana largely still not well understood, the fact that some folks may feel as if they are having a heart attack after consuming weed is not to be ignored. Marijuana dulls pain; in fact, it’s one of the many benefits touted for medicinal use. So, even if the weed is affecting the heart in a negative way that could lead to chest pain when sober, people might not feel the pain. You can’t ignore feelings of distress, including palpitations or chest pressure, when taking marijuana. The fact is, it might not be mimicking a heart attack so much as causing one.
Weed slows down your mental processes. It’s one of the main parts of marijuana that users remember (well, if you can remember anything). It’s that slow, gentle, absentmindedness that is the butt of so many pot jokes.
Imagine a person with diabetes smoking a little weed and having someone visit. The slow, halting movements and difficulty finding words are exactly what you’d expect to see during a bout of low blood sugar. Just don’t reach for the pot brownies to help fix the problem.
Is All That Vomiting From Pot or Gastroenteritis?
Pot makes some folks vomit. It even has a name: cannabinoid hyperemesis. Typically associated more with chronic marijuana use, cannabinoid hyperemesis leads to severe, uncontrollable vomiting. Some people have discovered that hot showers can reduce nausea temporarily, but the only surefire way to completely stop the condition is to stop smoking weed.
Not a lot is known about cannabinoid hyperemesis. While it is known to affect chronic tokers, uncontrollable vomiting has been documented in other examples of folks who simply took a lot of marijuana. There is a debate about whether or not you can actually overdose on weed, but the medical community generally agrees there is such a thing as marijuana poisoning. Vomiting is one of the effects that gets mentioned often.
For folks who start vomiting after smoking marijuana, the presence of vomiting while high could be easily mistaken for some infection or gastroenteritis. It’s very important to be honest about the use of cannabis. Those around the patient are going to have a really hard time identifying the cause of nausea unless they are aware of the patient’s marijuana consumption. This is particularly bad news for the folks who started smoking weed to treat their nausea, common use by chemotherapy patients.
Besides vomiting, pot is also known for causing a fair amount of heartburn among those who use it the most. There are a few options that chronic users can take to try to calm their indigestion, but the only guaranteed cure is to stop smoking.
While most panic attacks are psychiatric in nature, weed can definitely push the panic button. It’s not unheard of to see patients hyperventilating and scared of nothing in particular when high. Unfortunately, like many other adverse reactions of marijuana, time is the only cure. There isn’t an antidote on the market that will reverse the effects of marijuana. Indeed, for those who are susceptible to the panicky feelings that weed might produce, abstinence is the only option.
THC’s anxiety-inducing properties are notorious. Even in the past, when the amount of THC in a joint was nowhere near as potent as today, some folks didn’t like the way weed made them feel as if the police were coming any minute. The anxiety felt by consuming a drug that was unequivocally illegal was probably worse than in today’s more tolerant environment. Whatever the barriers to marijuana use that have been removed, however, are probably offset by the potency of the product.
One step beyond panic is paranoia. It’s a fine line, but when weed takes you there, it might not bring you back. Psychosis that is induced by marijuana doesn’t always subside when the pot is all metabolized in some vulnerable individuals. In most cases of THC-induced psychosis, cessation of use is the eventual cure, but there are examples of marijuana being the trigger of longer-term psychotic symptoms.
This is one reason to definitely stay away from the highest concentrations of THC. Whether you choose to use or not, pushing the THC limit can be a dangerous game.Marijuana is a complicated drug with lots of different faces. We don't yet know everything that it can do or all of its dangers.
A Perplexing Marijuana Side Effect Relieved by Hot Showers
By the time Thomas Hodorowski made the connection between his marijuana habit and the bouts of pain and vomiting that left him incapacitated every few weeks, he had been to the emergency room dozens of times, tried anti-nausea drugs, anti-anxiety medications and antidepressants, endured an upper endoscopy procedure and two colonoscopies, seen a psychiatrist and had his appendix and gallbladder removed.
The only way to get relief for the nausea and pain was to take a hot shower.
He often stayed in the shower for hours at a time and could be in and out of the shower for days.
When the hot water ran out, “the pain was unbearable, like somebody was wringing my stomach out like a washcloth,” said the 28-year-old, who works as a production and shipping assistant and lives outside Chicago.
It was nearly 10 years until a doctor finally convinced him the diagnosis was cannabinoid hyperemesis syndrome, a condition that causes cyclic vomiting in heavy marijuana users and can be cured by quitting marijuana.
Until recently the syndrome was thought to be uncommon or even rare. But as marijuana use has increased, emergency room physicians say they have been seeing a steady flow of patients with the telltale symptoms, especially in states where marijuana has been decriminalized and patients are more likely to divulge their drug use to physicians.
“After marijuana was legalized in Colorado, we had a doubling in the number of cases of cyclic vomiting syndrome we saw,” many of which were probably related to marijuana use, said Dr. Cecilia J. Sorensen, an emergency room doctor at University of Colorado Hospital at the Anschutz medical campus in Aurora who has studied the syndrome.
“C.H.S. went from being something we didn’t know about and never talked about to a very common problem over the last five years,” said Dr. Eric Lavonas, director of emergency medicine at Denver Health and a spokesman for the American College of Emergency Physicians.
Now a new study, based on interviews with 2,127 adult emergency room patients under 50 at Bellevue, a large public hospital in New York City, found that of the 155 patients who said they smoked marijuana at least 20 days a month, 51 heavy users said they had during the past six months experienced nausea and vomiting that were specifically relieved by hot showers.
Extrapolating from those findings, the authors estimated that up to 2.7 million of the 8.3 million Americans known to smoke marijuana on a daily or near-daily basis may suffer from at least occasional bouts of C.H.S.
“The big news is that it’s not a couple of thousand people who are affected — it’s a couple million people,” said Dr. Joseph Habboushe, an assistant professor of emergency medicine at N.Y.U. Langone/Bellevue Medical Center and lead author of the new paper, published in Basic & Clinical Pharmacology & Toxicology.
Others questioned the one-in-three figure, however. Paul Armentano, the deputy director for the National Organization for the Reform of Marijuana Laws (NORML), said that even with more widespread use of marijuana, “this phenomenon is comparatively rare and seldom is reported” and strikes only “a small percentage of people.”
And several physicians who routinely prescribe medicinal marijuana for conditions ranging from chronic pain to epilepsy said they have not seen the cyclic vomiting syndrome in their patients, but noted that they typically prescribe compounds that are not designed to produce a high and contain very low amounts of the psychoactive ingredient THC.
Dr. Habboushe said doctors in other parts of the country may be unfamiliar with C.H.S. or mistake it for a psychiatric or anxiety related syndrome. And even if they are aware of it, many regard it as a “rare, kind of funny disease,” replete with anecdotes of patients who spend hours in the shower.
But the condition can be quite serious. One 33-year-old military veteran who asked not to be identified by name described bouts lasting up to 12 hours in which he felt “like a puffer fish with sharp spikes was inflating and driving spikes into my spine from both sides. I’ve broken bones, and this blew it out of the water.”
“I know patients who have lost their jobs, gone bankrupt from repeatedly seeking medical care, and have been misdiagnosed for years,” Dr. Habboushe said.
“Marijuana is probably safer than a lot of other things out there, but the discussion about it has been so politicized and the focus has been on the potential benefits, without looking rigorously at what the potential downside might be,” he said. “No medication is free from side effects.”
Patients often arrive at the hospital severely dehydrated from the combination of hot showers and the inability to keep food or liquids down, and that can lead to acute kidney injury, said Dr. Habboushe.
But since many patients develop the syndrome only after many years of smoking pot, they don’t make the connection with their pot habit and have a hard time accepting the diagnosis.
The confusion is understandable, Dr. Sorensen said. “Marijuana is viewed as medicinal, and it’s given to people with cancer and AIDS. People know it’s used to help with nausea and stimulate the appetite, so it’s difficult to get patients to accept that it may be causing their nausea and vomiting.”
It’s unclear why marijuana can produce such discordant effects in some users. But Dr. Sorensen often tells patients that it’s similar to developing an allergy to a favorite food.
Getting the right diagnosis often takes a long time. The average patient makes seven trips to the emergency room, sees five doctors and is hospitalized four times before a definitive diagnosis is made, running up approximately $100,000 in medical bills, Dr. Sorensen’s study found.
“They get really expensive workups, lots of CT scans and sometimes exploratory surgery” to rule out dangerous conditions like appendicitis or a bowel obstruction, Dr. Sorensen said. “At the end of the day they’re told, ‘You’re smoking too much pot.’”
The symptoms of C.H.S. often do not respond to drug treatment, though some physicians have had success with the antipsychotic haloperidol (sold under the brand name Haldol) and with capsaicin cream.
The good news is that C.H.S. has a pretty simple cure: abstinence. Patients stop having pain and vomiting episodes when they quit smoking, experts say. And if they start smoking again, they are likely to have a recurrence.
Mr. Hodorowski said he quit smoking once he accepted that marijuana was the cause of his problems, but acknowledges he was in denial for a long time. Now, he says, he’s telling his story so other people can learn from his experience.
“I hope they’ll be honest with themselves so they don’t have to go through what I’ve been through,” he said. “I’m very lucky to have survived this.”Emergency room doctors are seeing a growing caseload of nausea and vomiting in marijuana users whose only relief is a long, hot shower. ]]>