Cannabinoid Hyperemesis Syndrome: A Review of Potential Mechanisms PMC

The retrospective cohort conducted by Yusuf et al. [25] had a moderate bias in selecting patients in the ED, as there was selective reporting of patient outcomes, as only the LOS in the ED was measured. CHS, cannabis hyperemesis syndrome; CB1, cannabinoid receptors 1; CTZ, chemoreceptor trigger zone; THC, tetrahydrocannabinol. While marijuana seems to bring on nausea in the stomach, in the brain it usually has opposite effect. When cannabinoids bind with brain receptors, they tend to prevent nausea and vomiting.

Cannabinoid Hyperemesis Syndrome (CHS) and Cyclic Vomiting Syndrome (CVS)

This suggests that high doses of THC can lead to low levels of endocannabinoids within the hypothalamus, which may prevent inhibitory control of the HPA axis. More research is still needed to understand the impact of cannabinoids on hypothalamic endocannabinoid and endocannabinoid-related enzymes. It is unclear, however, if this was due to an increase in cannabis use or an increase in cannabis use reporting due to the increased acceptance and legalization of cannabis. Schreck et al.62 determined that the rate of reporting in France is similar to that reported in international literature.

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• The symptoms of CHS include severe nausea, repeated vomiting, and stomach pain.
• The only known treatment to permanently get rid of CHS is to stop cannabis use completely.
• People often remain misdiagnosed for years, which delays treatment.
• Conditions can overlap or mask CHS including cyclic vomiting syndrome, eating disorders, or drug-seeking behavior [44].

At low doses, the effect of cannabis on your brain can have an antiemetic effect that suppresses nausea and vomiting. However, with repeated use in some people, it can have the opposite effect on the digestive tract. This results in the persistent vomiting and nausea characteristic of CHS. If you are experiencing severe vomiting or other concerning symptoms, contact your health care provider.

How can I find support groups, and how can I support others dealing with CHS as well?

Treatment that helps prevent dehydration and loss of electrolytes can help reduce your risk of many of these problems. It should be noted that the majority of evidence found for haloperidol were case studies, which had limited generalizability [30, 31, 33]. However, the RCT by Ruberto et al. [32] was found to have low overall bias, as there was appropriate cohort randomization, allocation concealment, and cannabinoid hyperemesis syndrome blinding of participants and outcome assessors without selective reporting of haloperidol used for CHS. A systematic review was conducted using PubMed, Ovid MEDLINE, Cochrane Central, EMBASE, and Google Scholar. Databases were used to search for articles on CHS published from January 2009 to June 2021, yielding 225 results of which 17 were deemed relevant and underwent review by 2 separate reviewers.

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

• One possible treatment option involves the use of benzodiazepines, such as lorazepam, to control nausea and vomiting.
• The use of lorazepam for CHS is also off-label, so a person’s doctor would need to make them aware of this fact.
• Researchers are currently studying several treatment options to manage the hyperemetic phase of CHS.
• As CHS is a new diagnosis, the manufacturers of these drugs did not design them for treating CHS, but a doctor may opt to prescribe them for this use.

The duration of cannabis administration ranged between 6 months to 11 years may precipitate symptoms of CHS. The Rome IV diagnostic criteria of CHS require cannabinoid use and persistence of N/V symptoms for at least the past 6 months. Cannabis cessation is noted to be the most successful management, but other treatments also demonstrated symptom relief; these include hot water hydrotherapy, topical capsaicin cream, haloperidol, droperidol, benzodiazepines, propranolol, and aprepitant administration. Cannabinoid Hyperemesis Syndrome, a very rare condition, often results from the chronic and heavy use of marijuana. The symptoms of CHS can be severe and include nausea, vomiting, and abdominal pain. A major sign of CHS includes cyclical episodes of nausea and vomiting.

Call your healthcare provider if you have had severe vomiting for a day or more. First, doctors treating people with CHS advise them to stop using marijuana. During the hyperemesis stage, doctors focus on preventing dehydration and stopping the symptoms of nausea and vomiting.

Can I still take edibles? What about CBD?

• Randomized controlled clinical trials are needed to identify the optimal pharmacotherapy for managing CHS.
• They also experience episodes of vomiting that return every few weeks or months.
• Neither edibles nor CBD are safe options for those with CHS, as the syndrome relates to cannabinoids as a whole, not just THC.
• Capsaicin, the active compound in chili peppers, acts on TRPV1 receptors, potentially modulating gastrointestinal sensory pathways and altering intestinal blood flow to provide relief from nausea and vomiting.

These usually happen for 3 to 4 days but can last as long as 1 week in bad cases. Patients with CVS also have times where they are feeling sick to the stomach and can also throw up for between 12 hours to about a week. This can happen when you are stressed, excited, have an infection or when women have their period.

Trying to moderate cannabis use comes with a very high likelihood of CHS returning. Tylenol (acetaminophen) for abdominal pain according to the package instructions. Do not exceed the recommended dose on the package – the “therapeutic dose” and “toxic dose” of Tylenol are very close to each other. Avoid ibuprofen (Advil), naproxen (Aleve) and other NSAIDs, as they are notoriously hard on your stomach even when healthy.

Practice Management

In older patients, especially those with hypertension, cardiovascular illnesses such as aortic pathology and atypical coronary artery syndromes may present as vague abdominal pain, nausea, and vomiting. To help you transition to the recovery phase, you can try a few home remedies such as regular hot baths. But too many of them may increase your risk for dehydration due to sweating. One 2018 study found that 32.9% of self-reported frequent marijuana users who’d gone to the emergency room (ER) had symptoms of CHS.

You may have symptoms and side effects of CHS for a few weeks after quitting cannabis. We’re trying to keep r/CHSinfo focused on CHS, including diagnosis, treatment, causes and support. Moderating cannabis use is such a complex topic, that it’s beyond the scope of this forum. Quitting cannabis use is the 100% cure for CHS – but it is such a complex topic, that it’s beyond the scope of this forum. Neither edibles nor CBD are safe options for those with CHS, as the syndrome relates to cannabinoids as a whole, not just THC. Most of his previous admissions were attributed to viral gastroenteritis due to the self-limited nature of the symptoms.