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Cannabinoid Hyperemesis Syndrome And Its Treatment

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Cannabinoid Hyperemesis Syndrome

If you use cannabis to get high or as part of your medical regimen to ward off nausea, boost appetite, or even quell pain, you could potentially be at risk of developing Cannabinoid Hyperemesis Syndrome. Anyone who takes cannabis on a regular basis for many years runs the risk of experiencing the unpleasant cyclic vomiting, nausea, and compulsive bathing associated with the syndrome. Treatment is still largely unknown, but once identified, steering clear of cannabis seems to be your best bet.

Cannabinoid Hyperemesis Syndrome (CHS) is characterized by a cluster of symptoms like cyclic nausea and vomiting and compulsive hot water bathing, as well as abdominal pain with no particular identifiable cause. Due to the overlap of some of these symptoms with other problems, it often goes undiagnosed or, more commonly, is misdiagnosed as something else. The bulk of those with CHS – 95 percent – have been found to use cannabis on a daily basis for an average of 9.8 years before seeing the onset of the syndrome.1

What Is Cannabinoid Hyperemesis Syndrome?

CHS is easily mistaken for other problems like an eating disorder, drug seeking behavior, or cyclic vomiting syndrome. In reality, the problem is linked closely to the use of cannabis, whether as therapy for other ailments or illicit use to get a “high.” And that can cause you to spend hours of your time undergoing investigations that lead nowhere. You also run up medical bills as you undergo treatments that don’t work, including psychiatric referrals.2

Once you know what you’re dealing with, getting rid of symptoms may simply involve stopping intake of cannabis. But with the risk of renal failure in more advanced cases of the syndrome, it is important to act quickly.

The Rise Of Cannabinoid Hyperemesis Syndrome

Cannabis or marijuana is the most commonly misused illicit drug in America. A 2015 National Survey on Drug Use and Health put the monthly usage at about 22.2 million people.3 In addition, its usage as therapeutic agent is also widespread due to its appetite stimulating, pain controlling, and antiemetic (fighting nausea/vomiting) properties. Those with muscular spasms from multiple sclerosis, patients with weakness or wasting away of their bodies due to AIDS or HIV, as well as anyone experiencing nausea/vomiting due to chemotherapy can benefit from using cannabis.4 This has contributed to the ignominious rise of CHS across the country, with people rushing into emergency rooms from the incessant vomiting and nausea.

Phases Of Cannabinoid Hyperemesis Syndrome

Once someone develops CHS, it runs a course of three phases.

1. Prodromal Phase

During this phase you may experience an aversion to food and have morning nausea. Sometimes you may actually end up vomiting. You may even see some weight loss. This phase lasts anywhere from a week to two weeks.5

In some, this can happen for months or even years before it progresses to the next phase.6

2. Hyperemetic Phase

During hyperemetic episodes, symptoms become more obvious and occur cyclically. You are likely to have very severe nausea and will vomit very frequently, retching as many as five times an hour. This may be accompanied by abdominal pain as well. You’ll probably find relief from having hot water baths, and this bathing is usually compulsive.7

Typically, you will see the acute hyperemetic phase happens every four to eight weeks. In between these episodes you may not have any symptoms at all!8

3. Recovery Phase

During recovery, your symptoms will start to go away. Problems may resolve as you stop using cannabis. Things can look up as early as just 12 hours after you stop using the drug. Be warned, however, that for some people it could take as much as three weeks. Also, resuming use of cannabis will, in all likelihood, cause all these symptoms to come right back. Abstinence is the only way to control the problem.9

Symptoms Of Cannabinoid Hyperemesis Syndrome

Spotting CHS in regular users of cannabis is easy if you know what to watch for. If you or anyone you know shows any of these symptoms, it’s time to suspect CHS.10

  • Recurrent nausea
  • Pain in the abdominal region that is often described as “colicky”
  • Cyclical vomiting
  • A compulsive urge to keep having hot water baths to ease other symptoms
  • Symptoms stop when you do not take any cannabis

Other symptoms noted in research include11:

  • Anxiety and agitation
  • Sweating
  • Tachycardia or an abnormal heart rate
  • Postural hypotension, where blood pressure falls when you stand up from a lying/seated position
  • Continuous sipping of water due to polydipsia or excessive thirst
  • Mild fever

The Risk Of Renal Failure

Cannabinoid Hyperemesis Syndrome (CHS) left unchecked can leave you severely dehydrated and put you at risk of prerenal failure. This condition, called cannabinoid hyperemesis acute renal failure (CHARF), has been found to be secondary to CHS in some patients.12 While renal impairment is not a commonly reported problem, researchers warn that it is best to stay vigilant and be aware of this complication due to the potentially life-threatening nature of CHARF.13

How Do You Treat Cannabinoid Hyperemesis Syndrome?

Treatment for CHS is still being explored. What appears to be universally agreed upon, however, is that stopping the use of cannabis helps most. Here are some of the things you could try to help ease the problem14:

  • Stop using cannabis. If you take it for therapeutic reasons, you may need to find alternatives.
  • If you have an acute case of the problem, you may need to undergo electrolyte and fluid replacement intravenously.
  • Proton pump inhibitors have also been used to treat gastritis symptoms.
  • To help with getting off cannabis, motivational enhancement training as well as cognitive-behavioral therapy (CBT) have been found to be effective.
  • The jury is still out on whether or not medications like sedatives, analgesics, antinausea medicines, or antiemetics actually help with treating the syndrome. Discuss options with your doctor.

References   [ + ]

1, 4. Sun, Shusen, and Anthony Zimmermann. “Cannabinoid hyperemesis syndrome.” Hospital pharmacy 48, no. 8 (2013): 650-655.
2, 11. Sullivan, Stephen. “Cannabinoid hyperemesis.” Canadian Journal of Gastroenterology and Hepatology 24, no. 5 (2010): 284-285.
3. What is the scope of marijuana use in the United States? National Institute on Drug Abuse.
5, 8, 9, 14. McCarron, Robert M. “Cannabinoid Hyperemesis Syndrome: A Result of Chronic, Heavy Cannabis Use: Hot Showers, Marijuana Cessation Relieve Nausea and Vomiting.” Current Psychiatry 12, no. 10 (2013): 48.
6, 7. A Galli, Jonathan, Ronald Andari Sawaya, and Frank K Friedenberg. “Cannabinoid hyperemesis syndrome.” Current drug abuse reviews 4, no. 4 (2011): 241-249.
10. Simonetto, Douglas A., Amy S. Oxentenko, Margot L. Herman, and Jason H. Szostek. “Cannabinoid hyperemesis: a case series of 98 patients.” In Mayo Clinic Proceedings, vol. 87, no. 2, pp. 114-119. Elsevier, 2012.
12. Habboushe, Joseph. “Cannabinoid hyperemesis acute renal failure: a common sequela of cannabinoid hyperemesis syndrome.” The American journal of emergency medicine 32, no. 6 (2014): 690-e1.
13. Abodunde, Oladapo A., Joseph Nakda, Nneka Nweke, and Raghava Levaka Veera. “Cannabinoid hyperemesis syndrome presenting with recurrent acute renal failure.” Journal of Medical Cases 4, no. 3 (2012): 173-175.