This is a timely story about addiction, suffering, and how one tenacious woman found her purpose in life. Everyone I’ve talked to about this story has been fascinated, full of questions. That got me more and more excited about sharing it.
Sometimes I just pinch myself that I became an accidental journalist. This week more than ever. Interviewing people like Elon Musk, Richard Branson and Meryl Streep is thrilling. Being in the same space as the Dalai Lama, or witnessing the first solar-powered plane take off from a Silicon Valley runway is inspiring, but this month’s assignment for the BBC outshines all of that. Raising awareness about a relatively unknown, and potentially lethal syndrome, and helping to save lives, gives my work a more profound purpose. My research shows the syndrome is growing in prevalence and severity around the world.
Katie Nava, a nurse in California, almost died from this syndrome, but she’s now helping people recover. I’m so thankful to her for sharing her vulnerability and her inspiring story so candidly.
“I gave up weed and went to my Facebook page. I’ve found my calling. It was an unfortunate way to find it. I owe my life to the page. We’re spreading awareness.” Nurse, Katie Nava.
We’re all aware that the impacts of the Covid pandemic on our mental health has been brutal. The data is only now coming to light and experts say it’s just the tip of the iceberg. So, if one of your coping mechanisms has been to start using, or use pot a wee bit more than you did previously, please read on and share this with friends who might be over-indulging their love for cannabis. And tell your friends in the medical field how to identify this syndrome.
Keith Humphreys is a professor at Stanford, an expert in addiction, and one of my favorite academic experts to interview. He sums up the problem like this:
“Everyone in public health needs to be engaged and not fall for the line that cannabis is unlike any other drug in history. Every drug can have a bad effect. That’s the reality of our experience, the reality of chemistry.” Keith Humphreys
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Here’s the report that aired this week on the BBC World Service program, Health Check.
Listen to the BBC podcast (starts at 12:34)
And Listen to the Fresh Dialogues podcast below:
Here’s a longer version of the transcript:
Alison van Diggelen: When Katie Nava had her first experience of Cannabinoid hyperemesis syndrome, CHS, she felt like she was going to die…
Katie Nava: It’s the most painful thing. You want to commit suicide in the middle of an episode.
The intensity made me nauseous. I’d spend the rest of day on the floor throwing up in this excruciating knotted up, doubled over pain. Like someone took a knife and twisted it in your stomach. You can’t stop it. We’ve coined the term scromiting: screaming while you vomit. My pain was always in the exact same place: It’s right where your stomach and esophagus meet. It’s just on fire. My throat would always be on fire, I had post nasal drip all the time…
Alison van Diggelen: For four years, Katie Nava, a licensed nurse in Southern California, was in and out of the Emergency Room, and had countless appointments with gastro, ENT and other specialist doctors. She had CAT Scans, colonoscopies, and doctors even suggested surgery to remove her gall bladder. Despite a digital trail of medical evidence from her Kaiser doctors, no one could identify what ailed her.
Katie Nava: I started thinking I was crazy. They would say nothing is wrong with me. I was getting labeled as a drug seeker. It hurt so much.
Alison van Diggelen: Finally, a nurse at another hospital recognized the symptoms and asked Katie Nava if she used marijuana. She was diagnosed with Cannabinoid hyperemesis syndrome, also known as CHS.
The first mention of CHS in the medical literature was not that long ago. In 2004 Australian doctors noticed a link between 19 cases of cyclic vomiting in people who used marijuana. Since then cases have been recorded in the UK, France, Australia, the Netherlands, Canada, Spain, New Zealand, as well as here in the US.
The bouts of vomiting, nausea, and severe abdominal pain tend to impact long term, heavy users of marijuana, though some younger people who smoke concentrates only a few times a week have had it too.
Dr. Kevin Hill, a practicing doctor and Professor of Psychiatry at The Beth Israel Deaconess Medical Center at Harvard Medical School says more research is necessary.
Kevin Hill: The precise mechanism is unclear at this point. It’s thought to involve the dysregulation of the body’s naturally occurring endocannabinoid system. There are receptors located throughout the body, primarily in the brain, sometimes in the GI tract.
Extensive use may lead to changes in function of the receptors. Ultimately those receptors in the GI tract, in the gut, appear to be affected in an adverse way, that’s when abdominal pain, nausea and vomiting can result. …
Alison van Diggelen: Nurse Katie Nava describes it more vividly:
Katie Nava: Your endocannabinoid system is like a fuse box and someone ripped it out. It’s like spaghetti wires misfiring everywhere. It’s why our bodies can’t thermo-regulate, it’s why our brains can’t talk to our stomachs properly. It doesn’t help that we’re so dehydrated, and why it’s the number one thing that kills CHS patients: kidney failure.
Alison van Diggelen: As well as the non-stop vomiting, patients also often experience dramatic weight loss, a rapid heart rate and dangerously low potassium levels. One piece of the puzzle that might help doctors to diagnose it is: if patients tell them that hot showers or baths help to alleviate these symptoms.
So does Dr Hill think it might be possible to identify those most at risk?
Kevin Hill: It’s very likely there’s a genetic component to it. Most people who use cannabis don’t have this problem, so it’s something particular to a subset who use it. What we do know is, if you use cannabis, this is a possibility and if they present with symptoms they need to stop using. If not appropriately diagnosed, you can have very serious consequences.
Alison van Diggelen: It’s been reported that two people have died from CHS. And the dehydration caused by vomiting can have long term impacts on the heart and liver. Once relatively rare, CHS is becoming more common around the world, especially where marijuana has been legalized. Dr. Hill estimates about three million people have suffered CHS in the United States and his hospital has treated thousands of patients.
Kevin Hill: I’m at Beth Israel Deaconess Harvard teaching hospital. I routinely work with folks in our emergency department… They’re seeing these cases more and more.
Alison van Diggelen: Some ER doctors in SF are seeing it on every shift. Other nurses in Denver see it about once a week, but it’s on the rise.
Keith Humphreys is a professor of behavioral sciences and a leading addiction scholar at Stanford University.
Keith Humphreys: The majority of Americans have access to recreational cannabis. At least 80-90% have access to medicinal cannabis… There’s always been a wink and a nod as to what medical cannabis is in the United States.
THC is the principal intoxicant in the plant. In the 1980s, 1990s, a typical plant might have 5-7% THC. Studies of the current legal market show they have 20%. Some products have 50-80%: DABS and wax extract. It’s dramatically stronger.
Speaking as a scientist, I don’t really know much what they do: there are fundamentally novel products I wouldn’t want to generalize, any more than I’d say: You can understand what it’s like to drink a pint of vodka, if you’ve had a pint of beer.
Great Increases in the dose of the drug can have effects you can’t infer from the low dose.
There’s been a great increase in the number of people who use cannabis every day… Perhaps tied to potency: More people are addicted. More users look like cigarette smokers; all day long they have cannabis going. That was uncommon in the days of lower potency.
Alison van Diggelen: One study from the Netherlands found that the concentration of THC (tetrahydrocannabinol) – the compound that makes you feel “high” – in cannabis sold in retail outlets had roughly doubled between 2000 and 2015. (from link above)
Humphreys says the number of people using cannabis in the United States is growing about 3-5% a year, but the volume of cannabis sold is going up much faster.
Kevin Hill: The purity and potency of any cannabinoid you use, including whole plant cannabis, is critical to know because it does appear the adverse effects of cannabis are often dose dependent….When I talk to patients, about what they’re using, I want to know specifically and ask them to bring in labels.
You have to know what you’re putting in your body, to know the potential outcome can be, either good or bad.
Alison van Diggelen: So – what’s more dangerous? Vaping, smoking or edibles?
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Kevin Hill: In terms of health effects, smoking is the worst possible thing you can do. Vaping is slightly better than combustible cannabis, but oral cannabis products are better in that way. We want people to be thoughtful…
There are always risks involved. You wanna get products from a reputable source. In general oral consumption is the least harmful, depending on the dose involved. If you get to the point where your use is creeping up… Sometimes intervention is necessary. Talk to a healthcare provider.
Alison van Diggelen: Professor Humphreys believes that alongside people learning more about what they’re using, healthcare professionals need to be aware of CHS – to catch it early.
Keith Humphreys: People who work in hospitals need to be aware of it and generally are not. We need more public health messaging to counter the industry message which is: it cures everything and has no downside!
We don’t tolerate that for other substances like tobacco, alcohol because we know it can harm people. We need it not just for CHS, but for memory problems, concentration problems. People do worse in school if they’re heavy users.
Public health is in a defensive crouch about cannabis, compared to tobacco and alcohol, in part because they have a powerful industry on the other side of the table. It’s also more cultural: no one wants to be a finger-wagging, blue rinse activist saying: bad bad cannabis! Once it’s legal, that argument is over. Now it’s just like any other thing.
This is really in the hands of our political leadership and regulators. Will we learn the lesson of alcohol and tobacco? If we don’t regulate we get a lot of public health damage. Are we going to treat this as a cash cow and let industry sell as much as it wants? Or will we say: wait a minute, if we take all the controls off, you get a lot of suffering. Everyone in public health needs to be engaged and not fall for the line that cannabis is unlike any other drug in history. Every drug can have a bad effect. That’s the reality of our experience, the reality of chemistry.
Alison van Diggelen: Katie Nava has learned the hard way about the risks associated with cannabis use….
Katie Nava: We’ve created a super plant – don’t abuse it! If someone had told me: don’t smoke 20 joints a day, I woulda listened. Now it’s too late. I’ve completely ruined my body, my endocannabinoid system’s wrecked.
Alison van Diggelen: Giving anti-nausea drugs and replacing the minerals lost during vomiting with electrolytes are central to treating CHS. Antipsychotic drugs like Ativan and haloperidol can also help. But the only proven way to cure CHS is to stop cannabis use entirely.
Katie Nava: It’s literally a game of Russian Roulette…it’s a ticking time bomb.
Alison van Diggelen: Nava stopped two years ago, and she even avoids foods like black pepper, truffle oils, and broccoli that contain cannabinoids. Helping run a Cannabinoid Hyperemesis Recovery support group on Facebook keeps her busy. Founded three years ago, the support group now has over 12,000 members from around the world. Membership is growing about 10% a month. (8500 of the members are in the U.S., 1400 in Canada, 400 in UK).
Katie Nava: It was my AA (Alcoholics Anonymous) meeting. It helped me stay sober. It was my exchange. I gave up weed and went to my Facebook page. I’ve found my calling. It was an unfortunate way to find it. I owe my life to the page. We’re spreading awareness.
Alison van Diggelen: What else does Nurse Nava think should be done to raise awareness?
Katie Nava: If dispensaries would just put up signs saying: Hey this is what CHS is! Then, if someone comes down with it, they wouldn’t spend four years in misery like I did.
Please check out more health and mental health stories on Fresh Dialogues.
And explore Fresh Dialogues stories of other inspiring women.
