Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Abstract

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.

Changes in Emergency Department Encounters for Vomiting After Cannabis Legalization in Colorado

“…Although not entirely clear, it is hypothesized that the cyclic vomiting is due to a disequilibrium with the endocannabinoid system and the brainstem and hypothalamic-pituitary-adrenal axis after heavy cannabis use. 8 The duration, frequency, route, or potency of cannabis products used that leads to greater risk for developing this illness has not been determined. However, a review of more than 200 patients diagnosed with CHS revealed that daily use of cannabis was reported in 47.9% of the patients and weekly use in 19.4% of the patients.…”

Paediatric cannabinoid hyperemesis

“…The endocannabinoid system (ECS) receptors cannabinoid type 1 (CB1) and cannabinoid type 2 (CB2) are G-protein coupled receptors that act by inhibiting adenylate cyclase. Their endogenous ligands are compounds derived from arachidonic acid, including Anandamide (AEA) and 2-AG (arachidonolyglycerol) [15]. CB1 receptors are found throughout many bodily systems, including the heart, spleen, lungs and bladder, but their main sites of action are the gastrointestinal and neurological systems [16].…”

A primer on medicinal cannabis safety and potential adverse effects

“…There are rare case reports of long-term, heavy recreational cannabis use promoting severe nausea and vomiting, which is known as the cannabis hyperemesis syndrome. [59][60][61] The syndrome is associated with compulsive bathing behaviour and resolves on cessation of cannabis use. Cannabis hyperemesis syndrome appears to be mediated by THC, and there is no evidence of CBD causing the syndrome.…”