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]. Patient education should therefore be provided with emphasis on the paradoxical nature of the symptoms of CHS. Furthermore, some authors have reported referring patients to drug rehabilitation programs in an attempt to raise the likelihood of long-term cannabis cessation [54,71]. Studies have demonstrated the efficacy of outpatient treatment options such as cognitive behavioral therapy and motivational enhancement therapy for marijuana dependence [73]. A recent, published in 2016, case report describes the first use in the literature of propranolol to treat CHS [117].
Clinical Features, Diagnosis and Treatment
This information is not published but raises questions regarding the role of an unidentified molecule, whether cannabinoid or non-cannabinoid (e.g., a pesticide) may precipitate of the syndrome. In practice, clinicians may have evolved treatment algorithms for managing CHS patients, but our search did not identify any studies reporting this. Oncology patients may be advised to use cannabinoids to relieve chemotherapy-induced nausea and vomiting, only to develop CHS over time.
- The patient also had received 2 esophagogastroduodenoscopies (EGDs), one 2 years prior and the other 5 years prior.
- 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).
- This leads to an important question, especially in light of our gradual societal paradigm shift toward liberalizing marijuana.
- Contact your health care provider if you suspect you might have CHS or for information on treatment options for cannabis use disorder.
- Most of the evidence on effective treatment and management comes from published case reports.
Pharmacology of Cannabinoids
The amount of cannabis consumed was categorized as either less than daily, daily, weekly, less than weekly, or dose not specified. A case series from Spain from 2012 to 2016 involved 6 patients (5 men) with an average age of 28.3 years who, on average, began to use marijuana at age 16. In this series, the mean amount of cannabis smoked per day was 7.5 cigarettes (range 1–12) for at least 1 year prior to the first episode of vomiting. The average cannabinoid hyperemesis syndrome 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. All patients found relief in hot showers and all were described as “uncooperative” with a CHS diagnosis. Upon being hospitalized, 100% of patients had complete resolution of all symptoms an average of 3.6 days after discontinuation of marijuana (range 2–5 days).
Skin Conditions
Or they might think it’s something else, since repeated throwing up is a sign of many health problems. You may need to see a gastroenterologist, a doctor who specializes in the digestive tract, for a proper diagnosis. In the brain, the cannabinoid system helps regulate several aspects of the endocrine system. CB1 receptor activation in the hypothalamus and pituitary gland results in modulation of all hypothalamic-pituitary axes [38].
How to Recognize the Signs of Cannabis Use Disorder
In one study the average duration of cannabis use prior to onset of recurrent vomiting was 16.3 ± 3.4 years [62]. There are at least four reported cases where the time lag was equal to or less than three years [54,59,60]. Daily marijuana use is characteristic and often reported as exceeding three to five times per day. On the second visit, CHS was diagnosed and the patients were treated with capsaicin cream 0.025% applied in a layer approximately 1 mm thick on the abdomen. In both cases, topical capsaicin provided symptomatic relief in about 30 min. Both patients reported a burning sensation where the capsaicin was applied but were satisfied with the results [97].
The serum levels of psychiatric drugs may be reduced in patients suffering from CHS or other vomiting syndrome. 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. For patients on psychiatric pharmacological https://ecosoberhouse.com/ regimens, CHS can have a destabilizing effect on the patient [126]. Furthermore, the distressing and relentless symptoms of CHS can worsen the patient’s mental health as well. A description of a patient with CHS in Australia revealed that her CHS symptoms exacerbated her anxiety disorder, and she presented to the ED with anxiety plus vomiting [127].
Cyclic Vomiting Syndrome (CVS)
- Some important questions for patients to better and more rapidly diagnose CHS are shown in Table Table11.
- When combined with the fact that people may not reveal they use cannabis, getting the right diagnosis can take years.
- In the brain, the cannabinoid system helps regulate several aspects of the endocrine system.
- Three out of 4 patients resumed marijuana use and presented at the hospital again.
- These studies exemplify the diagnostic difficulty in the identification of CHS and suggest that CHS may be more common than is reported.
The endocannabinoids are present in both the central nervous system [8] and enteric nervous system [15]. Anandamide and 2-AG are released locally on demand by neurons, are present in small quantities, and undergo rapid inactivation [8]. Endocannabinoids are thought to act as either neuromodulators or neurotransmitters [11]. Anandamide and 2-AG possess similar biochemical structures, but each has a distinct pathway for biosynthesis and degradation.
Cannabinoid Hyperemesis Syndrome (CHS): Causes, Symptoms, Treatment
Incidence and Prevalence
