Cannabinoids are compounds in the Cannabis sativa plant that bind to cannabinoid receptors in your brain, spinal cord, gastrointestinal tract and other body tissues. Examples of cannabinoids include tetrahydrocannabinol (THC) and cannabidiol (CBD). CB-1 receptors are present in the heart, which makes it possible that cannabinoids might affect myocardial performance 150.
Clinical Considerations
There is a new condition that is affecting marijuana users at a growing rate, and it’s called cannabinoid hyperemesis syndrome (CHS). CHS is a rare illness that comes as a result of chronic and prolonged usage of cannabis. Symptoms of CHS include extreme vomiting, nausea, dehydration, stomach pain and death in rare cases. Patients are often diagnosed with the syndrome based on the way they treat their own symptoms. Typically, patients can only find relief from intense and persistent nausea by taking hot baths or showers.
What are the risk factors for cannabinoid hyperemesis syndrome?
- Dr. Aimee Moulin, an emergency room physician at UC-Davis Medical Center in Sacramento, said she has seen a rise in the number of cases since California voters legalized recreational marijuana last November.
- People who use marijuana long-term — typically for about 10 to 12 years — are at risk of developing CHS.
- But it’s also important to acknowledge the positive uses of marijuana, Camilleri said.
- Doctors at the hospital ran tests and ordered scans but could not name the source of her unrelenting nausea and vomiting.
- 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.
For his part, Don Danielson has lost friends and been ridiculed for speaking out publicly about what happened to his son, he said. UW researchers Denise Walker and Ryan Petros have been studying the best way to help young people with psychosis stop using weed, as well as approaches for families of people addicted to cannabis. For people with CHS, the only way to confirm that diagnosis is to quit using cannabis. Irby had a hard time connecting the high-potency weed she considered a miracle cure for her depression to the disabling sickness that occurred a few years later. On several occasions, she got so ill that even the smell of food made her throw up.
What is the treatment for cannabinoid hyperemesis treatment?
The authors found no cases of geriatric CHS (≥65 years), but there is no reason evident why geriatric individuals who used marijuana long term would be immune from CHS. It is not known why the syndrome develops in some, but not all, long-term marijuana users and why symptoms take longer to manifest in some patients than others. Although there were very few case studies involving CHS patients with eating disorders, bulimia might present in such a way that it could be confused with CHS. About 35% of individuals with some form of substance use disorder have an eating disorder (which typically precedes the substance use disorder) versus 5% of the general population 174. A thorough history, physical examination and directed testing of differential diagnoses may assist in ruling out these diagnoses. The Rome IV criteria provide some objectivity to help with the diagnosis by placing CHS under the heading of functional gut-brain disorders, and consider it as a variant of CVS (Table 2).
Haloperidol is a familiar but unconventional antiemetic that may benefit CHS patients, likely because it blocks the brain’s postsynaptic dopamine receptors 111, 112. When dopamine receptors are blocked, the blockade reduces the effect of dopamine on the dopamine-2 receptors in the vomiting center 96. Haloperidol may further relieve nausea and vomiting by indirect activity at the CB1 receptors 111, 113. In a case study of a 27-year-old man who suffered repeated episodes of gastric pain, up to 20 vomiting episodes per day, coupled with severe nausea, multiple diagnostic tests were performed before a CHS diagnosis could be made. During his last hospitalization he was given conventional antiemetic therapy but his symptoms persisted for 2 more days.
However, our understanding of its effects has unfolded significantly over the last 3 decades. The extract of the plant cannabis sativa has been reported to be used for decades in the control of pain and cramps, according to the Chinese literature 1. Recognition of the function of the endocannabinoid system (ECS) was a breakthrough in explaining the effects of cannabis on different organs, at least in part 2.
Cannabis and psychosis
” said Beard, while recovering from a marijuana-related vomiting episode at a University of Iowa hospital in Iowa City, Iowa, in October. The Sobriety vomiting link to cannabis is counterintuitive to many, because of its widely known reputation as an anti-nausea remedy for cancer patients. There is no blood test to link the stomach ailment with marijuana use, so physicians often order pricey CT scans and lab tests to rule out other medical problems. Throughout the nearly two decades of pain, vomiting and mental fog, she visited the hospital about three times a year, but doctors never got to the bottom of what was ailing her. By 2016, she thought she was dying, that she “must have some sort of cancer or something they can’t detect,” Queen said. She started meeting separately with public health officials and then with cannabis industry leaders.
- Many people with CHS will compulsively shower or bathe — often for hours every day — to relieve CHS symptoms.
- The only proven way to prevent cannabis hyperemesis syndrome is to avoid cannabis (marijuana).
- Doctors often treat CHS patients who seek help at hospitals with fluids.
- Cannabinoid hyperemesis syndrome (CHS) is one of the more clinically challenging effects of cannabis consumption.
- ” said Beard, while recovering from a marijuana-related vomiting episode at a University of Iowa hospital in Iowa City, Iowa, in October.
His death came as a shock to his what is chs mother six months after his diagnosis. “It’s the best medication that helps her sleep for the last five years. Other theories behind rising cases include the widespread legalization and cultural acceptance of cannabis, as well as the higher tetrahydrocannabinol (THC) content in modern marijuana, experts told the NewsHour.
Patient Education
The patient admitted he had smoked marijuana on a daily basis for the past 20 years. In the ED, the physician treated him with IV propranolol 1 mg as this had been effective in cases of CVS. The patient continued to experience symptoms and received a second dose of IV propranolol 1 mg an hour later, whereupon his symptoms stopped completely.