Cannabinoid Hyperemesis

Joseph V. Pergolizzi Jr.,  Jo Ann LeQuang, John F. Bisney

Medical Cannabis and Cannabinoids, 2018, 1, 73–95

DOI: 10.1159/000494992

https://www.karger.com/Article/FullText/494992

Abstract :
Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients. Unlike other cyclic vomiting syndromes, CHS can be relieved by hot showers or topical capsaicin. Abstinence from cannabinoids causes CHS to resolve, sometimes in a matter of days or hours. Marijuana users as well as many clinicians are not aware of CHS, and patients may undergo unnecessary tests, scans, and other procedures to get an accurate diagnosis. Symptoms may be severe enough to require hospitalization. With liberalization of marijuana laws and favorable public opinion about the healing properties of cannabis, CHS may be more frequently observed in clinical practice.

Keywords :
Cannabis · Marijuana · Cannabinoid hyperemesis ·Cannabinoid vomiting syndrome · Hyperemesis ·Cyclicvomiting

Introduction
Cannabinoid hyperemesis syndrome (CHS) involves episodic cyclic vomiting that occurs in some cannabis users. Typical symptoms include intractable nausea and vomiting, refractory to conventional antiemetic therapy, often accompanied by abdominal pain. Other symptoms may include sweating, flushing, thirst, weight loss, and changes in body temperature. Patients may find relief by bathing in hot water. CHS resolves when cannabinoids are discontinued [1, 2]. Since marijuana is recommended as an antiemetic to chemotherapy patients, CHS seems paradoxical, but cannabinoids can have both proemetic as well as antiemetic effects. In America, 22.2 million Americans reportedly used some form of cannabinoids in the past month [3]. Since 2009, when the US Department of Justice published a memo to the effect that it would not prosecute users or sellers of medical marijuana who complied with their local state laws [4], marijuana use increased and with it, the rate of persistent vomiting increased 17.9% over prelegalization rates [5]. The Drug Abuse Warning Network (DAWN) states that marijuana mentions (the number of times “marijuana” is mentioned in a medical record) have increased 21% from 2009 to 2011 [3]. Since 2009, the rate of persistent vomiting has increased significantly and continues to increase at about 8% a year [5]. CHS cases have been reported from all over the world. This suggests that this once “rare” condition is going to emerge as an increasingly common presentation in emergency departments (ED) and clinics. CHS is not trivial; there are fatal cases of CHS (as cause of death or contributing to death) reported in the literature.

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