What is Cannabinoid Hyperemesis Syndrome?

Cannabis Related Vomiting

One of the most popular uses of medical cannabis is the treatment of nausea and vomiting, particularly in patients on chemotherapy. Dronabinol is an FDA- approved cannabis-based medication that is extensively prescribed for this purpose. With this knowledge, it could be shocking to patients to discover that cannabis is also capable of causing severe nausea and vomiting, in the form of hyperemesis syndrome. This only confirms the complex nature of cannabis and the need to develop a better understanding of the drug if we are to tap into its numerous benefits.

Do You Have Cannabinoid Hyperemesis Syndrome?

Also known as CHS, cannabinoid hyperemesis syndrome is a condition that results in ‘repeated and severe bouts of vomiting’ following the use of cannabis. The first use of the term in medical literature can be traced back to 2004. CHS is an extremely rare condition that manifests in a few long-term, heavy users of high THC cannabis.

People suffering from the condition usually experience an acute hyperemetic phase that is characterized by nausea, vomiting, gastrointestinal discomfort, and compulsive hot-water bathing. Due to the nondescript nature of CHS symptoms, the compulsion to bath in hot water during an episode is the hallmark of the condition. It occurs in more than 90% of cannabis users with CHS and it differentiates the condition from other diseases such as cyclic vomiting syndrome, stomach flu, appendicitis, gall bladder inflammation, etc.

The episodes are cyclic in nature, meaning after an episode, the patient stays symptom-free for a while and then experiences another episode. Because the condition shares similar symptoms with many other diseases, CHS is often misdiagnosed. The fact that some users may be reluctant to reveal their cannabis-use history to the doctor increases the chances of misdiagnosis.

What Causes CHS?

The exact cause of CHS or the specific risk factors that expose an individual to the condition is poorly understood. Activation of CBD receptors in the brain is known to regulate the vomiting centers and this is responsible for the antiemetic effect of cannabis. There are suggestions that cannabinoids such as Cannabigerol, THC, and CBD may also be capable of exerting a paradoxical effect on these centers. Patients develop CHS when this paradoxical effect prevails.

Some hypotheses suggest that CHS is caused by the interaction of cannabinoids with the cannabinoid receptors present in the digestive tract. The activity of cannabis in the GIT may lead to the following:

• Inhibition of acid secretion
• Alteration in intestinal motility
• Delay in gastric emptying
• Visceral pain
• Relaxation of the lower esophageal sphincter

When a patient starts using marijuana, the signals from the brain effectively control the activities of the receptors in the GI. With continuous use, however, the receptors in the brain may develop tolerance and stop responding to the drug as they should. The control signal from the CNS is no longer present and the user experiences bouts of vomiting upon using the drug. Unfortunately, there are obvious problems with this hypothesis although this doesn’t mean that the endocannabinoid receptors in the digestive tract do not have a role to play in the development of CHS.

Some researchers also suggest that certain genetic variations may predispose an individual to developing CHS. However, there is a dearth of evidence supporting this hypothesis and a definite pronouncement cannot be made.

What are the Symptoms of CHS?

The major symptoms of CHS have been highlighted earlier. To have a better understanding of the condition, it can be divided into three phases; the prodromal, hyperemetic and recovery phases.

Prodromal Phase

If you’re going through the prodromal phase, you’ll experience mild symptoms such as early morning nausea and abdominal discomfort. Depending on your body, the prodromal phase may last for weeks or months. A lot of people use more marijuana at this stage because they think it would help their nausea.

Hyperemetic Phase

During this phase, you’ll experience severe symptoms that may include

• Ongoing nausea
• Repeated bouts of vomiting
• Severe abdominal pain
• Loss of appetite and weight loss
• Dehydration

The vomiting episodes are usually intense and overwhelming. Many people suffering from the condition report at the emergency center at this phase. The compulsive hot water showers also come in at this phase. Your symptoms would be relieved after a hot shower and you might be tended to soak yourself in a hot bath for as long as you can. If you are not familiar with CHS, you might still find yourself using more marijuana and somewhat compounding the problem.

The hyperemetic phase often continues until the patient seeks medical care or stops using marijuana.

Recovery Phase

During the recovery phase, your body feels normal again. You are free of CHS symptoms and you can eat as you used to. This phase could also last for weeks or months. Often, patients experience CHS symptoms the moment they start using marijuana again.

What are the Possible Complications that Could Arise from CHS?

Any condition that could lead to severe bouts of vomiting could cause a wide range of complications. The main challenge here is dehydration and loss of electrolytes. If left unaddressed, CHS could potentially cause:

• Seizures
• Muscle spasms
• Abnormalities in heart rhythm
• Shock

It should be noted that CHS in itself is a very rare condition. Your chances of developing any of these complications are very slim, if not non-existent. As long as your loss of fluid or electrolytes is addressed, you have nothing to worry about.

How can I Treat CHS?

If you’ve experienced severe bouts of vomiting, reporting to your healthcare provider would be your best bet. Describe your symptoms as accurately as you can and respond to the questions asked honestly. Most people who have CHS do not experience symptoms once they stop taking cannabis. The purpose of your visit would be to correct fluid and electrolyte loss.

If you think you’re still in the prodromal phase, discontinuing cannabis is likely to relieve your symptoms. Some people feel relieved after taking over the counter medications that can control vomiting. Frequent hot showers and rubbing capsaicin cream on your belly may also help you control the symptoms. However, the most important intervention is discontinuing cannabis use.

What if I Use Medical Marijuana for Another Condition?

If you’re using cannabis for an approved condition, you’ll need to see your medical marijuana doctor if you develop CHS. Those that develop the condition are usually long-term users of high-THC cannabis. Thus, you may benefit from very-low THC strains or CBD only preparations. Whatever the case may be, your physician would be in the best position to advise you.

Is CHS Preventable?

Yes. For one thing, the number of people that develop CHS is negligible, in comparison with the number of people that use marijuana. To prevent CHS, you simply have to avoid long-term, heavy use of high THC cannabis. You may achieve this by refraining from excessive recreational use or via microdosing. Tips for safely enjoying marijuana edibles.

When using cannabis for any medical purpose, it is important to get legal. Self-medicating could put you at risk of a wide range of conditions you may not even know about. At Kind Health Florida, we have experienced marijuana doctors that would evaluate your case and help you obtain your medical marijuana card. Call us today to schedule an appointment.