What is cannabinoid hyperemesis syndrome and why are Northeast Ohio doctors seeing it more often?

Nicki’s long-term career goals include advancing in leadership roles within Virtue Recovery Center which is a quickly growing substance use disorder treatment facility. She hopes that one day her research and advocacy will help to save the lives of those who have been affected by substance use. She likes to say that advocacy is her passion and leadership is her superpower. Most patients see improvement within days to weeks after stopping. Most people with CHS who stop using cannabis have relief from symptoms within 10 days.

What Causes Cannabis Hyperemesis Syndrome?

Marijuana has a lot of active chemical compounds called cannabinoids. When you use weed, these compounds bind to cannabinoid receptors found in your brain, digestive tract (gut), and certain cells in your body. Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main cannabinoids in marijuana products. THC is what’s responsible for the “high” most people feel when they use marijuana.

CHS Phases and Timeline

Because of this possible complication, it’s important to use caution with marijuana and other cannabis products. If you think you have CHS or cannabis use disorder, talk to a healthcare provider. These are some of the hallmarks of cannabinoid hyperemesis syndrome, a medical condition that’s on the rise. However, as I’ve stated many times already, CHS generally occurs in those with chronic (typically years) and heavy (near-daily) cannabis use. As you may suspect at this point, chronic cannabis use can lead to the downregulation, desensitization, and internalization of the CB1 and TRPV1 receptors. Downregulation of these receptors diminishes the endogenous anti-emetic mechanisms, leading to abdominal pain, nausea, and emesis.

Recovery Phase

When an individual stops using cannabis, symptoms generally begin to improve during the recovery phase. Bouts of repeated vomiting and extreme stomach pain often mark the condition. The only hope available to improve the condition is with the cessation of cannabis use. Some individuals may experience temporary relief from these symptoms by taking a hot shower or hot bath.

• The only hope available to improve the condition is with the cessation of cannabis use.
• Some people with CHS require pain relievers if abdominal pain is present.
• They must be present for at least the last three months and the beginning of symptoms must be at least 6 months prior to the diagnosis being made.
• This suggests that the area of the brain that’s involved in regulating body temperature—the hypothalamus—might be involved in CHS, D’Souza says.

Chronic Management of Cannabinoid Hyperemesis Syndrome (CHS)

Implementing these findings into clinical practice may be challenging due to limited resources, stigma surrounding cannabis use, and the complexity of managing psychosis. The findings are particularly significant given the increasing prevalence of cannabis use, especially high-potency strains, and the trend toward legalization in various regions. While previous research has established a connection between cannabis use and psychosis, the specific impact of withdrawal had been less explored. “No one has elucidated the underlying pathophysiology of why some people react to cannabis in a way that has paradoxical, completely opposite effects that almost everyone else has," he said. Still “why some people seem to be vulnerable to this and not others really seems to be a mystery,” says D’Souza. Here’s what researchers are unraveling about this curious condition.

• Not everyone with the condition seeks medical help or tells their provider that they use marijuana.
• He continued, "We know that in patients with cancer marijuana actually reduces nausea and vomiting -- so for many patients, understanding that for them this is a poison -- is a tough pill to swallow."
• The CHS recovery phase starts when you stop your marijuana use.
• Once cannabis use is stopped, the symptoms of CHS will gradually start to subside.
• Meeting with a healthcare provider can ease the recovery process.

Cannabinoid Hyperemesis Syndrome (CHS): Causes, Symptoms, Treatment

The medicinal and recreational uses of Cannabis sativa have been recognized for thousands of years. Today, cannabis-derived medicines are used to treat a variety of conditions, including chronic pain, epilepsy, multiple sclerosis, and chemotherapy-induced nausea. However, cannabis use disorder (CUD) has become the third most prevalent substance use disorder globally. Cannabinoid receptors alcoholism treatment are the primary targets that mediate the effects of cannabis and its analogs. Despite their importance, the mechanisms of modulation and the full therapeutic potential of cannabinoid receptors remain unclear, hindering the development of the next generation of cannabinoid-based drugs.

Cannabinoid Hyperemesis Syndrome Complications

Once someone experiences it, they will likely be unable to tolerate cannabis in the future, Marino said. Cannabis typically reverses feelings of nausea, so doctors aren't sure what causes such a severe reaction, said Dr. Ryan Marino, a University Hospitals medical toxicologist. In a 2019 review of 271 cases, researchers found that the mean age for having CHS was 30 and that 69 percent of people were male.

What are the risks of untreated CHS?

These two conditions are hard to distinguish between and the main difference is CHS happens with using a lot of marijuana. If you have cannabinoid hyperemesis syndrome (CHS), the best treatment is to stop using weed, even what is cannabinoid syndrome if you've been doing it for years with no previous side effects. Once you do that, your repeated nausea and vomiting should go away and not return. Since THC is stored in your body fat, it can take weeks to months before all the symptoms go away and you notice a difference.

• This has increased both the number of people using the drug and the "high" in the available weed.
• Recent advancements in the development of allosteric drugs are highlighted, with a focus on positive and negative allosteric modulators (PAMs and NAMs) that target CB1 and CB2 receptors.
• Therefore, the first step in CHS treatment should always be IV fluids, preferably a crystalloid fluid such as normal saline or lactated ringers.
• In other instances, they may be given a benzodiazepine (such as alprazolam) or an antipsychotic medication (such as haloperidol) to try to stop an episode in its tracks.

Meeting with a healthcare provider can ease the recovery process. A combination of prescribed pharmaceuticals and OTC pain relievers used as recommended can manage symptoms.1 With continued abstinence and symptom management, full recovery can follow. As it progresses, the cycle of nausea, vomiting, dehydration, diarrhea, and abdominal pain becomes more frequent, and patients may attempt to self-medicate. Some patients increase their cannabis use, believing the anti-emetic benefits it provides will ease their symptoms when, in fact, it will only increase them.