Cannabinoid hyperemesis syndrome. A report of six new cases and a summary of previous reports

Abstract

Cannabinoid hyperemesis syndrome (CHS) is a medical condition which was identified for the first time in 2004 and affects chronic users of cannabis. It is characterized by cyclic episodes of uncontrollable vomiting as well as compulsive bathing in hot water. The episodes have a duration of two to four days. The vomiting is recognizable by a lack of response to regular antiemetic treatment, and subsides only with cannabis abstinence, reappearing in periods of consumption of this substance. The etiology of this syndrome is unknown. Up until June 2014, 83 cases of CHS were published worldwide, four of them in Spain.The first patient of CHS at Mataró Hospital was diagnosed in 2012. Since then, five new cases have been identified. The average duration between the onset of acute CHS episodes and diagnosis is 6.1 years, similar to that observed in previously published cases, an average of 3.1 years. This "delay" of CHS diagnosis demonstrates a lack of awareness with respect to this medical condition in the healthcare profession.With the objective of providing information concerning CHS and facilitating its timely diagnosis, a series of six new cases of CHS diagnosed in Mataró Hospital is presented along with a summary of cases published between 2004 and June 2014.

Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review

“…A total of 12 level‐4 case series involved 54 patients . For these case series, the following CHS pharmacologic treatments were reported as helpful: benzodiazepines (six), topical capsaicin (five), haloperidol (five), and olanzapine (one) . The 44 level‐5 case reports involved 44 patients .…”

Cannabinoid Hyperemesis

“…Five of the 6 patients were monitored by substance dependency units, and 3 of them abstained from cannabinoids; one discontinued marijuana and then relapsed and had another episode of acute intractable vomiting; one patient reduced marijuana use from 3 to one cigarette per day and had no further symptoms. One patient was lost to follow-up [129]. In this case series, the investigators noted that this latter patient – who continued to use cannabis – had the greatest number of acute episodes of CHS [129].…”

“…One patient was lost to follow-up [129]. In this case series, the investigators noted that this latter patient – who continued to use cannabis – had the greatest number of acute episodes of CHS [129]. Thus, severe symptoms may not be sufficient to compel an individual to discontinue marijuana or cannabis may have an adverse effect on the individual’s ability to make sound decisions [129].…”

Cannabinoid hyperemesis syndrome: a case report in Mexico

“…As an overview, since 2004, only 89 cases have been reported worldwide in 46 scientific articles (Contreras-Narváez et al, 2016), although none from Latin American countries. Regarding the characteristics of the 89 patients previously reported, the most outstanding findings were that 65% of the cases were men, with a mean of 30 years.…”

“…Mexico's National Addictions Survey not only identifies cannabis as the most widely used illicit drug, but also teenagers' and young people's drug of choice after alcohol and tobacco (Villatoro-Velázquez et al, 2016). In addition to epidemiological findings, there is sufficient scientific evidence on the psychiatric consequences of chronic cannabis use and abuse, such as: induced psychotic episodes, affective and anxious symptomatology, cognitive deterioration, amotivational syndrome and dependence (Hall, 2015;Volkow, Baler, Compton & Weiss, 2014), although little is known about other types of medical complications such as Cannabinoid hyperemesis syndrome (CHS) (Contreras-Narváez et al, 2016).…”