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. The refusal of many CHS patients to give up marijuana despite debilitating symptoms certainly suggests that marijuana may be far more addictive than previously believed and/or that prolonged marijuana use impairs an individual’s ability to make sound decisions.

Cannabinoid Hyperemesis Syndrome Prevalence

• And a 2022 Canadian study found that ER visits for CHS-related problems had increased 13-fold between 2014 and 2021.
• Over 90% of CHS patients exhibit this behavior 75, which is sometimes described as compulsive.
• This includes laboratory tests (complete blood count and differential, glucose, basic metabolic panel, pancreatic and hepatic enzymes, pregnancy test), urinalysis, urinary drug screen, and plain flat radiographic series 63,64.
• A physical exam is important when quitting marijuana, especially if forceful vomiting occurs, as it may indicate CHS syndrome, a condition sometimes linked to cerebral edema.
• Dr. Borgelt receives support from the Colorado Department of Public Health and Environment and the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

Most CHS patients discover the symptomatic relief of hot showers on their own and use this method to control symptoms 1. In a case study from Texas, a 27-year-old male patient with CHS reported he found relief in hot showers but over time, he became refractory to the hot water and ended up having to visit the ED 105. In America, 22.2 million Americans reportedly used some form of cannabinoids in the past month 3. The Drug Abuse Warning Network (DAWN) states that marijuana mentions (the number of times “marijuana” is mentioned in a medical record) have increased 21% from 2009 to 2011 3. Since 2009, the rate of persistent vomiting has increased significantly and continues to increase at about 8% a year 5.

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.

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Although its prevalence is unknown, numerous publications have preliminarily established its unique clinical characteristics. CHS should be considered as a plausible diagnosis in the setting of patients with recurrent intractable vomiting and strong history of cannabis abuse. Despite the well-established anti-emetic properties of marijuana, there is increasing evidence of its paradoxical effects on the gastrointestinal tract and CNS. Further initiatives are needed to determine this disease prevalence and its other epidemiological characteristics, natural history, and pathophysiology. Additional treatments are needed and efforts to discontinue cannabis abuse are paramount.

Hyperemetic phase

• Other medical conditions that may present similarly to CHS include, but are not limited to, bowel perforation, cholangitis, pancreatitis, and ruptured aortic aneurysm 184.
• This will help to rule out life-threatening causes or diagnoses that confer significant potential morbidity to the patient or to establish the presumptive diagnosis of CHS.
• In some cases, long-term damage to the gastrointestinal system can occur.
• It’s important to check with the insurance provider to confirm coverage details for specific treatments related to CHS.
• The Rome IV criteria list CHS as a subset of cyclical vomiting syndrome (CVS).

Education regarding the potential effects of long-term high doses of cannabinoids should be disseminated to physicians and the public to better detect and manage this debilitating syndrome. Future research, both clinical and pre-clinical, should continue to investigate the underlying mechanism and pre-disposing factors of CHS, to further understand the consequences of high-dose cannabinoid use and dysregulation of the endocannabinoid system. It remains unknown how changes to the endocannabinoid system could lead to the development of CHS and more empirical research is needed to identify the mechanism. The most effective treatment is stopping marijuana use, which can be achieved through medical detoxification and therapy. Treatment centers provide programs that support individuals in overcoming marijuana addiction and managing CHS symptoms through professional care, therapy, and aftercare support.

What happens if cannabis hyperemesis syndrome is left untreated?

Additionally, we provide resources that assist new users in making informed decisions about their usage. Have you considered how support groups can aid recovery for CHS patients? Research indicates that participation in these groups can significantly enhance emotional support and provide practical coping strategies. For instance, a case study highlighted the positive outcomes of a local support group, where participants reported reduced challenges and improved well-being through shared experiences and mutual guidance.

While marijuana has significant analgesic effects, statistics reveal that these do not surpass those of conventional medications like codeine, underscoring the need for moderation. Additionally, findings from the BART model and Harborview Medical Center alcoholism symptoms confirm a link between long-term marijuana use and an increased risk of postoperative nausea and vomiting (PONV). Experts advise that chronic marijuana users should be aware of their heightened risk for PONV, emphasizing the importance of making informed decisions about marijuana use.

The most effective way to reduce the effects and risks of CHS is to stop using cannabis. Medical treatment is recommended for managing symptoms and preventing complications. 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.

Investigators sought to create a consensus guideline for rapid identification and opioid-sparing treatment of patients with CHS. Understanding the recovery timeline is crucial, and it is important to stop marijuana cannabinoid hyperemesis syndrome use for recovery from CHS. The exact cause of CHS remains unclear, but it is increasingly linked to long-term marijuana use, particularly with high-THC varieties, which may disrupt the endocannabinoid system. At Leafy Mate, we are dedicated to creating a community of informed consumers through education and resource accessibility.

Moreover, recent findings suggest that the sympathetic nervous system may play a role in CHS, with symptoms like rapid heartbeat and sweating appearing during hyperemesis phases. Emergency medical assistance is recommended for these signs of dehydration. Remember, prompt intervention can significantly improve outcomes for those affected by this condition, and together, we can navigate this challenging experience.

Marijuana cessation was recommended to all patients, but there was no long-term follow-up. Haloperidol exerts antipsychotic effects by antagonizing dopamine D2 receptors in the mesolimbic and mesocortical pathways. Haloperidol is traditionally used to treat agitation; however, it has been used successfully as an antiemetic in general surgery and oncology. D2 receptors are also present in the chemoreceptor trigger zone, which may account for these antiemetic properties.