Government strategies for addressing cannabis use have been a constant debate in recent decades within regulatory and public health circles. It is acknowledged that consumption, especially at an early age, increases the risk of psychosis. At the same time, the experiences of various countries after changing their laws show that not all forms of legalization produce the same outcomes: where cannabis is freely commercialized on the market, problematic use increases, but that is not the case in places where the state controls sales.

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During a shift in the emergency department at the Ramón y Cajal Hospital in Madrid, Beatriz Mexía treated a 19-year-old man with severe nausea, vomiting, and abdominal pain. “He could not tolerate even a sip of water and was dehydrated. We gave him intravenous fluids, but the usual anti-emetics could not stop the vomiting,” she recalls. This fourth-year family medicine resident, who works at the Los Alpes Health Center in Madrid, that night witnessed a chronic, common — but little-known in Spain, even among health staff — clinical scenario caused by daily cannabis or marijuana use: cannabinoid hyperemesis syndrome (CHS), characterized by severe, cyclical episodes of vomiting and nausea.

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