Burden of Comorbidities in Hospitalizations for Cannabis Use-associated Intractable Vomiting during Post-legalization Period

Madireddy, Sowmya; Patel, Rikinkumar S; Ravat, Virendrasinh; Ajibawo, Temitope; Lal, Anthony; Patel, Jenil; Patel, Riddhi; Goyal, Hemant

doi:10.7759/cureus.5502

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…A large case series suggested that sufferers are typically under 50 years old, may experience weight loss with the onset of the disorder, have morning predominance of symptoms, have normal bowel habits and negative investigations 33 . Anxiety and depression appear to commonly coexist in CHS sufferers 34 …”

Section: Discussionmentioning

confidence: 99%

“…33 Anxiety and depression appear to commonly coexist in CHS sufferers. 34 The Rome IV criteria are the first attempt to characterise CHS by the Rome group in 2016. Unfortunately, the requirement for re- The same authors also showed significant overlap with CVS, with a reasonable assertion that CHS could be a subset of CVS with the added component of cannabis use.…”

Section: First Described In 2004 By Allen Et Al Chs Is Characterised Bymentioning

confidence: 99%

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Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

Andrews

Rehak

Woo

et al. 2022

Aliment Pharmacol Ther

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Summary Background Cannabinoid hyperemesis syndrome (CHS) is a poorly understood vomiting disorder associated with chronic cannabis use. Aims To characterise patients experiencing CHS in North America and to obtain a population‐based estimate of CHS treatment prevalence in Canada before and during the Covid‐19 pandemic Methods Internet survey of 157 CHS sufferers in Canada and the United States. Administrative health databases for the province of Alberta (population 5 million) were accessed to measure emergency department (ED) visits for vomiting, with a concurrent diagnostic code for cannabis use. Three time periods of 1 year were assessed: prior to recreational cannabis legalisation (2017–2018), after recreational legalisation (2018–2019) and during the first year of the Covid‐19 pandemic (2020–2021). Results Problematic cannabis use (defined as a CUDIT‐R score ≥8) was universal among the survey cohort, and 59% and 68% screening for moderate or worse anxiety or depression, respectively. The overall treatment prevalence of CHS across all ages increased from 15 ED visits per 100,000 population (95% CI, 14–17) prior to legalisation, to 21 (95% CI, 20–23) after legalisation, to 32 (95% CI, 31–35) during the beginning of the Covid‐19 pandemic (p < 0.001). Treatment prevalence among chronic cannabis users was as high as 6 per 1000 in the 16–24 age group. Conclusion Survey data suggest patients with CHS almost universally suffer from a cannabis use disorder, which has significant treatment implications. Treatment prevalence in the ED has increased substantially over a very short time period, with the highest rates seen during the Covid‐19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: First Described In 2004 By Allen Et Al Chs Is Characterised Bymentioning

confidence: 99%

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

Andrews

Rehak

Woo

et al. 2022

Aliment Pharmacol Ther

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“…24 The hospitalization rates for cannabisassociated intractable vomiting had increased by 28.6% from 2010 to 2015. 25 One pattern in CHS is recreational marijuana use, often starting during high school or college and continuing on a daily basis. The symptoms of cyclic vomiting episodes usually start after chronic daily intake for approximately 5 years.…”

Section: Epidemiologymentioning

confidence: 99%

Cannabinoid Hyperemesis Syndrome: Definition, Pathophysiology, Clinical Spectrum, Insights into Acute and Long-Term Management

Gajendran

Sifuentes

Bashashati

et al. 2020

Journal of Investigative Medicine

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Although cannabinoid hyperemesis syndrome (CHS) was first reported more than 15 years ago, it still remains an unfamiliar clinical entity among physicians worldwide. CHS is categorized by Rome IV classification as a functional gastroduodenal disorder. It is characterized by stereotypical episodic vomiting in the setting of chronic, daily cannabis use, with cycles decreasing by the cessation of cannabis. CHS is also associated with abdominal pain reduced by hot baths and showers with comparative well-being between attacks. Thus, its clinical presentation resembles ‘classic’ cyclic vomiting syndrome, but eliciting a cannabis history is crucial in diagnosing this entity. In acute attacks, parenteral benzodiazepines are very effective. For prevention and long-term management, tricyclic antidepressants such as amitriptyline are the mainstay of therapy requiring doses in the range of 50–200 mg/d to achieve symptom control. In addition, counseling to achieve marijuana cessation, accompanied by antianxiety medications, is necessary for sustaining clinical outcomes. Once the patient is in remission and off marijuana for a period of 6–12 months, then tapering the dose of amitriptyline can be implemented, with the goal of no therapy being achieved in the majority of patients over time. With the legalization of marijuana in many states, CHS will become an increasingly prevalent clinical entity, so educating about CHS is an important goal, particularly for emergency department physicians who generally first encounter these patients.

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“…These advances enhanced the understanding of cannabinoid (CB) receptors, which led to a better appreciation of the role of cannabis in inflammation, seizures, emesis, and as an appetite stimulant. There is a growing body of research showing the benefit of cannabis in the aforementioned disorders, and its legalization will further augment research on understanding its critical role in new drug developments [ 3 , 4 ]. However, these changes also come with substantial risks regarding its adverse effects, such as paradoxical hyperemesis, intoxication and behavioral changes (anxiety, panic attacks, and psychoactive changes).…”

Section: Introductionmentioning

confidence: 99%

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Perisetti

Gajendran

Dasari

et al. 2020

aog

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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 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. 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. The frequency and prevalence of CHS change in accordance with the doses of tetrahydrocannabinol and other cannabinoids in various formulations of cannabis. CHS is unique in presentation, because of the cannabis’s biphasic effect as anti-emetic at low doses and pro-emetic at higher doses, and the association with pathological hot water bathing. In this narrative review, we elaborate on the role of the ECS, its management, and the identification of gaps in our current knowledge of CHS to further enhance its understanding in the future.

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Burden of Comorbidities in Hospitalizations for Cannabis Use-associated Intractable Vomiting during Post-legalization Period

Cited by 8 publications

References 27 publications

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

Cannabinoid Hyperemesis Syndrome: Definition, Pathophysiology, Clinical Spectrum, Insights into Acute and Long-Term Management

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

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