Under the Microscope

Cannabinoid Hyperemesis Syndrome

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07/12/2021 A Debilitating Cannabis Use Condition for Some People

1. What is Cannabinoid Hyperemesis Syndrome?

Cannabinoid Hyperemesis Syndrome is a relatively new cited condition. Hyperemesis means excessive vomiting.

Sufferers report a cycle of illness including some flu-like symptoms, such as nausea, violent vomiting, abdominal pain, and dehydration.

In between these episodes, there are calm periods without symptoms. Many of these people end up with repeated trips to the emergency room. Not much is clinically known as to what causes this syndrome.

People that suffer from Cannabinoid Hyperemesis Syndrome are characterized as heavy consumers of cannabis. A heavy cannabis consumer would be someone that consumes cannabis several times a week to several times a day and may have consumed it for many years. This is a rare condition and the underlying cause of CHS is unknown at this time.

Some try to relieve symptoms at home with hot showers or bathing. This may become ritualistic in an attempt to help relieve the symptoms. The hot baths can have a soothing effect but they can also raise blood pressure and contribute to dehydration from sweating. People with Cannabinoid Hyperemesis Syndrome are experiencing real and repeated discomfort.

2. What Causes CHS?

There is no absolute cause of CHS pinpointed, as of yet. There are theories that heavy cannabis consumption can produce some type of systemic reaction. Other theories include the possibility that genetics may play a role in this debilitating condition.

Some researchers think CHS may arise because of overstimulation of your endocannabinoid system (ECS). The ECS is a supply chain of receptors in your body that respond to organic components in cannabis. Usually, cannabis is known to help with nausea.

There are even anecdotal studies showing the relief that cannabis can bring some cancer patients. Nausea is often associated with the toxic chemotherapy medications that are used in cancer treatment. Those that suffer from CHS are often finding the exact opposite of relief with cannabis. There just isn't enough information to study yet.

3. What are the Symptoms of CHS?

There may be years of continuous cannabis use before any symptoms arise. Typically, people who develop Cannabinoid Hyperemesis Syndrome experience uncontrollable nausea and violent vomiting sometimes along with abdominal pain for a period of several hours to several days. They can vomit up to 5 times an hour. They may become weak and sometimes lethargic. Many people with CHS make multiple trips to the ER.

Most people go through a 3 step phase in conjunction with this condition, the prodromal phase, the hyperemetic phase, and the recovery phase.

Prodromal phase: the main symptoms are frequent morning nausea and abdominal pain. Most CHS sufferers can keep up with normal eating habits during this time. Some people use more cannabis thinking it will help with nausea. This can drag on for months or years.

Hyperemetic phase: Symptoms experienced may include:

  1. continuous nausea
  2. repeated incidents of vomiting
  3. abdominal pain
  4. decreased nutritional intake
  5. weight loss
  6. dehydration

During this stage, vomiting can be overwhelming. Many people find that if they take a lot of hot showers during the day, it alleviates some nausea and vomiting. People often first want to see a physician in this phase.

The hyperemetic phase of CHS may begin again until the person completely stops using cannabis. When cannabis consumption is terminated, the person will then start into the recovery phase.

Recovery phase: once cannabis consumption ceases, symptoms taper off and then leave. A pattern of being able to eat a normal diet again is established. This aspect can continue for days or months. However, symptoms can and often return if cannabis consumption is resumed.

4. How is CHS Diagnosed?

Cannabinoid Hyperemesis Syndrome usually presents with repeated trips to the ER. These patients are usually well into suffering from abdominal pain, nausea, and violent vomiting. Unfortunately, many are sent home with just antiemetics and told it will get better.

Sometimes all is good, the symptoms alleviate as the patient slowly recovers. Periods between symptoms are often exhibited with a duration of complete symptom-free intervals. These anomalies in presentations as well as the similarities of symptoms that are so close to other conditions, make it difficult to diagnose.

Many people who suffer from CHS, suffer these patterns of illness until a complete history and workup are done. This could take years before a pattern is discovered. There are no distinctive tests to detect CHS. It is a process of elimination and medical workups to rule out other diseases.

Tests that might be ordered to help rule out other diseases include blood tests,  X-rays and body scans such as MRIs or CT scans. A medical and lifestyle history is recommended. It boils down to an exhaustive search for the cause and ruling out other possible conditions.

5. What is the Treatment Plan for Sufferers?

Acute treatment can include prescribing antiemetics, pain relievers, and making sure the patient is properly hydrated. Sometimes a hospital stay is in order to bring the body back to a normal state of hydration and nourishment. Hot baths or showers are recommended as long as it is bringing relief and does not cause additional problems.

When Cannabinoid Hyperemesis Syndrome is suspected it is recommended to stop all cannabis consumption. This can be a very hard idea for some to understand. These people have more than likely been consuming for a long time to gain the health benefits purported to be in cannabis.

When the medicine that has helped you for a long time, stops working and fights back, this can be disheartening. There hasn't been enough research to solve this conundrum. In the meantime, a small population of cannabis consumers is suffering until the scientific community can learn more about the mechanism that causes Cannabinoid Hyperemesis Syndrome.

6. What is on the Horizon for CHS?

With the increase of legalization of cannabis and the growing interest in cannabis as medicine, there may be an increase of cases where certain people are unable to partake in these benefits without repercussions. The numbers are small but growing.

Cannabinoid Hyperemesis Syndrome is a fairly new recognized medical condition. More research is needed to identify this syndrome and educate physicians. The only recognized advice currently for these patients is to completely stop consuming cannabis.

Perhaps with additional research, alternative treatment options can be developed for these patients. Until then the discontinuation of cannabis seems to be the only absolute cure.