And,the wind, it cries Mary…

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As a child of the 50s and 60s, I was surrounded by folks who experimented with all sorts of “mind-enhancing” drugs. Me? I was content to keep my experiments contained within my chem lab. (Nowadays, my fraternity brothers and friends would term me the “designated driver”.)

My kids always were certain that I must have used at least one drug- despite my protestations that I would not take anything that would mess with my mind. Until they met a slew of my fraternity brothers and fellow grad students, who vouched for the fact that I was the only one who passed the “party” by.

Now, I live in the Commonwealth of Virginia. And, it’s about as likely that they will pass a law allowing for the recreational use of marijuana (called Mary Jane in my day) as it is likely that climate change is a fiction. (Sorry, Virginia, climate change is real- just visit Norfolk, which is literally becoming overrun by its surrounding waters.)

But, there are plenty of states (CA, MA, ME, NV, DC, OR, WA, AK, and CO) that allow their citizenry to partake of marijuana. Both for recreational and medicinal purposes. Which may mean that the arrest rate for use may be dropping- but not that we know for certain it’s safe. (I am NOT talking about the governmental pablum that marijuana causes folks to switch to heroin, cocaine, and other hard drugs. That just doesn’t seem to have much truth behind it.)

Right now, some 2/3 of the folks in Colorado drive under the influence; in Oregon, those numbers are about 1/3, and 49% of young adults in Washington state admitted to the infraction.
But, almost 1/2 of the US over the age of 12 have indulged in marijuana intoxication. (The true number is 44%.) And, given that chronic use of marijuana is associated with acute kidney injury, we may be missing a vital health concern.

Chronic marijuana users are reporting symptoms such as nausea, weight loss, and disinterest in food. (This phenomenon is called the prodrome.) And, given that marijuana is an anti-emetic, it is very surprising that continued use of marijuana induces a hyperemetic phase in these folks. (The only thing that seems to work for them is taking prolonged, hot showers- unless, of course, they refrain from marijuana use.)

The hyperemetic phase is what leads to acute kidney injury- resulting from the dehydration (from the syndrome), metabolic alkalosis, among other maladies. Thankfully, only about 9% of marijuana users are so afflicted.

So, we see that the Cannabinoid Hyperemesis Syndrome involves three separate phases:   the prodromal, the hyperemetic, and then the recovery phase. The prodromal phase is the onset phase, which typically happens over the course of 4-6 hours of acute intoxication. This is when someone would begin to feel nauseous and experience abdominal discomfort. The hyperemetic phase (about 48 hours in duration) is when the syndrome has escalated; now it involves repetitive vomiting and abdominal cramping. The problem is that recovery can take weeks, requiring copious ingestion of fluids, administration of anti-nausea medications- and ceasing one’s marijuana usage.

These are the reasons why marijuana users have been denied kidney transplants. Most transplant centers routinely demand the cessation of marijuana and tobacco use for 6 to 12 weeks prior to any transplantation efforts. The physicians involved don’t want to preach about following the law or not- they simply want the best outcomes for their patients.

Some 7 states have already outlawed the practice of denying transplantation to marijuana users. But, the question remains what to do about the 9% of the chronic users who develop acute kidney intoxication.

Roy A. Ackerman, Ph.D., E.A.

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