Cannabinoid Hyperemesis Syndrome: Overview, Symptoms, and Outlook

Speak with a doctor or healthcare professional if you or someone you know has symptoms of CHS. CHS symptoms typically present in a cyclical pattern every few weeks to months when cannabis is being used. While I tried pot in my sophomore year of high school, I didn’t develop a real dependency until I was eighteen.

• It manifests through recurrent episodes of severe nausea, vomiting, and abdominal pain.
• The majority of these individuals are less than nineteen years of age 2.
• Analytical observational studies and their characterizations of CHS cases are described in online supplementary materials 35–42.
• The endocannabinoid system is responsible for the mechanisms involving cannabinoid receptors and the hypothalamic-pituitary-adrenal axis 2.
• They stimulate the cannabinoid receptors in various brain regions, including the temporal lobe, orbitofrontal cortex, insula, and parahippocampal areas, to produce their effects 29.
• In addition, she was initially instructed on cannabis cessation and a trial of topical capsaicin for treatment of CHS.

Cannabinoid Hyperemesis Syndrome (CHS): Causes, Symptoms, Treatment

• Both conditions predominantly affect younger individuals, with CHS showing a higher prevalence in males, which aligns with the higher rates of cannabis use among men.
• The CVS has strong links to mitochondrial dysfunction and neurobiological pathways related to migraine, while CHS is primarily influenced by chronic cannabis use and endocannabinoid system dysfunction.
• You’ll likely undergo a physical exam, and your doctor might ask questions like how often you use cannabis, how long you’ve been using, and what patterns you notice about your nausea.
• Researchers say that compounds such as THC can do this because of the cannabinoid receptors CB1 and CB2.

Cannabidiol (CBD) hypermesis syndrome and cannabigerol (CBG) are two additional cannabinoids found in cannabis that appear to modulate the anti-emetic properties of THC. Cannabidiol, in contrast to THC, is non-psychotropic, has a low affinity for CB1 and CB2 receptors 27, and acts as a partial agonist at the 5-HT1A receptor 28. CBD enhances the expression of CB1 receptors in the hypothalamus and amplifies the hypothermic effects caused by THC 29. In animals the effect of CBD on toxin-induced vomiting displays a biphasic response with low doses producing an anti-emetic effect whereas higher doses enhance vomiting 30,31. Those suffering from acute symptoms often present themselves to the emergency room for treatment. Many are reluctant to discuss their cannabis use, so the actual number of CHS cases may be under-reported.

Practice Management

On the other hand, I knew it was going to take all of my willpower to stay clean. By the time I got to the emergency room, it wasn’t just pain, it was all colors coming out of every orifice—green, yellow, blood. drug addiction It was hard to surrender to the fact that I had developed CHS within a few months of marijuana becoming legal in New York state.

Want to Learn More About Cannabinoid Hyperemesis Syndrome?

Visits and extensive recurring serum testing and imaging evaluations with increased healthcare-related costs. It is crucial to exclude other entities such as Addison’s disease, migraines, hyperemesis gravidarum, bulimia, and psychogenic vomiting, which can mimic CHS symptoms and may also occur alongside it. A thorough medical history, complete physical examination, and focused diagnostic testing help differentiate from these other differential conditions. CHS is classified as a type of functional gut–brain disorder and a variant of cyclic vomiting syndrome (CVS) per the Rome IV structured framework.

Hard Seltzers: Trendy Beverage or Hidden Health Risk?

• Many patients are hesitant to consider cannabis as the cause of their symptoms, which can delay diagnosis and hinder further research.
• CB1 receptors are mostly present in the brain, but they also occur in other organs.
• The majority of reported cases that have provided follow-up included a period of less than one year 6,52,54,56–60,62,68,71.
• In animal studies mice lacking CB1 receptors demonstrate enhancement in circadian HPA axis activity peaks and impairment in glucocorticoid feedback 39.

A pregnancy test was negative, and urinalysis showed the presence of ketones and a specific gravity of 1.032 (reference range, 1.002–1.030). Results of an autoimmune hepatitis panel were negative, and other results were within the reference range. Computed tomography of the abdomen with intravenous contrast showed narrowing of the third duodenal segment at the SMA level, a nonspecific finding that can be suggestive of SMA syndrome (Figure 1).

• At this time, the only known way to cure CHS is by quitting cannabis.
• Endocannabinoids play their part in allostasis by promoting recovery from stress and further bring back homeostasis of the neurotransmitters, neurohormones, and neuropeptides 32.
• A recent review has explored numerous potential explanations regarding various pharmacokinetic and pharmacodynamic factors of the cannabinoids 72.
• Fluid resuscitation is therefore a cornerstone of treatment during the hyperemetic phase.
• This isn’t just an academic debate about medical terminology – this is potentially the biggest threat to cannabis legalization since Reefer Madness.
• The effects of cannabis and its interactions on the various organ systems were elucidated further with the discovery of the endocannabinoid system (ECS) 1.

Many individuals either avoid seeking medical help or don’t mention their marijuana use during a doctor’s visit. Since 2004, doctors have identified key symptoms and characteristics of the condition that can help speed up diagnosis. However, researchers have yet to determine the cause of CHS since it does not affect all users of marijuana. The only treatments available to people with CHS are those that restore hydration and help control nausea and vomiting.

Management of CHS Patients

We’ve literally spent more federal money studying penguin mating habits than comprehensive cannabis medical research. In refractory CHS cases, experimental therapies such as benzodiazepines, tricyclic antidepressants, and dopaminergic agents like haloperidol have been explored. While the evidence supporting their efficacy is limited, these options could be considered in specific scenarios where conventional treatments prove inadequate.

Hot baths may relieve the nausea for a while, but they don’t cure CHS. Researchers are currently studying several treatment options to manage the hyperemetic phase of CHS. The only known treatment to permanently get rid of CHS is to stop cannabis use completely. You may have symptoms and side effects of CHS for a few weeks after quitting cannabis.