Moderate-quality outcomes are defined as those for which further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low-quality outcomes are those for which further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low-quality outcomes are those for which any estimate of effect is very uncertain. This material is not a substitute for the advice of a qualified health professional.
When to seek urgent care
- There is moderate evidence to support that the definitive treatment for CHS is cannabis cessation.
- While cannabis is revered for its nausea-calming (antiemetic) properties, it’s paradoxical that it causes severe nausea and vomiting in certain people.
- People with CHS often find they can’t keep food down and may even risk dehydration because of how frequently they throw up.
It has been suggested that this is due to the fact that cannabinoid use is about double in younger people compared to older individuals 135. The authors found no cases of geriatric CHS (≥65 years), but there is no reason evident why geriatric individuals who used marijuana long term would be immune from CHS. It is not known why the syndrome develops in some, but not all, long-term marijuana users and why symptoms take longer to manifest in some patients than others. Although there were very few case studies involving CHS patients with eating disorders, bulimia might present in such a way that it could be confused with CHS. About 35% of individuals with some form of substance use disorder have an eating disorder (which typically precedes the substance use disorder) versus 5% of the general population 174. A diagnosis of CHS is confirmed when all symptoms resolve for a long period of time (∼12 months) with the cessation of marijuana 15.
- These changes from hot bathing are probably not specific to CHS but can be seen across all functional nausea and vomiting disorders, including CVS, and are probably aggravated by cannabis use 9.
- This episode is debilitating and overwhelming, with patients vomiting and retching up to five times per hour, requiring several emergency room (E.R.) visits.
- Supportive care with IV fluids and anti-emetics is the mainstay of treatment in the acute phase of illness.
What are the Risk Factors for Cannabinoid Hyperemesis Syndrome?
They may increase their use of cannabis due to their belief in its beneficial effects in nausea relief. Pharmacists have an important role in CHS recognition, education, and symptom management. The purpose of this review is to describe cannabinoid hyperemesis syndrome (CHS), which is thought to be induced by long-term cannabis use, and provide clinical pharmacists with information to manage the hyperemetic phase of CHS. Sometimes, doctors actually recommend cannabis for specific conditions like cancer-related nausea. However, these beneficial effects seem to backfire when use becomes too frequent or too heavy. The active chemicals in cannabis build up in fatty tissues over time, and researchers believe this accumulation can overstimulate receptors, fueling persistent vomiting.
symptoms & signs
Further initiatives are needed to determine this disease prevalence and its other epidemiological characteristics, natural history, and pathophysiology. Additional treatments are needed and efforts to discontinue cannabis abuse are paramount. Cannabigerol (CBG) is a non-psychotropic cannabinoid that behaves as an antagonist at both the CB1 and 5-HT1A receptors 32. This antagonism reverses the anti-emetic actions of low-dose CBD, which likely occurs at the 5-HT1A receptor 33. The pro-emetic properties of CBD (at higher doses) and CBG may play a role in the severe nausea and vomiting observed in patients with Cannabinoid Hyperemesis Syndrome (Figure 2). Although the mechanism of cannabis that leads to intractable nausea and vomiting is still unclear, CHS is well documented in the medical literature.
side effects (often dose-related)
Many CHS patients are long-term marijuana users who object to marijuana discontinuation, even though it provokes symptoms severe enough to require hospitalization. This leads to an important question, especially in light of our gradual societal paradigm shift toward liberalizing marijuana. Certainly marijuana use disorder exists, but it is not clear if it is addictive in the same manner as opioids or alcohol.
Some individuals, for instance, also admitted to smoking 2000 mg of THC per day. The symptoms typically last a few weeks, though the throwing up Drug rehabilitation should ease up in a day or two. One study looking at Reddit posts on the subject found that spicy food, greasy food, coffee, black tea, and alcohol were frequently mentioned as CHS triggers. These foods/beverages are mostly acidic, but relationships between them and CHS have not been studied scientifically, although the co-use of weed and alcohol is well-known, the study authors said.
- Cannabis has become one of the most widely used substances in the world.
- The average length of time between the onset of symptoms and a CHS diagnosis was 6.1 years (range 1–10 years) and patients visited the ED at average of 10 times before diagnosis was made.
“It comes and goes and it happens in cycles,” Deepak Cyril D’Souza, the director of the Yale Center for the Science of Cannabis and Cannabinoids, said to the outlet. If it continued indefinitely, that would “force a person to stop” using cannabis. Along with the discovery of the CB1 and CB2 receptors has been the identification of endogenous arachidonic acid derivatives that bind to these receptors (Figure 1).
drug-drug interactions
In some cases, IV haloperidol or lorazepam (for anxiety) may provide relief for the CHS patient 14, 89. Treatment guidelines published by the San Diego Emergency Medicine Oversight Commission recommend supportive care (rehydration), patient education, and counsel to stop the use of cannabinoids 100. Topical capsaicin can be used to provide symptomatic relief but symptoms typically resolve in a day or two without cannabinoid use regardless of treatment. Benzodiazepines and opioids, although sometimes prescribed, have very limited effectiveness for this condition 100. Several previous studies have described the characteristics of frequent and prolonged hot shower use common among patients with CHS. Patients often adopt this behavior to alleviate nausea, vomiting, and abdominal pain symptoms of CHS, and some reports have referred to this symptom as CHS as “cannabis hot shower syndrome”.
How is CHS diagnosed?
CHS episodes generally last a few days but can persist for up to seven to 10 days. Patients may report that hot water alleviates symptoms, causing some to spend several hours in the shower 11. One doctor reported using injectable lorazepam to help control nausea and vomiting symptoms in an adult.
If you’ve tried to quit weed in the past but found it too difficult, this might be a sign cannabinoid hyperemesis syndrome of a deeper marijuana addiction. In that case, seeking a structured detox or addiction treatment program may be vital for lasting health. Diagnosing CHS might take time because not all medical professionals are familiar with it yet. You might need to share specific details or request a referral to a specialist, like a gastroenterologist, if symptoms persist. But once you and your provider identify CHS, you can start working on an effective plan to stop the cycle of vomiting. Because you still believe marijuana helps nausea, you might use it more often, accidentally making your condition worse.
Early recognition of CHS is essential to prevent complications related to severe volume depletion. The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems. Understanding the pathophysiology of the endocannabinoid system (ECS) remains central in explaining the clinical features and potential drug targets for the treatment of CHS.