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Does Pot Make You Puke?

Does Pot Make You Puke?

Does Pot Make You Puke? | Alternative Explanation for the “Pot Vomits”

A friend of mine sent me an article that makes me question whether or not does pot make you puke? The Cannabinoid Hyperemesis Syndrome (CHS – or the “pot vomits”) was first described in 2004 by Allen and colleagues in South Australia. As a syndrome, there is no definitive blood test or x-ray that can confirm the diagnosis – its just a constellation of signs and symptoms that, in the correct clinical circumstance, suggests a particular diagnosis. So does pot make you puke? In the case of CHS, that constellation of signs and symptoms include; heavy regular (usually daily) use of marijuana, abdominal cramping and cyclical vomiting ameliorated to a small extent by taking scalding hot showers (up to 5 or 6 times a day). Individuals that don’t receive any relief from the hot showers present to the emergency room and are frequently treated with IV fluid and butyrophenones like haloperidol, or undergo expensive workups to evaluate for possible bowel obstruction or some other intraabdominal catastrophe. All symptoms go away once the individual stops smoking pot.

Does Pot MAke You Puke

Cannabinoid Hyperemesis Syndrome

Interestingly, some individuals believe that since marijuana (cannabinoid oil) is often used to help the nausea of cancer chemotherapy or to increase the appetite in HIV patients, some recreational users of marijuana that are developing the cannabinoid hyperemesis syndrome believe that smoking MORE pot will help alleviate their symptoms of nausea and abdominal cramping, when the converse is true.

Enter my old friend Damien – one of the few people I know that has as clear an understanding of the scientific method as I do. That is – he has an open mind and is not afraid to ask uncomfortable questions. From deep in the heart of Texas, Damien brings forth a theory that its not the marijuana that is causing the CHS – its a pesticide contaminant thats doing it.

https://steemit.com/cannabis/@drutter/cannabis-hyperemesis-syndrome-chs-is-actually-azadirachtin-neem-poisoning

What’s that you say? Pot smokers are being poisoned by a pesticide and that’s the reason they are puking? Interesting theory. Does it hold water?

Well, the first thing we need to do is keep an open mind. There hasn’t been an actual study of the phenomenon – all we have is a bunch of case reports and as my old teacher Rick Dart used to say – the plural of anecdote is not data. A whole bunch of case reports is just that – a handful of stories. Nothing more.

The pesticide in question is azadirachtin, an obscure chemical without a lot of background information available regarding it’s toxicity. Azadirachtin is derived from neem oil, which is derived from the seeds of the the neem plant (Azadirachtin indica).  The chemical formula for azadirachtin in C35H44O16 and it looks like this:

azadirachtin - Does Pot Make You Puke

Chemical Structure of Azadirachtin

Azadirachtin has a strong garlicky/sulfur odor which might make the pot is supposedly is contaminating smell and taste like skunkweed. is just one of several different chemicals derived from neem oil but it has some unique characteristics that make it a unique, naturally occurring pesticide. It kills all kinds of insects, is very biodegradable (it degrades within 100 hours when exposed to water or sunlight) and has minimal toxicity to mammals.

The very fact that it is so readily biodegradable and it decomposes rapidly at high temperatures (higher than 137 degrees Farenheit) calls into question whether or not enough of the parents compound is available for consumption once the marijuana plant is harvested, dried and smoked (or suffused into an edible). The US Environmental Protection Agency merely lists azadirachtin as a skin irritant and there is no specific or special decontamination necessary for exposure, other than washing with soap and water. The human toxicity data for neem seed oil (NOT azadirachtin) consists of a couple of case reports suggesting that

1. Neem seed oil produced occasional diarrhea, nausea, and general discomfort when given orally as an anthelmintic.

Krieger, R. (ed.). Handbook of Pesticide Toxicology. Volume 1, 2nd ed. 2001. Academic Press, San Diego, California., p. 132
2. Thirteen cases including 2 fatal, poisoning cases due to neem seed (margosa) oil, a traditional remedy in India and Malaysia, were reported. Five to ten milliliters of the oil given orally to children against minor ailments caused vomiting, drowsiness, tachypnea with acidotic respiration, and polymorphonuclear leukocytosis, and encephalopathy developed within hours of ingestion. Seizures, associated with coma, developed in some cases. Autopsy demonstrated pronounced fatty acid infiltration of the liver and proximal renal tubules, with mitochondrial damage, and cerebral edema, changes consistent with Reye’s syndrome.

Krieger, R. (ed.). Handbook of Pesticide Toxicology. Volume 1, 2nd ed. 2001. Academic Press, San Diego, California., p. 132
That’s it. Not a whole lot more.
The LD50 dose for non-human mammals is ridiculously high:
LD50 Rat oral >5000 mg/kg

Crop Protection Handbook 2005. (Formerly Farm and Chemicals Handbook) Willoughby, OH: Meister Publishing Co., 2005., p. D-30
LD50 Rabbit oral >2000 mg/kg

Crop Protection Handbook 2005. (Formerly Farm and Chemicals Handbook) Willoughby, OH: Meister Publishing Co., 2005., p. D-30
LD50 Rabbit dermal >2000 mg/kg

Tomlin CDS, ed. Azadirachtin (11141-17-6). In: The e-Pesticide Manual, 13th Edition Version 3.1 (2004-05). Surrey UK, British Crop Protection Council.
LD50 Mouse oral 13 mg/kg /Neem extract/

Krieger, R. (ed.). Handbook of Pesticide Toxicology. Volume 1, 2nd ed. 2001. Academic Press, San Diego, California., p. 132
Since the guy that posted the original warning that it was the azadirachtin and not the cannabinoid that caused CHS failed to include a single relevant reference, we really don’t know what to believe. Still looking for the answer to the question does pot make you puke. The only cited reference was a case report from India of patient that tried to kill themselves by drinking a tall glass of neem oil – not exactly apples to apples when it comes to CHS. Be that as it may, based on what I’ve managed to gather from reputable toxicology and chemical databases, I’d have to say that the azadirachtin theory of CHS is not terribly plausible. The toxic potential and physical characteristics of the chemical simply don’t lend them to suggest a toxic potential.
That’s not to say it COULDN’T be true. Someone needs to perform a randomized, blinded trial of azadirachtin/pot versus azadirachtin-free/pot and measure the incidence of CHS. That’s the scientific method. So the answer to the question “Does pot make you puke?” remains – probably.
PB-does pot make you puke

Prep time for my trip to Hanoi in November!

 

 

Written by Poison Boy

Gerry O'Malley (a.k.a Poison Boy) is a board certified ER doctor and toxicologist with a interest in the unusual, terrifying and occasionally hilarious world of poisonings and toxicology. This site is an exploration of poisons of historical interest as well as in current events and pop culture.

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