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Cannabinoid Hyperemesis

Cannabis, also known as marijuana, is one of the most commonly abused drugs worldwide. Within the United States, more than 1/3 of individual states have passed laws enabling the use of medical marijuana. However, it seems that research and a distribution of knowledge on the possible negative side effects of marijuana is not able keep up with the fast pace at which legal use is spreading.

According to a study by Siva P. Sontineni and colleagues of the National Institute of Biotechnology Information (part of the U.S. National Institutes of Health), cannabinoid hyperemesis syndrome (CHS) is an under-recognized, yet possible, manifestation of chronic cannabis abuse.

The Suggested Guidelines for Clinical Diagnosis of CHS Are:

  • History of regular/chronic cannabis use for years.
  • Severe nausea and vomiting that recurs in a cyclic pattern over months.
  • Resolution of symptoms after stopping cannabis use.

Additionally, diagnosis can be supported by a peculiar, compulsive hot bathing pattern experienced by many patients diagnosed with CHS in which the patient finds relief by taking hot baths or showers, resulting in multiple hot baths/showers during the day to help improve symptoms. Severe abdominal pain may also be present in patients, and doctors must first rule out possible gall bladder or pancreatic inflammation along with verifying the above-listed criteria before diagnosing a patient with CHS.

Unfortunately, since studies on CHS have only recently begun–the first being an Australian case study in 2004–and many healthcare professionals and doctors are not as familiar with the disorder and often misdiagnose it as other problems such as cyclic vomiting syndrome.

According to the 2004 Australian case study authored by Dr. J.H. Allen and colleagues, published in GUT: An International Journal of Gastroenterology and Hepatology, nine patients hypothesized to have suffered from CHS were studied and all exhibited similar patterns.

Those Patterns Associated with CHS Include:

  • Patients began to profusely vomit, often without any warning.
  • Nausea, sweating, colicky abdominal pain, and excessive thirst were typically present.
  • To subdue discomfort, patients all sought relief in excessive hot bathing patterns.
  • Some patients, so dehydrated, needed IV fluid administration in hospitals.
  • The patients’ conditions would typically improve 24-48 after the IV fluid regimen.
  • Without cessation of marijuana, the cycle would repeat weeks or months later, often continuing for years.

Paradoxically, cannabis has been understood to be an anti-emetic (a drug that is effective against nausea and vomiting), which is why chemotherapy patients, for example, may find relief from treatment-induced nausea with medical marijuana. It is not yet understood why in some chronic cannabis users, contradictory effects are being found – those that cause nausea and vomiting instead of alleviate it.

To date, the only long-term solution for patients diagnosed with CHS is complete abstinence from cannabis. However in the short term, doctors may prescribe prescription medication and administer IV fluid regimens to address the initial symptoms.

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