Emerging Role of Chronic Cannabis Usage and Hyperemesis Syndrome

Heather Francis, PhD

Disclosures

South Med J. 2011;104(9):665 

Abstract and Introduction

Introduction

In "Cannabinoid Hyperemesis Syndrome: Literature Review and Proposed Diagnosis and Treatment Algorithm,'' Wallace and colleagues[1] have reviewed recent findings regarding the role of excessive cannabinoid usage and the resulting hyperemesis syndrome. This topic seems to be very recent as the authors propose that cannabinoid hyperemesis syndrome (CHS) was first described only 7 years ago and the diagnostic symptoms are largely unknown throughout the medical profession and among cannabis users. Symptoms including cyclic vomiting, abdominal pain, nausea, gastric pain and compulsive bathing to ease pain may be candidates for patients suffering from CHS.

Over the years, the medicinal use of cannabinoids in patients undergoing chemotherapy treatment has become commonplace. In this instance, the usage of cannabinoids alleviates the symptom of nausea, thus allowing the patient to tolerate chemotherapy treatments.[2,3] While it is possible that chemotherapy patients using medical cannabis can develop CHS, none seem to exist. Medicinal cannabis usage is not limited to cancer patients. There are numerous cases of cannabis usage being effective in the treatment of metabolic disorders like diabetes,[4] multiple sclerosis[5] and liver disease.[6] Here the authors report that the most prominent developers of this syndrome are the recreational cannabis users who began using cannabis from a very early age (even at the highly influential age of 9) and also those who use it chronically or daily. These people are at the highest risk to start showing symptoms of CHS, but even people who are not daily users are possibly subject to CHS. Unfortunately, CHS is not well known to physicians or chronic cannabis users and this information should be made known to both parties to allow for better treatment strategies.

Treatment of these patients includes the recommendation to cease cannabis use, rehydrating and psychological counseling. However, it was found that some patients cannot become orally hydrated and require intravenous hydration. Compulsive bathing is the most common home remedy but is not a long-term solution because one patient spent "all day" in the bathtub "300 out of 365" days. The authors highlight that extensive history of the presenting patient must be included and that denial by the patient is usually the biggest stumbling block for the physician to be able to make a proper diagnosis. Urine drug screening should be ordered if the patient admits to the symptoms above and no other cause is present. In cases of patients with CHS, on average, significant symptom resolution was noted following cannabis cessation. Eight patients reported a significant decline in daily vomiting one week after cannabis cessation, but due to lack of numerous cases and absence of many clinical trials, it is unclear whether intravenous hydration or cannabis cessation alone cures symptoms and which antiemetics assist effectively. Surprisingly, antiemetics such as metoclopramide, ondansetron, prochlorperazine, and promethazine failed to effectively relieve the symptoms of nausea and vomiting in patients with CHS.

The authors of this article advocate that cannabis is the most widely used illicit drug in the United States among all age groups and that availability is increasing among users. Although CHS diagnoses are relatively few in number, the authors hypothesize that CHS has the potential to begin commonly developing among cannabis users/abusers.

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