Cannabinoid Hyperemesis Syndrome and Its Treatment

Cannabis hyperemesis syndrome (CHS) is a rising illness in America. Its use can be directly correlated with the rise in availability of cannabis in the marketplace. As legalization of cannabis continues to spread, we can expect to see more of this condition, which, although not fatal, can have negative impacts on society and resources.

The cause of this syndrome is over-consumption of cannabis. It affects heavy cannabis users who have a month’s or year’s-long track record of regular cannabis consumption. The exact way in which cannabinoids cause the syndrome is unknown. However, some researchers believe it to be caused by cannabinoid-receptor burnout, which they theorize results from over stimulation of the receptors.

CHS is characterized principally by two symptoms: intense and persistent nausea and vomiting (N/V). The vomiting is so severe that some sufferers may vomit up to five times per hour. Other symptoms may include scattered or precise abdominal pain, diarrhea, and weight loss when other symptoms persist.

Treating CHS is not difficult-complete cessation of any ingestion or inhalation of cannabinoids eventually relieves the nausea and vomiting. However, symptoms may still persist long after stopping cannabis consumption. Fortunately, there are ways to alleviate these symptoms.

A handful of treatments were analyzed by a group of researchers to determine their effectiveness. They were hot water hydrotherapy, topical capsaicin, droperidol (a tranquilizer and anti-nausea medication), benzodiazapenes, haloperidol, propranolol (a beta-blocker), and aprepritant (an anti-nausea medication). Researchers pulled these treatment cases from research literature. [1]

What they found is that each of the treatments had some level of effectiveness under the right circumstances, even when dealing with severe cases of CHS. In particular, haloperidol, an anti-psychotic, was shown to be effective against severe resistant CHS, causing rapid cessation of N/V and abdominal pain symptoms.

These researchers postulated three main hypotheses regarding why CHS occurs: (1) gastrointestinal cannabinoid receptors reduce “gastric emptying” causing N/V; (2) during stress, fat is broken down, and if there are high amounts of THC stored in that fat, this THC is released into the body causing the symptoms; and (3) genetic polymorphisms or variations in P450 metabolic enzymes. The thought there is that changes in the metabolic rate of the enzyme in breaking down THC causes increased sensitivity.

The takeaway is that there’s a need for healthcare professionals, business people, and consumers to understand more about what CHS is. More cannabis is being consumed as time goes on, and health issues, such as CHS, are making appearances in hospitals and clinics around the country. One study reported that, out of 155 surveyed cannabis users, one-third experienced CHS symptoms. [2]

It’s especially important for the consumer to understand CHS, so as not to make mistakes treating it. What commonly occurs when regular cannabis users experience symptoms is they treat the symptoms with cannabis. It is not until they understand what CHS is that they realize over consumption of cannabis is the cause of their problems.

 

Reference

[1] Senderovich H, Patel P, Jimenez Lopez B, Waicus S. A systematic review on cannabis hyperemesis syndrome and its management options [published online ahead of print, 2021 Nov 1]. Med Princ Pract. 2021;10.1159/000520417. [journal impact factor = 1.927; times cited = 0]

 

[2] Habboushe J, Rubin A, Liu H, Hoffman RS. The prevalence of cannabinoid hyperemesis syndrome among regular marijuana smokers in an urban public hospital. Basic Clin Pharmacol Toxicol. 2018;122(6):660-662. [journal impact factor = 4.08; times cited = 36]

 

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