Jill Fuller unexpectedly moved back in with her 92-year-old mother after developing cannabinoid hyperemesis syndrome (CHS) from using THC gummies, an illness characterized by severe nausea and vomiting. Fuller's experience, which required hospitalization and a lengthy recovery, highlights a growing concern among medical professionals about the rise of CHS cases“Who loves you best?” Jill Fuller asked while carefully lifting her mother, Sarah, off of their living room couch.
“Well, you do, honey!” the 92-year-old replied without missing a beat.
“That’s an easy answer,” Fuller said with a smile and a wink as the two began a slow, cautious walk to the kitchen table.
Exchanging words of comfort before dinner has become a cherished ritual for the mother-daughter duo.
At 57 years old, Fuller shared she never expected to move back home with her mom.
“A higher being planned this,” Fuller shared of moving back in with her mother. “I never would’ve given up all those things. Now mom has someone coming home to her at 6:30 p.m., and she loves that. And I love that.”
On the menu this particular night: Chili topped with shredded cheese – but no sour cream, much to Sarah’s dismay.
As she watched the microwave tick down, Fuller reflected on her sudden illness that led to an unexpected journey home.
“It changed my life,” she said.
Fuller shared that it started with what she thought was a simple swap that would make her old nightly routine healthier.
“I started thinking, ‘I don’t want to be drinking wine every night, why don’t we try the store down the street?’” Fuller said. “It’s not one of those typical vape stores where you see red and green flashing lights. It looked like a healthy store.”
Fuller told WRAL Investigates that an employee helped pick out a type of THC gummies that she could take every evening before bed, instead of drinking alcohol.
Over the course of a few months, Fuller said her tolerance changed. What started as just one gummy a night became six.
“I went back in, and I asked, ‘Is there something else I can take instead of six gummies?’ They recommended a caramel with a little twist-tie,” Fuller said.
She continued, “The next day, I went to work, and I was just finishing my lunch when I got nauseous and I had no idea why. It kept on going, and they ended up taking me to the hospital.” As emergency room staff gave her an IV and tried to diagnose the issue, Fuller shared that the clinicians struggled to provide an answer.
Then, she made a comment that changed everything.
“I told them, ‘I’m not feeling any pain relief, maybe it’s because I have a tolerance to the gummies I’ve been taking.’ And they said, ‘Wait a minute, what?’” Fuller said
Fuller described it as a “switch” that went off in her medical team’s brains as they immediately informed her that she was suffering from something called cannabinoid hyperemesis syndrome (CHS).
CHS is a condition characterized by persistent nausea and vomiting, intense abdominal pain and loss of appetite. North Carolina physicians told WRAL Investigates it is most commonly reported among persistent users of marijuana products.
“They let me go home the next day, and I went home to my apartment, where I stayed for three or four days, and I was miserable,” Fuller said. “The only thing that could help me was hot showers – scalding hot.”
Fuller said she eventually moved back in with her mother when her doctor warned her she shouldn’t be alone while sick.
When her symptoms persisted, her sister eventually took her back to the hospital, where she stayed for a week.
“It took me a month to be able to get back to work,” Fuller said. “I was here suffering for so long.”
Even simple foods like broccoli were making her ill, to the point where Fuller resorted to a BRAT diet (bananas, rice, applesauce and toast).
It took a full 90 days for her to feel normal again.
“I thought I was doing something legal,” said Fuller. “I don’t smoke pot; I went to a store and bought these. I had no idea what I was doing to myself.”
Inside the ER: A rise of CHS in the Triangle
When it comes to patients walking through the doors of the Duke Regional Emergency Department, Dr. Joshua Ring has seen just about everything. Ring is an associate medical director with the emergency department at Duke Regional Hospital.
Recently, more patients have been presented with a particular set of symptoms: Persistent nausea and vomiting, abdominal pain and profound dehydration.
Ring says it’s evidence that CHS is becoming more common.
“I would say, anecdotally, that we’re seeing it on at least a weekly basis, if not sometimes daily,” Ring said. “We’ve been seeing it mostly in older teenage boys and young adults.”
Ring says CHS primarily affects daily users of marijuana, including people who use various THC products.
“We all have what are called endocannabinoid receptors in our brain and intestinal system,” Ring said. “For some reason, there are certain patients who use marijuana products on a daily basis, who have a down regulation of these receptors, so they don’t function as they’re normally supposed to.”
Endocannabinoid receptors are responsible for regulating things like sleep, pain and appetite.
When the receptors are “overloaded” due to persistent cannabis use, Ring explained it can “induce a lot of intestinal spasms,” which is likely what’s causing other symptoms clinicians are seeing such as upper abdominal pain, nausea and vomiting.
Diagnosing CHS: The challenge behind the mystery illness
CHS is not usually life-threatening, but Ring warned symptoms like extreme dehydration can cause more serious issues.
The physician also says a lack of awareness about CHS within the medical community and among patients has likely contributed to misdiagnoses.
“It is a clinical diagnosis, meaning there aren’t any specific tests that tell us that it is exactly what’s going on,” Ring told WRAL Investigates. “This is one of those disease processes that can go undiagnosed for a very long time. Patients can sometimes go months, even years before an official diagnosis.”
Key characteristics that can help clinicians differentiate CHS from other conditions include daily marijuana use, recurrent episodes of nausea within 24 hours of marijuana use, and temporary relief from hot showers or baths, according to Ring.
“There are now ICD-10 codes for cannabinoid hyperemesis syndrome,” Ring said. “I think more physicians are recognizing that and documenting that. I think moving forward, we’ll be seeing a little bit more helpful data to back up the number of presentations that we’ve been seeing.”
Ring shared having a consistent way to code for the syndrome across medical systems will also help contribute to more effective treatment and better patient outcomes.
“As it is, there’s an estimated 2.75 million patients per year who have cannabinoid hyperemesis syndrome, and I think the real number is probably a lot higher than that,” Ring theorized.
Ring continued, “I think being able to code for it with the latest iteration of the ICD-10 codes, we’ll be able to get a more accurate number. I think it will be helpful for those patients who are suffering that we’ll be able to identify it and then prescribe treatment.” What CHS treatment and the road to recovery look like
After determining that a patient is suffering from cannabinoid hyperemesis syndrome, Ring emphasized that the most important treatment course is to stop all marijuana use. In most cases, he says patients will feel relief within 24-48 hours.
“One of the problems is some patients do get temporary relief from smoking again,” he said. “Once we discharge them, they’ll smoke because it makes them feel better for a short period of time, but then it’s just going to continue.”
While a patient is still being treated in the emergency department, Ring says clinicians will often first check blood work to look for significant dehydration or electrolyte abnormalities.
Anti-nausea medications can also be prescribed, though Ring notes are not effective, and exactly why remains a mystery.
“Some of the more classic medications don’t always work for some reason, so we do rely on other medications that seem to interact with the dopamine receptors in the brain and those for whatever reason seem to have a better effect,” he said.
Another method that can provide relief for patients for largely unknown reasons is applying capsaicin cream to the abdomen, according to Ring.
Ring also said it’s unclear why patients report finding temporary relief from hot showers and baths.
“There was one study that showed 97% of patients had complete relief of their symptoms after they stopped using any cannabis products,” Ring noted. “Patients who are having acute exacerbation of CHS can have symptoms that last up to a couple of days, and in rare cases can even persist for a couple of weeks.”
The potency problem: How strong THC is fueling a rise in CHS
Despite being widely underdiagnosed across the United States, CHS is not a new diagnosis.
Ring told WRAL Investigates the syndrome was first described in medical literature more than 20 years ago.
“For some reason, it has not been widely popularized,” Ring said. “Prior to COVID, there were a few papers that came out about it.”
However, as cases rise, the physician anticipates science will follow, sharing that emerging data points to a potential link between stronger cannabis products and rising cases of CHS.
The Potency Monitoring Project is a program out of the University of Mississippi that has been contracted by the U.S. government to monitor THC levels for decades.
In 1995, the average percentage of THC in products seized by the DEA was 3.96%. By 2022, the recorded average was 16.14%, a more than 307% increase.
Colorado became the first state to legalize recreational marijuana use for adults in 2014.
The move was credited with a boom in state revenue in subsequent years, with the Marijuana Policy Project reporting the state generated more than $300-million in cannabis tax revenue in 2019 alone.
Around the same time, other data shows that cases of CHS were quietly increasing.
A study published in the Journal of the American Medical Association found recreational cannabis legalization in Colorado was associated with a 29% increase in vomiting-related emergency department encounters between 2013 and 2018.
“With the legalization in certain states, we’re seeing an influx of legal marijuana products in those states, into North Carolina and states where it’s not currently legal,” said Ring. “I think that’s accounting for some of the increase in presentations we’re seeing in the emergency department.”
A safer future? How legalization could in NC impact CHS cases
When asked about the observed increase of CHS among patients he has seen in the Triangle, Ring shared a lack of government regulation in North Carolina is likely contributing to more patients getting sick.
“In North Carolina, any of the products that you can by OTC, whether it’s Delta 8 or Delta 9, which are the two most common derivatives that we’re seeing, are completely unregulated,” he said.
Ring said this is causing patients to buy products with ingredients and potencies they aren’t fully aware of.
“In a package, even though it might say 10mg or 20mg, you don’t really know what you’re getting because again, it’s not under any government regulation,” Ring warned. “You may have one edible in the same package as another edible, and it has a completely different percentage or THC in it.
WRAL Investigates put this theory to the test in 2023. Products WRAL staff purchased and subsequently sent off for independent laboratory testing revealed products on North Carolina shelves were both mislabeled and were above the legal THC limit of 0.3%.
The total THC quantity in one product sampled came back at 12.75%, more than 4,000% higher than the legal limit.
Democratic Gov. Josh Stein revealed plans to call for statewide regulations to legalize THC products during an exclusive interview with WRAL News.
Stein announced the creation of a new state advisory council to review state policies, and explore methods to legalize products containing THC.
“In North Carolina, everywhere, if you go to a vape shop on Hillsborough Street, on Peace Street – three doors down from Broughton High School – you can get a hemp product, a cannabis product, with intoxicating THC. There is no age restriction on who can buy those products,” Stein said during the interview
He continued, “We’ve got kids able to buy intoxicating cannabis [THC], we’ve got adults buying it, having no idea what’s in that product. I believe adults should be able to choose what they want to do, but they need to have information, they need to be protected, and the public needs to be protected.”
A final warning
As Fuller counted more than a dozen pain and nausea medications she was prescribed while enduring months of prolonged symptoms after her cannabinoid hyperemesis syndrome diagnosis, she told WRAL Investigates she was committed to never using cannabis products again.
“It’s just something I will never repeat again,” she vowed.
The scars on her back from where she burned herself while taking hot showers serve as daily reminders.
Fuller stated she hopes her story can serve as a cautionary tale for other potential cannabis users about the dangerous side effects of products that she had to learn the hard way.
“It’s really important that people know this is a real thing,” Fuller said. “So if something happens to them, they can say, ‘Oh my God, don’t take my gallbladder out, I probably have cannabinoid hyperemesis syndrome.’”
Fuller also shared her support of more statewide regulation, expressing concern that other patients may fall victim to the same marketing she did.
“I hope if we are going to regulate it here in North Carolina, we don’t have to have so many people ending up in the ER with a syndrome that nobody knows what it is,” Fuller said.
As WRAL Investigates left Fuller to enjoy her home-cooked meal with her mother, she offered this final advice to others.
“If you know somebody who is smoking pot or doing gummies and feeling nauseous, ask them if they’ve taken a super-hot shower recently,” Fuller said. “If they have, a light bulb should come on, and you can tell them they need to be looked at for cannabinoid hyperemesis syndrome.”
