{Pictured above: Katy O'Shea | Somerville Patient Advocate)

What does Cannabis do for Nausea?

So how exactly does cannabis fight off nausea? According to Leafly, “The dorsal vagal complex (DVC) in the brainstem is the overall regulator of emesis (nausea/ vomiting), and it is responsible for communication between signals in the blood and the nerve cells that initiate emesis. The DVC and gastrointestinal tract have endocannabinoid receptors, and all have shown to exhibit anti-emetic responses when the receptors are activated by Δ9-THC (Delta-9-THC)”.

What this means is that when the Δ9-THC cannabinoids are activated through smoking or ingestion, they send out responses to the receptors in your GI tract and DVC to combat the emesis. I recommend looking for strains and products that are high in Δ9-THC for this exact reason. There are quite a few strains that treat nausea more effectively than others, some I will mention a little later on.

Cyclical Vomiting Syndrome (CVS) and My Story:

For as long as I can remember, I’ve always had a funky stomach. It wasn’t until 3 years ago when life as I knew it would change forever. From September 2018 to February 2019, I was throwing up every day, multiple times a day, and nobody could tell me why. I was diagnosed with a condition called Cyclical Vomiting Syndrome. The Mayo Clinic defines CVS as “episodes of severe vomiting that have no apparent cause. Episodes can last for hours or days and alternate with symptom-free periods. Episodes are similar, meaning that they tend to start at the same time of day, last the same length of time, and occur with the same symptoms and intensity”. I had to make a choice, let this condition take over my life until it killed me, or fight like hell everyday for the sake of normalcy. While some days are better than others, I’m very grateful for the progress I have made in two short years. However, it wasn’t an easy road to get to. Getting a diagnosis of CVS can be quite the lengthy process.

Before I was officially diagnosed, doctors told me I had a stomach bug, a dairy allergy, a gluten intolerance, and one that’s been making rounds in the ER the last few years, Cannabinoid Hyperemesis Syndrome.

Cannabinoid Hyperemesis Syndrome (CHS)

One of the first questions I get asked when at an Urgent Care Center or the ER is “do you smoke weed?”. The question we dread giving our doctors the real answer too. After answering yes, before I can even blink, I’m interrupted by “the reason you’re throwing up is because you’re smoking too much weed. Stop smoking and you’ll stop throwing up, you have CHS”. According to Cedars Sinai, “Cannabinoid hyperemesis syndrome (CHS) is a condition that leads to repeated and severe bouts of vomiting. It is rare and only occurs in daily long-term users of marijuana”. Unlike Cyclical Vomiting Syndrome, there is a cure for Cannabinoid Hyperemesis Syndrome. The only way to stop CHS is to... stop ingesting cannabis. So easy and simple!

Unfortunately, even in 2021, there is still a very large stigma attached to cannabis by medical professionals. Increasing cases of CHS really aren’t helping.

But are they really cases of CHS?

Due to the stigma of cannabis, patients are being misdiagnosed with CHS daily. In 2019, The Boston Globe reported on the subject and interviewed several different ER doctors as well as GI specialists to get their take on the matter. One of those doctors is Dr. Braden Kuo of Mass General Hospital. I am very lucky to be one of Dr. Kuo’s patients. He has been one of the only medical professionals who understands and appreciates the medical benefits of cannabis and encourages it for his patients. In the article he is asked about CHS; “Dr. Kuo believes some doctors are too quick to blame cannabis for the sicknesses when they learn about a patient’s pot consumption. He believes many people with other illnesses are misdiagnosed with cannabis syndrome because patients self-medicate with marijuana in an attempt to ease their nausea. The majority of the medical community is still very prejudiced against marijuana,” Kuo said. For many doctors, particularly inexperienced ones, he said, “as soon as they hear marijuana, they say, ‘Oh, you have [cannabinoid hyperemesis syndrome].’ ”

Getting to the Core of My Diagnosis:

The story I’m going to share is still quite traumatic, but it is an important story to tell as I came very close to death due to one doctor's mistake and assumptions of cannabis. One Saturday morning I was in the ER after being severely dehydrated and being up all night with intense nausea and dry heaving. The doctor I had seen asked if I smoked weed, I answered with an honest yes. Immediately, he rolls his eyes and tells me I have CHS and I need to stop smoking weed ASAP. He then gave me a medication called Haldol through my IV to help with nausea. I had never felt so fidgety, anxious, and angry in my life. As soon as the drug hit my system, I was trying to rip my IV out. I didn’t feel right. After getting discharged, I found myself walking in circles in my bedroom being unable to sit still.

The next morning, it felt as if everything was normal. I went about my day just as I normally did, showered, ate breakfast. But then I started to notice this weird sensation in my face. It was as if I was smiling but...I wasn’t trying to. Fast forward about 20 minutes later and my face became paralyzed, my breathing was heavier, and I was being carried down the stairs by the fire department on a one way trip back to the same ER. What we initially thought to be a stroke was actually a severe and delayed allergic reaction to the medicine given to me at the hospital the day prior. When a different doctor looked over the notes the previous doctor had made the day before, he could not understand why I was given that medication.

While CHS was eventually ruled out in my case, it is unfortunately a situation many have found themselves in. While information on CHS is still being discovered, we do know the best way to treat it is to cut back on your cannabis consumption, and to treat episodes of nausea and vomiting with hot showers. If you or someone you know are experiencing any symptoms that could be related to CHS, please get in touch with your doctor.

Katy’s Top 10 Cannabis Products for Nausea/ Vomiting: 

I feel like I am on a never ending quest to find the right products for my patients and myself. Throughout the years I’ve tried a lot of flower, concentrates, and edibles to combat the dry heaving, stomach cramps, fatigue, and headaches that can come with nausea and vomiting. Depending on the severity, I have found vape cartridges to work better than flower due to the strength of the concentrate. Go with whichever form of ingestion you feel the most comfortable with. Aim for products that yield little to no coughing to prevent gagging/ choking.

Please keep in mind, these are products that I use; everybody reacts to cannabis differently and I encourage you to find the ones that fit you and your needs, these are recommendations and you should always consult with a Patient Advocate before trying new products.

1) Do Si Do #22 - Indica Dominant Hybrid

Taking the #1 spot, a patient and staff favorite, Do Si Do #22. This is one of those strains that when we get in, it doesn’t hang around for too long. This strain is a cross of Girl Scout Cookies and Face Off OG. This strain’s high starts in the face with warm tingles filling your cheeks. As those tingles travel down to your feet, you’ll feel a wave of calm tuck you in like a blanket, followed by a couch lock that will drift you off into dreamland. This makes for a perfect nausea strain due to its strong Indica leaning effects. You may notice an increase in appetite before drifting off to sleep. I love this strain due to its strong sedative effects, I wake up feeling refreshed and a little hungry. At Sira, we usually have this strain available in flower, vape cartridges, as well as some concentrates as well. Choose the form of ingestion you’d prefer.

2) Super Lemon Haze Terp Cartridge - Sativa Dominant Hybrid

While Indica Dominant Hybrids work like magic on the stomach, it can be a bit of a challenge getting through the day when you feel like you’re on the verge of falling asleep. Send in the sativas! I’ve found relief in Super Lemon Haze as a way to treat my early morning nausea. A cross of Lemon Skunk and Super Silver Haze, Super Lemon Haze offers a citrusy sweet high that you’ll feel hit your body gently while erasing your anxieties of the impending day. When I’m medicating with it, I love that I can feel the nausea and intense stomach pains melt away, leaving me with an “I got this'' attitude. The sweet citrus flavor makes it a great way to start the day. As I like to mention to all my patients, be cautious when it comes to Sativa strains as some people have negative reactions. Consult with your Patient Advocate if you’re interested in exploring some of our options.

3) 2:1 Tincture

If you haven’t tried Sira’s Tincture before, then you my friend are missing out. Each drop packs a punch with a whopping 4 mgs of CBD and 2 mgs of THC. Tinctures are a great way to ingest cannabis as a smoke free option without having to wait too long for the effects to kick in. Tincture oil primarily is dropped under the tongue causing it to be absorbed through the mucus membrane with effects kicking in about 20-30 minutes after consumption. I selected the 2:1 due to the calming effects of the CBD that stays with you throughout the day. One of my biggest triggers of nausea is high anxiety situations, and with just a few drops in my morning iced coffee, I’m able to maintain a calm, cool, and collected attitude that powers me through the work day.

4) Betty’s Eddies (Somerville Only)

Betty’s Eddies have quickly become a patient and staff favorite from pretty much everyone at Sira Somerville. What makes these so special is that they’re gluten-free, vegan, and made with real fruits and vegetables. These salt water taffy-like chews come in flavors such as Elderberry, Apple Pie, Grape, and my favorite, Peach Mango. We also have them in different dosages ranging from 5mg-50mg. This isn’t a quick consumption edible like popping a gummy, it does take a few minutes to chew, like any taffy would. The ingredients in Betty’s Eddies are all natural, making it gentle on the stomach. With my experience with them, I’ve noticed the effect to be very calming as well as slightly sedating. Starting at only $20 for a 10 pack, these little guys are great to have on hand when in need of some relief for your stomach and your wallet.

5) Entourage SFV OG Single Use Vape

There is no worse feeling than going about your day, killing it at work, and all of a sudden, it hits you. You feel your stomach drop, that lump in the back of your throat forms, mouth watering, and you’re mapping out how you’re gonna make it to the restroom without puking on the carpet. Trust me, been there, done that. When that happens, you need relief and you need it right away. That’s why I like to carry an Entourage Single in my bag, you never know when you’re gonna need it! This disposable vape doesn’t require a charge, so it’s ready for you when you need relief. One strain I always make sure I have on hand is SFV OG. San Fernando Valley OG is one of my favorite hybrid strains of all time. It’s a strong body buzz that melts away physical pain while keeping you clear headed and aware of your surroundings. This strain is great for anytime of day, but is preferred more for daytime use. I use this when a wave hits me mid-commuting, or after a day of running around the dispensary and I need to melt my aches and pains away.

6) Kalm Fusion Strawberry Lemonade Drink Mix - 50mg, 150mg pkg. (Somerville Only)

When experiencing multiple episodes of vomiting, staying hydrated is incredibly important. Most of the time we struggle to keep food down and the only thing that does stay down is liquids. Introducing, cannabis infused drink mixes!! It’s a great way to medicate while staying hydrated at the same time. I like that while the flavor is great, it’s not as acidic as other lemonades and drink mixes, it really does remind me of a Crystal Lite pack! Acidic foods are like adding gasoline to a fire, and in my experience, this didn’t bother my stomach or acid reflux. Because it is quite a strong dose, don’t feel like you need to use the entire tube, the flavor of strawberry lemonade may not be as strong, but it will be a more enjoyable experience without feeling overwhelmed or anxious.

7) Cresco’s Humble Pie RSO (Somerville Only)

You know I had to put RSO on this list. A patient staple, RSO, better known as Rick Simpson Oil, stands out when compared to other forms of concentrate. RSO is a whole plant extract, meaning they use every part of the cannabis plant in making this liquid gold. What you’re left with is a potent and powerful concentrate that can be applied topically as well as ingested orally. It has been found to be very beneficial for cancer patients. I recommend Humble Pie specifically because it’s a hybrid strain, meaning that this is going to be ideal for anytime of day. Humble Pie is a cross of Cherry Pie and Grandpa’s Breath. Cherry Pie is known for its physical calming effects while Grandpa’s Breath is known for its mental pain relief, making this an ideal strain to calm your mind and body down when experiencing multiple episodes of vomiting and intense nausea.

8) Veterans Cannabis Project .4g Preroll 5 Pack - Captain’s Cake (Somerville Only)

When I first began my cannabis journey, one of the first strains I remember trying was Captain’s Cake. This Indica Dominant Hybrid is a cross of Girl Scout Cookies and White Fire OG with sweet and earthy aromas. The high is incredibly relaxing on the body, melting away your aches and pains. This strain is perfect for those suffering with physical pain. I didn’t pick this product just for the strain, they’re also the perfect sized preroll for when you need a small dose of cannabis. They come in 5 prerolled joints, and ready to fire up when you are!

These are also for a great cause. The Veterans Cannabis Project “is dedicated to improving U.S. military veterans’ quality of life through the opportunity of cannabis. We believe medical cannabis saves lives and that veterans deserve full, legal access”. A good chunk of our patients are Veterans, and I personally see at least 2 or 3 of them a day when I’m at Sira. By purchasing these prerolls, you’re helping to fight for the right of Veterans to medicate and heal.

9) Berkshire Roots Fruit Chews (Somerville Only)

Depending on the severity of our nausea, some cannabis consumption might be better than others. If you have the ability to hold some solids, edibles may be the way to go. One edible that I keep in my nightstand and only use when in episode is the Berkshire Roots Fruit Chews. Berkshire Roots is one of my favorite Cannabis companies in Massachusetts and carrying their products is a great way for our patients to try out different grows from around the state. These fruit chews are a thin disk, like a communion wafer but A LOT more tastier. The consistency is going to feel more like a gummy candy rather than a taffy consistency like the Betty’s Eddies. One flavor that we currently do not have but I hope to get back soon is the Lemon Ginger 1:1. The flavor is perfect, not too sour from the lemon and not too spicy from the ginger. It’s a 1:1 ratio so these are going to contain equal parts CBD to equal parts THC. I really like these for nausea because they’re small and thin, making them easily digestible and the effects are very relaxing and calming, which is exactly what you need to feel better. I have seen the Lemon Ginger chews at Berkshire Roots facilities in Pittsfield and in Boston.

10) Rainbow Belts Flower - Balanced Hybrid

When we get Rainbow Belts in, which only happens once in a while, this is a strain I encourage my patients stock up on. Rainbow Belts is typically my second choice of flower to treat my episodes and flair ups. A cross between Zkittlez and Moonbow, this bright green flower’s flavor really does remind me of lime flavored Skittles! The high is going to start with mental relaxation that is quickly followed by tingles starting from your head all the way down to your toes. While this strain is known for its relaxation, the sedation feeling is minimal, making this an ideal strain for any time of the day. Sometimes, I’ll throw a nugget of Rainbow Belts AND a nugget of Do Si do into my grinder for an experience of complete calm and peace.

Conclusion:

Now before you go, a couple of thoughts from the Nausea Queen. If you are experiencing nausea/vomiting frequently, as in multiple times a day, every day, I strongly encourage you to seek medical treatment. All the products I’ve discussed are what works for me, I can’t guarantee that everything on this list will work for you, but it should help to give you some guidance on what to look for. You might be wondering if there are any products I would NOT recommend for nausea/vomiting, and the answer is yes! There are some products that can even trigger vomiting as well. If you are using cannabis for treatment, keep in mind to stay clear of these types of products:

• Chocolate Bars/ Chocolate Drops: while a delicious sweet treat, chocolate can upset your stomach more than it already is, while once in a while is ok, I would not recommend this as a long time treatment specifically for nausea.
• Smoking Flower: this might sound contradictory, but it’s kind of true. Smoking flower can induce coughing which can lead to gagging, and well you know. I would play it by ear depending on the severity of your nausea. If you feel ok enough to smoke, go for it. If you feel a bit on the weaker side and that you might not be able to handle it, stick to a tincture or an edible.
• Special Flavored Edibles: with my experience, I noticed a big difference in which edibles I was able to hold down versus ones I couldn’t stomach. I recommend sticking with more basic flavors like green apple, watermelon, lemon, strawberry. Specialty flavors, depending on what exactly they are, can have a negative effect. I recommend avoiding flavors such as Spicy Strawberry or S'mores Cheesecake.

Incorporating cannabis into my regiment has made such a difference not just physically, but also on a mental and emotional level. It helped give me my life back. And that’s what I want to help you with. My only hope is that through this article, I’m able to help at least one person live a fuller life that isn’t controlled by their stomach.

Written by: Katy O’Shea | Patient Advocate, Somerville