Cannabis Causing More Than a High: The Risk of Pancreatitis

Key Takeaways
Cannabis use is often associated with neurological and psychological side effects, but it can also lead to gastrointestinal complications. This was highlighted in the case of a 37-year-old woman reported by Dr Alejandro Biglione and colleagues from Wellington Regional Medical Centre in Wellington, Florida.
Patient History
The patient experienced intermittent abdominal pain lasting 4 days, mainly in the epigastrium and left upper quadrant. She described the pain as dull to sharp and stabbing, radiating to the back. She denied any chest pain, shoulder pain, or use of alcohol or tobacco. Along with the pain, she experienced nausea and vomiting, which worsened after eating.
Her medical history revealed no surgeries and, apart from depression and anxiety, no significant illnesses. Two years prior, she had discontinued her prescribed serotonin reuptake inhibitor and turned to cannabis to manage her symptoms. She had been using approximately 7 g of cannabis (about a quarter ounce) two to three times daily for the past year, which she reported helped manage her anxiety and depression. She had been using cannabis since adolescence.
Findings
Vital signs were normal (temperature 36.8 °C, heart rate 93 bpm, blood pressure 102/68 mm Hg, respiratory rate 20 breaths per minute, oxygen saturation 97% on room air). 
BMI of 21.61 kg/m². 
Cardiovascular and respiratory auscultation should no abnormalities. 
Abdominal exam revealed tenderness in the epigastrium and left upper quadrant, with hypoactive bowel sounds. 
Laboratory results, including liver enzymes, were normal. Lipase levels were elevated at 5221 IU/L (normal: 0-160 IU/L), as were triglycerides at 79 mg/dL (normal: < 150 mg/dL). 
Chest X-ray was normal. 
Abdominal and pelvic CT scan without contrast: normal liver and gallbladder, mildly enlarged pancreas (suggestive of acute pancreatitis), sigmoid diverticulosis, and normal spleen, kidneys, appendix, bladder, and uterus. 
Abdominal ultrasound showed no abnormalities in the liver, gallbladder, bile ducts, pancreas, spleen, kidneys, or adrenal glands. 
Magnetic resonance cholangiopancreatography showed a normal bile duct (5 mm in diameter) and a distended gallbladder without wall thickening. 
Treatment and Course
Pain management and administration of ondansetron 4 mg for nausea and vomiting, with fluid replacement using Ringer’s lactate solution. 
The patient was discharged from the hospital after 2 days. 
Discussion
The neurological effects of cannabis include cognitive impairment, psychoactive disturbances, altered brain development, and an increased risk of psychotic disorders like schizophrenia. However, its impact on the gastrointestinal system is also significant, with conditions like hyperemesis syndrome and, potentially, acute pancreatitis.
Acute pancreatitis is typically triggered by factors such as alcohol, gallstones, and certain medications. Symptoms can vary from mild epigastric pain to severe organ dysfunction. In recent years, the incidence of acute pancreatitis has been on the rise, and increasing cannabis use may play a role in this trend. Biglione and colleagues highlighted this connection, referencing several studies, including one involving 45 patients with cannabis-induced acute pancreatitis and another reviewing gastrointestinal complications related to cannabis consumption.
Although the exact mechanism remains unclear, it’s believed that tetrahydrocannabinol binds to CB1 and CB2 receptors in the pancreas, potentially triggering inflammation. Given these findings, cannabis use should be considered a possible cause when diagnosing acute pancreatitis, according to the authors of this case report and supported by other research.
The prevalence of acute pancreatitis has increased steadily over the last few decades, as noted by Dr Armin Finkenstedt and Professor Michael Joannidis from the Landeskrankenhaus Innsbruck, Austria. In Germany, the two leading causes are gallstones and alcohol abuse, each accounting for 20% to 30% of cases. Other triggers include hypertriglyceridaemia, endoscopic retrograde cholangiopancreatography, hypercalcaemia, and certain medications.
Most patients develop mild, interstitial pancreatitis and recover within a few days with supportive care. However, more than 10% of cases progress to severe forms of pancreatitis. Data from Germany show that when organ complications occur, the mortality rate can exceed 12%.
The diagnosis of acute pancreatitis is typically based on characteristic abdominal pain—acute, persistent upper abdominal pain often radiating to the back—and elevated serum lipase levels, at least three times the normal upper limit. However, lipase has limitations in both sensitivity and specificity, so if clinical or lab findings are unclear, abdominal imaging (usually ultrasound) should be considered. An abdominal CT scan is not routinely required for diagnosis. In up to 30% of cases, the underlying cause is not immediately clear, necessitating further investigation. Endoscopic ultrasound is more sensitive for diagnosing biliary causes, while secretin-stimulated magnetic resonance cholangiopancreatography is more sensitive for diagnosing pancreatic divisum.
This story was translated from Univadis Germany using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. 
 
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