51
|
Villar-Martinez MD, Goadsby PJ. Pathophysiology and Therapy of Associated Features of Migraine. Cells 2022; 11:cells11172767. [PMID: 36078174 PMCID: PMC9455236 DOI: 10.3390/cells11172767] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Migraine is a complex and debilitating disorder that is broadly recognised by its characteristic headache. However, given the wide array of clinical presentations in migraineurs, the headache might not represent the main troublesome symptom and it can even go unnoticed. Understanding migraines exclusively as a pain process is simplistic and certainly hinders management. We describe the mechanisms behind some of the most disabling associated symptoms of migraine, including the relationship between the central and peripheral processes that take part in nausea, osmophobia, phonophobia, vertigo and allodynia. The rationale for the efficacy of the current therapeutic arsenal is also depicted in this article. The associated symptoms to migraine, apart from the painful component, are frequent, under-recognised and can be more deleterious than the headache itself. The clinical anamnesis of a headache patient should enquire about the associated symptoms, and treatment should be considered and individualised. Acknowledging the associated symptoms as a fundamental part of migraine has permitted a deeper and more coherent comprehension of the pathophysiology of migraine.
Collapse
Affiliation(s)
- Maria Dolores Villar-Martinez
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
- NIHR King’s Clinical Research Facility, SLaM Biomedical Research Centre, King’s College Hospital, London SE5 9RS, UK
| | - Peter J. Goadsby
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
- NIHR King’s Clinical Research Facility, SLaM Biomedical Research Centre, King’s College Hospital, London SE5 9RS, UK
- Department of Neurology, University of California, Los Angeles, CA 90095, USA
- Correspondence:
| |
Collapse
|
52
|
La Sala MS, Constantino E, Koola MM, Yel I, Chacko M. Treatment of Cannabis Hyperemesis Syndrome Using Haloperidol in a Pregnant Patient: Case Report. J Clin Psychopharmacol 2022; 42:506-508. [PMID: 35943399 DOI: 10.1097/jcp.0000000000001579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
53
|
Stoner MJ, Dietrich A, Lam SH, Wall JJ, Sulton C, Rose E. Marijuana use in children: An update focusing on pediatric tetrahydrocannabinol and cannabidiol use. J Am Coll Emerg Physicians Open 2022; 3:e12770. [PMID: 35813522 PMCID: PMC9255894 DOI: 10.1002/emp2.12770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michael J. Stoner
- Department of Pediatrics Division of Emergency Medicine Nationwide Children's Hospital The Ohio State University College of Medicine Columbus Ohio USA
| | - Ann Dietrich
- Department of Pediatrics and Emergency Medicine Prisma University of South Carolina College of Medicine Columbia South Carolina USA
| | | | - Jessica J. Wall
- Department of Pediatrics and Emergency Medicine University of Washington School of Medicine Seattle Washington USA
| | - Carmen Sulton
- Department of Pediatrics and Emergency Medicine Children's Healthcare of Atlanta at Eagleton Emory University School of Medicine Atlanta Georgia USA
| | - Emily Rose
- Department of Clinical Medicine Emergency Medicine (Educational Scholar) Department of Emergency Medicine Los Angeles County & USC Medical Center Keck School of Medicine of the University of Southern California Los Angeles California USA
| |
Collapse
|
54
|
Klazura G, Geraghty JR, Rojnica M, Sims T, Koo N, Lobe T. Cannabinoid Hyperemesis Syndrome Complicated by Pneumomediastinum: Implications for Pediatric Surgeons. CLINICAL SURGERY JOURNAL 2022; 5:6-13. [PMID: 36438163 PMCID: PMC9696622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cannabinoid Hyperemesis Syndrome (CHS) is a form of cyclic vomiting syndrome characterized by episodic vomiting occurring every few weeks or months and is associated with prolonged and frequent use of high-dose cannabis. CHS in the pediatric population has been increasingly reported over the last decade and can lead to life-threatening complications such as pneumomediastinum, which warrant careful consideration for surgical intervention. CASE PRESENTATION A 17-year-old female with no significant past medical history presented to the emergency department with abdominal pain, nausea, and vomiting for 24 hours. She had four episodes of green-yellow emesis followed by dry heaves. She also complained of chest and back pain, worse with deep inspiration. Upon further history, the patient reported a similar episode of abdominal pain and repetitive vomiting six months prior to the current episode. She smoked cannabis at least once daily and has done so for the past two years. Chest X-ray revealed a subtle abnormal lucency along the anteroposterior window and anterior mediastinum, consistent with a small amount of pneumomediastinum without any other acute intrathoracic abnormalities. Follow-up chest computed tomography with contrast showed multiple foci of air within the anterior and posterior mediastinum tracking up to the thoracic inlet. There was no evidence of contrast extravasation; however, small esophageal perforation could not be excluded. Given uncomplicated pneumomediastinum without frank contrast extravasation, the patient was treated medically with piperacillin-tazobactam, metronidazole, and micafungin for microbial prophylaxis; hydromorphone for pain control; as well as with pantoprazole, ondansetron, and promethazine. Nutrition was provided via total parenteral nutrition. The patient was intensely monitored for signs of occult esophageal perforation, but none were detected. She was advanced to a soft diet on hospital day eight, solid food diet on day nine, at which point antibiotics were discontinued, and the patient was subsequently discharged. CONCLUSION CHS in an increasingly common disorder encountered in the pediatric setting due to rising prevalence of cannabis use. The management of CHS and potentially life-threatening complications such as pneumomediastinum should be given careful consideration. Pneumomediastinum can be a harbinger of more sinister pathology such as esophageal perforation, which may warrant urgent surgical intervention.
Collapse
Affiliation(s)
- Greg Klazura
- Division of Pediatric Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Joseph R Geraghty
- Medical Scientist Training Program, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Marko Rojnica
- Division of Pediatric Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Thomas Sims
- Division of Pediatric Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Nathaniel Koo
- Division of Pediatric Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Thom Lobe
- Division of Pediatric Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| |
Collapse
|
55
|
BANERJEE SOHINI, DEACON ALYSSA, SUTER MELISSAA, AAGAARD KJERSTIM. Understanding the Placental Biology of Tobacco Smoke, Nicotine, and Marijuana (THC) Exposures During Pregnancy. Clin Obstet Gynecol 2022; 65:347-359. [PMID: 35125390 PMCID: PMC9042338 DOI: 10.1097/grf.0000000000000691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Widespread public health campaigns have reduces the prevalence of tobacco and nicotine exposures during pregnancy in the United States. However, tobacco and nicotine exposures during pregnancy persist as a common modifiable perinatal risk exposure. Furthermore, declines in tobacco use have been accompanied by parallel rises in both the prevalence and incidence of marijuana use in pregnancy. This is worrisome, as the macromolecules which comprise tobacco and marijuana smoke affect placental function. In this chapter we summarize the decades of evidence contributing to our understanding of the placental molecular pathophysiology accompanying these chemical exposures, thereby rendering risk of adverse perinatal outcomes.
Collapse
Affiliation(s)
- SOHINI BANERJEE
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - MELISSA A. SUTER
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - KJERSTI M. AAGAARD
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
56
|
Phillips KT, Pedula KL, Choi NG, Tawara KAK, Simiola V, Satre DD, Owen-Smith A, Lynch FF, Dickerson J. Chronic health conditions, acute health events, and healthcare utilization among adults over age 50 in Hawai'i who use cannabis: A matched cohort study. Drug Alcohol Depend 2022; 234:109387. [PMID: 35279458 DOI: 10.1016/j.drugalcdep.2022.109387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Research on cannabis-related health outcomes in diverse older adults is limited. The current study utilized a matched cohort study design to compare older adults in Hawai'i with identified cannabis diagnoses and matched controls on chronic health conditions, acute health events, and healthcare utilization from 2016 to 2020. METHOD Patients age 50 + were identified using ICD-10 diagnostic codes for cannabis use, abuse, and dependence using electronic health record data from an integrated health system (Kaiser Permanente Hawai'i). Those with cannabis diagnoses (n = 275) were compared to matched non-using controls (n = 275; based on age, sex) on chronic health conditions (coronary heart disease, hypertension, COPD, chronic non-cancer pain), acute health events (myocardial infarction, respiratory symptoms, stroke, persistent or cyclic vomiting, injuries), and healthcare utilization (outpatient, inpatient, and emergency department visits) following case identification for two years. RESULTS Participants were 19.3% Native Hawaiian/Pacific Islander, 24.4% Asian, 47.8% White, and 8.5% Other/Unknown, with an average age of 62.8 years (SD=7.3). Adjusting for covariates as possible, participants with a cannabis diagnosis had significantly greater risk of coronary heart disease, chronic non-cancer pain, stroke, myocardial infarction, cyclic vomiting, and injuries, over time, compared to controls. Cannabis use was associated with any and greater frequency of outpatient, inpatient, and emergency department visits. CONCLUSIONS In a diverse sample, older adults who used cannabis had worse health conditions and events and used more health services over a two-year period. Future studies should evaluate cannabis-related health outcomes, effects of cannabis problem severity, as well as implications for healthcare in aging populations.
Collapse
Affiliation(s)
- Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA.
| | - Kathryn L Pedula
- Hawai'i Permanente Medical Group, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Namkee G Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Kylee-Ann K Tawara
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA; School of Public Health, University of Washington, Seattle, WA, USA
| | - Vanessa Simiola
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ashli Owen-Smith
- School of Public Health, Georgia State University, Atlanta, GA, USA; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Frances F Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA; OCHIN Research, Portland, OR, USA
| | - John Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| |
Collapse
|
57
|
Vanstone M, Panday J, Popoola A, Taneja S, Greyson D, McDonald SD, Pack R, Black M, Murray-Davis B, Darling E. Pregnant People's Perspectives On Cannabis Use During Pregnancy: A Systematic Review and Integrative Mixed-Methods Research Synthesis. J Midwifery Womens Health 2022; 67:354-372. [PMID: 35445514 PMCID: PMC9324983 DOI: 10.1111/jmwh.13363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Abstract
Introduction Rates of perinatal cannabis use are rising, despite clinical evidence about the potential for harm. Accordingly, pregnant and lactating people who perceive a benefit from cannabis use may have a difficult time making informed decisions about cannabis use. Methods We conducted a systematic review of mixed‐methods research to synthesize existing knowledge on the perspectives of pregnant people and their partners about cannabis use in pregnancy. Six health and social science databases were searched up until May 30, 2021. There were no methodological, time, or geographic limits applied. We employed a convergent integrative approach to the inductive analysis of findings from all studies. Results We identified 26 studies describing views of 17,781 pregnant and postpartum people about cannabis use in pregnancy. No studies describing the views of partners were identified, and only one study specifically addressed the perspectives of lactating people. Comparative analysis revealed that whether cannabis was studied alone or grouped with other substances resulted in significant diversity in descriptions of participant decision‐making priorities and perceptions of risks and benefits. Studies of cannabis alone demonstrated a complex decision‐making process whereby perceived benefits are balanced against the available information about risk, which is often unclear and uncertain. Clear and helpful information was difficult to identify, and health care providers were not described as a helpful and trusted resource for decision‐making. Discussion Decision‐making about cannabis use is difficult for pregnant and lactating people who perceive a benefit from this use, although this decisional difficulty is seldom reflected in studies that examine cannabis as one of multiple substances that pregnant or lactating people may use. Our review suggests several approaches clinicians may take to encourage open and supportive conversations to facilitate informed decisions about cannabis use during the perinatal period.
Collapse
Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Janelle Panday
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anuoluwa Popoola
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shipra Taneja
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Communication, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Sarah D McDonald
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.,Department of Radiology, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rachael Pack
- Center for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Morgan Black
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Beth Murray-Davis
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.,McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Darling
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada.,McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
58
|
Schmid Y, Galicia M, Vogt SB, Liechti ME, Burillo-Putze G, Dargan PI, Dines AM, Giraudon I, Heyerdahl F, Hovda KE, Wood DM, Yates C, Miró Ò. Differences in clinical features associated with cannabis intoxication in presentations to European emergency departments according to patient age and sex. Clin Toxicol (Phila) 2022; 60:912-919. [PMID: 35404194 DOI: 10.1080/15563650.2022.2060116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate if clinical features associated with acute cannabis intoxication in patients presenting to Emergency Departments for medical assistance differ according to patient age and sex. METHODS We analysed presentations in the Euro-DEN Plus dataset from 2014 to 2019 in which cannabis was the only drug involved (except for alcohol), and age, sex and alcohol co-ingestion had been recorded. Age was considered as categorical (five groups; <20, 20-29, 30-39, 40-49 and ≥50 years), and sex as binary variable (male/female). We evaluated 12 key clinical features recorded during emergency department (ED) care. Risks of presenting with each of these clinical features according to patient age and sex were calculated by logistic regression models, and adjusted for sex, age and alcohol co-ingestion. RESULTS 4,268 of 43,633 Euro-DEN presentations (9.8%) fulfilled the inclusion criteria (median age: 26 years (IQR = 20-34), 70% male, 52% co-ingested alcohol). The frequency of clinical features was: anxiety 28%, vomiting 24%, agitation 23%, palpitations 14%, reduced consciousness 13%, acute psychosis 9%, hallucinations 9%, chest pain 7%, headache 6%, hypotension 4%, hypertension 3% and seizures 2%. Patients younger than 20 years more frequently had vomiting (34.7% of cases), reduced consciousness (21.5%), and headache (10.8%); and less frequently acute psychosis (5.5%). Patients older than 49 years more often had hypotension (6.5%) and less frequently vomiting (20%), anxiety (14%), agitation (14%) and reduced consciousness (10%). Males more frequently presented with hypertension (3.7 vs. 1.5%; OR = 2.311, 95%CI = 1.299-3.816), psychosis (10.4 vs 6.3%; 1.948, 1.432-2.430), chest pain (8.1 vs 4.5%; 1.838, 1.390-2.430) and seizures (2.5 vs 1.4%; 1.805, 1.065-3.060), and less frequently with vomiting (21.8 vs 28.2%; 0.793, 0.677-0.930), anxiety (25.4 vs 32.3%; 0.655, 0.561-0.766) and hypotension (2.9 vs 5.8%; 0.485, 0.350-0.671). CONCLUSIONS The prevalence of some clinical features typically associated with acute cannabis intoxication differed according to age and sex. The causes for these differences should be further investigated in order to better understand the pathophysiology of cannabis-related acute toxicity, and they may be relevant particularly for developing prevention campaigns and for treatment in specific sex and/or age groups.
Collapse
Affiliation(s)
- Yasmin Schmid
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Miguel Galicia
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Severin B Vogt
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Canary Islands, Spain
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Fridtjof Heyerdahl
- Prehospital Division, Oslo University Hospital, Oslo, Norway.,The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Knut Erik Hovda
- The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Christopher Yates
- SAMU 061 Balears. Grupo de trabajo de Toxicología Clínica. IdISBa.Mallorca, Palma de Mallorca, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | | |
Collapse
|
59
|
Mæland R, Lien L, Leonhardt M. Association between cannabis use and physical health problems in Norwegian adolescents: a cross-sectional study from the youth survey Ungdata. BMC Public Health 2022; 22:661. [PMID: 35382834 PMCID: PMC8985321 DOI: 10.1186/s12889-022-13136-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Cannabis use is increasing among young Norwegians and several studies show a high incidence of common physical health problems. An association has previously been found between cannabis use and mental health problems. Since physical and mental health problems often co-occur, the aim of this study is to explore the relationship between cannabis use and physical health problems. Methods In 2017–2019, the Norwegian youth survey Ungdata collected data from 249,100 Norwegian adolescents, which equalled around 80% of all lower secondary school pupils (13–15 years) and about 50% of upper secondary pupils (16–19 years) in Norway. Descriptive analysis was used to calculate the prevalence of cannabis use and bi- and multivariate logistic regression analysis to examine the association between cannabis use and physical health problems, controlled for sociodemographics and mental health problems. Results Almost 10% of Norwegian adolescents had used cannabis once or more in the previous 12 months. The use of cannabis increased with age and it was more prevalent among boys. There is a clear connection between physical health problems and cannabis use (OR = 1.582 (CI: 1.527–1.638)) even after adjusting for sociodemographic variables and mental health problems (OR = 1.366 (CI: 1.312–1.423)). Conclusion More studies are needed to explore if there might a bidirectional relationship between cannabis use and physical health problems where physical problems increase cannabis use and cannabis use increases the risk of physical health problems. More knowledge on the effect of and motivation for cannabis use are important for policy makers and health care professionals involved in young people.
Collapse
Affiliation(s)
- Ragnhild Mæland
- Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, 2381, Brumunddal, Norway.,Department of Health and Social Science, Inland Norway University of Applied Science, Elverum, Norway
| | - Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, 2381, Brumunddal, Norway. .,Faculty of Health Studies, VID Specialized University, Oslo, Norway.
| |
Collapse
|
60
|
Stith SS, Li X, Orozco J, Lopez V, Brockelman F, Keeling K, Hall B, Vigil JM. The Effectiveness of Common Cannabis Products for Treatment of Nausea. J Clin Gastroenterol 2022; 56:331-338. [PMID: 35258504 DOI: 10.1097/mcg.0000000000001534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
GOALS We measure for the first time how a wide range of cannabis products affect nausea intensity in actual time. BACKGROUND Even though the Cannabis plant has been used to treat nausea for millennia, few studies have measured real-time effects of common and commercially available cannabis-based products. STUDY Using the Releaf App, 886 people completed 2220 cannabis self-administration sessions intended to treat nausea between June 6, 2016 and July 8, 2019. They recorded the characteristics of self-administered cannabis products and baseline symptom intensity levels before tracking real-time changes in the intensity of their nausea. RESULTS By 1 hour postconsumption, 96.4% of people had experienced symptom relief with an average symptom intensity reduction of -3.85 points on a 0 to 10 visual analog scale (SD=2.45, d=1.85, P<0.001). Symptom relief was statistically significant at 5 minutes and increased with time. Among product characteristics, flower and concentrates yielded the strongest, yet similar results; products labeled as Cannabis indica underperformed those labeled as Cannabis sativa or hybrid; and joints were associated with greater symptom relief than pipes or vaporizers. In sessions using flower, higher tetrahydrocannbinol and lower cannabidiol were generally associated with greater symptom relief (eg, within 5 min). CONCLUSIONS The findings suggest that the vast majority of patients self-selecting into cannabis use for treatment of nausea likely experience relief within a relative short duration of time, but the level of antiemetic effect varies with the characteristics of the cannabis products consumed in vivo. Future research should focus on longer term symptom relief, including nausea-free intervals and dosing frequency; the risks of consumption of medical cannabis, especially among high-risk populations, such as pregnant women and children; and potential interactions between cannabis, conventional antiemetics, other medications, food, tobacco, alcohol, and street drugs among specific patient populations.
Collapse
Affiliation(s)
| | | | | | - Victoria Lopez
- College of Pharmacy, University of New Mexico, Albuquerque, NM
| | | | | | | | | |
Collapse
|
61
|
Niriella MA, Jayasena H, Withanage M, Devanarayana NM, De Silva AP. Chronic nausea and vomiting: a diagnostic approach. Expert Rev Gastroenterol Hepatol 2022; 16:311-320. [PMID: 35303783 DOI: 10.1080/17474124.2022.2056016] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic nausea and vomiting (CNV) are commonly encountered symptoms in medical practice. CNV is the presenting symptom in a variety of gastrointestinal and non-gastrointestinal disorders. However, in a significant percentage of patients without an obvious underlying cause, CNV poses a significant diagnostic challenge to the evaluating physician. AREAS COVERED A comprehensive clinical history and physical examination form the foundation for further diagnostic work-up. In the present review, we discuss the diagnostic approach to CNV, highlighting the epidemiology, pathophysiology, causes, and modes of evaluation of this condition. Specific investigations, carefully guided by clinical assessment and tailored for each patient, would be more beneficial in diagnosing CNV than empirically performing a blanket of investigations. EXPERT OPINION Whilst CNV remains a historically challenging diagnostic and therapeutic dilemma, research into this topic is limited. Hence, there is a growing call for more research into diagnostic modalities for CNV. With scientific advancement and further research, it is hoped that easy-to-use, cheap, noninvasive novel diagnostic modalities for CNV will be available soon.
Collapse
Affiliation(s)
- Madunil A Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Hiruni Jayasena
- Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | - Maduri Withanage
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Niranga M Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Arjuna P De Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| |
Collapse
|
62
|
Burillo-Putze G, Richards JR, Rodríguez-Jiménez C, Sanchez-Agüera A. Pharmacological management of cannabinoid hyperemesis syndrome: an update of the clinical literature. Expert Opin Pharmacother 2022; 23:693-702. [DOI: 10.1080/14656566.2022.2049237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - John R. Richards
- Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Consuelo Rodríguez-Jiménez
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain
- Clinical Pharmacology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | |
Collapse
|
63
|
Rotella JA, Ferretti OG, Raisi E, Seet HR, Sarkar S. Cannabinoid hyperemesis syndrome: A 6-year audit of adult presentations to an urban district hospital. Emerg Med Australas 2022; 34:578-583. [PMID: 35199462 PMCID: PMC9545654 DOI: 10.1111/1742-6723.13944] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the local experience of adult patients presenting with cannabinoid hyperemesis syndrome (CHS) to an urban ED in the outer northern suburbs of Melbourne. METHODS Retrospective chart review of adult patients presenting to the ED with a documented history of CHS or equivalent terminology from January 2015 to January 2021. Age, sex, cannabis use, clinical features, pathology results, imaging and symptomatic management were examined as well as outcomes regarding disposition, representation, morbidity and mortality. RESULTS One hundred and forty-two adult presentations were included. Sixty-seven were unique presentations and 29 were patients who represented during the study period. Most represented within 3 months (37.8%) and most represented at least twice. Males were overrepresented (68.7%). Patients were young (median age 31 years, interquartile range 23-35 years) and all had a history of regular cannabis use (usually daily). Cyclical nausea and/or vomiting was the most common clinical feature compared to others in previously reported diagnostic criteria. Patients typically had elevated white cell counts with associated neutrophilia (75.8%) and mild hypokalaemia (57.9%). Lipase was not elevated, and C-reactive protein was typically less than 50 mmol/L (98.2%). Imaging was not commonly performed but largely normal. Treatment was supportive with anti-emetic use, intravenous fluids and analgesia. There were no deaths or admissions to intensive care. CONCLUSIONS Cyclical nausea and vomiting was the most common feature observed in this cohort compared to other clinical features reported in prior studies. Serum lipase was normal and C-reactive protein only mildly elevated. Prospective studies are required to further assess these findings.
Collapse
Affiliation(s)
- Joe A 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
| |
Collapse
|
64
|
DeVuono MV, La Caprara O, Petrie GN, Limebeer CL, Rock EM, Hill MN, Parker LA. Cannabidiol Interferes with Establishment of Δ 9-Tetrahydrocannabinol-Induced Nausea Through a 5-HT 1A Mechanism. Cannabis Cannabinoid Res 2022; 7:58-64. [PMID: 33998876 PMCID: PMC8864431 DOI: 10.1089/can.2020.0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Cannabinoid hyperemesis syndrome (CHS) is characterized by intense nausea and vomiting brought on by the use of high-dose Δ9-tetrahydrocannabinol (THC), the main psychotropic compound in cannabis. Cannabidiol (CBD), a nonpsychotropic compound found in cannabis, has been shown to interfere with some acute aversive effects of THC. In this study, we evaluated if CBD would interfere with THC-induced nausea through a 5-HT1A receptor mechanism as it has been shown to interfere with nausea produced by lithium chloride (LiCl). Since CHS has been attributed to a dysregulated stress response, we also evaluated if CBD would interfere with THC-induced increase in corticosterone (CORT). Materials and Methods: The potential of CBD (5 mg/kg, ip) to suppress THC-induced conditioned gaping (a measure of nausea) was evaluated in rats, as well as the potential of the 5-HT1A receptor antagonist, WAY-100635 (WAY; 0.1 mg/kg, ip), to reverse the suppression of THC-induced conditioned gaping by CBD. Last, the effect of CBD (5 mg/kg, ip) on THC-induced increase in serum CORT concentration was evaluated. Results: Pretreatment with CBD (5 mg/kg, ip) interfered with the establishment of THC-induced conditioned gaping (p=0.007, relative to vehicle [VEH] pretreatment), and this was reversed by pretreatment with 0.1 mg/kg WAY. This dose of WAY had no effect on gaping on its own. THC (10 mg/kg, ip) significantly increased serum CORT compared with VEH-treated rats (p=0.04). CBD (5 mg/kg, ip) pretreatment reversed the THC-induced increase in CORT. Conclusions: CBD attenuated THC-induced nausea as well as THC-induced elevation in CORT. The attenuation of THC-induced conditioned gaping by CBD was mediated by its action on 5-HT1A receptors, similar to that of LiCl-induced nausea.
Collapse
Affiliation(s)
- Marieka V. DeVuono
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada
| | - Olivia La Caprara
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada
| | - Gavin N. Petrie
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Cheryl L. Limebeer
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada
| | - Erin M. Rock
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada
| | - Matthew N. Hill
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Linda A. Parker
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada.,*Address correspondence to: Linda A. Parker, PhD, Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, ON N1G 2W1, Canada,
| |
Collapse
|
65
|
Hill KP, Gold MS, Nemeroff CB, McDonald W, Grzenda A, Widge AS, Rodriguez C, Kraguljac NV, Krystal JH, Carpenter LL. Risks and Benefits of Cannabis and Cannabinoids in Psychiatry. Am J Psychiatry 2022; 179:98-109. [PMID: 34875873 DOI: 10.1176/appi.ajp.2021.21030320] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The United States is in the midst of rapidly changing laws regarding cannabis. The increasing availability of cannabis for recreational and medical use requires that mental health clinicians be knowledgeable about evidence to be considered when counseling both patients and colleagues. In this review, the authors outline the evidence from randomized double-blind placebo-controlled trials for therapeutic use of cannabinoids for specific medical conditions and the potential side effects associated with acute and chronic cannabis use. METHODS Searches of PubMed and PsycInfo were conducted for articles published through July 2021 reporting on "cannabis" or "cannabinoids" or "medicinal cannabis." Additional articles were identified from the reference lists of published reviews. Articles that did not contain the terms "clinical trial" or "therapy" in the title or abstract were not reviewed. A total of 4,431 articles were screened, and 841 articles that met criteria for inclusion were reviewed by two or more authors. RESULTS There are currently no psychiatric indications approved by the U.S. Food and Drug Administration (FDA) for cannabinoids, and there is limited evidence supporting the therapeutic use of cannabinoids for treatment of psychiatric disorders. To date, evidence supporting cannabinoid prescription beyond the FDA indications is strongest for the management of pain and spasticity. CONCLUSIONS As cannabinoids become more available, the need for an evidence base adequately evaluating their safety and efficacy is increasingly important. There is considerable evidence that cannabinoids have a potential for harm in vulnerable populations such as adolescents and those with psychotic disorders. The current evidence base is insufficient to support the prescription of cannabinoids for the treatment of psychiatric disorders.
Collapse
Affiliation(s)
- Kevin P Hill
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Mark S Gold
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Charles B Nemeroff
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - William McDonald
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Adrienne Grzenda
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Alik S Widge
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Carolyn Rodriguez
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Nina V Kraguljac
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - John H Krystal
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Linda L Carpenter
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| |
Collapse
|
66
|
Berken JA, Saul S, Osgood PT. Case Report: Superior Mesenteric Artery Syndrome in an Adolescent With Cannabinoid Hyperemesis. Front Pediatr 2022; 10:830280. [PMID: 35265566 PMCID: PMC8898831 DOI: 10.3389/fped.2022.830280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) occurs when the third portion of the duodenum is compressed between the superior mesenteric artery (SMA) and the aorta, causing duodenal obstruction. This condition most commonly arises from marked weight loss that reduces the size of the fat pad between these vessels, causing greater acuity of angulation. We present an unusual case of SMAS occurring in an adolescent due to precipitous weight loss resulting from cannabinoid hyperemesis syndrome (CHS). CASE PRESENTATION A 17-year-old adolescent presented emergently with voluminous bilious emesis. She endorsed a history of recent weight loss and a longstanding history of chronic heavy cannabis use associated with recurrent nausea and vomiting. Her chronic symptoms satisfied the Rome IV criteria for cannabinoid hyperemesis syndrome, but her acute vomiting symptoms were more extreme. Evaluation was significant for mild abdominal tenderness and fullness of the epigastrium. Contrast abdominal CT demonstrated moderate gastric and proximal duodenal distention with tapering of the lumen between the SMA and the aorta, consistent with SMAS. CONCLUSIONS To our knowledge, this is the first reported case of SMAS occurring as the result of CHS. Clinicians should be aware of this possible juxtaposition, when a patient with a history of chronic excessive cannabis use, stereotypical vomiting resembling cyclic vomiting syndrome, and considerable rapid weight loss presents with a sudden exacerbation of symptoms, even when a normal BMI is maintained.
Collapse
Affiliation(s)
- Jonathan A Berken
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Samantha Saul
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Peter T Osgood
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
67
|
Fischer B, Robinson T, Bullen C, Curran V, Jutras-Aswad D, Medina-Mora ME, Pacula RL, Rehm J, Room R, van den Brink W, Hall W. Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103381. [PMID: 34465496 DOI: 10.1016/j.drugpo.2021.103381] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
Collapse
Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Tessa Robinson
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Chris Bullen
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand
| | - Valerie Curran
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Maria Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico; Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosalie Liccardo Pacula
- Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Wim van den Brink
- Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia; National Addiction Centre, Institute of Psychiatry, Kings College London, United Kingdom
| |
Collapse
|
68
|
Nogueira JM, Fonseca I, Duarte M. Cannabinoid Hyperemesis Syndrome: A Case Report of an Underdiagnosed Condition. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:420-424. [PMID: 34901450 PMCID: PMC8630388 DOI: 10.1159/000512088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022]
Abstract
Cannabinoid hyperemesis syndrome (CHS) is characterized by episodic bursts of nausea, vomiting and abdominal pain, affecting chronic cannabis users. The clinical picture mimics an acute abdomen, usually leading to multiple assessments in the emergency department. Several complementary diagnostic examinations are performed with non-specific results, making differential diagnosis puzzling. We present a case of a 42-year-old man, who has been admitted multiple times to the emergency department in the last 3 months for abdominal pain, nausea and vomiting, without triggering factors and improving only with hot water baths. He was evaluated by different specialties, the various complementary diagnostic tests performed showed no significant results, and no definitive diagnosis was obtained. Treatment resulted only in a partial and transient resolution of symptoms. A more detailed medical history revealed cannabis use for more than 5 years, with a recent increase in the amount consumed. After psychoeducation, explaining the risks associated with consumption and its relationship with the clinical symptoms, which resulted in complete suspension of cannabis, there have been no new symptomatic episodes since then. We present an illustrative case of a poorly reported clinical entity despite having a probable significant prevalence, raising awareness in order that clinicians identify and properly manage these cases.
Collapse
Affiliation(s)
- João Machado Nogueira
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Inês Fonseca
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Marco Duarte
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Setúbal, Setúbal, Portugal
| |
Collapse
|
69
|
Masonbrink AR, Richardson T, Hall M, Catley D, Wilson K. Trends in Adolescent Cannabis-Related Hospitalizations by State Legalization Laws, 2008-2019. J Adolesc Health 2021; 69:999-1005. [PMID: 34511329 DOI: 10.1016/j.jadohealth.2021.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/06/2021] [Accepted: 07/21/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Adolescent cannabis use is associated with adverse health outcomes. The impact of cannabis legalization on adolescent cannabis-related hospitalizations remains unknown. We sought to assess whether state cannabis legalization is associated with adolescent cannabis-related hospitalizations. METHODS We conducted a retrospective cohort study of adolescent (11-17 years) hospitalizations at children's hospitals between January 1, 2008 and December 31, 2019 using the Inpatient Essentials database. We investigated differences in adolescent cannabis-related diagnosis during a hospitalization by state cannabis legalization status, including states with no legal use to medical cannabis laws (MCLs) and states with MCLs to nonmedical (>21 years old) cannabis laws (NMCLs). RESULTS Of 1,898,432 adolescent hospitalizations in 18 states and Washington, DC, there were 37,562 (2%) hospitalizations with a cannabis-related diagnosis, with 8,457 (23%) in states with no legal use, 20,444 (54%) in MCL states, and 8,661 (23%) in NMCL states. There was an increase in adjusted odds of a cannabis-related hospitalization in MCL (odds ratio 1.05, 95% confidence interval 1.04-1.06) and NMCL states (odds ratio 1.03, 95% confidence interval 1.02-1.03) between 2008 and 2019. Characteristics associated with the greatest increase in adjusted odds of a cannabis-related hospitalization postpolicy change included adolescents without an underlying mental health or other substance use disorder in MCL and NMCL states (p < .001) and younger age in NMCL states (13 vs. 16 and 17 years old, p = .02 and p = .02). CONCLUSIONS Cannabis-related adolescent hospitalizations at children's hospitals are increasing, with a disproportionate increase postlegalization in states with NMCLs. Interventions are warranted to increase cannabis use identification and treatment among at-risk adolescents in the hospital-based setting.
Collapse
Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Troy Richardson
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Department of Pediatrics, Children's Hospital Association, Lenexa, Kansas
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Department of Pediatrics, Children's Hospital Association, Lenexa, Kansas
| | - Delwyn Catley
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Karen Wilson
- Department of Pediatrics, Mount Sinai Health System and Kravis Children's Hospital, New York, New York
| |
Collapse
|
70
|
Sandhu G, Smith S, Stephenson K, Jaeger V, John R, Shaver C, Johnson C. Prevalence of cannabinoid hyperemesis syndrome and its financial burden on the health care industry. Proc (Bayl Univ Med Cent) 2021; 34:654-657. [PMID: 34732980 DOI: 10.1080/08998280.2021.1937874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Cannabis is the most commonly consumed recreational drug in the world. As more states legalize cannabis use in some form, the incidence of cannabinoid hyperemesis syndrome (CHS) is expected to rise. CHS is a constellation of symptoms including severe cyclical nausea and vomiting and epigastric or periumbilical abdominal pain as a result of long-term cannabis use. Recognizing the diagnosis and educating patients on the benefits of cessation is essential, as these patients often undergo extensive and repeated evaluations in the clinic, emergency department, and inpatient setting that could be avoided with extensive history taking and early recognition of the syndrome. In this study, we compared costs incurred by patients in various settings to determine if there is a difference between patients with and without CHS. Although there were not statistically significant cost differences between groups for all cost categories, it is clear that patients with CHS consume considerably more health care dollars than patients who deny cannabis use, and obtaining a detailed social history is imperative to prevent unnecessary workups and increased financial burden on the health care industry.
Collapse
Affiliation(s)
- Gurkaminder Sandhu
- Division of Gastroenterology, Department of Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Steven Smith
- Division of Gastroenterology, Department of Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Kristen Stephenson
- Division of Gastroenterology, Department of Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Victoria Jaeger
- Division of Gastroenterology, Department of Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Rebekah John
- Department of Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Courtney Shaver
- Baylor Research Institute, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Christopher Johnson
- Division of Gastroenterology, Department of Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
| |
Collapse
|
71
|
von Both I, Santos B. Death of a young woman with cyclic vomiting: a case report. Forensic Sci Med Pathol 2021; 17:715-722. [PMID: 34735682 DOI: 10.1007/s12024-021-00410-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 01/19/2023]
Abstract
We report the death of a 22-year-old woman, with a 3½ year history of cyclic vomiting and cannabis use since age 14, who developed torsades de pointes cardiac arrythmia while being treated in the emergency room for nausea and vomiting. Resuscitation restored spontaneous cardiac circulation, however, due to post-cardiac arrest anoxic brain injury, she never regained consciousness and was declared brain dead 4 days later. Postmortem examination confirmed hypoxic-ischemic encephalopathy, in keeping with the in-hospital diagnosis of brain death. The heart was anatomically normal but showed signs of acute post-cardiopulmonary arrest reperfusion injury. As a consequence of limited survival in hospital in a neuro-vegetative state, early bronchopneumonia and isolated pulmonary thromboemboli were seen. Toxicological studies confirmed cannabis use, in addition to the presence of haloperidol and ondansetron. Genetic studies were performed to rule out a possible channelopathy and revealed a mutation in the MYBPC3 and RYR2 genes. Death in this woman with cannabinoid hyperemesis syndrome was attributed to a fatal cardiac arrhythmia complicating vomiting-induced hypokalemia and treatment with QT interval prolonging and potentially arrhythmogenic medications, with the identified cardiac genetic mutations listed as contributing factors. The emphasis of this report is a) to raise awareness that death can occur due to cyclic vomiting, b) provide a brief but practical overview of cannabinoid hyperemesis syndrome, c) describe the findings from our postmortem examination and come to the most reasonable cause and mechanism of death, d) comment on the risk factors associated with torsades de pointes cardiac arrythmia, and e) conclude that a complete postmortem examination is needed to exclude an anatomical or toxicological cause of death in cannabinoid hyperemesis syndrome, a disabling but preventable disorder.
Collapse
Affiliation(s)
- Ingo von Both
- Provincial Forensic Pathology Unit, Department of Laboratory Medicine & Pathobiology, Ontario Forensic Pathology Service, University of Toronto, 25 Morton Shulman Avenue, Toronto, ON, M3M 0B1, Canada. .,Office of the Chief Medical Examiner, Department of Laboratory Medicine & Pathology, University of Alberta, 7007 - 116 Street NW, Edmonton, AB T6H 5R8, Canada.
| | - Brittini Santos
- Provincial Forensic Pathology Unit, Department of Laboratory Medicine & Pathobiology, Ontario Forensic Pathology Service, University of Toronto, 25 Morton Shulman Avenue, Toronto, ON, M3M 0B1, Canada
| |
Collapse
|
72
|
Burillo-Putze G, Trujillo-Burillo D, García-Hernandez JC, López-Hernández MA, Hernández-Ramos I, Ramos-Suárez I, Richards JR. Cannabis hyperemesis syndrome: Incidence and treatment with topical capsaicin. Med Clin (Barc) 2021; 159:183-186. [PMID: 34756408 DOI: 10.1016/j.medcli.2021.07.028] [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: 05/19/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 12/01/2022]
Abstract
There are few studies in Spain on cannabinoid hyperemesis syndrome (CHS), as well as on the use of topical capsaicin as a treatment. METHODS Retrospective study of patients over 14 years of age seen in a hospital emergency department during 2018 and 2019 with a diagnosis of CHS based on the following criteria: compatible clinical picture, cannabis use less than 48h and positive urine cannabis test. Epidemiological and clinical variables, attendance times and treatment (including use of topical capsaicin 0.075%) were collected. RESULTS Fifty-nine attendances were studied, from 29 patients (4.4 cases/10,000 visits, 95% CI 2.8-4.7). Fifty per cent returned for CHS, differing only in more tobacco (P=.01) and cocaine (P=.031) use. Capsaicin was used in 74.6% of visits. The mean time to resolution of vomiting after application was 17.87min. CONCLUSIONS Although probably underdiagnosed, CHS has a low incidence in the emergency department in Spain, with high patient recurrence. The use of capsaicin ointment is efficient and safe.
Collapse
Affiliation(s)
- Guillermo Burillo-Putze
- Departamento de Medicina Física y Farmacología, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España; Grupo de investigación Urgencias y toxicología clínica: patologías agudas y procesos asistenciales (GRUCATOX), Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España.
| | - David Trujillo-Burillo
- Departamento de Medicina Física y Farmacología, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - Jose Carlos García-Hernandez
- Departamento de Medicina Física y Farmacología, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - M Angeles López-Hernández
- Grupo de investigación Urgencias y toxicología clínica: patologías agudas y procesos asistenciales (GRUCATOX), Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España; Servicio de Urgencias, Hospital Universitario de Canarias, San Cristóbal de La Laguna , Santa Cruz de Tenerife, España
| | - Iván Hernández-Ramos
- Grupo de investigación Urgencias y toxicología clínica: patologías agudas y procesos asistenciales (GRUCATOX), Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España; Servicio de Urgencias, Hospital Universitario de Canarias, San Cristóbal de La Laguna , Santa Cruz de Tenerife, España
| | - Isabel Ramos-Suárez
- Grupo de investigación Urgencias y toxicología clínica: patologías agudas y procesos asistenciales (GRUCATOX), Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España; Department of Emergency Medicine, University of California, Davis Medical Center, Davis, California, Estados Unidos
| | - John R Richards
- Department of Emergency Medicine, University of California, Davis Medical Center, Davis, California, Estados Unidos
| |
Collapse
|
73
|
Carter J, Chang J, Birriel TJ, Moustarah F, Sogg S, Goodpaster K, Benson-Davies S, Chapmon K, Eisenberg D. ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:1956-1976. [PMID: 34629296 DOI: 10.1016/j.soard.2021.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jonathan Carter
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California.
| | - Julietta Chang
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - T Javier Birriel
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Fady Moustarah
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Stephanie Sogg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Kasey Goodpaster
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Sue Benson-Davies
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Katie Chapmon
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Dan Eisenberg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| |
Collapse
|
74
|
Cates AL, Farmer B. Chronic Drug Use and Abdominal Pain. Emerg Med Clin North Am 2021; 39:821-837. [PMID: 34600640 DOI: 10.1016/j.emc.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are a variety of gastrointestinal pathologies that may be emergently identified in the patient who chronically uses alcohol or other substances. Patients may present to an Emergency Department with abdominal complaints existing on a spectrum from vague and benign to systemically toxic and potentially life-threatening. This article highlights ethanol, opioids, and other common substances of abuse and how they may contribute to gastrointestinal complaints.
Collapse
Affiliation(s)
- Alexis L Cates
- Division of Medical Toxicology, Department of Emergency Medicine, Einstein Healthcare Network, Korman B-14, 5501 Old York Road, Philadelphia, PA 19141, USA.
| | - Brenna Farmer
- Quality and Patient Safety, Department of Emergency Medicine, Weill Cornell Medicine, New York Presbyterian/Lower Manhattan Hospital Emergency Department
| |
Collapse
|
75
|
Abstract
OBJECTIVE Cannabis Hyperemesis Syndrome (CHS) is characterized by recurrent episodes of intractable emesis associated with heavy use of cannabis. Recognition of CHS can be problematic due to the lack of specific biomarkers, which can point the clinician to the diagnosis. We present, retrospectively, a series of adolescent/young adult patients who presented to a pediatric gastroenterology (GI) service with acute on chronic nausea and vomiting, subsequently found to have CHS with associated elevated urinary cannabis metabolite concentrations. METHODS We describe 15 patients referred to our pediatric GI division for intractable emesis with spot urinary cannabis metabolite carboxy-THC (THC-COOH) concentrations from January 1, 2018 through April 20, 2019. Urinary testing was performed using gas chromatography mass-spectrometry (GC-MS) in a manner consistent with Clinical Laboratory Improvement Amendments (CLIA) requirements at Mayo Clinic laboratory (Rochester, MN). The laboratory cutoffs were 3.0 ng/mL. Data was extracted via chart review and analyzed via online statistical application. RESULTS Fifteen patients (seven females, eight males) were studied with an average age of 17.7 years. All patients reported frequent cannabis use for at least 1 month and exhibited intractable, non-bilious emesis for at least 2 weeks. Twelve patients also reported weight loss. Two patients had underlying gastrointestinal disease (one with Crohn disease and one with irritable bowel syndrome). All patients had essentially normal GI workup including laboratory tests, imaging studies and endoscopies.Fourteen of 15 patients had urinary THC-COOH concentrations >100 ng/mL, with seven individuals exhibiting levels >500 ng/mL. One patient had a urinary TCH-COOH concentration level under 100 ng/mL had not used cannabis for 2 weeks. Most other patients had used cannabis within 2 days of providing a urine sample. The Binomial test for CHS patients with urinary THC-COOH levels over 100 ng/mL was significant with a P-value of <0.0005 (one tail test). CONCLUSION CHS is associated with an elevated urinary THC-COOH level usually exceeding 100 ng/mL, which is indicative of significant chronic cannabis exposure. In patients with a history consistent with CHS, urine THC-COOH testing may help guide the diagnostic evaluation of these patients and decrease the need for further workup.
Collapse
|
76
|
Bukke VN, Archana M, Villani R, Serviddio G, Cassano T. Pharmacological and Toxicological Effects of Phytocannabinoids and Recreational Synthetic Cannabinoids: Increasing Risk of Public Health. Pharmaceuticals (Basel) 2021; 14:ph14100965. [PMID: 34681189 PMCID: PMC8541640 DOI: 10.3390/ph14100965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
Synthetic Cannabinoids (CBs) are a novel class of psychoactive substances that have rapidly evolved around the world with the addition of diverse structural modifications to existing molecules which produce new structural analogues that can be associated with serious adverse health effects. Synthetic CBs represent the largest class of drugs detected by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) with a total of 207 substances identified from 2008 to October 2020, and 9 compounds being reported for the first time. Synthetic CBs are sprayed on natural harmless herbs with an aim to mimic the euphoric effect of Cannabis. They are sold under different brand names including Black mamba, spice, K2, Bombay Blue, etc. As these synthetic CBs act as full agonists at the CB receptors, they are much more potent than natural Cannabis and have been increasingly associated with acute to chronic intoxications and death. Due to their potential toxicity and abuse, the US government has listed some synthetic CBs under schedule 1 classification. The present review aims to provide a focused overview of the literature concerning the development of synthetic CBs, their abuse, and potential toxicological effects including renal toxicity, respiratory depression, hyperemesis syndrome, cardiovascular effects, and a range of effects on brain function.
Collapse
|
77
|
Shah D, Sklar R, Ganti L, Walker J. An Ominous Cause of Headache in a Teenager. Cureus 2021; 13:e16934. [PMID: 34513504 PMCID: PMC8412887 DOI: 10.7759/cureus.16934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/22/2022] Open
Abstract
We present the case of an adolescent male who presented to the emergency department with headache and vomiting. We discuss the differential diagnosis and the need to maintain a high index of suspicion to avoid missing ominous causes of headache. In this case, the patient had a pineoblastoma, detected on a noncontrast CT scan. The CT scan was done as part of the emergency department workup to evaluate headache accompanied by vomiting in this otherwise healthy teenager.
Collapse
Affiliation(s)
- Dipal Shah
- Emergency Medicine, Ocala Regional Medical Center, Ocala, USA
| | - Rachel Sklar
- Emergency Medicine, Brown University, Providence, USA
| | - Latha Ganti
- Emergency Medicine, Envision Physician Services, Plantation, USA.,Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium Emergency Medicine Residency Program of Greater Orlando, Olrando, USA
| | - Joshua Walker
- Emergency Medicine, Ocala Regional Medical Center, Ocala, USA
| |
Collapse
|
78
|
Wise JL, Vazquez-Roque MI, McKinney CJ, Zickella MA, Crowell MD, Lacy BE. Gastric Emptying Scans: Poor Adherence to National Guidelines. Dig Dis Sci 2021; 66:2897-2906. [PMID: 32418002 DOI: 10.1007/s10620-020-06314-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Accurately diagnosing gastroparesis relies upon gastric emptying scintigraphy (GES) being performed correctly. Jointly published protocol guidelines have long been available; however, the extent to which practitioners adhere to these guidelines is unknown. AIMS This study aimed to assess national compliance with established GES protocol guidelines. METHODS We developed a questionnaire addressing the key protocol measures outlined in the Consensus Recommendations for Gastric Emptying Scintigraphy. Survey questions addressed patient information collection (15), patient preparation and procedure protocol (16), meal content and preparation (7), imaging (3), interpretation (4), reporting (7), and institutional demographic data (7). The anonymous questionnaire was distributed electronically to members of the Society of Nuclear Medicine and Medical Imaging (SNMMI) and non-member recipients of the SNMMI daily email newsletter. One response per medical institution was permitted. RESULTS A total of 121 out of 872 potential medical institutions (MI) responded (13.9%); 49 (40.4%) were academic/teaching medical centers. The annual number (mean) of GES procedures was 199.9 (range 5-2000 GES/year). On average, MI performed 33.5/52 (64%) of protocol measures according to guidelines while academic medical centers performed 31.5/52 (61%) of protocol measures according to guidelines. Only 4 out of 88 MI (4.5%) performed GES while adhering to three critical measures: validated study duration; controlled blood glucose levels; and proper restriction of medications. CONCLUSIONS Low compliance with GES protocol guidelines, even among academic medical centers, raises the likely possibility of misdiagnosis and improper management of upper gastrointestinal symptoms. These results highlight a need for increased awareness of protocol guidelines for gastric scintigraphy.
Collapse
Affiliation(s)
- Journey L Wise
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Maria I Vazquez-Roque
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Caleb J McKinney
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michael A Zickella
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michael D Crowell
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| |
Collapse
|
79
|
Dosani K, Koletic C, Alhosh R. Cannabinoid Hyperemesis Syndrome in Pediatrics: An Emerging Problem. Pediatr Rev 2021; 42:500-506. [PMID: 34470869 DOI: 10.1542/pir.2019-0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cannabis use has been evolving in both recreational drug use and medicinal uses, in part due to the recent introduction of various strains and components. With increasing use, we have seen emergence of a hyperemesis syndrome called cannabinoid hyperemesis syndrome characterized as intractable vomiting, nausea, and abdominal pain in the context of prolonged cannabinoid use. Although the antiemetic properties of cannabis have been known for years, the paradoxical effect of hyperemesis has yet to be elucidated. Herein we discuss the current research, epidemiology, and diagnosis and treatment of cannabinoid hyperemesis syndrome. Without timely diagnosis and treatment, patients may experience significant physical and emotional distress, as well as place unnecessary financial burden on the medical system.
Collapse
Affiliation(s)
- Kaushal Dosani
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV
| | - Carolina Koletic
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV
| | - Rabea Alhosh
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV
| |
Collapse
|
80
|
Affiliation(s)
- Mark B Mycyk
- Research Division, Department of Emergency Medicine, Cook County Health, Chicago, Illinois
| | - Joanne C Routsolias
- Research Division, Department of Emergency Medicine, Cook County Health, Chicago, Illinois
| |
Collapse
|
81
|
Wang GS, Buttorff C, Wilks A, Schwam D, Tung G, Pacula RL. Changes in Emergency Department Encounters for Vomiting After Cannabis Legalization in Colorado. JAMA Netw Open 2021; 4:e2125063. [PMID: 34533572 PMCID: PMC8449280 DOI: 10.1001/jamanetworkopen.2021.25063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Cannabis hyperemesis syndrome is an emerging clinical issue associated with cannabis use. Legalization of cannabis has led to an increase in vomiting-related illnesses in health care settings. OBJECTIVE To examine whether legalization of cannabis in Colorado has been associated with increases in vomiting-related emergency department (ED) visits. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional design was used to assess the increase in ED claims for vomiting reported to the Colorado Hospital Association between January 1, 2013, and December 31, 2018, in counties that had no prior cannabis dispensaries before legalization compared with those that did. A total of 820 778 patients seeking care through Colorado EDs were included in the analysis. EXPOSURES The number of medical and recreational cannabis dispensaries per county per quarter. MAIN OUTCOMES AND MEASURES County per capita rate of vomiting-related ED claims per quarter. RESULTS Vomiting-related ED health care encounters increased from 119 312 in 2013 to 153 699 in 2018 (29% increase). Over this period, 203 861 patients (25%) were aged 0 to 18 years; 114 201 (14%) were aged 19 to 25 years, and 502 771 (61%) were aged 26 years or older; 510 584 patients (62%) were female. Additional recreational dispensaries were associated with increased vomiting-related ED visits (incidence rate ratio, 1.03; 95% CI, 1.01-1.05), but counties with high baseline medical dispensary exposure experienced smaller increases in vomiting-related ED visits than counties with no baseline medical dispensary exposure (incidence rate ratio, 0.97; 95% CI, 0.95-0.99). Counties with a high number of medical marijuana dispensaries had increases at a 5.8% slower rate than counties with none. CONCLUSIONS AND RELEVANCE The findings of this study suggest that cannabis legalization in Colorado is associated with an increase in annual vomiting-related health care encounters with regard to exposure to these markets. It may be useful for health care clinicians to be aware of cannabis hyperemesis syndrome and inquire about cannabis use when appropriate.
Collapse
Affiliation(s)
- George Sam Wang
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora
| | | | - Asa Wilks
- RAND Corporation, Santa Monica, California
| | | | - Gregory Tung
- Department of Health Systems, Management & Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
| |
Collapse
|
82
|
Affiliation(s)
- Raymen R Assaf
- Pediatric Emergency Medicine, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 21, Torrance, CA 90502, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Kelly D Young
- Pediatric Emergency Medicine, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 21, Torrance, CA 90502, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
83
|
Eis D. Übelkeit und Erbrechen als Symptome in der Notfallmedizin. Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
84
|
Hsu J, Herrmann Z, Kashyap S, Claassen C. Treatment of Cannabinoid Hyperemesis With Olanzapine: A Case Series. J Psychiatr Pract 2021; 27:316-321. [PMID: 34398582 DOI: 10.1097/pra.0000000000000564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The use and availability of cannabis for recreational and medical purposes has become more widespread with increased legalization. Adverse health outcomes of this increased use include cannabinoid hyperemesis syndrome (CHS), which is underrecognized in medical settings. Cessation of substance use is the recommendation of choice for the complete resolution of CHS. However, interventions that provide rapid relief may be necessary in treatment-refractory cases. Little evidence is available to guide care in these cases. Here we report 4 cases of treatment-refractory CHS, all of which remitted after treatment with olanzapine. Olanzapine is known to block multiple neurotransmitter receptors involved in nausea and vomiting in chemotherapy-induced nausea and vomiting. Outcomes of the cases reported here suggest that off-label use of olanzapine may be effective in the symptomatic treatment of refractory CHS and may be the preferred treatment in cases in which comorbid psychotic symptoms or agitation are present.
Collapse
Affiliation(s)
- Jennifer Hsu
- HSU, HERRMANN, KASHYAP, CLAASSEN: Department of Psychiatry, John Peter Smith Hospital, Fort Worth, TX
| | | | | | | |
Collapse
|
85
|
Hakimian D, Benson AA, Khoury T, Massarwa M, Israel S, Salameh S, Gershinsky Y, Shapira B, Muszkat M. Gastrointestinal manifestations of synthetic cannabinoids: a retrospective cohort study. BMC Gastroenterol 2021; 21:274. [PMID: 34229620 PMCID: PMC8259032 DOI: 10.1186/s12876-021-01847-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Synthetic cannabinoids (SC) are chemical substances which activate cannabinoid receptors similarly to tetrahydrocannabinol, but with a higher efficacy. These substances are used as illicit recreational drugs, often smoked as herbal mixtures. The continuing availability and rapid evolution of SC is an ongoing health risk. The adverse effects of SC are wide ranging, and span from mild behavioral changes to death. Knowledge regarding gastrointestinal (GI) manifestations of SC use is sparse. METHODS Single tertiary-care referral medical center retrospective study. RESULTS The medical records of patients presented to hospital emergency care due to SC use between January 2014 and February 2018 were retrieved from Hadassah Mount Scopus Hospital's computerized database. The records were reviewed for clinical outcomes and laboratory tests. Fifty-five (55) patients were identified with a hospital presentation due to SC use. Twenty-one (21) out of 55 patients (38%) reported gastrointestinal complaints. The most common complaints were abdominal pain and vomiting. Of those, 28% had recurrent emergency department presentations due to abdominal pain and 66% presented with leukocytosis. Serum lactate was elevated in 66% of patients with GI manifestations. One patient had an abnormal computerized tomography (CT) abdominal angiography scan, which was compatible with intestinal ischemia. CONCLUSIONS The clinical spectrum of gastrointestinal manifestations in SC intoxication ranges from mild symptoms, such as abdominal pain and vomiting, to even more severe symptoms suggestive of intestinal ischemia. Clinicians should be aware that abdominal pain and other gastrointestinal complaints can be associated with SC use.
Collapse
Affiliation(s)
- David Hakimian
- Institute of Gastroenterology and Liver Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91240, Ein Kerem, Jerusalem, Israel.
| | - Ariel A Benson
- Institute of Gastroenterology and Liver Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91240, Ein Kerem, Jerusalem, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Bar-Ilan Faculty of Medicine, Safed, Israel
| | - Muhammad Massarwa
- Institute of Gastroenterology and Liver Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91240, Ein Kerem, Jerusalem, Israel
| | - Sarah Israel
- Department of Internal Medicine, Hadassah Medical Center Mt Scopus and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shaden Salameh
- Department of Emergency Medicine, Mt Scopus and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonatan Gershinsky
- Department of Emergency Medicine, Mt Scopus and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Barak Shapira
- Braun School of Public Health and Community Medicine, Hebrew University Ein Kerem Medical Campus, Jerusalem, Israel
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | - Mordechai Muszkat
- Department of Internal Medicine, Hadassah Medical Center Mt Scopus and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
86
|
Russo EB, Spooner C, May L, Leslie R, Whiteley VL. Cannabinoid Hyperemesis Syndrome Survey and Genomic Investigation. Cannabis Cannabinoid Res 2021; 7:336-344. [PMID: 34227878 PMCID: PMC9225400 DOI: 10.1089/can.2021.0046] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Cannabinoid hyperemesis syndrome (CHS) is a diagnosis of exclusion with intractable nausea, cyclic vomiting, abdominal pain, and hot bathing behavior associated with ongoing tetrahydrocannabinol (THC) exposure. Increasing cannabis use may elevate CHS prevalence, exacerbating a public health issue with attendant costs and morbidity. Objective, Design, and Data Source: This study, the largest contemporaneous database, investigated genetic mutations underlying CHS. Patients with CHS diagnosis and ongoing symptoms were compared with current cannabis users lacking symptoms. Target Population: A screening questionnaire was posted online. Of 585 respondents, 205 qualified as the CHS pool and 54 as controls; a reduced pool of 28 patients and 12 controls ultimately completed genomic testing. Results: Patients and controls were high-frequency users of cannabis flower or concentrates (93%), using multiple grams/day of THC-predominant material. Among patients, 15.6% carried diagnoses of cannabis dependency or addiction, and 56.6% experienced withdrawal symptoms. About 87.7% of patients improved after cannabis cessation, most suffering recurrence rapidly after resumption. Findings in patients included mutations in genes COMT {odds ratio, 12 (95% confidence limit [CL], 1.3–88.1) p=0.012}, transient receptor potential vanilloid receptor 1 (TRPV1) (odds ratio, 5.8 [95% CL, 1.2–28.4] p=0.015), CYP2C9 (odds ratio, 7.8 [95% CL, 1.1–70.1] p=0.043), gene coding dopamine-2 receptor (DRD2) (odds ratio, 6.2 [95% CL, 1.1–34.7] p=0.031), and ATP-binding cassette transporter gene (ABCA1) (odds ratio, 8.4 [95% CL, 1.5–48.1] p=0.012). Limitations: Some participants were reluctant to undergo genetic testing; only 28 of 99 CHS patients who agreed to testing ultimately returned a kit. Conclusion: This is the largest patient cohort of CHS examined to date, and first to note associated mutations in genes affecting neurotransmitters, the endocannabinoid system, and the cytochrome P450 complex associated with cannabinoid metabolism. Although the sample size was smaller than desired, these preliminary findings may contribute to the growing body of knowledge, stimulate additional investigation, help elucidate the pathophysiology of CHS, and, ultimately, direct future treatment.
Collapse
Affiliation(s)
| | | | - Len May
- Endocanna Health, Los Angeles, California, USA
| | - Ryan Leslie
- Endocanna Health, Los Angeles, California, USA
| | | |
Collapse
|
87
|
Vodovar D, Caré W, Dufayet L, Batisse A. Cannabidiol-induced toxicity: who is the culprit? Am J Emerg Med 2021; 47:284-285. [PMID: 34112527 DOI: 10.1016/j.ajem.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/02/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Dominique Vodovar
- Centre Antipoison de Paris, Hôpital Fernand Widal - Fédération de Toxicologie de l'AP-HP, Paris 75010, France; Inserm UMRS-1144, Faculté de Pharmacie, Paris 75006, France; UFR de médecine, Université de Paris, Paris 75010, France.
| | - Weniko Caré
- Centre Antipoison de Paris, Hôpital Fernand Widal - Fédération de Toxicologie de l'AP-HP, Paris 75010, France; Inserm UMRS-1144, Faculté de Pharmacie, Paris 75006, France; Service de médecine interne, Hôpital d'instruction des armées Bégin, Saint-Mandé 94160, France
| | - Laurène Dufayet
- Centre Antipoison de Paris, Hôpital Fernand Widal - Fédération de Toxicologie de l'AP-HP, Paris 75010, France; Inserm UMRS-1144, Faculté de Pharmacie, Paris 75006, France; UFR de médecine, Université de Paris, Paris 75010, France; Unité Médico-Judiciaire, Hôpital Hôtel-Dieu - AP-HP, Paris 75004, France
| | - Anne Batisse
- Centre d'addictovigilance de Paris, Hôpital Fernand Widal - AP-HP, Paris 75010, France
| |
Collapse
|
88
|
Ruberto AJ, Sivilotti ML, Forrester S, Hall AK, Crawford FM, Day AG. Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled Trial. Ann Emerg Med 2021; 77:613-619. [DOI: 10.1016/j.annemergmed.2020.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 01/21/2023]
|
89
|
Affiliation(s)
- David C Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Adrienne Hughes
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.,Oregon Poison Center, Portland, OR
| | - B Zane Horowitz
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.,Oregon Poison Center, Portland, OR
| |
Collapse
|
90
|
Zhong W, Shahbaz O, Teskey G, Beever A, Kachour N, Venketaraman V, Darmani NA. Mechanisms of Nausea and Vomiting: Current Knowledge and Recent Advances in Intracellular Emetic Signaling Systems. Int J Mol Sci 2021; 22:5797. [PMID: 34071460 PMCID: PMC8198651 DOI: 10.3390/ijms22115797] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023] Open
Abstract
Nausea and vomiting are common gastrointestinal complaints that can be triggered by diverse emetic stimuli through central and/or peripheral nervous systems. Both nausea and vomiting are considered as defense mechanisms when threatening toxins/drugs/bacteria/viruses/fungi enter the body either via the enteral (e.g., the gastrointestinal tract) or parenteral routes, including the blood, skin, and respiratory systems. While vomiting is the act of forceful removal of gastrointestinal contents, nausea is believed to be a subjective sensation that is more difficult to study in nonhuman species. In this review, the authors discuss the anatomical structures, neurotransmitters/mediators, and corresponding receptors, as well as intracellular emetic signaling pathways involved in the processes of nausea and vomiting in diverse animal models as well as humans. While blockade of emetic receptors in the prevention of vomiting is fairly well understood, the potential of new classes of antiemetics altering postreceptor signal transduction mechanisms is currently evolving, which is also reviewed. Finally, future directions within the field will be discussed in terms of important questions that remain to be resolved and advances in technology that may help provide potential answers.
Collapse
Affiliation(s)
- Weixia Zhong
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
| | - Omar Shahbaz
- School of Medicine, Universidad Iberoamericana, Av. Francia 129, Santo Domingo 10203, Dominican Republic;
| | - Garrett Teskey
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
| | - Abrianna Beever
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA; (A.B.); (N.K.)
| | - Nala Kachour
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA; (A.B.); (N.K.)
| | - Vishwanath Venketaraman
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA; (A.B.); (N.K.)
| | - Nissar A. Darmani
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
| |
Collapse
|
91
|
Lewis B, Leach E, Fomum Mugri LB, Keung MY, Ouellette L, Riley B, Judge B, Fleeger T, Jones JS. Community-based study of cannabis hyperemesis syndrome. Am J Emerg Med 2021; 45:504-505. [PMID: 34103168 DOI: 10.1016/j.ajem.2021.05.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Brian Lewis
- Spectrum Health, Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States
| | - Erin Leach
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Larissa B Fomum Mugri
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Man Yee Keung
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Lindsey Ouellette
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Brad Riley
- Spectrum Health, Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States
| | - Bryan Judge
- Spectrum Health, Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States
| | - Tiffany Fleeger
- Spectrum Health, Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States
| | - Jeffrey S Jones
- Spectrum Health, Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States.
| |
Collapse
|
92
|
Lee A, Coralic Z. Use of Capsaicin Cream in Cannabinoid Hyperemesis Syndrome in Patients Presenting to the Emergency Department. Ann Pharmacother 2021; 56:151-154. [PMID: 33998315 DOI: 10.1177/10600280211018516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclical nausea, vomiting, and abdominal pain often relieved with hot showers. Patients with CHS are usually long-term cannabis smokers whose symptoms are not relieved by antiemetics. The use of topical capsaicin has been recently reported as an adjunctive therapy in the emergency department (ED). OBJECTIVE To describe the use of capsaicin cream in patients presenting to the ED with suspected CHS. METHODS We performed a retrospective review of patients with suspected CHS receiving capsaicin in an ED from July 2014 to October 2018. We report data on demographics, cannabis consumption, hot showers use, length of stay, concurrent treatments, pain scores, and adverse events. RESULTS There were 57 patients who received capsaicin cream for suspected CHS. Nearly all patients received antiemetics (98%), whereas 47% of patients received an opioid. Antiemetics were typically administered first (median, 1.6 hours; interquartile range [IQR], 0.9-2.4]), followed by an opioid (median, 1.8 hours [IQR, 1-3.75]), followed by capsaicin cream (median 4 hours [IQR, 2.7-5.2]). The overall precapsaicin pain score was 8 (IQR, 2-9), decreasing to 5.5 (IQR, 0-8). Around 42% of patients received no further symptomatic therapy after capsaicin. No adverse drug events to capsaicin were reported. CONCLUSION AND RELEVANCE This is the largest retrospective study describing capsaicin cream use in suspected CHS patients with a focus on abdominal pain relief. Capsaicin treatment was associated with a modest pain score reduction. Application of these findings may help providers in identifying more effective therapies to provide symptomatic relief for CHS patients.
Collapse
Affiliation(s)
- Allison Lee
- University of California San Francisco School of Pharmacy, CA, USA
| | - Zlatan Coralic
- University of California San Francisco School of Pharmacy, CA, USA.,Departments of Pharmacy and Emergency Medicine, University of California San Francisco, CA, USA
| |
Collapse
|
93
|
Boursier A, Caron C, Dekemp J, Fague V, Fulcrand J, Boccara E, Caous AS, Lemaire A. [Dronabinol and hyperemesis syndrom: A potential risk?]. Therapie 2021; 77:495-496. [PMID: 34045079 DOI: 10.1016/j.therap.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Amélie Boursier
- Pôle 8 cancérologie et spécialités médicales, centre d'évaluation et de traitement de la douleur, centre hospitalier de Valenciennes, 59300 Valenciennes, France.
| | - Clément Caron
- Centre régional de pharmacovigilance du Nord-Pas de Calais, CHRU de Lille, 59045 Lille, France
| | - Joelle Dekemp
- Centre régional de pharmacovigilance du Nord-Pas de Calais, CHRU de Lille, 59045 Lille, France
| | - Vassili Fague
- Pôle 8 cancérologie et spécialités médicales, service de chirurgie gynécologique, centre hospitalier de Valenciennes, 59300 Valenciennes, France
| | - Julie Fulcrand
- Pôle 8 cancérologie et spécialités médicales, centre d'évaluation et de traitement de la douleur, centre hospitalier de Valenciennes, 59300 Valenciennes, France
| | - Eugénie Boccara
- Pôle 7 psychiatrie, unité de traitement de la dépendance, centre hospitalier de Valenciennes, 59300 Valenciennes, France
| | - Anne-Sylvie Caous
- CEIP-addictovigilance, service de pharmacologie médicale, CHU de Lille, 59035 Lille cedex, France
| | - Antoine Lemaire
- Pôle 8 cancérologie et spécialités médicales, centre d'évaluation et de traitement de la douleur, centre hospitalier de Valenciennes, 59300 Valenciennes, France
| |
Collapse
|
94
|
Ali AA, Mathew R, Maaliki N, Shelley P. Recurring vomiting, skin discolouration: the easily overlooked thermal element of cannabinoid hyperemesis syndrome. BMJ Case Rep 2021; 14:e242062. [PMID: 33762293 PMCID: PMC7993339 DOI: 10.1136/bcr-2021-242062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Aleem Azal Ali
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Reshmi Mathew
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Naji Maaliki
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Patrisha Shelley
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| |
Collapse
|
95
|
Leu N, Routsolias JC. Cannabinoid Hyperemesis Syndrome: A Review of the Presentation and Treatment. J Emerg Nurs 2021; 47:483-486. [PMID: 33712244 DOI: 10.1016/j.jen.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022]
Abstract
After the increasing legalization of cannabis, there has been a rising trend in cannabis consumption, especially among heavy users. Cannabinoid hyperemesis syndrome is a syndrome of cyclic vomiting related to chronic cannabis use. The difficulty of diagnosis and treatment of this syndrome has led to a disproportionately high use of health care resources. Although the exact mechanism of cannabinoid hyperemesis syndrome is still unknown, patients typically progress through prodromal, hyperemetic, and recovery phases. Persistent vomiting in a patient who reports relief with hot showers should trigger the consideration of cannabinoid hyperemesis syndrome as a possible diagnosis. For treatment, antipsychotics such as haloperidol or droperidol have been shown to be more effective than conventional antiemetics for symptom control. Capsaicin should also be considered, given its positive efficacy and low adverse-effect profile. Providers must be aware of cannabinoid hyperemesis syndrome, its diagnosis, and treatment, given the increasing prevalence. Further research is required to elicit the exact mechanism and additional therapies for this syndrome.
Collapse
|
96
|
Qin C, Hu J, Wan Y, Cai M, Wang Z, Peng Z, Liao Y, Li D, Yao P, Liu L, Rong S, Bao W, Xu G, Yang W. Narrative review on potential role of gut microbiota in certain substance addiction. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110093. [PMID: 32898589 DOI: 10.1016/j.pnpbp.2020.110093] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/22/2020] [Accepted: 08/30/2020] [Indexed: 12/14/2022]
Abstract
As a neuropsychiatric disorder, substance addiction represents a major public health issue with high prevalence and mortality in many countries. Recently, gut microbiota has been certified to play a part in substance addiction through various mechanisms. Hence, we mainly focused on three substance including alcohol, cocaine and methamphetamine in this review, and summarized their relationships with gut microbiota, respectively. Besides, we also concluded the possible treatments for substance addiction from the perspective of applying gut microbiota. This review aims to build a bridge between substance addiction and gut microbiota according to existing evidences, so as to excavate the possible bi-directional function of microbiota-gut-brain axis in substance addiction for developing therapeutic strategies in the future.
Collapse
Affiliation(s)
- Chenyuan Qin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Jiawei Hu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Yiming Wan
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Mengyao Cai
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Zhenting Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Zhao Peng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Yuxiao Liao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Dan Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Ping Yao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Liegang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China
| | - Shuang Rong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, IA 52242, USA
| | - Guifeng Xu
- Department of Epidemiology, College of Public Health, University of Iowa, IA 52242, USA; Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA 52242, USA
| | - Wei Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China; Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, 430030 Wuhan, China.
| |
Collapse
|
97
|
Dufayet L, Laborde-Casterot H, Larabi A, Etting I, Alvarez J, Vodovar D. Syndrome cannabinoïde suite à la consommation d’huile de cannabidiol, à propos d’un cas. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2020.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
98
|
Impact of Recreational Cannabis Legalization on Hospitalizations for Hyperemesis. Am J Gastroenterol 2021; 116:609-612. [PMID: 33657044 DOI: 10.14309/ajg.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Chronic cannabis use had been associated with hyperemesis. We sought to determine whether cannabis liberalization contributed to increased hospitalizations for hyperemesis. METHODS Cannabis use and admissions for hyperemesis in legalized states were compared with those of nonlegalized states, before and after cannabis legalization, using state inpatient databases. RESULTS From 2011 to 2015, cannabis use increased 2.2 times in legalized states and 1.8 times in nonlegalized states. The odds of presentation with hyperemesis were higher in 2015 compared with those of 2011 in all states. DISCUSSION Recreational legalization may be contributing to rising cannabis use. Hospitalizations for hyperemesis have also increased but did not seem to be solely due to cannabis legalization.
Collapse
|
99
|
Cannabinoid Hyperemesis Syndrome: A Case Study in a Tunisian Young Man. Case Rep Med 2021; 2021:6617148. [PMID: 33628261 PMCID: PMC7884104 DOI: 10.1155/2021/6617148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/05/2021] [Accepted: 01/29/2021] [Indexed: 11/26/2022] Open
Abstract
The increasing prevalence of cannabis use in the world requires awareness of cannabis-related disorders such as cannabinoid hyperemesis syndrome. This syndrome includes cyclic episodes of nausea, vomiting, and the learned behavior of hot bathing in individuals with chronic cannabis use. We present the case of a suspected cannabinoid hyperemesis syndrome that required a review of the literature to retain the diagnosis. The following case illustrates how cannabinoid hyperemesis syndrome awareness may lead to the diagnosis.
Collapse
|
100
|
Abstract
Cannabis use disorder (CUD) is an underappreciated risk of using cannabis that affects ~10% of the 193 million cannabis users worldwide. The individual and public health burdens are less than those of other forms of drug use, but CUD accounts for a substantial proportion of persons seeking treatment for drug use disorders owing to the high global prevalence of cannabis use. Cognitive behavioural therapy, motivational enhancement therapy and contingency management can substantially reduce cannabis use and cannabis-related problems, but enduring abstinence is not a common outcome. No pharmacotherapies have been approved for cannabis use or CUD, although a number of drug classes (such as cannabinoid agonists) have shown promise and require more rigorous evaluation. Treatment of cannabis use and CUD is often complicated by comorbid mental health and other substance use disorders. The legalization of non-medical cannabis use in some high-income countries may increase the prevalence of CUD by making more potent cannabis products more readily available at a lower price. States that legalize medical and non-medical cannabis use should inform users about the risks of CUD and provide information on how to obtain assistance if they develop cannabis-related mental and/or physical health problems.
Collapse
|