The Real Cost of Marijuana—A 200 Billion Dollar Problem

There are many people around the country and the world who believe that marijuana can be used as medicine. But for some users, their chronic and extended use of marijuana has had the effect of causing illness, not alleviating it. In fact, marijuana use has been sending people to emergency rooms across the country as they seek relief from severely painful physical symptoms. And every visit to the emergency room results in thousands of dollars in costs to individuals, insurance companies or state or federal agencies.

The physical symptoms sending people to the ER were intense, extended bouts of agonizing abdominal pain with nausea and vomiting that would not respond to any of the usual treatments. The only solution was to soak in a very hot bath or shower. Some people were in such intense discomfort that they literally ended up spending several hours a day immersed in hot water.

It took emergency room doctors a long time to realize that daily or near-daily marijuana use was at the root of this problem. When enough cases had accumulated for researchers to identify the cause of the problem, they named the condition Cannabinoid Hyperemesis Syndrome or CHS.

That name breaks down as follows:

• Cannabinoid: Coming from the cannabis/marijuana plant (or having similar chemical structure or function).
• Hyperemesis: Hyper means excessive and emesis refers to vomiting.
• Syndrome: A number of symptoms that occur at the same time and relate to a single condition.

But Doesn’t Cannabis Alleviate Vomiting?

In some cases it may, which probably confused researchers and delayed identification of the cause of this vomiting. When a patient suffers from nausea while receiving chemotherapy, for example, cannabis has eased the discomfort for some patients and allowed them to keep down food. Researchers now think that this benefit results from the way certain components of cannabis affect the brain.

But of course, when marijuana is used, it is not just simply affecting the brain. It affects every cell in the body. We now know that daily or near-daily use of marijuana for months or years can affect the intestinal system by causing this severe pain, nausea and vomiting.

ERs across the Nation Caught Off Guard by CHS

As marijuana was increasingly legalized for medical or recreational use across the United States, more people began arriving in emergency rooms to get help. For years, doctors could not diagnose this problem and could not resolve the pain and vomiting, no matter what drug they prescribed for the symptoms.

In this chart, you can see how daily marijuana use by senior high school students began increasingly sharply in the early 1990s. This statistic has remained between 5.5% and 6.5% for most of the last nine years.

In the next chart, you can see how daily marijuana use has increased among young adults aged 18 to 28.

Finally, a few doctors made the connection between heavy pot use and the symptoms of CHS. Medical reports began to circulate through the profession and finally, more patients began to be diagnosed with the correct problem.

It’s vital that diagnosis be as fast as possible because these severe bouts of vomiting can trigger dehydration, kidney disorders and tears in the esophagus.

What is the primary recommended treatment for this problem? Cessation of marijuana use.

Too-Strong Medicine?

Recently, some practitioners have had success using haloperidol (Haldol) to treat this problem in the emergency room. This is a drug used to treat mental illness. Some of those taking this drug refer to the “Haldol shuffle”—a shuffling walk—that results from taking it. A partial list of side effects includes the following:

• Blank facial expression
• Nausea
• Vomiting
• Breast enlargement
• Confusion
• Tongue that sticks out of the mouth
• Uncontrollable face or jaw movements
• Seizures
• Stiff or weak muscles
• Loss of consciousness

When the best treatment of CHS is so simple, it might seem like overkill to use a drug with these side effects as a treatment.

It’s common for patients to deny that their marijuana use could possibly be causing this problem, which means they may be seen in the emergency room again and again.

There have also been a few cases of pregnant women arriving in the emergency room with untreatable vomiting and nausea. It’s easy to find websites that advise pregnant women to use cannabis for morning sickness. Some doctors even recommend it. It’s interesting to note that while cigarette smoking and alcohol consumption during pregnancy have decreased in the last 15 years, marijuana use increased 62%.

What complicates a correct diagnosis in the case of pregnant woman is the assumption that this woman might be suffering from hyperemesis gravidarum, a dangerously severe form of morning sickness. The giveaway is if the hospitalized patient spends most of her time in a hot shower to relieve her symptoms. Misdiagnosis could prolong the time the patient is hospitalized, resulting in higher treatment costs and possibly more harm to the mother and baby.

Adding Up the Big Price Tag

A recent study surveyed more than 2000 emergency room patients to determine if they might meet the criteria for CHS. Based on the results of this survey and comparing it to the general population, researchers concluded that as many as 2.75 million people could suffer from CHS each year.

A second study published in 2019 compiled the cost of treating 17 patients who were diagnosed with CHS after extensive examinations, x-rays and treatment. Because this condition is still not broadly understood by practitioners, correct diagnosis was delayed and the costs mounted accordingly. The average cost of these cases ended up reaching $76,920.92 per patient.

How could it cost so much to treat these patients? Here’s the list of diagnostic tests one hospital said were needed to rule out other causes for the vomiting:

• Blood tests for anemia and infection
• Tests for electrolytes
• Tests for pancreas and liver enzymes
• Pregnancy test (females)
• Urine analysis
• Drug screen
• X-rays of the abdomen
• Upper endoscopy
• Head CT scan
• Abdominal CT scan

Calculating the total cost for 2.75 million patients at $76,920.92 apiece brings the total bill to $211.5 billion.

Hopefully by now, more practitioners are alert to this condition and these cases are starting to be diagnosed more quickly. Still, patients who deny that their marijuana use could possibly be causing this vomiting and sickness may be hard to convince and so could find themselves back in the ER again.

The good news is that such severe symptoms are easily treated at no expense at all, once doctors come up with the right diagnosis. Simply cease using marijuana and the symptoms will go away. In fact, the patient who has suffered from CHS will save money because he or she no longer needs to buy marijuana.

As always, the greatest safety for the health of one’s body and mind is sobriety.

Reviewed and Edited by Claire Pinelli, ICAADC, CCS, LADC, RAS, CAP