But why is CHS an episodic condition with sometimes very long asymptomatic periods between attacks? Another puzzling question is why CHS symptoms in many patients resolve completely in a very short period of time − even hours − when marijuana use is discontinued. Acute treatment of CHS is supportive care and patient education; the only effective long-term approach to CHS is marijuana cessation. In fact, the authors know of no reports in the literature of a CHS patient who continued to experience symptoms after marijuana was discontinued. In a retrospective case series from the UK, 10 CHS patients were followed for a median of 9.5 months (range 1–20 months) following counseling to stop using marijuana to avoid symptoms.
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Cannabinoid hyperemesis syndrome, also known as CHS, can arise in response to long-term cannabis use. The syndrome consists of vomiting, nausea and abdominal pain, which can often be alleviated by taking hot showers. Five months later, as Denney pored over a coroner’s report for answers, she finally accepted that marijuana played a pivotal role in her son’s death. The autopsy report, which Denney received in March, attributed her son’s death to dehydration due to cannabinoid hyperemesis syndrome. 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.
- The team gave Brian both Haldol and Phenergan, which helped his vomiting improve.
- Brian, who loved sports and the movie “Twilight,” was close to his family and called himself his mother’s “snuggle bunny.” He was beloved uncle BubBub to his toddler nephew, Zayden.
- The paper analyzed the public testimony of 33 cannabis industry supporters who spoke before the House Commerce & Gaming Committee over the course of four years against measures to regulate high-THC cannabis.
- The frequency and prevalence of CHS change in accordance with the doses of tetrahydrocannabinol and other cannabinoids in various formulations of cannabis.
- The patient found that hot water relieved his symptoms better than anything else.
- On several occasions, she got so ill that even the smell of food made her throw up.
- This effect causes delayed gastric emptying and continues to inhibit transit through the small intestine.
What are other impacts of cannabis use?
While clinicians and most regular marijuana users regard CHS as a rare condition − if they have heard of it at all − the literature suggests otherwise. Many cases of CHS are likely misdiagnosed or not medically treated at all. In a study in Spain, a questionnaire was sent out to all patients over 18 years of age who attended a single outpatient marijuana rehabilitation center in 2014; of the 22 respondents, 18.2% reported symptoms suggestive of CHS 71. However, reliable data on the incidence and prevalence of CHS are not known.
Hyperemetic phase
The HPA axis is the main neuroendocrine system activated by the body when confronting stress 56. In a healthy individual, the stress response results in the release of corticotrophin-releasing hormone from the hypothalamus into the capillaries and going to the pituitary gland. This causes the pituitary gland to release adrenocorticotropic hormone into the blood stream, which activates the adrenal cortex and leads to the production of corticosteroids 57. The HPA axis and the sympathetic nervous system must balance their activities in response to stressors. While stress response is vital to survival, prolonged stress increases the allostatic load and can have adverse effects on health 58, 59. Interestingly, endocannabinoids play a role in allostasis, that is, they promote the recovery from stress and help to reestablish homeostasis of neurotransmitters, neurohormones, and neuropeptides 60.
Symptoms and Causes
- UW researchers Denise Walker and Ryan Petros have been studying the best way to help young people with psychosis stop using weed, as well as approaches for families of people addicted to cannabis.
- However, there are numerous cases of people with the condition being hospitalized for weeks.
- Preclinical studies suggest that endocannabinoids and THC may evoke bradycardia, hypotension, and decreased contractility of the myocardial tissue 149.
- The PPI pantoprazole provides this information on its labeling, but it is not widely appreciated among clinicians since there are no known published case studies of this in the literature 76.
Seventy percent of pa tients reported symptoms typically began in the morning 120. Many clinicians and the general public − including avid marijuana users − are unaware of the existence of CHS, and many patients undergo unnecessary tests, scans, and what is chs procedures to get at the root of their sometimes debilitating symptoms. With the liberalization of marijuana laws and growing favorable public opinion about the benefits of marijuana, CHS is likely to become increasingly more common.
Hot Showers
There is currently not a vast amount of medical literature about CHS, and most of the clinical reports are case reports of individuals or small case series, which do not provide high-quality medical evidence. The heterogeneity of the case reporting makes data synthesis impossible. Since there are no laboratory or radiographic examinations that can be used to diagnose CHS, CHS should be diagnosed based on symptoms and patient behaviors. In some cases, CHS is a diagnosis of exclusion after other hyperemetic conditions (such as hyperemesis gravidarum, psychogenic vomiting PV, or CVS) are ruled out. Chalfonte LeNee Queen is still struggling to completely quit marijuana, but her symptoms are down to a dull stomachache.
The doctor was clueless as to what to do to help Brian quit smoking and suggested that we could try a stress center. They also decided to send a suppository to the pharmacy for the vomiting. Some doctors believe CHS is due to overstimulation of the endocannabinoid system, a network marijuana addiction of receptors in the body that respond to compounds in cannabis. But it’s also important to acknowledge the positive uses of marijuana, Camilleri said. He also warned that people with serious mental illnesses, such as schizophrenia, should be cautious about marijuana use, as studies show cannabis can exacerbate the effects of those illnesses. Neither the psychological treatments nor the pharmacological treatments seem to be that effective,” he said.
With the widespread use, increased potency and legalization of marijuana in multiple states in the U.S., CHS may be becoming increasingly common. CHS patients are often resistant to finding out that marijuana causes their symptoms. Many CHS patients are long-term marijuana users who object to marijuana discontinuation, even though it provokes symptoms severe enough to require hospitalization. This leads to an important question, especially in light of our gradual societal paradigm shift toward liberalizing marijuana. Certainly marijuana use disorder exists, but it is not clear if it is addictive in the same manner as opioids or alcohol. Since CHS is thought to occur only with long-term marijuana use, a CHS diagnosis is often ruled out for adolescents and children.
Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases
CBG is not psychotropic and acts as an antagonist at both CB1 and serotonin receptors 46. This antagonism might theoretically reverse the antiemetic effects of low doses of CBD at the serotonin receptor 38. Thus, it is possible that the severe nausea and intractable vomiting of CHS might be due to the combined proemetic effects of high-dose CBD coupled with CBG’s antagonism at the serotonin receptors 13.
In a retrospective review of CHS patients admitted to a single urban ED in France, 7 patients were identified with a mean age of 24.7 years (range 17–39 years); most were men. Five patients agreed to work with the addiction team and discontinued the use of marijuana, but 2 patients refused and resisted the notion that they should give up marijuana 130. One surefire sign of the illness is when patients find relief in hot showers and baths. Queen said she would vomit repeatedly unless she was in a hot shower — so she’d stay in there for hours. Toxicologists say the heat may distract the brain from pain receptors in the abdomen but, like the syndrome itself, that phenomenon is not well understood.
