Doctors also noticed that individuals with CHS would take frequent hot showers and baths. When people with CHS stop using marijuana, their symptoms of nausea and vomiting usually disappear. Nausea and vomiting tend to return if they start using marijuana again. The first reports came from doctors treating regular users of marijuana for nausea and vomiting in South Australia.
Case reports have demonstrated a remission in CHS symptoms upon cessation of cannabis use for extended periods 6,51–54,57,59–62,68,71. Unfortunately, many of these patients relapse upon resuming cannabis 6,59,61,62. It has been suggested that many of these patients increase or continue their cannabis use because of their perception that it will have beneficial effects on nausea 52.
- With the widespread use of cannabis, both recreationally and therapeutically, the paradoxical effect of CHS deserves further attention.
- Researchers have identified two receptors called CB1 and CB2 to which marijuana molecules attach.
- The patient also reported burning abdominal pain but no diarrhoea or fever.
- Probably, a crucial factor in the genesis of CHS is the composition of cannabis.
Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review
- One theory behind CHS is that chronic overstimulation of the body’s endocannabinoid receptors leads to your body not being able to control nausea and vomiting.
- Conventional antiemetics are not contraindicated but are generally ineffective likely because of the atypical mechanisms behind CHS.
- Most people with CHS who stop using cannabis have relief from symptoms within 10 days.
Doctors have a lack of knowledge of CHS, and this makes it hard to identify people with the condition. Some researchers have published their findings from their personal experience with the condition in clinical journals. As CHS is a newly described condition, many doctors may find it challenging to diagnose and treat.
What are the Risk Factors for Cannabinoid Hyperemesis Syndrome?
“There is evidence that if you send a message to the brain that competes with the message that’s causing the nausea, vomiting, that you can suppress it,” Camilleri said. One possible explanation for this is called “gate control theory,” which postulates that to some extent, the brain can regulate how much pain it perceives. While waiting for answers, she noticed an educational pamphlet on cannabinoid hyperemesis syndrome (CHS), a little-known illness characterized by an onset of intense vomiting. She wondered if her gastric distress might have been caused by the marijuana she regularly and legally smoked at her home in Toronto. Studies show that about 80% of people with CHS recover when they completely stop using marijuana. On the flip side, if you keep consuming cannabis, the syndrome often returns, and the cycle continues.
The cannabinoid hyperemesis syndrome duration of this phase ranges from weeks to months, depending on resuming marijuana use, which may trigger another relapse. Throughout this phase, the patient maintains an average weight and returns to their baseline state 49. A small dataset study showed five mutations with plausible etiological roles in the phenomenology of CHS symptoms and signs.
Cannabinoid hyperemesis syndrome: a rare health complication putting chronic cannabis users at risk
Stopping can be hard for heavy users Halfway house because of withdrawal symptoms such as irritability, poor sleep, and low appetite. Support from a clinician, counselor, or treatment program can make the process easier. Stress-management skills, regular sleep, and non-drug strategies for pain or anxiety reduce relapse risk.
Clinical Diagnosis of CHS
The syndrome is linked to frequent, long-term exposure rather than to a single use. People who start using cannabis at a young age, who use concentrated products, or who increase their intake over time may have higher exposure. Stress, poor sleep, and heavy use during the day are common in patient histories. Some scientists suspect a genetic factor that changes how people respond to THC and other cannabinoids, but no single gene has been confirmed. The prevalence of cannabis use disorder is expected to rise as legal restrictions on its recreational use decrease in several states.
- Typically, patients can only find relief from intense and persistent nausea by taking hot baths or showers.
- Cannabis hyperemesis syndrome (CHS) is a gut–brain axis disorder characterized by recurring nausea and vomiting intensified by excessive cannabis consumption.
- Caution should be made against the overprescription of lorazepam, as it can cause physical and/or psychological dependence especially in CHS patients who are vulnerable to substance abuse.
- A vicious cycle can occur in which CHS patients taking psychiatric medications suffer nausea and vomiting, increase their use of marijuana to manage those symptoms, and exacerbate their mental health condition.
- Seven of the patients abstained from marijuana during this time and had no further episodes; 3 patients resumed their use of marijuana and had further episodes 120.
That early introduction might increase the likelihood of problems appearing in adulthood. Also, frequent use—such as smoking or consuming cannabis products at least once a week—often places individuals at a higher risk compared to more sporadic users. CB-1 receptors are present in the heart, which makes it possible that cannabinoids might affect myocardial performance 150.
Health Products
Many patients are hesitant to consider cannabis as the cause of their symptoms, which can delay diagnosis and hinder further research. Moving forward, physicians should be aware of rising cannabis use and identify potential CHS cases to ensure proper treatment and investigation. Further research, particularly at the microscopic level, is essential to better understand this condition. While several treatments provide symptom relief, it is important to be cautious with certain medications. Narcotic pain medications, for instance, should generally be avoided in CHS patients. Opioids may exacerbate CHS symptoms due to their association with bowel dysfunction, and they could also potentially lead to opioid dependence in chronic users 47.
Living With Cannabinoid Hyperemesis Syndrome
This is probably the reason for its non-inclusion in the Rome IV diagnostic criteria for CHS. There were 5 men and 5 women included, mean age 27 years (range 19–51 years) with symptoms of abdominal pain, nausea, and hyperemesis refractory to medical therapy. The mean delay to the accurate diagnosis of CHS was 15.2 ± 10.5 months with a median of 4 ED admissions (range 0 to 14). All patients had a history of long-term use of cannabis (mean length 42 months, range 15–81.8 months), and 80% found relief in taking hot showers. In this group, 9 patients smoked marijuana for recreation, while the other patient had been prescribed synthetic cannabinoids (nabilone 2 mg twice a day) to treat multiple sclerosis.
And a 2022 Canadian study found that ER visits for CHS-related problems had increased 13-fold between 2014 and 2021. (Recreational use and sale of cannabis in Canada was legalized starting in 2018). It’s not clear what percentage of all heavy marijuana users have experienced CHS. People who use cannabis often should watch for patterns of stomach pain, nausea, and vomiting that come and go.
Low-quality studies are defined as double-downgraded randomized trials or observational studies. Very low-quality studies are defined as triple-downgraded randomized trials or downgraded observational studies or case series/case reports. The two major metabolites found in humans are 11-hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-THC- Δ9-tetrahydrocannabinol (THC-COOH) 20. 11-OH-COOH is a psychotropic metabolite that is equipotent to THC in terms of producing psychic effects and lowering intraocular pressure 25.
