Episode 168: Is It Really "Bad Weed"? The Science and Data of CHS with Dr. Codi Peterson

Welcome to the Cannabis Cultivation and Science Podcast. I'm your host, Tad Hussey of KISS Organics. This is the podcast where we discuss the cutting edge of growing from a science-based perspective and draw top experts from around the industry to share their wisdom and knowledge. And just a friendly reminder that as of this podcast launch, the Cannabis Cultivation and Science Conference is less than a month and a half away. The workshop spots are already full, but there are conference tickets still available. It's gonna be an amazing event, even better than last year, and you can learn more about it at kisorganics.com, or we now have a dedicated website at cultivation.science. Just for the conference. Now, today's podcast is a little bit different, but I believe it's an important issue, and I wanted to make growers aware of some of the newest research around cannabis hyperemesis syndrome, or CHS. This has been an area that is steeped in speculation and misinformation, and many cannabis users question if it's even a real syndrome or linked to some other environmental or medical problem. My guest this week is Dr. Cody Peterson. Dr. Peterson is a pediatric emergency pharmacist, educator, and cannabis science expert dedicated to bridging healthcare, public policy, and cannabis through rigorous education, research, and advocacy. He holds a PharmD from Duquesne University and an MS in medical cannabis science and therapeutics from the University of Maryland Baltimore. He serves as chief science officer at The Kinigma, a science-forward cannabis media company, and is an associate clinical professor at UV Irvine, where he teaches pharmacology and cannabis science. In addition to his academic work, Dr. Petersen teaches paramedics and first responders through OCEMT and continues to practice clinically in a pediatric emergency department in Southern California, where he regularly treats cannabis-related conditions in adolescents. He is the co-founder of the Pharmacists Cannabis Coalition of California, a nonprofit, a nonprofit advancing evidence-based cannabis education for healthcare professionals, and serves on the board of directors for Americans for Safe Access. His work focuses on translating complex cannabinoid science into practical guidance for clinicians, policymakers, and patients.

Now onto the show. The show.

What's up, Tad? How are you doing today?

I'm doing great. I was so fortunate. I didn't get your whole presentation at CannMed this year. I got distracted and came in late, but what I did catch was really fascinating to me. And so I'd love to learn a little bit more about you here for the podcast and then dive right into your research. So tell me a little bit about yourself.

Yeah, thanks for catching what you did catch. You know, I really like getting on stage and sharing and educating in that way. A little bit about me is I'm by night a pediatric night shift pharmacist at a hospital in Orange County, and that's where I spend 7 out of every 14 nights. And during the daytime though, I'm mostly an educator, an associate professor at UCI, University of California Irvine, that is. And then which is where we kind of went down this publication pathway, but also a paramedic educator and just all around kind of out there teaching people about cannabis science on LinkedIn, Instagram, cannabis science educator, you could say. How I got into this in short is always had an interest in cannabis. I had the opportunity to go back and get my master's degree in medical cannabis science and therapeutics from U Maryland, who was doing it through their pharmacy school. And I went ahead and graduated from that program in 2022. I've been out here kind of just advocating and, and trying to sort of make a place for pharmacists to prioritize patients. I'm on the board of PCCC as well as the board of Americans for Safe Access. So I'm a busy, a busy human, but I loved getting away to Tahoe to go galavant in the forest and talk about my favorite plants.

Well, I really appreciate the work that you're doing around education and research. And this recent research that you did was really fascinating to me as a cultivator or being on the cultivation science thing, because some of the findings that you had related to cultivation of this plant. So let's, let's just dive right into it. I don't want to give anything away, but what, what did you recently study and what were some of your basic findings around it?

Yeah, the focus of our research is, and much of my research right now is on something known as cannabinoid hyperemesis syndrome, also sometimes called cannabis hyperemesis syndrome. So, we can break that down. Cannabis, cannabinoid, THC is a cannabinoid, cannabis, we kind of all know about that if you're listening to this podcast. Then, I want to talk about hyperemetic or hyperemesis or emesis rather. And, this means lots of vomiting. Hyper means lots and emesis is vomiting. Last is a syndrome, which is a collection of symptoms. So these individuals are presenting, looking very similarly with very similar patterns going between feeling pretty normal, going about their daily routine, smoking weed all day, to then waking up in the morning, just not feeling good, kind of restless, maybe hot and cold, like just not kind of feeling ill. And some days they, they go on and they feel fine and, and it's no big deal. And then one day they'll have an episode. And this again, typically in the morning, People will wake up, they'll feel really not good, they'll start puking. They puke at least every hour, almost that, for the entire day, sometimes multiple days, sometimes in rare cases, more than 10 days of nonstop vomiting where you cannot eat or drink anything without immediately puking back up. So, that's on the severe side, but 10% of women who took our study, which comes out to almost 100 women because we had a total of 1,100 participants and 70% were women. More than 10% had 10-day episodes of vomiting. This is not, and this is important, Tad, this is not, I smoke and I get puke and I puke. That, that can happen, but that's really not the classic presentation. Remember, this is a syndrome. It looks a certain way. What we see is people go about their day, they're heavy long-term cannabis consumers, usually consuming multiple times per day. We can talk about some of the specifics of what we found. And they don't really have that much going on, maybe some low-level GI stuff and heartburn or indigestion or feeling full, weird appetite stuff, and then they fall into these vomiting episodes usually the next day, right? So, it's not like they smoked at the Phish concert and somebody passed around a Cheech and Chong and then someone's puking. That can happen. Usually, that's acute problems associated with THC and alcohol at the same time or just kind of, you know, amateur status as some people get crowned in the space. But, none of that is the same as this syndrome that creates vomiting. And, you wouldn't know if we were in a circle together, Tad, most of the time these CHS people, these individuals afflicted with CHS can still smoke in the circle. They're not vomiting. It's not like, you know, he's out, he no longer— he responds immediately. It's this chronic low-level dysregulation that's happening that's really impacting people's lives. And so we were the first and the largest so far to try to care— or certain— not the first, take that back, the largest so far to try to characterize who these individuals are that have developed this somewhat rare but increasingly more common vomiting condition known as C—

That was a great explanation. I was not aware of how debilitating this truly was. Like, I'd heard scrometing, I've heard of CHS. I've never experienced it myself. I actually don't have any friends that I know of personally that have experienced it either, so I haven't dove as deeply into it. And I was really shocked with what, what you shared specifically, and then talking to some people at the conference about like how dramatic of an impact it can have on your life and with ER visits and potentially, you know, 10 days is wild.

10 days is an extreme episode. You'd be admitted to the hospital that whole time. Imagine all the things that go awry when you're not home. It's bills, it's not getting your paychecks, it's feeding your animals. It's, uh, it's missing class. It's missing graduations because you cannot leave because you're retching. And then think, okay, it like people sort of, once they do come to terms with, okay, this is my marijuana use. Now they have to grapple with that and like not consuming. And if they do consume, maybe their loved ones know. And so there's all this shame built into the condition and people say, why can't you just quit? And people are like, well, it doesn't really seem like it's the weed and the weed helps me some of the time. And it's this really complicated web of a syndrome of, of chronic high-dose users. So like, let's just get into something that we found. 96.5% of everyone we sampled in, in 1,134 people, 96.5% of them were everyday, and 50 or 45% were more than 6 times per day. Okay, so this is a chronic frequent, I smoke all day thing. Now, that's not shade, that's not shame, that's just the reality. We just asked people, hey, if you have this, What, how were you consuming around the time that you got that? And a lot of my patients in the hospital, remember I work in an emergency department, so I do see pediatric patients, those under 21 coming into the hospital who have no other medical issues, but they've developed this vomiting condition. And when you ask them, you know, about their cannabis use, it's almost always, not always, but almost always, I use a vape and I use it all day long. Right? How many times a day? I don't know. You know, because by the time you, if you're sucking on a vape, by the time noon comes around, you generally don't feel it anyway. Right? So like, people just become sort of like an adult pacifier similar to a nicotine stick at some point. Now, comes with its own set of challenges and its own set of benefits. So again, I'm not trying to crush on that, but that's what we found is people are consuming lots of times per day. We found that vapers, consumed more times per day, 6 or more was most common, whereas our smokers were 3 to 5 or 1 to 2. But I wanna point this out, both vaping and smoking were very common in our, what's considered a large sample of 1,100 people. Both smoking and vaping were common. We also saw dabbing and edibles implicated even alone. People who said they only took edibles, Now, that was a very small group of people, about 30. Same thing with our dabbers. It was a pretty small, I only dab, because most people also smoke. But when we asked only smokers and only vapers, we had 300 people who only smoked and 300 people— oh, sorry, 100 people who only vape. So 300 smokers, 100 vapers. And we saw for the vapers, they responded, how long before when you started vaping to when you started vomiting, they said about 1 to 2 years most commonly, and our smokers said 10 years or more most common. Okay, so we saw this shift. It's not just those ranges, we saw literally across the spectrum, right? I'm just saying average was longer for our smokers. Why that is, I'm not sure, but it could have to do with— we found the vapers use more frequently every day. It could have to do with the THC concentration or just The fact that it's decarboxylated already in the vape cartridge as you vape it. I, I don't know. One thing I wanna be clear, I'm talking real fast. I'm talking about all this. I wanna bring this back to a couple things. This is happening and so we need to research it. Okay. I didn't do this research to answer all the questions. I wish. In fact, what I did was to create more questions, but I wanted to answer one question and created 25 more in the process. I wanted to be like, who are these people? What are they using? Where are they getting their weed? Right? Because there's this trope online that it's dirty weed, that it's cheap weed, that it's whatever. And what we saw was actually that people get their cannabis all over the place. So we saw 60%— again, they could— people could select all the choices, but most people selected licensed dispensary. Almost everyone, 60, 70% of people said, oh, I get my weed from dispensary. Half the people said they still go to the licensed, unlicensed dealer. So that's the illegal shop or to the, to the plug. Then you've even got some people going to smoke shops. 10% of people were reporting going to smoke shops to get their weed. Home grow, people said they got their own weed or weed from friends 20% of the time. Now people could select multiple there, right? So that adds up to way more than 100, but later in the study, we asked you, Or we asked them, hey, what, you know, if you just got it from one place, you know, like, uh, so we could be sure that like, if you got it from a dispensary, that you looked the same as if you got it from, from your, uh, plug. Everyone had the same symptoms, whether they got it from dispensary, whether they got it from the drug dealer, whether they got it from their home garden. We saw symptoms spread out almost the same. Some other things in their weed. We said, what's in your cannabis? Most people said Delta-9 THC, right? And some people said Type 2. So that's a combined THC and CBD. That was a much smaller percent, about 15% of the sample versus 60%. Okay. We did see 8— 3 people said CBD was the dominant thing in the weed that they were consuming. And, um, we do have a small sample of Delta-8 consumers that reported, uh, specifically getting that being the primary cannabinoid in what they're doing. Once again, more than 6 times a day was very common. Almost everyone was daily in their, how often they used. And we saw flowers first, vapes reported second, dabbing reported third, edibles reported fourth, and dry herb vaping did get an honorable mention. And then on average, people were dabbing 3 grams per week of concentrates. Smoking 10 grams per week of flour, or, and/or we don't have this distinguished in that way, and vaping 2 1-gram vape carts. That was the way we tried to characterize that because that's a really hard thing to do. Also of note, we didn't characterize people's products. I didn't have the means to try to get people's products into a lab to try to run them. This is an exceedingly hard study to do. For multiple reasons, including the fact that people consume many products. And so like if they got two strains, you would need to test both of them, right? And like, so that's a really hard thing to do to be like, oh, you got sick from weed, send me what you've been smoking and test that. There's regulatory challenges and whatever. That's sort of like maybe one day in the future, if you have ideas, you're listening to this podcast, you're like, oh, we could do it this way. Great. But right now we're not able to characterize the products or, or currently have no good scientific model to do to try to test people. There's also not any good experiments that we can do to placebo people, right? If somebody has CHS, you can't be like, oh, well, if we give you the 5% THC, will you get into a 10-day vomiting episode? No IRB is going to approve that. And so there's a lot of leaps and challenges we have to address here, but we just wanted a picture. And what we found is people get their weed everywhere. It's mostly THC. They smoke it or vape it or dab it mostly all day. And, um, you know, the market was sort of free of that. They all had similar symptoms. Some other stuff that I wanted to highlight is we went online. If you just Google image search CHS and triggers, you'll find a bunch of image lists and it had a bunch of things. So we wanted to ask people about these triggers. The things that most people most commonly reported being a trigger was actually stress. Far and away, people had stressful episodes and reported stress as the number one thing that induces these episodes, which is weird. And, if you think about THC's basic effect on our stress response, it's supposed to kill our stress, right? But, it's not one-directional. If you take a large dose, especially I know you're not a heavy user, you can get anxious, you can get paranoid, you can get more stressed. And so the ECS balances both sides of this stress coin, and it appears that these individuals are out of balance.

Cody, isn't there research to show too that for heavy users, the baseline for anxiety tends to increase? I thought I've seen that other as separate unrelated research.

A bunch of stuff out there actually. So sort of like in a chronic user, you might be more susceptible to anxiety and stress as opposed to before, you know, in early days, acute THC seems to zap the anxiety and zap the stress, but chronic exposure leads to this. And so, this is likely what we're seeing in a similar fashion, but we're not dealing with stress. We're dealing with the function of the GI tract and its ability. The other thing that people said was messing them up a lot was greasy foods, alcohol, acidic foods, caffeine, stuff that's irritating to the stomach. So, there seems to be some sort of sensitivity developing in these CHS individuals. They can get sick with a greasy— greasy meal and that can send them into a hyperemetic episode.

So yeah, I have a couple of questions. I have a ton of questions, but I do want to highlight something here at the beginning-ish of this podcast. And that's that it's, I know a lot of people that are cannabis advocates are constantly trying to point out all the good that cannabis brings to people's lives and its therapeutic effects and things like that. And I totally understand that. And so anything that shows cannabis as being detrimental or particularly potentially harmful Negative. You get a lot of, yeah, you get a lot of pushback on within the community because people are advocating so hard for this.

Uh, yep, we've been in this fight for 50 years. Absolutely.

So I totally want to acknowledge that. And I just want to share though that like this research is still very important. And I think we need to acknowledge that CHS isn't going anywhere and that this is really predominantly affecting the people who are the heaviest users who are losing, losing out because of their, you know, not only just this horrible physical experience they're going through, but it may be affecting it's probably affecting their culture and their friendships because they're no longer able to interact in the same way.

Go out and smoke with the homies anymore. Maybe they're home growers and that was part of their culture. It's also just become, I mean, it's part of my identity, right? I'm an advocate. I'm here and I do take flak to your point. I take a lot of flak, particularly on like a platform that's like, like if you reposted it on, on X or something. Not, not so much my audience, but, but when I get out there, you know, I'm a shill for big alcohol, right? I'm taking money. I'm, I'm in bed with Sam. Meanwhile, I'm aligned with Americans for Safe Access, has been in this fight for a long time. And I think this is a really good time to really try to tease apart the word, the words you used. You said they're cannabis users. That's true. But what did I, what's in their cannabis? It's a lot of THC. And have we gotten away from what made this plant that thing that you couldn't have too much of by making it so, you know, abundant in one cannabinoid. We say we hate pharma, but yet we're cranking out everything infused with THCA diamonds, which is a pharmaceutical. It's a purified drug. And so, like, and so it doesn't line up that we would be, first of all, exiling these people. They are part of our community. And two, that we wouldn't be like, oh, hey, We've been breeding this plant for this thing for a long time and now this new thing has popped up. Maybe we need to be breeding it for something else. Maybe we need to be tempering THC. Maybe we need to be harvesting earlier. Maybe we lost something in the process of this, this new domesticated, you know, germplasm that's, that's going around through, through the US and North America market, which is almost, you know, most of the places we see this condition. Is sort of, and our survey was sort of westernized places. The US, we had participants from Canada, a few from Mexico. We had one person from every continent, but that doesn't say very much, right? But we have people from Europe, South Africa, and some places that were sort of colonized. So we don't know who this is affecting and what it is, but we do know that it's our heavy consumers. It's people that were either our customers or our friends or our whatever. So we need to really cut the stigma and try to just get down to what's going on here. If I'm getting flack for doing science, imagine how like your, your friend would feel if they go to the doctor, they say, hey, you got this vomiting condition. Then you go to your friend and he says, that's not real, bro. They're lying to you. And you're like, I don't know. It's, I've been sick a lot lately and I, that's the only thing that makes sense. Imagine how exiled you would feel. And so I think it's really just important to lead with compassion.

The, the last thing I want to add to that is just that we need to research it in order to understand it so we can potentially come up with a solution.

Yeah.

And harm reduction and all of these like easy things to do. So this is a great step. So one thing that we went to research that we, we went and looked at is something known as a prodrome. Okay. We have a syndrome, a collection of symptoms. A prodrome is the collection of symptoms that comes before. So for people with migraines, often we talk about an aura. They might have changes in vision. They might have these sort of signals. If they have those signals, they're supposed to take a pill in 30 minutes to zap that migraine. Okay. That's the prodrome of the migraine syndrome. It's the same thing for CHS. We have these low-level GI symptoms that seem to pop up in the morning. It's stomach pain. It's nausea. It's gagging or kind of like almost puking. It's not dry heaving, but it can be anxiety, constipation, or diarrhea. All this like, just like not normal for me stuff that can come on maybe just one day before an episode, or which is a little more sinister. This can linger on for years and it can be in the background just I don't know what's wrong with me, you know, just indigestion for years. And then people have an episode like one time a year or, or, you know, just like they'll have this vomiting episode. No one knows what it's for or whatever, but this will go on for years and years and years. But the whole time they have this kind of just, I don't do well with dairy and I, I'm kind of like picky with my foods and sometimes I get diarrhea and sometimes I gag in the morning or whatever, whatever. And so we're trying to bring together this collection of like, what is this early warning syndrome so that if and when it can happen, people develop this condition, they can identify this happens. So I'm going to get there in a minute, but the number one treatment is quit weed. And you know how bad it sucks as a weed advocate to look at somebody and be like, you got to quit. So instead of just like the textbook says, no more weed for you, sir, because that's the way the world works, right? Abstinence is a great track record. I want to empower people with with identifying their prodromal symptoms. And if we can do that, we can empower them to temper their use and to potentially avoid unnecessary hospitalizations and episodes because most people are experiencing the prodrome of this condition. Does that make sense?

Yes. So, and I'm thinking particularly of someone in my life I know who is a admittedly very heavy user who's had low GI, low-level GI issues pretty much their entire life. And it made me wonder, actually, after your talk, I actually texted him. I was like, hey, do you think this could be related? But then in order for it to be CHS, technically they have to have that vomiting experience. If they've never had that, does this qualify as CHS or could those things be related? Have you—

I mean, to qualify as CHS, cannabinoid hyperemesis, I pretty much definitively stand by, you know, you have to have vomiting episodes. In fact, in my ideal definition, I don't make the rules. We, we would have two just to like, you know, cuz like shit can happen. There's no test. I can't take a fingerprint, right? So in order for this, and, and there's some ways that we've tried to build that into the science, uh, but, but no, I wouldn't call that CHS, but I'm not willing to say that it has nothing to do with weed either, right? Like there, there's a, the reason why I said it, talked about this is like, this looks different for everyone. And so like maybe homeboy's system is strong enough so that he never gets fully knocked over in, in his ECS. And I guess I'll, I'll jump in and explain that now, what I think is happening here.

So ECS stands for endocannabinoid.

Yeah, your endocannabinoid. I just wanna clarify, we've all probably heard of this in the space if we're, if cultivators are here working on this, um, or listening to this podcast. But basically our endocannabinoid system is a regulatory system present in every single organ system in our body, right? It's not its own organ system. It's in every other organ system. It's in almost every tissue type, almost every cell type. It is a cellular communication system and we are made up of billions and billions and billions of cells. So, they all have to talk and they talk endocannabinoid. They speak many languages, but the one that's universal between all the systems, the dopamine neurons don't speak serotonin, but they speak endocannabinoid and they can talk to each other in that fashion. Okay. So, the endocannabinoid system is this master regulatory system present in all vertebrate on planet Earth. It's in the birds, it's in the fish, it's in— I almost said the trees, which is not true. It's in every animal with a spine. Okay. I don't have to go through them. It's in your dog, it's in your cat, it's in your parrot, et cetera. So, the endocannabinoid system is there. Now, the way I like to think of it is a buoy system. Life on Earth is crazy. Think of it kind of like an ocean. Things can always change. The wind can blow from different directions. Sometimes the waves are big, sometimes it's beautiful and calm, sometimes it's sunny, sometimes it's raining. So this system is a buoy and you're on the ocean. This is not a great example, but you're the buoy. You're getting hit by a wave and whatever. Now we can take cannabis as wind, right? And we can nudge the buoy. I'm stoned right now. All good, right? But it's a buoy. It stands back up in a couple hours. We're good to go. We're not high anymore. Some of us learn to like to be this way, right? Sometimes the buoy can kind of get resistant to cannabis and so it no longer tilts, right? What's happening in CHS is I like to explain explain it. And remember, we don't really know. There's lots of theories. But this system that interconnects all your other systems, your stress system, your reward system, your GI tract, the system that is there regulating it, the buoy system, it gets knocked over, right? And so it can't stand back up and now we're vomiting. And after a few days of vomiting, it finally gets to stand back up. And if we continue to insult it with that cannabis wind, It's likely that it's gonna continue to fall over because it can't drain out and get to a point where the buoy is now functioning properly. So that's sort of my metaphor for what I, I think is the best way to understand the ECS and more importantly what's happening in this paradoxical, right? So that means unexpected side effect of THC because we know that this was the first thing the government acknowledged cannabis was good for, which was nausea and vomiting associated with chemo. 1984. Dude, like this goes back. So now why are people vomiting? I don't know, but something in the modern environment, whether it's our diets, whether it's our social media environment and something in the weed, maybe it's the THC. I would strongly look there first since that's the only thing in the plant that is verifiably 30% of what is in it. Everything else, if this is 60% legal weed, it's all been tested already. Not to say there can't be other pesticides, but then why are people also getting it from the plugs weed? Cuz that would have different pesticides. They still use Eagle 20. They don't care. Nobody's looking at it, right? And so we wouldn't see the same presentation of this nausea and vomiting in those different circumstances. And this is why I'm really trying to push back and get out here and be like, look, you see this very consistent prodrome and hyperemetic phase across every source, across every delivery system, you know, a little bit of edibles, but mostly inhalation and mostly many times a day. It seems to be a dysregulation of that bouy system that's ultra important. And no one's saying all of that to say that cannabis is just like cannabis is the problem. Most scientists are saying it's THC, that it's an activator of that CB1 receptor. That is sort of setting this imbalance off down the road. And one point there I would make is there is some case reports of a synthetic cannabinoid, K2 Spice, if you remember from the, the 2000s, that has caused vomiting episodes as well. So there's reason to believe it's not just THC, but it's actually overstimulation of this system. The buoy gets knocked over by the wrong circumstance. And remember, you're on the ocean. It's not just the cannabis wind. There's the stress wind. There's the, the wind of your menstrual cycle. If you're, uh, you know, have a uterus and blah, blah, blah, blah, blah, it goes on. So there's something about the person and their cannabis use and their genetic code and their environment and their stress situation that leads to the BUI not functioning right.

So based on your research, you're fairly confident that it's not related to neem or a particular pesticide because 2 people will maybe smoke the same cannabis and only one will get CHS. You've also, like you said, you've seen it across every cultivation style method.

Yeah, I made that argument.

I love that.

I'm going to stick with that, but that doesn't prove anything, right? I didn't test the weed. I hear you cultivators who say this is neem. Yeah. So thanks for bringing up, Tad, about this, these pesticides concerns. I am not saying I have definitively proven that it has nothing to do with pesticides. Pesticides. In fact, I think that it's possible that some people are getting ill from a pesticide, going to the doctor and sort of lackadaisically or lazily being diagnosed. I think that is a small subsection of patients, but what I see and what my data supports is this is an overuse problem. And again, the most obvious reason to consider that is everyone's reporting what's in their cannabis and it's a bunch of THC. Now that didn't happen before or whatever. I think it's fair to say that with the advent of LED lighting and improved growing techniques, and most importantly HPLC, we now know what we're looking for. We're growing for that and we're in a race to THC high, unfortunately price low. That's just a fact. You can look across every market in the world basically.

Now, Dr. Cody, when you say an overuse issue, that's not a judgment on your part as to the amount people are using. It's more just a And I use the word flooding of your endocannabinoid system. You use the buoy system because the, you explained why flooding wasn't really the most accurate way, but it's this idea of just maybe too much THC in this circumstance for your body is sort of the thought.

In the circumstance in their body, right? And so what, uh, to your point, I think flooding feels like that acute effect. I smoked at the Phish concert. I had had a couple drinks and I get sick. That can happen. That is expected. But that's not what we're dealing with. We're dealing with somebody who's not doing those things. Maybe they had one drink the night before and it started to trigger, but like they're not in these acute reactions. It's this cyclical, every couple months this happens. And in the time between, I've got low-level symptoms. No, it's not judgment. It is a— people are experiencing this and I want to try to find a way to empower them to experience it less, suffer from it less. And if we're going to be honest, we need to look at THC as the offending agent. I wanted to get back to why not pesticides. I tried to talk to some toxicologists and understand why they believe that this isn't neem. Well, for starters, with neem, it's true that ingesting a large amount of neem oil can cause nausea, vomiting, but that'll happen pretty directly after you do that. And in addition to that, You get multiple changes in the body. You see hepatotoxicity, cell injury in the liver. We don't see that with CHS. You see seizures. We don't see that with CHS. You see, um, uh, chain encephalopathies, swelling of the brain with— when, when you're vomiting from neem oil, you can have brain swelling. That's not what's happening. And that happens shortly after ingesting the neem oil as expected. These cannabis consumers can smoke weed, the same amount of weed every day for 3 weeks and on the 4th week, who knows why, maybe they ate something spicy, maybe they didn't eat the right meal at the right time or whatever, and they get sick. And then they can be sick for a day or 2 days, and then they'll keep smoking. In the next few days, they— smoke won't make them sick, so why would they ever think that that's what's causing a sickness? Mm-hmm. I wanna back up one more time. Neem toxicity doesn't make sense as a sole thing, and then so, okay, it's just other pesticides. Well, there's hundreds of different pesticides and each one affects people differently. So there's organophosphates, which are a very common, uh, class of pesticide. There's neonicotinoids, which is a very common class of pesticide and multiple other classes. And then each of those classes is associated with a different toxidrome is the scientific word, the presentation of the toxicity, the syndrome of toxicity, toxidrome. And so that's not this syndrome. Each one of them has their own bucket in these. We already know this. We know because we treat pesticide exposure in industrial farms, and this is not the type of vomiting that people develop. So while I cannot say definitively pesticides are not involved, it doesn't make sense. If you're like investigating a crime and you've got this suspect, you just want it to be that suspect, but the evidence doesn't fit. You need to look at the, the boyfriend, which is THC in this case, who's there. You know, he's always been a good guy hanging around, always helpful before, says he didn't do anything wrong. You know, so I just think that we need to be more sincere with this and not exile our individuals. And if it has something to do with THC, that doesn't end the cannabis industry. Hell, if it ends the THC race to the bottom, I think people would appreciate that. And, but maybe we need to focus on what other cannabinoids can we be, you know, integrating in to help reduce side effects, to help improve productivity, to help improve creativity, not just like what gets me the most blasted.

Yeah.

I wanna go back to something you said about neem oil though, specifically, and just pesticides in general, this idea that the dose makes the poison. So when you talk about all those effects from neem oil, you're not seeing that regularly from people who are applying neem, say in, in veg to their plants. You know, these things break down under UV light.

Over course of a couple weeks. Absolutely.

Versus chugging neem oil where you might see those things.

And if there was so much neem oil on this herb, people would taste it, right? We know that it's not, it's not innocuous, right? It, it has a flavor, so people aren't dipping their stuff in neem.

Yeah. I have seen people fail for, pesticides that are chemistries that are not allowed in the United States specifically that we're using neem oil because that neem tree was sprayed with a pesticide in India before it was harvested and it actually made it into the oil, which was interesting when that cannabis flower got tested, there was some residue there that—

Look, we test the shit out of cannabis. Legal cannabis is tested heavily, more heavily than certainly any other agricultural product in the United States. Now, have we figured it all out?

Hell no.

We've got bad incentives and a broken structure and broken, fractured 48 markets, blah, blah, blah, blah, blah. That's not why I'm here to talk about. But we have tested a lot of these products that people are consuming and the untested and people's home grow. I have a 75-year-old man, been sick for 30 years, didn't know, grew my own weed the whole time, nothing but dirt and chicken shit. Like he doesn't spray. I'm like, what do you want me to say? This is a Again, maybe something changed in his life. Maybe his ECS just can't support smoking weed like he did in his 40s and 50s at the age of 70. And like, that wouldn't be weird either. We've got good evidence that the endocannabinoid system changes. That's why it's important that teens don't smoke weed all day. I'm not saying it's the worst thing in the world, but like, we think that there's a negative effect cuz their ECS is different than the adults, is different than the babies, the old people and the babies. We have all of this thing changing, this buoy system that's critically important to every phase of our life. And when we consume something that's 30% or 78% or 90% of one psychotropic drug all day long, every day for multiple years, this can happen. I wanna tell you a statistic real quick about how long people have been consuming for on average. Where's this at? I just have a little image on my side. Okay. The most common range of consuming before getting symptoms is 3 to 5 years, but a quarter of everyone, a, that's 300 people in my sample, said it was more than 10 years of consuming cannabis before this happened.

So, well, let's, let's dive into the demographics, but I do want to ask you one question before that, and that's specifically about combustion. So wouldn't, if it was something specific to say how neem or pesticide or something is related to how that, you know, when it gets when you put it into your pipe, for example, or your joint versus say eating it as an edible where it's just been decarboxylated, wouldn't we see that in the data if it was something relating to how combustion impacts? Yeah.

I mean, if it was just combustion, it would only happen in smoking. It wouldn't happen in vaping. And we saw it almost like sort of those equally reported. And we also saw it in dabbing and we also saw it in edibles and the pesticides that get through those processes and those, those are all kind of different, right? Depends on So again, the pesticide theory is— I get why people went there. I do think there is pesticide contamination, and I do think there are some people who get sick occasionally from pesticides that could even be wrongly diagnosed with CHS, but that's not what I'm describing. I go and interview every one of these, these individuals that come through the hospital when I'm working, and I talk to them, and very rarely do I see one that doesn't fit a very typical high-frequency user of a high-THC product over long periods that develop low-level GI symptoms that They're no longer getting benefit from cannabis. Now they start puking and now they're having trouble accepting or believing that it's the cannabis. It's like a very classical picture for most patients, not everyone. I, before demographics, I wanted to get back to one more thing. The pesticide versus, versus not. I'm at CannMed getting ready to give this talk. I meet a random woman at the bar. She's a grower from indigenous territory in Minnesota. Okay. She's been a grower for 30 years, 25 years, been all through Oregon and kind of the whole thing, everything through trim to lead grower and blah, blah, blah, indoor, legal, illegal, every type of market you can imagine. And I go, she goes, what are you presenting on? I said, CHS. Have you, have you ever met anyone with CHS? And she goes, my ex-husband. And I said, stop. Let me just, let me just predict what happened here. Your ex, he's a longtime grower and smoker with you. You guys are always smoking the same weed. Then all of a sudden, out of nowhere, he gets sick. She's like, yeah. And he's like, okay, wait, wait, I want to go further. And I'm like, okay, I assume that he started to get sick. He really didn't know what it was about. He kind of ignored it and it kind of went away or didn't happen very often. But then he started to get sick again and he would usually, he would wake up and he would wake up with heartburn or indigestion or something like that. And she was like, yeah, every morning at 4:00 AM he'd wake up out of bed. He was sweating. He couldn't stop. He was just restless. He was pacing in the room. And I said, "Oh, okay." You know, and that went on for a while, but then likely he figured out that he could take a bath and that would help him for a little while, but it didn't actually help once he tried to get out of the bath. So, he would always be in the bathtub so much so that you'd have to bring him his bong in the bathtub. And her like floor hit the— here, here, Jai. And she was like, "How would you— how could you possibly know that?" And that's because people really, once they figure out this hot bath helps me with my nausea, they always want to be in the hot bath. But they're also heavy weed smokers. And we ask people in our survey part 2 that hasn't come out yet, I don't think. We ask them like, shoot, I lost that train of thought. I want to go back to my friend here. He gets sick. He's in the bathtub. He's a vomiter. I said, where does he get his weed? She said, we get, we grew it. You know, like this is our cultivation. This is what we do. She's like, I knew all the inputs and we smoked out of the same jar. It was on the coffee table. You know, so now we've got 2 people smoking the same weed. I said, did you smoke more than him? She's like, yeah. He would've said no, but yeah, absolutely. I smoked more than him, which is, which isn't uncommon. Women can, can definitely handle their weed. To that point, all of that to say, this guy, this cultivator, this guy who loved weed forever, developed a very classic syndrome, one that I could predict without letting this woman finish her story. And they smoked the same weed. So how is it pesticides? And you could say, oh, well, genetic differences in how you respond to pesticides. Sure. But then I would counter genetic differences in how you respond to the thing that is 25% by dry weight in that herb that you consume all day long is a much more plausible theory than the one that has already been tested for, shown to be clean. And if it is there, is a low PPM relatively speaking to 25%.

Yeah.

I mean, the argument about this, it just doesn't make any sense and we can't keep shaming people in, in saying they're smoking bad weed when they develop a syndrome from the very weed we're growing, Tad. Someone who smokes your weed could have this syndrome, right? And that's not your fault. But, but if we say it's pesticides, it is your fault, dog.

Yeah, I do like that. I do like that we can't just throw everything and just call it bad weed, cuz that probably isn't the case. Cuz a lot of heavy users I know are very, you know, nuanced and particular about the cannabis they consume and very proud of the fact that they either grow or consume high-quality cannabis.

Nice rosin, right? We have plenty of dabbers that showed up in our sample. We didn't have a lot of dab-only people and we didn't have very many edible-only, so we didn't include them.

You don't hear people say like, I just bought a really shitty ounce, or I, you know, I've, I've ran outta money and I've just been buying cheap weed lately. You didn't see that data? Yeah.

I mean, no, we, we didn't. We have a lot of data that I can't share yet. That's free text, right? So sort of qualitative, qualitative data that we haven't yet processed. No, I did. We saw a trend and this is a little pre-release in the data that kind of suggested people when they, when they went to vape carts, you know, I used to smoke flower all day and then I went to vapes and I got it. But to caveat that, we also saw people that said, I used to vape all day and then I went to flower and I got it. So like, it's not all totally clear, but we do see some of this transitioning or changes in delivery systems potentially. Inducing these episodes.

Could it be heavy metals?

Yeah, again, the fact that it's in every licensed market and unlicensed market, right? We test for 4 or at least 4 heavy metals in every legal market and 60% of people are there. Then we see in every delivery system including edibles, although edibles only, no, and that would kind of suggest it could be tolerated. Heavy metals are a big problem. But the cyclical nature of this condition where it's showing up not after an acute ingestion, right? Or, or just sort of during episodes that are induced by something external like stress or food does not suggest heavy metal toxicity, which is a big problem, but doesn't look like that either. Right. That's not the toxidrome.

I would expect, and again, I'm not an expert on this, but I do a lot on the cultivation side because cannabis is a hyperaccumulator. So we're always trying to reduce heavy metal uptake in cannabis. What, what I would expect is, let's just use lead as an example, is you would see over time, rather than this acute response, you'd see like, you know, intellectual challenges and other deterioration of organs and things caused by high lead exposure. 'Cause we know what that looks like in a human, but you wouldn't see these acute vomiting experiences linked to further exposure, right, at the time.

If you ingest lead or heavy metals in general, it's already in you, okay? So we don't see an immediate response. Yeah, then we see an episode, but then that resolves, and then they go back to normal life for a couple days or a couple weeks or a couple months, and then they go into an episode again, but they didn't change their weed use. Again, the temporal pattern between those behaviors and the condition don't make sense. It makes a lot more sense that it's an imbalance of a regular— the regulatory systems And importantly, it's not the only syndrome like this. There's something known as cyclic vomiting syndrome, which looks a lot like this condition, but those patients respond quite well to weed and find benefit, and they respond to medicines that our cannabinoid hyperemesis vomiters do not. But, but something in the regulatory pathways are overlapping there, and we're seeing these episodes of vomiting followed by periods of remission or stability. And then some of this prodrome as well.

All right. So I wanna, I wanna cover demographics and then I wanna talk about what solutions or therapeutic options CHS sufferers have. So first off, my question is, you know, you mentioned a genetic component. Are you seeing racial differences in your data at all?

This is so early on. Yeah, I, I would love to. So we did see a lot of white people and a lot of women in my study. But my study was not geared towards measuring that at all. That's just who showed up. And so I really, we really can't extrapolate anything from my research about demographics, et cetera. Of course I have the data, right? It was 70% white, 70% female, probably 80% in North America, maybe 85, kind of middle-aged. But to your, to your point, the data that's emerging has been very mixed. So the most recent evidence, it was our first citation, so I read their paper, says that this is sort of 21 to 25-year-old Hispanic men. But that is not what, who responded to my sample. But granted, I'm on, I got most of my people through a Facebook group, right? And so people looking to recover. And so we really don't know. And people also often ask me how many people have this. We really don't know. Okay. Low estimates. Like the lowest is like 500,000 to 1 million and no one really believes that. The highest is 7.5 million. That was just recently published. I don't know if I would really believe that. So that's 7.5 people actively suffering, which if you think about the, let's say 20% of American adults are cannabis consumers, real quick math, 250, that's 50 million people. 20, if you have 20% are regular consumers. So that would be, almost half of regular consumers. I don't believe that number either, right? So like, it's somewhere in the middle. I think best estimates I've seen are maybe 2 million people, 2.5 million people. That's a lot of people suffering from this vomiting condition though. And then we need to tease apart, are they in hyperemesis? If they are, and what can we do to kind of pull people back from this ledge, right? If they've been on the ProDromal, maybe they have an episode, can we bring back their use? Abstinence doesn't work. So I get everybody on this, like, I need abstinence, I need a long tea break, 6 months, and then we can consider how we go back with knowledge, with awareness, with other tools like CBG and CBN, uh, things that aren't THC at all, like, uh, beta-caryophyllene on the CB2 receptors for inflammation. Like, there's other stuff in cannabis that we can use it doesn't have to be just about getting stoned. Uh, and, and in these patients, it can't be anymore. They're gonna have to find a new balance.

I wanna get into that, but real quick. So did you have any, like, was there any race that just wasn't represented in your study? Like, were there like no Asians or Native Americans? Yeah.

I mean, they were all pretty small outside of, but we did have like sort of one of everything. Let me just grab that for you.

That's what I was curious about.

And then, Super easy and right here.

So you don't know if there, but there also could be this thing that like I, for example, as a low-level user could be susceptible to CHS, but maybe my, maybe my, my usage has not hit a point where I've triggered these sort of responses. Do you think maybe there's a component in every person that either makes them predisposed to or not predisposed to CHS?

Yeah. So Ethan Russo did the sort of groundwork here to start this conversation. There's much work to still be done to verify and validate what he found. But, he found 6 individual, what they're, what are called SNPs or random mutations that he was able to associate with individuals suffering from CHS that those who were not suffering from CHS but smoked a lot of weed too did not have. So, there are 6 of those. I have the demographics in front of me. We asked about all the demographics, we had a little bit of everyone, but mostly 76% white people, 3% Asian, 5% Black or Afro-American, 10% Hispanic, about 1% Middle Eastern, 0.3% Pacific Islander. And then I got a few others. And then from all over the world, but almost exclusively US, 86% USA, 8% Canada, 3% Europe, 2% Australia, and then like 2 people from Mexico, 1 from Central America, 1 from Europe, 1 from Africa.

So, so basically this is a global phenomenon.

It's a global phenomenon, but like my data is North America. Like I'm not trying to make assessments. This is happening more. I just spoke with an Israeli researcher at CanMed, Dedi Miri. And you know, the question is, is, are we not looking? Or is this something that's not on the radar of the international community? Or is it, you know, I mentioned, you know, our sample, uh, sorry, it was, uh, 32 from Europe. I think I said one. Australia, Europe, Canada, and USA is my sample. Now, is that because we're English speaking and we're through the Facebook group? Or is it because white people have more of these SNPs that we're talking about? Nobody knows. But we did have someone of every race and every sort of continent, even if it was only one from Asia, for example.

Yeah. And there was some interesting data in your demographic stuff as it split out that I want you to explain. How did gender impact the expression of CHS in terms of like duration or intensity? You actually found some differences there from what I remember.

Yeah, this is one of our biggest findings in my opinion. Um, you know, sort of setting sort of the NEEM thing away and more focusing back on what we aim to do, which was to understand individuals. We did ask men and women the same questions and then we broke them down into what people experienced. So when we asked people, how long do you vomit for, we saw that more often than not, about 30% of men said just 1 day, and then distributed all the way out to some men, about, uh, 10% of men actually. I'm looking at the graph right now, said 10-day episodes. But then we asked women, and women pretty infrequently said 1 day, most commonly said 3 to 5 days, and much statistically significantly, like Way more longer episodes, 3 to 5 days, 6 to 9 days, 10 or more days. Women said, yeah, that's, that's where I land. And so men have these shorter vomiting episodes and women have these much more prolonged episodes. They're probably more likely to seek care for that reason. They're more likely to be in the Facebook groups for that reason, because everybody's sort of talking about it. Men, you vomit for a day. You might sort of just, you know, I don't know what the hell that was about some seafood. I hate oysters. Never doing that again. Not drinking like that ever again or whatever. So, so, but, but it's spread across the board for both men and women, but women had statistically longer episodes. And the other thing that they, they just had more symptoms in general, they had more abdominal pain, more, more things of that nature.

So just to, just to reiterate, what you're seeing with it is for a patient, they're going to consume a lot of cannabis in general, most likely. They, they consume at some, at some point the night before, and then the next day, is it always 24 hours? I know this is sort of—

it's usually within 24 hours of the last smoke, not exclusively. Sometimes it can take a couple days, but, but almost always. But it's also, also not usually right after, right? It's usually the next day or later in the evening. Or it's later, it's not after the high is worn off. Yeah, basically.

Yeah.

After the THC is starting to come back off.

And then when that's happening, it's a pretty acute or, you know, I don't know, violent event where it's like a strong vomiting response from what you—

it's different for everybody, but the thing that's remarkable about it is it's a lot of abdominal pain. You're cramping. It feels like, like someone's pinching or visceral pain. And then you'll vomit and usually for the first 1 or 2, you'll get out the food or the water you had before, but then most of the rest of the vomiting, which lasts a day or 4 days or whatever, is dry heaving and like kind of just like having nothing to get out, maybe some bile, maybe some spit, right? And this is where scrometing comes from. And I, and I do wanna make note, I think scrometing is hyperbolic and being used by the media and all that. But also when we asked people. Do you ever vomit and scream? Scrommet, in parentheses. Yeah, 50% said they've experienced scrommeting. So like, it's— yes, it's made up and hyperbolic and everything, but it is happening. And I didn't tell them, I don't— I do or don't want you to say this, right? I just said, do you experience this when you're having a hyperemetic episode? And they were like, yes, I vomit and scream. Now I'm not putting those together. They specifically chose scrommeting.

So if you're listening to this podcast and you think you might have CHS or might be experiencing CHS, what, what options do you have? Like, what are the therapeutic things that people can do?

All right. So, Tad, you asked me two questions: what someone should do when they get into hyperemetic episode vomiting, and when they first sort of realize they have CHS. And the answer is start to quit, start to work on healing your endocannabinoid system. And if you ever do go back to to cannabis. Let's leverage minors. Let's do things that, that we know are not the thing that insulted your ECS in the first place, which was probably and usually high THC cannabis regularly. And apparently too regularly for your health state, genetics and your health state.

Yeah. One question I had in response to that was, can a heavy user go back to cannabis after a CHS episode at some point? What happens? Or is it just impossible.

Yeah, that's where I'm kind of trying to allude to. Look, again, the textbook says no, says you can never do it again. The real-world experience is, if you go back to using anything remotely like you used to use, yes, you will have another vomiting episode. You'll fall back into this cycle of like vomit and then prodrome and then vomit. But some people— this is a minority of people— some people can find this balance. Where they smoke on the weekend and it's no big deal and they like to integrate or they dab CBG now instead of THC and they just smoke in the evenings. The real-world takeaway is much different than the textbook. So we ask people, what'd you do after you got CHS? You know, you, you, you figured out CHS. So 40% of people quit entirely, never went back. 10% of people just reduced their use. 30% of people quit and then came back. Some of them used more, some of them use the same. And then 10% of people just keep smoking. That's what they said they did when they figured out they got CHS. And there are small percentages of people who just kept smoking and didn't get sick anymore. And so like, I don't have all the answers. I don't have— I don't have it figured out, sort of what CHS is and why people get it. But I think knowledge is perhaps the most powerful thing we can share with people. They need to know that this exists. They need to know the signs and symptoms, and they need to know that there are potentially tools, but also there are, you know, potentially downsides to overusing some of these cannabinoid tools such as THC in this case.

Is there anything besides hot baths that people can really get consistent relief with at home?

Yeah, hot baths goes back in the literature all the way back to the first definition of this syndrome in 2004 by Allen et al. And so in 2004 in Australia, there's a case series of, I wanna say, 9 patients, and they've noticed 8 out of 9 were taking these hot baths. Since that time, hot baths has been in the whole conversation. I do have that data right in front of me by chance. I'm glad you asked it. About 80% of our samples, so 4 out of 5 said hot baths helped them. There's some people that said that they didn't try. So hot baths are there, but they're not mandatory. They help most people, but they only help whilst hot while you're actually in the bath and sort of break the nausea while you're hot. So tools that we use in the hospital is hot chili oil, capsaicin, the same stuff that makes your mouth burn when you eat a jalapeño. We apply it to your belly and your back and your abdomen. And then, um, in addition to that, there's also heating pads that people can use at home, you know, electric heating pads. Be careful because you can burn yourself. So those are some ways for heat, but then there's a bunch of other things people have tried. Some people like running. I don't recommend it, but some people have done that. There's again, these, these antacid medications, there's magnesium supplements, there's digestive enzymes. None of these have a great track record of breaking through. Microdosing psilocybin, that'll come out on our next release. There we had like, you know, a small group of people are desperate.

I'm sure if they're in the middle of it, my concern with a hot bath would be you're potentially sweating and dehydrating yourself. And if you can't keep any liquids down, you're going to eventually need to go in and get fluids at the ER.

Yeah, that's part of the cycle. I agree. People have also complained about their gas bill, right? $600— my patient's parents— $600 gas bill because she just runs the shower all day long.

Oh, that's so brutal. So can we talk a little bit about that? Because I was talking with a woman who works in insurance. We shared a car back to the airport. And one of the things she was mentioning is these people end up having to go in repeatedly to the ER, to urgent care on a consistent basis, or she mentioned one person who would go from one urgent care to another urgent care just simply to get more relief. And it sounded like one, there's a lot of stigma in these hospitals around someone, you know, you're a cannabis user. And so that's a challenge, but then also just getting, you know, the cost of this syndrome and as people are trying to just get some level of relief.

It's, it's so multilayered. People miss work, people miss the, their events. People have to go to the hospital. They gotta pay the copay, they gotta pay the, the bills out of pocket. They gotta pick up at the pharmacy. They like, it's so layered that it's really hard. Our next paper, so we did this big survey. First one was 1,100 people. We talked about that today. Part 2, I'm publishing soon. It was about a smaller sample of 750. Um, and it's gonna talk more about healthcare burden and total cost and how many admissions. But 10% of people are going to the hospital have been there more than 10 times, and every ED visit's a few thousand dollars minimum, right? So you can add it up. Now, who's paying that? Who's subsidizing that in the complex healthcare system that we have? That's a different conversation. But this is very real. The repeats, the bounce backs, and you know, a lot of people don't know about it. Some people are going to the hospital 10 times before anyone mentions CHS. 5 times. Caps, whatever.

Okay.

So—

Oh, 'cause they don't wanna mention their cannabis use?

Yeah, they're lying.

They're not—

they're not telling the truth. No one ran a urine drug screen or they did run a urine drug screen, but then when asked about cannabis use, maybe they said they only just smoked one time and then maybe it's, uh, a— a kid, right? So I see these patients a lot, the 15-year-old, 16-year-old, no one's really even suspecting weed. They go to the GI clinic, they get an antacid, they do— they get an endoscope and no, they don't see anything. And then finally somebody goes, do you vape all day? So it's Look, there's a lot more to this story, but my takeaway, what I want people to take away from this is most evidence does not support pesticide exposure. And almost every expert— I cannot find anyone doing research to support the pesticide theory. If you know them, you listen to this, you're like, you know, a guy, he's got a good background, he's ready to take— have this dialogue. I want to speak with them. I cannot find a single expert on pesticides or cannabis that has a justifiable defense on how this is. Now, what's a lot easier to be is like, well, we don't know it's not pesticides. And look, I'll play that game too. We don't know it's not a lot of things. We, you know, maybe it's solar radiation. I mean, it's just like, that doesn't— we can't, we can't play that game, but it would make the most sense to look and say, hey, what has changed in recent years in cannabis? There's a trend line that shows THC has gone up. There's a trend line that shows use every day has gone up and daily use and frequency of use. So it's, it's, and it's not unreasonable to think that something that can have antiemetic effects at low doses, at the right dose in the right setting, that really, really high doses of that could actually do the opposite. That's actually pretty logical, I think, when you sit down and really consider it.

No, that makes sense.

I'm just looking at some of my questions here. And one of the other questions I had was, you know, again, thinking back to, you know, if I, if I'm experiencing CHS, I don't want to go to the hospital because I want— I don't want to explain it. I don't want to deal with a huge hospital bill. When do I need to consider going either for dehydration or for fluids? At what point should we encourage folks to make that trip just out of, you know, their own safety? Because the last thing we want is anyone to get seriously injured.

Yeah, look, you bring up a good point, Ted. People have died from dehydration, kidney injury, and electrolyte derangement. They're so dehydrated, lost all this water, the other electrolytes are too high. This is a real problem. I'm not trying to give out basic medical advice, but any episode that's lasting more than 2 days where you can keep zero fluid down You're starting to get to a dangerous level of dehydration which can start to zap your kidneys. Okay? I think a few hours, it sucks. CHS episodes are horrible. There's a lot of pain involved. It totally blows. You can come to the hospital. We can give you some medicine and it might help. It might help break the episode. But if we don't break the cycle, like this is just gonna keep happening. And so, you know, I think it's important that we— we teach our patients that these episodes can recur. They usually recur with less severity. If you're actually quitting THC or weaning off, they tend to get shorter and not longer. We tend to have less symptoms overall, so we can move towards healing and if we do it sort of thoughtfully. But I think one of the biggest problems is, is doctors are not telling patients that this can keep happening and then patients don't believe that it's THC cuz they got sick anyway, even though they quit for the last 2 or 3 days and they vomited again, for example. I think that's a really good, a really good thing that we can help them avoid. What was your question?

I'm rambling. No, I think, I think you touched on it. And I guess the thing that I want to, I want to get a little clarity on is, so the question was like, when should you go to the hospital, which you kind of answered because it is, it is more serious, but then if the only real known solution to date is to reduce cannabis use or abstinence, unfortunately, but yet abstinence or reduction of cannabis user for use for heavy users can cause withdrawal symptoms that also can look like CHS. What, what is a typical patient path towards recovery after this acute phase?

Yeah, that's a really good point in trying to distinguish withdrawal and which doesn't really have these episodes of vomiting, but can have nausea, vomiting, and appetite changes, diarrhea, like that can all happen with withdrawal. It is kind of hard, but one distinguishing factor is usually within the last 1 to 2 days, if you use, it's not withdrawal, it's, it's actually CHS. And then if it's more than that, 2, 2 days, 3 days, 4 days, 7 days, then that's probably acute withdrawal. There's this weird thing overlap that I kind of mentioned before we got on this call is there is a small section of people. I think it was like 15%, maybe 20% of our cohort that said when you pull THC away, when you quit weed, then you get an episode. We're still trying to tease that apart. I just got some data back from my statistician yesterday. That we need to look at and see if we can see any trends in, in that, but probably more questions than answers in that regard. There's no doubt that coming off of cannabis can be stressful. It's not as bad as opioids. It's not as bad as alcohol. It's not as bad as benzos, but it can be hard. Your dreams are gonna be vivid. You're gonna be irritable and cranky. You're gonna not know what to do with your hands or like what to do with your time. And all of that is what I try to prep my patients for. But honestly, after 2 weeks, 3 weeks, things start to fall back to normal. You start to think more clearly. You start to wonder why you needed weed all day, every day anyway, and maybe you could just find a better balance. And that tends to sort of clear up, in my opinion, with my patients over the short term. Once again, this is not everyone. Some people never have any of these side effects. Some people never have a damn negative thing happen to them from THC, and good for you, honestly. I'm happy for you. I'm probably closer to your camp than not. But there are people that have negative effects, whether it's too much edibles and they have a bad trippy experience, whether it's anxiety and paranoia, whether it's racing heart. There, there are negative side effects, whether it's vomiting in a chronic user. This isn't perfect because nothing is, and that's okay. I hope you guys learned a lot today and you take away from that is like cannabis is so amazing and it does all these amazing things, but also it's not perfect. We're seeing this new condition. We should address it head on and we should not put our head in the sand like a, what is it? An ostrich? Yeah. Yeah.

No, I love that.

That was a great, a great way of summarizing the conversation today. And yeah, as someone who, and I think every cannabis user has that too much edibles story where they did have, you know, vomiting or anxiety, you know, I've, I've done it and it's, it's not what we're, what you're talking about today. And I just want to clarify that that's a very different experience altogether. So yeah, we need it. We need a couple of solutions for folks that allows us to better treat and understand this without demonizing the research itself.

Yeah. Or the plant itself. Again, cannabis is a plant with many, many, many tools inside of it. I'm not trying to demonize anything. I'm just saying these individuals that consume a lot of THC, we've all been growing a lot of weed, all focused on THC. Maybe there is a more balanced path forward.

I love that. Well, thank you so much, Dr. Cody, for your research, for your time. I really appreciate it.

You're very welcome. Thanks for having me, Ted.

That was Dr. Cody Peterson, and you are listening to the Cannabis Cultivation and Science Podcast. If you like the podcast, please leave us a rating and review and give us a follow on Instagram and YouTube. And don't forget, at Kiss Organics, we have a wide array of products we offer on our website, ranging from soils, amendments, and beneficial insects to soil test analysis and commercial consulting. We carefully research all the products we offer and manufacture to make sure they are science-based and meet our high standards of quality. Thanks for listening.