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Wightman RS, Perrone J, Collins AB, Lakamana S, Sarker A. An analysis of cannabinoid hyperemesis syndrome Reddit posts and themes. Clin Toxicol (Phila) 2023; 61:283-289. [PMID: 37014024 PMCID: PMC10368483 DOI: 10.1080/15563650.2023.2183790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Reddit hosts a large active community of members dedicated to the discussion of cannabinoid hyperemesis syndrome. We sought to describe common themes discussed and the most frequently mentioned triggers and therapies for cannabinoid hyperemesis syndrome exacerbations in the Reddit online community. METHODS Data collected from six subreddits were filtered using natural language processing to curate posts referencing cannabinoid hyperemesis syndrome. Based on a manual review of posts, common themes were identified. A machine learning model was trained using the manually categorized data to automatically classify the themes for the rest of the posts so that their distributions could be quantified. RESULTS From August 2018 to November 2022, 2683 unique posts were collected. Thematic analysis resulted in five overall themes: cannabinoid hyperemesis syndrome-related science; symptom timing; cannabinoid hyperemesis syndrome treatment and prevention; cannabinoid hyperemesis syndrome diagnosis and education; and health impacts. Additionally, 447 trigger and 664 therapy-related posts were identified. The most commonly mentioned triggers for cannabinoid hyperemesis syndrome episodes included: food and drink (n = 62), cannabinoids (n = 45), mental health (e.g., stress, anxiety) (n = 27), and alcohol (n = 22). Most commonly mentioned cannabinoid hyperemesis syndrome therapies included: hot water/bathing (n = 62), hydration (n = 60), antiemetics (n = 42), food and drink (n = 38), gastrointestinal medications (n = 38), behavioral therapies (e.g., meditation, yoga) (n = 35), and capsaicin (n = 29). DISCUSSION Reddit posts for cannabinoid hyperemesis syndrome provide a valuable source of community discussion and individual reports of people experiencing cannabinoid hyperemesis syndrome. Mental health and alcohol were frequently reported triggers within the posts but are not often identified in the literature. While many of the therapies mentioned are well documented, behavioral responses such as meditation and yoga have not been explored by the scientific literature. CONCLUSIONS Knowledge shared via online social media platforms contains detailed information on self-reported cannabinoid hyperemesis syndrome disease and management experiences, which could serve as valuable data for the development of treatment strategies. Further longitudinal studies in patients with cannabinoid hyperemesis syndrome are needed to corroborate these findings.
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Affiliation(s)
- Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jeanmarie Perrone
- Center for Addiction Medicine and Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandra B Collins
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
| | - Sahithi Lakamana
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Abeed Sarker
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
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2
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Legare CA, Raup-Konsavage WM, Vrana KE. Therapeutic Potential of Cannabis, Cannabidiol, and Cannabinoid-Based Pharmaceuticals. Pharmacology 2022; 107:131-149. [DOI: 10.1159/000521683] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Background:</i></b> There is a growing interest in the use of cannabis (and its extracts), as well as CBD oil (hemp extracts containing cannabidiol), for therapeutic purposes. While there is reason to believe that cannabinoids may be efficacious for a number of different diseases and syndromes, there exist limited objective data supporting the use of crude materials (CBD oil, cannabis extracts, and/or cannabis itself). <b><i>Summary:</i></b> In the present review, we examined data for pure cannabinoid compounds (dronabinol, nabilone, and CBD), as well as partially purified medicinal cannabis extracts (nabiximols), to provide guidance on the potential therapeutic uses of high-THC cannabis and CBD oil. In general, data support a role for cannabis/cannabinoids in pain, seizure disorders, appetite stimulation, muscle spasticity, and treatment of nausea/vomiting. Given the biological activities of the cannabinoids, there may be utility in treatment of central nervous system disorders (such as neurodegenerative diseases, PTSD, and addiction) or for the treatment of cancer. However, those data are much less compelling. <b><i>Key Message:</i></b> On balance, there are reasons to support the potential use of medical cannabis and cannabis extract (Δ<sup>9</sup>-THC-dominant or CBD-dominant), but much more careful research is required.
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Senderovich H, Patel P, Jimenez Lopez B, Waicus S. Reply to Letter "Cannabis-Related Cyclic/Episodic Hyperemesis Conditions: From Suspected to Definitive Cannabinoid Hyperemesis Syndrome". Med Princ Pract 2022; 31:499-500. [PMID: 35817006 PMCID: PMC9801376 DOI: 10.1159/000525992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 01/02/2023] Open
Affiliation(s)
- Helen Senderovich
- Department of Family and Community Medicine, University of Toronto, Geriatrics and Palliative Care Baycrest Health Sciences, Toronto, Ontario, Canada
- *Helen Senderovich,
| | - Preet Patel
- Department of Medicine, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Sarah Waicus
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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4
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Bonnet U. Cannabis-Related Cyclic/Episodic Hyperemesis Conditions: From Suspected to Definitive Cannabinoid Hyperemesis Syndrome. Med Princ Pract 2022; 31:497-498. [PMID: 35817019 PMCID: PMC9801365 DOI: 10.1159/000525991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/28/2022] [Indexed: 01/03/2023] Open
Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Castrop-Rauxel, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany
- *Udo Bonnet,
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Shahsavari D, Reznick-Lipina K, Malik Z, Weiner M, Jehangir A, Repanshek ZD, Parkman HP. Haloperidol Use in the Emergency Department for Gastrointestinal Symptoms: Nausea, Vomiting, and Abdominal Pain. Clin Transl Gastroenterol 2021; 12:e00362. [PMID: 34060494 PMCID: PMC8162512 DOI: 10.14309/ctg.0000000000000362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 04/23/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Haloperidol (HL) has successfully been used for nausea and abdominal pain in emergency departments (EDs). This study examines outcomes and predictive factors for clinical improvement of patients presenting to an ED with gastrointestinal (GI) symptoms (nausea, vomiting, and abdominal pain) who received HL. METHODS Review of patients' records who presented to our ED between August 2016 and March 2019 with GI symptoms and received HL. International Classification of Diseases, Tenth Revision codes were used to identify patients. RESULTS In all, 281 patients (410 encounters) presented to the ED with GI symptoms and received HL for their symptoms: 66% were women, 32% had diabetes, 68% used marijuana, and 27% used chronic opioids. Patients received HL 1.1 ± 0.3 times with dose 2.5 ± 3.0 mg, mostly intravenously (84.6%). Total ED length of stay was 7.5 ± 3.9 hours (3.2 ± 2.1 hours before HL and 4.4 ± 3.4 hours after). Approximately 4.4% of patients developed side effects to HL, including 2 patients with dystonia which improved with medication before discharge. Most patients (56.6%) were discharged home while 43.2% were admitted to hospital mostly because of refractory nausea or vomiting (70.1%). Receiving HL as the only medication in the ED led to lower hospital admission (odds ratio = 0.25, P < 0.05). Diabetes, cannabinoid use, anxiety, male sex, and longer ED stay were associated with increased hospital admissions. DISCUSSION Most patients treated in our ED with HL for GI symptoms, particularly nausea, vomiting, and/or abdominal pain, were successfully treated and discharged home. HL use seemed relatively safe and, when used as the only medication, led to less frequent hospital admissions.
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Affiliation(s)
- Dariush Shahsavari
- Department of Gastroenterology, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Zubair Malik
- Department of Gastroenterology, Temple University, Philadelphia, Pennsylvania, USA
| | - Mark Weiner
- Weill Cornell Medical College, New York, New York, USA
| | - Asad Jehangir
- Department of Gastroenterology, Augusta University, Augusta, Georgia, USA
| | - Zachary D. Repanshek
- Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Henry P. Parkman
- Department of Gastroenterology, Temple University, Philadelphia, Pennsylvania, USA
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Rangan V, Ukleja A. Treatment of Cyclic Vomiting Syndrome: Is Bathing a Panacea or Is It in Hot Water? Dig Dis Sci 2021; 66:935-937. [PMID: 32651745 DOI: 10.1007/s10620-020-06448-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Vikram Rangan
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Dana 535, Boston, MA, 02215, USA.
| | - Andrew Ukleja
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Dana 535, Boston, MA, 02215, USA
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7
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Kichloo A, Albosta M, Aljadah M, El-Amir Z, Goldar G, Khan MZ, Dahiya DS, Vallabhaneni S, Wani F, Singh J. Marijuana: A systems-based primer of adverse effects associated with use and an overview of its therapeutic utility. SAGE Open Med 2021; 9:20503121211000909. [PMID: 33786179 PMCID: PMC7958160 DOI: 10.1177/20503121211000909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/12/2021] [Indexed: 12/18/2022] Open
Abstract
Marijuana use is on the rise in the United States. By the end of 2019, 33 states have legalized marijuana use and marijuana byproduct use for medical purposes. However, marijuana use does not come without side effects. This manuscript reviews the increasing usage of marijuana and the different forms (natural and synthetic) that patients may use when presenting to clinicians. It also addresses the biochemical and behavioral changes observed with marijuana use, including the location and changes associated with cannabinoid receptors (abbreviated CB1 and CB2). These two topics lead into an extensive review of the side effects of marijuana use. This manuscript discusses gastrointestinal side-effects, such as Cannabinoid Hyperemesis Syndrome, pancreatitis, and hepatotoxicity. It also briefly reviews cardiovascular, neurologic, and pulmonary side effects. This article provides an overview of therapeutic effects of marijuana including the antiemetic effect, its medical utility as an appetite stimulant, and usefulness in cancer patients post-chemotherapy. A thorough social history pertaining to marijuana use is an important consideration for clinicians in patients presenting with a variety of symptoms, including those effecting the gastrointestinal, cardiovascular, pulmonary, or neurologic systems.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Michael Albosta
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Michael Aljadah
- Department of Internal Medicine,
Medical College of Wisconsin, Milwaukee, WI, USA
| | - Zain El-Amir
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Ghazaleh Goldar
- Department of Internal Medicine,
Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Muhammed Zatmar Khan
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine,
Central Michigan University College of Medicine, Saginaw, MI, USA
| | | | - Farah Wani
- Department of Family Medicine,
Samaritan Medical Center, Watertown, NY, USA
| | - Jagmeet Singh
- Department of Nephrology, Guthrie
Robert Packer Hospital, Sayre, PA, USA
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8
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Schwartz BE, Baker KK, Bleinberger AJ, Lleshi A, Cruz-Cano R. Intravenous haloperidol for the treatment of intractable vomiting, cyclical vomiting, and gastroparesis. World J Emerg Med 2021; 12:228-231. [PMID: 34141040 DOI: 10.5847/wjem.j.1920-8642.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Brad E Schwartz
- Department of Emergency Medicine, University of Maryland Capital Region Health, UM Prince George's Hospital Center, Cheverly 20785, USA
| | - Karen Keller Baker
- Department of Emergency Medicine, University of Maryland Capital Region Health, UM Prince George's Hospital Center, Cheverly 20785, USA
| | | | - Amina Lleshi
- Ross University School of Medicine Bridgetown, Bridgetown 11093, Barbados
| | - Raul Cruz-Cano
- Department of Epidemiology and Biostatistics, School of Public Health of the University of Maryland, Baltimore 21201, USA
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9
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Assessment of Gastric Emptying Times Between Pediatrics and Adults With Cyclic Vomiting Syndrome. J Clin Gastroenterol 2020; 54:e89-e92. [PMID: 32569030 DOI: 10.1097/mcg.0000000000001352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND & AIMS Cyclic vomiting syndrome (CVS) is characterized by episodes of nausea and vomiting separated by symptom-free intervals. Rome IV guidelines have now distinguished CVS from other disorders such as cannabinoid hyperemesis. The pathogenesis of CVS, however, is poorly understood. Limited data exist on gastric emptying (GE) in patients with CVS. Therefore, the authors aim to measure the GE profile in pediatrics and adults with CVS. MATERIALS AND METHODS Patients with the diagnosis of CVS (per NASPGHAN and Rome IV) between December 1998 and March 2017 who underwent gastric emptying study (GES) and without documented cannabis use were included. Clinical features including demographics, medication use, and comorbidities were also recorded. Frequency of rapid, normal, and delayed emptying was reported, and multinomial univariate logistic regression was used to identify factors associated with each type of emptying. KEY RESULTS Sixty-seven subjects were included (50.7% female individuals, pediatrics n=15, adults n=52). At 2-hour retention, 40% of pediatric patients met criteria for rapid, 33.3% for normal, and 26.7% for delayed GE. In adults, 50% met criteria for rapid, 46.2% for normal, and 3.8% for delayed GE. For every 5-year increase in age, odds of rapid emptying on GES increased. CONCLUSIONS (1) GE is predominantly rapid at 2 hours in pediatrics and adults with CVS. (2) Rapid GE seems to increase with age. (3) Current guidelines do not recommend GE in the initial management, however, further studies may play a role to help differentiate CVS from other functional gastric disorders.
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10
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Lee-Cheong S, Grewal A, Hestvik L, Rafizadeh R, Schütz C. Cannabinoid Hyperemesis Syndrome: A Case Report and Discussion Regarding Patients with Concurrent Disorders. Can J Hosp Pharm 2020; 73:290-293. [PMID: 33100362 PMCID: PMC7556397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Stephen Lee-Cheong
- , MB, BCh, BAO, is a student in the Post-Graduate Certificate in Pain Management program of the Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta
| | - Amrita Grewal
- , BSc, PharmD, was, at the time of this study, a student in the PharmD program of the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia. She has since graduated from the program
| | - Lukas Hestvik
- , MN-NP(F), BSN, is with the Burnaby Centre for Mental Health and Addiction, Burnaby, British Columbia
| | - Reza Rafizadeh
- , BSPharm, ACPR, BCPP, RPh, is with The University of British Columbia and the BC Psychosis Program, Vancouver, British Columbia, and is also with the Burnaby Centre for Mental Health and Addiction, Burnaby, British Columbia
| | - Christian Schütz
- , MD, PhD, MPH, FRCPC, is with the University of British Columbia, Vancouver, British Columbia, and the Burnaby Centre for Mental Health and Addiction, Burnaby, British Columbia
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11
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DeVuono MV, La Caprara O, Sullivan MT, Bath A, Petrie GN, Limebeer CL, Rock EM, Hill MN, Parker LA. Role of the stress response and the endocannabinoid system in Δ 9-tetrahydrocannabinol (THC)-induced nausea. Psychopharmacology (Berl) 2020; 237:2187-2199. [PMID: 32399633 DOI: 10.1007/s00213-020-05529-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/16/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE Dysregulation of the endocannabinoid (eCB) system by high doses of Δ9-tetrahydrocannabinol (THC) is hypothesized to generate a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis contributing to cannabinoid hyperemesis syndrome (CHS). OBJECTIVES AND METHODS Using the conditioned gaping model of nausea, we aimed to determine if pre-treatments that interfere with stress, or an anti-emetic drug, interfere with THC-induced nausea in male rats. The corticotropin-releasing hormone (CRH) antagonist, antalarmin, was given to inhibit the HPA axis during conditioning. Since eCBs inhibit stress, MJN110 (which elevates 2-arachidonylglycerol (2-AG)) and URB597 (which elevates anandamide (AEA)) were also tested. Propranolol (β-adrenergic antagonist) and WAY-100635 (5-HT1A antagonist) attenuate HPA activation by cannabinoids and, therefore, were assessed. In humans, CHS symptoms are not alleviated by anti-emetic drugs, such as ondansetron (5-HT3 antagonist); however, benzodiazepines are effective. Therefore, ondansetron and chlordiazepoxide were tested. To determine if HPA activation by THC is dose-dependent, corticosterone (CORT) was analyzed from serum of rats treated with 0.0, 0.5, or 10 mg/kg THC. RESULTS Antalarmin (10 and 20 mg/kg), MJN110 (10 mg/kg), URB597 (0.3 mg/kg), propranolol (2.5 and 5 mg/kg), WAY-100635 (0.5 mg/kg), and chlordiazepoxide (5 mg/kg) interfered with THC-induced conditioned gaping, but the anti-emetic ondansetron (0.1 and 0.01 mg/kg) did not. THC produced significantly higher CORT levels at 10 mg/kg than at 0.0 and 0.5 mg/kg THC. CONCLUSIONS Treatments that interfere with the stress response also inhibit THC-induced conditioned gaping, but a typical anti-emetic drug does not, supporting the hypothesis that THC-induced nausea, and CHS, is a result of a dysregulated stress response.
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Affiliation(s)
- Marieka V DeVuono
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Olivia La Caprara
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Megan T Sullivan
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Alexandra Bath
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Gavin N Petrie
- Departments of Cell Biology and, Anatomy and Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Cheryl L Limebeer
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Erin M Rock
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Matthew N Hill
- Departments of Cell Biology and, Anatomy and Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Linda A Parker
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, ON, N1G 2W1, Canada.
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DeVuono MV, Parker LA. Cannabinoid Hyperemesis Syndrome: A Review of Potential Mechanisms. Cannabis Cannabinoid Res 2020; 5:132-144. [PMID: 32656345 PMCID: PMC7347072 DOI: 10.1089/can.2019.0059] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: Cannabinoids have long been known for their ability to treat nausea and vomiting. Recent reports, however, have highlighted the paradoxical proemetic effects of cannabinoids. Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclical episodes of nausea and vomiting, accompanied by abdominal pain following prolonged, high-dose cannabis use, which is alleviated by hot baths and showers. Little is known about the cause of this syndrome. Discussion: Cannabinoids produce a biphasic effect on nausea and vomiting, with low doses having an antiemetic effect and high doses producing emesis. Presentation and treatment of CHS are similar to cyclical vomiting syndrome as well as chemotherapy-related anticipatory nausea and vomiting, suggesting that these phenomena may share mechanisms. The prevalence of CHS is not known because of the symptomatic overlap with other disorders and the lack of knowledge of the syndrome by the public and physicians. Treatment with typical antiemetic drugs is ineffective for CHS, but anxiolytic and sedative drugs, along with hot showers, seem to be consistently effective at reducing symptoms. The only known way to permanently end CHS, however, is abstinence from cannabinoids. Case studies and limited pre-clinical data on CHS indicate that prolonged high doses of the main psychotropic compound in cannabis, Δ9-tetrahydrocannabinol (THC), result in changes to the endocannabinoid system by acting on the cannabinoid 1 (CB1) receptor. These endocannabinoid system changes can dysregulate stress and anxiety responses, thermoregulation, the transient receptor potential vanilloid system, and several neurotransmitters systems, and are thus potential candidates for mediating the pathophysiology of CHS. Conclusions: Excessive cannabinoid administration disrupts the normal functioning of the endocannabinoid system, which may cause CHS. More clinical and pre-clinical research is needed to fully understand the underlying pathophysiology of this disorder and the negative consequences of prolonged high-dose cannabis use.
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Affiliation(s)
- Marieka V. DeVuono
- Department of Psychology and Collabortive Neuroscience Program, University of Guelph, Guelph, Canada
| | - Linda A. Parker
- Department of Psychology and Collabortive Neuroscience Program, University of Guelph, Guelph, Canada
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13
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Pergolizzi Jr. JV, LeQuang JA, Bisney JF. Cannabinoid Hyperemesis. Med Cannabis Cannabinoids 2019; 1:73-95. [PMID: 34676325 PMCID: PMC8489348 DOI: 10.1159/000494992] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/30/2018] [Indexed: 11/08/2023] Open
Abstract
Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients. Unlike other cyclic vomiting syndromes, CHS can be relieved by hot showers or topical capsaicin. Abstinence from cannabinoids causes CHS to resolve, sometimes in a matter of days or hours. Marijuana users as well as many clinicians are not aware of CHS, and patients may undergo unnecessary tests, scans, and other procedures to get an accurate diagnosis. Symptoms may be severe enough to require hospitalization. With liberalization of marijuana laws and favorable public opinion about the healing properties of cannabis, CHS may be more frequently observed in clinical practice.
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