Some individuals, for instance, also admitted to smoking 2000 mg of THC per day. The best and only way to prevent or reduce your risk for CHS is to avoid or quit marijuana use. This word is a combination of “screaming” and “vomiting.” You’re in so much pain that you’re screaming while you’re vomiting. It tends to affect people who use cannabis at least once a week and happens more often in adults who’ve been using cannabis since their adolescent years.
How common is CHS, and is the number of patients with it climbing?
- In this context a comprehensive history along with initial screening tests should be performed to exclude acute conditions and emergencies (e.g pancreatobiliary disease, intestinal obstruction, pregnancy, etc).
- Symptoms of CHS likely won’t return if you’ve completely stopped using cannabis.
- Researchers are still trying to figure out exactly what causes CHS in some people who regularly use cannabis but not others.
- Additional pharmacological research is needed regarding the pro-emetic effects of additional cannabinoids and their metabolites.
- Many people experience temporary relief from their nausea and vomiting when bathing in hot water.
A novel pilot randomized controlled trial by Dean et al. 88 showed that topical 0.1% capsaicin reduced nausea from the baseline by 46% at 60 min, compared to 24.9% in the placebo topical cream group. Additionally, capsaicin’s anti-emetic effect was more effective at 60 min than 30 min after the first application 88. Significant improvements in nausea and vomiting, as well as shorter length of hospital stay, were noted in patients treated with 0.075% topical capsaicin applied to the abdominal region 62. cannabinoid hyperemesis syndrome 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.
What other marijuana-related problems are emergency departments seeing these days?
- Cannabinoids are compounds in the Cannabis sativa plant that bind to cannabinoid receptors in your brain, spinal cord, gastrointestinal tract and other body tissues.
- However, questions remain about the dosage of cannabis, individual and genetic susceptibility, abstinence period and the inclusion of abdominal pain as a criterion.
- Doctors have a lack of knowledge of CHS, and this makes it hard to identify people with the condition.
- While these are all just theories, they make sense with what we know about cannabis and its impact on the human body.
Studies suggest that CHS may involve disruption at the hippocampal–hypothalamic–pituitary level 22. Chronic cannabis use can lower pituitary hormone levels, including the growth hormone, follicle-stimulating hormone, and luteinizing hormone, which has been shown to normalize after stopping use 23,24. The symptoms typically last a few weeks, though the throwing up should ease up in a day or two. One study looking at Reddit posts on the subject found that spicy food, greasy food, coffee, black tea, and alcohol were frequently mentioned as CHS triggers. These foods/beverages are mostly acidic, but relationships between them and CHS have not been studied scientifically, although the co-use of weed and alcohol is well-known, the study authors said. Researchers aren’t sure exactly why weed causes CHS symptoms only in some people.
ECS and CHS
Currently, doctors do not have treatment guidelines for the management of CHS. Most of the evidence on effective treatment and management comes from published case reports. Some researchers have published their https://ecosoberhouse.com/ findings from their personal experience with the condition in clinical journals.
- The endocannabinoids are present in both the central nervous system 8 and enteric nervous system 15.
- These genes are COMT, transient receptor potential vanilloid receptor 1 (TRPV1), CYP2C9, the gene coding for the dopamine-2 receptor (DRD2), and the ATP-binding cassette transporter gene (ABCA1).
- Soon Facebook groups dedicated to CHS started to appear as well, with thousands of people who claimed they had these same symptoms.
- Some may be finding that there can be very real — and serious — complications that come with cannabis use.
- A small dataset study showed five mutations with plausible etiological roles in the phenomenology of CHS symptoms and signs.
- A novel pilot randomized controlled trial by Dean et al. 88 showed that topical 0.1% capsaicin reduced nausea from the baseline by 46% at 60 min, compared to 24.9% in the placebo topical cream group.
Clinical Presentation, work up and differential diagnosis of Cannabinoid Hyperemesis Syndrome
Table 2 summarizes some of the epidemiological and clinical characteristics that may help distinguish CVS and CHS. A thorough history, physical examination and directed testing of differential diagnoses may assist in ruling out these diagnoses. The Rome IV criteria provide some objectivity to help with the diagnosis by placing CHS under the heading of functional gut-brain disorders, and consider it as a variant of CVS (Table 2). Venkatesan et al have proposed a new criterion for CHS with the use of clinical features, cannabis use patterns including duration and frequency, and symptoms resolution after at least 6 months of cessation 48. However, questions remain about the dosage of cannabis, individual and genetic susceptibility, abstinence period and the inclusion of abdominal pain as a criterion. The clinical effects of volume depletion dominate complications related to CHS.
Medical
CHS symptoms typically present in a cyclical pattern every few weeks to months when cannabis is being used. One study found up to 6% of people who went to the emergency room for cyclical vomiting had CHS. In the brain, the cannabinoid system helps regulate several aspects of the endocrine system. CB1 receptor activation in the hypothalamus and pituitary gland results in modulation of all hypothalamic-pituitary axes 38. Receptor activation leads to inhibitory effects on the release of growth hormone, thyroid hormone, prolactin, and luteinizing hormone 38. In animal studies mice lacking CB1 receptors demonstrate enhancement in circadian HPA axis activity peaks and impairment in glucocorticoid feedback 39.
Cannabis hyperemesis syndrome (CHS) is a form of functional gut-brain axis disorder characterized by bouts of episodic nausea and vomiting worsened by cannabis intake. It is considered as a variant of cyclical vomiting Alcoholics Anonymous syndrome seen in cannabis users especially characterized by compulsive hot bathing/showers to relieve the symptoms. CHS was reported for the first time in 2004, and since then, an increasing number of cases have been reported. With cannabis use increasing throughout the world as the threshold for legalization becomes lower, its user numbers are expected to rise over time. Despite this trend, a strict criterion for the diagnosis of CHS is lacking. Early recognition of CHS is essential to prevent complications related to severe volume depletion.