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The recent 2024 American Gastroenterology Association (AGA) clinical practice update recommended combining evidence-based psychosocial interventions and pharmacological treatments for the successful long-term management of CHS 63. In patients with CHS, elevated urinary concentrations of the cannabis metabolite carboxy-THC (THC-COOH) exceeding 100 ng/mL are indicative of significant chronic cannabis exposure. They may also prescribe antipsychotic medications such as haloperidol (Haldol) or olanzapine heroin addiction (Zyprexa) to help you calm down as you switch to the recovery phase. The only way to end CHS symptoms is to completely stop using all marijuana products. After you quit, you may still have symptoms and side effects for a few days to a few weeks.
Cannabinoid Hyperemesis Syndrome: A Case Report and Discussion Regarding Patients with Concurrent Disorders
Research suggests that CB1 receptors regulate the effects of marijuana on the gastrointestinal tract. On the basis that only a small number of regular and long term users of marijuana develop CHS, some researchers suggest that genetics might play a role. Other researchers theorize that the effects of marijuana can change with chronic use. With the consumption of marijuana increasing due to the legalization of its recreational use in many states, doctors may receive more reports of side effects from marijuana use. They also experience episodes of vomiting that return every few weeks or months. The only proven way to prevent cannabis hyperemesis syndrome is to avoid cannabis (marijuana).
When to Seek Emergency Medical Help
The only way to stop CHS and its symptoms is to completely quit using cannabis. Most people who quit using cannabis experience no more CHS symptoms within 10 days, but sometimes it may take weeks or months for symptoms to stop. Symptoms of CHS likely won’t return if you’ve completely stopped using cannabis. The mechanism of action of topical capsaicin likely involves TRPV1 receptors.
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However, cannabinoid receptor activation results in adverse psychoactive effects (including depression and suicidal thoughts), which is concerning for them in clinical use 104. With more research, the complexity of allostery can be elucidated, which will be beneficial in the development of safe and efficacious drugs with no neuropsychiatric side effects. In hospitalized patients with CHS during the hyperemesis phase, a “nothing by mouth” regimen and IV hydration are typically employed until symptoms improve. As recovery progresses, patients are initially given clear liquids and gradually advance to a regular diet as tolerated.
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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Researchers are still trying to figure out exactly what causes CHS in some people who regularly use cannabis but not others. This article will explain the causes of CHS and the available treatment options. The patient provided verbal informed consent for the publication of this case report.
- Haloperidol is a familiar but unconventional antiemetic that may benefit CHS patients, likely because it blocks the brain’s postsynaptic dopamine receptors 111, 112.
- Haloperidol is a D2 receptor antagonist that acts within the mesolimbic and mesocortical pathways.
- They stimulate the cannabinoid receptors in various brain regions, including the temporal lobe, orbitofrontal cortex, insula, and parahippocampal areas, to produce their effects 29.
- Some CHS patients have attempted substitution with cannabidiol (CBD) products but with no success.
- They are in the cerebral cortex, anterior cingulate gyrus, hippocampus, cerebellum, and basal ganglia.
That’s because hot water can help ease cannabinoid hyperemesis syndrome symptoms like nausea. The hot temperature affects a part of the brain called the hypothalamus, which regulates temperature and throwing up. Cannabinoid hyperemesis syndrome (CHS) happens when you have cycles of nausea, vomiting and abdominal pain after using cannabis (marijuana) for a long time. People with CHS often find temporary relief from these symptoms by taking hot baths and showers. Based on published case reports of CHS, lorazepam could be considered as an agent of choice in the management of the acute hyperemetic phase of CHS to relieve symptoms of nausea and vomiting (Table 1). The role of lorazepam and its optimal dosing requires further clinical evaluation.
- These vomiting bouts feel relentless and severe, and over-the-counter medications rarely help.
- It’s worth noting that you don’t always need that full 19-year timeline, as some people can develop CHS sooner, especially if they’re using especially potent cannabis or consuming it in large amounts.
- As cannabis becomes more potent and widely available, CHS is increasingly prevalent.
- Cessation of cannabinoid use will lead to complete resolution of symptoms.
- With the widespread use of cannabis, both recreationally and therapeutically, the paradoxical effect of CHS deserves further attention.
Studies indicate that when patients trust their physicians, they are more likely to disclose sensitive health-related behaviors and adhere to medical recommendations 107. This trust also encourages patients to accept a CHS diagnosis, preventing them from seeking unnecessary medical consultations and receiving inappropriate treatments. Discontinuation of cannabis use in any form is required for complete long-term management of CHS.
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People in the hyperemetic phase can take up to 12 hot showers or baths during the day to relieve symptoms. The hot temperatures may provide some relief as they affect your hypothalamus, the part of your brain that regulates both vomiting and your internal body temperature. While clinical features such as chronic cannabis use, intractable vomiting, and relief with hot baths are commonly reported, these are not pathognomonic. The development of a validated CHS diagnostic tool, potentially incorporating biomarkers like cannabinoid metabolites or genetic polymorphisms, could revolutionize early detection and management. Although laboratory examinations and advanced imaging studies (e.g., CT scans, ultrasounds) are often negative, they play a crucial role in ruling out other conditions. The lack of significant diagnostic findings in CHS patients underscores the importance of a thorough patient history and clinical suspicion.
CB2 receptors are likely involved in the inhibition of inflammation, visceral pain, and intestinal motility in the inflamed gut 9,14. If the endocannabinoid system gets disrupted by excessive use of cannabinoids, the stimulation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system may occur. Stress is regulated and controlled partially by the endocannabinoid system, and the HPA axis is the main neuroendocrine system activated by the stress response and therefore cannabinoids 30. The HPA axis and sympathetic nervous system must balance their roles to mediate the stress.
As research progresses, careful consideration will be needed to balance therapeutic benefits with the potential for harmful side effects, particularly for vulnerable populations. The modulation of CB1 receptors holds promise but also necessitates further investigation to ensure the safety and well-being of patients undergoing such treatments 44-46. The only treatment identified to fully resolve the symptoms of CHS is cannabis cessation. In contrast, patients who continued using cannabis experienced persistent symptoms. Furthermore, in cases where patients resumed cannabis use after a period of amphetamine addiction treatment abstinence, the same symptoms reemerged 5. This highlights the importance of cannabis cessation in managing CHS, though it is crucial to emphasize that while this intervention resolves symptoms, there is currently no definitive “cure” for CHS; treatment focuses on symptom management.
Patients present with recurrent episodes of nausea, vomiting, and dehydration with frequent visits to the emergency department. In nearly all cases there is a delay of several years in the onset of symptoms preceded by chronic marijuana abuse 6. 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.
There exists no epidemiological data regarding the incidence and prevalence of CHS among chronic marijuana users. The syndrome is likely underreported given its recent recognition 74,75. 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.
Despite negative workups, physicians must consider CHS when standard treatments fail and patients continue to present with persistent symptoms related to cannabis use. Ironically, one of the potential complications of long-term cannabis use is a condition called cannabis hyperemesis syndrome (CHS). CHS patients present to the emergency department (E.D.) during the hyperemesis phase.