Recent research noted that type 1 cannabinoid receptors in the intestinal nerve plexus exhibit an inhibitory effect on gastrointestinal motility. At the same time, the thermoregulatory function of endocannabinoids might explain compulsive hot bathing in CHS patients. The prevalence of cannabis CHS is expected to rise as legal restrictions on its recreational use decrease in several states. Education and awareness are vital in diagnosing and treating CHS as its prevalence increases.
The Department of Emergency Medicine
When cannabis is the underlying cause, learning about CHS can be a life-changing discovery. A key question in understanding CHS is the underlying cause of its development. Pergolizzi et al. 20 provide an in-depth exploration of the pathogenesis of CHS. Cannabis contains over 100 different cannabinoids, with delta-9-THC and CBD being the primary compounds. These cannabinoids bind to cannabinoid receptors type 1 (CB1) and type 2 (CB2), which are distributed throughout the body.
How Is CHS Diagnosed?
- Recent studies have explored the potential use of biomarkers in diagnosing CHS.
- Despite the syndrome’s increasing prevalence, many physicians are unfamiliar with its diagnosis and treatment.
- People living with CHS often discover that hot baths and showers offer temporary relief from their intense nausea.
- Furthermore, emerging clinical strategies combining gradual cannabis cessation with TCA therapy have demonstrated effectiveness in achieving sustained CHS remission within a period of six to 12 months.
- Cannabinoids affect the pituitary–adrenal axis and stress-responsive brain regions.
Due to its lipophilic nature, THC accumulates in adipose tissue over time 24. This storage creates a “reintoxication” effect, where stored THC can be released under conditions such as stress or prolonged fasting 24. Chronic cannabis users tend to have significant THC reserves in their fat tissue, which can be mobilized during stressful situations. While clinical features such as chronic cannabis use, intractable vomiting, and relief with hot baths are commonly reported, these are not pathognomonic. The development of a validated CHS diagnostic tool, potentially incorporating biomarkers like cannabinoid metabolites or genetic polymorphisms, could revolutionize early detection and management. The studies included focused on individuals diagnosed with CHS, as well as those with comparable conditions such as CVS, and chronic cannabis users exhibiting symptoms similar to CHS.
What are the possible complications of cannabinoid hyperemesis syndrome?
Conventional antiemetics are not contraindicated but are generally ineffective likely because of the atypical mechanisms behind CHS. The prevalence of cannabis use disorder is expected to rise as legal restrictions on its recreational use decrease in several states. Nearly 20 years after CHS’s first report, current acute and long-term treatment strategies remain unfamiliar to many practitioners.
There is a clear need for more robust studies to assess the prevalence, demographics, and long-term outcomes of CHS in a variety of populations. This includes not only observational studies but also randomized controlled trials to assess potential treatment options drug addiction for CHS. Given the rise of CHS cases in regions with legalized cannabis markets, public health agencies should prioritize research funding to fill these gaps and inform future policy. The absence of standardized diagnostic criteria for CHS is a significant challenge in clinical practice. Standardized guidelines would help healthcare providers identify CHS more efficiently and reduce the likelihood of misdiagnosis.
Literature published between January 2004 and September 2012 was searched in PubMed using the terms “cannabinoid hyperemesis syndrome” and “cannabis hyperemesis syndrome”. Diagrammatic representation of the pathophysiology of cannabinoid hyperemesis syndrome (CHS).4 5 TRPV1, transient receptor potential vanilloid 1. Some reports note that CHS tends to appear more often in people who used cannabis heavily during their teen years. That early introduction might increase the likelihood of problems appearing in adulthood.
What is cannabinoid hyperemesis syndrome? Here’s what to know, and why experts say it’s on the rise
After stopping cannabis use, symptoms generally resolve within days or months. But a 2019 study concluded that it potentially accounts for up to 6 percent of emergency room visits for recurrent vomiting. But it’s also important to acknowledge the positive uses of marijuana, Camilleri said. He also warned that people with serious mental illnesses, such as schizophrenia, should be cautious about marijuana use, as studies show cannabis can exacerbate the effects of those illnesses.
And primary care providers, are vital in diagnosing and treating CHS as its prevalence rises. This will provide more data on CHS and facilitate the development of targeted novel therapeutic interventions for this condition in the future. Also, future longitudinal research exploring genetic predisposition and biomarkers could aid in diagnosing and treating CHS. It is also essential to study the public health implications of the legalization of cannabis in different states and its impact on healthcare utilization. The orthosteric ligands of the CB1R were considered to be potential pharmaceuticals in the treatment of disorders such as drug addiction, obesity, and pain 33. However, cannabinoid receptor activation results in adverse psychoactive effects (including depression and suicidal thoughts), which is concerning for cannabinoid hyperemesis syndrome them in clinical use 104.