However, many experts consider these treatments to be ineffective for managing nausea and vomiting in people with CHS. Doctors also noticed that individuals with CHS would take frequent hot showers and baths. When people with CHS stop using marijuana, their symptoms of nausea and vomiting usually disappear.
Cannabis Cessation
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. And a 2022 Canadian study found that ER visits for CHS-related problems had increased 13-fold between 2014 and 2021. (Recreational use and sale of cannabis in Canada was legalized starting in 2018). It’s not clear what percentage of all heavy marijuana users have experienced CHS.
What is the treatment for cannabinoid hyperemesis treatment?
These chemicals can change the time it takes your stomach to empty food. As the laws regarding the possession and use of marijuana change, CHS may become more prevalent because more people will have legal access to the drug. Doctors have a lack of knowledge of CHS, and this makes it hard to identify people with the condition. As people with CHS often only consult their doctors during the hyperemesis stage, there is a lack of knowledge regarding the treatment of people during the prodromal stage.
- “Cannabinoid” refers to cannabis (marijuana) and “hyperemesis” is a word meaning “prolonged vomiting.”
- After you quit, you may still have symptoms and side effects for a few days to a few weeks.
- This evolution has been accompanied by a concerning uptick in cases of Cannabinoid Hyperemesis Syndrome (CHS), characterized by distressing bouts of nausea and vomiting with varying degrees of severity.
- Pharmacists have an important role in CHS recognition, education, and symptom management.
The Three Stages of CHS
Nausea and vomiting tend to return if they start using marijuana again. Richards and Dutzak [34] presented a single case study that examined an extreme case of CHS in the ER who had intractable N/V, abdominal discomfort and who was unresponsive to standard antiemetics. One milligram followed by 1 mg IV injections of propranolol 1 h apart led to rapid termination of N/V and complete resolution of hyperemesis after the second injection [34]. It should be noted there was limited evidence for propranolol use as it was the only case study we found involving a single patient [34]. When you do this, your symptoms usually start to go away in few days to a few months.
- Incorporating cognitive-behavioral therapies encompassing stress management techniques, relaxation exercises, and coping strategies can complement pharmacological interventions in addressing the cyclical nature of CHS and assisting patients in navigating the emotional toll of their symptoms.
- Although the exact mechanism of action for cannabinoids are yet to be determined, there are 3 main hypotheses regarding CHS gastrointestinal cannabinoid receptors 1 (CB1), overriding cannabinoid lipid buildup and genetic polymorphisms in the P450 system.
- Indeed, the symptoms of pesticide poisoning are different than the symptoms of CHS.
- While synthetic cannabinoids have been accepted as one of the main drugs to relieve N/V, their dosage and duration of administration have not been thoroughly investigated long term.
- CHS, cannabis hyperemesis syndrome; CB1, cannabinoid receptors 1; CTZ, chemoreceptor trigger zone; THC, tetrahydrocannabinol.
- In clinical practice CHS is most often confused with cyclic vomiting syndrome (CVS).
This characteristic partially explains its prolonged elimination half-life. A large reservoir of stored THC in fat tissue may produce a “reintoxication effect” secondary to increased lipolysis during times of increased stress or food deprivation [23]. These characteristics of THC may have implications in Cannabinoid Hyperemesis Syndrome as these patients are chronic users of cannabis who likely have large lipid stores making them susceptible to increased cannabinoid levels in the plasma during times of stress. This article will discuss the seemingly contradictory effects of cannabinoids on nausea and vomiting, and the prevailing theories about CHS’ mechanisms. A case study which examined clonazepam in treatment-resistant individuals with CHS revealed that 2 doses of 0.5 mg of clonazepam led to rapid cessation of adverse symptoms, complete symptomatic relief and discharge within 24 h after administration [29]. It should be noted that the evidence for benzodiazepine use in CHS is limited, as there was only 1 case study reported with only 4 patients who experienced N/V relief after administration of benzodiazepines [29].
When you use weed, these compounds bind to cannabinoid receptors found in your brain, digestive tract (gut), and certain cells in your body. Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main cannabinoids in marijuana products. THC is what’s responsible for the “high” most people feel when they use marijuana. One study found that 32.9% of self-reported frequent marijuana users who came to an emergency department for care met the criteria for CHS.
Help quitting cannabis
Cannabidiol (CBD) 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 cannabinoid hyperemesis syndrome vomiting displays a biphasic response with low doses producing an anti-emetic effect whereas higher doses enhance vomiting [30,31]. Literature published between January 2004 and September 2012 was searched in PubMed using the terms “cannabinoid hyperemesis syndrome” and “cannabis hyperemesis syndrome”. One theory behind CHS is that chronic overstimulation of the body’s endocannabinoid receptors leads to your body not being able to control nausea and vomiting.
Etiology of CHS
- Cannabinoid Hyperemesis Syndrome is a new and under recognized clinical entity.
- With the emergence of cannabis and its widespread usage in various settings, clinicians and users should be more aware of the long-term effects of cannabinoids.
- Propranolol has also shown relief in N/V for individuals with severe recurrent CHS [34].
- If you have symptoms, your doctor will do a physical exam and ask for your detailed medical history.
Experts think that when you first smoke weed, your brain signals are more important, but after repeated use of the drug, the brain receptors may no longer respond to marijuana in the same way, causing more nausea and vomiting. When you use marijuana for many years, it can start to slowly change how the receptors in your body respond to the cannabinoid chemicals. For example, the drug affects the receptors in the esophageal sphincter, the tight band of muscle that opens and closes to let food go from your throat to your stomach.
