When pot harms


National Post (Latest Edition) - - ISSUES & IDEAS - Dr. Jes­sica Ross

That was def­i­nitely vomit, I thought as I stepped in a slip­pery sub­stance and caught the rail of the stretcher to avoid slid­ing un­der­neath. That bil­ious smell does not come out of shoes.

Af­ter or­der­ing an in­tra­venous, a cock­tail of antiemet­ics, and a change of footwear for my­self, I run through a men­tal list. What causes a 14- year- old pa­tient to vomit like this? Ap­pen­dici­tis? Menin­gi­tis? Over­dose? As an emer­gency room physi­cian, it’s al­ways Big Bad Di­ag­noses that run through my mind first.

When I re­turn, I find my pa­tient still slightly green, but no longer vom­it­ing. He has a mop of brown hair and looks much older than 14 years. I perch on the edge of his stretcher and check the name on his chart: Nick.

“Hi, Nick,” I start, “how are you feel­ing?”

As I gather my ini­tial in­for­ma­tion, I learn that Nick is a seem­ingly very healthy young man. No fever, di­ar­rhea, or trop­i­cal va­ca­tions in his re­cent past. I run through my usual line of ques­tion­ing as his mum hov­ers be­side him, hold­ing his hand, be­fore ask­ing, “Would you mind head­ing to the wait­ing room for a few min­utes?”

When she l eaves, t he truth comes out. I learn that at 14 years old, Nick drinks al­co­hol ca­su­ally and from his own es­ti­mate, has been smok­ing pot ev­ery day for the past two years.

Com­bined wit h t hat knowl­edge and a phys­i­cal exam that re­veals noth­ing of note, I think I’ve cinched my di­ag­no­sis. “Nick, I’m go­ing to run a few tests to rule out any­thing wor­ri­some. But I’m fairly con­fi­dent your vom­it­ing is be­cause of all the pot you’ve been smok­ing.”

Nick was suf­fer­ing from Cannabi­noid Hyper­eme­sis Syn­drome ( CHS) — ab­dom­i­nal pain, nau­sea and in­tractable vom­it­ing due to chronic, reg­u­lar cannabis use. Never heard of it? Nei­ther had Nick’s par­ents. Just a short time ago, it wasn’t on most doc­tors’ radars ei­ther. And this is a prob­lem. The le­gal­iza­tion of recre­ational mar­i­juana is upon us, and cannabis use in youth is al­ready ram­pant. Sur­vey­ing grade 7 to 12 stu­dents, one in five had tried cannabis, and over one in 10 had used it in the past month, with an av­er­age ini­ti­a­tion age of 15 years. We al­ready treat many of th­ese pa­tients for CHS. And, if we’re any­thing like the state of Colorado, we could see nearly a dou­bling of cases as they did fol­low­ing lib­er­al­iza­tion.

CHS poses se­ri­ous health ef­fects, such as de­hy­dra­tion. It also con­trib­utes to missed school and work, and is costly on our al­ready fal­ter­ing health-care sys­tem. Pa­tients of­ten present mul- tiple times to emer­gency de­part­ments, un­dergo ex­pen­sive and some­times in­va­sive tests, con­sul­ta­tions and treat­ments be­fore they are ap­pro­pri­ately di­ag­nosed. By i ncreas­ing aware­ness amongst both the pub­lic and the health- care pro­fes­sion, pa­tients can be treated promptly (with hot show­ers, top­i­cal cap­saicin cream and firm ad­vice to quit), and the cost sav­ings could be sig­nif­i­cant.

Un­for­tu­nately, most youth think that us­ing mar­i­juana is gen­er­ally safe. Re­searchers spec­u­late that’s thanks in part to me­dia, which lacks cov­er­age about po­ten­tial health ef­fects. In fact, most youth think there’s no po­ten­tial for se­vere harm from mar­i­juana use. We need ed­u­ca­tion for youth, par­ents, and health- care prac­ti­tion­ers — and we need to share more sto­ries like Nick’s.

In the lead up to the le­gal­iza­tion of the pos­ses­sion and con­sump­tion of recre­ational mar­i­juana, sched­uled for July 1 of next year, Health Canada has pri­or­i­tized ed­u­cat­ing youth about the health ef­fects of cannabis. The Cana­dian Pe­di­atric So­ci­ety (CPS) and the Cana­dian Psy­chi­atric As­so­ci­a­tion have come for­ward with po­si­tion state­ments warn­ing of the harms of cannabis in youth. They out­line risks such as i mpaired brain de­vel­op­ment, in­creased preva­lence of men­tal ill­ness, and di­min­ished school per­for­mance and life­time achieve­ment. How­ever, there was no men­tion of CHS in ei­ther of th­ese doc­u­ments.

It will be es­sen­tial for those tasked with this mas­sive un­der­tak­ing to fig­ure out what to say by en­gag­ing stake­hold­ers, in­clud­ing the Cana­dian As­so­ci­a­tion of Emer­gency Physi­cians, in or­der to shed some light on CHS. We need to find out how to say it and who should say it so youth will lis­ten. And, this all needs to be done start­ing now; we are on a tight time­frame, af­ter all. July 1 is com­ing up fast, and we aren’t ready.


With the le­gal­iza­tion of the pos­ses­sion and con­sump­tion of recre­ational mar­i­juana sched­uled for July 1 of 2018, Health Canada has pri­or­i­tized ed­u­cat­ing youth about the health ef­fects of cannabis.


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