If the patient quits cannabis consumption, vomiting due to CHS largely subsides. It’s possible that with lower amounts or lower frequency, patients might be able to use cannabis again, but the science is unclear. Typical antiemetics such as ondansetron, commonly known as Zofran, have often been found ineffective at suppressing nausea caused by CHS. There are some drugs that may help, such as amitriptyline, Camilleri said. Experts also aren’t clear on what causes CHS, or why some people develop it while others don’t. Since it was first identified in 2004 in Australia, researchers have looked at the effects of cannabis on the vomiting centers of the brain.
What is Cannabinoid Hyperemesis Syndrome (CHS)?
Other organs where CB1 receptors have been identified are the spleen, heart, liver, uterus, bladder, and vas deferens 10. In the gastrointestinal system, CB2 receptors are expressed by lamina propria plasma cells and activated macrophages, as well as by the myenteric and submucosal plexus ganglia in human ileum 9,12,13. CB2 receptors are likely involved in the inhibition of inflammation, visceral pain, and intestinal motility in the inflamed gut 9,14. Future studies are needed to better understand the etiology, prevalence, and risk factors for developing CHS (eg, understanding medical, psychiatric, ethnic, or socioeconomic conditions as well as amount and potency of cannabis). Randomized controlled clinical trials are needed to identify the optimal pharmacotherapy for managing CHS. 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.
- 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).
- The patient reported that he got the rash from prolonged exposure to hot water in showers that he took to relieve the symptoms of his CHS 143.
- Recognizing the risks of developing CHS can empower marijuana users to take preventative actions, such as reducing or ceasing their marijuana use if they experience any signs of the condition.
- The cannabis plant contains over four hundred different chemicals, with sixty possessing cannabinoid structures 76.
Clinical Features, Diagnosis and Treatment
There is moderate evidence to support that the definitive treatment for CHS is cannabis cessation. In this study, 96.8% of patients who ceased cannabis use experienced complete resolution of symptoms. In Colorado, rates of CHS have doubled since 2009, when cannabis was legalized there.3 However, it is important to note that CHS often goes unrecognized by clinicians, which may lead to an extensive and costly patient workup.
1. Prodromal Phase
There may also be a genetic susceptibility at work, and depression and anxiety are common in people with the syndrome. “The paradox is, we don’t understand what’s triggering this in a particular moment,” says David Levinthal, director of the Neurogastroenterology and Motility Center at the University of Pittsburgh Medical Center. Among the leading suspects, he says, are lack of sleep and intense stress. One theory about the cause of CHS involves the hypothalamic-pituitary-adrenal (HPA) axis, which regulates Sober living house the body’s stress responses by adjusting hormone balances.
Cannabinoid Hyperemesis Syndrome: Symptoms, Causes, and Treatment
With the large prevalence of marijuana use in the world, why does it appear that so few patients develop CHS? Certain individuals may have a genetic polymorphisms in the cytochrome P450 enzymes responsible for the metabolism of the cannabinoids 62,72. This could result in excessive levels of pro-emetic cannabinoids or emetogenic metabolites.
Assessment of Study Quality
- Despite the well-established anti-emetic properties of marijuana, there is increasing evidence of its paradoxical effects on the gastrointestinal tract and CNS.
- CHS causes you to have repeated episodes of vomiting, severe nausea, stomach pain, and dehydration.
- Coverage typically depends on the plan, but treatments such as hospital visits, IV fluids, anti-nausea medications, and therapy for cannabis use disorder are often included.
Right now, the only known effective treatment for CHS is to stop cannabinoid hyperemesis syndrome using cannabis. The literature contains a wealth of case studies and case reports on patients suffering from CHS; these case reports come from around the world but have striking similarities. The mechanism of action of topical capsaicin likely involves TRPV1 receptors.
Cannabinoid hyperemesis syndrome: a rare health complication putting chronic cannabis users at risk
- “The paradox is, we don’t understand what’s triggering this in a particular moment,” says David Levinthal, director of the Neurogastroenterology and Motility Center at the University of Pittsburgh Medical Center.
- CB-1 receptors are present in the heart, which makes it possible that cannabinoids might affect myocardial performance 150.
- In a healthy individual, the stress response results in the release of corticotrophin-releasing hormone from the hypothalamus into the capillaries and going to the pituitary gland.
- As of 2022, that average is about 16 percent; the oil in vape cartridges like what Callaham was using can reach as high as 85 percent.
- In a retrospective review of CHS patients admitted to a single urban ED in France, 7 patients were identified with a mean age of 24.7 years (range 17–39 years); most were men.
Many people turn to more cannabis to help with the nausea, which can make symptoms worse. Modern companies have “turned out inconspicuous vape pens, fast-acting edibles and pre-rolled joints infused with potency enhancers and concentrates” that contain as much as 99% THC. With these new products, hospitals saw influxes of CHS, and researchers called for more public health guidance and education for providers. These treatments focus on stopping cannabis use and supporting overall recovery. Although these phases describe the typical progression, each individual’s experience with CHS may vary. By exploring the effects of cannabinoids on the GI system, we can gain a deeper understanding of how CHS develops and identify potential avenues for treatment and prevention.