These strategies have all demonstrated a reduction in relapse rates 13, 30, 37. Cannabinoid hyperemesis syndrome (CHS) can affect people who use cannabis (marijuana) long-term. No studies have evaluated the treatment of abdominal pain, as its incidence in CWS is significantly less than in CHS. Furthermore, in light https://ecosoberhouse.com/ of the pathophysiological processes behind CWS, its presence may not be a direct consequence to THC but simply a response to emesis (and if present, may be a sign that the patient is experiencing CHS rather than CWS).
What are the symptoms of cannabinoid hyperemesis syndrome?
During stress, fat is broken down leading to the release of large amounts of THC causing CHS symptoms 10, 11. Further, genetic polymorphisms in the metabolic P450 enzymes lead to a change in the metabolic rate of THC breakdown causing hyper or hyposensitivity 12, 13. In-depth mechanisms for different CHS hypotheses are presented in Figure Figure11.
Ondansetron, Metoclopramide, and Antihistamines
Benzodiazepines have been reported effective in some cases but can pose a risk of dependence. Severe nausea, vomiting, and stomach pain are the hallmark symptoms of cannabinoid hyperemesis syndrome (CHS). The word “cannabinoid” refers to compounds uniquely found in cannabis, and “hyperemesis” means severe vomiting. While this paper covers many of the key pathophysiological and therapeutic possibilities for cannabis use disorders presenting to acute care, limitations arising from the retrospective nature of a literature review were identified during manuscript writing. We believe more research is needed regarding both acute and long-term treatment options. Proving the emetic and antiemetic effects of cannabinoids is difficult due to the overlapping nature of the symptoms with other conditions such as cyclic vomiting syndrome, viral gastroenteritis, and bulimia nervosa 14.
Review Questions
Furthermore, propranolol in patients with chronic obstructive pulmonary disease (COPD) and sinus bradycardia should be avoided, as it worsens bronchoconstriction and bradycardia 47. Awareness in the public and healthcare professionals about the risk of the development of CHS in prolonged cannabis users will help fill existing knowledge gaps. We included systematic reviews, retrospective cohorts, case reports, and randomized-controlled trials (RCTs), written in the English language; from January 2009 to June 2021 that described the use of cannabinoids and CHS in adult and older populations (18 years and older) were included. We assessed adults and older populations with N/V who were using recreational or medicinal cannabinoids. The management options included pharmacological treatments and water hydrotherapy which were compared to placebo. The outcomes included the effectiveness of the interventions seen in decreasing N/V induced by cannabinoids.
While the opioid epidemic has garnered much attention, other forms of substance use disorders (SUD) continue to have significant impacts on health and wellness. Globally, alcohol use disorder (AUD) is the most prevalent SUD with over 100 million estimated cases in 2016. Cannabis use disorder (CUD) is the third most prevalent SUD with an estimated 22 million cases worldwide (following opioid use disorder at 26 million cases). We aim to disrupt how medical providers and trainees can gain public access to high-quality, educational content while also engaging in a dialogue about best-practices in EM and medical education. MR and EPH conceptualized the article, reviewed the literature, and drafted the first version.
- Aprepitant is a Neurokinin 1 (NK1) receptor antagonist and similarly to capsaicin is involved in the regulation of substance P to alleviate N/V in CHS 35.
- Probably, a crucial factor in the genesis of CHS is the composition of cannabis.
- Symptoms will usually improve after 1 or 2 days, as long as you don’t use cannabis during this time.
Table 2
Furthermore, indications, contraindications, and drug-drug interaction should be kept in mind and risks versus benefits weighed in older adults with multiple comorbidities while considering the management options. In older populations, benzodiazepines should be used with caution in the management of CHS due to the potential risk of addiction, cognitive impairment, development of cannabinoid hyperemesis syndrome delirium, and falls 45. Haloperidol should also be used with caution in patients with dementia and Parkinson’s disease, as dopamine blockade can dramatically worsen symptoms causing extrapyramidal side effects and incapacitation 46.
