Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Experts also aren’t clear on what causes CHS, or why some people develop it while others don’t. Since it was first identified in 2004 in Australia, researchers have looked at the effects of cannabis on the vomiting centers of the brain. Researchers need to study CHS in more detail to make it easier for doctors to recognize and treat the condition. Further studies are also necessary to determine the causes of CHS and its risk factors. Results from these case studies suggest that lorazepam might be an effective drug to control symptoms during the hyperemesis stage.

Treatment / Management

Early recognition of CHS is essential to prevent complications related to severe volume depletion. The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems. Understanding the pathophysiology of the endocannabinoid system (ECS) remains central in explaining the clinical features and potential drug targets for the treatment of CHS.

Similar articles

These two conditions are hard to distinguish between and the main difference is CHS happens with using a lot of marijuana. If you have cannabinoid hyperemesis syndrome (CHS), the best treatment is to stop using weed, even if you’ve been doing it for years with no previous side effects. Once alcoholism treatment you do that, your repeated nausea and vomiting should go away and not return. Since THC is stored in your body fat, it can take weeks to months before all the symptoms go away and you notice a difference.

• Any effort to regulate Washington’s cannabis has faced stiff resistance from industry lobbyists in Olympia, including tactics that lawmakers and researchers compare to those used by big tobacco and big pharma.
• The endocannabinoid system is thought to play a role in gastrointestinal motility 123, 124 appetite 125, nausea/vomiting 126, inflammation 127, mood 128, sleep 129, pain 130, and more.
• Cannabis can both induce and subdue vomiting, a paradox doctors don’t fully understand, Camilleri said.
• This antagonism reverses the anti-emetic actions of low-dose CBD, which likely occurs at the 5-HT1A receptor 33.

Management and Treatment

The cannabis plant contains over four hundred different chemicals, with sixty possessing cannabinoid structures 76. The pro-emetic effects of two of these cannabinoids, CBD and CBG, have been discussed in this review and what is chs could conceivably play a role in the development of CHS. Additional pharmacological research is needed regarding the pro-emetic effects of additional cannabinoids and their metabolites. Another proposed explanation is that in susceptible individuals the pro-emetic effect of cannabis on the gut (e.g. delayed gastric emptying) overrides its anti-emetic CNS properties 62. This hypothesis is supported by the demonstration of delayed gastric emptying on gastric emptying scintigraphy in some cases 6,55,62.

General Health

However, doctors exercise caution when prescribing lorazepam because it is a controlled substance with the potential for abuse and addiction. The use of lorazepam for CHS is also off-label, so a person’s doctor would need to make them aware of this fact. Some researchers have published their findings from their personal experience with the condition in clinical journals. Researchers have identified two receptors called CB1 and CB2 to which marijuana molecules attach.

• According to data from the Department of Public Health, cannabis-related emergency room visits increased by 53% in Maryland from 2022 to 2023.
• During the hyperemesis stage, doctors focus on preventing dehydration and stopping the symptoms of nausea and vomiting.
• There’s no cure for this syndrome, with the only known, surefire treatment being abstinence from marijuana.
• Recognition of the function of the endocannabinoid system (ECS) was a breakthrough in explaining the effects of cannabis on different organs, at least in part 2.

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. Since 2004, doctors have identified key symptoms and characteristics of the condition that can help speed up diagnosis. However, researchers have yet to determine the cause of CHS since it does not affect all users of marijuana. Cannabinoid hyperemesis syndrome (CHS) is a condition that sometimes develops due to the long term use of marijuana. Ultimately, the treatment of any illness is the removal of precipitating factors, not merely the management of its symptoms. Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body.

• Although its prevalence is unknown, numerous publications have preliminarily established its unique clinical characteristics.
• Other known complications of forceful and uncontrolled vomiting include aspiration and subsequent pneumonitis or aspiration pneumonia as well as injury to the esophageal wall such as Boerhaave’s syndrome.
• “It may be that the cannabinoid is only sort of one aspect of the way the patient is hurting that needs to be addressed to really get them to heal,” he said.
• If you’re interested, reach out to a mental health professional like a licensed psychologist or therapist.

Pathophysiology of CHS

• As CHS is a relatively recently recognized and studied phenomenon easily confused with other diseases, there is a paucity of sizeable randomized control studies.
• Ron Buckley, a CHS sufferer, remembers similar symptoms from what he initially believed was a mystery illness.
• 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.
• The new law requires dispensaries as of Jan. 1, 2025, to display “a conspicuous notice at the point of sale” about potential health risks, especially for people under the age of 25, of consuming cannabis.
• As cannabis products like vapes, shatter, and dabs have reached near 100% potency, doctors across Washington state are seeing an increase in cannabis-related disorders, including CHS.

Many hypotheses have been proposed to explain the pathophysiology of CHS (Table 3); however, the GRADE quality of evidence to support any of the proposed mechanisms was very low. The endocannabinoid system is thought to play a role in gastrointestinal motility 123, 124 appetite 125, nausea/vomiting 126, inflammation 127, mood 128, sleep 129, pain 130, and more. There is also some evidence to suggest that cannabinoids interact directly with CB-1 receptors in the gastrointestinal tract and alter gastrointestinal motility 16, 92, 95, 132–134.

Similar articles in PubMed

The effects of this learned behavior are temperature-dependent 6, fast acting 6, but short-lived 6,56,62. Hot showers improve symptoms of nausea and vomiting 6,52–56,60,62,68,71, abdominal pain 6,56,71, and decreased appetite 68 during the hyperemetic phase. The precise mechanism by which hot bathing produces a rapid reduction in the symptoms of CHS is unknown.