SYDNEY, N.S. — Call it the green flu.
Nausea. Uncontrollable vomiting that can last for 24 hours. Severe abdominal pain.
It might sound like the makings of a stomach virus, or a case of food poisoning, but those are the main symptoms of cannabinoid hyperemesis syndrome. And with Nova Scotia set to legalize recreational use of marijuana on Oct. 17, the voice of Nova Scotia’s more than 3,500 physicians says he expects more and more cases to crop up in emergency rooms.
“Basically, in chronic users of cannabis, some people seem to develop this cycle of vomiting and stomach pain,” Doctors Nova Scotia president Dr. Tim Holland said Tuesday. “It can be somebody who’s been smoking marijuana or cannabis for years, every day, and it’s fine. And then they suddenly develop these episodes where they’ll vomit almost non-stop for a 24-hour period, and nothing seems to help them except hot showers and cannabis use; they’ll be fine for a bit, and then they’ll have another cycle of vomiting.”
Holland said the only way to stop it is to stop using cannabis for weeks.
“But sometimes the only thing that can help it is the cannabis, so it’s a really unfortunate syndrome, and we haven’t been able to figure out who’s likely to get it and who isn’t. But once you do have it, the only real solution is to stop.”
Holland said he’s personally diagnosed a few cases of cannabinoid hyperemesis syndrome while practising emergency medicine at Colchester East Hants Health Centre in Truro. However, he suspects it’s been around much longer.
“I bet you we’ve actually seen it for decades. But where patients weren’t as comfortable volunteering their cannabis use, we probably never knew what it was before.”
Decreased stigmatization and the opportunity to more thoroughly research the health effects of cannabis are two reasons – cannabinoid hyperemesis syndrome aside – Holland believes legalization will be good for the overall health of Nova Scotians.
He said more and more patients are open about their cannabis use, and that will continue to improve once it becomes legal. “That’s a positive thing because it’s much easier for me to make diagnoses, make health recommendations to a patient, when I understand everything that’s going on in their life,” said Holland, who also co-founded the Newcomer Health Clinic (formerly the Transitional Health Clinic for Refugees) in Halifax and practises family medicine part-time at the Sipekne’katik Health Centre in Indian Brook.
Something to talk about
Doctors in Newfoundland and Labrador are taking it a step further.
The Newfoundland and Labrador Medical Association will be launching an ad campaign and website called oktotalk.ca to let the public know that it’s OK to talk to their doctor if they have questions about how cannabis use might affect their health. The website will also have answers to some of the common questions physicians hear.
“For many, talking about personal cannabis use with their doctor can be difficult or awkward,” association president Dr. Tracey Bridger said in an email. “Some patients may feel embarrassed or fear they will be judged.”
There are still major health concerns, however.
Holland, 38, said the biggest potential impact is on mental health. People who are prone to psychosis, schizophrenia or manic episodes can be triggered by cannabis use.
“If you have a history of bi-polar disorder or schizophrenia, you should not be using cannabis. You’re at high risk of having a psychotic episode. The question around that though is, does that put everybody at risk? And that we don’t fully understand. Some physicians are concerned that cannabis use in our late-teens, early 20s could predispose somebody who may not have mental illness toward having it. That said, that evidence is shaky, and we need to have better research into that.”
Bridger said while not all of the health risks associated with cannabis use are known or fully understood, cannabis is addictive, and it can lead to many negative health effects. In 2017, the Newfoundland and Labrador Medical Association surveyed family doctors, emergency medicine physicians and psychiatrists in the province to ask what sort of things they’ve been seeing in their patients as a result of recreational cannabis use. In addition to cannabinoid hyperemesis syndrome, she said some of the common issues included anxiety, panic attacks, psychosis, and withdrawal symptoms, as well as work-related issues such as the inability to focus or even maintain a job.
Another potential health problem is the question of whether marijuana smoke itself can injure lungs.
Holland said while the full effects aren’t known, it’s reasonable to assume smoking marijuana can be harmful.
“We know tobacco smoke definitely causes lung cancer – it has horrible effects on the body. We don’t yet understand how the smoke with cannabis affects users, but theoretically if smoke causes damage with tobacco, it could cause damage with marijuana, so we are encouraging users to vaporize over smoking.”
Bridger said cannabis smoke contains many of the same harmful toxins found in tobacco, and those chemicals place regular users at an increased risk for developing serious lung diseases like chronic obstructive pulmonary disease, as well as severe allergic reactions.
“Cannabis use can also result in damage to blood vessels, artery inflammation, increased heart rate and chest pain, which is concerning for anyone with a heart condition. While evidence is limited, regular users may potentially be at an elevated risk for developing lung, head and neck cancer.”
Impaired driving is an issue
The final big concern for Doctors Nova Scotia is a secondary effect of cannabis use – impaired driving.
“Cannabis can impair driving in many individuals, and that can, of course, cause bodily harm to the driver or the potential victim of a motor-vehicle collision caused by cannabis intoxication,” Holland said.
Strong public health strategies are key to making legalization work in Nova Scotia, according to Holland. Before he started his one-year term as president of Doctors Nova Scotia in June, Holland served as chair of the association’s policy and health issues committee. In that role, he helped craft six recommendations that Doctors Nova Scotia presented to the province in March, saying they would minimize the harms associated with cannabis use.
With the exception of their suggestion that cannabis be restricted to people age 21 and over, Holland said it appears most of those suggestions are reflected in the Cannabis Control Act.
“I’m optimistic that aside from the age recommendation, they seem to be paying attention to some of the important public health strategies that need to take place. The rollout, of course, is key. As of right now, it looks like things are set up for success,” he said.
“So long as we are able to implement the appropriate public health strategies along with legalization, I think Nova Scotia is going to be better off in five, 10 years in regard to the way Nova Scotians are using cannabis and in terms of a public health perspective.”
Bridger said while Newfoundland and Labrador Medical Association hasn’t taken a position on Ottawa’s decision to legalize cannabis for recreational purposes, she believes provincial governments must use the lessons learned from alcohol and tobacco to ensure legislation and regulations are developed to minimize the harms associated with cannabis use.
“While provinces may benefit from increased revenue as a result of cannabis production and sale, we believe that governments’ first priority must always be protecting the health and well-being of their citizens. This includes expanded support for prevention, early identification and cannabis cessation treatments within the framework of mental health and addictions. “Governments also have an obligation to establish harm reduction strategies and to increase public awareness about the significant harms associated with cannabis use.”
Medical Society of Prince Edward Island president Dr. Kris Saunders could not be reached for comment.