If you have cannabis use disorder and need help quitting, professional treatment is available. 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. With the widespread use, increased potency and legalization of marijuana in multiple states in the U.S., CHS may be becoming increasingly common. The CHS treatment guideline will assist frontline clinicians to reduce use of unnecessary healthcare resources and promote safe prescribing to help mitigate contributing to the opioid crisis.
Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review
Since 40-50% of traditional cyclic vomiting syndrome patients were chronic cannabis users, it is reasonable to extrapolate these guidelines to CHS until more specific literature is published. 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. In patients predisposed to symptoms, overstimulation of said receptors may result in increased gastric acid secretion and impaired gut motility and relaxation of the gastro-esophageal sphincter, as well as dysregulated basal sympathetic activity, altogether resulting in hyperemesis. Further to this, abdominal discomfort can also occur and is thought to be due to THC-induced splanchnic vasodilation (and cutaneous vasoconstriction), a phenomenon known as “cutaneous-stealing syndrome” [8]. The excessive self-administration of hot showers, a feature well-described in the literature [5], is thought to reverse this by inducing peripheral vasodilatation of the peripheries and redistributing blood flow away from the gastrointestinal tract [4].
Cannabinoid hyperemesis syndrome: pathophysiology and treatment in the emergency department
They are however also encountered in cannabis withdrawal syndrome (CWS), an often debated but officially (ICD and DSM) recognized withdrawal syndrome. Distinguishing between these two pathologies is important as the underlying mechanism and treatment options differ. Per the consensus guideline, treatment should focus on symptom relief and education on the need for cannabis cessation.
- We aim to disrupt how medical providers and trainees can gain public access to high-quality, educational content while also engaging in a dialogue about best-practices in EM and medical education.
- They are however also encountered in cannabis withdrawal syndrome (CWS), an often debated but officially (ICD and DSM) recognized withdrawal syndrome.
- Haloperidol and topical capsaicin have pathophysiologic bases and evidence for use in CHS.
- They should further advise patients that immediate cessation of cannabis use is the only method that has been shown to completely resolve symptoms.
- They are likely more effective than 5-HT3 antagonists (eg, ondansetron), though evidence amounts to systematic reviews of cases and 1 small RCT.
How soon after cannabis hyperemesis syndrome treatment will I feel better?
The only known treatment to permanently get rid of CHS is to stop cannabis use completely. You may have symptoms and side effects of CHS for a few weeks after quitting cannabis. Not everyone with the condition seeks medical help or tells their provider that they use marijuana. While the opioid epidemic has garnered much attention, other forms of substance use disorders (SUD) continue to have significant impacts on health and wellness. Globally, alcohol use disorder (AUD) is the most prevalent SUD with over 100 million estimated cases in 2016.
Sudden abstinence or drop in intake in patients whose dopaminergic pathway has been upregulated in response to high doses of cannabinoids could therefore theoretically cause symptoms of withdrawal. This has been well demonstrated in regularly THC-exposed animals and humans, whom, when administered cannabinoid hyperemesis syndrome Rimonabant© (a CB1 receptor blocker, used to treat obesity) [11, 12], rapidly develop abdominal pain and hyperemesis. In addition to these withdrawal symptoms, other disturbances have also been described in these patients, such as irritability, anxiety, sleep disturbances, and loss of appetite.
Haloperidol for treatment of cannabinoid hyperemesis syndrome
Other Literature Sources
- Expert panel members engaged in an iterative process to provide evidence-based input into the draft guideline until complete consensus was achieved.
- Regarding nausea, antipsychotics should be withheld as they tend to decrease central dopamine levels and may worsen withdrawal symptoms such as craving [42].
- Using the keywords “Cannabis,” “Hyperemesis,” “Syndrome,” “Withdrawal,” and “Emergency Medicine,” we completed a literature review of three different electronic databases (PubMed®, Google scholar®, and Cochrane®), up to November 2021.