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Shah M, Jergel A, George RP, Jenkins E, Bashaw H. Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study. J Pediatr 2024; 271:114054. [PMID: 38615942 DOI: 10.1016/j.jpeds.2024.114054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/15/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To identify clinical characteristics that distinguish cannabinoid hyperemesis syndrome (CHS) from cyclic vomiting syndrome (CVS), 2 conditions marked by episodes of nausea, vomiting, and abdominal pain. STUDY DESIGN We performed a retrospective chart review of patients admitted to a large children's health care system from 2015 through 2022. Patients with CHS and CVS were identified by the electronic medical record using International Classification of Diseases, Ninth and Tenth Revision codes. RESULTS Of 201 patients screened, 125 were included. Patients with CHS were older than those with CVS (mean [SD] 18.06 [1.41] vs 14.50 [2.91] years, P < .001). There were no significant differences in sex, race, ethnicity, or hospital length of stay between groups. Patients with CHS were more likely to have a positive urine drug screen (86% vs 2.9%, P < .001), lower mean (SD) serum potassium (3.62 [0.77] vs 3.88 [0.49], P < .001), and greater mean (SD) serum creatinine (0.83 (0.41) vs 0.63 (0.17), P < .001). The average (SD) systolic blood pressure was significantly greater in patients with CHS (systolic blood pressure 124.46 [10.66] vs 118.55 [10.99], P = .032) compared with children of comparable age range with CVS. Imaging was obtained in 36% of all patients, and only 2.4% had abnormalities. CONCLUSIONS Clinical features including older age, greater systolic blood pressure, positive urine drug screen, and select electrolyte findings might distinguish CHS from CVS. Abdominal imaging in both conditions is of low yield. These findings may allow for early recognition and appropriate therapy in CHS patients.
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Affiliation(s)
- Meera Shah
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
| | - Andrew Jergel
- Emory University Rollins School of Public Health, Atlanta, GA
| | - Roshan P George
- Division of Nephrology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Elan Jenkins
- Children's Healthcare of Atlanta, Atlanta, GA; Department of Pediatric Hospital Medicine, Emory University School of Medicine, Atlanta, GA
| | - Hillary Bashaw
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
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Soh J, Kim Y, Shen J, Kang M, Chaudhry S, Chung TH, Kim SH, Hwang Y, Lim D, Khattak A, Frimer L, Yoo JW. Trends of emergency department visits for cannabinoid hyperemesis syndrome in Nevada: An interrupted time series analysis. PLoS One 2024; 19:e0303205. [PMID: 38809874 PMCID: PMC11135771 DOI: 10.1371/journal.pone.0303205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/21/2024] [Indexed: 05/31/2024] Open
Abstract
Cannabis-related emergency department visits have increased after legalization of cannabis for medical and recreational use. Accordingly, the incidence of emergency department visits due to cannabinoid hyperemesis syndrome in patients with chronic cannabis use has also increased. The aim of this study was to examine trends of emergency department visit due to cannabinoid hyperemesis syndrome in Nevada and evaluate factors associated with the increased risk for emergency department visit. The State Emergency Department Databases of Nevada between 2013 and 2021 were used for investigating trends of emergency department visits for cannabinoid hyperemesis syndrome. We compared patients visiting the emergency department due to cannabinoid hyperemesis syndrome with those visiting the emergency department due to other causes except cannabinoid hyperemesis and estimated the impact of cannabis commercialization for recreational use. Emergency department visits due to cannabinoid hyperemesis syndrome have continuously increased during the study period. The number of emergency department visits per 100,000 was 1.07 before commercialization for recreational use. It increased to 2.22 per 100,000 (by approximately 1.1 per 100,000) after commercialization in the third quarter of 2017. Those with cannabinoid hyperemesis syndrome were younger with fewer male patients than those without cannabinoid hyperemesis syndrome. A substantial increase in emergency department visits due to cannabinoid hyperemesis syndrome occurred in Nevada, especially after the commercialization of recreational cannabis. Further study is needed to explore factors associated with emergency department visits.
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Affiliation(s)
- Jaeseung Soh
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea
| | - Yonsu Kim
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
| | - Jay Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
| | - Mingon Kang
- Department of Computer Science, Howard Hughes College of Engineering, University of Nevada, Las Vegas, NV, United States of America
| | - Stefan Chaudhry
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Tae Ha Chung
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
- Department of Family Medicine, Wonju Severance Hospital, Wonju, Gangwon Province, Korea
| | - Seo Hyun Kim
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
- Connection Sphere, Las Vegas, NV, United States of America
| | - Yena Hwang
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Daniel Lim
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Adam Khattak
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Leora Frimer
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
| | - Ji Won Yoo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United States of America
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Wightman RS, Metrik J, Lin TR, Collins AB, Beaudoin FL. Cannabinoid hyperemesis syndrome: Clinical trajectories and patterns of use three months following a visit to the emergency department. Acad Emerg Med 2024; 31:463-470. [PMID: 37387520 DOI: 10.1111/acem.14773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Cannabinoid hyperemesis syndrome (CHS) is a clinical condition of cyclic vomiting, nausea, and abdominal pain associated with chronic cannabis use. Despite increased recognition of CHS, there are limited details on cannabis use practices and symptoms over time. Understanding what happens in the period surrounding the emergency department (ED) visit, including any changes in symptoms and cannabis use practices following the visit, can help inform the development of patient-centered interventions around cannabis use disorder for patients with CHS. METHODS A prospective observational cohort (n = 39) of patients with suspected CHS recruited from the ED at the time of a symptomatic cyclic vomiting episode was followed for 3 months. Disease progression, cannabis use practices, and health care utilization were monitored. RESULTS Participants reported high rates of persistent CHS symptoms (abdominal pain, nausea, or cyclic vomiting) in the 2-week period immediately following an ED visit with a median duration of 7 days. Cannabis use frequency and quantity were reduced immediately after the ED visit, but most participants returned to pre-ED visit cannabis use patterns within a few days. Recurrent ED visits for cyclic vomiting were reported by 25% of participants who completed follow-up during the 3-month follow-up period. CONCLUSIONS Participants continued to have ongoing symptoms after the ED visit, but most managed symptoms on their own and did not return to the ED. Longitudinal studies beyond 3 months are needed to better understand the clinical course of patients with suspected CHS.
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Affiliation(s)
- Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island, USA
- Providence VA Medical Center, Providence, Rhode Island, USA
| | - Timmy R Lin
- Brown Emergency Medicine, Providence, Rhode Island, USA
| | - Alexandra B Collins
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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Kriss M, Shingina A, Hamel S, Winder GS. Cannabis use in liver transplant candidates and recipients. Liver Transpl 2024; 30:530-543. [PMID: 38289264 DOI: 10.1097/lvt.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/20/2024] [Indexed: 03/24/2024]
Abstract
The increasing legality and acceptance of cannabis sale and consumption across the United States has led to a measurable increase in cannabis use nationwide, including in liver transplant (LT) candidates and recipients. With over 75% of liver transplant recipients transplanted in states with legalized use of medicinal and/or recreational cannabis, liver transplant clinicians must have expertise in the assessment of cannabis use given its potential impact on clinical care. In this review, the authors provide an understanding of nomenclature and tools to assess cannabis use, highlight essential components to guide clinical policy development and implementation, and discuss the potential impacts of cannabis use on patients' transplant course.
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Affiliation(s)
- Michael Kriss
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Colorado Center for Transplantation Care, Research and Education, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alexandra Shingina
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie Hamel
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Humphries C, Gillings M. RCEM best practice guideline: suspected cannabinoid hyperemesis syndrome in emergency departments. Emerg Med J 2024; 41:328-331. [PMID: 38448215 DOI: 10.1136/emermed-2024-213886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Cannabinoid hyperemesis syndrome (CHS) is an episodic syndrome of cyclic vomiting in the context of the prolonged use of cannabis. The Royal College of Emergency Medicine Toxicology Special Interest Group has produced guidance to support emergency medicine clinicians with the recognition and treatment of people experiencing CHS.Considerations regarding recognition, investigation and communication are discussed, and recommendations regarding treatment options (which include haloperidol and capsaicin) are made. There is a focus on making recommendations on the best available evidence.
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Alshaarawy O, Balasubramanian G, Venkatesan T. Cannabis use in the United States and its impact on gastrointestinal health. Nutr Clin Pract 2024; 39:281-292. [PMID: 38142306 DOI: 10.1002/ncp.11111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/13/2023] [Accepted: 11/17/2023] [Indexed: 12/25/2023] Open
Abstract
In recent years, the legalization and social acceptability of cannabis use have increased in the United States. Concurrently, the prevalence of cannabis use has continued to rise, and cannabis products have diversified. There are growing concerns regarding the health effects of regular and high-potency cannabis use, and new research has shed light on its potentially negative effects. Here, we review evidence of the gastrointestinal (GI) effects of cannabis and cannabinoids. Dysregulation of the endocannabinoid system might contribute to various GI disorders, including irritable bowel syndrome and cyclic vomiting syndrome, and endocannabinoids have been found to regulate visceral sensation, nausea, vomiting, and the gut microbiome. Cannabis has been shown to have antiemetic properties, and the US Food and Drug Administration has approved cannabis-based medications for treating chemotherapy-induced nausea and vomiting. Yet, chronic heavy cannabis use has been linked to recurrent episodes of severe nausea and intractable vomiting (cannabinoid hyperemesis syndrome). Given the considerable heterogeneity in the scientific literature, it is unclear if cannabinoid hyperemesis syndrome is truly a distinct entity or a subtype of cyclic vomiting that is unmasked by heavy cannabis use and the associated dysregulation of the endocannabinoid system. The changes in cannabis legalization, availability, and public risk perceptions have outpaced research in this area and there is a need for robust, prospective, large-scale studies to understand the effects of cannabis use on GI health.
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Affiliation(s)
- Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Gokulakrishnan Balasubramanian
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Thangam Venkatesan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Arendash JM, Chiu C, Wang J, Mihm F. Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report. J Med Case Rep 2024; 18:161. [PMID: 38500192 PMCID: PMC10949556 DOI: 10.1186/s13256-024-04497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND This report presents a case of cannabinoid-induced hyperemesis syndrome causing repeated violent retching in a patient with a large (8 cm) adrenal pheochromocytoma resulting in hypertensive urgency. CASE PRESENTATION A 69-year-old white male patient with a previously diagnosed pheochromocytoma presented to the emergency department with nausea and vomiting and was found to have hypertensive urgency. Computed tomography scan did not show any acute abdominal pathology and history was inconsistent with a gastrointestinal etiology. Patient had a history of daily cannabinoid use for many years and repeated self-limited hyperemesis episodes, and thus a diagnosis of cannabinoid-induced hyperemesis syndrome was made. It was concluded that the likely explanation for the hypertensive urgency was from physical compression of his adrenal tumor during the episodes of retching resulting in a catecholamine surge. The patient was given antiemetics and admitted to the intensive care unit for blood pressure management. Blood pressure was initially controlled with phentolamine and a clevidipine infusion, then transitioned to oral doxazosin and phenoxybenzamine. Hyperemesis and abdominal pain resolved after 24 hours, and his blood pressure returned to baseline. The patient was discharged with the recommendation to stop all cannabis use. On follow-up, his blood pressure remained well controlled, and he subsequently underwent adrenalectomy for tumor removal. CONCLUSION Hyperemesis can cause hypertensive events in patients with pheochromocytoma by increasing abdominal pressure, leading to catecholamine release.
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Affiliation(s)
- Jeffrey M Arendash
- Department of Anesthesiology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA.
| | - Cornel Chiu
- Department of Anesthesiology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
| | - Jocelyn Wang
- Department of Anesthesiology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
| | - Fred Mihm
- Department of Anesthesiology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
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8
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Kallurkar A, Kaye AD, Shekoohi S. Marijuana Use, Vaping, and Preoperative Anesthetic and Surgical Considerations in Clinical Practice. Anesthesiol Clin 2024; 42:53-63. [PMID: 38278592 DOI: 10.1016/j.anclin.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
In recent years, marijuana and vaping have acquired widespread popularity, with millions of people using them for a variety of reasons, including recreational purposes. However, these practices have often overlooked the implications on surgery and the preoperative anesthesia considerations. Marijuana can influence a patient's response to anesthesia, alter postoperative pain management, and increase the risk of complications, whereas vaping can have negative effects on the respiratory system and hinder the body's ability to recover after surgery.
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Affiliation(s)
- Anusha Kallurkar
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA; Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
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Benoy R, Ramirez C, Hitchcock M, Reardon C. Cannabis Use in Adolescent and Young Adult Athletes: A Clinical Review. Sports Health 2024; 16:279-284. [PMID: 37950433 PMCID: PMC10916776 DOI: 10.1177/19417381231208661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
CONTEXT Cannabis use among the general population has increased over time, in part due to decriminalization of use and greater social acceptance of cannabis use. These changes have contributed to increased availability of cannabis products, thus raising the likelihood that a subset of adolescent and young adult athletes will use cannabis. Therefore, it is imperative that clinicians and other providers working with young athletes have a thorough understanding of the impact cannabis can have on the athletic performance and overall health of a young athlete. EVIDENCE ACQUISITION PubMed (Medline), CINAHL, PsycINFO, and SportDiscus databases were used to perform a literature search of articles published between January 1, 2010 and December 31, 2022. Additional articles were reviewed based on references obtained from initial articles. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Survey studies suggest that up to 1 in 4 athletes have used cannabis at least once in the last year. Age, sex, race, sexual orientation, level of competition, and country of residence of an athlete all contribute to differing rates of cannabis use among athletes. The scientific literature does not support using cannabis for athletic performance, and multiple studies have demonstrated notable impairments in objective athletic performance measures. Cannabis use can also negatively impact an athlete's overall health via cardiovascular, gastrointestinal, and mental health symptoms and disorders. CONCLUSION Cannabis use among adolescent and young adult athletes is common, and rates of use are influenced by many different factors. Current evidence suggests that cannabis use can worsen sport performance, negatively impact an athlete's general health, and contribute to negative mental health outcomes.
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Affiliation(s)
- Ryan Benoy
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cesar Ramirez
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mary Hitchcock
- University of Wisconsin-Madison, Ebling Library for the Health Sciences, 2339 Health Sciences Learning Center, Madison, Wisconsin
| | - Claudia Reardon
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Marshall A, Fai C, Han J, Yule AM, Jangi S. Rising Inpatient Utilization and Costs of Cannabis Hyperemesis Syndrome Hospitalizations in Massachusetts After Cannabis Legalization. J Clin Gastroenterol 2024; 58:247-252. [PMID: 37224284 DOI: 10.1097/mcg.0000000000001857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 03/27/2023] [Indexed: 05/26/2023]
Abstract
GOALS We described the demographics, inpatient utilization, and cost of services among patients hospitalized for putative cannabinoid hyperemesis syndrome (CHS) predating and postdating cannabis legalization in Massachusetts. BACKGROUND As the recreational use of cannabis has been widely legalized nationally, the resulting shifts in clinical presentation, health care utilization, and estimated costs of CHS hospitalizations remain unclear in the postlegalization era. STUDY We performed a retrospective cohort study among patients admitted to a large urban hospital between 2012 and 2021, before and after the date of cannabis legalization in Massachusetts (Dec 15, 2016). We examined the demographic and clinical characteristics of patients admitted for putative CHS, the utilization of hospital services, and estimated inpatient costs pre and postlegalization. RESULTS We identified a significant increase in putative CHS hospitalizations pre and post-cannabis legalization in Massachusetts (0.1% vs 0.02% of total admissions per time period, P < 0.05). Across 72 CHS hospitalizations, patient demographics were similar pre and postlegalization. Hospital resource utilization increased postlegalization, with increased length of stay (3 d vs 1 d, P < 0.005), and need for antiemetics ( P < 0.05). Multivariate linear regression confirmed that postlegalization admissions were independently associated with increased length of stay ( Β = 5.35, P < 0.05). The mean cost of hospitalization was significantly higher postlegalization ($18,714 vs $7460, P < 0.0005), even after adjusting for medical inflation ($18,714 vs $8520, P < 0.001) with intravenous fluid administration and endoscopy costs increased ( P < 0.05). On multivariate linear regression, hospitalization for putative CHS during postlegalization predicted increased costs ( Β = 10,131.25, P < 0.05). CONCLUSIONS In the postlegalization era of cannabis in Massachusetts, we found increased putative CHS hospitalizations, with a concomitant increased length of hospital stay and total cost per hospitalization. As cannabis use increases, the recognition and costs of its deleterious effects are necessary to incorporate into future clinical practice strategies and health policy.
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Affiliation(s)
| | - Caitlin Fai
- Department of Internal Medicine, Tufts Medical Center
| | - John Han
- Tufts University School of Medicine
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Sushrut Jangi
- Tufts University School of Medicine
- Department of Internal Medicine, Tufts Medical Center
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Kilani Y, Aljabiri Y, Arshad I, Alsakarneh S, Aldiabat M, Castro Puello P, Vahanyan A, Vikash F, Kumar V, Numan L, Thor S. Cannabis use and cyclical vomiting syndrome: An open debate. Dig Liver Dis 2024; 56:272-280. [PMID: 37880016 DOI: 10.1016/j.dld.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/06/2023] [Accepted: 10/01/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Cyclical vomiting syndrome (CVS) carries a significant financial burden on the U.S. healthcare system due to the recurrent emergency department visits and inpatient hospitalizations. We aimed to update the literature on the predictors of hospital utilization and readmission among individuals admitted with CVS. METHODS This is a retrospective nationwide study of patients hospitalized with a primary diagnosis of CVS. Using weighted data from the National Inpatient Sample (NIS) and the National Readmission Database (NRD), we conducted a multivariate regression analysis to assess predictors of length of stay (LOS), and 30-day readmission. RESULTS Primary admissions for CVS totaled 35,055 in the NIS, and 31,240 in the NRD. 2012 patients (6.4%) were readmitted within 30 days. On multivariate regression, cannabis use was associated with reduced LOS (adjusted Mean Difference (aMD) = -0.53 days, 95% CI: -0.68 to -0.38), and 30-day readmissions (adjusted Hazard Ratio (aHR) = 0.63, 95% CI: 0.54-0.73). DISCUSSION Cannabis use among CVS admissions was associated with reduced LOS and 30-day readmissions; these results could be in fact driven by Cannabis Hyperemesis Syndrome (CHS)-related hospitalizations and the effect of cannabis cessation on decreased symptomatology. ICD-10 coding for CHS should be transitioned to specific codes to improve the differentiation between CVS and CHS-related hospitalizations.
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Affiliation(s)
- Yassine Kilani
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medical College, New York, USA.
| | - Yazan Aljabiri
- Department of Medicine, Washington University in St. Louis, Saint Louis, USA
| | - Iqra Arshad
- Department of Medicine, Saint Louis University School of Medicine, Saint Louis, USA
| | - Saqr Alsakarneh
- Department of Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Mohammad Aldiabat
- Department of Medicine, Washington University in St. Louis, Saint Louis, USA
| | - Priscila Castro Puello
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medical College, New York, USA
| | - Anush Vahanyan
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medical College, New York, USA
| | - Fnu Vikash
- Department of Medicine, Jacobi Medical Center, New York, NY
| | - Vikash Kumar
- Department of Medicine, Brooklyn Hospital Center, New York, USA
| | - Laith Numan
- Department of Gastroenterology & Hepatology, Saint Louis University, Saint Louis, USA
| | - Savanna Thor
- Division of Gastroenterology & Hepatology, SUNY Downstate Health Sciences University, New York, USA
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Shine D, Goodin A. Cannabis Hyperemesis Syndrome: What Do We Know? Med Cannabis Cannabinoids 2024; 7:86-90. [PMID: 39015607 PMCID: PMC11250556 DOI: 10.1159/000539182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 07/18/2024] Open
Affiliation(s)
- Dionna Shine
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Amie Goodin
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA
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Boehnke KF, Wu CL, Clauw DJ. Thoughtfully Integrating Cannabis Products Into Chronic Pain Treatment. Anesth Analg 2024; 138:5-15. [PMID: 38100797 PMCID: PMC10730114 DOI: 10.1213/ane.0000000000005904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Cannabis products (CPs) and cannabis-based medicines (CBMs) are becoming increasingly available and are commonly used for pain management. The growing societal acceptance of cannabis and liberalization of cannabis laws allows patients to access CPs with minimal clinical oversight. While there is mechanistic plausibility that CPs and CBMs may be useful for pain management, the clinical trial literature is limited and does not refute or support the use of CBMs for pain management. Complicating matters, a large and growing body of observational literature shows that many people use CPs for pain management and in place of other medications. However, products and dosing regimens in existing trials are not generalizable to the current cannabis market, making it difficult to compare and reconcile these 2 bodies of literature. Given this complexity, clinicians need clear, pragmatic guidance on how to appropriately educate and work with patients who are using CBMs for pain management. In this review, we narratively synthesize the evidence to enable a clear view of current landscape and provide pragmatic advice for clinicians to use when working with patients. This advice revolves around 3 principles: (1) maintaining the therapeutic alliance; (2) harm reduction and benefit maximization; and (3) pragmatism, principles of patient-centered care, and use of best clinical judgment in the face of uncertainty. Despite the lack of certainty CPs and chronic pain management use, we believe that following these principles can make most of the clinical opportunity presented by discussions around CPs and also enhance the likelihood of clinical benefit from CPs.
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Affiliation(s)
- Kevin F. Boehnke
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher L. Wu
- Department of Anesthesiology, Pain Medicine and Critical Care; Hospital for Special Surgery; New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel J. Clauw
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
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Tuvel AL, Winiger EA, Ross JM. A Review of the Effects of Adolescent Cannabis Use on Physical Health. Psychiatr Clin North Am 2023; 46:719-739. [PMID: 37879834 DOI: 10.1016/j.psc.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The current review highlights the available research related to cannabis and indicators of physical health in a variety of domains. Various studies have found associations between cannabis use with pulmonary, cardiovascular, gastrointestinal, and endocrine function as well as body mass index and sleep. At this time, more research is needed to understand the influence of cannabis use on physical health, particularly among adolescent samples.
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Affiliation(s)
- Abigail L Tuvel
- Department of Psychology and Neuroscience, University of Colorado Boulder, 1777 Exposition Drive, Boulder, CO 80301
| | - Evan A Winiger
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, 1890 N Revere Court, Aurora, CO, 80045
| | - J Megan Ross
- Department of Psychiatry, Division of Addiction Sciences, Treatment and Prevention, University of Colorado Anschutz Medical Campus, 1890 N Revere Court, Aurora, CO, 80045.
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15
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Kirby J, Naren T. Cannabinoid hyperemesis syndrome in pregnancy: Challenges and opportunities. Aust N Z J Obstet Gynaecol 2023; 63:746-752. [PMID: 37259610 DOI: 10.1111/ajo.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
Antenatal cannabis consumption is common and associated with adverse perinatal outcomes, including low birthweight, pre-term birth and increased rates of admission to neonatal intensive care. Cannabinoid hyperemesis syndrome (CHS) comprises severe, cyclical episodes of vomiting, intractable nausea and abdominal pain observed in chronic cannabis users. CHS, particularly during pregnancy, poses a diagnostic dilemma with a tendency to be ineffectively managed secondary to reduced clinician awareness and a scarcity of available therapies. This clinical perspective explores the current literature on CHS in pregnancy, available pharmacotherapeutics, and recognises the current barriers to improving clinical care.
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Affiliation(s)
- Jordan Kirby
- Obstetrics & Gynaecology Resident, Department of Obstetrics & Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Thileepan Naren
- Addiction Medicine Advanced Trainee, Drug Health Services, Western Health, Melbourne, Victoria, Australia
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16
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Taboun ZS, Sadeghi J. The bidirectional relationship between opioids and the gut microbiome: Implications for opioid tolerance and clinical interventions. Int Immunopharmacol 2023; 125:111142. [PMID: 37918085 DOI: 10.1016/j.intimp.2023.111142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
Opioids are widely used in treating patients with acute and chronic pain; however, this class of drugs is also commonly abused. Opioid use disorder and associated overdoses are becoming more prevalent as the opioid crisis continues. Chronic opioid use is associated with tolerance, which decreases the efficacy of opioids over time, but also puts individuals at risk of fatal overdoses. Therefore, it is essential to identify strategies to reduce opioid tolerance in those that use these agents. The gut microbiome has been found to play a critical role in opioid tolerance, with opioids causing dysbiosis of the gut, and changes in the gut microbiome impacting opioid tolerance. These changes in turn have a detrimental effect on the gut microbiome, creating a positive feedback cycle. We review the bidirectional relationship between the gut microbiome and opioid tolerance, discuss the role of modulation of the gut microbiome as a potential therapeutic option in opioid-induced gut dysbiosis, and suggest opportunities for further research and clinical interventions.
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Affiliation(s)
- Zahra S Taboun
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Javad Sadeghi
- School of Engineering, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada.
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17
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Hashemi D, Gray K. Cannabis Use Disorder in Adolescents. Psychiatr Clin North Am 2023; 46:647-654. [PMID: 37879829 DOI: 10.1016/j.psc.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
With increasing cannabis potency, increasing variety of methods of cannabis use, and lower perceived risk of cannabis use, it is increasingly important clinicians who work with adolescents remain up-to-date on the latest literature regarding cannabis use and its associated outcomes. Adolescent cannabis use is associated with chronic cognitive, psychosocial, psychiatric, and physical outcomes. Clinicians working in this field should be able to recognize cannabis use disorder, understand how adolescent cannabis use can impact the developing mind, and have informed discussions with patients and families regarding risks of use.
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Affiliation(s)
- Daniel Hashemi
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, South Carolina 29425, USA.
| | - Kevin Gray
- Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC 29425, USA
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18
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Hasin DS, Wall MM, Alschuler DM, Mannes ZL, Malte C, Olfson M, Keyes KM, Gradus JL, Cerdá M, Maynard CC, Keyhani S, Martins SS, Fink DS, Livne O, McDowell Y, Sherman S, Saxon AJ. Chronic pain, cannabis legalisation, and cannabis use disorder among patients in the US Veterans Health Administration system, 2005 to 2019: a repeated, cross-sectional study. Lancet Psychiatry 2023; 10:877-886. [PMID: 37837985 PMCID: PMC10627060 DOI: 10.1016/s2215-0366(23)00268-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Cannabis use disorder is associated with considerable comorbidity and impairment in functioning, and prevalence is increasing among adults with chronic pain. We aimed to assess the effect of introduction of medical cannabis laws (MCL) and recreational cannabis laws (RCL) on the increase in cannabis use disorder among patients in the US Veterans Health Administration (VHA). METHODS Data from patients with one or more primary care, emergency, or mental health visit to the VHA in 2005-19 were analysed using 15 repeated cross-sectional VHA electronic health record datasets (ie, one dataset per year). Patients in hospice or palliative care were excluded. Patients were stratified as having chronic pain or not using an American Pain Society taxonomy of painful medical conditions. We used staggered-adoption difference-in-difference analyses to estimate the role of MCL and RCL enactment in the increases in prevalence of diagnosed cannabis use disorder and associations with presence of chronic pain, accounting for the year that state laws were enacted. We did this by fitting a linear binomial regression model stratified by pain, with time-varying cannabis law status, fixed effects for state, categorical year, time-varying state-level sociodemographic covariates, and patient covariates (age group [18-34 years, 35-64 years, and 65-75 years], sex, and race and ethnicity). FINDINGS Between 2005 and 2019, 3 234 382-4 579 994 patients were included per year. Among patients without pain in 2005, 5·1% were female, mean age was 58·3 (SD 12·6) years, and 75·7%, 15·6%, and 3·6% were White, Black, and Hispanic or Latino, respectively. In 2019, 9·3% were female, mean age was 56·7 (SD 15·2) years, and 68·1%, 18·2%, and 6·5% were White, Black, and Hispanic or Latino, respectively. Among patients with pain in 2005, 7·1% were female, mean age was 57·2 (SD 11·4) years, and 74·0%, 17·8%, and 3·9% were White, Black, and Hispanic or Latino, respectively. In 2019, 12·4% were female, mean age was 57·2 (SD 13·8) years, and 65·3%, 21·9%, and 7·0% were White, Black, and Hispanic or Latino, respectively. Among patients with chronic pain, enacting MCL led to a 0·135% (95% CI 0·118-0·153) absolute increase in cannabis use disorder prevalence, with 8·4% of the total increase in MCL-enacting states attributable to MCL. Enacting RCL led to a 0·188% (0·160-0·217) absolute increase in cannabis use disorder prevalence, with 11·5% of the total increase in RCL-enacting states attributable to RCL. In patients without chronic pain, enacting MCL and RCL led to smaller absolute increases in cannabis use disorder prevalence (MCL: 0·037% [0·027-0·048], 5·7% attributable to MCL; RCL: 0·042% [0·023-0·060], 6·0% attributable to RCL). Overall, associations of MCL and RCL with cannabis use disorder were greater in patients with chronic pain than in patients without chronic pain. INTERPRETATION Increasing cannabis use disorder prevalence among patients with chronic pain following state legalisation is a public health concern, especially among older age groups. Given cannabis commercialisation and widespread public beliefs about its efficacy, clinical monitoring of cannabis use and discussion of the risk of cannabis use disorder among patients with chronic pain is warranted. FUNDING NIDA grant R01DA048860, New York State Psychiatric Institute, and the VA Centers of Excellence in Substance Addiction Treatment and Education.
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Affiliation(s)
- Deborah S Hasin
- Columbia University Irving Medical Center, New York, NY, USA; Columbia University Mailman School of Public Health, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Melanie M Wall
- Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Carol Malte
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Mark Olfson
- Columbia University Irving Medical Center, New York, NY, USA
| | - Katherine M Keyes
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | - Charles C Maynard
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Salomeh Keyhani
- San Francisco VA Health System, San Francisco, CA, USA; University of California at San Francisco, San Francisco, CA, USA
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - David S Fink
- New York State Psychiatric Institute, New York, NY, USA
| | - Ofir Livne
- New York State Psychiatric Institute, New York, NY, USA
| | - Yoanna McDowell
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Scott Sherman
- New York University, New York, NY, USA; VA Manhattan Harbor Healthcare, New York, NY, USA
| | - Andrew J Saxon
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA
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19
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Wong J, Gill M, Stead T, Huang D, Ganti L. Cannabinoid hyperemesis syndrome presenting with ventricular bigeminy. J Cannabis Res 2023; 5:36. [PMID: 37858157 PMCID: PMC10585805 DOI: 10.1186/s42238-023-00203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
The is a case of a 28-year-old male presenting to an emergency department (ED) via emergency medical services (EMS) with a chief complaint of "gastritis." He was noted to have bigeminy on the pre-arrival EMS electrocardiogram. He was ultimately diagnosed with cannabinoid hyperemesis syndrome (CHS). CHS is becoming an exceedingly common emergency department presentation due to the poorly regulated but widespread availability of cannabis products. The authors discuss a case of CHS and ventricular bigeminy.
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Affiliation(s)
| | | | - Thor Stead
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Derrick Huang
- Ocala Regional Medical Center, Ocala, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Latha Ganti
- Brown University, Providence, RI, USA.
- University of Central Florida College of Medicine, Orlando, FL, USA.
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20
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Rogers CI, Pacanowski CR. The relationship between cannabis and anorexia nervosa: a scoping review. J Eat Disord 2023; 11:186. [PMID: 37858278 PMCID: PMC10585887 DOI: 10.1186/s40337-023-00887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Relapse rates in Anorexia Nervosa (AN) remain high, warranting exploration of further treatments. Cannabinoid agonists are of interest as they have shown successful outcomes in the treatment of associated conditions, such as post-traumatic stress disorder. This scoping review explores the endocannabinoid system (ECS), benefits/harms/null effects of cannabinoid treatment, and harms of cannabis use in AN. METHODS PubMed, PsycINFO, Cochrane, and Web of Science were searched for studies published between 2010 and August 2023, with human participants that explored the ECS, cannabinoid treatment, or cannabis use, and included 1 or more keywords for both cannabis and AN in the title and or abstract. Reports describing secondary anorexia, reports not available in English, grey literature, reports combining data from AN with other conditions, and reports only reporting the prevalence of cannabis abuse/dependence were excluded. Data were extracted from 17 reports (n = 15 studies). For the ECS, outcomes included genetics such as allele expression related to the ECS, cannabinoid receptor availability, and circulating levels of endocannabinoids. For benefits/harms/null effects of cannabinoid treatment, outcomes included changes in weight, eating disorder (ED) symptoms, physical activity (PA), and hormones. For harms of cannabis use, outcomes included genetics related to cannabis use disorder and associations between cannabis use and ED symptoms. RESULTS Eight studies (n = 8 reports) found abnormalities in the ECS in AN including expression of related alleles, genotypes, and haplotypes, availability of cannabinoid receptors, and levels of endocannabinoids. Three studies (n = 5 reports) found benefits/harms/null effects of cannabinoid treatment. Benefits included weight gain, improved ED symptoms and reduced PA, while null effects included no changes in weight or ED symptoms, and harms included increased PA and lowered adipose hormones. Four studies (n = 4 reports) expanded upon harms of cannabis use, including genetic predispositions to cannabis use disorder, and compensatory behaviors related to cannabis use. CONCLUSION Limited evidence suggests that abnormalities in the ECS in AN may render cannabis a potential treatment for weight restoration and associated symptoms. Future research may wish to investigate individualized dosing approaches to maximize beneficial effects while minimizing harms. Level II Evidence: Scoping Review.
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Affiliation(s)
- Chloe I Rogers
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA.
| | - Carly R Pacanowski
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
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21
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Riha R, Winchell R, Safo D, Gentges J. Cannabinoid Hyperemesis Encounters After Medical Legalization in Oklahoma. Cureus 2023; 15:e46465. [PMID: 37927644 PMCID: PMC10624147 DOI: 10.7759/cureus.46465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Medical cannabis has recently become legal in Oklahoma. Cannabinoid hyperemesis syndrome (CHS) is severe nausea, vomiting, and often abdominal pain typically seen in heavy users of cannabis. The aim of this study is to determine whether emergency department (ED) diagnoses of CHS have increased after medical legalization. Methods We performed a retrospective chart review study of equivalent time periods prior to and after the first legal sales of medical cannabis in Oklahoma. Data were gathered from a single urban ED of adult patients with diagnosed or suspected CHS. We analyzed data using a chi-square analysis of CHS cases as a proportion of total ED visits. Results Diagnosed and suspected CHS visits increased from 43 cases in the eight months preceding the first legal sale to 62 cases in the eight months after legalization. This represents a statistically significant increase in ED visits for CHS (p = 0.026). Total ED encounters were 30,437 and 28,362, respectively, during those time periods. The proportion of visits for CHS was much higher (220/100000 vs 13.3/100000) than previously reported in the literature. The pre-legalization and post-legalization groups did not differ by age, sex, history of GI illness and diabetes, pregnancy, or other drug use. Conclusion We observed a statistically significant increase in ED visits for CHS after the first legal sales of medical cannabis in Oklahoma. Our high proportion of ED visits for CHS could be related to study design, increased provider awareness, high THC levels in Oklahoma's medical cannabis, or increased numbers of cannabis users after legalization. Increases in ED visits for CHS and other cannabinoid-related illnesses must be weighed against the positive effects for cannabis users by policymakers.
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Affiliation(s)
- Randal Riha
- Department of Emergency Medicine, St. John's Ascension, Tulsa, USA
| | - Ryan Winchell
- Department of Emergency Medicine, University of Oklahoma Health Sciences Center, Tulsa, USA
| | - Danielle Safo
- Department of Emergency Medicine, University of Oklahoma Health Sciences Center, Tulsa, USA
| | - Joshua Gentges
- Department of Emergency Medicine, University of Oklahoma Health Sciences Center, Tulsa, USA
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22
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Brown JM, Wilsey MJ, Dhana L, Lonsdale H. Acute Treatment of Adolescent Cannabinoid Hyperemesis Syndrome With Haloperidol, Lorazepam, and/or Capsaicin: A Single Institution Case Series. J Psychiatr Pract 2023; 29:354-358. [PMID: 37678364 DOI: 10.1097/pra.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Cannabinoid hyperemesis syndrome (CHS), an under-recognized and seemingly paradoxical condition, arises in some adolescents and adults who chronically use cannabis. It presents acutely with intractable nausea, vomiting, and abdominal pain but standard antiemetic therapy leads to improvement for only a minority of patients. Randomized controlled trial evidence in adults indicates the superiority of haloperidol over ondansetron in alleviating the acute symptoms of CHS, but safe and effective treatment for adolescents with the disorder is currently unknown. The successful use of topical capsaicin has also been reported. We report a case series of 6 adolescent patients with CHS who presented to Johns Hopkins All Children's Hospital and were treated with haloperidol, lorazepam, and/or capsaicin. Four patients given 5 mg intravenous (IV) haloperidol and 2 mg IV lorazepam and 1 patient treated with 5 mg IV haloperidol and peri-umbilical topical capsaicin (0.025%) experienced full acute symptomatic relief. One patient, treated only with topical capsaicin, reported improvement of symptoms with some persistent nausea. Haloperidol/lorazepam, haloperidol/capsaicin, and topical capsaicin alone appear safe and effective in adolescents, but larger studies are required to confirm our findings.
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23
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Solmi M, De Toffol M, Kim JY, Choi MJ, Stubbs B, Thompson T, Firth J, Miola A, Croatto G, Baggio F, Michelon S, Ballan L, Gerdle B, Monaco F, Simonato P, Scocco P, Ricca V, Castellini G, Fornaro M, Murru A, Vieta E, Fusar-Poli P, Barbui C, Ioannidis JPA, Carvalho AF, Radua J, Correll CU, Cortese S, Murray RM, Castle D, Shin JI, Dragioti E. Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies. BMJ 2023; 382:e072348. [PMID: 37648266 PMCID: PMC10466434 DOI: 10.1136/bmj-2022-072348] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To systematically assess credibility and certainty of associations between cannabis, cannabinoids, and cannabis based medicines and human health, from observational studies and randomised controlled trials (RCTs). DESIGN Umbrella review. DATA SOURCES PubMed, PsychInfo, Embase, up to 9 February 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews with meta-analyses of observational studies and RCTs that have reported on the efficacy and safety of cannabis, cannabinoids, or cannabis based medicines were included. Credibility was graded according to convincing, highly suggestive, suggestive, weak, or not significant (observational evidence), and by GRADE (Grading of Recommendations, Assessment, Development and Evaluations) (RCTs). Quality was assessed with AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). Sensitivity analyses were conducted. RESULTS 101 meta-analyses were included (observational=50, RCTs=51) (AMSTAR 2 high 33, moderate 31, low 32, or critically low 5). From RCTs supported by high to moderate certainty, cannabis based medicines increased adverse events related to the central nervous system (equivalent odds ratio 2.84 (95% confidence interval 2.16 to 3.73)), psychological effects (3.07 (1.79 to 5.26)), and vision (3.00 (1.79 to 5.03)) in people with mixed conditions (GRADE=high), improved nausea/vomit, pain, spasticity, but increased psychiatric, gastrointestinal adverse events, and somnolence among others (GRADE=moderate). Cannabidiol improved 50% reduction of seizures (0.59 (0.38 to 0.92)) and seizure events (0.59 (0.36 to 0.96)) (GRADE=high), but increased pneumonia, gastrointestinal adverse events, and somnolence (GRADE=moderate). For chronic pain, cannabis based medicines or cannabinoids reduced pain by 30% (0.59 (0.37 to 0.93), GRADE=high), across different conditions (n=7), but increased psychological distress. For epilepsy, cannabidiol increased risk of diarrhoea (2.25 (1.33 to 3.81)), had no effect on sleep disruption (GRADE=high), reduced seizures across different populations and measures (n=7), improved global impression (n=2), quality of life, and increased risk of somnolence (GRADE=moderate). In the general population, cannabis worsened positive psychotic symptoms (5.21 (3.36 to 8.01)) and total psychiatric symptoms (7.49 (5.31 to 10.42)) (GRADE=high), negative psychotic symptoms, and cognition (n=11) (GRADE=moderate). In healthy people, cannabinoids improved pain threshold (0.74 (0.59 to 0.91)), unpleasantness (0.60 (0.41 to 0.88)) (GRADE=high). For inflammatory bowel disease, cannabinoids improved quality of life (0.34 (0.22 to 0.53) (GRADE=high). For multiple sclerosis, cannabinoids improved spasticity, pain, but increased risk of dizziness, dry mouth, nausea, somnolence (GRADE=moderate). For cancer, cannabinoids improved sleep disruption, but had gastrointestinal adverse events (n=2) (GRADE=moderate). Cannabis based medicines, cannabis, and cannabinoids resulted in poor tolerability across various conditions (GRADE=moderate). Evidence was convincing from observational studies (main and sensitivity analyses) in pregnant women, small for gestational age (1.61 (1.41 to 1.83)), low birth weight (1.43 (1.27 to 1.62)); in drivers, car crash (1.27 (1.21 to 1.34)); and in the general population, psychosis (1.71 (1.47 to 2.00)). Harmful effects were noted for additional neonatal outcomes, outcomes related to car crash, outcomes in the general population including psychotic symptoms, suicide attempt, depression, and mania, and impaired cognition in healthy cannabis users (all suggestive to highly suggestive). CONCLUSIONS Convincing or converging evidence supports avoidance of cannabis during adolescence and early adulthood, in people prone to or with mental health disorders, in pregnancy and before and while driving. Cannabidiol is effective in people with epilepsy. Cannabis based medicines are effective in people with multiple sclerosis, chronic pain, inflammatory bowel disease, and in palliative medicine but not without adverse events. STUDY REGISTRATION PROSPERO CRD42018093045. FUNDING None.
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Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ontario, ON, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Early Psychosis: Interventions and Clinical detection Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
- Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, and NHS Trust, Southampton, UK
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Marco De Toffol
- Psychiatry Unit, Veris Delli Ponti Scorrano Hospital, Department of Mental Health, ASL Lecce, Lecce, Italy
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | - Min Je Choi
- Yonsei University College of Medicine, Seoul, South Korea
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Trevor Thompson
- Centre of Chronic Illness and Ageing, University of Greenwich, London, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alessandro Miola
- Neurosciences Department, Padua Neuroscience Center, University of Padua, Italy
| | - Giovanni Croatto
- Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy
| | - Francesca Baggio
- Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy
| | - Silvia Michelon
- Department of Mental Health, AULSS 7 Pedemontana Veneto, Italy
| | - Luca Ballan
- Department of Mental Health, AULSS 7 Pedemontana Veneto, Italy
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Francesco Monaco
- Department of Mental Health, Asl Salerno, Salerno, Italy
- European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Pierluigi Simonato
- Department of Clinical, Pharmaceutical and Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Paolo Scocco
- Mental Health Department, ULSS 6 Euganea, Padova, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Andrea Murru
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical detection Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center Berlin, Berlin Institute of Health, Charité Universitätsmedizin, Berlin, Germany
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, CA, USA
| | - Andrè F Carvalho
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Joaquim Radua
- Institut d'Investigacions Biomediques August Pi i Sunyer, CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Samuele Cortese
- Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, and NHS Trust, Southampton, UK
- Clinical and Experimental Sciences (Central Nervous System and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, NY, USA
| | - Robin M Murray
- Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, UK
| | - David Castle
- Department of Psychiatry, University of Tasmania, Sandy Bay, TAS, Australia
- Co-Director, Centre for Mental Health Service Innovation, Department of Health, Tasmania, Australia
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
- Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul, South Korea
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
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24
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Khalid N, Abdullah M, Khalil M, Afzal MA, Hindawi M. Cannabis Hyperemesis Syndrome in a Young Patient: A Case Report and Literature Review. Cureus 2023; 15:e43868. [PMID: 37736461 PMCID: PMC10511210 DOI: 10.7759/cureus.43868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Cannabis hyperemesis syndrome (CHS) is a condition characterized by recurrent episodes of severe vomiting, abdominal pain, and intractable nausea in chronic cannabis users. With the legalization of recreational marijuana in many states, awareness of CHS is crucial to prevent delayed diagnosis or misdiagnosis. This case report presents a 25-year-old male with a history of type 1 diabetes mellitus and chronic cannabis use who presented to the emergency department with vomiting and epigastric pain. Our literature review sheds light on existing treatment options for this syndrome and gives future direction for research.
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Affiliation(s)
- Noman Khalid
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Muhammad Abdullah
- Department of Medicine/Department of Public Health and Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Shaikh Zayed Federal Postgraduate Medical Institute at Shaikh Zayed Medical Complex, Lahore, PAK
| | - Musa Khalil
- Medicine, Shaikh Zayed Hospital, Lahore, PAK
| | | | - Mulham Hindawi
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
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25
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Wightman RS, Metrik J, Lin TR, Li Y, Badea A, Almeida R, Collins AB, Beaudoin FL. Cannabis Use Patterns and Whole-Blood Cannabinoid Profiles of Emergency Department Patients With Suspected Cannabinoid Hyperemesis Syndrome. Ann Emerg Med 2023; 82:121-130. [PMID: 37479395 PMCID: PMC10363750 DOI: 10.1016/j.annemergmed.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/17/2023] [Accepted: 03/03/2023] [Indexed: 07/23/2023]
Abstract
STUDY OBJECTIVES The objectives of this study were to characterize the detailed cannabis use patterns (eg, frequency, mode, and product) and determine the differences in the whole-blood cannabinoid profiles during symptomatic versus asymptomatic periods of participants with suspected cannabinoid hyperemesis syndrome recruited from the emergency department (ED) during a symptomatic episode. METHODS This is a prospective observational cohort study of participants with symptomatic cyclic vomiting onset after chronic cannabis use. Standardized assessments were conducted to evaluate for lifetime and recent cannabis use, cannabis use disorder, and cannabis withdrawal symptoms. Quantitative whole-blood cannabinoid testing was performed at 2 times, first when symptomatic (ie, baseline) and at least 2 weeks after the ED visit when asymptomatic. The differences in cannabinoid concentrations were compared between symptomatic and asymptomatic testing. The study was conducted from September 2021 to August 2022. RESULTS There was a difference observed between delta-9-tetrahydrocannabinol metabolites, but not the parent compound during symptomatic episodes and asymptomatic periods. Most participants (84%) reported using cannabis > once per day (median 3 times per day on weekdays, 4 times per day on weekends). Hazardous cannabis use was universal among participants; the mean cannabis withdrawal discomfort score was 13, indicating clinically significant rates of cannabis withdrawal symptoms with cessation of use. Most participants (79%) previously tried to stop cannabis use, but a few (13%) of them had sought treatment. CONCLUSION Patients presenting to the ED with cannabinoid hyperemesis syndrome have high cannabis use disorder scores. Further studies are needed to better understand the influence of THC metabolism and concentrations on symptomatic cyclic vomiting.
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Affiliation(s)
- Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, School of Public Health at Brown University, Providence, RI.
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, RI; Providence VA Medical Center, Providence, RI
| | | | - Yu Li
- Department of Epidemiology, School of Public Health at Brown University, Providence, RI
| | - Adina Badea
- Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Robert Almeida
- Forensic Toxicology Laboratory, Department of Health, Rhode Island, Providence, RI
| | - Alexandra B Collins
- Department of Epidemiology, School of Public Health at Brown University, Providence, RI
| | - Francesca L Beaudoin
- Department of Epidemiology, School of Public Health at Brown University, Providence, RI
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26
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Hasin DS, Wall MM, Alschuler D, Mannes ZL, Malte C, Olfson M, Keyes KM, Gradus JL, Cerdá M, Maynard CC, Keyhani S, Martins SS, Fink DS, Livne O, McDowell Y, Sherman S, Saxon AJ. Chronic Pain, Cannabis Legalization and Cannabis Use Disorder in Veterans Health Administration Patients, 2005 to 2019. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.10.23292453. [PMID: 37503049 PMCID: PMC10370240 DOI: 10.1101/2023.07.10.23292453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background The risk for cannabis use disorder (CUD) is elevated among U.S. adults with chronic pain, and CUD rates are disproportionately increasing in this group. Little is known about the role of medical cannabis laws (MCL) and recreational cannabis laws (RCL) in these increases. Among U.S. Veterans Health Administration (VHA) patients, we examined whether MCL and RCL effects on CUD prevalence differed between patients with and without chronic pain. Methods Patients with ≥1 primary care, emergency, or mental health visit to the VHA and no hospice/palliative care within a given calendar year, 2005-2019 (yearly n=3,234,382 to 4,579,994) were analyzed using VHA electronic health record (EHR) data. To estimate the role of MCL and RCL enactment in the increases in prevalence of diagnosed CUD and whether this differed between patients with and without chronic pain, staggered-adoption difference-in-difference analyses were used, fitting a linear binomial regression model with fixed effects for state, categorical year, time-varying cannabis law status, state-level sociodemographic covariates, a chronic pain indicator, and patient covariates (age group [18-34, 35-64; 65-75], sex, and race and ethnicity). Pain was categorized using an American Pain Society taxonomy of painful medical conditions. Outcomes In patients with chronic pain, enacting MCL led to a 0·14% (95% CI=0·12%-0·15%) absolute increase in CUD prevalence, with 8·4% of the total increase in CUD prevalence in MCL-enacting states attributable to MCL. Enacting RCL led to a 0·19% (95%CI: 0·16%, 0·22%) absolute increase in CUD prevalence, with 11·5% of the total increase in CUD prevalence in RCL-enacting states attributable to RCL. In patients without chronic pain, enacting MCL and RCL led to smaller absolute increases in CUD prevalence (MCL: 0·037% [95%CI: 0·03, 0·05]; RCL: 0·042% [95%CI: 0·02, 0·06]), with 5·7% and 6·0% of the increases in CUD prevalence attributable to MCL and RCL. Overall, MCL and RCL effects were significantly greater in patients with than without chronic pain. By age, MCL and RCL effects were negligible in patients age 18-34 with and without pain. In patients age 35-64 with and without pain, MCL and RCL effects were significant (p<0.001) but small. In patients age 65-75 with pain, absolute increases were 0·10% in MCL-only states and 0·22% in MCL/RCL states, with 9·3% of the increase in CUD prevalence in MCL-only states attributable to MCL, and 19.4% of the increase in RCL states attributable to RCL. In patients age 35-64 and 65-75, MCL and RCL effects were significantly greater in patients with pain. Interpretation In patients age 35-75, the role of MCL and RCL in the increasing prevalence of CUD was greater in patients with chronic pain than in those without chronic pain, with particularly pronounced effects in patients with chronic pain age 65-75. Although the VHA offers extensive behavioral and non-opioid pharmaceutical treatments for pain, cannabis may seem a more appealing option given media enthusiasm about cannabis, cannabis commercialization activities, and widespread public beliefs about cannabis efficacy. Cannabis does not have the risk/mortality profile of opioids, but CUD is a clinical condition with considerable impairment and comorbidity. Because cannabis legalization in the U.S. is likely to further increase, increasing CUD prevalence among patients with chronic pain following state legalization is a public health concern. The risk of chronic pain increases as individuals age, and the average age of VHA patients and the U.S. general population is increasing. Therefore, clinical monitoring of cannabis use and discussion of the risk of CUD among patients with chronic pain is warranted, especially among older patients. Research in Context Evidence before this study: Only three studies have examined the role of state medical cannabis laws (MCL) and/or recreational cannabis laws (RCL) in the increasing prevalence of cannabis use disorder (CUD) in U.S. adults, finding significant MCL and RCL effects but with modest effect sizes. Effects of MCL and RCL may vary across important subgroups of the population, including individuals with chronic pain. PubMed was searched by DH for publications on U.S. time trends in cannabis legalization, cannabis use disorders (CUD) and pain from database inception until March 15, 2023, without language restrictions. The following search terms were used: (medical cannabis laws) AND (pain) AND (cannabis use disorder); (recreational cannabis laws) AND (pain) AND (cannabis use disorder); (cannabis laws) AND (pain) AND (cannabis use disorder). Only one study was found that had CUD as an outcome, and this study used cross-sectional data from a single year, which cannot be used to determine trends over time. Therefore, evidence has been lacking on whether the role of state medical and recreational cannabis legalization in the increasing US adult prevalence of CUD differed by chronic pain status.Added value of this study: To our knowledge, this is the first study to examine whether the effects of state MCL and RCL on the nationally increasing U.S. rates of adult cannabis use disorder differ by whether individuals experience chronic pain or not. Using electronic medical record data from patients in the Veterans Health Administration (VHA) that included extensive information on medical conditions associated with chronic pain, the study showed that the effects of MCL and RCL on the prevalence of CUD were stronger among individuals with chronic pain age 35-64 and 65-75, an effect that was particularly pronounced in older patients ages 65-75.Implications of all the available evidence: MCL and RCL are likely to influence the prevalence of CUD through commercialization that increases availability and portrays cannabis use as 'normal' and safe, thereby decreasing perception of cannabis risk. In patients with pain, the overall U.S. decline in prescribed opioids may also have contributed to MCL and RCL effects, leading to substitution of cannabis use that expanded the pool of individuals vulnerable to CUD. The VHA offers extensive non-opioid pain programs. However, positive media reports on cannabis, positive online "information" that can sometimes be misleading, and increasing popular beliefs that cannabis is a useful prevention and treatment agent may make cannabis seem preferable to the evidence-based treatments that the VHA offers, and also as an easily accessible option among those not connected to a healthcare system, who may face more barriers than VHA patients in accessing non-opioid pain management. When developing cannabis legislation, unintended consequences should be considered, including increased risk of CUD in large vulnerable subgroups of the population.
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Affiliation(s)
- Deborah S Hasin
- Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, USA
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Melanie M Wall
- Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Dan Alschuler
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Zachary L Mannes
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Carol Malte
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Mark Olfson
- Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, USA
| | - Katherine M Keyes
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA
| | - Jaimie L Gradus
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Magdalena Cerdá
- New York University, 50 West 4th Street, New York, NY 10012, USA
| | - Charles C Maynard
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA
- University of Washington, 1400 Ne Campus Parkway, Seattle, WA 98195, USA
| | - Salomeh Keyhani
- San Francisco VA Health System, 4150 Clement St, San Francisco, CA 94121, USA
- University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA
| | - David S Fink
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Ofir Livne
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Yoanna McDowell
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Scott Sherman
- New York University, 50 West 4th Street, New York, NY 10012, USA
- VA Manhattan Harbor Healthcare, 423 E 23rd St, New York, NY 10010, USA
| | - Andrew J Saxon
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
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27
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Hewitt M, Ma P, Coyle E, Leidlein S, Jennings K, Wanis N, Miller J. Natural language processing improves estimates of the epidemiology of cannabinoid hyperemesis syndrome. Am J Emerg Med 2023:S0735-6757(23)00311-X. [PMID: 37349236 DOI: 10.1016/j.ajem.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Marlee Hewitt
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Philip Ma
- Wayne State University School of Medicine, Detroit, MI, USA
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28
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Geraci E, Cake C, Mulieri KM, Fenn NE. Comparison of Antiemetics in the Management of Pediatric Cannabinoid Hyperemesis Syndrome. J Pediatr Pharmacol Ther 2023; 28:222-227. [PMID: 37303765 PMCID: PMC10249977 DOI: 10.5863/1551-6776-28.3.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/16/2022] [Indexed: 06/13/2023]
Abstract
OBJECTIVE As a result of recent legislative changes allowing for increased access to marijuana products, there have been increasing rates of cannabis abuse among adolescents and subsequent diagnoses of cannabinoid hyperemesis syndrome (CHS). Most available literature on this syndrome exists within the adult population and describes benzodiazepines, haloperidol, and topical capsaicin as potentially efficacious in the management of CHS. The objectives of this study were to identify antiemetics and compare their efficacy and safety in the management of pediatric CHS. METHODS A retrospective review of Penn State Children's Hospital electronic health record was performed to identify patients 18 years or younger who had an emergency department or inpatient encounter, a cannabis hyperemesis-related diagnosis code, and met diagnostic criteria for CHS. Antiemetic efficacy was determined using subjective patient perception of nausea and objective documentation of vomiting. Benzodiazepines, haloperidol, and topical capsaicin were classified as nontraditional antiemetics, whereas all other antiemetics were classified as traditional. RESULTS Nontraditional antiemetic medications appeared to be more effective in resolving patient symptoms compared with traditional antiemetics. Analysis of all ordered antiemetics demonstrated a gap in partial or full symptom resolution between nontraditional and traditional agents. Reported adverse effects were minimal. CONCLUSIONS Cannabinoid hyperemesis syndrome is an underrecognized and underdiagnosed condition characterized by cyclic vomiting related to chronic cannabis use. Abstinence from cannabis remains the most effective approach to mitigating morbidity associated with CHS. Medications such as lorazepam or droperidol may have benefit in managing toxidrome symptoms. Traditional antiemetic prescribing remains a key barrier to effective management of pediatric CHS.
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Affiliation(s)
- Emily Geraci
- Department of Pharmacy, University of Rochester Medical Center–Golisano Children's Hospital, Rochester, NY (EG)
| | - Carrie Cake
- Department of Pharmacy, Penn State Children's Hospital, Hershey, PA (CC, KMM)
| | - Kevin M. Mulieri
- Department of Pharmacy, Penn State Children's Hospital, Hershey, PA (CC, KMM)
| | - Norman E. Fenn
- Department of Pharmacy Practice, Manchester University College of Pharmacy and Natural Sciences, Fort Wayne, IN (NEF)
- Department of Pharmacy, Parkview Regional Medical Center, Fort Wayne, IN (NEF)
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29
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Collins AB, Beaudoin FL, Metrik J, Wightman RS. "I still partly think this is bullshit": A qualitative analysis of cannabinoid hyperemesis syndrome perceptions among people with chronic cannabis use and cyclic vomiting. Drug Alcohol Depend 2023; 246:109853. [PMID: 36996524 PMCID: PMC10121940 DOI: 10.1016/j.drugalcdep.2023.109853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Cannabis is the most widely used psychoactive substance in the United States (US), with reported use patterns increasing among adults in recent years. Cannabinoid hyperemesis syndrome (CHS) has been one concern related to increased cannabis use patterns. US emergency departments have reported an increase of CHS cases over the last decade, yet little is known about CHS. This study explores the experiences of people with chronic cannabis use and cyclic vomiting and their perceptions of CHS. METHODS Semi-structured interviews were conducted with 24 people recruited from a prospective cohort of patients presenting to Rhode Island emergency departments with symptomatic cyclic vomiting and chronic cannabis use. Data were analyzed thematically using NVivo. FINDINGS Participants characterized their cyclic vomiting as related to food and alcohol consumption patterns, stress, and existing gastrointestinal issues. Despite recurrent episodes of cyclic vomiting, nausea, and abdominal pain, many participants remained uncertain whether their symptoms were driven by cannabis. Many participants relied on at-home research to assess their symptoms and seek out management approaches. Clinical treatment recommendations focused on cannabis cessation. However, most participants felt clinical recommendations failed to consider the complexity and challenge of stopping cannabis use given the chronicity of use and therapeutic benefits some perceived cannabis to have. CONCLUSIONS Although cannabis cessation is the only reported CHS cure to date, additional clinical and non-clinical treatment approaches are needed to better support people with chronic cannabis use and cyclic vomiting to meet their ongoing needs.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA; Providence VA Medical Center, Providence, RI, 02908, USA
| | - Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
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30
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George P, Wahl M. Cannabis Toxicity in Children and Adolescents. Pediatr Ann 2023; 52:e181-e186. [PMID: 37159059 DOI: 10.3928/19382359-20230307-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The legalization of recreational and medical cannabis has increased the availability and potency of cannabis products in homes and communities. Although state laws regarding legalization and commercial sale often encompass adult use only, pediatric toxicity from unintentional exposures to cannabis edibles and adolescent harm from chronic use are increasing in states and countries that have relaxed laws on use. Unintentional edible ingestions are shown to increase in regions that legalize and commercialize cannabis products at the retail level. Long-term effects on teenagers regarding psychiatric changes as well as acute gastrointestinal effects from hyperemesis syndrome are well documented in the medical literature. This article provides clinical information on the presentation, evaluation, and management of adverse effects from pediatric and adolescent teen exposures to cannabis seen in acute care and emergent settings. [Pediatr Ann. 2023;52(5):e181-e186.].
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31
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Lathrop JR, Rosen SN, Heitkemper MM, Buchanan DT. Cyclic Vomiting Syndrome and Cannabis Hyperemesis Syndrome: The State of the Science. Gastroenterol Nurs 2023; 46:208-224. [PMID: 37074964 DOI: 10.1097/sga.0000000000000730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 04/20/2023] Open
Abstract
This article provides a narrative review of the state of the science for both cyclic vomiting syndrome and cannabis hyperemesis syndrome along with a discussion of the relationship between these 2 conditions. The scope of this review includes the historical context of these conditions as well as the prevalence, diagnostic criteria, pathogenesis, and treatment strategies for both conditions. A synopsis of the endocannabinoid system provides a basis for the hypothesis that a lack of cannabidiol in modern high-potency Δ 9 -tetrahydrocannabinol cannabis may be contributory to cannabis hyperemesis syndrome and possibly other cannabis use disorders. In concluding assessment, though the publications addressing both adult cyclic vomiting syndrome and cannabis hyperemesis syndrome are steadily increasing overall, the state of the science supporting the treatments, prognosis, etiology, and confounding factors (including cannabis use) is of moderate quality. Much of the literature portrays these conditions separately and as such sometimes fails to account for the confounding of adult cyclic vomiting syndrome with cannabis hyperemesis syndrome. The diagnostic and therapeutic approaches are, at present, based generally on case series publications and expert opinion, with a very limited number of randomized controlled trials and a complete absence of Level 1 evidence within the cyclic vomiting literature overall as well as for cannabis hyperemesis syndrome specifically.
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Affiliation(s)
- James R Lathrop
- James R. Lathrop, DNP, FNP, ARNP, is a PhD student under the Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Sheldon N. Rosen, MD, is Clinical Associate Professor, Division of Gastroenterology, School of Medicine, University of Washington, Seattle
- Margaret M. Heitkemper, PhD, RN, FAAN, is Professor and Elizabeth Sterling Soule Endowed Chair in Nursing, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Diana Taibi Buchanan, PhD, RN, is Associate Professor and Mary S. Tschudin Endowed Professor of Nursing Education, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
| | - Sheldon N Rosen
- James R. Lathrop, DNP, FNP, ARNP, is a PhD student under the Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Sheldon N. Rosen, MD, is Clinical Associate Professor, Division of Gastroenterology, School of Medicine, University of Washington, Seattle
- Margaret M. Heitkemper, PhD, RN, FAAN, is Professor and Elizabeth Sterling Soule Endowed Chair in Nursing, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Diana Taibi Buchanan, PhD, RN, is Associate Professor and Mary S. Tschudin Endowed Professor of Nursing Education, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
| | - Margaret M Heitkemper
- James R. Lathrop, DNP, FNP, ARNP, is a PhD student under the Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Sheldon N. Rosen, MD, is Clinical Associate Professor, Division of Gastroenterology, School of Medicine, University of Washington, Seattle
- Margaret M. Heitkemper, PhD, RN, FAAN, is Professor and Elizabeth Sterling Soule Endowed Chair in Nursing, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Diana Taibi Buchanan, PhD, RN, is Associate Professor and Mary S. Tschudin Endowed Professor of Nursing Education, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
| | - Diana Taibi Buchanan
- James R. Lathrop, DNP, FNP, ARNP, is a PhD student under the Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Sheldon N. Rosen, MD, is Clinical Associate Professor, Division of Gastroenterology, School of Medicine, University of Washington, Seattle
- Margaret M. Heitkemper, PhD, RN, FAAN, is Professor and Elizabeth Sterling Soule Endowed Chair in Nursing, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Diana Taibi Buchanan, PhD, RN, is Associate Professor and Mary S. Tschudin Endowed Professor of Nursing Education, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
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32
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Hasin DS, Wall MM, Choi CJ, Alschuler DM, Malte C, Olfson M, Keyes KM, Gradus JL, Cerdá M, Maynard CC, Keyhani S, Martins SS, Fink DS, Livne O, Mannes Z, Sherman S, Saxon AJ. State Cannabis Legalization and Cannabis Use Disorder in the US Veterans Health Administration, 2005 to 2019. JAMA Psychiatry 2023; 80:380-388. [PMID: 36857036 PMCID: PMC9979011 DOI: 10.1001/jamapsychiatry.2023.0019] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/21/2022] [Indexed: 03/02/2023]
Abstract
Importance Cannabis use disorder (CUD) is increasing among US adults. Few national studies have addressed the role of medical cannabis laws (MCLs) and recreational cannabis laws (RCLs) in these increases, particularly in patient populations with high rates of CUD risk factors. Objective To quantify the role of MCL and RCL enactment in the increases in diagnosed CUD prevalence among Veterans Health Administration (VHA) patients from 2005 to 2019. Design, Setting, and Participants Staggered-adoption difference-in-difference analyses were used to estimate the role of MCL and RCL in the increases in prevalence of CUD diagnoses, fitting a linear binomial regression model with fixed effects for state, categorical year, time-varying cannabis law status, state-level sociodemographic covariates, and patient age group, sex, and race and ethnicity. Patients aged 18 to 75 years with 1 or more VHA primary care, emergency department, or mental health visit and no hospice/palliative care within a given calendar year were included. Time-varying yearly state control covariates were state/year rates from American Community Survey data: percentage male, Black, Hispanic, White, 18 years or older, unemployed, income below poverty threshold, and yearly median household income. Analysis took place between February to December 2022. Main Outcomes and Measures As preplanned, International Classification of Diseases, Clinical Modification, ninth and tenth revisions, CUD diagnoses from electronic health records were analyzed. Results The number of individuals analyzed ranged from 3 234 382 in 2005 to 4 579 994 in 2019. Patients were largely male (94.1% in 2005 and 89.0% in 2019) and White (75.0% in 2005 and 66.6% in 2019), with a mean (SD) age of 57.0 [14.4] years. From 2005 to 2019, adjusted CUD prevalences increased from 1.38% to 2.25% in states with no cannabis laws (no CLs), 1.38% to 2.54% in MCL-only enacting states, and 1.39% to 2.56% in RCL-enacting states. Difference-in-difference results indicated that MCL-only enactment was associated with a 0.05% (0.05-0.06) absolute increase in CUD prevalence, ie, that 4.7% of the total increase in CUD prevalence in MCL-only enacting states could be attributed to MCLs, while RCL enactment was associated with a 1.12% (95% CI, 0.10-0.13) absolute increase in CUD prevalence, ie, that 9.8% of the total increase in CUD prevalence in RCL-enacting states could be attributed to RCLs. The role of RCL in the increases in CUD prevalence was greatest in patients aged 65 to 75 years, with an absolute increase of 0.15% (95% CI, 0.13-0.17) in CUD prevalence associated with RCLs, ie, 18.6% of the total increase in CUD prevalence in that age group. Conclusions and Relevance In this study of VHA patients, MCL and RCL enactment played a significant role in the overall increases in CUD prevalence, particularly in older patients. However, consistent with general population studies, effect sizes were relatively small, suggesting that cumulatively, laws affected cannabis attitudes diffusely across the country or that other factors played a larger role in the overall increases in adult CUD. Results underscore the need to screen for cannabis use and CUD and to treat CUD when it is present.
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Affiliation(s)
- Deborah S. Hasin
- Columbia University and New York State Psychiatric Institute, New York
| | - Melanie M. Wall
- Columbia University and New York State Psychiatric Institute, New York
| | - C. Jean Choi
- Mental Health Data Science, New York State Psychiatric Institute, New York
| | | | - Carol Malte
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - Mark Olfson
- Columbia University and New York State Psychiatric Institute, New York
| | | | | | | | - Charles C. Maynard
- VA Puget Sound Health Care System and University of Washington, Seattle, Washington
| | - Salomeh Keyhani
- San Francisco VA Health System and University of California at San Francisco, San Francisco
| | | | | | | | | | - Scott Sherman
- VA Manhattan Harbor Healthcare and New York University, New York
| | - Andrew J. Saxon
- VA Puget Sound Health Care System and University of Washington, Seattle, Washington
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Wightman RS, Perrone J, Collins AB, Lakamana S, Sarker A. An analysis of cannabinoid hyperemesis syndrome Reddit posts and themes. Clin Toxicol (Phila) 2023; 61:283-289. [PMID: 37014024 PMCID: PMC10368483 DOI: 10.1080/15563650.2023.2183790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Reddit hosts a large active community of members dedicated to the discussion of cannabinoid hyperemesis syndrome. We sought to describe common themes discussed and the most frequently mentioned triggers and therapies for cannabinoid hyperemesis syndrome exacerbations in the Reddit online community. METHODS Data collected from six subreddits were filtered using natural language processing to curate posts referencing cannabinoid hyperemesis syndrome. Based on a manual review of posts, common themes were identified. A machine learning model was trained using the manually categorized data to automatically classify the themes for the rest of the posts so that their distributions could be quantified. RESULTS From August 2018 to November 2022, 2683 unique posts were collected. Thematic analysis resulted in five overall themes: cannabinoid hyperemesis syndrome-related science; symptom timing; cannabinoid hyperemesis syndrome treatment and prevention; cannabinoid hyperemesis syndrome diagnosis and education; and health impacts. Additionally, 447 trigger and 664 therapy-related posts were identified. The most commonly mentioned triggers for cannabinoid hyperemesis syndrome episodes included: food and drink (n = 62), cannabinoids (n = 45), mental health (e.g., stress, anxiety) (n = 27), and alcohol (n = 22). Most commonly mentioned cannabinoid hyperemesis syndrome therapies included: hot water/bathing (n = 62), hydration (n = 60), antiemetics (n = 42), food and drink (n = 38), gastrointestinal medications (n = 38), behavioral therapies (e.g., meditation, yoga) (n = 35), and capsaicin (n = 29). DISCUSSION Reddit posts for cannabinoid hyperemesis syndrome provide a valuable source of community discussion and individual reports of people experiencing cannabinoid hyperemesis syndrome. Mental health and alcohol were frequently reported triggers within the posts but are not often identified in the literature. While many of the therapies mentioned are well documented, behavioral responses such as meditation and yoga have not been explored by the scientific literature. CONCLUSIONS Knowledge shared via online social media platforms contains detailed information on self-reported cannabinoid hyperemesis syndrome disease and management experiences, which could serve as valuable data for the development of treatment strategies. Further longitudinal studies in patients with cannabinoid hyperemesis syndrome are needed to corroborate these findings.
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Affiliation(s)
- Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jeanmarie Perrone
- Center for Addiction Medicine and Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandra B Collins
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
| | - Sahithi Lakamana
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Abeed Sarker
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
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Shah S, Schwenk ES, Sondekoppam RV, Clarke H, Zakowski M, Rzasa-Lynn RS, Yeung B, Nicholson K, Schwartz G, Hooten WM, Wallace M, Viscusi ER, Narouze S. ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids. Reg Anesth Pain Med 2023; 48:97-117. [PMID: 36596580 DOI: 10.1136/rapm-2022-104013] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear. METHODS In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement. RESULTS Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes. CONCLUSIONS Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.
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Affiliation(s)
- Shalini Shah
- Dept of Anesthesiology & Perioperative Care, UC Irvine Health, Orange, California, USA
| | - Eric S Schwenk
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Hance Clarke
- Anesthesiology and Pain Medicine, Univ Toronto, Toronto, Ontario, Canada
| | - Mark Zakowski
- Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Brent Yeung
- Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, USA
| | | | - Gary Schwartz
- AABP Integrative Pain Care, Melville, New York, USA.,Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Mark Wallace
- Anesthesiology, Division of Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Eugene R Viscusi
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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35
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Mbakop RNS, Kesiena O, Greene TE, Amakye D. Cannabinoid Hyperemesis Syndrome in a 23-Year-Old Woman with Uncontrolled Type 1 Diabetes Mellitus. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e938418. [PMID: 36806029 PMCID: PMC9946048 DOI: 10.12659/ajcr.938418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients with type 1 diabetes mellitus may experience gastrointestinal symptoms, including those suggestive of diabetic gastroparesis. Cannabinoid hyperemesis syndrome (CHS) includes nausea, vomiting, and abdominal pain in the setting of chronic cannabinoid use. This report presents a case of CHS in a 23-year-old woman with uncontrolled type 1 diabetes mellitus. CASE REPORT A 23-year-old woman with chronically uncontrolled type 1 diabetes mellitus had been presenting monthly at the emergency department for the last 2 years, for acute bouts of intractable nausea and vomiting, occasionally with abdominal pain. Given her history of uncontrolled diabetes, she had been managed for diabetic gastroparesis with prokinetics. A gastric emptying study 6 months prior to admission was normal, and the patient had had multiple unremarkable abdominal computed tomography imaging scans. On this admission, she benefitted from supportive management with only temporary improvement of symptoms. On further questioning, she reported consistent use of cannabis for the last few years, and regression of acute vomiting with hot baths at home. With counseling, she ceased cannabis for 2 months and was symptom-free during this period. CONCLUSIONS This report has shown the importance of taking a comprehensive drug history in all patients, including in patients with type 1 diabetes, and is a reminder that cannabinoid use can cause severe nausea, vomiting, and abdominal pain in this patient group.
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36
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Ince HY, Phan H, Nasr SZ, Pierce JM, Malas N. Clearing up the smoke: Physical and mental health considerations regarding cannabis use in adolescents with cystic fibrosis. Pediatr Pulmonol 2023; 58:398-407. [PMID: 36349504 PMCID: PMC10098788 DOI: 10.1002/ppul.26241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
The cannabis plant is the most used federally illegal drug in the United States and is widely used by adolescents. Cannabis has complex effects on the body and mind. All health professionals who take care of adolescents with cystic fibrosis (CF) should be aware of the factors impacting cannabis use in CF. Given limited evidence regarding the benefits of cannabis and the significant risks, clinicians have the responsibility to identify risk of cannabis use early, counsel patients about the risks, provide a safe space for ongoing conversations about cannabis use in the context of CF care, and deliver evidence-based interventions.
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Affiliation(s)
- H Yavuz Ince
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hanna Phan
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Samya Z Nasr
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica M Pierce
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Nasuh Malas
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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37
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Holt AK, Poklis JL, Peace MR. The history, evolution, and practice of cannabis and E-cigarette industries highlight necessary public health and public safety considerations. JOURNAL OF SAFETY RESEARCH 2023; 84:192-203. [PMID: 36868647 PMCID: PMC10829760 DOI: 10.1016/j.jsr.2022.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/29/2022] [Accepted: 10/25/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Alaina K Holt
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States; Integrative Life Sciences Doctoral Program, Virginia Commonwealth University, Richmond, VA, United States.
| | - Justin L Poklis
- Department of Pharmacology & Toxicology, Virginia Commonwealth University, Richmond, VA, United States.
| | - Michelle R Peace
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States.
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38
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Drouin S, Rizkallah É, Conus F, Larney S, Kaur N, Djignefa Djade C, Jutras-Aswad D. Association Between Markers of Vulnerability for Cannabis-Related Harms and Source of Supply: Secondary Analysis of a Representative Population Survey. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:109-118. [PMID: 36168206 PMCID: PMC9923133 DOI: 10.1177/07067437221128470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In 2018, the sale of non-medical cannabis was authorized in the province of Quebec in Canada, within a public monopoly under the Société Québécoise du Cannabis (SQDC). The objective of this study was to offer a description of the cannabis-using population regarding the sources of cannabis supply and to explore whether at-risk individuals are purchasing cannabis at SQDC. METHOD We used data from a cross-sectional, representative population survey (age >18 years, n = 1799), the Enquête Québécoise sur le Cannabis, which was completed between February and June 2019. Analyses involved adjusted binary logistic regressions, incorporating population weights, to assess 7 potential indicators of harm. RESULTS The vulnerability profiles of SQDC consumers (47.8%) and those acquiring their cannabis elsewhere (52.2%) were similar in terms of frequency of cannabis use (adjusted odds ratio [aOR] = 0.46; 95% confidence interval [CI] = 0.12-1.67), motivation to use (aOR = 0.62; 95% CI = 0.16-2.46), concomitant consumption of other substances (aOR = 0.80; 95% CI = 0.14-4.75), cannabis-impaired driving behaviours (aOR = 0.93; 95% CI = 0.26-3.36), psychological distress (aOR = 0.99; 95% CI = 0.26-3.79), and problematic cannabis use (aOR = 0.46; 95% CI = 0.13-1.64). However, SQDC consumers were more likely to be aware of the cannabinoid content of the product purchased compared to those who acquired their cannabis from other sources (aOR = 4.12; 95% CI = 1.10-15.40). CONCLUSIONS No association was detected between the source of cannabis supply and potential vulnerability indicators of cannabis-related harms, but SQDC consumers were more aware of the cannabinoid content of the products purchased. These results suggest that the regulated government supply in Quebec is reaching a substantial portion of those with potential high vulnerability to harm. Whether this knowledge translates into a reduction in the negative consequences related to consumption is still to be determined.
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Affiliation(s)
- Sarah Drouin
- 177460Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Department of Psychiatry and Addictology, 5622Université de Montréal, Montreal, QC, Canada
| | - Élie Rizkallah
- 177460Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Department of Psychiatry and Addictology, 5622Université de Montréal, Montreal, QC, Canada
| | - Florence Conus
- 25456Institut de la Statistique du Québec, Québec, QC, Canada
| | - Sarah Larney
- 177460Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Department of Family Medicine, and Emergency Medicine, 5622Université de Montréal, Montreal, QC, Canada
| | - Navdeep Kaur
- 177460Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Codjo Djignefa Djade
- 177460Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Didier Jutras-Aswad
- 177460Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Department of Psychiatry and Addictology, 5622Université de Montréal, Montreal, QC, Canada
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Wo S, Schwartz K, Zimmerman E. Abdominal Pain, Vomiting, and Weight Loss in a 17-Year-Old Girl. Clin Pediatr (Phila) 2023; 62:166-169. [PMID: 36609183 DOI: 10.1177/00099228221114966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Shane Wo
- Rady Children's Hospital, San Diego, CA, USA.,University of California San Diego, San Diego, CA, USA
| | - Kristy Schwartz
- Rady Children's Hospital, San Diego, CA, USA.,University of California San Diego, San Diego, CA, USA
| | - Elise Zimmerman
- Rady Children's Hospital, San Diego, CA, USA.,University of California San Diego, San Diego, CA, USA
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40
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Rothenberg R, Selesny S, Su MK. Re: Cannabinoid hyperemesis syndrome: A 6-year audit of adult presentations to an urban district hospital. Emerg Med Australas 2023; 35:185-186. [PMID: 36344260 DOI: 10.1111/1742-6723.14137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Roger Rothenberg
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Samantha Selesny
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Mark K Su
- Department of Health and Mental Hygiene, New York City Poison Control Center, New York, New York, USA
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Rotella JA, Ferretti OG, Raisi E, Seet HR, Sarkar S. Response to Re: Cannabinoid hyperemesis syndrome: A 6-year audit of adult presentations to an urban district hospital. Emerg Med Australas 2023; 35:186-187. [PMID: 36344249 DOI: 10.1111/1742-6723.14136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Joe-Anthony Rotella
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Olivia G Ferretti
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Elham Raisi
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Hao Rui Seet
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Soham Sarkar
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
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42
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Hashemi D, Gray K. Cannabis Use Disorder in Adolescents. Child Adolesc Psychiatr Clin N Am 2023; 32:13-20. [PMID: 36410900 DOI: 10.1016/j.chc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
With increasing cannabis potency, increasing variety of methods of cannabis use, and lower perceived risk of cannabis use, it is increasingly important clinicians who work with adolescents remain up-to-date on the latest literature regarding cannabis use and its associated outcomes. Adolescent cannabis use is associated with chronic cognitive, psychosocial, psychiatric, and physical outcomes. Clinicians working in this field should be able to recognize cannabis use disorder, understand how adolescent cannabis use can impact the developing mind, and have informed discussions with patients and families regarding risks of use.
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Affiliation(s)
- Daniel Hashemi
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, South Carolina 29425, USA.
| | - Kevin Gray
- Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC 29425, USA
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Popoola A, Panday J, Taneja S, Greyson D, McDonald SD, Patel T, Darling E, Vanstone M. Pregnant and lactating people's strategies to mitigate the risk of cannabis consumption. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231202406. [PMID: 37776037 PMCID: PMC10541750 DOI: 10.1177/17455057231202406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Multiple studies have demonstrated that pregnant and lactating people who use cannabis perceive a variety of benefits from that use, offering some explanation of why rates of use continue to increase. OBJECTIVES The aim of this study was to explore pregnant and lactating people's perceptions of the risks of cannabis use and understand what steps, if any, they take to mitigate these risks. DESIGN Qualitative description. METHODS We analyzed semi-structured interviews with 52 Canadians who made the decision to start, stop, or continue using cannabis during pregnancy or lactation between 2019 and 2021. Data collection iterated with analysis. We used a conventional (inductive) approach to content analysis. RESULTS Perception of risk was found to be an essential component of decision-making about cannabis use. We identified a cycle of "risk identification," "management," and "observation" of effects. First, the pregnant or lactating person assesses the risks and weighs them against the perceived benefits of cannabis use. Second, they take action to minimize risks, with some choosing abstinence. Others, often those who were using cannabis to manage symptoms, continued cannabis use but devised a variety of other risk mitigation strategies such as, decreasing the amount or frequency of their use, changing the form of cannabis, and strategically timing their use with caregiving responsibilities. The final stage of the cycle involves seeking information about whether or not the initial perceived risk has manifested after implementing mitigation strategies, through observations and clinical information about the pregnancy or child. CONCLUSION Participants consistently engaged in deliberation about the risks and benefits associated with their perinatal cannabis use. Nearly all implemented strategies intended to minimize risk. Our results highlight the need for more research to inform clear public health messaging about risk mitigation to minimize the potential harms of perinatal cannabis use. This work informs clinicians about patient-perceived risks and mitigation strategies which could in turn help inform shared decision-making conversations.
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Affiliation(s)
- Anuoluwa Popoola
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Janelle Panday
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Shipra Taneja
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Devon Greyson
- Department of Communication, University of Massachusetts Amherst, Amherst, MA, USA
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sarah D. McDonald
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Tejal Patel
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Darling
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Muacevic A, Adler JR, Gutierrez-Castillo M. A Case of Cannabinoid Hyperemesis Syndrome and Acute Kidney Injury: A Review of the Literature. Cureus 2023; 15:e34350. [PMID: 36865973 PMCID: PMC9974265 DOI: 10.7759/cureus.34350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Cannabis is a commonly used illicit drug worldwide with many noted adverse effects and medical properties. It has been previously used in medicine for the management of chemotherapy-induced nausea and vomiting. The chronic use of cannabis is well-known to be associated with psychological and cognitive adverse effects, however, cannabinoid hyperemesis syndrome is a less commonly recognized complication of chronic long-term use of cannabis, though it does not occur in the majority of chronic cannabis users. Here we present the case of a 42-year-old male who presented with classical clinical features of cannabinoid hyperemesis syndrome.
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Affiliation(s)
| | - John R Adler
- Internal Medicine, Jersey City Medical Center, Jersey City, USA
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Abstract
The current review highlights the available research related to cannabis and indicators of physical health in a variety of domains. Various studies have found associations between cannabis use with pulmonary, cardiovascular, gastrointestinal, and endocrine function as well as body mass index and sleep. At this time, more research is needed to understand the influence of cannabis use on physical health, particularly among adolescent samples.
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Affiliation(s)
- Abigail L Tuvel
- Department of Psychology and Neuroscience, University of Colorado Boulder, 1777 Exposition Drive, Boulder, CO 80301
| | - Evan A Winiger
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, 1890 N Revere Court, Aurora, CO, 80045
| | - J Megan Ross
- Department of Psychiatry, Division of Addiction Sciences, Treatment and Prevention, University of Colorado Anschutz Medical Campus, 1890 N Revere Court, Aurora, CO, 80045.
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Guerra J, Naidoo V, Cacabelos R. Potential effects of cannabinoids on audiovestibular function: A narrative review. Front Pharmacol 2022; 13:1010296. [PMID: 36605398 PMCID: PMC9807921 DOI: 10.3389/fphar.2022.1010296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
The growing interest in the development of drugs that target the endocannabinoid system has extended to conditions that affect the audiovestibular pathway. The expression of cannabinoid (CB) receptors in that pathway has been widely demonstrated, indicating a therapeutic potential for drug development at this level. These medications may be beneficial for conditions such as noise-induced hearing loss, ototoxicity, or various forms of vertigo of central or peripheral origin. The therapeutic targets of interest include natural or synthetic compounds that act as CB1/CB2 receptor agonists/antagonists, and inhibitors of the endocannabinoid-degrading enzymes FAAH and MAGL. Furthermore, genetic variations implicated in the response to treatment and the development of related disorders such as epilepsy or migraine have been identified. Direct methods of administering these medications should be examined beyond the systemic strategy.
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Affiliation(s)
- Joaquin Guerra
- Neuro-Otolaryngology Unit, EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, Bergondo, Corunna, Spain,*Correspondence: Joaquin Guerra,
| | - Vinogran Naidoo
- Department of Neuroscience, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, Spain
| | - Ramon Cacabelos
- Genomic Medicine, EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, Bergondo, Corunna, Spain
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[Use of dronabinol in the treatment of resistant neuropathic pain: Feedback from patients followed in a multidisciplinary pain center]. ANNALES PHARMACEUTIQUES FRANÇAISES 2022:S0003-4509(22)00159-6. [PMID: 36513153 DOI: 10.1016/j.pharma.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/27/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Dronabinol is a drug composed of synthetic delta-9-tetrahydrocannabinol. In France, dronabinol requires a named Temporary Utilisation Authorisation (TUA), for the treatment of refractory neuropathic pain. Few data currently exist concerning its efficacy and tolerance. We present our feedback on its use for chronic pain patients, the multidisciplinary supervision and the monitoring set up by the clinical pharmacist. METHOD This retrospective monocentric study presents Patients Global Impression of Change and tolerance data from patients treated with dronabinol in a pain center between October 2020 and July 2021. We present their satisfaction towards the care process. RESULTS Nineteen patients were treated with dronabinol during the study period. - The clinical pharmacist issued 180 advices for patients and doctors. Patients reported a positive impact of the telephone follow-up carried out by the clinical pharmacist. - 75% (n=9/12) of patients who continued treatment for more than 3 months reported improvement in their health. - 74% (n=14/19) of patients had at least one adverse event, six patients needed to discontinue the treatment. DISCUSSION-CONCLUSION Dronabinol represents an alternative that can improve the quality of life of some patients suffering from refractory neuropathic pain. Nevertheless, as with any medicine, its initiation requires a rigorous evaluation of the benefit-risk balance. The close collaboration between the physician and the clinical pharmacist allows a secure management patients and makes this complex drug circuit easer.
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Shah J, Fermo O. Review of systemic and syndromic complications of cannabis use: A review. Medicine (Baltimore) 2022; 101:e32111. [PMID: 36626471 PMCID: PMC9750691 DOI: 10.1097/md.0000000000032111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE OF REVIEW Prescribed and non-prescribed cannabis use is common. Providers in specialties treating chronic pain - primary care, pain management, and neurology-will be coming across medical cannabis as a treatment for chronic pain, regardless of whether they are prescribers. It is important to be aware of the systemic and syndromic complications of acute and chronic cannabis use in the differential diagnosis of cardiac, cardiovascular, cerebrovascular, gastrointestinal, and psychiatric disorders. RECENT FINDINGS Medical cannabis is legal in 36 states. Studies have shown several potentially serious adverse effects associated with cannabis use. SUMMARY Cannabis use has the potential to cause several complications that can be easily overlooked without a preexisting high index of suspicion.
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Affiliation(s)
- Jay Shah
- University of Queensland/Ochsner Clinical School, Brisbane, QLD, Australia
| | - Olga Fermo
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
- * Correspondence: Olga Fermo, Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL, USA (e-mail: )
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Brown CS, Sarangarm P, Faine B, Rech MA, Flack T, Gilbert B, Howington GT, Laub J, Porter B, Slocum GW, Zepeski A, Zimmerman DE. A year ReviewED: Top emergency medicine pharmacotherapy articles of 2021. Am J Emerg Med 2022; 60:88-95. [DOI: 10.1016/j.ajem.2022.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/09/2022] [Accepted: 07/17/2022] [Indexed: 11/24/2022] Open
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Razban M, Exadaktylos AK, Santa VD, Heymann EP. Cannabinoid hyperemesis syndrome and cannabis withdrawal syndrome: a review of the management of cannabis-related syndrome in the emergency department. Int J Emerg Med 2022; 15:45. [PMID: 36076180 PMCID: PMC9454163 DOI: 10.1186/s12245-022-00446-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cannabis-related medical consultations are increasing worldwide, a non-negligible public health issue; patients presenting to acute care traditionally complain of abdominal pain and vomiting. Often recurrent, these frequent consultations add to the congestion of already chronically saturated emergency department(s) (ED). In order to curb this phenomenon, a specific approach for these patients is key, to enable appropriate treatment and long-term follow-up. Objectives This study reviews cannabinoid hyperemesis syndrome (CHS) and cannabis withdrawal syndrome (CWS), in a bid to help promote better understanding and handling of pathologies associated with chronic cannabis use. Following a literature review, we present a novel therapeutic algorithm aimed at guiding clinicians, in a bid to improve long-term outcomes and prevent recurrences. Methods Using the keywords “Cannabis,” “Hyperemesis,” “Syndrome,” “Withdrawal,” and “Emergency Medicine,” we completed a literature review of three different electronic databases (PubMed®, Google scholar®, and Cochrane®), up to November 2021. Results Although often presenting with similar symptoms such as abdominal pain and vomiting, cannabinoid hyperemesis syndrome (CHS) and cannabis withdrawal syndrome (CWS) are the result of two differing pathophysiological processes. Distinguishing between these two syndromes is essential to provide appropriate symptomatic options. Conclusion The correct identification of the underlying cannabis-related syndrome, and subsequent therapeutic choice, may help decrease ED presentations. Our study emphasizes the importance of both acute care and long-term outpatient follow-up, as key processes in cannabis-related disorder treatment.
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Affiliation(s)
- Mohammad Razban
- Department of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland. .,University of Bern, Bern, Switzerland.
| | | | - Vincent Della Santa
- Department of Emergency Medicine, Cantonal Hospital of Neuchatel, Neuchatel, Switzerland
| | - Eric P Heymann
- Department of Emergency Medicine, Cantonal Hospital of Neuchatel, Neuchatel, Switzerland
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