A few years ago, a resident in Yale’s Primary Care Residency Program was presented with a mystery: A 22-year-old woman arrived in the ER vomiting uncontrollably. Her nausea was so extreme, it didn’t ease with antiemetic medication. She’d suffered these bilious bouts sporadically for about a year, spending many sleepless nights hunched over a basin in the ER while confused doctors attempted a diagnosis. She didn’t exhibit any of the gastrointestinal complaints that usually accompany a stomach virus or food poisoning; CT scans, a pregnancy test, endoscopy, colonoscopy, and screenings for liver or kidney disease were all clear. There was one clue: While resistant to medication, the nausea and vomiting eased when the patient took a hot shower, and she told the doctor that she had been compulsively showering to obtain relief.
Later that night, stumped and concerned, the young doctor Googled the main symptoms. She discovered a 2004 report published by a South Australian psychiatrist who had observed the sudden onset of cyclical vomiting, extreme nausea, and obsessive showering among 19 long-term chronic marijuana smokers. After she established that her patient had been smoking weed daily for a number of years, the Yale resident took the only advice the literature gave her and told her ailing patient to stop smoking. The syndrome, cannabinoid hyperemesis, is only about a decade old, and doctors do not know exactly what causes it, though a 2011 report notes that its appearance coincides with an increased national rate of marijuana consumption (2.6 million new users each year in the U.S.).
Here, a 33-year-old photo producer talks about her experience with CHS, which started suddenly when she moved from the East Coast to L.A.
I hear you have been through some trauma?
Yes. I lost my best friend. My husband and I decided we were going to move to L.A., which is where I grew up. We just got married last summer. I was working as a photo producer in Chicago, but I quit a month before we were set to leave for one last hurrah. My smoking increased. I’ve always smoked every day, and I smoke a lot more than most people, but I never smoked before work. I was free, and I could smoke as much as I wanted. When that month was up, I arrived in L.A. and I went straight to my new house, I ate some food and went on FaceTime to give my a friend a tour (my husband was out of town on business). As we chatted I rolled a joint, but as soon as I took a hit, I felt really sick. Really, really sick. I ended the call and immediately started vomiting. I couldn’t stop throwing up.
Are you typically that much of a puker, or was that abnormal?
I never get sick. I assumed I had food poisoning. I thought, I can handle it. I’ll work through it. I’ve had a bad hangover before. Then, within an hour, I called my dad and said, “You need to come get me, I need to be with somebody.” I was so sick, I was scared to be alone. The vomiting was continuous. I couldn’t keep anything down, and it lasted for a week.
A whole week! Did you seek medical help?
I called my friend who is also a doctor. He said it sounded just like norovirus — that awful stomach bug people get on cruise ships. But that is super contagious, and nobody around me got sick. So, after about six days, I went to the ER because I couldn’t keep anything down. They said I was dehydrated and gave me fluids and potassium and did some tests. My husband remembers they said the test results were inconclusive, but that it was possible I had a virus.
Were you smoking during that first week of sickness?
Only a little bit, to sleep, but there was no real point — the vomiting was so continuous. And I had awful abdominal pains, right around my rib cage. You know when you’re hung-over and you want to throw up to get it all out? It wasn’t like that. I was really extreme. I was doing anything to avoid throwing up. At one point, even eating ice chips made me puke. So I just lay on my bed with a wet towel on my chest, sucking on ice chips, letting them melt down my face because I couldn’t swallow. My mouth was dry and gross, and I began to compulsively shower. I wanted to clean up, and when I was under the water, I felt good.
Were you someone who typically enjoyed a shower when you were stoned?
No, I hate showering. I’m not a dirty person. But I find showering a pain, and it’s not something that I do regularly. I would take cold showers because I was just so sweaty and gross, but then I started to take hot ones. I would say I showered about five times a day. It felt better to be in the shower.
What did you think was going on?
I just didn’t know. The main symptom was vomiting, and that was just so strange. They gave me a pregnancy test right away, but I knew it wasn’t that because my husband had been in L.A. for a month without me before I got there. I believed the norovirus theory. This isn’t that flattering, but I’ll admit I’m not a big … “washer.” I don’t touch things with paper towels or obsessively use hand sanitizer. I was at JFK. I ate food. I went to the ATM. JFK’s disgusting. I got it. I became very cautious about hygiene because I never wanted to experience that again.
And then things just went back to normal. I’d been working full-time since my last semester of college, so I was enjoying life before rushing to look for a new job. I went back to my old habits. I was smoking more than normal — well, more than when I was working. Also, it’s L.A., so we’d be driving around, running errands, which meant lots of joints for the car. My friends here don’t work normal hours, so we would be at the beach smoking. That lasted for about three months: I wasn’t sick at all.
And then …?
It happened again. My husband and I went to the farmers’ market in Hollywood. It was insanely hot — we met some friends there — but I remember being really hot. When we got home, I was bending over, putting produce in the crisper, and then I stood up and felt light-headed, so I lay down for the rest of the day. That night, we went and had dinner at a restaurant in Koreatown. We ate a lot of pork. I usually have a good stomach, but we did have ice cream for dessert, and I’m pretty much lactose-intolerant, I’ve always known that. I have never been one to avoid milk entirely. I just deal with the gas, and I really wanted to try this Korean ice cream. The next morning, I woke up early to go to a workout class, and as soon as I got there, I went to the bathroom and started throwing up wildly. I thought it was food poisoning again. I was like, Why is all the food here toxic? I took some Pepto Bismol and threw up for half the day. I was very sweaty and I felt awful, but luckily, it only lasted two days.
Did you go to the doctor?
No. And when I felt better, I went back to my normal smoking habits. I didn’t think to link the two at all. My husband was doing a lot of online research, and he suggested I stop smoking weed because he read that it can encourage your gag reflex if you are already sick. And then, almost exactly a month later, it happened a third time. This time, it lasted for another week. I didn’t want to go to hospital, but at one point it looked like I had been throwing up blood, so we went to the ER. They asked the same questions and did a pregnancy test. Nothing was showing up — they said I probably scratched my throat from throwing up so much. But that only explained the blood.
We asked to see a specialist, but I was sent to an internist first. He didn’t find anything, but since I’m lactose-intolerant, he referred me to a GI specialist. As he was going through my medical history, he asked if I smoke cigarettes. I said no, only socially, if anything. Then he asked if I drink. I was like, “No.” Well, occasionally. I’m not AA sober, but I’m not a drinker — I couldn’t even tell you an average of drinks per week because it’s so rare. But I told him that I smoke a lot of pot. He asked how often, and I said every single day for the past 15 years. He just looked at me and said, “I think I know what this is.”
Oh dear …
And then he said it: “You have CHS,” which stands for cannabinoid hyperemesis syndrome. He gave me a pretty loose rundown. It’s an intolerance that only develops in long-term habitual smokers. It’s more likely to happen to people who start smoking weed regularly when they’re younger. I couldn’t believe it. I wouldn’t believe it — I asked to be tested right away, and that’s when he told me that there is no test. It’s new, and he’s been seeing it in a lot of patients, and I fit the profile. The only way to know for sure is to eliminate every other possible explanation, quit smoking, and if it happens again, then you know it’s not that. But he pretty much guaranteed that wouldn’t happen.
Did the doctor give you any other options?
I told him I’d been smoking a lot because I hadn’t been working — I could just tone it down a bit. He was like, “Nope.” So, I suggested that I stop for a while and then go back? I asked if it would clear up. He wasn’t evasive or rude, but he was just like, “Nope.”
Were you ever concerned that you were allergic to your new environment, or that there was something toxic about L.A.?
Totally! I had mostly been buying from a friend who grows it herself, so it was outdoor and organic. Well, not certified organic, but at least it wasn’t branded with names like “Coo Coo Bubblegum Princess.” It was like: Here’s weed! I traced back and realized that every time I got sick, I’d just gotten the weed from a dispensary. I wondered if it was just too intense, or not what I was used to.
How much were you smoking?
I was buying about two ounces a month. But I just always had it. When people came over, we’d smoke my pot. I pretty much always mix tobacco with it. I asked my doctor if that was an issue — what if I vaped or used a bong? I was like, “Do I really need to cut it out totally?” I wanted some information, but I couldn’t find anything. My doctor wasn’t exactly going to recommend that I smoke pot. He’d tell me about some of his other patients who’d just go back to their normal situation and three months later they are back in the hospital, having lost 30 pounds. I was thinking, This is fucking absurd. How can weed make me this sick? No. Come on.
But they ruled out everything else, right?
I did a stool and pregnancy test. Colonoscopy. Endoscopy. They were all clear. I tried to do a bunch of research, but there’s so little out there. It did look like I could potentially have Crohn’s disease — but I had to have a DNA test to be certain. My husband gently suggested I quit for a month, and then maybe I could bring it back gradually. So I quit. I had smoked every single day for the last 15 years, maybe even longer.
Not even one break?
Once I went to a wedding where we didn’t really know anyone, and it felt too sketchy to bring it. I didn’t want to get arrested on the way. But it was only two days, and I was drinking.
How old were you when you started smoking?
I was in my junior year of high school, and it became an everyday thing from then on. I moved to Chicago to go to college, and my boyfriend and my roommate both smoked. It was our thing.
What sort of a stoner were you?
I’m not someone who sits in a basement playing video games. Weed didn’t make me antisocial. I didn’t get the munchies. I have an insanely good memory. My doctor asked me, “Why do you smoke?” I told him that it’s not a huge coping mechanism, it’s just what I do. It’s my vice. I never felt like it made me antisocial or depressed or overweight or unhealthy. When I was stoned, I wasn’t sitting around watching TV. As cheesy as it sounds, I was into crafting, and smoking made me more creative. It was just fun. I was the sort of person who would smoke pot and clean the house — it made me want to do those things. Often I just wanted a good old bag of Schwag from Mexico that I could smoke all day long. Probably because of the quantity and the way that I smoke, I love the burn. There was a period in my life where I was a pot snob, but now I am like, whatever, the weaker the better, to be honest.
How many spliffs were you smoking per day?
My doctor and I figured out that it was probably about ten.
So what was the initial withdrawal like?
Terrible. It was the worst thing. I couldn’t sleep, and when I did sleep, I had the craziest dreams. In one, Gigi Hadid was my Uber driver in New York as a Fashion Week promotion. She gave me sage advice after the diamond popped out of my engagement ring and we spent hours looking for it in Central Park. Knowing I couldn’t smoke made me so unmotivated. It was really hard to accept. It colored how I thought about everything. Someone might point out a house to me and say, “That’s cute.” I’d be thinking, Yeah, right. So cute. And it even has a cute balcony. What’s the point of having a balcony unless you can smoke pot on it? “Look at this cute vacation home!” How can all this nature be enjoyed not-stoned? What’s the point of going to the beach if you can’t smoke pot? What do I do? Just sit there?
There was a little bit of a defeatist mentality. I would cry all the time, and I’m not an emotional person. Then I had an anger phase. I kept looking back at the amount of weed I’d smoked over the years, thinking, God it was all my fault! Why did I have to smoke so much? If I was on a six-hour car ride, did I really need six joints? I could have smoked four and been fine. I got mathematical about it, thinking if I had just cut out X number of joints, I could still be smoking today. I’d kept an old joint, and sometimes I’d light it and have a fake little religious ritual where I would waft it like a sage stick around the room — it smelled so good. Then there was guilt. I felt bad that everyone was so worried about me and if it was self-inflicted, and I didn’t want to put them through that. I felt like a lost body. At first, I forgot things. I felt very disorganized and dumb. It was all I could think about. I was super self-conscious of not being a Debbie Downer.
Did part of you wish it was Crohn’s disease?
When they told me that might be it, I was like, “Fingers crossed — Crohn’s!” Everyone thought I was insane. Crohn’s is serious. I was like, “Yeah, well, I have done the research, and I could deal with it if I could smoke pot.” I started seeing a doctor who does nutrition and yoga and acupuncture and cupping and all that cockamamie shit — I really needed a different perspective. My GI doctor just did not understand how important weed is to me, my life, and my identity.
This doctor looked at my test results and said I should do a three-month detox. He suggested that if I do go back to smoking, I should do it in a cleaner way, i.e., I should vape or smoke out of a water pipe. He also told me to drink lots of water and flush my system, and that if I do start smoking after the detox, I shouldn’t do it within two hours before I go to bed because it sits in your body in a weird way and you can’t flush it out. I was totally that person who smoked and then went to bed. He said I should only have sessions separated by at least six hours. So I was like, “Okay, how many times a day does that mean I can smoke?” My father was very worried. He was like, ‘This is bullshit: Why don’t you just eat it?’ I was like, “No, I think that’s probably worse, and I need to smoke to know that I am high, anyway.”
The act of smoking is the pleasure — a lot of people don’t understand that …
Exactly. Just sitting there chatting and smoking a joint is one of the absolute best things in life, and I didn’t know if I would ever be able to do that again. The GI specialist actually told me to go to rehab. I told him he should go to hell. Essentially, he was like, “If you think you’re going to have a problem stopping, you should go to a place that can assist you in doing that, like a rehab facility.” I was like, “Come on! No way.”
Do you think he just didn’t understand how important it is to you?
Totally. And he was focused on getting to the bottom of why I did it. He suggested that I go to a therapist — I was like, “No. I just like it. Don’t you get it? It’s just fun!” And I don’t have a personal relationship with him, he doesn’t know who I am. I can tell him I had a job and that I’m a functioning person, but it’s hard for him to know that. During one of my darkest moments, I was Googling things like, “Can CHS be cured with acupuncture?” and “CHS: Will I ever be able to smoke again.” I found a couple of message boards; the only other time I have done that was to look up theories about Lost. I was desperate.
Did you post anything?
No, but I’ve been reading through them, and there are people offering sensible advice. Some talk about going back to weed but switching to a vape, and they have been fine, but joints still make them sick for a week. But I have not been able to find any legit research that says, “This is what a cannabinoid is, and this is how it is stored in your body.” What’s happening? Where are they hanging out? I have no idea. One of the ways that they clinically diagnose CHS is by asking sufferers if they take showers. If they do, then it has to be this. Yes, the showers do help, but that’s so unscientific. They also say that it affects your hypothalamus gland, which is the part of the brain that controls your body temperature.
Did you have an identity crisis when you quit?
I find myself asking, “Who am I? What am I doing with my life?” Everything’s more fun when you’re stoned, or when you know you have the option to get stoned. And L.A. is tough because every corner I turn, I see a weed store. And I can smell it everywhere. I know someone is smoking right now, and it’s not me.
It is sort of an identity, isn’t it? Even if you aren’t public about it …
Definitely. When I quit, I actually thought, I’m not cool anymore. My edge has been taken away. Now I am just a normal person with a bunch of weed paraphernalia and iconography. But that’s not who I am anymore. What does that make me? Who does that make me?
I was irrationally sad and depressed thinking about what my life would be like. Who am I now? There was definitely a time in my life when I didn’t advertise it to everybody. But then it got to the point where I thought, Fuck it, I’m a stoner — who cares if you all know. I also think because I was a functioning stoner, I felt like I was getting so much stuff done, but I was stoned the whole time. When I stopped it was like, “Okay, now it’s time to take a look at what I’m doing with my life, and what I’m doing is actually nothing.”
How do you feel as a person since you quit? Is there a new post-stoner version of you?
When I was stoned all the time, I was like, “The house is dirty, I’m going to clean it.” Now it’s like, “The house is dirty, and I don’t want to fucking deal with it.” Things annoy me more. I was always annoyed by little things, but I could have a smoke and fix it. Now it’s all terrible.
When I lived in Chicago, I would eat out a lot. I wasn’t Suzy Homemaker, but I wasn’t down on my knees scrubbing shit. My husband did the cooking. And then, when we first moved here, I was recently married. I had more time and a larger home, so I was like, “This domestic stuff is fun! I’m going to read a recipe and cook! I’m redecorating the house.” And now that I’m not smoking, that stuff seems so uninteresting to me. It’s like, cooking is just a boring task. Who am I? I am not your housewife. I didn’t sign up for this. And my husband is by no means that “type of guy” — he’s the nicest, sweetest most supportive person, but I had liked doing all that stuff, and now it’s just like, “Oh gosh, this is so laborious.”
I know you’re planning on starting again soon, at a reduced pace … Are you concerned about getting “the fear,” or your reduced tolerance, or even associating it with that bad illness?
I’m pretty aware that my tolerance will have changed, but I do I wonder, if I smoke again, if I’ll trip out like when I was a teenager. I worry I might be paranoid. I am definitely going to take it slow. The official date is supposed to be next Thursday, but I’m not going to throw a party for myself and get a cake. I think I might wait a few more days. I’m pretty superstitious.